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4.7.1 Health Assessments and Action Plans


This procedure summarises the arrangements that should be made for the promotion, assessment and planning of health care for Looked After Children.

It applies to all Looked After Children. Children remanded other than on bail will be Looked After Children, though different provisions will apply - see Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure, Care Planning.

It should be read in conjunction with Promoting the Health and Wellbeing of Looked After Children (DHSC).


In October 2018, a new Section 3.5, Consent to Health Care Assessments was added.


1. The Local Authority and the Clinical Commissioning Group
2. Principles
3. Health Assessments
  3.1 Good Health Assessment and Planning
  3.2 Frequency of Health Care Assessments
  3.3 Responsibility for Health Assessments
  3.4 Arranging Health Care Assessments
  3.5 Consent to Health Care Assessments
4. Health Action Plans
  4.1 Strength and Difficulty Questionnaires
  4.2 Out of Area Placements

1. The Local Authority and the Clinical Commissioning Group

Cambridgeshire County Council, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Looked After Children, including those who are Eligible and those children placed in adoptive placements. This includes promoting each child's physical, emotional and mental health. Every Looked After Child must have a series of health assessments so that a health action plan can be developed and maintained to reflect their health needs as part of their overall Care Plan.

The Cambridgeshire & Peterborough Clinical Commissioning Groups (CPCCG) and NHS England have a duty to cooperate with requests from Cambridgeshire County Council to undertake health assessments and provide any necessary support services to Looked After Children without any undue delay and irrespective of whether the placement of the child is an emergency, short term or in another CCG. This also includes services to a child or young person experiencing mental illness.

Social workers, as part of the arrangements for making placements should always advise the CCG when a child is initially accommodated. Where there is a change in placement which will require the involvement of another CCG, the child's 'originating' CCG, outgoing (if different for the 'originating CCG) and new CCG should be informed.

Where a child is placed within another CCG area, (i.e. outside Cambridgeshire and Peterborough), the CPCCG remains responsible for any additional health services that might be commissioned (see also Out of Area Placements Procedure).

For situations where the local authority has parental responsibility and so is required to consent to medical treatment for a child, see the Scheme of Delegated Authority.

2. Principles

  • Looked After Children should be able to participate in decisions about their healthcare and all relevant agencies should seek to promote a culture that promotes children being listened to and which takes account of their age;
  • That others involved with the child, parents, other carers, schools, etc are enabled to understand the importance of taking into account the child's wishes and feelings about how to be healthy;
  • There is recognition that there needs to be an effective balance between confidentiality and providing information about a child's health. This is a sensitive area, but 'fear about sharing information should not get in the way of promoting the health of looked After Children'. (See Annex C: Promoting the Health and Well-being of Looked After Children (DHSC));
  • When a child becomes Looked After, or moves into another CCG area, any treatment or service should be continued uninterrupted;
  • A Looked After Child requiring health services should be able to access these without delay and any wait should be no longer than a child in a local area with an equivalent need;
  • A Looked After Child must always be registered with a GP and Dentist near to where they live in placement;
  • A child's clinical and health record will be principally located with the GP. When the child comes into local authority care, or moves placement, the GP should fast-track the transfer of the records to a new GP.

3. Health Assessments

3.1 Good Health Assessment and Planning

The social worker has an important role in promoting the health and welfare of Looked After Children:

  • Working in partnership with parents and carers to contribute to the Health Action Plan;
  • Ensure that consents and permissions with regard to delegated authorities are obtained to avoid any delay. Note: However, should the child require emergency treatment or surgery, then every effort should be made to contact those with Parental Responsibility to both communicate this and for them to share in providing medical consent where appropriate. Nevertheless, this must never delay any necessary medical procedure (see Section 3.5, Consent to Health Care Assessments);
  • Ensure that any actions identified in the Health Action Plan are progressed in a timely way by liaising with relevant health professionals;
  • In recognising that a child's physical, emotional and mental health can impact upon their learning, where this is necessary, to liaise with the Virtual School Head to ensure as far as possible this is minimised for the child. (Should there be any delay in the child's Health Action Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
  • To support the Looked After Child's carers in meeting the child's health needs in an holistic way; this includes sharing with them any health needs that have been identified and what additional support they should receive, as well as ensuring they have a copy of the Care Plan;
  • Where a Looked After Child is undergoing health treatment, to monitor with the carers how this is being progressed and ensure that any treatment regime is being followed;
  • To communicate with the carer's and child's health practitioners, including dentists, those issues which have been properly delegated to the carers;
  • Social workers and health practitioners should ensure the carers have specific contact details and information on how to access relevant services, including CAMHS and self-help services such as CHUMS, Keep your Head, KOOTH, etc;
  • Ensuring that every child has a copy of their health action plan.

It is important that, at the point a child becomes Looked After, as much information as possible is understood about the child's health, especially where the child has health or behavioural needs which might present challenges or risks to themselves, their carers or others. Also, parent/ family health history and the child's birth and background history are important in building a picture of current and, potentially, future needs.

Key information must be fully shared with the carers, together with an understanding as to what support they will receive.

3.2 Frequency of Health Assessments

Each Looked After Child must have a Health Assessment at specified intervals:

  • The Initial Health Assessment (IHA) must be conducted within 20 working days of the child becoming looked after and the Health Action Plan should be available for the child's first Looked After Review (unless one has been undertaken within the previous 3 months);
  • For children under five years, Review Health Assessments (RHA) must be undertaken at least once every six months;
  • For children aged over five years, Review Health Assessments (RHA) must occur at least annually.

