Improving the health assessment process for children in care

We spoke to social care staff about the health assessment process of children who are in the care of Lambeth Council. The aim was to identify how the service could be improved and reduce delays in assessments.
A young boy being checked by the doctor

Looked after children

A ‘looked after’ child is a child who is in the care of the local authority (the council), either by being placed in council accommodation, and/or placed in the care of a person employed by the council. In Lambeth there are 352 looked after children as of March 2019, 166 of which were picked up into the care system in that year. 

The Initial health assessment

While a child is in care, the council has a parenting responsibility, which includes safeguarding and promoting the welfare of the child in care. This includes looking after a child’s physical, emotional and mental health, and identifying any early signs of health issues. When a child first enters the care system, an Initial Health Assessment is necessary in order to understand and meet the child’s physical, medical and emotional needs. It should be done by a medical practitioner and be completed within 20 working days from when the child has come into the council’s care. Following this, Review Health Assessments are also required 6 or 12 months after this, to ensure the child is well and is getting the support they need.

In Lambeth, Mary Sheridan Centre, part of Evelina London Hospital, has been commissioned to carry out both the initial and review assessments. But we found that the Initial Health Assessments (IHA) were not always being carried out in a timely manner. Only 37% of looked after children last year had their IHA done within the 20 day period, and only 69% of children and young people had a Review Health Assessment.

Finding out how improvements could be made

Our aim was to find out why there was such a shortfall in the system, and what could be improved to ensure that all children in care get their Initial and Review Health Assessments in a timely manner. We spoke to social care professionals who worked with looked after children and who were in charge of carrying out the referrals, to understand what the issues are at the moment.

We carried out 11 focus groups in total and spoke to 61 social workers and team managers, Business Support Officers (BSOs), and Independent Reviewing Officers (IROs).

People shared that the factors affecting the shortfall were

  1. A general lack of understanding amongst social workers about the IHA process;
  2. Lack of clarity on the part of social workers on the role of the Business Support Officers that may lead to unrealistic expectations; and
  3. Varying experience on communication and interaction between social worker teams and the health team at Mary Sheridan Centre.

To address the issues, we made the following recommendations

  1. Address knowledge and skills gap through a mandatory programme of learning and development opportunities for social workers. 
  2. Revisit the role descriptions of people involved in the referral process, and ensure all understand the importance of Initial and Review Health Assessment. Team Managers can be proactive with providing inductions to all their team members when they first start with the team.
  3. Improve the communication between social care teams, BSOs, and health team at Mary Sheridan Centre. 
  4. A review of the accessibility and user-friendliness of the different referral forms and where possible, simplify them.


We received a response from Lambeth Children’s Social Care (CSC) in July 2020, which highlighted that based on our recommendations, action has been taken to improve the service.

These include revised training for new staff to ensure they know about and follow through with IHA referrals, better monitoring of the IHA process, clarity around roles and accountability of staff involved in making IHA referrals, and further efforts to encourage young people to take up the IHA referral. In general, Children Social Care has improved systems and processes to ensure that looked after children and young people are referred for IHA within the 20-day period. Some improvements had been recorded in the last few months and continued to be monitored.

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