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5.5.1 Promoting the Health of Looked After Children and Young People in Bolton

NOTE

From 3 December 2012, all children remanded other than on bail will be Looked After Children. Different provisions will apply in relation to those children/young people - see Section 8, Care Planning for Young People on Remand in the Remands to Local Authority Accommodation or to Youth Detention Accommodation Procedure.

RELEVANT CHAPTER

Greater Manchester Safeguarding Procedures, Suicide and Self Harm

RELEVANT GUIDANCE

DfE and DoH, 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)

AMENDMENT

This chapter was updated in September 2017 by adding a link to 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), (see Relevant Guidance above).


Contents

  1. Introduction
  2. Context
  3. Roles and Responsibilities (Bolton Clinical Commissioning Group (CCG))
  4. Roles and Responsibilities of Bolton Children's Services

    Appendix 1: Caldicott


1. Introduction

Children and young people who are Looked After are amongst the most socially excluded of all young people and include children who are Remanded to Local Authority Accommodation or Youth Detention Accommodation. They are frequently reported in government research, policy and guidance to have greater needs than their peers, yet are less likely to receive adequate health care and treatment and be supported in developing their knowledge and skills in making decisions that promote health and well being. They need to receive care in a setting that actively promotes health and well-being for children and young people, as well as staff and carers.

This policy updates previous local guidance by responding to recent legislative change at a national level and provides an ‘at a glance’ reference to offer a ‘who does what’ clarity of role for professionals.


2. Context

Legislation and policy guidance covering aspects of the factors directly affecting the health and well-being of Looked After Children and young people includes:

Children Act 2004 and Every Child Matters Agenda

The “Every Child Matters” agenda highlighted the need for Councils to look more closely at models of integrated working and how a range of services can be delivered in local areas at one access point.

Adoption and Children Act 2002

Implementation of Legislation and Regulations January 2006.

Private Fostering Agreement Regulations 2005

Re-launch of requirements undertaken in October 2005.

Asylum & Immigration Act 2004

Climbié Recommendations

Care Matters

The Children (Leaving Care) Act 2000 specifies that health considerations should form an integral part of pathway planning (DoH 2001).

The Care Standards Act 2000 places a duty on Care Homes to promote and protect the health of children.

Care Planning, Placement and Case Review (England) Regulations 2010 provide that a Looked After child’s first Health Care Assessment must be conducted before their first placement or, if not reasonably practicable, before the child’s first Looked After Review (unless one has been done within the previous 3 months.) Each Looked After Child’s Care Plan must incorporate a Health Plan in time for the first Looked After Review.

Legal Aid Sentencing and Punishment of Offenders Act 2012 extends the category of children considered as Looked After Children.

In order to achieve effective continuity of health services, agencies involved in caring for young people will ensure that personnel at all levels of their organisations understand the implications of this policy and what is required of them in order to put it into practice.

Young people will be provided with the knowledge and information to enable them to make informed choices in relation to their health and will be supported in accessing services that can help them.

The document recognises the most important promoters of health are the workers and carers who have regular face-to-face contact with young people. It is hoped this policy and statement of service provision will help to raise the confidence and awareness of these people in engaging with young people and providing them with accurate information, help and support.

Bolton Clinical Commissioning Group (CCG) will, together with other agencies, contribute to building the capacity of organisations to deliver this health promotion agenda. Joint training of care staff and foster carers will be undertaken on a regular basis.

The specific roles and responsibilities of all agencies to maintain and promote the health and well-being of Looked After Children and Young People are outlined in detail in the following pages.


3. Roles and Responsibilities (Bolton Clinical Commissioning Group (CCG))

  • Ensure that the health and well-being of Looked After children and young people is an identified local priority;
  • Ensure that structures are in place to plan, manage and monitor the delivery of health care for all Looked After children;
  • Ensure that clinical governance and audit arrangements are in place to assure the quality of health assessments and Health Planning;
  • Ensure that there is a named public health professional, who will input into children in need issues, including child protection, as necessary. Looked After Children are part of this wider group of children in need;
  • Identify a Designated Professional (doctor and nurse) to provide strategic leadership and advice in relation to the health needs of Looked After children;
  • Where a child is placed “out of authority”, ensure systems are in place to provide continuity of the health assessment and planning process;
  • Through the commissioning process ensure that Looked After children are registered with GP's and dentists near to where the child is living;
  • When Looked After children need to register with a new GP (e.g. when they enter care or change placement), ensure systems are in place to “fast track” the GP held clinical and dental records;
  • Ensure systems are in place through the commissioning process to make sure that Looked After children are not disadvantaged when they move from one PCT to another, i.e. NHS waiting lists;
  • Ensure that arrangements are in place for the transition from child to adult health services;
  • Ensure that an appropriate data set is collected and reviewed annually.

