Safeguarding Children Annual Report. Reporting period April (2012) March (2013)

Transcription

1 Safeguarding Children Annual Report Reporting period April (2012) March (2013)

2 Table of Contents Section Title Page Section One Introduction 3 Section Two National Context 3 Statutory responsibilities A brief outline of Statutory Responsibilities Brief outline of safeguarding duties Section Three Local Context 5 Progress on Priorities Governance Performance Trafford Safeguarding Children Board (TSCB) Child Death Review Process Integrated Inspection SCRs/DHRs Section Four Conclusion 17 Priorities for the year ahead 17 Section Five Appendices 18 2

3 1.0 Introduction This is the first safeguarding report for the NHS Trafford CCG and sets out progress and developments from 1 st April 2012 to March 31 st March National Context 2.1 Statutory responsibilities Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any service that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children. Section 11 places a duty on NHS organisations, including the NHS Commissioning Board (NHS CB) and Clinical Commissioning Groups (CCGs), NHS Trusts and NHS Foundation Trusts Safeguarding children practice is further directed by the following legislation, guidance and reports (not exhaustive); Children Acts 1989 and 2004 Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004 (HM Government 2007) Working Together to Safeguard Children (HM Government 2013) Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (2013), NHS Commissioning Board The Munro Review of child protection. A child centred system (2011) A child centred system. The Government s response to the Munro review of child protection (2011) Common Assessment Framework for Children and Families (2005) Child Protection Responsibilities of Primary care Trusts (2002) Every Child Matters (2004) Children s NSF (2004) Quick reference guide: When to suspect child maltreatment, National Institute for Health and Clinical Excellence (2009) Care Quality Commission Review of arrangements in the NHS for safeguarding children (July, 2009) The Protection of Children in England: A progress Report (Laming, March 2009) The Protection of Children In England Action Plan: The Government Response to Lord Laming (May, 2009) GM/Trafford Safeguarding Children Board safeguarding children procedures Statutory Guidance on promoting the Health and well-being of Looked After Children (DH 2009) The implications and detail of the Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (listed above) in relation to children and young people is further described particularly in sections 2.2, 2.3, 3.2 and 3.3 of this report From April 2013, CCGs led by GPs and other clinicians are responsible for commissioning most local healthcare services. The NHS Commissioning Board (NHS CB) will support CCGs and hold them to account. The NHS CB is responsible itself for commissioning some services, namely primary care, specialised health services, prison health care and some public health services 3

4 (for example health visiting until 2015). The Local Authorities are responsible for most local public health services (this will include health visiting services from 2015), supported by Public Health England. The focus remains on improving outcomes and driving standards of care for the population as a whole, but with an emphasis on tackling inequalities 2.2 A brief outline of statutory responsibilities The NHS CB, CCGs and NHS provider organisations should have in place arrangements that reflect the importance of safeguarding and promoting the welfare of children including; A clear line of accountability for the commissioning and or/provision of services designed to safeguard and promote the welfare of children A senior board level lead to take leadership responsibility for the organisation s arrangements Clear arrangements for information sharing with other professionals and the Local Safeguarding Children Board (LSCB) A Designated professional lead (in commissioning organisations) Named professionals lead (in provider organisations) Safe recruitment practices and policies Appropriate supervision and support for staff, including access to mandatory safeguarding children training in keeping with national guidance 1. This includes those who predominantly work with adults Clear policies in line with those from the LSCB 2.3 Brief outline of safeguarding duties Health professionals are in a strong position to identify and respond to safeguarding concerns. This includes understanding risk factors, communicating effectively with children and families, assessing needs/risk and capacity as well as sharing information with other agencies in order to promote an appropriate response Certain health care staff are key to safeguarding and promoting the welfare of children and these include, for example; Health visitors GPs School Nurses Paediatricians Those working in maternity Child and adolescent mental health workers Adult mental health workers Those working in alcohol and drug services Unscheduled and emergency care settings and secondary and tertiary care NHS CB is responsible for ensuring that the health commissioning system as a whole is working effectively to safeguard and promote the welfare of children as well as being accountable for the services it directly commissions. The NHS CB will also lead on improvement in safeguarding practice and outcomes. This means that the NHS CB should ensure that there are effective mechanisms for 1 Safeguarding Children and Young People: roles and competencies for health care staff, Royal College of Paediatrics and Child Health (2010) 4

