Fostering Medical Assessments

The Fostering Medical Assessment Process

In this article experienced fostering and adoption medical adviser Dr Matt Orr explains the reasons behind the medical assessment, how the process works and tips on how to make the process go smoothly.

Why do I need a medical assessment?

There is statuary requirement to assess the health of prospective foster carers. Under Regulation 26, schedule 3 of the Fostering Services (England) Regulations 2011, fostering agencies must obtain a medical report on all prospective foster carers as part of the assessment process.

Regulations aside, the medical assessment process and provision of a medical report is essential to ensure that any prospective foster carers can consistently meet the needs of a child or young person in their care.

Children enter foster care for a variety of reasons, often due to circumstances beyond their control. Many have experienced neglect, abuse, parental substance misuse, domestic violence, or family breakdown, which can leave lasting emotional and psychological effects. Some children may have been removed from their birth families due to safeguarding concerns, while others may have experienced multiple placement moves, leading to instability and a lack of trust in adults. These experiences make them vulnerable, often manifesting in challenging behaviours such as difficulties with attachment, emotional regulation, and trust. Some children may struggle with anxiety, aggression, withdrawal, or difficulty forming relationships, as their early experiences have shaped how they respond to the world around them. Others may have additional needs, such as developmental delays, disabilities, or special educational or physical needs, requiring extra support. Foster carers play a crucial role in providing the stability, patience, and nurturing environment these children need to heal, develop, and thrive. This requires potential foster carers to have adequate health and resilience to cope with these potential challenges.

How does the medical assessment process work?

Applicant health declaration

Each applicant completes a declaration of their own health, usually using the form AH. This has questions about health, lifestyle and family history. Some of the questions may seem slightly irrelevant, but it is important to complete all the sections open and honestly. One example would be the question about occupation, this provides a wealth of information. For example, if you occupation requires lots of heavy lifting on a daily basis, you are unlikely to struggle with the lifting and bending involved in the care of a young child. Similarly, please do complete the exercise and lifestyle section with as much detail as possible, as this can provide a vital window into your physical abilities.

Honesty is key when completing the form. Intentional failure to declare something on the medical form that is discovered later in the assessment process may not reflect well. It will also make assessing your suitability more difficult and may cause delay while further information is sought.

If you have any medical conditions, particularly those that might affect your day-to-day activities, affect your ability to work or trigger the payment of incapacity or disability benefits (such as ESA or PIP), please ensure that you add as much information about how these impact on your ability to carry out everyday tasks and what, if any support your require to manage these. Without this information, there may be delays to the assessment process while this information is gathered at a later date.

Whilst the medical information you provide is kept confidential from anyone outside the assessment process, it will be seen by your GP and the agency medical adviser. Your social worker and members of the fostering panel will also see a summary of the information.

GP medical assessment

After you have completed the applicant section of the form AH you will be required to make an appointment with your GP, where they will check the information you have provided on the form AH matches that on the medical records, and they will add any information missing. They will also carry out a very brief examination consisting of height, weight, blood pressure check and a dip test of your urine. This completed form with then be forwarded to the agency medical adviser who will prepare a medical report.

Fostering medical report

It is the responsibility of agency medical adviser to summarise any medical conditions and explain how these could potentially impact on your ability to manage the demands of fostering. This report will look at your current health and how your health might develop in the future. If you are considering long-term fostering, it is important that the fostering agency can be assured that your health is likely to remain sufficient throughout the length of the placement. This is not an exact science and people’s health can change suddenly. However, it is important to be able establish as best as is possible if you are likely to remain in good enough health until a child or young person reaches adulthood.

The agency medical adviser does not make a decision regarding your medical suitability but rather acts to explain in lay terms to the foster panel members what your medical conditions mean and how they might have an impact.

The medical adviser may also make a recommendation on the likely suitable type and length of placement and any support that may be required, but this is only a recommendation. The panel make the final decision.

Should further enquiries or exploration be required regarding any medical issues, the medical adviser would outline any action required.

Frequently asked questions

Are there any medical conditions that would prevent me from fostering?

There are no single medical conditions that would absolutely bar an applicant from applying to be a foster carer and each case is assessed on an individual basis. However, some examples of conditions where it might not be appropriate include conditions such as a life limiting illness with only a very short life expectancy or severe disability where the applicant themselves requires a significant level of care and therefore has very little or no capacity to care for a child or young person. This list is not exhaustive but gives some idea of conditions where the applicant is very unlikely to be approved.

What if I smoke?

It is now well established that passive (second-hand) smoke is very dangerous and poses a serious health risk to those exposed to it. Even if a person smokes outdoors, there is still some risk that particles will enter the home and could affect the other occupants. It is a particular risk to children under five and those with certain medical conditions. You are therefore unlikely to accepted as a foster carer for a child under five if you smoke. You will also be required to not smoke in the house or car.

What about vaping?

Vaping will not prevent you from fostering. However, you may be required to not vape within the home or car.

There is still very little data on the long-term effects of vaping on the person vaping and those passively exposed. However, it is thought to be less harmful than smoking but is not risk free. It has been used successful to aid smoking cessation. However, there is a potential that the vapour discharged could be irritant to children with respiratory conditions. There is also a potential risk of role modelling, whereby a child or young person might want to copy your behaviour. It should also be noted that nicotine should be kept safely away from children at all times as it can cause serious harm if ingested.

Can I foster if I am overweight or obese?

Being overweight or obese is not a barrier to fostering. There are, however, several considerations.

Being overweight or obese increases the risk of a variety of health conditions including diabetes, heart disease and certain types of cancers. The presence of obesity would be taken into consideration along with any other risk factors when looking at potential long-term health.

It is also important to establish that a child will be provided with a health balanced diet and lifestyle. Some exploration would therefore need to take place regarding how a child would be provided with a consistently healthy lifestyle.

Lastly, very severe obesity can occasionally have an impact on functional ability. Should this be the case, any impairment would need to be taken into consideration.

What if I’ve had mental health issues?

Fostering can be a demanding and at times, stressful role. Therefore, a certain level of mental resilience is required. As you have read above, children in foster care, often need additional emotional support, which requires a certain level of emotional responsiveness. If a foster carer is having difficulty with their own mental health issues, it can sometimes be difficult to be emotional available enough and it can make it more difficult to cope with the some of the challenges faced in fostering.

However, having a current or previous mental health issues is not always a barrier to fostering.

Mental illness is very common. It is estimated that up to 50% of people will suffer from a mental health condition in their lifetime. These conditions are therefore commonly noted on health declarations, with many applicants successfully being approved.

Each case is assessed individually and various factors considered such as the severity and impact of the condition, whether it is currently controlled, the likelihood of recurrence and what treatment and support are available.

Am I too old?

Age is not a barrier to fostering and with age comes very useful life experiences which can be invaluable. However, with age also comes are-related health issues. The general health of the applicant is more important than their age. However, with long-term fostering, age must be a consideration due to the fact that the likelihood of many health conditions including dementia, cancer and cardiovascular disease such as strokes and heart attacks significantly increases in likelihood with age.

As discussed already, each case is considered on a case-by-case basis.

About the author

Dr Matt Orr has been an NHS GP for over 20 years and a fostering and adoption agency medical adviser for over 15 years, having provided many thousands of medical reports during that time. He founded Orr Medical in 2010 to provide a reliable and responsive service to fostering and adoption agencies throughout the UK. Now with over 50 clients, Orr Medical is the UK’s number one provider of fostering and adoption medical reports.

Find out more about fostering, adoption and the medical assessment process at Expert Fostering & Adoption Medical Assessments