A missing link in paediatric equity: healthcare Gold Card for children in care

A Gold Card for children in care would represent a step toward the kind of coordinated, child-centred healthcare we all strive for, writes Dr Suzanne Packer, AO FRACP.

After decades of working with vulnerable children and families, I continue to be confronted by the same truth: the children who need health care most often have the hardest time accessing it.

Children in out-of-home care arrive in the care system carrying not only the burden of trauma, but also the legacy of neglect — developmental, emotional and medical. Many of these children have never had the chance to become known and supported by a regular GP, to keep up to date with vaccinations, or to have early health concerns recognised and followed up. And yet we still expect these children to function in schools, homes and communities.

In theory, they are safely under our care. In practice, they are left to fall through the gaps of a healthcare system that is not designed for complexity and certainly not for continuity. This is not just a failure of compassion, it is a failure of clinical best practice.

That’s why I support the introduction of a national Gold Card for children in care. Not as a symbolic gesture, but as a much-needed structural reform that could support consistent, coordinated and trauma-informed health care from the moment a child enters the system through to adulthood.

More than safety and the case for stability

One of the enduring challenges in child protection is the way we define “success.” Too often, once a child is physically safe, the system moves on — ticking the immediate safety box and assuming the job is done. But the work of healing, development, and long term wellbeing doesn’t start and stop with safety. The important work begins once the child has achieved stability in daily life.

Despite decades of compelling evidence about the importance of early brain development, particularly for mental and emotional health, our policies and services have failed to reflect the urgency of these findings. The fact that we are still giving the same talks on infant mental health that we did 25 years ago is a damning indictment of our inertia.

For children who’ve had little or no stability, achieving predictability in healthcare can offer a critical foundation for their future lives. A regular GP, a known paediatrician, and access to consistent allied health professionals can help build trust, track developmental progress, and identify concerns early. Continuity of care isn’t a luxury; it is the very basis of effective paediatric practice.

Barriers to preventive supports

There are barriers to accessible services such as drop-in baby health clinics and community playgroups, that span logistical, social, economic, and emotional factors. These are the spaces that provide non-judgemental support, and which recognise and respond to the need for early intervention. In the past, these were often the trusted local supports for struggling families, especially those trying to parent differently from how they themselves were parented.

Now, too often families must present in crisis before they can get help. The path to support is increasingly bureaucratic and medicalised, denying carers and parents the opportunity to ask for guidance before problems escalate. This is particularly so for families who cannot use technology to get health referrals. The result? Missed diagnoses. Delayed treatment. Avoidable emotional distress. And in many cases, their adult lives are poorer than they should be because of these unaddressed issues.

A system designed for ticking boxes not building futures

Our current system rewards compliance over connection. Carers are left to find and organise appropriate health services on their own. GPs and paediatricians often see children with no medical history and no authority to act. Therapists operate in silos. Children are ticked off as having seen a specialist, but no one circles back to ask what changed, or what improved because of this service, or what needs to happen next.

In my own practice, I addressed this by inviting children in care to see me for regular, six-monthly reviews. These check-ins were not just clinically useful, but essential for the carers as well. Carers have almost no options for debriefing on their concerns and observations. These reviews became a safe space to debrief, raise concerns, and plan for the future. It was in those reviews that I learned so much — from the children, from the carers, and about the complexities of their lives.

The case for a Gold Card

This is where a Gold Card could make a meaningful difference, not just by covering the cost of care, but by legitimising a consistent, centralised approach to health support. It would signal to GPs, therapists, educators and carers alike that a child’s health matters not only today, but over the long term, enabling continuity across placements, providers and jurisdictions. This isn’t a new concept, such a system already exists and operates successfully for Veterans. It just needs duplication and refinement to focus on the health needs of children in care.

A national health register linked to the Gold Card would allow key professionals to access the same content, helping them deliver more timely, coordinated and effective care. For young children especially, therapeutic support in group-based settings such as specialised playgroups is critical. These children must be seen not only as medical cases, but as developing humans who need to learn within social environments. This social learning about relationships in early childhood is fundamental for our mental and physical health as adults.

For GPs, the Gold Card could reduce the burden of fragmented care by providing clarity around consent, medical history and referral pathways. It gives clinicians the tools to offer genuinely holistic, trauma-informed care, without the roadblocks.

Empowering the right clinicians

Some GPs may be reluctant to take on this work and understandably so. It is complex, emotionally draining, and time-intensive, often exceeding what a standard consult allows. In a system already strained by workforce shortages, brief appointments, and administrative burdens, few feel equipped to take on more without structural support. But for those who do see the value in long-term paediatric relationships, a Gold Card could provide the authority, continuity, and coordination needed to act early, follow through, and build trust.

The Gold Card would not fix everything. But it would be a start, a signal that these children are not just cases to be managed but lives to be supported. That healing takes time. That trust is earned. That care must be continuous.

It’s not just about the child

We must also support those who support the child. Foster and kinship carers are carrying extraordinary loads. We see many tapping into their Superannuation to fund and create suitable homes. Others fund therapy or support services out of pocket. The system often expects them to advocate, coordinate, and provide care with little or no relief.

When I asked one carer what would help, she didn’t say therapy or funding. She said: “An emergency pizza fund for the bad days”. That speaks volumes about the human realities we overlook. A Gold Card won’t cover everything, but it could at least guarantee that carers aren’t starting from zero every time a child arrives. Instead, they can continue to implement an established health care plan.

From fragmentation to collaboration

Years ago, it seemed more possible in communities to bring education, police, child protection and health professionals together at the same table to plan for the needs of a single child. Today, the well intentioned privacy laws are too often misapplied, creating barriers and excuses, which prevent this kind of collaboration. The result is a fragmented system where no one holds the full picture of the child’s life and difficulties, and the child bears the cost.

The Gold Card could help change that. It has the potential to act as a catalyst for integrated case planning, by linking children’s records to a shared digital platform or portal accessible by case managers, foster carer, educators and allied health providers, allowing all stakeholders to contribute to and update a single, unified care plan for the child. Every service touchpoint, from school to dental care can be logged and tracked, supporting continuity across placements, reduced duplication of assessments and referrals and stronger advocacy for the child’s needs over time.

The Gold Card would mean a return to shared decision making, to seeing the child not as a problem to be managed, but as a person with potential. A return to remembering why we entered this work in the first place.

As medical professionals, we have a unique opportunity to advocate for systems that support the care we know is needed. We are not just service providers; we are witnesses to what happens when care is inconsistent and disconnected. The Gold Card represents a step toward the kind of coordinated, child-centred healthcare we all strive for.

These children deserve nothing less than a system that sees them, supports them, and stays with them.

For more information visit https://www.futureoffostercare.org.au/  and https://www.cfecfw.org.au/

About the centre for excellence in child and family welfare

The Centre is Tasmania and Victoria’s peak body for child and family services. For over 100 years, the Centre has advocated for the rights and wellbeing of children, young people and families, ensuring their right to be heard, to be safe, to access education and to remain connected to family, community and culture. For more information visit www.cfecfw.org.au.