Health and Wellbeing, Health Notifications and Access to Services
REGULATIONS AND STANDARDS
Related guidance
Amendment
These chapters were updated in September 2023 and should be re-read throughout.
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.
Adults 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.
Adults 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, adults must establish whether the child has an EHC plan. If the child does, adults 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.
Adults 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.
Adults 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, adults 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, adults 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 adults 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). Adults 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, Substance Misuse, and Smoking Policy.
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 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 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;
- 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.
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.
The Caldecott Foundation aims to provide a healthy living environment for the children. Therefore we actively discourage them from smoking. All buildings, homes and vehicles are ‘Smoke Free’ and adults and visitors are not permitted to smoke in front of children. Each home should designate an area, where adults may smoke.
Adults should ensure that children are educated about smoking & vaping. It is accepted that the more that children know, the more likely they are to make good decisions about how to deal with smoking, vaping, drinking and the misuse of drugs / substances. Good communication ensures the right messages and information are passed on.
Some children/young people may already smoke before they are placed in their home. Adults should support and encourage such young people to reduce or stop smoking. Support is available from the Looked After Children’s Nurse or the young person’s GP. This should be discussed with the child/young person’s social worker and addressed as part of the young person’s Health Plan.
Staff are not permitted to purchase or give cigarettes, tobacco, vapes, or the materials for making or lighting cigarettes or tobacco to children.
Action on Smoking and Health (ASH) has developed a resource with advice from teachers, and educational experts on health and safeguarding. The ASH youth vaping briefing for local authorities is available online and includes:
- National data on youth attitudes and behaviour;
- An explanation of the laws on vaping;
- How to report any breaches;
- A myth-buster.
ASH guidance on developing policies on vaping For Designated Safeguarding Leads, suggests;
- Vaping is not for children;
- While it can help people quit smoking, if you don’t smoke don’t vape;
- However, most children who try vaping, have also tried smoking, and vaping is far less harmful than smoking, which kills up to two thirds of smokers;
- Uptake of vaping has a distinctive age profile. The key ages for take up are 16, 17 and particularly 18, although it can occur earlier;
- It is illegal to sell cigarettes or nicotine containing vapes to under-18s, but it is not illegal to smoke or vape underage and response should be proportionate;
- Through a contextual safeguarding lens, the main source of supply to children of cigarettes and vapes is shops. Children under 18 should be asked where they got their vape (or cigarette) from. Complaints can be made to trading standards through the Citizens Advice online portal;
- Earlier this year the UK government launched a consultation looking into the environmental and health impacts of vaping, and is considering responses.
Disposable vapes cause litter problems, are a fire hazard and appeal too strongly to children, according to local councils in England and Wales. Therefore any known usage of these needs to be monitored by the registered manager of the home.
All homes should be alcohol free zones; alcohol should not be brought or kept on the premises. It is not possible or practical to implement a blanket ban on young people entering licensed premises as many restaurants and leisure facilities are licensed to sell alcohol. Where children and young people are likely to be exposed to others consuming alcohol, for example at public events, adults should ensure that this is appropriately risk assessed. In circumstances where licensing laws would allow a young person to consume alcohol this should not be allowed. Adults will never purchase or provide alcoholic drinks for young people under the age of eighteen.
Adults are not permitted to consume alcohol at any time whilst on duty, including during holidays or celebrations with the children. Adults must not arrive at work under the influence of alcohol.
Adults should ensure that children/young people are educated about alcohol and its effects.
If adults are concerned that a child/young person has been drinking alcohol, this should be raised with the home’s manager and the child’s social worker as required. Where it becomes evident, or it is suspected, that a child or young person has been drinking alcohol, the most appropriate response will vary dependent on how much the young person has had to drink or how it has affected them. These options are outlined below:
- Offering fluids - water, squash;
- Periodic monitoring and checks by staff - 10 minutes, 30 minutes, hourly, etc;
- Contacting health professionals for advice e.g. G.P.;
- Hospitalisation for day patient or overnight stay if appropriate, etc.
We would like to encourage everyone to drink plenty of water to stay hydrated. People who take any of the following medications are advised to be more vigilant of their intake of water:
- Oral Medications for Type 2 Diabetes;
- Laxatives for Constipation;
- Excedrin Migraine for Migraine;
- Potassium-Sparing and Thiazide Diuretics for High Blood Pressure;
- Antidepressants and some anti-anxiety medications can interfere
with the body's ability to regulate temperature, blood pressure, and fluid
balance, which can impair the body’s heat regulation system, causing it to heat
up faster than normal; - Those with ADHD and/or Autism may be especially prone to dehydration due to
hyperfocus, forgetfulness, and lower self-awareness. Stimulant medications can
also lead to dehydration.
These medications and others can sometimes lead to decreased thirst, increased sweating, and in some cases, cause dry mouth, which can all contribute to dehydration. Some of which are sertraline, Citalopram, Duloxetine, Mirtazapine.
This communication is a supportive measure designed to highlight the higher risk of dehydration to some colleagues and young people given the increasing temperatures. There may be other factors which could lead to an increased risk of dehydration and so this is something that we all should keep
in mind.
If children appear to require or request it, appointments should be made for them to see their GP or other medical practitioners as appropriate.
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.
Additionally, the child's Medical Record should be updated.
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: September 16, 2024
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