Medication

It is essential that a child looked after or young person's medication record is kept clearly and accurately. Information about medication should be part of the initial medical examination and written health assessment and should be included as part of the ongoing medical examinations and health assessments held:

• at least once every 6 months before the child's fifth birthday;
• at least once a year thereafter.

1. Information about the child's medication needs should be included on the child's personal health plan.
2. Every child should be registered with a medical practitioner.  Carers should ensure the child consults the medical practitioner whenever the need arises.
3. Competence under the Fraser Guidelines is based on the ability to understand what is involved in each situation in which medical treatment is required.  Young people under 16 cannot, therefore, give blanket consent to medical treatment.  The situation is different, however, with respect to refusal of treatment.  The courts have decided that anyone with parental responsibility can, in certain circumstances, override the refusal of a (Fraser Guidelines) competent child.  Such circumstances have involved serious medical conditions such as anorexia, leukaemia and organ transplant. Urgent legal advice will need to be sought.
4. In the case of young people over 16, parental permission is not required and the young person may give consent to, or refuse, treatment although in certain circumstances a court may over rule this decision.
5. Carers must ensure that any medication is administered as prescribed.  Young people over 16 may hold and administer their own medication.  Some children under 16 may be able to self administer medication providing there has been a careful assessment of their ability which has involved a health practitioner responsible for prescribing the medication.
6. When a child is looked after issues of consent to treatment (which includes medication) must be clearly understood by the carers and the child:
   • for children under 16 who are accommodated the right to give consent on behalf of the child remains with the parents or those with parental responsibility
   • for children under 16 on a community parenting order then parents share parental responsibility with the department and it will be a matter of negotiation who should give consent, although parents should be consulted
   • the Fraser Guidelines (Mental Health Act 1983 Code of Practice 1999) indicate that young people under 16 have a right to confidential medical advice and treatment without parental consent providing all of the following apply
     • they understand the advice and are mature enough to understand what is involved
     • the doctor cannot persuade them to inform parents or those with parental consent
     • their physical or mental health will suffer if they do not have treatment
     • that it is in their best interests to be given such treatment without parental consent and
     • that in the case of contraception or substance misuse, the young person will continue to put themselves at risk of harm if they do not have the treatment.
7. Final decisions about competence rest with the medical practitioner.

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