Consents and Delegated Authority

Poor planning around delegation of authority can delay decision-making and lead to Looked After Children missing out on opportunities that enable them to experience a fulfilled childhood and feel part of the daily life of their children’s home.

Looked After Children report that problems obtaining consent from parents and local authorities before they can take part in 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 residential or foster 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.

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 would usually be appropriate for them 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:

• Can the child understand the question being asked of them?
• Do they appreciate the options open to them?
• Can they weigh up the pros and cons of each option?
• Can they express a clear personal view on the matter as distinct from repeating what someone else thinks they should do?
• Can they be reasonably consistent in their view on the matter, or are they constantly changing their mind?

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 Reference guide to consent for examination or treatment, second addition 2009.

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 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.