• contents
• keywords & contacts
• quick guide
• values
• contact us
• search
• forms library
• yot procedures

Contents

1. Introduction
2. Policy, Legal Requirements and Guidance
3. Corporate Parenting and 'Partner Agency' Responsibilities
4. Key Practice Principals for Health Assessments (medicals) and Health Care Plans
5. Consent: Routine/Non-routine or Emergency/Non-emergency Medical Care
6. Medicals (Health Assessments)
7. Local Arrangements made with Bromley Primary Care Trust (BPCT) Medical Advisor to Bromley Social Services
8. Requesting Medicals
9. Initial Medicals
10. Subsequent Statutory Medicals ("Annual Medicals")
11. Comprehensive Medicals (Health Assessments)
12. Health Plans for Looked After Children

1. Introduction

This procedure  covers the arrangements required for the health care of children who are looked after by the London Borough of Bromley (the 'responsible authority'). 

See also Health Care Assessments Procedure regarding the range of legal issues,  and concepts children's 'age and understanding' and 'capacity' to consent to medical treatments. 

2. Policy, Legal Requirements and Guidance

Schedule 3 of the Arrangements for Placement of Children (General) Regulations 1991 sets out health considerations to which responsible authorities are to have regard:

child's state of health; child's health history; effect of the child's health and health history on their development; possible need for an appropriate course of action which should be identified to assist necessary change of such care, treatment or surveillance; possible need for preventive measures, such as vaccination and immunization, and screening for vision and hearing; existing arrangements for the child's medical and dental care and treatment; and health and dental surveillance

Note the range of legislation and regulations listed in "Legislation" at the top of this procedural guidance. The national initiative from the DOH - Quality Protects (QP) - was launched September 1998 and subsequently extended from a three-year to a five-year programme.  Designed to improve the quality and management of children's social services it set "Objectives" and "targets" and expected "outcomes" for standards of service including the health care for children in need.  QP, because of national concerns and the impact of several serious formal Inquiries brought a particular focus on the needs of children in the public care system, i.e. children 'looked after' by local authorities.  Local health care arrangements for children in need, and looked after children in particular, may vary between local authorities but the underlying principals and values will be held in common across the country.  The overall QP "Objective 4", regarding looked after children, requires the 'responsible authority' (in this case Bromley) to: "ensure that children looked after gain maximum life chance benefits from educational opportunities, health care and social care". "Sub-objective" 4.2 requires: "ensuring that children looked after enjoy a standard of health and development as good as all children of the same age living in the same area".

Practice Comment

This "Objective" is measured through following key performance indicators:

• take up of immunizations;
• take up of six monthly dental checks and recommended dental and orthodontic treatment.
• take up of medical examinations required by statute;
• growth and developmental assessments through health surveillance for children under 5;
• pregnancies of girls aged less than 16 years;
• access to information and advice about health and healthy lifestyles.

3. Corporate Parenting and 'Partner Agency' Responsibilities

1. Bromley, as the responsible authority is required under the Children Act 1989 to arrange health assessments and on-going health care for all its looked after children/young people.  Bromley should have the same parental expectations as would be expected of caring parents with regard to promoting the health of its (looked after) children.
2. Corporate parenting can potentially involve any department of the responsible authority.  It is led by the Social Services' Children and Families Division; with active involvement of Housing and Education Departments; and a developing role for Leisure & Community Services.
3. Specific statutory obligations to meet the health care of all children in need are also shared in partnership with NHS Health Authorities.  Health care for looked after children is therefore an extensive partnership, which includes Bromley Council, Parents, independent agency Carers, Partner Agencies - and various local organizations in the private and voluntary sectors.
4. The local health care policies and provisions should demonstrate positive promotion of healthy lifestyles for children in need as well as providing regular medical surveillance, and day-to-day health care services for children looked after.

4. Key Practice Principals for Health Assessments (medicals) and Health Care Plans

Good Practice Comment

The information and comments made by the doctor from any medical examination should be shared with the child/young person's carers where appropriate.  There may be occasions, however, where a young person may wish aspects of their health care to remain confidential from their carers.  Great care should be taken by social workers to ensure that a child/young person is listened to and their wishes and feelings taken into account according respecting their age and understanding.

