Guidance on Health Assessments for Looked After Children in Scotland

Section 3 - Health Service Responsibilities for Looked After Children (Health Assessment)

In 2009, a letter was issued to NHS Board Chief Executives (CEL 16 (2009)) making the following recommendations:

• Each Territorial Health Board should nominate a Board Director who will take a corporate responsibility for looked after children and young people and care leavers by 30 June 2009.
• The Director will be responsible for ensuring that Health Boards fulfil their statutory duties under the Looked After Children Regulations (1996)*. This will enable the Board, on the basis of information from local authority partners, to identify all looked after children and young people and care leavers in their areas by 31 July 2009, including those who are looked after at home and those placed from outwith their Health Board areas.
• The Director will also be responsible for the implementation of Next Step (a) under Action 15 of We Can and Must Do Better:

Joint assessment and planning which takes into account the views of the young person and includes details of their particular health needs, including registration with a GP, dentist, regular health and dental checks, advice on sexual health, mental health and emotional wellbeing and access to any mental health services required.

• The Director will ensure that the Board offers ever currently looked after child and young person in their area a health assessment by April 2010. Any new child or young person coming into the system from March 2010 should have a health assessment within 4 weeks of notification to the Health Board.
• The Director will ensure that the Board offers a mental health assessment to every looked after children and young person. This recommendation should be phased in line with the implementation of "Mental Health of Children and Young People Framework for Promotion Prevention and Care" (FPPC) by 2015.
• The Director will ensure that every looked after child or young person who has general and mental health needs identified as part of their health assessment, the person undertaking that health assessment takes responsibility for ensuring their care plan is delivered/coordinated as appropriate.
• The Director will ensure, using existing systems, that the performance of the Board in carrying out general and mental health assessments for looked after children and young people, and the health outcomes of those assessments, is reported annually to the Scottish Government.

*(now replaced by the Looked After Children (Scotland) Regulations 2009).

Health Board Director with Responsibility for Looked After Children (LAC Director)

CEL 16 (2009) recommended that each Territorial Health Board should nominate a Board Director to take a corporate responsibility for looked after children and young people and care leavers. In 2012 the Looked After Children Strategic Implementation Group (LACSIG), in consultation with LAC Directors, described what was expected from LAC Directors, clarifying the role and responsibilities.

The LAC Director should ensure that the Health Board works with placing authorities in its area to ensure:

• the Board is able to identify all looked after children and young people in its area, making sure there are clear procedures in place, detailing who should be informed and how.
• structures are in place so health professionals are involved in the decision-making process regarding care placements where there are specific health needs.
• there are processes and resources in place to support health professionals with the complex issue of health consent and confidentiality.
• arrangements are in place for a registered medical practitioner or a registered nurse to offer a written assessment of the child's health and their need for health care within 4 weeks of notification.
• that looked after children's nurses, school nurses, health visitors and paediatricians have the capacity to:
  - receive referrals;
  - identify health records and request them from the NHS Board in whose care they are held;
  - provide a comprehensive health assessment;
  - make sure that the looked after children and young people are engaged with primary care, secondary care and specialist care as required;
  - facilitate transfers where looked after children and young people move to another health board area, including information sharing and continuity of service delivery and care planning.

• information and data from the health assessment is fed back into the Child's Plan.
• a Lead Professional is identified to ensure the child's health needs are addressed. Where the lead professional is not from the Health Board, a key worker should be identified to liaise over delivery of healthcare.
• arrangements are made for looked after children and young people to be provided with healthcare services, including medical and dental treatment.
• the connection between the child protection processes and wider structural processes to support and plan services for vulnerable people.
• procedures are in place so the Health Board is able to offer a mental health screen to every looked after child or young person by 2015.

At Health Board level, the Director should

• engage Board members in the Corporate Parenting agenda.
• ensure s/he is able to access specialist health advisors.
• ensure mechanisms are in place for multi-agency partnership working
• support Board members to ensure that the needs of looked after children and young people are articulated within the Community Plan, associated action plans, Integrated Services Plan and Single Outcome Agreement.
• actively seek to promote the needs of looked after children and young people within service design and improving patient care.
• ensure that arrangements are in place for the transition of looked after children and young people from child health to adult health services.
• advocate on issues around consent, confidentiality and implications of data protection, relevant to looked after children and young people.

Child Health Commissioners

There is a Child Health Commissioner appointed in every Health Board in Scotland. Whilst there is some variance across Scotland, the broad role of the Child Health Commissioner should include the following -

• Lead on local child health strategy
• Board and CHP reports with a children's element
• Regional planning
• Involving children and young people in service planning and provision
• Child health contribution to local delivery plans and Single Outcome Agreements
• Communication across local systems on new policy
• Providing advice to NHS Board on policy matters
• Champion partnership working with local authority and other key local partners
• Involvement in performance reviews of child health services
• Participation in the National Child Health Commissioners Group.

This role was set out more fully in CEL 19 (2011).

In addition, many of the Child Health Commissioners are leading on the looked after children health strategy in their Board wide area.

Out of Area Placements (cross boundary and cross border placements)

CEL 06 (2013) sets out the procedures for establishing the Responsible Commissioner for an individual's care within the NHS. Paras 75‑80 outline arrangements for looked after children where they are placed in a setting out with their home Board area:

Establishing The Responsible Commissioner: Guidance and Directions for Health Boards, March 2013

• Children who are looked after by local authorities can remain at home or be provided with accommodation away from their normal place of residence (i.e., kinship/foster/residential placement, respite care). The responsible Health Board should be established by the usual means identified in paragraph 6 et seq (i.e. the address where the child is ordinarily resident).
• The Looked After Children (Scotland) Regulations 2009 place a duty on local authorities to notify Health Boards when they place children in a kinship/foster/residential setting. There may also be cases where a child who is looked after at home moves to a new area. The duty to notify applies regardless of whether or not the child moves out of the original local authority area. This applies in respect of placements with foster carers and kinship carers as well as placement in a residential establishment and must be carried out as soon as reasonably practicable. Where placements are arranged urgently the notification should be done as soon as reasonably practicable.
• Under regulation 3(3)(b) of The Looked After Children (Scotland) Regulations 2009, when a child becomes (or is about to become) looked after, the local authority must obtain a written health assessment by a registered medical practitioner or a registered nurse. CEL 16 (2009) recommended that this is offered within four weeks of notification to the Health Board. A new assessment may not be necessary where one has been carried out within three months of the child becoming looked after.
• If a looked after child moves to a new area, the receiving Health Board should honour the current health care plan until this is changed following a new assessment. Arrangements should be made, in discussion between those currently providing the health care and with the new Health Board and relevant specialist services, to ensure continuity of health care. Continuity in some circumstances may involve continued care from the original provider until a handover can be arranged. Any changes in the health care commissioning responsibilities must not be allowed to disrupt the ultimate objective of providing high quality, timely care for the individual child or young person. It is important to ensure a smooth handover of clinical care where that is the agreed best plan for the child.
• For all looked after children, the local authority and receiving Health Board should identify a lead professional to ensure the child's health needs are addressed.
• When a child who is looked after reaches the age of 18, the test to determine their ordinary residence does not change: the ordinary residence of the child on his or her eighteenth birthday will identify the responsible Health Board, unless the child is attending a special school when the rule set out in paragraph 73 will apply.