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Poor planning around delegation of authority can delay decision-making and lead to Children Looked After missing out on opportunities that enable them to experience a fulfilled childhood and feel part of the daily life of their children's home.
Children Looked After report that problems obtaining parents' and local authorities' consent to everyday activities makes them feel different from their peers and causes them embarrassment and upset. Failure to delegate appropriately, or to make clear who has the authority to decide what, can also make it more difficult for residential workers to carry out their caring role and form appropriate relationships with the children in their care.When deciding who should have authority to take particular decisions, the most appropriate exercise of decision-making powers will depend, in part, on the long term plan for the child, as set out in the child's Permanence Plan.
For example, where the plan is for the child to return home, the child's parents should expect to continue to have a significant role in decision-making. However where the plan is for long term foster or residential care, then carers should have a significant say in the majority of decisions about the child's care.
The Placement Plan will set out how, on a day-to-day basis, the child will be cared for and their welfare safeguarded and promoted, this will include arrangements for contact, medical care and education/training.
Wherever possible, the most appropriate person to take a decision about the child should have the authority to do so, and the Placement Plan should provide clarity about who has the authority to decide what.
Whatever the Permanence Plan for the child, the carer's (and / or the child if they are of sufficient age and understanding to make these decisions themselves) should have delegated authority to take day-to-day parenting decisions (e.g. routine decisions about health/hygiene, education, leisure activities) This enables carers to provide the best possible care for the child.
Decisions about activities where risk assessments have already been carried out by those organising / supervising the activity, e.g. school trips or activity breaks, should be delegated to the child's carer. There is no expectation that local authorities / children's homes staff should duplicate risk assessments.
Where any day-to-day parenting decisions are not delegated to the carers, the reasons for this should be set out in the child's Placement Plan. Reasons for not delegating certain decisions include past experiences or behaviour. For example, where a child has been identified as vulnerable to exploitation by peers or adults, then overnight stays may need to be limited, and the home may want the child's social worker to manage this.
Any decision about delegation of authority must consider the views of the child. In some cases a child will be of sufficient age and understanding to make decisions themselves. For example, they may have strong views about their personal appearance, and it may be decided that they should be allowed to make these kinds of decisions themselves
When deciding whether a particular child, on a particular occasion, has sufficient understanding to make a decision, the following questions should be considered:
Regardless of a child's competence, some decisions cannot be made until a child reaches a certain age, for example, tattoos are not permitted for a person under age 18 and certain piercings are not permitted until the child reaches age 16
The legal position concerning consent and refusal of health treatment for those under 18 years old is set out in chapter 3 of the Department of Health and Social Care's Reference guide to consent for examination or treatment, second addition 2009.
Whilst consent to examination or treatment should usually be sought from a parent or person with Parental Responsibility before a medical examination is carried out or treatment is provided, there may be situations where this is not possible, for example, a child requires urgent attention.
In an emergency, when urgent medical treatment is required, but no prior consent has been given and it is impossible to locate parents or a person with parental responsibility, then a child who has reached their 16th birthday may give consent. Dependent on their age and level of understanding, a child who has not reached the age of 16 years may be regarded by a doctor as capable of giving consent. In a 'life or limb' situation, a doctor may decide to proceed without any consent.
Children who have reached the age of 16 years can seek the advice of a medical practitioner without referral to or the consent of parent(s) or those with Parental Responsibility, and may decide to keep that advice and any subsequent treatment confidential. In such circumstances, they may share certain information with staff - and may request that it is only shared with specified other people. Such requests should be respected, unless to do so would place the young person or others at risk of injury or harm.
Children who have yet to reach the age of 16 years should be treated in a manner which is consistent with their age and level of understanding. Where possible, their wishes should be respected, but all reasonable steps should be taken to encourage them to discuss any concerns with their parent(s), a close relative or guardian. They should also be encouraged to consult their social worker or another responsible person, such as a staff member.
Once the arrangements have been made for a child to see a medical practitioner, the child can request that they do so unaccompanied; such a request should be respected.
Whilst it may be unusual for a doctor or other health care professional to provide advice or treatment to a child under 16 without parental knowledge or advice, they can do so if they believe the child is of an age and level of understanding (Gillick Competency) to understand the implications of the decision they are taking. Decisions about whether to provide advice or treatment without consent or consulting parent(s) or carers are for a practitioner's clinical judgement.
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