The Young Person’s Health Advisor Will:

  • Co-ordinate the provision of annual health reviews for young people 11-18 years, ensuring that each young person is offered a health assessment by an appropriately trained health professional. The first Health Care Assessment 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;
  • Identify and engage ‘hard to reach’ young people, ensuring a health assessment is conducted, Health Plan completed to ensure that health needs are identified and timely referrals made;
  • Act as the main point of contact for advice and referral for young people with complex health issues;
  • Facilitate the uptake of immunisations of Looked After young people and, where necessary, undertake any outstanding immunisations;
  • Advise Looked After young people and their carers that each Looked After child should be registered with a local GP and dentist;
  • Act as a specialist health advisor for Looked After young people, focusing particularly on sexual health and relationships, mental health and substance use;
  • Provide health promotion advice and support, as required, to young people 11 - 18 years, carers, and social workers with special emphasis on sexual health, behaviour, mental health and substance use;
  • Advise and inform carers, social workers, educational staff and others on the health needs of Looked After young people;
  • Participate in the training of carers and professionals in relation to meeting the health needs of young people Looked After;
  • Work collaboratively with key partners including YOT, Project 360, BEST and The Parallel in identifying and addressing the health needs of Looked After young people 11- 18 years;
  • Work in a multi-agency and multi-disciplinary environment in order to develop links with young people and their families/carers, statutory and voluntary organisations that provide services for Looked After young people;
  • Attend statutory reviews of Looked After young people as appropriate;
  • Report regularly to the Safeguarding Steering group.

NHS Practitioners have an important role to play in the identification of the health care needs of children and young people who are Looked After. They often have prior knowledge of the child, birth parents and carer, helping them to take a holistic and child-centred approach to health care decisions.

NHS Staff will:

  • Act as advocates for the health of each child or young person who is Looked After;
  • Conduct Health Needs Assessments in respect of Looked After young people aged 11 years plus, where that young person has identified a preference for a GP assessment;
  • Ensure timely access to a GP or other health professional when a child requires a consultation;
  • Ensure that the relevant health information is available, on request; to the health professional who is carrying out the health needs assessment on Looked After children, subject to appropriate consents;
  • Maintain a record of the health assessment and contribute to any necessary action within the Health Plan;
  • Ensure that the clinical records flag up the “Looked After status” of the child, so that his/her particular needs can be acknowledged;
  • Ensure that the GP records of Looked After children transfer quickly and efficiently within 2 weeks when there is a change of GP;
  • Ensure that Looked After children are identified as such within any referral letters to other community or secondary paediatric services, together with the name and contact details of the social worker;
  • Alert the service provider within the referral letter if the Looked After child has been on a waiting list for a similar service in another area.

The Designated Professionals

The broad role of the designated doctor and nurse is to assist relevant NHS bodies in fulfilling their responsibilities as commissioners of services to improve the health of Looked After children. They will advise relevant bodies on, and contribute to planning, strategy and audit of quality standards for health services for Looked After children. As well as providing expert advice, the designated doctor and nurse will take a strategic overview of the service and monitor quality.

The Designated Doctor and Nurse will:

  • Develop and ensure awareness of relevant policies, procedures and roles in relation to Looked After children and young people;
  • Maintain regular contact with local health staff undertaking health assessments. They will also liaise with social services departments and other areas over health assessments and Health Plans for out of authority placements;
  • When a child moves from Bolton to another area, the responsibility for the child will transfer to the area in which the child now resides. Therefore, it will be the responsibility of the Designated Doctor to provide health data to the relevant NHS bodies;
  • Ensure that all relevant staff are appropriately trained in undertaking health assessments for Looked After children;
  • Monitor the quality of the health assessments ensuring that sensitive health promotion is offered to all;
  • Contribute to the production of health data on Looked After children ensuring an effective system of audit is in place;
  • Produce an annual report, evaluating the delivery of health services for Looked After children and young people.

