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1. Introduction

1.1 This document is a summary of the new comprehensive guidance Promoting the Health of Looked after Children. The new guidance sets out a framework for the delivery of services from health agencies and social services to more effectively promote the health and wellbeing of children and young people in the care system.

1.2 The summary sets out the new statutory requirements and explains the key actions, and new roles and responsibilities for Councils with Social Services Responsibilities (CSSRs), Strategic Health Authorities (StHAs) and Primary Care Trusts (PCTs).

1.3 Children looked after by local authorities have usually already been identified as children in need in the community and some will have been in need of protection. Many have profoundly increased health needs in comparison with children and young people from comparable socio-economic backgrounds. They may well have health needs arising from:

  • living in families affected by drugs, alcohol or domestic violence;
  • special needs or a disability;
  • coming from highly mobile families.

They may also have experienced poorer access to services including universal services such as dental services, immunisations, routine child health surveillance and health promotion because of language or cultural barriers.

Key changes

1.4 Councils must now put in place arrangements to ensure every looked after child has their health needs assessed on entering care and has a health plan setting out how the assessed needs will be met. Arrangements must also be in place for the health plan to be regularly reviewed.

1.5 Feedback from young people confirms that they find the current system unhelpful. A health care system based on annual "medicals" is seen as stigmatising and impersonal - and without recognisable outcomes for them.

1.6 This new guidance sets out a holistic model of health, including the contribution of a number of agencies. In addition to new good practice guidelines on health assessment, planning and review, new regulations - Children Act (Miscellaneous Amendment) (England) Regulations 2002 - also revise the existing legal framework, as follows:

  • a health assessment is to be undertaken as soon as practicable after a child starts to be looked after, once available health information has been collated;
  • the audit of a child's health at the health assessment is expanded and now includes physical and mental health, and health promotion;
  • the first health assessment will be undertaken by a suitably qualified medical practitioner, which may include a physical examination;
  • a written report of the health assessment and a health plan is to be prepared for each child;
  • the frequency of subsequent health reviews for children aged between 2 and 5 is increased to at least once in every six months. For children aged over 5 years the review should be at least once a year;
  • such health reviews may now be undertaken by whoever is deemed most appropriate. This might be a registered nurse or midwife under the supervision of a registered medical practitioner;
  • notifications are now required to both the PCT in the area from which the child is leaving and the PCT area to which the child is moving.
  • Whenever the child comes to professional attention the approach to health assessment should be holistic and include a comprehensive review of health needs including dental and oral health, hearing and sight.

1.7 The domains and dimensions of the Framework for the Assessment of Children in Need and their Families will, in future, be used for the assessment of all children in need and their families, including those living with their families, in need of protection, looked after, care leavers and children being placed for adoption. The Assessment Framework and the Looking After Children System have been brought together to create the Integrated Children's System which will provide a common framework for assessment, intervention, planning and review for all children in need. (Department of Health, 2002)

1.8 When this system is fully implemented all children in need, including those looked after, will have a core assessment which will provide key baseline information on the child's health needs and strengths from which to monitor future progress.

The legislative framework and policy context

1.9 The guidance reflects the principles of the UN Convention on the Rights of the Child and is particularly informed by the requirements of the Children Act 1989. The Children Act (Miscellaneous Amendment) (England) Regulations 2002 revise the legal framework within which the guidance operates.

1.10 To deliver the vision for excellent joined up public services to meet the individual needs of children, the Government is developing a National Service Framework (NSF) for children. This will provide a key context for improving the health of children by setting in place new national standards for service delivery.

1.11 The NHS Plan also includes a number of core principles that are pertinent to the provision of care for looked after children and young people. Primary Care Trusts (PCTs) are now the lead organisation for assessing need, planning and delivering all health services. Twenty eight Strategic Health Authorities will provide strategic leadership and manage the performance of PCTs.

1.12 Local plans in the NHS will focus on partnership working and engagement with stakeholders.

1.13 All authorities should now have in place a joint CAMHS strategy between health services and local Councils. This should make specific reference to timely and appropriate access to CAMHS for looked after children.

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