Commissioners
& Providers
DCS, DPH, Lead
member
My GP
My carers
My IRO
Your lookedafter child needs
you all!
My named
professional
My designated
teacher and
Virtual School
Head
My parents
My friends
My social
worker
Designated
nurses and
doctors
To help them
be healthy
Promoting the health and
well-being of looked-after children
What the revised statutory
guidance means for you… and them!
Michael Allured and Alan Bell
Department for Education and Department of Health
Status of the guidance
• Issued by Secretary of State under s7 Local
Authority Social Services Act 1970
• Must be followed by LAs unless there is a
good reason not to
• Issued under s10 and s11 of the Children Act
2004 and LAs, CCGs and NHS England must
have regard to it
Our approach
The trouble with life isn't
that there is no answer, it's
that there are so many
answers.
(Ruth Benedict, Anthropologist,
1887-1948)
The overarching ‘golden’
principles
• Many have a part to play in promoting the health of looked-after
children
• Mental and emotional health are as important as physical health, as
they impact on reaching potential and all aspects of life
• Cooperation and communication – e.g. fast-track GP health records
• Understand the needs of your looked-after population through the
JSNA process and plan for them
• Looked-after children should always be registered with a GP and
have access to a dentist
• Looked-after children should never be denied a service because of
the location or length of their placement
• Keep the child’s voice at the centre of what you do
Strategic planning is key
• Everyone’s responsibility: LAs, CCGs and NHS England
• All commissioners of health services should have appropriate
arrangements and resources in place to meet the physical,
emotional and mental health needs of looked-after children
• Gather information to inform strategic priorities through the JSNA
process – ensure looked-after children on the agenda
• Commissioning of services for individual looked-after children
should be consistent with the responsible commissioner guidance
• CCGs should have access to the expertise of designated doctors and
nurses
• Plan for smooth transitions out of care
• Commissioned services should meet certain requirements (para 20)
Health assessments, plans
and reviews
• The Care Planning Placement and Case Review Regulations
(England) 2010 set the legislative framework for care
planning
• Assessments and plans cover areas in schedule 1 of the regs
• LA, as corporate parent, is responsible for making sure this
happens – and CCGs should cooperate
• Initial health assessment must be done by a doctor; review
health assessments can be done by a nurse
• Requirement to have a statutory health assessment doesn’t
apply if a child refuses it
The principles of a good
health assessment
• Some of the principles described in paragraphs 44 to 48 of
the statutory guidance:
– they aren’t isolated events
– they focus on the whole child and inform all aspects of care planning
– they are undertaken with the child’s consent (if he or is competent to
give it); are child centred and take account of individual needs, wishes
and feelings; are age-appropriate
– they result in the child having clear expectations of future consultation
and treatment
– they pay particular attention to health conditions that may be more
prevalent in looked-after children
– they are integrated with any other assessments or plans
Promoting good emotional
and mental health
• Understanding the whole child’s needs (the links between
emotional, mental and physical health): integral to care
planning
• It’s not just the responsibility of CAMHS – and not all lookedafter children will need CAMHS
• How do you know if a child’s emotional and mental health
issues need addressing? How are you using the SDQ
screening tool?
The bottom line:
– CCGs, LAs and NHS England should work together to ensure that
CAMHS and other services provide targeted and dedicated support to
looked-after children according to need, in a tailored way
The Taskforce report on
children’s mental health
Dismantle barriers for vulnerable children to get support:
• Care pathways incorporating evidence-based interventions
• Flexible acceptance criteria for referrals, based on
presenting needs and level of concern
• Sensitive enquiry about neglect, violence and abuse
• Strengthened lead professional approach
• Pilot roll-out of teams specialising in supporting e.g. lookedafter and adopted children, possibly on sub-regional basis
• Embed mental health practitioners in services or teams
working with e.g. looked-after children
What primary care teams
should do
• Ensure timely access to a GP or other appropriate health
professional when a looked-after child requires a consultation
• Provide summaries of the health history of a child who is
looked after
• Maintain a record of the health assessment and contribute to
any necessary action from the health plan
• Make sure the GP-held clinical record for a looked-after child
is maintained and up-to-date
• Transfer health records quickly when a child moves or leaves
care
• If in doubt, avoid temporary registrations
The roles of designated and
named health professionals
Designated doctors and nurses:
• Strategic – help commissioners to fulfil
responsibilities for looked-after children
• Ensure arrangements to meet health needs of
looked-after children placed out of area
Named doctors and nurses:
• Provide advice and expertise for fellow
professionals
• Coordinate provision of services
• Ensure timeliness and quality of health
assessments
See the Royal Colleges’ intercollegiate framework
Out of authority placements
In deciding on the suitability of a placement, LAs should ask:
• Will my child be able to access the health services he or she
will need?
• Have there been the appropriate discussions with any
specialist health services in the area?
• Will the CCGs ensure continuity of healthcare?
• Who will be best placed to undertake health assessments?
• As the LA corporate parent, have I complied with the care
planning notification requirements?
• Has my DCS signed off the decision to place out of authority?
• Has the child’s voice been heard? How will we avoid ‘out of
sight, out of mind’?
Transitions from care
Because health needs won’t change just because a
child or young person leaves care, health
professionals and social workers should ensure:
• that there are suitable transition arrangements in
place so that the child’s health needs continue to
be met
• in particular, that prospective adopters and care
leavers know how to obtain information about
local health services, advice and support
Key messages for practice –
how to use this guidance
• Unpack each section and audit your practice against
it. There’s more there than you think
• Don’t look for the guidance to tell you all the answers
• Understand how it relates to other statutory
guidance
• Use the resources cited at the back of it
• Use it to influence discussions about strategic
planning as well as day-to-day practice
If I...
At the end of the road,
At the end of the walk,
I’ll take my time to look back.
If I were to die there and then,
Would you cry?
What if I caught you?
Would you lie?
If I broke down
And tears came streaming down my face
Would you think I was a sad case?
If I were to ask you this,
Would you lie and take the mick?
HW (age 11)
Contact details
Michael Allured
DfE Lead: Education and Health of Looked After Children
Department for Education
020 7783 8081
michael.allured@education.gsi.gov.uk
Alan Bell
Team Leader – Vulnerable Children
Department of Health
020 7210 5246
alan.bell@dh.gsi.gov.uk
Thank you for
participating in the
consultation and
joining us for this
workshop today