Objective: To examine the outcomes of statutory health assessment of children looked after by an English City Council.
Design: Retrospective longitudinal documentary analysis.
Setting and participants: Health records of all children looked after by Southampton City Council who had attended at least two statutory health assessments within a designated paediatric service from 1996 to 1999.
Main variables studied: Demographic characteristics of the children; physical and mental health problems identified at assessment and extent to which health recommendations were implemented.
Results: Twenty-seven boys and 22 girls aged 6 months-15 years were identified who had attended at least two assessments. One-hundred and four physical and mental health needs were identified at care entry requiring further assessment or intervention. More health problems were identified for girls than boys. At care entry 15/49 of the children were not fully immunized. At review, on average 14 months later, recommendations had only been implemented in just over half of children.
Conclusions: In common with previous studies this work confirms that the statutory health assessment identifies health need and health neglect that may otherwise go unrecognized. Whereas children's needs and problems were diverse, many continued to suffer health neglect in the system of public care designed to help them. In order to be effective, statutory health assessments must be a health promoting rather than disease screening exercise delivered by professionals skilled to address diverse health needs. Crucially, the heath assessment can only succeed as a tool for health advocacy if complementary to and integrated with local authority care and review.