1. Children's Social Care should fulfil the role of an active concerned parent in promoting and monitoring the child or young person's health and development; and should, where possible and appropriate, actively involve the child or young person's birth parents.
2. All agencies should recognise that children in public care may need higher levels of parenting and health input in order to achieve the same health outcomes as other children in the population.
3. Health care for looked after children are not a one-off medical event but a continuous process of ensuring provision of high quality healthcare managed through a process of childcare planning and review.
4. Services should aim to promote the future health and well-being of the child or young person and not focus solely on the detection of ill-health.
5. Services should be delivered in a way that enables and empowers the child or young person to take appropriate responsibility for their own health.
6. The child or young person's informed consent to all healthcare treatment should be actively sought and recorded in a way appropriate to the child or young person's age and understanding.
7. The initial health assessment will inform the drawing up of a health care plan, which can then be monitored, including through the LAC review system, and amended as necessary to meet the child's changing needs.
   
   See Section 12, Health Care Plans for Looked after Children.
8. Services should be delivered in a sensitive age-appropriate way that recognizes the importance of choice and accessibility.
9. Services should be non-discriminatory and promote equality of access and anti-racist practice.
10. Health needs of looked after children and young people should be assessed within a child-centred and holistic framework.
11. Organisation of services should take account of the needs of a population which experiences frequent moves which should not multiply or compound their disadvantage.

5. Consent: Routine/Non-routine or Emergency/Non-emergency Medical Care

Consent: Non-routine or emergency medical care

See Procedure Health 2 for a fuller breakdown of information on consent issues.

1. The social worker has to advise the Head of Service in writing.  This could be on any of the following: all surgery; medical procedures involving anaesthesia; other intrusive medical procedures (excluding routine injections and routine dental care); where a child is suffering a life-threatening illness; and all treatment requiring hospitalization, or hospitalization under the direction of a Consultant.
2. Where a person's life is in danger, including a child or young person looked after by the local authority, a doctor may proceed with emergency medical care without other parties' consent.
3. Use the Bromley form MED.5 to advise the Assistant Director in writing.
4. MED.5 is to be used for children subject to legal orders, but also to advise the Assistant Director where children are accommodated, under S.20 CA1989, but parental consent was not given, or the section "Agreements" in the Funding/Request Form was not by the social worker with the parent(s).
5. Social workers should take note of the Funding/Request Form question nos. 14, 15, 23,  last page of the Funding/Request Form, and the section on "Agreements", no.7 - which gives a variety of medical treatment options for parental decision-making and agreement.

Consent for routine and non-emergency medical care

1.	These consents should be discussed with the parent.  (See point 5 in above section on "Agreements".)  The social worker completing the LAC admission documentation for the child must ensure that Parental Consent is signed prior, or at the time of placement, in the  Funding/Request Form. See also Procedure Health 3: Documentation
2.	Clear agreements should be in place for children and young people/carers and birth parents as to the arrangements for meeting that child's health care needs for the time that they are 'looked after' by Bromley.  See "Health", question no.2 in the Placement Plan Part 2 (PP2). This covers current:
	medical care; dental care; eye tests; hearing tests; preventive and other health care e.g. speech therapy; any additional arrangements arising for a child's disability  e.g. equipment.
3.	Where a child is under 16 and accommodated it will be for the child's parent(s) to consent to treatment.
4.	The parent may delegate the consent to routine medical treatment to the responsible authority or to the carers in particular.  If the latter, the social worker completing the LAC admission must ensure Bromley form MED.4 is completed for the carers at the start of placement.

6. Medicals (Health Assessments)

Practice Comment

In summary looked after children's medicals should cover:

• The child's current state of health;
• Their health history;
• Family health history;
• Current health needs of the child; and
• Arrangements for meeting their health needs.

1. The key regulations are set out in the following statutory instruments: The Arrangements for Placement of Children (General) Regulations 1991 and The Review of Children's Cases Regulations 1991.  These regulations are printed as appendices in the Children Act 1989 Regulations and Guidance.  See either in Volume 3 or Volume 4.
   
