Ten top tips for the health service

Identifying and notifying private fostering arrangements

  1. Know the legal definition of private fostering

    Private fostering is when a child under the age of 16 (under 18 if disabled) is cared for by someone who is not their parent or a ‘close relative’. This is a private arrangement made between a parent and a carer, for 28 days or more. Close relatives are defined as step-parents, grandparents, brothers, sisters, uncles or aunts (whether of full blood, half blood or marriage/affinity).

    There is a duty on the part of parents and prospective carers entering into private fostering arrangements to notify their local authority. This is in order to safeguard and protect the child’s welfare as well as ensuring that the child, carer and parent are receiving appropriate support and help.

  2. Know what to do if you suspect that a child is privately fostered

    You also have a responsibility to safeguard the welfare of the children that you encounter in your daily work. If you think that a child is privately fostered, you should discuss this with the child’s carer and parent (if they are in contact with your service) and encourage them to notify the local authority of the arrangement. If you suspect that neither party has been in touch with the local authority, you should request their permission to contact them yourself. If consent is not given and you still suspect that the child is privately fostered, you should notify the local authority children’s services duty team. Where the child is of an appropriate age and understanding, you should consult with them and, if possible, obtain their consent. In some cases a patient may be a known private foster carer. It is still important to ensure that they have notified the local authority of this particular arrangement.Follow guidance about ‘What to do if you are worried a child is being abused’ published by the Department for Education

  3. Understand the rules about confidentiality

    Are you worried about breaching confidentiality? If, after advising the child’s carer to notify the local authority of a private fostering arrangement, you believe that they have not done so, by contacting the local authority you are ensuring that the child’s welfare and safety come first. A child in a private fostering arrangement who is not brought to the attention of the local authority is a child who may be in need or at risk of harm. You will be acting appropriately by informing the local authority. Be aware that some carers or parents may be anxious about having the local authority involved in their private arrangement. Reasons for this include:

    • a fear of racism
    • concern that the local authority may consider the arrangement unsuitable
    • because they have something to hide or simply
    • because they think that it’s nobody’s business but their own.
  4. Look for signs that a child might be privately fostered

    Consider the following:

    • Is the child under the age of 16 (or 18 if disabled)?
    • Has the child mentioned that they are no longer living at home or living with someone else?
    • Is the child accompanied to the clinic or GP surgery by someone other than a parent/recognised carer?
    • Is the carer vague about the child’s routines/needs?
    • Has a patient turned up at the GP surgery with a new child/ series of different children? Or, when you visit the home do you meet different children?
    • Is it clear with whom the child is living, and what relation the person is to the child?
    • If the child has come from overseas, do you know the purpose of the visit and the living arrangements? Are they accompanied by their parents? Is the child here for the purposes of education?
    • Ask whether the child is an unaccompanied asylum seeker. An unaccompanied minor who is not in local authority care may be living in a private fostering arrangement.
    • Could the child be a trafficked child?
  5. Ascertain who has parental responsibility for the child

    One way of ascertaining the relationship between the child and the person who accompanies them is to the clinic/surgery/school is to ask the latter whether they have parental responsibility (PR) for the child. A private foster carer does not have parental responsibility.

    • Who is looking after the child and what is their relationship to the child?
    • Do they have parental responsibility for the child? Can they provide documentary evidence?
    • Ascertain who does have PR, their relationship to the child, their whereabouts and whether they have given their agreement to this arrangement.
    • Who is able to provide medical consent for routine health care, immunisations and emergencies? If the carer cannot provide evidence of delegation of consent, ascertain how they intend to do so.
    • Who has the Personal Child Health Record and the child’s NHS card?
    • Do not confuse a privately fostered child from a child who is ‘looked after’ and is in local authority foster care.
  6. Check health records

    Check existing records to see whether there are any discrepancies, a lack of clarity about the child’s living arrangements and who has parental responsibility. Access previous health records for the child. Check existing records of the carer to ascertain any information that might tell you whether they have looked after other children under private fostering arrangements.

  7. Be alert to signs that a child may have been trafficked

    Trafficked children are particularly vulnerable and will often be reluctant to disclose details of their living arrangements. Some of the signs to look out for include:

    • A child who appears not to have any money but has a mobile phone and/or is expensively dressed;
    • A child who exhibits self assurance, maturity and self-confidence that you would not expect from a child of that age;
    • A prepared story very similar to those that other trafficked children have given;
    • Signs of physical or sexual abuse, and/or has a sexually transmitted infection, or unwanted pregnancy;
    • A history with missing links and unexplained moves;
    • A child who goes or appears to go missing for periods that are unexplained;
    • A child who appears to be malnourished, or who has an eating disorder;
    • A child who works very long hours and appears very tired;
    • Signs that the child is misusing alcohol, drugs or other substances;
    • Signs of self-harm, including cutting and overdosing;
    • A child who lives with adults who are not their parents and with whom they do not appear to have a good relationship;
    • A child who appears to have limited freedom of movement;
    • A child who appears excessively frightened of being deported;
    • A child who dresses in a manner inappropriate for her/his age;
    • An older child/teenager accompanied by an adult of whom s/he appears frightened;
    • A child who appears to be sexually promiscuous;
    • A child who is not registered with a GP and appears not to be enrolled in a school;
    • Any signs that the child has been brought into the country illegally for the purposes of adoption.
  8. Share your concerns with others

    Discuss your concerns with other health colleagues who may have contact with the child or the carer, including the school nurse. Contact the local authority private fostering officer for further advice and information to help you identify and notify a private fostering arrangement.

  9. Know what happens after you notify the local authority

    When the local authority receives notification about a private fostering arrangement they must arrange for an officer to visit within seven working days. The officer must see the premises, interview the child, carer and all members of their household, and at least speak to the parents. The local authority must carry out an assessment to ensure that the private fostering arrangement is suitable and can meet the welfare needs of the child. If the arrangement is deemed unsuitable, the parents may have to make alternative arrangements. In some cases this can mean the child coming into care. Where the arrangement is deemed suitable, the local authority must continue to visit and monitor the arrangement for as long as it continues.

  10. Find out more about private fostering

    • Invite the local authority private fostering officer to PCT or team meetings in order to help raise awareness about private fostering and forge professional links.
    • Ensure that you and your colleagues carry the telephone numbers of the local authority private fostering officer and duty teams.
    • Attend multi-agency LSCB training.
    • Get further information about private fostering by visiting the following websites:
      www.cfab.uk.net and www.ecpat.org.uk
Posted in Blog, Health.

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