Who can make decisions about a child’s medical care in kinship care?

The person who can consent to a child’s medical treatment is usually the person with parental responsibility, unless the child is mature enough to consent for themselves or authority has been delegated to someone else. A kinship carer does not automatically gain parental responsibility simply because the child lives with them. The exact position depends on the legal arrangement and the type of treatment involved.

What parental responsibility means

Parental responsibility is the legal authority to make important decisions about a child’s upbringing, including healthcare. It may be held by a parent, an adopter, a guardian or another person granted it by a court. A kinship carer may also have parental responsibility through a child arrangements order or a special guardianship order. If the child is looked after by the local authority under a care order, the local authority shares parental responsibility with the parents and may limit how it is exercised.

Where a kinship arrangement is informal, the child’s parents normally retain parental responsibility. The carer can look after the child and deal with ordinary healthcare needs, but should not assume that they can consent to every form of treatment. The written agreement made with the parents, social worker or local authority should explain who is expected to arrange appointments, provide consent and receive medical information.

Routine healthcare

Everyday decisions can often be made by the person caring for the child, particularly where they are necessary to keep the child well and are consistent with the care plan. Examples may include taking the child to a GP or dentist, accepting advice about minor illness, agreeing to ordinary examinations and giving medication in line with instructions already provided.

Healthcare professionals may ask the carer to show evidence of their relationship to the child or their authority to act. Keep copies of relevant court orders, placement documents, written delegation arrangements and contact details for the child’s social worker. Taking these documents to appointments can prevent uncertainty, particularly when the child’s legal status is not obvious from their medical record.

Significant treatment and procedures

For operations, procedures involving anaesthesia, some vaccinations, mental health treatment, admission to hospital or treatment with substantial risks, the clinician will need to identify the appropriate decision-maker. They may seek consent from a person with parental responsibility or confirmation that authority has been delegated to the carer or local authority.

Having parental responsibility does not mean every person with it must sign every consent form. In many situations, one person with parental responsibility can give valid consent. However, a healthcare professional may involve other people where there is disagreement, a serious risk, a court order, or uncertainty about who has authority. A parent’s objection should not be ignored, particularly where the proposed treatment is significant or legally complex.

The child’s own views

Children should be involved in decisions about their healthcare in a way that reflects their age and understanding. A child under 16 may be able to consent to treatment if they understand its nature, purpose, benefits, risks and alternatives well enough to make the decision. This is commonly referred to as being Gillick competent . A young person aged 16 or 17 is generally presumed to have capacity to consent to their own medical treatment, although there can be exceptions where capacity is in question.

Consent must be voluntary and informed. A child who understands the decision may not simply be overruled because an adult disagrees, although professionals may need to take further advice where treatment is refused or the child’s safety is at risk. The clinician, rather than the carer, assesses the child’s capacity for the particular decision.

When authority has been delegated

For children in care, the local authority’s care plan should set out who can make different types of healthcare decision. Authority may be delegated to a kinship foster carer for routine or specified matters, but the limits should be clear. Delegation for one decision does not necessarily give the carer authority for all future treatment.

Ask the social worker or supervising professional to confirm the arrangement in writing if the paperwork is unclear. The confirmation should identify the child, the carer, the decisions covered and any matters that must be referred back to a parent, the local authority or the court.

Emergency treatment

In an emergency, doctors can provide treatment that is immediately necessary to protect the child’s life or prevent serious deterioration when it is not practical to obtain consent first. The medical team should record why urgent treatment was required and will normally contact the relevant parent, local authority or carer afterwards.

If parents and carers disagree

Do not delay urgent medical care while trying to resolve a disagreement. For non-urgent treatment, ask the clinician to explain whose consent is required and request a written record of the issue. Speak to the child’s social worker, the local authority’s fostering or kinship care team, and any guardian or solicitor involved in the case.

If the disagreement cannot be resolved, the matter may need legal advice or a court decision. The appropriate route depends on the child’s legal status and the treatment proposed. A carer should not sign a consent form simply because they are the child’s day-to-day caregiver if they are unsure that they have authority to do so.

Practical steps for kinship carers

• Ask for the child’s legal status and healthcare decision-making arrangements to be explained at the start of the placement.
• Keep copies of court orders, placement agreements and any written delegation of authority.
• Tell the GP, dentist and hospital who the child lives with and who can consent to treatment.
• Ask clinicians to distinguish between routine care, planned significant treatment and emergency treatment.
• Make sure the child’s views are heard in an age-appropriate way.
• Record appointments, advice, medication and consent decisions, especially where responsibility is shared.
• Obtain specialist legal advice if the child’s parents disagree, the treatment is serious, or the legal documents conflict.

The safest approach is to check the child’s legal status and written care arrangements before a significant appointment. This gives the healthcare professional a clear basis for deciding who can consent and helps ensure that the child’s welfare remains the central consideration.