Looked After Children and Care Leavers

What is a Looked After Child?

 A child is legally defined as ‘Looked After’ by a Local Authority if he or she:

  • is accommodated by the local authority for a continuous period of more than 24 hours
  • is subject to a Care Order (to put the child into the care of the local authority)
  • is subject to a Placement Order (child placed for adoption)

A looked after child might be living with foster parents, at home with their parents under the supervision of the Local Authority, in a residential children’s home or other residential settings like schools or a secure unit.

A looked after child might have been placed in care voluntarily by parents, or more commonly, the Local Authority may have intervened because a child was at significant risk of harm.

The terms looked after child(ren) (LAC) or child looked after (CLA), child(ren) in care (CIC) are used interchangeably and mean the same thing. Children prefer that the abbreviations are not used.

Looked after children are, by legal definition, under 18 years of age.

The looked after child population within a Local Authority, is a mix between those who originate from that borough and those who are under the care of other Local Authorities and live in the borough.

What is a Care Leaver?

The Children (Leaving Care) Act 2000 which amended the Children Act 1989 defines a care leaver as a person who has been in the care of the Local Authority for a period of 13 weeks or more spanning their 16th birthday.

Growing up in care can affect an individual for their whole life. Health and social care staff need to consider a care leaver as anyone who has spent any time in care of the state (such as foster care or residential children’s home).

Young people with care experience may live in supported accommodation or alone from the age of 16. A looked after child becomes a care leaver when they reach their 18th birthday.

Young people who have had experience in care need support throughout their lives.

Career opportunities for people who are care leavers

What are Health Assessments?

A health assessment is a regular check-up that all children and young people in care have.

Health assessments identify health needs and make recommendations to support a child or young person to ensure their needs are met.

When a child or young person is removed from their families to go into foster or residential care, they are required by law to be offered an Initial Health Assessment (IHA). This should take place within 28 days (20 working days) of a child coming into care.

The IHA is a holistic assessment of physical and mental health needs that assess the past medical health, any missed health problems, and any missed screening opportunities. In Surrey the IHA is completed by a paediatrician.

A Review Health Assessments (RHA) is requested by a social worker every six months for children under five years old and annually for those over five and up to 18 years. These may be undertaken by an appropriately Registered Nurse, Health Visitor or School Nurse.

With consent, recommendations from a IHA and RHA are shared with the social worker and GP and are used to write a health care plan. The health care plan forms part of the care plan which is reviewed by the independent reviewing officer (IRO) at the child or young persons Looked After Children’s Review.

You can find out more about health assessments for young people, parents and carers on the Healthy Surrey website. 

Health assessment for looked after children | Healthy Surrey

How we look after children and young people in Surrey

The role of NHS Surrey Heartlands

NHS Surrey Heartlands has a statutory responsibility to support Looked After Children under the Children Act 2004 and under statutory guidance for Promoting the Health and Wellbeing of Looked After Children 2015 (Department for Education, Department of Health and Social Care). 

Both set out a duty to comply with requests from the Local Authority to provide support and services to Looked After Children, including the statutory requirement for the completion and quality assurance of health assessments.

The role of the Looked After Children and Care Leavers Team

The role of the Surrey Heartlands Designated Looked After Children's Team is to:

  1. Listen to the voice of the child – ensuring that children and young people’s voices are at the heart of the work we do.
  2. Promote the health and welfare of Looked After Children and Care Leavers – overcoming health inequalities and improve the social determinants of health.
  3. Provide strategic leadership and oversight.
  4. Fulfill corporate parenting responsibilities.
  5. Advocate for children and young people – challenge and escalate issues with a child first approach to ensure the child’s needs are met.
  6. Work in partnership – with multi-agency partners and stakeholders to improve the health and wellbeing of Looked After Children and Care Leavers.
  7. Influence commissioning.
  8. Be accountable to service users – demonstrate clear governance structures to ensure good service delivery and promote good outcomes for people who use our services.

Looked After Children and Care Leavers Strategy

Children who have experienced care are at particular risk of poor outcomes and must be a focus of ICSs in their work regarding health inequalities.

(Office for health improvement and disparities)

Building on the areas of priority indicated within the Health and Social Care Act (2022), NHS Surrey Heartlands have worked collaboratively with partner agencies and stakeholders to co-design a Looked After Children and Care Leavers Health Partnership Strategy.

The aim of the strategy shows how we will:

  • work in partnership to safeguard and improve the health and wellbeing of Surrey’s looked after children and care leavers
  • reduce the experience of health and social inequalities.

The strategy is included in the Surrey Heartlands Joint Forward Plan.

Surrey Heartlands Looked After Children and Care Leaver Strategy 2023-2026 [docx] 250KB

Surrey’s Looked After Children Sufficiency Strategy

Surrey County Council produces Sufficiency Strategies for both children and young people with additional needs and disabilities and those looked after.

Sufficiency means having enough of the right accommodation and services, in the right places, to effectively support Surrey's children, young people and families. This also includes thinking about the quality of those services and whether or not they are making a positive difference to the lives of children, young people and families. The aim of a sufficiency strategy is to enable the system of support to realise better outcomes.

Surrey County Council Commissioning sufficiency strategies

Care Leaver Covenant

Surrey County Council signed the Care Leaver Covenant on 31 March 2023.

The Care Leaver Covenant (CLC) is a national inclusion programme that supports Care Leavers aged 16 to 25 to live independently. The scheme is funded by the Department for Education (DfE) and it encourages local authorities, voluntary organisations and private sector businesses to sign up and make pledges to support care leavers in England.

As part of the Care Leavers Covenant, NHS Surrey Heartlands have been selected as one of 10 Integrated Care Board Pathfinders to enable care leavers to access career opportunities across the NHS.

Care Leaver Covenant

Career opportunities for people who are care leavers