.30 The following must also be consulted: the child’s IRO, the child’s relatives and parents where appropriate, the CCG (or local health board in Wales) that commissions secondary health care if the child requires secondary health services, and the Virtual School Head. 27 the arrangements which it will need to put in place to enable the child to access services such as primary and secondary health care. 79. Where the child will require specialist health services such as child and adolescent mental health services (CAMHS), the CCG (or local health board in Wales) that commissions secondary healthcare in the area authority should be consulted, so that the responsible authority can establish whether the placement is appropriate and able to meet the child’s needs. The designated nurse and doctor for looked-after children in the area authority will also be a valuable source of advice and information. 80. When a looked-after child or child leaving care is moved out of a CCG area, arrangements should be made through discussion between the “originating CCG”, those currently providing healthcare and new providers to ensure continuity of healthcare. CCGs should ensure that any changes in the healthcare provider do not disrupt the objective of providing high quality, timely care. The needs of the child should be the first consideration. 81. The Care Planning, Placement and Case Review (England) Regulations 2010 require local authorities making distant placements to consult with children’s services in the area of placement. They also require the Director of Children’s Services of the responsible authority to approve these placements.30 The process for making distant placements and who should be consulted is described in Statutory guidance on out of authority placements of looked-af