5 LSCBs and Health and Well Being Boards to raise concerns about the engagement and leadership of the local NHS. From 1 st April 2013 CCGs are the major commissioners of local health services and will be responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. CCGs should employ or have in place a contractual agreement to secure the expertise of designated professionals All providers of NHS funded health services including NHS Trusts, NHS Foundation Trusts and public, voluntary sector, independent sector and social enterprises should identify a named doctor and named nurse (and named midwife where maternity services are provided). GP practices should have a lead for safeguarding, who should work closely with named GPs Local Context Trafford has approximately 56,500 children and young people aged 0 to 18, representing nearly 25% of the total population of the borough 3 Trafford Children and Young People Service (CYPS) was formed in 2007, as a unique partnership between the Local Authority, Primary Care and Acute Hospital Trusts. Its vision was based upon a determination to ensure better outcomes for children and young people by providing integrated commissioning and delivery services. These were to be co-ordinated around the needs of the child or young person, rather than the needs of the organisations responsible for commissioning and delivering these services. This vision remains at the heart of the CYPS model. The Trafford CYPS brings together staff from the council, Bridgewater Community Healthcare NHS Trust (until 31 st March when the NHS provider will be Pennine Care NHS Foundation Trust), Central Manchester Foundation Trust (CMFT) and Greater Manchester Police who are all deployed into the service under a strategic partnership agreement. This makes for an integrated approach to the delivery of children s services with multi-agency teams co-located, for example: 3 Area Family Support Teams which include professionals groups such as (not exhaustive) health visitors, school nurses, social workers Multi-agency referral and assessment team the front door of Children s Social Care (this team includes a health practitioner) The multi-agency Youth Offending Service (YOS), which also includes a health practitioner CAMHS Children with Additional Needs Service (CANS) The Safeguarding Children Health Team which consists of : the Designated Nurse Safeguarding Children and Children in Care 3 Named Nurses Designated doctor Safeguarding Children and Children in Care Named Doctor 2 Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children: HM Government (2013) 3 Child Health Profile (2013), ChiMat 5

6 2 Children in Care Nurses 1 Health Visitor based in the YOS Named GP (part of wider team, not part of CYPS) Health visitor liaison Health staff are essential in order to drive joint working with partner agencies, particularly children s social care colleagues so that best outcomes may be achieved for the most vulnerable children in Trafford. With regard to vulnerable children and young people, at the time of writing this report the following data was relevant: 1,345 cases open to Trafford Children s Social Care, of which, 785 child in need cases (58.36% of open referrals) 292 children in care (26.69% of open referrals) 215 children subject of a child protection plan (15.99% of open referrals). Of the 215 child protection plans, the categories of registration are; Emotional abuse: 92 (42.8%) Neglect: 96 (44.7%) Physical: 15 (7%) Sexual: 11 (5.1%) Multiple: 1 (0.5%) 4 The purpose of highlighting the above data in this report is to illustrate the numbers of known vulnerable children and young people in Trafford (who have met the criteria for Children s Social Care involvement) at any one time, rather than provide any analysis of what such data tells us. Analysis of data relating to open cases to children s social care is an ongoing key feature of work within CYPS. There is an even majority spread of children subject to a child protection plan between those residing in the West (34 of these in the Partington area) and North of the borough, with 49 children in central (Sale area) and 29 in the South. Data regarding the number of Common Assessment Framework (CAFs) completed is collated by the Local Authority which demonstrates a continuing increased use of the CAF in which to engage with/assess children and families at a level below which Children s Social Care are involved. The number of CAFs initiated in October 2012 was 180 and has risen to 272 at the end of March Work is underway to assist with the provision of data regarding how many CAFs are completed by health professionals. The open referrals to Children s Social Care described above form a major part of the work undertaken by health professionals across the health system, particularly health visitors and school nurses In Trafford, health visitors and school nurses continue to prioritise safeguarding children work, particularly regarding the contribution to multi-agency assessment and planning, for example, case conferences, core groups and Multi-Agency Risk Assessment Conferences (MARAC) 5 4 Social Care Summary document (April 2013), Trafford Council Performance & Partnership Team 5 MARAC is the (victim led) forum to which high risk domestic abuse cases are referred for multi-agency assessment and planning 6

