Health Care Assessments and Plans
Scope of this chapter
This procedure applies to all Children in Care. Children remanded other than on bail will be Children in Care. Different provisions will apply in relation to those children/young people - see Remands to States of Guernsey Accommodation (including Secure Accommodation).
This procedure summarises the arrangements that should be made for the promotion, assessment, and planning of health care for Children in Care.
Related guidance
- Aftercare following a Hospital Admission under the Mental Health (Bailiwick of Guernsey) Law 2010
- DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015)
- Children’s Attachment: Attachment in Children and Young People who are Adopted from Care, in Care or at High Risk of Going into Care, NICE Guidelines (NG26)
The Service and partner agencies, through its Corporate Parenting responsibilities, has a duty to promote the welfare of Children in Care, including those who are Eligible and those children placed in adoptive placements. This includes promoting the child’s physical, emotional and mental health; every Child in Care needs to have a health assessment so that a Health Plan can be developed to reflect the child’s health needs and be included as part of the child’s overall Care Plan.
The relevant Committee areas alongside Health & Social Care (HSC) have a duty to cooperate with requests from the Service to undertake health assessments and provide any necessary support services to Children in Care without any undue delay and irrespective of whether the placement of the child is an emergency, short term. This also includes services to a child or young person experiencing mental illness. On such occasions, the Service must seek support from the Child and Adolescent Mental Health Service.
- Children in Care 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 Children in Care' (see Annex C: Principles of confidentiality and consent, DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children (March 2015) for additional best practice guidance);
- When a child becomes a Child in Care, or moves into another any treatment or service should be continued uninterrupted;
- A Child in Care requiring health services should be able to access these without delay and any wait should 'be no longer than a and other child in the Bailiwick with an equivalent need';
- A Child in Care should 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 care, or moves placement, the GP should fast-track the transfer of the records to a new GP if this is specifically required.
Role of Social Worker in Promoting the Child's Health
The social worker has an important role in promoting the health and welfare of Children in Care:
- Working in partnership with parents and carers to contribute to the Health Plan;
- Ensuring 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 seek for them 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);
- Ensuring that any actions identified in the Health Plan are progressed in a timely way by liaising with health relevant professionals;
- In recognising that a child’s physical, emotional and mental health can impact upon their learning, where this is necessary, liaising with the Education Service to ensure as far as possible this is minimised for the child. (Should there be any delay in the child’s Health Plan being actioned, the impact for the child with regard to their learning should be highlighted to the relevant health practitioners);
- Supporting the Child in Care 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 Child in Care is undergoing health treatment, monitoring with the carers how this is being progressed and ensure that any treatment regime is being followed;
- Communicating 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;
- Ensuring the child has a copy of their Health Plan.
It is important that at the point of accommodating a child, as much information as possible is understood about the child’s health, especially where the child has health or behavioural needs which potentially pose a risk to themselves, their carers and others. Any such issues should be fully shared with the carers, together with an understanding as to what support they will receive as a result.
Each Child in Care must have a Health Care Assessment at specified intervals as set out below.
- The first Assessment must be conducted before the first placement or, if not reasonably practicable, in time for the Health Care Plan before the child's first Child in Care Review (unless one has been done within the previous 3 months);
- For children under five years, further Health Care Assessments should occur at least once every six months;
- For children aged over five years, further Health Care Assessments should occur at least annually.
If a child is transferred from one Looked After Placement to another, it is not necessary to plan an assessment within the first month. In these circumstances, the social worker should furnish the carer/residential staff with a copy of the child's Health Care Plan.
If no plan exists, the social worker should arrange an assessment so that a plan can be drawn up and available for the child’s first Child in Care Review which will take place within 20 working days.
The first Health Care Assessments must be conducted by a registered medical practitioner. Subsequent assessments may be carried out by a registered nurse or registered midwife under the supervision of a registered medical practitioner, who should provide the social worker with a written report (see Section 3.4, Arranging Health Care Assessments).
The social worker should liaise with the carer/residential staff to arrange the first assessment with the child's GP or Designated Nurse for Children in Care.
Before a Health Assessment takes place, social workers must complete Part A of the CoramBAAF 'Initial Health Assessment Form' to ensure it is available at the time of the appointment.
In order for the Health Assessment to be conducted, the social worker must ensure that the parent(s) have given consent - this will usually be recorded on the Placement Information Record/Initial Health Assessment Form at the point of being received into care.
The health professional conducting the assessment will complete a relevant CoramBAAF Form and a Health Plan, which should be passed to the child's social worker - who should give copies to carers/residential staff.
A valid consent will be necessary for a Health Care Assessment. Who is able to give this consent will depend on the age and understanding of the child. In the case of a very young child, the Service as corporate parent can give the consent. An older child with mental capacity may be able to give their own consent.
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, as corporate parent, is giving consent, the ability to give that consent 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 Placement 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.
Each Child in Care’s Care Plan must incorporate a Health Plan in time for the first Child in Care Review, with arrangements as necessary incorporated into the child’s Placement Plan/Placement Information Record.
This plan must be reviewed after each subsequent Health Care Assessment and at the child's Looked After Review or as circumstances change.
Information should also be given about any allergies. See also Health and Safety Procedure.
Understanding a Child in Care's emotional, mental health and behavioural needs is as important as their physical health. All local authorities are required to use the Strength and Difficulty Questionnaires (SDQs) to assess the emotional needs of each child.
The SDQ Questionnaire, along with any other tool which may be used to assist, can be used to identify the needs and be part of the child’s Health Plan.
Where an Out of Jurisdiction placement is sought, the Service should make a judgment with regard to the child’s health needs and the ability of the services in the proposed placement area to fully meet those needs. The Service should seek guidance from within its own partner agencies and the potential placement area to seek such information out.
The receiving Local Authority should be fully advised of any placement or placement changes to ensure that any health needs or Health Plan are not disrupted through delay as a result of the move. The Child in Care remains the responsibility of the Service and as such health care provision will often require local funding and the child may not be entitled to health care provision, post-adoption support or therapeutic services via the local CAMHS service in another local authority area. Such arrangements will all be considered and will form the plan overseen by the Court or Tribunal process prior to any legal decision to place a Child in Care out of the jurisdiction.
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.
Last Updated: November 25, 2025
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