Looked After Children and Care Leavers

Looked After Child (LAC) is a child or young person up to the age of eighteen years who is legally accommodated by the local authority. In England & Wales the term ‘LAC’ is defined in law under the Children Act 1989. A child is looked after by a local authority (LA) if he or she is in their care or is provided with accommodation for more than 24 hours by the authority. 

There are four main groups 

  • accommodated under voluntary agreement with their parents (section 20) 
  • subject of a care order (section 31) or interim care order (section 38) 
  • subject of emergency orders for their protection (section 44 and 46) 
  • compulsorily accommodated including remanded to LA or subject to a criminal justice supervision order with a residence requirement (section 21). 

The main reason for children being in care remains as a result of abuse and neglect, but 

only England and Wales publish information on why children are looked after. 

Other reasons for being looked after include: 

  • family dysfunction (England: 15%, Wales 14%) 
  • family in acute stress (England: 8%, Wales: 8%) 
  • child’s disability (England: 3%, Wales: 4%) 
  • parent’s illness or disability (England: 3%, Wales: 3%) 
  • socially unacceptable behaviour (England: 1%, Wales: 2%). 

This is important as children’s pre-care experience can continue to affect them for many years after 18 and children remain vulnerable within the care system, with many children experiencing numerous placement moves. The NHS Long Term Plan recognises this vulnerability which includes care leavers and is a particular risk during periods of transition. 

Looked after children are over four times more likely to have an emotional or mental 

health need than their non looked after peers. (Intercollegiate Document for Looked after Children) 

Locally identified health needs of Looked After Children in Southwark include the following: 

Overweight/obesity (23%), EHCP (25%), ASD/Autism (10%), Sleep issues (33%), Previously seen by CAMHS/Carelink (16%), Child Sexual Exploitation (CSE) risk (15%), missing episodes (35%)  

Further information 

Promoting the Health and Wellbeing of Looked After Children 

Looked after Children: roles and competencies of healthcare staff 

Looked After Children Guidance 

Documents: 

Health Needs of Looked After Children and Care Leavers – GP Forum – June 2019

Parental Responsibility is: All rights, powers and duties of parents in relation to a child and his property. Section 3 Children’s Act  1989 

PR is retained and only held by the birth parents if: child is under Section 20 – a voluntary agreement. 

PR is can be shared between Local Authority and parents if:a child or young person is in care and an order is imposed by the courts (Full care orders Section 31 and Section 38.)  

Exceptions: 

If a child or young person’s health is threatened and emergency treatment is needed, health professionals are allowed to act in the best interest of the Child or Young person. 

The health professional should consider the child or Young Person has cognition and understands the risks and benefits of treatment and has capacity to make decisions (see GMC 0-18 guidance for doctors). 

Young People aged 16/17 are presumed capable to consenting to medical treatment. Treatment may not be given if the Young Person does not have capacity (Mental Capacity Act 2005). 

If you require further information talk to the Social Worker. 

Delegated Authority- Local Authority Medical Consent Form 

Foster carers, Residential Carers/Staff do not have PR for Looked After Children or Young People and therefore cannot provide consent, however when presenting to the practice should bring a copy of the Local Authority Medical Consent Form 

Delegated Authority is used by the Local Authority to give carers responsibility for day to day decision making for children in their care. Consent for this is obtained using the Local Authority Medical Consent Form. This is signed by the birth family at the time the Child or Young Person is placed in care and the foster carer is given a copy of this form. 

If you require further information talk to the Social Worker or LAC team 

Eligible Young People are young people aged 16 or 17, have been Looked After for a period or periods totalling at least 13 weeks starting after their 14th birthday and are still Looked After. (This total does not include a series of short-term placements of up to four weeks where the child has returned to the parent.) There is a duty to support these young people up to the age of 18. 

In addition as of April 2018, Local Authorities have a duty which requires them to offer Personal Advisors support to all care leavers up to age 25, irrespective of whether they are engaged in education or training.  This includes care leavers who return to the local authority at any point after the age of 21 up to age 25 and request PA support. 

This duty incorporated support on services that teach about, support and enable good health and wellbeing. It should include links to, or information about, universal health services that might be particularly relevant to care leavers, as well as specific health and wellbeing services targeted at them. 

Further support locally from: https://southwarkcareleavers.co.uk/ 

Further information 

NHS Long term plan – Care Leavers 

Applying corporate parenting principles to looked-after children and care leavers 

Catch 22 

Care Leavers Association 

See presentation linked in documents from GP Safeguarding forum June 2019 on Care Leavers for further summary, health needs and role of all professionals 

Supporting documents to be uploaded

GP records can provide a continuous record for children who have moved between placements. 

Suitable coding to support recognition:  

Looked after child  [snomed: 64841000000100] 

Care Leaver  [snomed: 770347003] 

Ensure on significant problem list as current defaults to minor on EMIS 

Useful documents