Who makes healthcare decisions for a baby in foster care?

Healthcare decisions for a baby in foster care are governed by parental responsibility, the legal basis of the placement and any authority delegated to the foster carer. The person who can consent may therefore differ from one placement to another, and the details should be recorded in the baby’s placement plan and discussed with the fostering and social work teams.

Parental responsibility and the placement’s legal status

Parental responsibility is the legal authority to make important decisions about a child’s upbringing, including healthcare. A baby’s birth mother usually has parental responsibility, and a birth father may also have it depending on the circumstances. A local authority does not automatically acquire parental responsibility simply because it is looking after a baby. Its authority depends on the legal order or agreement under which the child is accommodated.

For example, where a baby is accommodated with the agreement of the people with parental responsibility, those people generally continue to hold that responsibility. Where a court has made a care order, the local authority shares parental responsibility and can make decisions within the scope of that order. A court may also make specific directions about particular medical decisions. These arrangements must be checked rather than assumed.

What foster carers can usually decide

Foster carers are not normally given parental responsibility merely because a baby lives in their household. However, the local authority or another person with parental responsibility may delegate authority for day-to-day healthcare. This commonly allows a carer to:

• register the baby with a GP, health visitor or dentist;
• take the baby to routine appointments;
• consent to ordinary examinations and treatment where the authority has been delegated;
• follow prescribed medication instructions;
• arrange treatment for minor illnesses or injuries in accordance with the placement plan; and
• share relevant information with healthcare professionals to support the baby’s care.

The exact limits are important. Delegated authority may cover routine healthcare but exclude procedures, vaccinations or treatments that are considered significant in the circumstances. Foster carers should read the written arrangements and ask the child’s social worker or supervising social worker if the wording is unclear before consenting to anything outside normal day-to-day care.

Decisions that may need wider agreement

Significant medical treatment, surgery, invasive procedures, decisions with lasting consequences and treatment where there is a serious disagreement may need consent from the relevant person with parental responsibility or direction from the court. The social worker should establish who needs to be consulted and ensure that the healthcare professional has the correct consent.

There is no single list that makes every decision automatically routine or significant. The baby’s age, health, diagnosis, urgency and the likely consequences of treatment all matter. A vaccination, for instance, may be dealt with under the placement’s agreed healthcare arrangements in one situation, while a particular medical procedure may require further consultation. Foster carers should not rely on informal assumptions or on what happened in another placement.

What happens in an emergency?

If a baby needs urgent treatment, the priority is obtaining necessary medical care and telling the relevant professionals as soon as possible. Doctors can act in an emergency where treatment is needed to prevent serious deterioration or save the child’s life, even when it is not practical to obtain prior consent from every person with parental responsibility. The foster carer should explain the placement circumstances, provide the contact details held for the social work team and follow the hospital’s safeguarding and consent procedures.

Afterwards, the foster carer should inform the child’s social worker and fostering team, keep a record of what happened and retain discharge information or follow-up instructions. Any further treatment should be considered under the baby’s agreed authority arrangements.

Birth parents’ involvement

Birth parents may remain involved in healthcare decisions, particularly where they retain parental responsibility. Their views should be considered in accordance with the legal arrangements, the baby’s welfare and any court directions. This does not mean that every appointment or decision can be delayed while agreement is sought. The social worker should explain how consultation will work, who will communicate with the parents and what will happen if views differ.

Foster carers should not make promises to birth parents about treatment, withhold relevant information or attempt to resolve a legal disagreement themselves. They should pass questions to the child’s social worker, who can coordinate with the local authority, health professionals and, where necessary, legal advisers or the court.

The baby’s health information and records

Foster carers need enough health information to provide safe daily care. This may include the baby’s medical history, allergies, medication, immunisation record, developmental checks, hospital letters and details of ongoing referrals. They should receive information on a need-to-know basis and keep it securely, following the fostering service’s requirements for confidentiality.

At appointments, carers should tell professionals that the baby is looked after and explain who has authority to consent. They should take the child’s health record and placement documentation where appropriate, make sure advice is understood and record any change in medication or follow-up care. If information is missing, the carer should raise this promptly rather than guessing about the baby’s history.

What to check before a baby is placed

Before or at the start of a placement, foster carers should ask for clear written information about:

• the legal basis of the placement and who holds parental responsibility;
• which routine healthcare decisions are delegated to them;
• any decisions requiring consultation or specific consent;
• the arrangements for vaccinations, hospital appointments and medication;
• who should be contacted in an emergency or if professionals disagree; and
• how birth parents will be involved and informed.

These arrangements can change if the court makes a new order, the baby’s health needs alter or the placement plan is reviewed. Foster carers should ask for the written plan to be updated when authority or responsibility changes. When in doubt, they should contact the child’s social worker before making a non-urgent decision. The aim is to ensure that the baby receives timely care while every decision is made by the person legally authorised to give consent.