   Planned and unplanned placement to care
2. Planned placements: where entry of a child/young person into the public care system is planned in advance  - all aspects of care planning, including setting up initial medical assessments and overall health care plan, should be arranged in advance of the child becoming looked after. (See Post placement arrangements chapter Please link)
3. Where children's become looked after as the result of an unplanned all planning and documentation processes should take place as soon as possible after the start of the care episode.  (See Post placement arrangements chapter Please link)

7. Local Arrangements made with Bromley Primary Care Trust's (BPCT) Medical Advisor to Bromley Social Services

Practice Comment

The Consultant Community Paediatrician in the BPCT is appointed as the "Designated Doctor for Looked after Children" and "Medical Advisor for Adoption and Fostering" for Bromley Social Services.

1. The following are the local arrangements made with Bromley's Medical Advisor who is the Designated Doctor for LAC, and is based at the Phoenix Children's Resource Centre (known as 'Phoenix Centre'). See address in Section 9, Initial Medicals, point (9) below:
2. All initial medicals should be carried out by GPs as these medicals have to meet a timescale of being completed within two (2) weeks of the beginning of the care episode.
3. Subsequent regular statutory medicals for children aged 0 - 5 years old should be booked with a community paediatrician at the Phoenix Centre.  This will be every six months for children aged 0 - 2; and annually for children aged  2 - 5 years old.
4. Comprehensive medicals identified as necessary for a looked after child aged 0 - 10 years should be booked with a community paediatrician at the Phoenix Centre.
5. Comprehensive medicals for young people aged 11 years and over should be discussed with the Medical Advisor at the Phoenix Centre and arrangements made as appropriate.
6. The Medical Advisor at the Phoenix Centre will review all medicals reports conducted by GPs and will propose a comprehensive medical if viewed as clinically necessary.
7. The Medical Advisor progresses agreements for payment of fees to examining doctors for undertaking medicals for looked after children.
   
   *Medicals booked at Phoenix Centre will also be dependent on whether distance from child's placement is reasonable to expect the child to travel.

8. Requesting Medicals

General

Good Practice Comments

1. Continuity of health care Try to ensure this by arranging for the child or young person to be seen by their own G.P. who will know the child already and have their health records.
2. Personal Child Health Record (PCHR) Ask the parents for the (red cover) PCHR so this can be held, and up-dated while the child is looked after, by the carers.  The PCHR is primarily used for children aged 0 - 5 years, though it has sections for recording health data for older children e.g. their immunization record
3. 'Centile Charts'  When a child/young person is looked after ensure that the "Girl's (or Boy's) Growth Assessment Chart" (centile chart) is used consistently and forwarded to the doctor for each new medical. DO NOT START A NEW ONE for each medical which would prevent plotting of the centile chart information from each medical examination.
4. Health assessments documents are specific health preparations and assessments for looked after children who have adoption as their care plan - cases for which the Bromley Adoption Team provides specialist input.
5. Health 3 also includes a brief summary of the DOH 'LAC materials', i.e. the Essential Information Records (EIR 1 and EIR2), Placement Plans (Funding/Request Form and PP2), Care Plans (CPs), Review of Arrangement records (ROAs) and Assessment and Action Records (AARs).
   
   Procedural Steps
6. The following guidance breaks down the steps for social workers required to arrange the following medical services for LAC:

Initial medicals; Subsequent regular medicals- commonly known as "annual medicals"; Comprehensive health assessments (medicals); And arranging LAC's overall health care plans.

Practice Comment

Whilst it may not be possible, at the point of a child's entry to the public care system to obtain a comprehensive picture of their health background, it is important to obtain information about:

• current and past illnesses
• any prescribed medication
• allergies e.g. pets, peanuts
• outstanding hospital appointments / follow up treatment
• disabilities

9. Initial Medicals

See procedure Health 2 regarding fuller details on Consent to medical treatment.

Practice Comments:

A General Practitioner should carry out all INITIAL medicals because this first statutory medical needs to take place within a maximum of two (2) weeks from the start of the current care episode. 