Information presented will include:

  • Number and % of LAC registered with a GP/dentist near to the address of the placement;
  • No and % of LAC who have attended a dentist on an annual basis;
  • No and % of LAC with outstanding immunisations identified;
  • No and % of LAC referred to specialist services following assessment;
  • No and % of LAC referrals actioned and completed within 3 months;
  • No and % of LAC who had Health Plans agreed by the time of first review;
  • No and % of LAC receiving initial health assessment within 28 days of being notified by social services that the child is in care;
  • No and % of LAC receiving annual reviews within an interval no more than 13 months from the previous review;
  • No and % of LAC receiving sensitive health promotion information.

The School Nursing Service will:

  • Ensure every school age child, including those who are formally excluded from school, has a named School Nurse;
  • Advise the Carer that each Looked After child should be registered with a GP and Dentist;
  • Conduct Review Health Assessments and complete Health Care-plans in respect of Looked After children, copies of which will be sent to Halliwell Admin who will send a copy to the child’s Social worker and their GP;
  • Provide health promotion, support and advice, as required, to Carers and Looked After children, focusing particularly on sexual health, mental health and substance use;
  • Support the Social Worker in the completion of health information in the LAC system;
  • Attend statutory reviews in respect of Looked After children;
  • Support Looked After children in schools with specific health needs;
  • Ensure immunisations are up-to-date.

Health Visitors will (for Children below the Age of School Entry):

  • Ensure that the agreed Child Health Promotion Programme is carried out as per local protocols - the contact should be a face-to-face contact with both the Looked After child and their carer/s.

    Special consideration should be given to:
    • Speech and language;
    • Gross and fine motor function;
    • Vision and hearing;
    • Play and pre-literacy skills;
    • Social and self help skills.
  • Advise carers that all Looked After children should be registered with a GP and dentist;
  • Attend statutory reviews in respect of Looked After children;
  • Conduct Review Health Needs Assessments in respect of Looked After children as deemed appropriate by the Designated Doctor. This will include a holistic assessment of the child’s health care needs and will incorporate relevant health promotion topics, e.g.:
    • Attachment behaviour;
    • Physical health;
    • Growth;
    • Diet;
    • Immunisations;
    • Play and early learning;
    • Safety;
    • Oral and dental health.

A Health Plan will be completed which will identify areas of need, plan of action and eventual outcome. A copy of the plan will be forwarded to the designated doctor for inclusion into the child’s GP medical record and social services care plan. The original copy will remain within the child’s health visiting record.

Community Children's Nursing Service will:

  • Ensure that specialist community nursing services will be provided, as needed, for Looked After children.

The Child and Adolescent Mental Health Service (CAMHS) will:

  • Consider all referrals for Looked After children at their weekly allocations meeting;
  • Where appropriate, offer Looked After children direct services to meet their needs;
  • If a direct service is not deemed appropriate, CAMHS will offer the referrer a consultation to consider the mental health needs of the child and how these might best be met;
  • Attend statutory reviews, as appropriate, and provide written reports when this is not possible.

The CAMHS-LAC Service will:

  • Liaise with CAMHS and Children’s Services to develop procedures to limit duplication and ensure effective interagency working regarding the mental health needs of Looked After children;
  • Provide an additional resource to meet the demand for direct work and consultation;
  • Offer joint training with Social Services to staff and carers on the mental health needs of Looked After children;
  • Evaluate the effectiveness of training and consultation;
  • Develop further projects in consultation with the steering group;
  • Will regularly report to the steering group and to the ‘Towards a Brighter Future’ group.


