Health and Wellbeing, Health Notification and Access to Services

The manager must ensure that each young person’s day-to-day health and well-being needs are met; that young people receive advice, services and support in relation to their health and well-being. Young people must have access to specialist help, as required, including support for their mental health.

Staff should work to make the Service an environment that supports each young person’s physical, mental and emotional health, in line with the approach set out in the Service’s Statement of Purpose.

Staff must help each young person to:

• Achieve the health and well-being outcomes that are recorded in the relevant plans;
• Attend any appointments, for the purpose of meeting the young person’s health and well-being needs.

‘Wellbeing’ means the quality of a young person’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 young person. 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 young people. There is a competency framework which details the abilities that enable staff to effectively safeguard, protect and promote the welfare, health and wellbeing of looked after young people and care leavers in Looked After Children: Roles and Competencies of Healthcare Staff. 

The Care Planning Placement and Case Review (England) Regulations 2010 set out that the responsible local authority (meaning the local authority that looks after the young person, i.e. the accommodating local authority) must make sure that its Looked After young people are provided with appropriate healthcare services. The health and wellbeing of Looked After young people must be assessed at regular intervals and the young person’s Care Plan must include an individual health plan setting out the approach that the accommodating authority will follow, and the desired outcomes required to meet the young person’s health needs. See Health Care Assessments and Plans Procedure. 

The specific responsibilities of the Service towards supporting the health and well-being of each young person should be agreed with the accommodating authority and recorded in the young person’s relevant plans as appropriate. For looked after children, it is the joint responsibility of the registered person and the accommodating authority that this is agreed at the time of placement.

The Care Leavers (England) Regulations 2010 set out that the responsible local authority must make sure that its care leavers are provided with appropriate healthcare services. Information on the young person’s health and development, that is, the arrangements for the young person’s medical and dental care, must be reflected in their health plan, which was established within their care plan when they were looked after. This plan should also facilitate access to specialist health and therapeutic services as well as detail arrangements in place to support the young person to understand the actions they can take to maintain a healthy lifestyle. Details of the local authority’s responsibilities for the health of its care leavers are set out in Children Act 1989: Planning Transition to Adulthood for Care Leavers.

See also Preparation for Leaving Care.

When considering whether a young person placed in the setting by a different local authority will be eligible for secondary health care services, the setting and the accommodating authority and the local authority in which the setting is located should support the young person to access these services where necessary, taking into account the NHS England guidance on establishing the responsible commissioner: Who Pays? Determining Responsibility for Payment to Providers. 

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 young people to navigate these services, advocating on their behalf where necessary and appropriate. The Service must have good links with health agencies to promote good health, be well informed about local health services such as CYPMHS and sexual health services in the area it covers, and take this into account when deciding on admissions.

The registered person and staff should understand the health and mental health needs of young people and support them to access services and medication where appropriate and/or necessary, such as working with young people to encourage them to attend appointments or supporting young people to put measures in place for them to manage their own medication responsibly. This should align with the Service’s Statement of Purpose.

Young people will have varied pre-care experiences. A large proportion of young people engaged with children’s social care have experiences related to trauma, neglect and abuse. The registered person should ensure that staff are prepared and able to listen to young people who want to talk about who they are and where they come from, including their past experiences and relationships, and support young people to access relevant services where this is required, for example, mental health services. This should be agreed with the accommodating authority. The registered person should encourage staff to engage in regular reflective practice to ensure staff wellbeing is supported, enabling staff to continue to support young people with their experiences of trauma and mental health needs. 

A young person’s relevant plans may include a strategy for a particular type of support, treatment, or intervention (for example therapy relating to neglect or abuse). Staff will need to understand the purpose of any such support and the ways in which the past experiences of abuse or neglect may manifest itself in the day-to-day life of the young person.

For young people with special educational needs and disabilities, staff should establish whether the young person has an EHC plan. If the young person does, staff should take account of the health objectives it specifies.

The manager must ensure that staff have the relevant skills and knowledge to be able to:

• Respond to the health needs of young people;
• Administer basic first aid and minor illness treatment if the young person cannot do it themselves.

Where appropriate, the young person’s family should be involved in supporting the young person’s health needs as well.

Staff should have the relevant skills and knowledge to be able to help young people to understand, and where necessary, work to support them to change negative behaviours in key areas of health and wellbeing such as, but not limited to, nutrition and healthy diet, exercise, mental health, sexual relationships, sexual health, contraception and use of new psychoactive substances, drugs, alcohol and tobacco.

See also procedures on Drugs and Substance Misuse and Smoking and Alcohol. 

In most instances, young people will autonomously store and self-administer their own prescribed medications.

For some young people who may need additional support with their medications, staff should support the young person to ensure safe medication practices, such as providing a lockable medication box, helping the young person set alarms or reminders to take their medications, and so on.

In some instances, if the young person requests it, staff may assist with the storing and managing of certain medicines if this assistance is in support of the young person’s journey to do this within increasing autonomy in the future and stay safe while doing so. However, if a young person cannot manage their own ongoing medication needs at all independently it is likely that a higher level of care is needed and supported accommodation is not the right type of setting to meet the young person’s health needs and keep them safe.

Staff should encourage young people to keep records of the administration of their medication. If the young person has agreed to keep a record of their medication, this should be recorded and how they will do this (such as on their phone) on the care/pathway plan.

The registered person should ensure the Service has policies and appropriate arrangements in place for managing, administering, and disposing of medication, including processes for record keeping. Where the registered person or staff have questions or concerns about a young person’s medication, or their ability to administer this themselves, they should discuss these with the young person, take necessary safeguarding actions, and approach a medical professional such as a General Practitioner (GP) or community pharmacist.

Some young people may be prescribed controlled drugs. Examples of controlled drugs are morphine and pethidine for pain, methadone for withdrawal and Ritalin for hyperactivity.

ALL CONTROLLED DRUGS MUST BE STORED SAFELY BY BEING KEPT IN A LOCKED CABINET. NO MORE THAN 28 DAYS' SUPPLY SHOULD BE KEPT AT A TIME.

See also CQC information on Controlled Drugs

Medication should be disposed of when:

• The expiry date has been reached;
• The course of treatment is completed;
• The medication has been discontinued.

Unless instructed by a GP/Pharmacy, unused/expired medicines should be returned to the Pharmacy.