1.	As far as reasonably practicable, in accordance with Regulation 5 of the Arrangements for the Placement of Children Regulations 1991 the following are statutory requirements before the placement is made to place a child [Regulation 5(1)(b) and (c)]:
	The local authority must notify the District Health Authority in writing for the district in which child is living; and the child's registered medical practitioner - General Practitioner (GP). Social workers should note that the Bromley in-house form P.5 must be used for sending this information to the LACCS Administrator, who amends the LACCS database and notifies the above information to the external agencies/parties.
2.	The initial medical should be booked with the General Practitioner (GP) to take place unless child has already been examined, and this medical took place within the last three(3) months immediately prior to the before the placement placement start date.  Children should not be subjected to unnecessary repeat medical examinations.
3.	If an initial medical is required and it cannot be arranged before the placement start it must take place as soon as practicable after the care episode begins.  Regulation 7
Practice Comment:
	It is a Bromley Children and Young People Division policy decision and practice standard, in accordance with recommendations of the Department of Health (DOH) that, in all circumstances where the initial medical did not take place before child started to become looked after, it must take place within a maximum of 14 days from the LAC state date.  Next steps
4.	The social worker arranges for the following forms to be sent to the examining doctor:
	MED.1 MED.2 IHA - Initial Medical form. Note (BAAF form is titled "Initial Health Assessment Record") "Girl's (or Boy's) Growth Assessment Chart" - commonly known  as 'centile charts'.
5.	Where the relevant GP is not available or unable to complete a medical within the maximum of 14 days from the LAC start date, advice/request for a medical should be sought from the Medical Advisor (Dr Adeyeo) at Phoenix Health Centre, Bromley to arrange for another examining doctor to undertake the medical in time.
6.	The Head of Service should be notified of this service difficulty.
7.	The examining doctor should return to the social worker:
	IHA MED.2 (and doctor's invoice if possible), Centile chart
Practice Comment:
	The examining doctor, or other health professional, should identify the child's health needs and take immediate appropriate action and recommend further action to be taken if necessary.  It is a matter of clinical responsibility to determine whether the child/young person is in need of a more comprehensive medical to address their health needs.  Next steps
8.	The social worker then sends to the Medical Advisor, after Group Manager's authorisation confirms details in the MED.2:
	MED.3 photocopy of IHA (keep original on child's casefile records) centile chart Examining doctor's MED.2 (and invoice)
	Further statutory regulations and guidance
9.	In addition to arranging the statutory medical the social worker should also consider the following which are also part of statutory regulations and guidance: The need to be alert to health care needs of children from ethnic minority groups and ensure they receive appropriate health care; The need to ensure that the child is registered with a general practitioner, and a dental practitioner; In the case of children with disabilities, and those with special needs, particular consideration should be given to achieving continuity of specialist medical care.
Practice Comment
	If the social worker does not have access to the child/young person's immunisation history and require this to complete the Essential Information Record 2 (EIR2) - for children who received their immunizations in Bromley - contact the child health information section at: Bromley PCT, Bassetts House, Broadwater Gardens,  Farnborough, BR6 7UA.  Tel:  01689 853388. Next Steps Statutory LAC Reviews
10.	Medical information should be available to inform the 1st or subsequent statutory LAC reviews.  Social workers should give particular attention when completing the DOH Review of Arrangements form nos. 11(e), 12, 18 - on consultation with the Health Service; no. 20 - for last medical examination date, and no. 21 for the disability register.
11.	The Independent Reviewing Officer for the LAC review should formally address question 25(f) in the "Issues for Discussion"  which concern the health arrangements for the child/young person at the first, and every subsequent, statutory LAC review.  The independent chairperson should also ensure details of this discussion, together with any review decisions / recommendations are recorded.