4. Roles and Responsibilities of Bolton Children's Services

The District Worker will:

  • Complete all of the necessary sections relating to health needs in the Looking After Children documentation, including details of immunisations, forthcoming appointments, treatment, medication and family history of illness. As prescribed by Looking After Children guidance, this should be completed prior to the first Annual Health Assessment; if this is not done, then the social worker must attend the initial medical and provide background information to the medical examiner;
  • Actively engage the Looked After child in discussions about health and health promotion issues and, where appropriate, provide information to assist the Looked After child;
  • Ensure their relevant administrative office informs all appropriate health professionals when a child becomes Looked After;
  • Attend LAC reviews and provide written updated health care information, attaching the Health Plan to LAC information;
  • Proactively ensure that the Looked After child is enabled to attend all necessary health and dental appointments;
  • Act as the co-ordinator to ensure that the health needs of the Looked After child are appropriately addressed (consulting with the appropriate health professional where necessary);
  • Ensure that health professionals involved have all the necessary information relating to the background and circumstances of the Looked After child;
  • Request the ‘red book’ (personal child health record) from the parent and provide this to the Carer. For older children ensure access to health fax;
  • Inform the Carer of any health issues, either initial or ongoing, for the Looked After child or their family, e.g. via the Health Plan;
  • Keep parents fully informed of any health issues and, wherever possible, involve parents in appointments or treatment for the Looked After child;
  • Obtain the appropriate consent for any medical treatment from the birth parent, wherever this is possible (cross reference to consent);
  • Inform all appropriate health professionals when a Looked After child moves placement or ceases to be Looked After;
  • Keep self up-to-date on relevant issues important to the needs of Looked After children.

The Foster Carer will:

  • Ensure that the Looked After child is registered with a local GP and Dentist;
  • Keep an accurate and dated record of all health issues and treatment relating to the Looked After child and ensure this record. along with any health concerns the carer may have in respect of the child. are presented at statutory reviews;
  • Proactively ensure the child or young person is enabled to attend health appointments and clinics, to attend with the child or young person unless agreed unnecessary and provide the health professional with any relevant information in respect of physical and emotional well-being, including behaviour;
  • Keep the Social Worker informed of any health and dental issues relating to the Looked After child;
  • Involve children and young people in discussions and decisions regarding their health care in accordance with their age, understanding and in consultation with the child’s social worker, including issues around eating, hygiene, alcohol, drugs and sexual health;
  • Promote healthy living home environments and health awareness for all children and young people being Looked After and encourage the child in age- appropriate personal responsibility for own health and hygiene;
  • Encourage children and young people to participate in leisure activities, hobbies and sport. These should be tailored to the needs of the individual, including those with special needs, seeking the advice and support of their supervising social worker where necessary;
  • Provide nutritionally balanced meals with young people being encouraged to eat a varied and healthy diet. They should be encouraged to participate in the planning, purchase and preparation of food to gain an understanding and appreciation of healthy eating;
  • Participate in the development of Health Plans for children and young people, monitoring and initiating any required action Encouraging and supporting contact and communication with the child or young person’s family, appropriately, as agreed in Care Plans;
  • Keep self up-to-date on relevant issues important to the needs of Looked After children, e.g. through active participation in knowledge and skill development opportunities, supervision, training, etc.

The Residential Social Worker will:

  • Ensure that the Looked After child is registered with a local GP and Dentist;
  • Keep an accurate and dated record of all health issues and treatment relating to the Looked After child;
  • Proactively ensure the child or young person is enabled to attend health appointments and clinics, to attend with the child or young person, unless agreed unnecessary, and to provide the health professional with any relevant information in respect of physical and emotional well-being including behaviour;
  • Keep the Social Worker informed of any health and dental issues relating to the Looked After child;
  • Involve children and young people in discussions and decisions regarding their health care in accordance with their age and understanding, including issues around eating, hygiene, alcohol, drugs and sexual health;
  • Promote healthy living home environments and health awareness for all children and young people being Looked After and encourage the child in age- appropriate personal responsibility for own health and hygiene;
  • Encourage children and young people to participate in leisure activities, hobbies and sport. These should be tailored to the needs of the individual, including those with special needs;
  • Provide nutritionally balanced meals with young people being encouraged to eat a varied and healthy diet. They should be encouraged to participate in the planning, purchase and preparation of food to gain an understanding and appreciation of healthy eating;
  • Attend statutory reviews in respect of the Looked After child and provide a written update re any health issues and appointments, highlighting any concerns;
  • Participate in the development of Health Plans for children and young people, monitoring and initiating any required action;
  • Encourage and support contact and communication with the child or young person’s family, as agreed in Care Plans;
  • Keep self up-to-date on relevant issues important to the needs of Looked After children, e.g. through active participation in knowledge and skill development opportunities, supervision, training, etc.

