Health and Wellbeing, Health Notifications and Access to Services
Regulations and Standards
Related guidance
The registered manager must ensure that each child’s day-to-day health and well-being needs are met; that children receive advice, services and support in relation to their health and well-being; and that children are helped to lead healthy lifestyles.
Staff should work to make the Home an environment that supports children’s physical, mental and emotional health, in line with the approach set out in the Home's Statement of Purpose.
Staff must help each child to:
- Achieve the health and well-being outcomes that are recorded in the child's relevant plans (see also Health Care Assessments and Plans Procedure);
- Understand the child's health and well-being needs and the options that are available in relation to the child’s health and well-being, in a way that is appropriate to the child's age and understanding;
- Take part in activities, and attend any appointments, for the purpose of meeting the child's health and well-being needs; and
- Understand and develop skills to promote the child's well-being.
‘Wellbeing’ means the quality of a child's life. This is multi-dimensional and includes dimensions of physical, emotional and social well-being; both for the immediate and future life of the child. It incorporates subjective measures such as happiness, perception of quality of life and life satisfaction as well as objective measures around supportive personal relationships, education and training resources and health status.
DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children provides information about the statutory obligations and duties of local authorities and Health bodies to support and promote the health of looked-after children.
The responsible local authority (the local authority that looks after the child) must make sure that its looked after children are provided with appropriate healthcare services. The health of looked after children must be assessed at regular intervals and the child's Care Plan must include an individual health plan setting out the approach that the placing authority will follow, and the desired outcomes required to meet the child's health needs. See Health Care Assessments and Plans Procedure.
For children with special educational needs and disabilities, staff must establish whether the child has an EHC plan. If the child does, staff must take account of the health objectives it specifies.
The specific responsibilities of the Home towards supporting the health and well-being of each child should be agreed with the placing authority and recorded in the child's Placement Plan. It is the joint responsibility of the registered manager of the Home and the placing authority that this is agreed at the time of placement.
Staff should have sufficient understanding of relevant health services, including the functions of the designated nurse for looked-after children in their area. They should support children to navigate these services, advocating on their behalf where necessary and appropriate. The Home's manager must ensure the Home has good links with health agencies to promote children’s good health, is well informed about local health services such as CYPMHS and sexual health services in the area it covers and takes this into account when deciding on admissions.
Staff should encourage children to take a proactive role in looking after their day-to-day health and wellbeing. Where children have specific health needs or conditions, they should be supported to manage these subject to their age and understanding. When a child needs additional health or wellbeing support, staff should work with the child's placing authority to enable proper and immediate access to any specialist medical, psychological or psychiatric support required, and challenge them if this doesn't happen. Homes have a key role in organising and ensuring each child's attendance at the necessary primary and secondary health services. Most health services that a child needs to access will be provided by other organisations. If these services are not accessible, or are withdrawn, staff should inform and engage with those who also hold a responsibility for the child's health to ensure their health needs are met.
The registered manager must ensure that staff have the relevant skills and knowledge to be able to:
- Respond to the health needs of children;
- Administer basic first aid and minor illness treatment;
- Help children to manage long-term conditions and where necessary meet specific individual health needs arising from a disability, chronic condition or other complex needs.
Where appropriate, the child's family should be involved in supporting their child's health needs as well as in providing permission for treatment.
In line with their individual health plans and the ethos of the Home, children must be offered advice, support and guidance on health and wellbeing to enhance and supplement that provided by their school through Personal, Social and Health Education (PSHE). Staff should have the relevant skills and knowledge to be able to help children understand, and where necessary work to change negative behaviours in key areas of health and well-being such as, but not limited to, nutrition and healthy diet, exercise, mental health, sexual relationships, sexual health, contraception and use of legal highs, drugs, alcohol and tobacco.
See also procedures on Drugs and Substance Misuse and Smoking and Alcohol.
When a child is placed in the Home, the social worker must arrange for the Health Authority, in the area where a child is placed, to be notified of the placement.
The manager of the Home should arrange for the following:
- For the child to be allocated with a Link Worker (Keyworker) who will be responsible for promoting their health and educational achievement, liaising with key professionals, including the Clinical Nurse Specialist, the child's GP and dental practitioner. The Link/Keyworker will also be responsible for ensuring that up to date information is kept on the child in relation to their health needs, development, illnesses, operations, immunisations, allergies, medications, administered, dates of appointments with GP's and specialists (see Keyworker Guidance);
- For the child to be registered with a GP; (All young people residing at the Home for a period longer than four weeks will be registered with a General Medical Practitioner (GP) or medical practice convenient to the Home. Each young person will be consulted regarding the GP Practice, and the gender of their nominated Doctor, although individual allocations may be subject to the policy of the GP’s Practice;
- For the child to be registered with a Dentist;
- For the child to be registered with an Optician;
- For a Health Care Assessment to be carried out in relation to the child as set out in Health Care Assessments and Plans Procedure;
The Home will aim to register the young person within 5 working days of admission to the Home with required health practitioners– unless further information is required from Qualified Social Worker or their carers).