10. Subsequent Statutory Medicals "Annual Medicals"

1.	After the initial medical subsequent regular medicals are commonly known as "annual medicals".  This is not an accurate term and social workers should give particular attention to the age of the looked after children when booking the next statutory medical - as the statutory frequency for children under two (2) years old is different.
2.	SUBSEQUENT MEDICALS should be provided for all looked after children/young people at least at the minimum following frequency:
	once every six (6) months for children under two years old;  and annually for all other ages of looked after children
3.	Social workers should give consideration to the needs of the individual child in deciding which G.P. should be used, or another specialist doctor, if the child is already receiving medical care. Next steps
4.	The social worker arranges for following forms to be sent to be sent to the examining doctor.  The social worker should note that though the AME is entitled "Annual Medical Report on a Child or Young Person in Foster Care" it is a universal form, i.e. also for children who are placed in residential provision:
	MED.1 MED.2 Form AME If the examining doctor does not have access to the child's health records due to a change of placement, the previous completed AME should be sent to the doctor as well as the new AME .  It is essential that the G.P. has adequate information about the child's previous health care. Centile chart - the current "Girl's (or Boy's) Growth Assessment Chart".  DO NOT START A NEW ONE for each medical.  This would be prevent plotting of the chart at each subsequent medical examination.
5.	The comments made by the examining doctor must be acted on, and health information should be shared where appropriate with the child's Carers.  There may be occasions where a child/young person may wish medical information to remain confidential from their Carers.  See procedure Health 2 on consent issues.
6.	Social workers should consult with their line manager if in any doubt about confidentiality and sharing health information from a child's medical history with any other party.
7.	Where the expected G.P. or specialist doctor will not be available, or unable, to complete the subsequent medical, advice should be sought from the Medical Advisor at the Phoenix Health Centre.  Next steps
8.	The examining doctor returns to the social worker:
	Completed AME; MED.2 claim form (and invoice if available); Up-dated centile chart. Next steps
9.	The social worker then arranges for:
	Photocopy of AME (keep original on child's case file records), Form MED.3 Form MED.2 (and invoice if available Centile chart to be sent to the Medical Advisor Dr N. Adeyeo, Consultant Paediatrician (Community), Phoenix Children's Resource Centre (address at 8 (7) above)  Next steps
10.	As with Initial medicals up-to-date medical information from subsequent medicals is crucial for each statutory LAC review.  The social worker should ensure completed questions on health in the Review of Arrangements form (ROA).  See particularly nos. 11(e), 12, 18 - on consultation with the Health Service - and no. 20 for last medical examination date; and no. 21 regarding the Disability Register). Next steps
11.	Likewise the independent reviewing officer (chairperson) for the LAC review should formally address no. 25(f) in the "Issues for Discussion" on health arrangements for the child/young person.  And record in writing details of the discussion/any new  decisions made which affect the health care plan aspects of the child/young person's overall Care Plan.