The Supervising Social Worker (Fostering or Adoption Team) will:

  • Ensure that the foster carer has received all necessary Looking After Children documentation from the placing social worker, that all of the necessary sections relating to health needs in the Looking After Children documentation, including details of immunisations, forthcoming appointments, treatment, medication and family history of illness are fully completed and that consent for the child to receive medical treatment is appropriately obtained;
  • Ensure that the foster carer has received a written Health Plan and that they understand how to use, maintain and share it appropriately with the child;
  • Ensure that all foster carers are properly trained in health care, first aid, hygiene issues, communicable diseases and health promotion matters;
  • Support the foster carer in developing the skills and knowledge to actively engage the Looked After child in discussions about health issues and, where appropriate, provide information to assist the Looked After child and, if necessary, advocate on behalf of the child;
  • To support the foster carer in proactively ensuring that the Looked After child is enabled to attend all necessary health and dental appointments;
  • Keep self up-to-date on relevant issues important to the needs of Looked After children;
  • Provide information about health services local to a placement when proposing a placement for a child, to ensure that any specialist health services for a child do not break down due to placement;
  • Help the foster care to secure appropriate health services for the child, where necessary.

The Independent Reviewing Officer will:

  • Remain independent and within the Looked After Child Review process, seek the views of the Looked After child or young person about their own health needs. The views should preferably come directly from the child or young person, using the views booklet as a tool, or be represented via an advocate;
  • If a Looked After young person has chosen to opt out of the statutory medical or health assessment process, then guidance should be offered and they should be signposted to alternative advice and support in relation to their general health and welfare;
  • Monitor the effectiveness of Health Plans for children and young people who are Looked After;
  • If the health needs of a Looked After child or young person are not being appropriately met, the reviewing officer will address this through the Looked After Child reviewing system and ensure that the relevant professionals are aware of the issues;
  • Promote the health and welfare of the Looked After young person by ensuring that they are provided with a Health fax and enough information to guide them and support them in making informed choices and taking responsibility for their own health needs in the future;
  • Provide statistical information about the health and health assessments of Looked After young people and children.

360 (Young Persons Substance Misuse Team)

The National Updated Drug Strategy 2002 places a strong emphasis on all professionals and carers involved with young people to work together to “prevent today’s young people from becoming tomorrow’s problematic drug users” and to reduce the harm caused to individuals their families and communities (Home Office 2002).

Project 360º is an integrated multi agency team of substance misuse workers providing holistic assessment and treatment services targeted at the more serious and complex end of substance misuse amongst young people less than 19 years.

The team includes:

  • Nurse;
  • Substance misuse workers;
  • Family support workers;
  • Emotional Health Practitioner.

Services available for Looked After Young People and their carers include:

  • Holistic assessment;
  • Full assessment of health needs and appropriate treatment;
  • Sexual health and contraceptive services;
  • Counselling;
  • Substitute prescribing;
  • Community detoxification;
  • Harm reduction;
  • Referral for inpatient detoxification;
  • Relapse prevention;
  • Family support;
  • Consultation and advice for professionals and carers;
  • Training for professionals and carers.

Taking Care with Drugs: Responding to substance misuse among Looked After children provides agencies and carers with detailed guidance on, policy development, consent and confidentiality, assessment, interventions, and managing premises and incidents (Drugscope 2002).

The Parallel (Bolton's Young Peoples Health Centre) can:

Assist Looked After or young people leaving care aged 11-20 (20 to 25 yrs if special needs) to access GP’s and other health services based at The Parallel, ensuring that information can be shared with the young persons own GP, with the young person’s consent.

Bolton Children’s Services Department will:

Assist in young persons health programme by:

  • Providing free swimming passes to all Looked After children which will also allow carers or other significant adults to accompany them to local facilities;
  • By engaging with social care staff, help to assess and promote the individual leisure requirements of Looked After children and care leavers allowing free access to leisure facilities where possible;
  • Where appropriate, provide work experience placements for the LASE scheme which seeks to allow Care Leavers an extended work placement within local authority workplaces.

