4.23 Hospital Discharge Guidelines for Vulnerable Children
SCOPE OF THIS CHAPTER
This procedure applies where a child is to be discharged from hospital in circumstances where there are child protection/child concern issues in relation to the child or the child is Looked After.
This includes situations where a child is admitted for reasons other than Non Accidental Injury but, during the course of their admission, child protection concerns arise. In these circumstances, therefore, the discharge arrangements described below must be followed.
Concerns outside Child Protection
If, during the course of a child's stay in hospital, concerns about their vulnerability / compromised parenting become apparent, but significant harm is not yet identified then, at a minimum, the hospital staff should consider the need to hold a discharge planning meeting, in consultation with named professionals for safeguarding children.
At a discharge planning meeting, professionals need to consider what further support is required and who else may need to be informed of the situation in order for services to be co-ordinated and a CAF considered.
- Children Discharged from Children's wards where there are Child Protection Concerns
- Young People Discharged from Adult Wards
The discharge should be agreed between Children's Social Care and the Consultant Paediatrician.
The child should not be discharged at weekends or on bank holidays unless Children's Social Care has agreed that it is safe to do so and this is documented in the child's medical record and a multi-disciplinary discharge plan has been completed.
Children's Social Care should aim to agree arrangements for the child's discharge within a working day of the child being medically fit for discharge.
Where a Strategy Discussion/Meeting is to be held regarding any child, that meeting should be called whilst the child is still an inpatient and the meeting should be held at the hospital. Decisions from the meeting should inform the discharge plan for the child. Please see the Strategy Discussion Procedure for further information.
Children's Social Care should, whenever possible, have a contingency plan in place for discharge should there be a heavy demand for beds/cots during the child protection investigation. Good communication between paediatrician, social worker and nursing staff is essential on these occasions, and all communications should be documented.
Discharge arrangements should be documented in the child's hospital record, and all documentation should be signed and dated appropriately. The name and designation of the professional responsible for discharge should be printed with the signature. No child about whom there have been child protection concerns should be discharged without the Consultant's authorisation.
For all children that are admitted where there are child protection concerns, the health visitor or school nurse (dependent upon the age of the child) must be informed of the pending discharge.
All relevant professionals involved with the child should be involved in the discharge planning process.
Where a child is not registered with a GP and Children's Social Care is actively involved with a child, they will proactively support the family in registering with a GP practice.
Consultants are responsible for writing the medical report for the child, copies of which will be sent to the GP, Children's Social Care, health visitor or school nurse. These will be prioritised as urgent and distributed within 48 hours.
If a child is being discharged into foster care or into secure accommodation, the following information must be collated and documented prior to discharge as part of the discharge planning process:-
- The name and address of the child's placement, unless in circumstances where the child is being placed at a secure address;
- Who has Parental Responsibility? Is it the parents, one or other parent, Local Authority or others?
- The address where follow-up appointments are to be sent;
- How birth parents are to be informed of the discharge and the follow-up arrangements.
The child's GP/health visitor/school nurse/social worker/ midwife or community paediatric nurse must be involved in the discharge planning arrangements as described above.
Where a child is the subject of a Child Protection Plan, a Child in Care or a Child in Need with social work involvement, the allocated social worker should be informed of admission and discharge. The need to hold a discharge planning meeting should always be considered in any of these cases.
Currently children above the age of 16 years are admitted and nursed on adult wards.
Section 11 of the Children Act 2004 places a duty on the NHS to make arrangements to safeguard and promote the welfare of children. Children are defined as being those under the age of 18years.
Where children aged 16 to 18 years have been admitted to adult wards but there is concern regarding the young person's welfare, either in terms of the young person's physical or mental health or physical, intellectual, emotional, social or behavioural development, then the young person should be treated as being a Child in Need.
Any dilemmas regarding consent and/or self discharge in an adolescent where there are concerns regarding that young person's physical or mental health or physical, intellectual, emotional, social or behavioural development should always be discussed with the appropriate agencies prior to discharge.In these circumstances, consideration must be given to referring the young person to Children's Social Care - see Making Referrals to Children's Social Care Procedure.