11. Comprehensive Medicals (Health Assessments)

1.	A detailed medical assessment in the Department of Health's DOH guidance is referred to as the "comprehensive health assessment".
2.	Practice regarding the use of the comprehensive medical is addressed with in the DOH Consultation Document "Promoting Health for Looked after Children" (2000).  This forthcoming national guidance is to be issued in its final form before the end of 2002 and is expected to closely follow the drafted guidance.
3.	The need for a looked after child/young person to have a comprehensive medical  is a clinical decision.  Children/young people should not be subjected to unnecessary extra medical examinations if there is not a clinical need.  Such care should particularly be taken with children with disabilities who, in many cases, have to cope with a high level of medical examination and intervention.
Practice comment
	If a doctor makes this decision at the Initial Medical then the Comprehensive Medical must take place WITHIN THREE MONTHS (12 weeks)  from the start date of the child becoming looked after.  Next steps
4.	The medical form IHA is only to be used for initial medicals.  The AME is used for annual/six-monthly statutory medicals.
5.	For a comprehensive medical the social worker must use the relevant BAAF Form sets C, or D or YP - depending on the age of the looked after child/young person. Next steps
	Reciprocal arrangements with other Health Authorities
6.	If the clinical decision is for the comprehensive medical to be conducted by a Paediatrician, rather than a General Practitioner, this medical is to be booked to take place at the Phoenix Health Centre, Bromley except where children/young people are in out of borough / long distance placements - or where it is unreasonable or disruptive, to expect the child to travel to the Phoenix Centre.  Then reciprocal arrangements can be made for medicals to be held in the placement locality.  This is arranged between Bromley Health Authority (HA) through the BPCT with the relevant other Health Authority. See  also sections 3 (11) and 11 (1) below.
7.	Social workers should be mindful - in placing looked after children outside the borough boundaries - that health care arrangements will need extra discussion.  And that special arrangements may already be in place for medical care for looked after children in the receiving Health Authority.
8.	The Medical Advisor at the Phoenix Centre will provide liaison and advice regarding comprehensive medicals as necessary. Next steps
9.	The social worker will select Form C, Form D, or Form YP according to age of the child/young person.  The front sheets of the C, D, or YP Form must be completed prior to the medical by the social worker. Next steps
10.	The social worker, together with the main caregiver should also complete the relevant Annex for Form C or Form D.
11.	If the front sections of Form C, D, or YP are not filled in appropriately the examining doctor will not have complete information, and the quality of the comprehensive medical will be impaired. Next steps
12.	The social worker will then arrange for the relevant forms to be sent to the examining doctor:
	MED.1 MED.2 - Form C (and Annex to Form C) for child under 5; OR Form D (and Annex to Form D) for child 5 - 10 years; OR Form YP for young person aged 11 years and over; Current centile chart.
13.	Otherwise than undertaking a comprehensive medical determined as clinically necessary at the Initial Medical - any  other comprehensive medicals can take place at any time during the period of the child/young person's care episode.  But, as stated above, on all occasions the need for a child to undergo this detailed health assessment is a clinical decision.
14.	Particular care should be taken to ensure that looked after children with disabilities, whose level of medical needs and health service provision may be considerably higher than other looked after children, are not subjected to unnecessary extra, uncoordinated and poorly-planned medical examinations.
Practice Comment
	Children/young people with disabilities are often knowledgeable about their own medical conditions and should be listened to and actively involved in their health care plans according to their age and understanding. Next steps
15.	The examining doctor, returns to the social worker:
	Original of Forms C, D, or YP (for the child's casefile records) MED.2 completed for fee claim The centile chart Next steps Note: if the examining doctor is a paediatrician in the Medical Advisor's team at the Phoenix Children's Resource Centre, Bromley s/he will provide a copy of the medical report (C, D or YP); and copy of the completed MED.2 to the Medical Advisor for processing. Note: if the examining doctor is a GP, or a paediatrician in another Health Authority, the social worker will forward copies of the medical report (C, D or YP) and MED.2 with a completed MED.3 cover letter after Group Manager authorisation. Request for comprehensive medical on behalf of the Responsible Authority
16.	If the social worker or carers, as Bromley corporate parent representatives, believe their child might benefit from a comprehensive medical this can be discussed with the Medical Advisor at the Phoenix Centre.
17.	If the carers are employed by an independent fostering agency or residential unit, i.e. not an employee of the Responsible Authority,  the carers should discuss this first with the child/young person's social worker, who would then contact the Medical Advisor as the corporate parent. Involvement of birth parents in children's health care plans
18.	Social workers should be mindful of the important roles birth parents can undertake for their children, even while their child is looked after.  Parents can champion or advocate for their children in accessing and using services; and may be able to use their knowledge and understanding of their child to help social workers seek the most suitable resources to support their child's health care plan. Practice Comment Children and young people in residential care should expect an equal standard of healthcare.  Social workers should be particularly alert to ensuring the quality of health care plans of children in residential care provision at a distance from Bromley, and/or outside the area of the local Health Authority.  Next steps Health care planning review at 2nd LAC statutory review
19.	Medical information should be available for the 2nd LAC review.  This is a crucial, early, stage in the care episode.  The child's Care Plan must be addressed formally at this review with regard to the new national standard for 'permanency planning'. See new Permanence Planning Guidance and Procedure and Practice Guidance for Social Workers 2002.  This is being issued in a 'stand-alone' folder.  It will be incorporated into the text of the revised Bromley Children and Families Procedures Manual when the latter is available. See also Regulation 3(1) & (2) in Review of Children's Cases Regulations 1991, found in Volumes 3 or 4 of the Children Act 1989 Regulations and Guidance.

