Implementation of health recommendations after initial statutory health assessment.

Author:Croft, G.
Position:Health notes - Report

The Department of Health guidance document, Promoting the Health of Looked After Children (2002), acknowledges the importance of a multi-agency approach in ensuring that the health needs of this vulnerable group of children are met. The statutory health assessment forms the basis for identifying health problems. Current requirements are for an initial health assessment within four weeks of entering the care system, followed by a bi-annual health assessment for all looked after children (LAC) under age five years and annually for those over five.

Our service is based in a health centre in an ethnically diverse area of inner London. Initial health assessments (IHA) are usually undertaken by a consultant paediatrician, staff grade doctor or paediatric specialist registrar. Where a child has been placed outwith travelling distance of our clinic, the GP is asked to undertake the health assessment and return to us. We use the BAAF Form IHA for the assessment and to formulate a summary, health care plan and recommendations for action. This is then sent to the social worker and copies sent to the carer or young person, GP and health visitor or school nurse. It is ultimately the social worker's responsibility (as the corporate parent) to ensure that the recommendations are carried out.

The number of LAC in our borough has fallen significantly in the last three years and currently stands at 272 (approx 68 per 10,000 children and young people

The percentage of LAC undergoing statutory health assessment has risen steadily from 79% in 2003 and now regularly exceeds 90% on a month-by-month basis. Our study was prompted by concern that the high uptake rate identified by the local authority performance monitoring system was providing false assurance that the children in our care system were receiving the health care they need. At the time of the review health assessment (RHA), it is often unclear whether a particular health recommendation has been implemented. This occurs especially when the child has attended his or her GP for the RHA and no mention of previous recommendations is made on the RHA form, or when there has been a change in carer. Furthermore, the reported performance figures relate only to children who have been looked after for a year or more. Many children in our area undergo initial health assessment and then return home or are placed with family members.

Aim of the study

  1. To ascertain whether the recommendations in the health care plan for children undergoing initial health assessment had been implemented within a six-month timescale.

  2. To identify whether there were difficulties in implementing specific types of recommendation and possible reasons for these.

  3. To suggest ways in which the implementation rate could be improved.


A retrospective review was undertaken of individual case files of all LAC undergoing initial health assessment between January and June 2007. Fifty-one children and young people were identified. The health care plan arising from the IHA was reviewed and information pertaining to each health recommendation was obtained from the case file where documented, and otherwise from the social worker, carer, health visitor, GP, young person, etc.


* Recommendations which were primarily the remit of other agencies, e.g. education services.

* Recommendations that were ongoing and non-specific, e.g. ongoing routine developmental review of a normally developing child.

Health care plan recommendations were categorised as follows:

* Immunisations: obtaining history and/or administering outstanding immunisations.

* Referrals for eye/hearing checks.

* Request for information on birth or past medical history from GP/health visitor/school nurse.

* Request for information from social worker on parental history.

* Miscellaneous, e.g. referrals to therapy or hospital services.


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