7 The Health Visitor Call to Action implementation plan is on target for Trafford 6 with the expectation that Trafford meets the target of 15 extra whole time equivalent health visitors by April 2015 This additional health visiting resource will be utilised for the delivery of the early help agenda, together with a more focused support package around maternal emotional and mental health. At present health visiting programmes support the partnership plus and safeguarding offer fully, following improved engagement with primary care and training in motivational interviewing for all teams. It is envisaged that partnership working with children s centres and other partner agencies will continue to focus on young parents and brief intervention packages for clients where alcohol and substance misuse are issues 7 A review of the Trafford school nursing service was carried out internally with Trafford CYPS, led by the Integrated Commissioning Unit (ICU) and supported by health colleagues. The final report was published in March The aims of the review were: To undertake a timely review (July 2012 to March 2013) of the service to ensure a service that will meet the needs of a changing school age population and maximise its contribution to improved outcomes To inform the commissioning service specification for 2013/2014 To support the service with transitional arrangements so that it can deliver against the specification and requirements within national guidance 9 To ensure that the Healthy Child programme is effectively delivered locally and To ensure that children and young people and their families are involved in the review and redesign of the service As a result of the school nursing review, a number of recommendations have been put forward and an action plan is currently being developed to ensure the implementation of such recommendations. The review includes one recommendation directly linked to safeguarding which states that the school nursing service should: work proactively with safeguarding colleagues to review and monitor the involvement of school nurses in the safeguarding process including case conference attendance and report writing 3.2 Progress on Priorities CCG authorisation CCGs are statutory NHS bodies with a range of statutory duties, including safeguarding children. Although CCGs are not responsible for commissioning 6 The Health Visitor Implementation Plan requires all areas to increase Band 6 Health Visitor numbers according to a set national formula. 7 Unpublished, Trainer, J (2013) 8 Trafford School Nursing Review, CYPS Integrated Commissioning Unit (2013) 9 DH, getting it right for children, young people and families: Maximising the contribution of the school nursing team: Vision and Call to Action (2012) 10 DH, Healthy Child Programme from 5-19 years (2009) 7

8 primary medical care, they do have a duty to support improvements in the quality of primary medical care Both CCGs and the NHS CB are statutorily responsible for ensuring that the organisations from which they commission services provide a safe system that safeguards children (and adults) at risk of abuse or neglect. The Trafford pathfinder CCG was successful in obtaining authorisation in December 2012 and became a functioning CCG from April 1 st In order to achieve this and with particular reference to safeguarding children, the pathfinder CCG were able to satisfy domains 4 and 5 of the CCG authorisation guidance 11 (see 2.2 of this report) An Executive Lead for safeguarding has been identified and is now a member of the Trafford Safeguarding Children Board Changes to employment arrangements for CYPS health staff: There have been changes to local employment arrangements for CYPS health staff in the form of two separate TUPE processes. This involved various changes to provider organisation arrangements and included the following NHS Trusts: Trafford Health Care Trust (acquired by CMFT in 2012) Central Manchester NHS Foundation Trust (CMFT) Bridgewater NHS Community Trust Pennine Care Foundation Trust (PCFT) PCFT was confirmed as the preferred provider for adult, children and young peoples and CAMHS services which took effect from 1 st April 2013 Throughout these processes, the safeguarding children agenda has remained a priority with a business as usual ethos being encouraged in order to ensure an ongoing child focused approach at an operational and strategic level during the various changes Community Paediatrics The changes to provider organisation arrangements has resulted in a revised delivery of the section 47 medical process for Trafford children and young people who have been referred to Children s Social Care where there are safeguarding concerns and a Paediatric medical is required. The Trafford Community Paediatric Service now provides the resource for section 47 medicals for Trafford children (in hours). University Hospital of South Manchester (UHSM) will continue to provide a service to Trafford children in the following circumstances: Where medicals are required out of office hours Where a child requires a medical and is under the age of 18 months Procedure has been revised to reflect the changes to practice. The issue of section 47 medicals is a standing agenda item for the CYPS Safeguarding Governance Committee to ensure information regarding outcomes is captured and lessons learnt where relevant. All the medical statutory safeguarding arrangements are in place, these include: 11 Clinical commissioning group authorisation: draft guide for applicants (2012): NHS Commissioning Board: A special health authority 8