Issues of Consent

The following information should be read with recognition of Children Act (1989) and subsequent legislation and guidance, which places duties on all social care staff to recognise the potential for harm to the child or young person caused by significant ‘drift and delay’ in decision making. If in doubt seek legal advice.

Informed consent must be sought for any health assessment, examination or treatment after careful explanation has been given to the young person, parent or adult with Parental Responsibility (explanations given to children and young people should be age-appropriate.) Young people aged 16 and 17 years are presumed to have the competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can also give consent (although ideally parents will be involved - or those with Parental Responsibility).

Parental Responsibility

For children who are accommodated on a voluntary basis, Parental Responsibility remains with the birth mother or both parents if married. An unmarried birth father only has Parental Responsibility if this has been obtained legally.

For children who are the subject of Care Orders or Interim Care Orders, this Parental Responsibility is shared with the local authority. Parental consent should always be sought in the first instance as far as this is reasonably possible, although the local authority is able to give consent in the best interests of the child, if this is being unreasonably withheld by the parent. Shortage of time is not, in itself, sufficient justification for not attempting to seek parental consent.

Foster Carers, and residential social workers who provide day-to-day care for children and young people, are unlikely to hold Parental Responsibility. It is possible for those with Parental Responsibility to give authority to someone who cares for a child on a regular basis to give consent under defined circumstances, such as emergency treatment or routine treatments, but this needs to be clearly stated in the Health Plan and Placement Information Record.

Consent to Health Treatment

In the Placement Agreement, parental agreement is sought for routine dental and medical assessment. This covers routine child health surveillance, immunisations and emergency treatment if parents cannot be contacted and immediate treatment is in the child’s best interests. It is essential that sufficient information is given, for example, information on the benefits and risks of proposed treatments and alternative treatments, and that this information is given in a manner that can be understood.

It must be clarified at the outset whether there are particular treatments, e.g. certain immunisations to which the parents would object, and these should be explicitly identified in the Health Plan and placement information record.

In the event of an emergency, if parental consent cannot be obtained, consent should be sought from the appropriate Principal Manager in consultation with the medical practitioner with clinical responsibility for the child.

Specific consent should be sought for all planned procedures involving an operation, general anaesthetic, or medical investigations in consultation with the medical practitioner with clinical responsibility for the child.

When the Looked After child is subject to an Interim Care Order, for anything other than routine medical treatment, the permission of the court may need to be sought. If in doubt, legal advice should be taken.

Children aged 16 and 17

Once young people reach 16 years they are presumed in law to be competent to give consent for themselves for their own medical, surgical or dental treatment and any associated procedures.

Children 15 Years and under

Children under 16 are not automatically presumed to be legally competent to make decisions about their healthcare. However, the courts have stated that under 16’s will be competent to give valid consent to particular interventions if they have sufficient understanding and intelligence to enable them to understand fully what is proposed (sometimes known as Gillick Competence). In other words, there is no specific age when a child becomes competent to consent to treatment: it depends on the child and the seriousness and complexity of the treatment being proposed.

If a child under 16 is competent to consent for themselves to a particular intervention, it is still good practice to involve the family in decision making unless the child specifically requests that this should not happen and cannot be persuaded otherwise.

Where a competent child does ask for their confidence to be kept, it must be respected, unless disclosure can be justified on the grounds of ‘public interest’, e.g. that there is reasonable cause to suspect that the child is suffering or likely to suffer significant harm.

If a competent child consents to treatment, a parent cannot over-ride that consent.

Refusal of Consent by the Looked After Child

In the event of a Looked After child refusing a non-urgent health assessment or examination, attempts should be made by the Social Worker, health professional or carer to counsel them about the importance of healthy lifestyle choices. If the child is agreeable, the health professional may still carry out some parts of the assessment such as health promotion and education. There should always be flexibility in approach which would allow the Looked After child or young person to see another health professional if this would enable their health needs to be addressed.

If a competent child refuses treatment, then legally a parent can consent if it is in the best interests of the child. This rule applies until the child reaches the age of 18 years.

Confidentiality

“All health issues are discussed in reviews in front of everyone attending, and therefore I have met many young people who will try to hide their health problems rather than let a carer know that something is wrong and risk it being talked about in front of other people attending their reviews”.