12. Health Plans for Looked After Children 

1.	This section outlines key principals concerning health care planning for looked after children drawn from the: consultation document "PROMOTING HEALTH FOR LOOKED AFTER CHILDREN: a guide to healthcare planning, assessment and monitoring" (2002).
2.	Placements outside the boundary of the local authority have already been identified as creating a particular barrier to accessing health services. For some children and young people such a placement will be 'accidental', i.e. there was no suitable placement within the authority on the day it was required.
3.	Health care planning should therefore be alert to the likelihood that there is not a 'best match' between the needs of the child and the services available.
4.	For other children it will be a planned placement designed to meet very specialised needs.  In the case of some disabled children possibly even jointly funded by the Health Authority. These are usually high cost placements in the independent sector (which are frequently outside the local authority boundary) and for children and young people with more complex needs.
5.	The social worker should be mindful that such placements require a high level of coordinated decision-making between partner agencies, which as well as Bromley's Children and Families Division and the Health Authority, may also include the Education Departments in Bromley, and another local authority if the child is placed outside the Borough.
6.	Social workers should consult with their line managers regarding the use of the Joint Interests Panel and the arrangements for sharing costs between the partner agencies and departments.
7.	Notification of placements required under the Arrangements for Placement of Children Regulations 1991 are particularly important when children are placed out of authority. This is vital to ensure fast transfer of records and identification of health needs.
8.	The health care assessment should identify health issues to be addressed in the child's health care plan. Following discussion with the social worker, carers, the child/young person (at a level appropriate to their age and understanding), and parents as appropriate, this will be incorporated in the child's overall DOH Care Plan.
9.	Implementation will be monitored as an integral part of the child or young person's LAC statutory reviews. The LAC reviews should consider the appropriateness of the health plan in the light of any subsequent health condition, or events that may impact on the child's health.
10.	Discussion at the LAC reviews will need to take account of issues of confidentiality and privacy for the child or young person.
11.	At each child or young person's statutory review the health assessment must be fully considered to check that all necessary actions have been carried out. The social worker should ensure that the summary of the Assessment and Action Record (AAR) is available to all subsequent reviews from the 3rd review (at 10 months from the start of the care episode) onwards.  It will be the responsibility of the LAC review to determine whether a different health assessment is required to that stipulated in the health care plan.
12.	From the start of a child's life it is important to keep track of their health history..  Most parents carry this information in their head and can draw on this when needed. Together with the child's GP and other health professionals, health information is built up over time.  It should be readily available and as a corporate parent Bromley needs to sure that clear written records are kept by the social worker.
	Practice Comment
13.	For the child who becomes looked after, changes in carer, GP and other health professionals, can mean this detailed knowledge becomes difficult to access, is overlooked, or lost. There is still evidence from research and practice that local authorities are not passing on all relevant information about a child or young person's experiences and behaviour at the time of placement. This makes the process of healthcare planning extremely difficult and may jeopardise the placement.
14.	Health care plans should include information on: Treatment prescribed with follow up arrangements; Any referrals made to specialist services (e.g. hospital, CAMHS, Child Development Centre and community services, e.g. speech therapy) with arrangements to monitor receipt and keeping of appointments; Conditions needing review - to include by whom and when; Arrangements for ongoing and future health promotion and lifestyle; Advice - to include who will give this; The need for aids and adaptations for some disabled children.
	Practice Comment
15.	If any part of the health plan for the child has not been carried out the independent reviewing officer from the QA and CP Unit must report this to the Principal Service Manager (Care and Resources), who is the nominated senior manager for looked after children in Bromley Children and Families Division.
16.	Detailed child health records  Carers, as well as professionals, need to keep detailed records of a child's health. The responsible authority should facilitate this process and ensure that this information stays with the child when ever they move and that it continues to be collected. Genetic and family history is crucial information which must stay with the child's or young person's records.
17.	The Looking After Children system provides a FRAMEWORK FOR A SYSTEMATIC APPROACH TO ASSESSMENT, CARE PLANNING AND REVIEW. The Assessment and Action Records are designed to help assess children's progress, monitor the quality of the care they are receiving and make plans for improvements across seven developmental dimensions; Health, Education, Identity, Family and Social Relationships, Social Presentation, Emotional and Behavioural Development and Self Care Skills. See the  procedure Health 3: Documentation for summaries of key points in the Looking After Children DOH documents regarding health care planning.

This information should be updated regularly and shared with the social worker, carers, child and usually the parents.

Note: Bromley procedures for health care of Looked after Children Refer to all sections of procedures on the health of looked after children to improve service delivery and standards of care: Health 1:  this procedure Health 2:  on consent issues Health 3:  on documentation Health 4:  on healthy lifestyles - forthcoming procedure

End