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Contents

1. Frequency of Health Assessments
2. Requesting a Health Assessment
3. Arranging a Health Assessment
4. The Health Assessment
5. Health Action Plans

1. Frequency of Health Assessments

Each Looked After Child must have a Health Assessment at specified intervals, as set out below.

• The first Health Assessment must be conducted before the first placement, if not reasonably practicable, before the child’s first Looked After Review (unless one has been done within the previous 3 months);
• For children under five years, further Health Assessments should occur at least once every six months;
• For children aged five and over, further Health Assessments should occur at least annually.

If a child is transferred from one placement to another, it is not necessary to carry out a new Health Assessment within the first month.  In these circumstances, the child's social worker should furnish the staff/carers with a copy of the child’s current Health Action Plan.

2. Requesting a Health Assessment

It is the responsibility of the child's social worker to ensure that Health Assessments are carried out in accordance with the timescales set out in Section 1.

In order to set up a Health Assessment, the child's social worker should complete and fax Part 1 of the form "Request for Health Assessment for Child or Young Person Looked After" to the Looked After Children's Health Coordinator:

• Immediately the child becomes looked after; and
• At least 8 weeks before a child is due for a subsequent Health Assessment.

Social workers must not make request arrangements for Health Assessments to be carried out by GP's without the agreement of the Looked After Children's Health Coordinator.

All completed request forms must be sent to the Looked After Children's Health Coordinator with the social worker's name and contact number in the top right hand corner. Incomplete forms will be returned for completion. Those sections that cannot be completed due to lack of available information, e.g. in relation to asylum seeking children, should have N/A written in them.

If a child changes address or is away on holiday for an extended period after a request has been sent, the social worker must notify the Looked After Children's Health Coordinator to avoid the delay caused by missed appointments.

3. Arranging a Health Assessment

On receipt of the faxed form, the Looked After Children's Health Coordinator will pass the request to the Designated Doctor and Designated Nurse for Looked After Children who will decide who will undertake the Health Assessment and make the necessary arrangements. In the case of children placed outside the borough, this may by arranged through other community paediatricians, health visitors or school nurses.

Social workers must not arrange any Health Assessments directly unless requested to do so by the Designated Doctor or Designated Nurse.

For children placed in the borough, the social worker will be informed of the appointment for the Health Assessment. For children placed outside the borough, appointment letters are usually sent directly to residential staff/carers with a copy to the social worker.

It is the social worker's responsibility to ensure that the staff/carers and the child are aware of the importance of the Health Assessment and encouraged to attend the appointment. The social worker must provide the previous Health Assessment to the staff/carer to take with them to the appointment and ensure that the parent-held health record ('red book') is available at the appointment as well as the current Health Action Plan.

Where the red book has been lost or mislaid the social worker must notify the Looked After Children's Health Coordinator who will arrange for a replacement to be issued.

The social worker must ensure that the child is given information about the Health Assessment so that his or her informed consent to the Health Assessment can be given. Where a child refuses to consent to a Health Assessment, the social worker must inform the Looked After Children's Health Coordinator who will arrange as appropriate for the health assessor to contact/meet the child to discuss his or her anxieties and concerns. If a child is of sufficient age and understanding, s/he may choose not to have a Health Assessment.

The child's social worker must also ensure that the parent's written consent for the Health Assessment (which is usually recorded on the Placement Plan/Placement Information Record) is available.

As well as ensuring that parental consent has been given, on each occasion a Health Assessment is due to take place, the child's social worker must wherever possible seek the views of the parent and others with Parental Responsibility about the child's health care needs and any health information they provide must be passed to the health assessor.

Where a parent refuses to consent to a Health Assessment, the social worker must ascertain the reasons by discussing their concerns with them and inform the Looked After Children's Health Coordinator. In all cases but particularly where the child is Accommodated, the social worker must seek an urgent resolution and seek legal advice if necessary. Where parental consent is not available for an accommodated child, e.g. in the case of an asylum seeking child, the child's written consent must be given and the Health Assessment can only go ahead on that basis.

4. The Health Assessment

The first Health Assessment will usually be carried out by a community paediatrician or other qualified medical practitioner; subsequent Health Assessments will be carried out by a registered nurse or midwife acting under the supervision of a qualified medical practitioner - for children placed within the borough, this will usually be a health visitor or school nurse.

The health assessor will complete a Health Assessment Form (provided by the Primary Care Trust) and send it to the Designated Doctor.

The first Health Assessment will include a review of the child's immunisation record.

The child should also be tested and treated for sickle cell disorders where appropriate.

5. Health Action Plans

Following evaluation of the Health Assessment, the Designated Doctor or the Looked After Children's Health Coordinator will arrange for the identified action points to be sent to the child's social worker, together with the Health Assessment Form completed by the assessor.

Copies of both must be placed by the social worker on the child's case record.

The social worker will then draw up the child's Health Action Plan - a pro forma is available - and is responsible for ensuring this is implemented. This will address all relevant health issues for the child, not only general health care issues but also issues related to the child's sexual health, drug and substance misuse, smoking, diet, exercise, obesity, nutrition and eating disorders etc. See the other procedures in the section of the manual related to the Health of Looked After Children.

A copy of the Health Action Plan must be given to the staff/carers and must be made available at the child's Looked After Review. 

The Health Action Plan must be reviewed after each subsequent Health Care Assessment and at the child’s Looked After Review or as circumstances change.

End