Details of the registration or any changes must be recorded, by the social worker, in the Placement Information Record, a copy of which must be forwarded to the Home by the social worker, at the latest, within 14 days of the placement.
Additionally, the child's Medical Record should be updated.
Each child must have access to the dental, medical, nursing, psychiatric and psychological advice, treatment and other services they require.
Children’s health needs must be identified (including their mental and sexual health needs, as appropriate), and they must have access to local health services when they need them.
If a child's needs are such that specialist health care is required e.g. children with a disability or visual impairment, the Home's manager must ensure that local specialist services are secured, in conjunction with the social worker and relevant healthcare professionals from the Placing Authority. The Home's manager should keep the General Medical Practitioner informed of the process of care and any suggested changed to the child's care.
If there are any serious concerns about the emotional or mental health of a child, the Home's manager must alert the social worker, and seek a review of the child's placement and/or request an assessment under the Mental Health Act 1983.
Any strategies/services that are provided, must be outlined in the child's Placement Plan/Health Care Plan.
If children appear to require or request it, appointments should be made for them to see their GP or other medical practitioners as appropriate. All appointment must be recorded on Charms and where possible the outcome of the appointment.
When appointments are made, account should be taken of the child's wishes, for example, to see a practitioner of a preferred gender identity. Also, appointments should preferably be made which do not disrupt the child's education.
Parents, those with parental responsibility and the child's social worker should, if possible, be consulted before making appointments; and they should be informed of the outcome.
See: Consents and Delegated Authority Procedure.
As appropriate, the Chronology/Referral and Information Record should be updated to take account of these appointments. Care should be taken to ensure that the top copy, held by the social worker, and the copy held in the Home are updated.
If the young person enters the home with a treatment regime already in progress, then the home will enter the details into the young person’s Placement, Care and Pathway Plan and monitor progress on a regular basis. Where progress appears unsatisfactory, or if the young person complains of any other ailment/illness or condition for which medical treatment should be sought, then a GP consultation will be arranged without delay.
Where a treatment regime is in progress which involves for example attendance at an outpatient clinic, then the home will make suitable and satisfactory arrangements for these to take place.
At times, young people may require unplanned or emergency treatment. This could be due to a small incident where the young person may need to attend a walk-in clinic as the incident has arisen outside of GP hours or a GP appointment is not available; immediate advice should be sought through 111 (NHS non-emergency number) when staff using their Parental role feel it is not in the young person’s best interest to wait for assessment or treatment.
There will also be times when due to an accident or incident young people need emergency treatment. It is paramount that staff are responsive to the level/speed of emergency treatment that is required. If the situation is life-threatening (or necessary) staff will call the emergency services 999.
Any incident of this nature will be reported to the on-call Manager immediately. The on-call Manager will report this as appropriate and support the Home in reporting to external agencies in a timely and prompt manor, taking into account the young person needs.
If a young person has an accident either in the Home or externally that does not require emergency attention but staff consider a medical assessment is necessary, it must be recorded and the on-call Manager informed of the incident and outcome.
All treatment refusals including planned treatments will be reported to the relevant representative of the placing authority and recorded on Charms.
Non-attendance of planned treatments:
If the young person refuses to engage in or share their intention not to attend or receive planned treatment this should be reported to and recorded by the Home Manager. If the young person refuses on a second occasion; the Home Manager will discuss this formally with the Regional Manager to review effective strategies to promote engagement:
- Contacting the placing Social Worker and where appropriate the young person’s family/Carer/s who may be able to engage with and encourage the young person to attend;
- Consider contacting the relevant health service delivering the planned treatment for advice and guidance, to seek support in enabling the young person to access the treatment required;
- Inform the LAC Nurse as there could be a delay in treatment if medical professionals agree the young person requires more time to process and understand the need for treatment.
Where young people flatly refuse treatment and miss a planned treatment appointment this must be escalated by the Home Manager where possible before the appointment is missed, or on the day of the missed appointment.
Home Managers must ensure a robust plan is put in place and shared with Regional Managers, and the placing Social worker.
A meeting of all parties must be held within 7 working days following a repeated refusal to attend a treatment appointment, with all parties agreeing a planned approach of action.
Refusal of Unplanned / Emergency Treatment (Hospital):
Young people can decide to refuse unplanned or emergency treatment, even though it is not in their best interest.
