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Primary Care Trusts (PCTs)

5.2 Under the Children Act 1989 health authorities and NHS Trusts have had a duty to comply with requests from the local council to help them provide support and services to children in need. This duty has now passed to Strategic Health Authorities and PCTs.

5.3 It is vital that PCTs participate in inter-agency children's services planning through contributing to the local strategic plan.. The PCT should ensure that the health and wellbeing of looked after children and young people is identified as a local priority and that structures are in place to plan, manage and monitor the delivery of health care services to these children.

5.4 As commissioners of health services for looked after children/young people and other children in need, Chief Executives of PCTs should:

The Responsible Commissioner

5.5 When a child is placed away from the home CSSR, the home CSSR keeps responsibility for the child i.e. remains the responsible authority. However, within the NHS, when a child moves from the area served by one PCT to another, the new PCT will assume responsibility for meeting the child's health needs. When such placements occur the designated doctor from the PCT covering the responsible authority and the designated doctor from the new PCT should communicate, both to ensure relevant health assessments are carried out and to provide health data to the responsible authority who will be undertaking regular reviews.

5.6 There should be no gaps in responsibility. No treatment should be refused or delayed due to uncertainty or ambiguity as to which PCT is responsible for funding a child or young person's health care provision.

5.7 When a child is first placed he/she may initially be registered as a temporary resident. Unless the placement has been made under an agreed series of short term placements (e.g. for respite care), the child should, as soon as possible, be fully registered with a GP within the PCT area in which she/ he is now living. Clinical records held by the previous GP should be "fast tracked" to the new GP. It is the responsibility of the responsible authority i.e. the placing CSSR to ensure a full health assessment takes place and that a health plan is drawn up and implementation initiated at the start of a care episode. It is recommended that the responsible authority's designated doctor undertakes this function on their behalf. This may well involve discussions with services local to the placement and can include delegating components of the assessment to a local doctor.

5.8 The first health plan should make it clear who will be clinically responsible for reviewing the plan and for follow up assessments. It is recommended that the designated doctor for the placing authority retains a monitoring function to ensure the child's health needs are being met.

5.9 The child should have access to local services including specialist services as soon as he/she moves. However there will be times when it is clinically more appropriate for the child, at least initially, to continue to attend specialist services where they are already known. This will need to be decided on a case by case basis.

5.10 When a child is known to have complex medical, dental, developmental or emotional or mental health needs the availability of suitable local services should be considered before placement.

5.11 Before a child moves arrangements should be made (in discussion with the new PCT and any specialist services needed) which ensure that any existing health care plan continues to be implemented. A new assessment should not usually be necessary. This principle should apply for moves between care placements and when a child returns home.

5.12 Where a looked after child attends boarding or special school the rules set out in the Establishing Responsible Commissioner guidance (paragraphs 45 - 47) will apply.

Primary Care Teams

5.13 Primary care teams have an important role to play and should work closely with the designated professionals, acting as advocates for the health of each child. They will often have prior knowledge of the child or young person and may be particularly well placed to undertake this role.

5.14 Primary care teams should ensure timely access to a GP or other health professional when a looked after child requires a consultation. This may include referrals to specialist services taking account of the particular needs and circumstances of looked after children.

5.15 Primary care teams should provide, when needed, timely summaries of the health history of a looked after child or young person and ensure that this is passed promptly to health professionals undertaking health assessments.

5.16 It is also the role of primary care teams to maintain a record of the health assessment and contribute to any action in the health plan. It is particularly important that they ensure that records flag up the "looked after" status of the child, so that his/her particular needs can be acknowledged.

The designated professionals

5.17 The broad role of the designated doctor and nurse is to assist PCTs in fulfilling their responsibilities as commissioners of services to improve the health of looked after children. They will advise the PCT 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.

5.18 The designated doctor will:

5.19 The designated nurse will:

5.20 The designated doctor and nurse should maintain regular contact with local health staff undertaking health assessments. They will also liaise with social services departments and other PCTs over health assessments and health plans for out-of-authority placements.

5.21 The designated doctor should also produce an annual report, evaluating the delivery of health services for looked after children and young people.

5.22 The designated doctor and nurse should also ensure that all relevant staff are appropriately trained. This will include responsibility for planning local training for GPs, paediatricians and nurses undertaking health assessments for looked after children.

Planning across health and social care

Contraception and sexual health services

5.24 Looked after children and care leavers are at a particular risk of teenage pregnancy and drug misuse, and at a younger age than their peers. Service planning and delivery of local teenage pregnancy and drugs strategies will therefore take account of the needs of this particularly vulnerable population. Attention should be paid to the needs of boys and young men and young people from black and minority ethnic groups who may experience particular difficulty in accessing services.

5.25 Social work staff and carers have a key role to play in providing information and support to looked after children and young people on these issues. It is their role, and professional duty, to ensure that looked after children and young people (including under 16s) and care leavers are encouraged to seek contraceptive and sexual health advice if it appears that they are - or are likely to be sexually active. Further information can be obtained from the local teenage pregnancy co-ordinator or through the teenage pregnancy strategy:

Young people's drug services

5.26 Looked after children may be less likely to access drug education and support at school and it is crucial that other opportunities are available for them to receive the information and support that they need. Residential staff and foster carers have an important role in providing support that complements drug education provision in schools and ensuring that looked after children are aware of local services and how to access them.

5.27 The Department of Health has funded DrugScope to produce policy guidance for local councils 'Taking Care with Drugs: responding to substance use among looked after children' (DrugSCope, 2002) aims to assist elected members, managers, practitioners and parents/carers to develop and implement local policy and good practice. The Drug Education Forum (DEF) and the National Children's Bureau (NCB) have also been funded by the Department of Health to produce practice guidance for residential care workers and foster carers.