SCOPE OF THIS CHAPTER
This Guidance relates to all Children Looked After.
1. Placement Planning
Before a child is placed in foster care or residential care, consent must be obtained wherever possible, usually from the parent, or a person with Parental Responsibility, for the following:
- Urgent or emergency medical treatment;
- First aid, health care assessments, advice and treatment, including immunisations;
- Allowing the child to participate in swimming, outdoor or other pursuits which have a risk attached to them;
- Whether the child can be administered non-prescribed medicines (such as Paracetamol) or home remedies;
- Overnight stays with friends away from the foster home or residential home.
Where there is a person who holds Parental Responsibility such consent must be given, in writing, on the blue medical card and the pink delegated authority card.
Having secured initial overarching consent, it will be necessary for the child's social worker to review with the person with Parental responsibility how much to delegate to the foster carer on a regular basis and record this on the child's delegated authority decision support tool. This will include consent for holidays, school/educational visits inside & outside the UK. Any specific consent for medical treatment will be recorded on the blue medical card.When the parent, or person with Parental Responsibility, gives consent to medical assessments, treatment and advice, it should be understood that children aged sixteen and over, and others under that age who have sufficient understanding, may override the consent in some circumstances. This is explained below.
2. General Guidance Regarding Consent, Including Consent to Medical Treatment
- Written consent must be obtained from a parent or person with Parental Responsibility when a child becomes Looked After on a blue medical card;
- If consent is refused or any conditions are placed upon the consent, details of the refusal or conditions must be recorded on the blue medical card;
- In relation to medical treatment, for children under 16 subject to a Care Order or Interim Care Order, the Team Manager should give consent to routine examination and treatment if the parent is unable or unwilling to do so;
- Where the child is subject to a Care Order or Interim Care Order and in need of surgery, a general anaesthetic or other specific medical intervention, the child's social worker should actively seek to involve the parent in discussions with medical staff. They should record the specific procedure on the blue medical card and obtain the parents signature on the blue medical card so that the foster carer or residential worker can sign the hospital consent forms when they attend the hospital with the child;
- Where a child is subject to a Care Order or Interim Care Order and the parent refuses to consent or cannot be found; consent can be given by the Senior Manager for the child. They can consent for a Foster carer, Social Worker, Team Leader or Service Leader to attend the hospital, discuss the surgery, anaesthetic and risks with the doctor(s), and sign consent;
- If consent is delegated to the Foster Carer or residential worker then the parent or Senior Manager should complete the blue medical card so that the foster carer or residential worker can attend the hospital with the child to discuss and sign the hospital consent form;
- If the child is accommodated under Section 20 of the Children Act then only the parent has parental responsibility and therefore the power to consent or delegate their consent to others. If the parent refuses to consent or delegate consent, this should be brought to the attention of senior management and legal advice should be sought as a matter or urgency;
- Children of 16 and over have the right to consent to medical treatment and some children below 16 may be regarded as of sufficient understanding and maturity to consent to medical treatment without the need for parental consent (this is referred to as Fraser Competence);
- Other than in exceptional circumstances, all reasonable steps should be taken to inform the parent(s) or others with Parental Responsibility before medical advice or treatment is sought for a child Looked After. If this is not achieved, they should be informed as soon as practicable thereafter. The level of information imparted should reflect the current Care Plan;
- Steps should always be taken to promote decision-making on the part of children and to ensure their views and wishes are obtained, considered and accounted for;
- It is the responsibility of the child's social worker, together with residential staff and foster carers to support the child to engage with medical professionals. The older and more mature a child, the greater weight should be given to their views. Indeed, a doctor may regard a child as Fraser Competent i.e. capable of giving or refusing to give consent, even if under sixteen. This will be the decision of the medical professional involved. For such consent by a child to be valid, it must be informed and freely given for those under as well as over 16 years;
- In an emergency, when urgent medical treatment is required and every effort has been made to locate parents or a person with Parental Responsibility, the following may apply:
- A child who has reached his/her sixteenth birthday may give consent;
- A responsible adult acting in loco parent is, may give consent on the parents' behalf so long as all reasonable steps have been taken to consult the parent(s) or those with Parental Responsibility and such action is not against their expressed wishes. In the case of a child who is looked after, this will involve the relevant senior manager having a discussion with the medical professional involved before considering whether it is appropriate to give consent;
- Dependent on his/her age and level of understanding, a child who has not reached the age of sixteen may be regarded by a doctor as capable of giving consent (Fraser Competent);
- In a 'life or limb' situation, a doctor may decide to proceed without any consent;
- Consent should be given in writing, but it is equally valid if given verbally, provided it was informed and freely given. Written consent is preferred where children are in receipt of services away from home and may require urgent medical treatment in an emergency. Where it is only possible to acquire verbal consent, it should be given in the presence of a reliable witness e.g. acting on behalf of the Local Authority.
Further local information may be added here as required.