“I certainly couldn’t think of anything worse than having my carer and social worker discuss whether or not I was still wetting the bed at fourteen whilst in the presence of virtual strangers and my form tutor.” 

Promoting the Health of Looked After Children (DoH 2003).

Research and experience have shown repeatedly that keeping children safe from harm requires professionals and others to share information: about a child’s health and development and exposure to possible harm; about a parent who may need help to, or may not be able to, care for a child adequately and safely; and about those who may pose a risk of harm to a child. Often, it is only when information from a number of sources has been shared and is then put together that it becomes clear that a child is at risk of or is suffering harm.

In order to plan effectively and meet the needs of Looked After children, it will be necessary to share confidential information between carers, educationalists, health professionals and social care staff. All those providing service to a Looked After child should be aware that the approach to confidential information should be the same, whether it is within your own organisation or an external agency or individual.

The general principle of confidentiality is that ‘in general - and in all walks of life - any personal information given or received in confidence for one purpose may not be used for a different purpose or passed to anyone else without the consent of the provider of the information. The ‘duty of confidence’ is long established in common law, but with proper safeguards, need not be construed so rigidly that, when applied to the NHS or related services, there is a risk of it operating to a patient’s disadvantage or to that of the public generally.’

The sharing of this information should by guided by a balanced view based on certain good practice principles. Clearly the need to know should be measured against the rights of the child. The principles of the Data Protection Act and the Caldicott protocols help provide this balance. See Appendix 1: Caldicott.

Both carers and health and social care professionals have a general duty to protect confidentiality.

Some guidelines on the ‘need to know’ principle:

  • Check why the information is needed. What is the purpose of the disclosure?
  • Check that the child/young person/parent has been informed that the information is being sought;
  • Consider both the amount and nature of information being sought and if disclosure is appropriate in protecting the welfare of the child;
  • To whom is the disclosure being made and is the recipient under a duty to treat the material as confidential?
  • Seek advice from the Designated Paediatrician or medical practitioner with clinical responsibility for the young person, Specialist Health advisor for Looked After Children or the Senior Child Protection manager. Further advice could come from Caldicott Guardians;
  • Record what has been shared and with whom.

All confidential issues should only be shared on a need to know basis. All written health information on a child or young person should only be shared with the consent of the author of the originating report.

Hepatitis and HIV information should be shared as per the local guidance notes: Guidance notes for the investigation and management of children who may be at risk of blood borne viruses. (Bolton PCT October 2003.)

Out of Area Placements

Where an Out of Authority placement is sought, the responsible authority 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 placing authority should seek guidance from within its own partner agencies and the potential placement area to seek such information out.

The originating CCG, the current CCG (if different) and the proposed area's CCG should be fully advised of any placement changes and to ensure that any health needs or heath plan are not disrupted through delay as a result of the move.

Where these are Placements at a Distance the Care Planning, Placement and Case Review (England) Regulations 2010 make it a requirement that the responsible authority consults with the area of placement and that Director of the responsible authority must approve the placement.

Where the child's health situation is more complex, it is likely that both Health and 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 Social Care services in the area where the child is placed.

Further reference on Consent and Confidentiality:


Appendix 1: Caldicott

What is Caldicott?

A review commissioned by the Chief Medical Officer to investigate ways in which patient information is used in the NHS.

The Caldicott committee made a number of recommendations aimed at improving the way the NHS handles and protects patient information.

These are summarised by:

  • Six Information Management Principles.

The Six Caldicott Principles:

  1. Justify the purpose(s) of using confidential information;
  2. Only use it when absolutely necessary;
  3. Use the minimum that is required;
  4. Access should be on a strict need-to-know basis;
  5. Everyone must understand his or her responsibilities;
  6. Understand and comply with the law.

What is the Data Protection Act 1998?

The Data Protection Act 1998 became law in March 2000. It sets standards which must be satisfied when obtaining, recording, holding, using or disposing of personal data.

These are summarised by 8 Data Protection Principles.

As well as information held on computers, the Data Protection Act 1998 also covers most manual records, e.g.

  • Health; 
  • Personnel;
  • Occupational Health;
  • Volunteers;
  • Finance;
  • Supplier;
  • Contractors;
  • Card Indices.

