1.4.1 Children in Hospital

Principal responsibilities
Legislative basis for intervention
Principles of Intervention
Practice
Appendix 1: Definition

1. Principal responsibilities;

The team operates a duty system and holds a caseload which reflects the Trust's priorities. Work accepted for intervention will include;

Child protection where the patient is not currently known to the department. Includes all categories of harm and pre-birth planning.
Legal and statutory work arising from the above.
Permanency planning when adoption is requested.
Assessment of need, where the Trust's eligibility criteria are met and the patient is not currently known to the department.
A distinct response to referrals for a child with cancer. The Trust has a service level agreement with the Sargent Cancer Care, a charitable organisation.
A significant liaison role in child protection, by facilitating the work of colleagues from health and throughout the Trust.
Promotion of a multi agency approach in the practical response to, and development of the Trust’s core business.

Any referral or request for assistance should in the first instance be passed to the duty Social Worker. The referral process, eligibility criteria and other assessments will apply as per the Children in need/ managing the thresholds of care instructions. There are however, circumstances specific to children as in-hospital patients, which may on occasion be considered. These are listed in the following section.

2. Legislative basis for intervention

The Children Act 1989 contains a range of private law orders that are designed to facilitate the care of children with their families. In particular to define the life arrangements for a child where it has not been possible for these to be agreed between their Carers: most often separated Parents.

Section 8 of the Act contains provision for two Orders which are sometimes used to ensure that a child receives appropriate medical treatment: i.e. a Prohibited Steps Order and a Specific Issue Order.

These are available to resolve single issues and replace the previous procedure of using Wardship. For example, where a child is refusing wardship and thereby endangering his/her life, the hospital/ Local Authority can apply for a Specific Issue Order, which would require the Court to consider whether the treatment should proceed.

Alternatively, in a situation in which a family want to remove their child from hospital when to do so would endanger life, the hospital/Local Authority could apply for a Prohibited Steps Order which would prevent this, but would not otherwise intervene in their Parenting.

The Act requires a health authority accommodating a child for more than 3 months to notify the Local Authority who must then satisfy itself that the child’s welfare is ”adequately safeguarded and promoted”. In some cases this will require an initial or core assessment to be undertaken to determine the child’s needs.

Section 85 of the Children Act 1989 covers children placed by health authorities in NHS hospitals (and children in local education authority accommodation) and those placed by statutory agencies in a private hospital. See Appendix 1 for Definition.

Section 86 of the Children Act 1989 applies to children in private hospitals who are there to receive treatment, specialised care or Education “ because they are handicapped, chronically ill or have special educational needs”. See Appendix 1 for Definition.

In these cases there is concern that these children may have little or no contact with their families and their position should be reviewed systematically to ensure their needs are being met.

3. Principles of Intervention

Brighton and Sussex University Hospitals NHS Trust will notify Brighton and Hove Trust of any child as defined above.

Brighton and Hove Council will acknowledge all such referrals and complete an assessment in accordance with statutory regulations and guidance.

Brighton and Sussex University Hospitals NHS Trust and Carers will be informed of the outcome of all assessments and any further action deemed necessary.

Both paper and electronic records of notifications and outcomes will be held. Annual review will identify the extent and trend of notifications and service improvements will be recommended if necessary.

4. Practice

Within Brighton and Hove there are two NHS hospitals where children may fall within provisions of sections 85 and 86 of the Children Act 1989. These are the Royal Sussex County Hospital (in practice the Trevor Mann Baby Unit) and the Royal Alexandra Children’s Hospital.

The local authority is represented by a social work office based at the Royal Alexandra Children’s Hospital.

It is agreed that the responsible senior nurse at each NHS site will ensure that notifications are made to the local authority social work office at the R.A.C.H. A form (S85/86) has been designed for this purpose and Parents/Carers will be informed of the referral.

If not currently known to the local authority, the social work office of the R.A.C.H. will undertake an initial assessment (see form FAI) in accordance with the principles of the Assessment Framework (DOH 2000).When a child is known to another office within the Children and Young People's Trust (CYPT), details will be passed to that office. The responsible team will respond to the referrer via the social work office at the RACH.

Both the referring hospital and Parents/Carers will be fully involved in the assessment and informed of the outcome. Should action be needed to safeguard and promote the child’s welfare, including the use of statutory functions, such action will be discussed.

Records will be reviewed by the local authority annually in December in order to consider both the numbers and nature of referrals. The aim will be to identify any pattern or trend and to recommend service improvements if necessary.

5. Appendix 1: Definition

Section 85 of the Children Act 1989 states that where a child is provided with accommodation by any health authority:

for a consecutive period of at least three months; or
with the intention, on the part of that authority, of accommodating him for such a period, the health authority shall notify the responsible authority when the responsible authority is defined as the local authority within whose area the child was ordinarily resident immediately before being accommodated, or where it appears that the child was not ordinarily resident within the area of any local authority, the local authority within whose area the accommodation is situated.

Section 86 of the Children Act 1989 states that where a child is provided with accommodation in any residential care Home, nursing Home or mental nursing Home:

for a consecutive period of at least three months: or
with the intention, on the part of the person taking the decision to accommodate him of accommodating him for such period, the person carrying on the Home shall notify the local authority within whose area the Home is carried on..

Where the local authority is notified under either of these sections they shall

take such steps as are reasonably practicable to enable them to determine whether the child’s welfare is adequately safeguarded and promoted while so accommodated, and
consider the extent to which (if at all) they should exercise any of their functions under this Act with respect to the child.