If emergency services have been called and the young person refuses treatment or to go to hospital, this will be recorded by the emergency service. It must also be reported to an on-call Manager at the time of refusal. On-call Managers will support and instruct the staff team in relation to the reporting of the refusal to the placing authority. This reporting must be agreed and undertaken as soon as possible. The on-call Regional Manager will be advised of the outcome.
Where a young person refuses any assessment, this must be recorded within the Home, and reported to the on-call Manager immediately. The Home must robustly monitor any pain medication given and report back to the on-call Manager if the request for pain management is excessive and or if the refusal continues for 8 hours.
The Home Manager must inform the placing Social Worker/ EDT on the day of refusal and if the young person continues to refuse treatment then a meeting with the placing Social Worker, Regional Manager and relevant family member/s or carer/s should be held within 24 hours. The Regional Manager must inform senior management that the meeting is taking place and what treatment has been refused.
If the young person continues to refuse treatment the concerns will be escalated within Homes2Inspire, and senior management will chair a meeting within 72hrs. This meeting will include the placing Social Worker, family and health professionals including the LAC Nurse, to review the situation and agree recording and escalation within their respective organisations.
The main objectives of the health assessments are to undertake an assessment of any health risks and an opportunity to redress past health neglect, collate health history including peri-natal history and to:
- Ascertain and advise on relevant family history;
- Review immunisation status and missed health screening episodes including dental and oral health;
- Assess current health and mental health concerns;
- Review and advise on known existing health problems;
- Identify any sexual health issues and sexual health awareness;
- Ascertain outstanding appointments;
- Identify mental health, behavioural and emotional needs;
- Recognise development or learning concerns;
- Plan appropriate action and ensure recommendations are carried through;
- Discuss lifestyle issues;
- Plan follow up appointments as required.
Where the assessment indicates that a health assessment has not been undertaken for at least six months, then the purpose and benefit of such a procedure will be discussed with the young person, and upon agreement, arrangements made with the GP and the placing social worker.
Subsequent health assessments will be arranged in accordance with a timeframe recommended by the GP.
The young person’s Placement, Care and Pathway Plan and Behaviour and Risk Management Plan will take into consideration:
- Medical history;
- Any specific medical or other health interventions which may be required;
- Any necessary preventative measures (self – administration medicines);
- Allergies or known adverse reactions to medication;
- Any dental health needs;
- Any optical needs;
- Records of development checks;
- Specific treatment therapies or remedial programmes needed in relation to physical, emotional, or mental health;
- Health monitoring required of staff;
- The involvement of the young person’s parents or significant others in health issues;
- Objectives individual to the child relating to health and well-being progress.
Information relating to health will be recorded within Charms in the child’s individual case file – there is specific sections of Charms for Health, these include ‘Notes’, ‘Personal Details’ and GP details. Where there is a high risk health need this will also be recorded as a ‘Warning’ so that this can be immediately accessed when reviewing the electronic record.
All children/young people will have a bespoke individualised ‘Safer handling plan’ that details the physical intervention holds that can be used on the child; these are reviewed alongside health assessments and following any use of physical intervention.
Education, Health and Care (EHC) plans, which were introduced in 2014, look at all the needs of a young person and consider how specific outcomes can be achieved. Where a young person’s special educational needs (SEN) cannot be met within a standard mainstream setting an EHC plan may be issued following assessment, which details what additional educational support is required. The Home will request information about any existing EHC plan on admission and will take full account of the details specified in the plan, working with relevant professionals to ensure that the young person is able to access all the support to which they are entitled, and making sure that all staff within the Home are fully aware of the specific needs of that young person. EHC plans are reviewed annually and the home will contribute to this process.
The Home will encourage all young people to participate in educational programmes designed to improve their general health and wellbeing delivered at both School and in the Home.
Such Programmes will cover:
- Immunisation and Screening;
- Nutrition and Diet; including promoting ‘5 a day’, banning energy drinks in the home (in line with legislation banning the sale to under 16’s)
- Exercise and Rest;
- Personal Hygiene;
- Sexual Health; Sexual Exploitation;
- The effects of alcohol, smoking and other substances;
- HIV and Aids, and other blood borne diseases;
- Protecting oneself against bullying and abuse both within and outside the home, including on-line and social platforms.
The Home/ Deputy Manager is responsible for governing how this policy is implemented into their homes and be able to evidence compliance for any internal or external audits.
Staff have free access to all policies, they are held on Charms.
Policies should be read in conjunction with the homes risk register.
Legislation, Statutory Guidance and Government Non-Statutory Guidance
DfE and DHSC Statutory Guidance on Promoting the Health and Well-being of Looked After Children
Last Updated: June 10, 2024
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