If a child is transferred from one Looked After Placement to another, it is not necessary to conduct another health assessment unless there are changes to the child's health needs. The social worker must provide the new carer/residential staff with a copy of the child's Health Action Plan.

3.3 Responsibility for Health Assessments

The Initial Health Assessment must be conducted by a registered medical practitioner. In Cambridgeshire, initial assessments are conducted by a Community Paediatrician within a clinic setting. Review assessments may be carried out by a registered medical practitioner (in a clinic setting) or by a Looked After Children Specialist Nurse (under the supervision of a registered medical practitioner). Review Health Assessments conducted by the nurses are generally undertaken within the child's foster/residential placement unless they have requested otherwise. A copy of the Health Action Plan will be provided to the social worker who will share this with the carer/residential staff as appropriate and the health team send a copy to the child's GP.

3.4 Arranging Health Assessments

The social worker completes SOC 408 placement form and organise for consent and background health information to be sent to the Looked After Children's Health team within 5 days of the child becoming looked after. This should be sent by secure email to Cambridgeshire Community Services (CCS) at The CCS health team liaise with the carer/residential staff, to arrange the Initial Health Assessment with the LAC health team, organising an interpreter where required.

For the Health Assessment to be conducted, the social worker must ensure that the parent(s) and Children's Services (where required) have given consent. This is usually obtained at the point of admission.

The health professional conducting the assessment will complete a Health Action Plan, which will be passed to the child's social worker who gives copies to carers/residential staff and ensures it is available to the IRO and the Looked After Review.

3.5 Consent to Health Care Assessments

A valid consent will be necessary for a Health Care Assessment. Who is able to give this consent will depend on the legal status, age and understanding of the child. In the case of a young child who is the subject of a Care Order, the local authority as corporate parent can give the consent. An older child with mental capacity may be able to give their own consent regardless of their legal status.

In relation to unaccompanied asylum seeking/migrant children who are accommodated, under 16, and for whom no-one has parental responsibility, consent must be obtained by the social worker from their Head of Service for all medical matters.

Young people aged 16 or 17

Young people aged 16 or 17 with mental capacity are presumed to be capable of giving (or withholding) consent to their own medical assessment/treatment, provided the consent is given voluntarily and they are appropriately informed regarding the particular intervention. If the young person is capable of giving valid consent, then it is not legally necessary to obtain consent from a person with Parental Responsibility

Children under 16 – 'Gillick Competent'

A child of under 16 may be Gillick Competent to give (or withhold) consent to medical assessment and treatment, i.e. they have sufficient understanding to enable them to understand fully what is involved in a proposed medical intervention. 

In some cases, for example because of a mental disorder, a child's mental state may fluctuate significantly, so that on some occasions the child appears Gillick Competent in respect of a particular decision and on other occasions does not.

If the child is Gillick Competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid, and additional consent by a person with parental responsibility will not be required.

Children under 16 - Not 'Gillick' Competent

Where a child under the age of 16 lacks capacity to consent (i.e. is not Gillick Competent), consent can be given on their behalf by any one person with Parental Responsibility. Consent given by one person with Parental Responsibility is valid, even if another person with Parental Responsibility withholds consent. (However, legal advice may be necessary in such cases). Where the local authority, is responsible for giving consent, this may be delegated to a carer (foster carer or registered manager of the children's home where the child resides) as a part of 'day-to-day parenting', which will be documented in the child's Care Plan. (see Delegation of Authority to Foster Carers and Residential Workers Procedure).

For further information on consent, see Department of Health and Social Care Reference guide to consent for examination or treatment.

4. Health Action Plans

Each Looked After Child's Care Plan must incorporate a Health Action Plan in time for the first Looked After Review, with any ongoing treatment/ actions incorporated into the child's Placement Information Record.

This Action Plan must be reviewed after each subsequent Health Assessment and at the child's Looked After Review, or as circumstances change.

4.1 Strengths and Difficulties Questionnaires

Understanding a Looked After Child's emotional, mental health and behavioural needs is as important as their physical health. The Strengths and Difficulties Questionnaire (SDQ) is used to assess the emotional needs of each child and, along with any other tool which may be used to assist, should be used to identify the child's emotional and mental health needs within the child's Health Action Plan.

The SDQ is sent out by the LAC Health team in time for it to be returned for the Health Assessment. For the IHA, if there is insufficient time to do this the SDQ is undertaken within the assessment. The SDQ is returned and scored by the LAC Health team. If there are concerns regarding the child's emotional/mental health the practitioner conducting the assessment will liaise with the child's social worker and Team Clinician. Ongoing referrals will then be made to support services, as appropriate.

(See Appendix B of the 'DfE Promoting the Health and Well-being of Looked-after Children', Strengths and Difficulties Questionnaire).

4.2 Out of Area Placements

Where an Out of Authority placement is identified, it will be important to ensure that there are services in the proposed placement area to fully meet the child's health needs. This is particularly important where mental health input is required. It may be helpful to seek guidance from partner agencies, both locally and within the potential placement area to check this.

The CPCCG and the proposed area's CCG should be fully advised of any placement changes by email to the Designated Nurse at to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

Where the child's health situation is more complex, it is likely that both Health and Children's Social Care services will need to be commissioned. This will need to be undertaken jointly within the originating agencies' respective fields of responsibility together with the Health and Children's Social Care services in the area where the child is placed. Should a child/young person require a mental health assessment or ongoing therapies the Psychological Therapies Standard Operating Procedure should be used to request funding through the CPCCG.