In England and Wales the term ‘looked after children’ is defined in law under the Children Act 1989. A child is looked after by a local authority if he or she is in their care or is provided with accommodation for more than 24 hours by the authority. Looked after children fall into four main groups:
- Children who are accommodated under voluntary agreement with their parents (section 20);
- Children who are the subject of a care order (section 31) or interim care order (section 38);
- Children who are the subject of emergency orders for their protection (section 44 and 46);
- Children who are compulsorily accommodated. This includes children remanded to the local authority or subject to a criminal justice supervision order with a residence requirement (section 21).
The term ‘looked after children’ includes unaccompanied asylum seeking children, children in friends and family placements, and those children where the agency has authority to place the child for adoption. It does not include those children who have been permanently adopted or who are on a special guardianship order.
In Scotland the term ‘looked after children’ is defined in law under the Children (Scotland) Act 1995, section 17(6). Looked after children fall into four groups:
- Children for whom the local authority are providing accommodation under section 25 of this Act (a voluntary arrangement);
- Children who are subject to a compulsory supervision order or an interim compulsory supervision order (under the Children’s Hearings (Scotland) Act 2011);
- Children who are subject to an order made in England, Wales or Northern Ireland which the Scottish Local Authority has responsibilities for by virtue of Regulation
- Children who are subject to a valid permanence order under section 80 of the Adoption and Children (Scotland) Act 2007
In Northern Ireland the term could also include children receiving respite care – the content of this Intercollegiate Framework in Northern Ireland is pertinent to looked after children in kinship, non-kinship and residential placements for more than 24 hours, as a result of safeguarding concerns, and not to children subject of respite provision.
Those children and young people formerly in care before the age of 18 years of age. Such care could be in foster care, residential care (mainly children’s homes), or other arrangements outside the immediate or extended family.
In 2016/17 there were approximately 96,000 looked after children in the UK:
- at 31 March 2018, 3,109 children were in care in Northern Ireland;
- at 31 July 2018, there were an estimated 14,738 looked after children in Scotland
- at 31st March 2018 there were 6,405 looked after children in Wales; and
- in England there were 75,420 at 31st March 2018.
The total number of looked after children in the UK has increased every year since 2010. For the majority this is as a result of abuse or neglect, although there is an increasing number of unaccompanied asylum seekers and children who have been trafficked from abroad. Looked after children and young people have greater mental health problems, as well as developmental and physical health issues such as speech and language problems, bedwetting, coordination difficulties and sight problems.
Key nursing roles
Nurses have an important role in supporting and promoting the health and wellbeing of looked after children. This includes:
Health visitors and school nurses
Health visitors and school nurses provide support, information and advice as part of universal services.
Specialist nurses for looked after children
The term Nurse Specialist denotes a nurse with additional knowledge skill and experience in working with looked after children responsible for assessing and promoting wellbeing in the looked after child population.
Named nurse for looked after children
Named Nurses have an important role in promoting good practice within the provider organisation. This is a high-level operational role bringing both expertise and extensive experience. They will work in, and are employed by, a health provider organisation. The Named Nurse is the principal health contact for Social Care, improving the health outcomes for Looked After Children and Care Leavers by working with the individual, their carers, the corporate family and the wider community.
Designated nurse for looked after children
The role in England is statutory:
- to assist CCGs and other commissioners of health services in fulfilling their responsibilities to improve the health of looked-after children
- intended to be strategic, separate from any responsibilities for individual looked-after children
In Wales professionals for Safeguarding (and LAC) are employed by Public Health Wales. The strategic overview of health services for looked after children within each Health Board is fulfilled by the Named Doctors for LAC with additional responsibility (Named Doctor for LAC, strategic role).
In Scotland specialist paediatricians, GPs and nurses deliver services for looked after and accommodated children/young people, including health assessments and provide medical advice to Fostering and Adoption panels. The lead paediatrician for each area has a strategic overview and responsibility. In addition NHS Health Boards have a nominated Board Director with corporate responsibility for looked after children, young people and care leavers. See: CEL 16 (2009).
The knowledge, skills and competences of health care staff in respect of looked after children can be found in the RCN & RCPCH (2020) intercollegiate framework. See: Looked after children: Knowledge, skills and competences of healthcare staff.
The Royal College of Nursing has undertaken surveys of nurses working with looked after children – see: RCN survey of nurses working with looked after children. These have highlighted considerable variations in caseloads throughout the country, with a wide range of different ways of working and providing services and in some areas means that looked after children receive a poor or limited service in comparison to others. Issues raised by members continue to be highlighted to Ministers and NHSE.