The Data Protection Principles

Personal data must be:

  1. Processed Fairly and Lawfully
  2. Processed for Specified Purposes
  3. Adequate, Relevant and not Excessive
  4. Accurate and Kept Up-to-date
  5. Not Kept for Longer than Necessary
  6. Processed in Accordance with the Rights of Data Subjects
  7. Protected by Appropriate Security (Practical and Organisational)
  8. Not Transferred Outside the EEA without Adequate Protection

Principle 1

Processed Fairly and Lawfully

There should be no surprises, so inform data subjects why you are collecting their information, what you are going to do with it and who you may share it with:

E.g. when formulating a research project remember to be open and transparent about what you will be doing with the information.

E.g. when working in a team, ensure that the patient/client is aware of whom the members of the team are, and that all those involved with their care may need to see their notes.

  • Be open, honest and clear.

Principle 2

Processed for Specified Purposes

Only use personal information for the purpose(s) for which it was obtained.

E.g. personal information on a Patient Administration System must only be used for healthcare purposes - not for looking up friends’ addresses or birthdays.

  • Only share information outside your practice, team, home, ward, department or service if you are certain it is appropriate and necessary to do so.
  • If in doubt, check first!

Principle 3

Adequate, Relevant and not Excessive

Only collect and keep the information you require. It is not acceptable to hold information unless you have a view as to how it will be used. Do not collect information “just in case it might be useful one day!”

E.g. taking both daytime and evening telephone numbers if you know you will only call in the day.

  • Explain all abbreviations;
  • Use clear legible writing;
  • Stick to the facts - avoid personal opinions and comments.

Principle 4

Accurate and Kept Up-to-date

Take care inputting information to ensure accuracy. How do you know the information is up-to-date? What mechanisms do you have for checking the information is accurate and up-to-date?

E.g. each time a patient attends a clinic, they should be asked to confirm that their details are correct - address, telephone number, etc.

  • Check existing records thoroughly before creating new records;
  • Avoid creating duplicate records.

Principle 5

Not Kept for Longer than Necessary

  • Follow retention guidelines:
    • For the Record (HSC 1999/053);
    • GP Records (HSC 1998/217).
  • Check your organisation’s retention policy;
  • Ensure regular housekeeping/spring cleaning of your information;
  • Do not keep “just in case it might be useful one day”;
  • Check your organisation’s disposal policy;
  • Dispose of your information correctly.

Principle 6

Processed in Accordance with the Rights of Data Subjects

  • Subject access;
  • Prevention of processing;
  • Prevent processing for direct marketing (an end to junk mail and faxes!);
  • Automated decision taking;
  • Compensation;
  • Rectification/blocking/erasure;
  • Request an assessment.

Principle 7 (Practical)

Protected by Appropriate Security (Practical and Organisational)

  • Ensure security of confidential faxes by using Safe Haven/Secure faxes;
  • Always keep confidential papers locked away;
  • Do you have a clear desk policy?
  • Ensure confidential conversations cannot be overheard;
  • Keep your password secret;
  • Ensure information is transported securely.

Principle 7 (Organisational)

Protected by Appropriate Security

Your organisation should have …

  • Good information management practices;
  • Guidelines on IT security;
  • Staff training;
  • Confidentiality clause in employment contracts;
  • Procedure for access to personal data;
  • A disposal policy/procedure for confidential information;
  • Confidentiality contracts with third parties.

    E.g. archiving companies, cleaners, temporary staff, outside contractors.

Principle 8

Not Transferred Outside the EEA without Adequate Protection

  • If sending personal information outside the EEA ensure consent is obtained and it is adequately protected
  • Be careful about putting personal information on website's - gain consent first.
  • Check where your information is going

    E.g. where are your suppliers based?

The EEA comprises: United Kingdom, France, Belgium, Germany, Denmark, Ireland, Netherlands, Sweden, Portugal, Spain, Finland, Luxembourg, Italy, Austria, Greece, Norway, Iceland, Liechtenstein.

To sum up, remember that information must be:

  1. Held securely and confidentially;
  2. Obtained fairly and efficiently;
  3. Recorded accurately and reliably;
  4. Used effectively and ethnically;
  5. Shared appropriately and lawfully.

End