9 Designated Doctor Safeguarding and Children in Care Designated Paediatrician for child deaths Named Doctor (hospital) Named Doctor (community) Lead Paediatrician for adoption and fostering 3.3 Governance Safeguarding arrangements are an integral part of the CCG s quality and governance frameworks and, as such, will be managed in accordance with the frameworks and their supporting policies. NHS Trafford CCG will be expected to have a clear line of accountability within the organisation for safeguarding children. As such, ultimate accountability for safeguarding children will be with the chief officer. In order to ensure the duties related to this accountability are discharged and to secure significant senior level management and governing body leadership, NHS Trafford CCG s Executive lead for safeguarding will be responsible for ensuring the CCG has the correct procedures and capacity in place and the CCG is fulfilling in full any partnership duties. In doing so the Executive lead for safeguarding will work closely with the designated nurse for safeguarding within the locality 12. In order to further prioritise the safeguarding children agenda across the various governance systems, the Designated Nurse Safeguarding Children is a member of the following quality, performance and governance forums: Section 75 Joint Commissioning Management Board 13 NHS Trafford CCG Quality, Finance and Performance Committee CYPS Safeguarding Governance Group (with Designated Doctor) Trafford Health Safeguarding Children Network 14 (with Designated Doctor) CYPS Health Performance Governance sub Committee of the Integrated Quality and Safety Committee Contract Development Board 15 Greater Manchester Safeguarding Clinical Collaborative (with Designated Doctor) 3.4 Performance Key Performance Indicators (KPIs) 12 Trafford CCG Safeguarding Children Framework (2012) 13 The Joint Commissioning Management Board plans and directs the commissioning of children services based on the commissioning priorities stated within the Children and Young People s Strategy (CYP Strategy) as the strategic commissioning plan for the Children s Trust Board. This is to ensure compliance with Trafford s Section 75 partnership agreement 14 Purpose: To develop and oversee the strategic and operational management of safeguarding children across Trafford health system. 15 The Contract Development Board is part of a new structure to capture contract monitoring and quality and includes both commissioners and providers at an appropriately senior level. The structure will be informed by 3 sub committees: Finance, Activity and Performance/Quality and Patient Safety/Service Development 9

10 KPIs have been monitored through the (previously named) Service Quality and Contract meetings held between Commissioners and Providers. From April 2013 the Contract Development Board and associated structure will have the ultimate responsibility for contract monitoring A Greater Manchester agreed audit tool has been included into the contract between Trafford NHS CCG and Pennine Care NHS Foundation Trust to monitor safeguarding standards on an annual basis. NHS organisations who provide a service to Trafford residents where Trafford NHS CCG are associate commissioners, for example Greater Manchester West Mental Health Trust will be monitored via contractual arrangements with the lead commissioners in conjunction with the relevant Designated Professionals. There is only one KPI directly linked to safeguarding children and this relates to safeguarding children training (discussed below) There are two KPIs relating to children in care: Children 0-5 receiving a minimum of twice yearly health assessments Children age 5+ years receiving a minimum of yearly health assessments Additional national data is required for report on a yearly basis. The table below shows the most recent annual data against the areas of performance 2011/2012 Percentage of under 5s with up to date child health promotion checks 94/6% Percentage of CiC 12 months with up to date immunisations 97% Percentage of CiC longer than 12 months who had their teeth checked by a dentist in the year 97% Percentage of CiC longer than 12 months who had their annual health assessment in the year 97.5% In addition, the safeguarding health team monitor data (monthly) relating to the number of initial health assessments done within the statutory time scale of 28 days (from being received into care). This data shows a consistent improvement with 66.7% of under 5 year olds and 100% of over 5 year olds receiving initial health assessments within the statutory timescale for March Narrative is provided for any data showing less than 100% which gives direction as to how timeliness of health assessments may be improved, for example addressing non-attendance. Safeguarding training and supervision are key areas in relation to provider organisations giving assurance that appropriate mechanisms are in place to safeguard children Safeguarding Children Training: Single agency training is available (and mandatory depending on staff group) for all health staff across the Trafford health system at levels 1, 2 and 3 16, provided by the Health Safeguarding Children Team. Joint work between the Organisational Development and Training Department and Named Nurses has 16 Safeguarding Children and Young People: roles and competencies for health care staff: Intercollegiate document (2010), Royal College of Paediatrics and Child Health 10

