§ The Countess of Mar
asked Her Majesty's Government:
Whether it is within the remit of the Children Act 1989 for the matter of competent medical treatment being followed by a child (in the case of a competent child, with his/her consent or, in the case of non-competent child, with parental consent) to be challenged; and [HL443]
Whether it is the responsibility or within the authority of a doctor, a National Health Service trust, a health authority or a local authority' to seek a ruling from a court, under the inherent jurisdiction, regarding which type of medical treatment a. child should receive in the case of a child who is already receiving competent medical treatment (in the case of a competent child, with his/her consent or, in the case of a non-competent child with parental consent; and [HL444]
Whether where there is not a generally agreed method of treatment, it is within the authority, or is the responsibility of a doctor to refer a child to a local authority as a child who is suffering or likely to suffer significant harm because the child's parents have declined the treatment offered by that doctor and have chosen instead, with the agreement of the child's general practitioner to follow an alternative 179WA competent treatment provided by another doctor; and whether it is within the local authority's Children Act 1989 powers to initiate action under Section 47 or to apply for an Assessment Order (Section 43), an Emergency Protection Order (Section 44) or a Care Supervision Order (Part IV) in those circumstances; and [HL445]
Whether it is within the remit of Section 47(1) of the Children Act 1989 for a local authority to initiate child protection procedures in order to investigate a child who is following competent medical advice and treatment as suffering or likely to suffer significant harm, following a referral from a doctor or education officer challenging the child's doctor's advice and treatment; and [HL446]
Whether it is a matter for clinical judgment to determine whether a child diagnosed as suffering from a chronic illness such as myalgic encephalomyelitis is fit to attend school or, if not fit to attend school fit to benefit from home tuition; whether any resultant loss of education or social isolation because the child remains at home under his/her doctor's advice is a matter of child protection concern; and whether in those circumstances, it is within the remit of the Children Act 1989 to make a referral or initiate a Section 47 investigation on the grounds of impairment of development. [HL447]
§ Lord Hunt of Kings Heath
Parents local authorities and other interested parties with the leave of the court as required may apply for a determination by the court of issues concerning a child's welfare under the court's inherent jurisdiction and the Children Act 1989. Normally, a child's parents would decide on that child's behalf (where the child is competent with his or her agreement) between a range of treatment options. The jurisdiction of the court would generally be invoked in connection with medical treatment where those with parental responsibility disagreed as to the appropriate treatment or where the competent child was opposed to treatment which his or her parents sought. Such proceedings would only be initiated by medical professionals or a referral made in these circumstances to a local authority where the medical professionals involved had genuine concerns that the healthcare decisions being made by those with parental responsibility for a child (or by a competent child himself or herself) were not in the child's best interests.
If somebody believes that a child may be suffering, or may be at risk of suffering significant harm, they should always refer their concerns to the local authority social services department. While professionals should seek, in general, to discuss any concerns with the family and, where possible, seek their agreement to making referrals to social services, this should only be done where such discussion and agreement seeking will not place a child at increased risk of significant harm.
Local authorities have a statutory duty, under Section 47 of the Children Act 1989, to make enquiries if they have reasonable cause to suspect that a child in their area is suffering, or is likely to suffer significant 180WA harm, to enable them to decide whether they should take any action to safeguard or promote the child's welfare.
The Framework for the Assessment of Children in Need and their Families is equally relevant in these circumstances as a structured framework for collecting, drawing together and analysing available information about a child and family. It will help to provide sound evidence on which to base often difficult professional judgments about whether to intervene to safeguard a child and promote his or her welfare and, if so, how best to do so and with what intended outcomes.
It is inevitable that each child protection referral will turn on its own facts but it is vital that all such referrals, whatever their origin, are taken seriously. Following appropriate assessment, and where appropriate police investigation, the local authority should take whatever action it considers necessary to safeguard the child and promote his or her welfare. This may include taking emergency action to protect the child or initiating proceedings in the family court.
Local education authorities must make arrangements for the provision of suitable education for children who cannot attend school for reasons of illness or injury, It is for each local education authority to decide in individual cases what is suitable provision and this might include, for example, home tuition. In making their decision, local education authorities would of course need to take account of advice provided by medical professionals. There should be close liaison between hospital consultants, general practitioners, schools and the appropriate local education authority, so that educational support can be provided quickly and effectively for sick children. The Department for Education and Skills will be publishing revised guidance on the education of sick children in the autumn.