Children in Hospital

Children who are in hospital should have their overall welfare safeguarded and promoted in the same manner as all other children.


1. Overview 

1.1 Hospitals should take all reasonable steps to ensure that children are cared for in secure children’s wards and are provided with suitable adult supervision and care. Wherever possible, children should be consulted about where they would prefer to stay in hospital and their views should be taken into account and respected.  All school age children are seen by a Teacher when admitted to hospital. Appropriate work and activities are planned and supervised depending on their clinical condition and ability to complete

 

2. Child likely to be Hospital over three months

2.1 Section 85 of The Children’s Act 1989 states that ‘where a child is provided with accommodation by any NHS Foundation Trust for a consecutive period of at least three months’ Children’s Social Care are to be informed so that they can assess the child’s needs and decide whether services are required.

Such children are potentially vulnerable by virtue of their being accommodated outside of the family.

2.2 The agency providing accommodation to the child should notify the Children’s Hub or MACH.  If the notification is being made by a health agency, a copy should also be made to the Named Nurse for Child Protection. The notification should include as a minimum:

  • Child's name
  • Child's date of birth
  • Child's address immediately prior to admission or accommodation (or for a new born baby, the address of the child's mother immediately prior to delivery)
  • Date of admission or accommodation
  • Name, address and contact person of the agency providing accommodation
  • Name and contact information for the child's parents or anyone else who has parental responsibility in respect of the child
  • Name and contact details of the person making the notification

2.3 Upon notification that a child form their area is living in such arrangements, Children's Social Care  should assess whether the child's welfare is being adequately safeguarded and promoted and whether any additional services or interventions should be offered to the child and / or the family. The assessment should be completed within 10 working days of the notification. The child should be visited as part of the assessment in order to gain their wishes and feelings and their views about the care that they are receiving and the views about the circumstances which have led to their accommodation.

2.4 On completion of the Initial Assessment, the social worker along with their team manager will determine if the child is a child in need as defined in Section 17 of the Children Act 1989 and what, if any services and support should be provided to the child and/or their family in order to meet any assessed needs. When the assessment is concluded recommendations may be made to the accommodating authority as to actions that may be needed in order to ensure that the child’s welfare is being promoted and that all of their needs are being met appropriately.

2.5 When the child is no longer being provided with accommodation, the agency accommodating the child must inform Children’s Social Care and in the case of a health agency, the Named Nurse for Child Protection.

 

3. Child where there are concerns for child’s care on discharge

3.1 Where there are known concerns over a child’s safety and welfare on discharge from hospital, hospital staff must discuss concerns with Children’s Social Care prior to discharge allowing time for multiagency discussion. There must be a multiagency plan/agreement in place to ensure the ongoing promotion and safeguarding of the child’s welfare.

 

4. Communication by Doctors

4.1 The named consultant involved in the care of a child, about whom there are concerns about the possible risk of significant harm, must provide Children’s Social Care with a written statement of the nature and extent of their concerns. This may initially be by way of a SAFER form and subsequently by a full medical report if required. If, following further investigations or discussions, the opinion of the named consultant changes then this should be communicated to social care by creating an amendment to the original report. A telephone call to, or from Children's Social Care may be made if any clarity or explanation of the report is required.

 

5. Child with Child Protection Plan who has an Unplanned Admission to Hospital

5.1 Any child who is subject to a protection plan or who is a Children in Our Care will be flagged on CP-IS on admission to hospital. An automatic notification will be sent to the Social Worker.

5.2 Hospital staff should liaise with Children’s Social Care and the Social Worker/Team Manager should seek as much clarity as possible regarding the reason for the unplanned admission. If the admission was due to an inflicted injury or neglect a strategy meeting should be held.

 

6. Child who Ingests Illegal/Prescribed Substances

6.1 Where a child requires hospital treatment due to an accidental ingested illegal/non-prescribed substance or adult medication e.g., Methadone, an immediate referral should be made to Children’s Social Care. A strategy meeting should then be arranged to consider the safety and well-being of the child and any other children within the household.

6.2 Where an adolescent child has ingested substances recreationally, consideration should be given to the context and possibility of harm surrounding the substance use. Where the substance use raises concerns of potential significant harm (e.g., suspected links to drug supply (county lines), vulnerability to exploitation, hospital treatment required) then consideration should be given to the need for a SAFER referral.

6.3 Where a child or adolescent has taken an intentional overdose or presented with other forms of deliberate self-harm a comprehensive assessment by CAMHS clinician should be undertaken. This should include a review of their social circumstances. Where child or adolescent presents repeatedly following episodes of self-harm or where there are any concerns regarding social factors precipitating or perpetuating their difficulties consideration should be given to the need for a SAFER referral. If in any doubt clinicians are encouraged to seek advise and support from safeguarding team on case by case basis.

 

7. Refusal by Child of Medical Assessment/ Treatment

7.1 Any staff faced with a situation where a child/young person’s life may be in danger because of his/her refusal to accept medical assessment and/or treatment, should contact Children’s Social Care as a matter of urgency.

7.2 Young people aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances.

Like adults, young people (aged 16 or 17) are presumed to have sufficient capacity to decide on their own medical treatment, unless there's significant evidence to suggest otherwise.

Children under the age of 16 can consent to their own treatment if they're believed to have enough competence and understanding to fully appreciate what's involved in their treatment. This is known as being Gillick competent.

Otherwise, someone with parental responsibility can consent for them.

This could be:

  • the child's mother or father
  • the child's legally appointed guardian
  • a person with a residence order concerning the child
  • a local authority designated to care for the child
  • a local authority or person with an emergency protection order for the child

7.3 Where treatment is required as a direct consequences of a mental disorder and there is a belief that young person may be eligible for detention under Mental Health Act an urgent input ought to be sought from CAMHS Crisis Team who will be able to involve an appropriate consultant psychiatrist if needed.

7.4 If a young person refuses treatment, which may lead to their death or a severe permanent injury, their decision can be overruled by the Court of Protection.

The Consultant should, without delay, liaise with their Trust Legal Services and determine whether an application should be made to the Court for an order to obtain the medical assessment and/or treatment.

 

8. Non-medical Supervision

8.1 Where a child is in hospital and the child requires supervision on non-medical grounds, it is the responsibility of children’s social care to arrange that supervision.