Looked after children in an inner-city London borough: Health needs identified at the Initial Health Assessment (IHA)

Children enter local authority care in the UK for many different reasons. The main one recorded in official statistics is ‘abuse and neglect’ which applies to 60% of admissions and the health implications of such adverse experiences are obvious. Other reasons, such as disability, family dysfunction, acute stress and difficult behaviour, also carry similar risks which may be less salient. While looked after children have many of the same health issues as their peers, the impact of past experiences on their health is likely to be greater than for other children in society. Local authorities have a legal duty under the Children Act 1989 to safeguard and promote the health and welfare of all the children they look after whatever their needs. This variety in the reasons for care admissions means that the population of looked after children is extremely diverse. With regard to age, for example, a snapshot of those in care in the UK at any one time shows that nearly a quarter of them are aged over 15 years and only 5% under one year old, suggesting a plethora of late teenage rather than paediatric health problems. But the statistics for admissions to care over a 12-month period show a different picture, with 20% of the children entering care in their first year of life. When these characteristics are combined with the types of needs and their shortand long-term implications, the range of children’s possible health problems becomes clear, as does their likely complexity. This is also a major public health issue as in the UK 100,000 children are looked after at any one time and many more move in and out of the care system each year. In this note we present the findings of an audit into the identification of the health needs at the Initial Health Assessment (IHA) of children entering care. We describe these together with subsequent actions. We also specifically attend to the specific health problems of the oldest cohort (16–17-years-old) as identified at the IHA.