Medical adviser to adoption agency

All health care staff need education, support, and leadership both locally and nationally in order to fulfil their duties in meeting the needs of both children and young people in care, and care leavers.

These role descriptions should be read in conjunction with appropriate level 3 (link to IHA section), 4 and 5 competencies. Significant expertise, knowledge and skills related to health and outcomes for children and young people in care, and care leavers is a pre-requisite for senior posts.

These posts should be separate to other safeguarding children, young people, and adult posts.

The post holder must have an enhanced disclosure check, in line with health professionals in clinical practice working with children and young people less than 18 years old. These professional posts comprise a regulated activity under the Disclosure and Barring Service (DBS) (for England and Wales), Disclosure Scotland (for Scotland) and Access Northern Ireland (for Northern Ireland).

Professionals should be of good professional standing.

All adoption agencies must have a medical adviser (Adoption Agency Regulations 2005 for England; Adoption Agencies (NI) Regulations 1989 for Northern Ireland; Adoption Agencies (Scotland) Regulations 1996; Adoption Agencies (Wales) Regulations 2005) who is fully registered with the General Medical Council and has an enhanced disclosure check under the Disclosure and Barring Service (DBS) (for England and Wales), Disclosure Scotland (for Scotland) and Access Northern Ireland (for Northern Ireland).

There is considerable variability in arrangements across the UK, so this job description will need to be tailored to meet local needs and demands of a particular post.

The job description should be jointly agreed by the relevant health trust(s)/health boards/adoption agency(ies) covered by the post. It is important that the job plan reflects the workload, as this is frequently underestimated. Throughout this job description, where the term children and young person in care is used, this applies to children with a care plan for adoption.

The medical adviser (MA) for adoption must:

• be an advocate for children for whom the care plan is adoption
• have undergone higher professional training in paediatrics. Alternatively, by virtue of experience and practice, have demonstrated appropriate competencies, for example paediatricians following the SAS (Specialty and Specialist Doctors) career route, as advised by the level 5 senior strategic lead/designated doctor for children and young in care (England and Northern Ireland)/lead clinician for children and young person in care and accommodated children (Scotland)/level 4 senior/named doctor for children and young person in care strategic role (Wales) (see relevant job description)
• have relevant experience of working with children in care and in the clinical management of children including those with neuro-developmental, emotional, behavioural and attachment difficulties, child protection, and adult health issues pertinent to parenting. The role of Medical Adviser for Voluntary Adoption Agencies, who largely recruit adult carers, may be undertaken by a GP with expertise or other registered medical practitioner who has relevant specialist training. However, they should have knowledge of the complex presentation and needs of children in care as these agencies are likely to be recruiting carers for such children.

For medical advisers, whose sole role is as medical adviser to adoption panel it is important that they keep up to date with paediatric practice and:

• have the ability to achieve other competencies as appropriate to the role
• have experience of, and the ability to work in, a multi-agency setting
• have relevant knowledge of health and developmental issues of children adopted from abroad, if providing intercountry adoption services
• have good verbal and written communication skills, with an ability to express complex medical issues in lay terms

• it is preferred practice, but not obligatory, that the medical adviser should undertake statutory health assessments of children and young in care
• provide a written health report on each child being considered for adoption, which should include comments on birth history, family history, past medical history, current physical and mental health, and current behaviour. If age appropriate, a developmental or functional assessment, should assess the future implications for the child of their health history, and previous family and social situation, including their experiences in the care system
• provide a written report to the agency on the health of prospective adopters, which will include interpretation of health and lifestyle information provided by the applicant and their GP; it may be necessary to liaise, with consent, with specialists including the Named GP for safeguarding about details of health problems identified
• it is good practice for the medical adviser to share all appropriate information with prospective adopters and to meet with them to discuss the needs of the child or children with whom they are matched, it is also good practice to provide a written report of this meeting
• be available to advise prospective adopters on health matters of children being considered for adoption from abroad, and ideally undertake health assessment of the children
• be available for the agency decision maker (ADM) as required to advise on health implications for the child

• serve as a full panel member to the adoption panel, with the responsibility for taking part in panel consideration of cases and to contribute to the panel recommendation. Responsibilities of all panel members include attending a locally agreed percentage of all panels, attending panel training, and having an annual appraisal as a panel member. The minimum attendance which is usually required at panels is 75%
• as specified in the Adoption Agency Regulations for England and Wales, and the National Minimum Standards, the medical adviser should work in partnership with the adoption agency to ensure that the written summary health report on the child and adult will be available to the agency in time to allow circulation to panel members in advance (e.g. for child, Part C of Form Initial Health Assessment – children and young people)
• be available at panel to discuss their written report and to answer questions on health issues at the request of other panel members
• contribute to the identification of adoption support needs
• contribute to court reports on children in placement orders/freeing orders and adoption order applications, and on prospective adopters

The medical adviser for adoption should:

• advise on particular health matters that arise in connection with the adoption process
• support and advise other health professionals and relevant managers on health issues relevant to adoption for example, consent issues for children placed for adoption, and adoption support including post placement
• work closely with the local safeguarding and health professionals working with all children and young people in care and accommodated children to ensure delivery of high-quality clinical services through monitoring and audit
• maintain contact and work closely with local paediatricians, local child and adolescent mental health services, primary care, and other relevant health professionals and specialists
• work closely with partner agencies to address the health needs of children who have a care plan for adoption
• work closely with the adoption agency and the heath provider to influence processes and pathways that improve timely health outcomes for children for adoption
• be able to offer training on adoption matters to health personnel, prospective adopters, and partner agencies, including adoption agency, panel, and carers
• ensure that personal practice conforms to policies and procedures relevant to adoption, as outlined in statute and professional practice guidelines

• as a specialist post, the medical adviser is likely to be unique within their provider service; therefore, it is essential to maintain contact with other medical advisers regionally and nationally; membership of the (UK membership organisation for professionals working across adoption and children in care) Health Group is recommended as it offers professional support, notification of training opportunities, updates on policy and practice, and access to national and regional meetings
• the medical adviser should attend continuing professional development (CPD) activities in order to maintain competencies in the area; the medical adviser should also attend general panel training to maintain awareness of adoption practice and legislation, including intercountry adoption, where dealt with by the agency; it is the responsibility of the employer to support specialist training which is likely to be external
• the medical adviser will also need to access CPD in general, and developmental paediatrics to ensure an up to date knowledge base from which to advise the adoption agency

• the medical adviser should have a professional appraisal on an annual basis; ideally opinions and feedback should be sought from a colleague with expertise in adoption to support the appraisal process and ensure competency
• medical advisers on panels in England and Wales will require an annual appraisal as a panel member, as outlined in statutory Guidance for England (Adoption and Children Act 2002 Guidance Department of Health) and Regulations for Wales (Adoption Agency Wales) Regulations 2005.

• programmed activities for the post should be agreed and a corresponding adjustment made to the medical adviser’s other clinical duties within the job plan (see below)
• programmed activities available should be proportionate to the population of children for adoption in the locality
• appropriate administrative support for the medical adviser should be agreed with capabilities to manage the sensitive and specialised nature of the work
• there should be support and supervision for the individual. This is an acknowledgement of the sometimes stressful nature of this work

 (these have not been updated from the last edition)

These recommendations have been derived by consensus from consultation with the CoramBAAF Health Group Advisory Committee and regional health groups, and prospective audit of services. These recommendations reflect the actual time required to undertake specific tasks and should be used as a guide to long term planning for delivery of high-quality services.