s can be aggregated to help quantify the needs of the local looked-after children population and should be used by local authorities and CCGs as they develop their JHWSs.11 More information about the use of the SDQ for individual looked-after children can be found in Annex B. If they wish, local authorities may use other tools to supplement the SDQ. Commissioning health services 15. CCGs are the main commissioners of health services, with the exception of: • certain services commissioned directly by NHS England (primary care, high secure psychiatric services, highly specialist in-patient mental health services, other specialised services and the majority of health services for prisoners and members of the armed forces) • health improvement services commissioned by local authorities; and • health protection and promotion services provided by Public Health England. 16. All commissioners of health services should have appropriate arrangements and resources in place to meet the physical and mental health needs of looked-after children. 17. Services for individual children placed out of the CCG area should be consistent with the responsible commissioner guidance Who Pays? Determining responsibility for payments to providers (see pages 12 and 13 of that guidance). 18. CCGs should ensure: • they can access the expertise of a designated doctor and nurse for looked- after children (see page 13). Where a designated professional is employed by a different NHS organisation, this will need to be set out in a local agreement 10 The SDQ is an internationally validated brief behavioural screening questionnaire about 4-16 year olds. It exists in three parts: one for the carer, another for the child’s teacher and a third part for the child. While the Department for Education requires loc