There has been no change to the intercollegiate document1 and legislation and statutory duties surrounding looked after children.
Plans must link to national guidance, eg Personal Protective Equipment (PPE) and social distancing.
Principles for the recovery of LAC services
While this document primarily relates to the system and processes across England, the principles below can be applied as appropriate across the other nations of the UK.
- As always children and young people should remain at the centre of decision making, with their best interests paramount. We acknowledge that the voice of the child or young person may have been missed in the COVID-19 contingency arrangements and opportunities for children to express their views with confidence need to be considered, eg face to face appointments. Many agencies are leading on consultations and supporting children and young people to ensure their voice is heard with consultations or research – CoramVoice, youth advocacy service and NSPCC, and we need to incorporate the ideas and views of children and young people in care.
- It may be helpful to consult with young people locally about their experiences of COVID-19, lockdown and of accessing health care (including virtual health assessments). Feedback can then be used to inform recovery planning and new ways of working.
When considering how to move forward, services should review lessons learnt and ways of working together across agencies. Innovation and development of the ‘new normal’ are important, eg incorporating new technologies and other service developments into business as usual working and allowing the flexibility to engage with young people who may have previously refused assessments.
We acknowledge there is likely to be an increase in safeguarding referrals/assessments and then also an increase in the number of children in care with Initial Health Assessments (IHA) and Review Health Assessments (RHA) (in six to 12 months’ time) required. Current decisions are about balancing service requirements and capacity against individual needs.
General standards for LAC services
The following general standards can be used to aid discussion and service planning:
- Statutory guidance2 advises that a holistic health assessment is undertaken when a child enters care. This is to ensure any missed health concerns and new issues can be diagnosed and assessed, as well as provides the opportunity to speak with children and young people.
- IHAs undertaken by telephone contact only during the pandemic should be completed with a physical examination, growth parameters and review; rarely this may be achieved by another professional, eg if signing to a new GP practice and initial assessment including growth parameters undertaken, or child protection medical undertaken within three months, or recent or planned outpatient attendance in paediatrics. This should be a clinical decision, any referrals deferred from consultations should be actioned and letters etc. sent. Any investigations not able to be completed during the time period, eg blood tests need to be given priority.
- RHAs undertaken by telephone contact only during the pandemic may not require face to face assessment and could be considered complete unless clinical issues identified during the telephone/virtual consultation indicates that face to face follow up is required. Most services will have clinically assessed need/risk already. It may be that in some cases RHAs are brought forward so that the child is seen face to face earlier than the due date.
- When considering new workload clinical risk assessment of all IHAs and /or RHAs must be undertaken with no discrimination for any factors including originating authority.
- Timescales need to be short, ideally completed within three to six months (prior to RHA and sooner if needed for adoption process). This will need to be thought through as a balance between maintaining service or potential increase in new referrals and the need for these children and young people to have a complete health assessment. Growth may be measured by other teams.
- Innovative solutions may be needed, eg increase service capacity by ‘retired return to work’ colleagues staying on, colleagues phasing return to work or able to see green/non-COVID-19 patients only completing assessments.
- Looked after children personnel should be re-deployed back to their substantive post in the first wave with designated professionals for LAC also returning to their role to oversee and offer strategic guidance and quality assurance.
- Discussion with local providers may be needed to allow for flexibility in working arrangements and additional work or capacity may be needed to meet increased demand.
- Liaise with partner agencies such as social care and be aware of recovery plans for universal services who could support assessments for looked after children, eg health visitors, School Nurses, GPs.
- Adoption pathways and court requirements will affect how statutory health assessments are prioritised. Close liaison with local social care teams to jointly agree ways forward are needed. Good communication is vital.
- Consider liaison with stakeholders, eg Local Safeguarding Children’s Partnership, Corporate Parenting Board, CCGs.
Supported by the National Network of Designated Health Professionals (NNDHP), NHSE LAC Clinical Reference Group, CoramBAAF
- 1. RCN (2019) Safeguarding children and young people: Roles and competencies for healthcare staff www.rcn.org.uk/professional-development/publications/pub-007366
- 2. Department of Health and Department for Education (2015) Promoting the health and wellbeing of looked-after children www.gov.uk/government/publications/promoting-the-health-and-wellbeing-of-looked-after-children--2