8.50 Children in hospital
Added in December 2020
Date of next review December 2022
See also Brighton & Hove Children's Services Procedures Manual - Children in Care Staying Temporarily in Hospital
Hospitals should be child-friendly, safe and healthy places for children.
Wherever possible, children should be consulted about where they would prefer to stay in hospital, and their views should be taken into account and be respected.
Care should be provided in an appropriate location and in an environment that is safe and well suited to the age and stage of development of the child or young person.
A safeguarding risk assessment should be undertaken to ensure the safety of other patients in the setting
Children under 16 should not usually be cared for on an adult ward, although if they are aged 14 or over, they may be given a choice. Hospital admission data should include the age of children so that hospitals can monitor whether children are being given appropriate care in appropriate wards.
Hospitals must have policies in place to ensure that their facilities are secure and regularly reviewed. Staff should be appropriately trained.
Children admitted to specialist hospitals can present with complex safeguarding and child protection issues. They may have sustained serious and life-threatening non-accidental injuries, or there may be concerns related to fabricated Fabricated or induced illness (FII) and Perplexing Presentations (including FII by carers) These children may have suffered, or be vulnerable to suffer, significant harm through physical, sexual and emotional abuse and/or neglect.
Furthermore, if there are lapses in the care provided for the child, they could suffer significant harm whilst in hospital. Every attempt should be made to allow continuity of care packages (for example OT, Physio and specialist services). Specialist Hospital protocols should outline responsibilities and necessary actions in accordance with legal duties, procedures and accepted good practice:
Children who require treatment as an in-patient in a psychiatric setting will usually be admitted voluntarily; otherwise the Mental Health Act 1983 or the Children Act 1989 will apply. The admission criteria will differ, such as acute (crisis or short term), for eating disorders or challenging behaviour.
Age ranges can vary considerably, and some children may be admitted to an adult psychiatric setting. Catchment areas for some hospitals may cover a regional or national area depending on the specialism. Under the Children's Homes and Looked after Children (Miscellaneous Amendments) (England) Regulations 2013, Local Authorities are required to consult and share information before placing children in distant placements. The Director of Children's Services (DCS) must approve of these placements.'
These changes reinforce Local Authorities' responsibilities as corporate parents for looked-after children to provide high-quality care and support. There will be circumstances where a distant placement will be the most suitable for a child, such as where the child has complex treatment needs that cannot be met by services within the area of the responsible authority.
There will also be children who require an out of authority placement to ensure they can be effectively safeguarded. Such placements will require effective planning, engagement and information sharing with the services likely to be responsible for meeting the child's needs in the future.
Where consent for treatment is required, it should be clarified by the lead professional (e.g. LA children's social care, child and adolescent mental health services (CAMHS)) whether this is being carried out under the Mental Health Act 1983 or the Children Act 1989. There needs to be clarification of who holds Parental Responsibility.
If any child who is considered to be Fraser competent is unwilling to remain as an informal patient consideration should be given to use the Mental Health Act 1983.
For children under 16 where a Fraser competent child wishes to discharge themself as an informal patient from hospital, the contrary wishes of those with parental responsibility will ordinarily prevail.
Where there is dispute consideration should be given to use the Act. Similarly, if a 16 or 17-year-old in unwilling to remain in hospital as an in-patient, consideration may need to be given whether they should be detained under the Act. Onward care planning should be undertaken in partnership with the child/ young person.
Children in psychiatric settings may need to be isolated from other patients or require control and restraint on occasions, and staff should be appropriately trained to meet their needs and safeguard their welfare. When a child is admitted to psychiatric settings where adults are in-patients, a risk assessment must be undertaken to avoid the child being placed in vulnerable situations.
Children admitted to psychiatric settings may disclose information about abuse or neglect concerning themselves or others. Disclosures may be made when the child feels it is safe to talk or when the child is angry, distressed or anxious. All allegations should be treated seriously.
Discharging children from hospital- at the point of admission, a complex case panel should be considered with appropriate health and social care professionals attending to ensure safe discharge planning and on-going care.
Any concerns about Significant Harm to a child within a hospital or health-based setting must be referred to Children's Social Care in whose area the hospital is located following the Making a Referral Procedure. If there are allegations against people who work with, care for or volunteer with children, the LADO should be consulted Allegations Against People who Work with, Care for or Volunteer with Children
When the child has been in hospital, or is planned to be, for three months or more, the appropriate health/hospital trust must notify the Responsible Authority i.e. the Local Authority for the area where the child is normally resident or, if this is unclear, where the child is accommodated. This is so that the Local Authority can assess the child's needs under the Assessment Framework and decide whether services are required under Children Act 1989 (Section 85).
Liaison with the child's placing authority may be required from admission to ensure effective planning, engagement and information sharing. Case responsibility for the child rests with the home authority, and the home authority should work in partnership with the Trust and with the host authority Children's Social Care.
Any child who is an in-patient in a hospital, and about whom there are child protection concerns, should be discharged home with a referral to establish; that the home environment is safe, the concerns by medical staff are fully addressed and there is a plan in place for the on-going promotion and safeguarding of the child's welfare - see the Making a Referral Procedure and Action on Receipt of Referrals Procedure.
Considerations during transition periods
Particular attention is required in the discharge planning of newborns from neonatal intensive care units since these babies are at high risk of re-admission to hospital. They need an adequately coordinated programme of follow-up, with particular attention to vision, hearing and developmental progress, as well as the co-ordinated input of services such as genetics.
Children with long-term conditions need preparation for the move from children's to adult services. All children with on-going health needs should have a plan developed with them for the transition of their care to adult services, which is coordinated by a named person. If there are child protection concerns for such a child, the LA vulnerable adults service should be informed as part of the transition planning.
For further reading and information see the National Service Framework for Children, Young People and Maternity Services (NSF) 2004 and the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984-1995: Learning from Bristol.