11 produced a comprehensive data set of staff working in the NHS provider organisation against the level of training required. Therefore it has been possible to demonstrate levels of compliance. At year end 2012, the NHS provider organisation (then Bridgewater NHS Community Trust) was able to demonstrate the following compliance across adult and children services (available head count taking into account long term sickness, maternity leave etc): Level 1 training: 98.34% Level 2 training: 100% Level 3 training: 100% The health safeguarding children team are in the process of producing a single agency safeguarding children training report to cover the period 2012/2013 which will further demonstrate compliance and describe what staff say regarding the impact of training on their individual practice. Single agency training includes an additional training course to equip health practitioners with an understanding of domestic abuse, specifically how to recognise, how to ask the question (routine enquiry) and the impact on children. This training has been deemed mandatory for health visitors. At the time of writing this report, 49 out of a possible 52 health visitors had attended the training (with a plan to facilitate the remaining 3 HVs to attend). In total 139 health practitioners have attended 8 domestic abuse training sessions with each sessions accommodating participants. A recent audit of this training was positive in that all attendees reported some knowledge gain with the majority rating that they gained very much knowledge in addressing domestic abuse with service users 17 In addition, health staff have access to TSCB multi-agency training and attendance to relevant courses is encouraged to compliment single agency training. The Named Nurses target particular health staff to attend specific courses thought to be most relevant to their role, lead or expertise. Health staff are well represented on the multi-agency courses and the safeguarding health team contribute to the development and delivery of training. Development of the training programme is co-ordinated through the TSCB Training Committee which reports annually to the TSCB. A bespoke safeguarding children level 3 training programme was delivered to Trafford GPs in 2012 which resulted in 85% of GPs attending. Those who were unable to attend are now routinely invited to single agency level 3 safeguarding children training. Of note, from 1 st April 2013 the NHS CB via its area teams is responsible for the co-ordinating and funding of safeguarding training for GPs and potentially other primary care professionals. Safeguarding Children Supervision All health staff working regularly and directly with children in Trafford Children and Young Peoples Service receive mandatory safeguarding children supervision in keeping with policy Trafford Safeguarding Children Health Domestic Abuse Review of Training (2013) 18 Trafford Safeguarding Children Supervision Policy for Health Professionals (2012) 11

12 A recent safeguarding supervision audit demonstrated that the majority of staff responding to the survey were satisfied with the safeguarding children supervision process. The purpose, aims and outcomes of Trafford s Safeguarding Children Supervision Policy appear to be reflected in the survey responses. Health professionals reported that safeguarding children supervision enhanced and validated their practice, enabling confidence to identify risks to children Trafford Safeguarding Children Board Section 13 of the Children Act 2004 requires each local authority to establish a Local Safeguarding Children Board (LSCB) for their area and specifies the organisation s and individuals (other than the local authority) that should be represented on LSCBs. The statutory functions of LSCBs are: To co-ordinate what is done by each person or body represented o the Board for the purpose of safeguarding and promoting the welfare of children in the area; and To ensure the effectiveness of what is done by each such person or body for those purposes. In order to fulfil its statutory function and LSCB should use data and, as a minimum should: Assess the effectiveness of the help being provided to children and families, including early help Assess whether LSCB partners are fulfilling their statutory obligations Quality assure practice Monitor and evaluate the effectiveness of training Whilst LSCBs do not have the power to direct other organisations they do have a role in making clear where improvement is needed. Each LSCB member retains their own existing line of accountability for safeguarding 20 Trafford Safeguarding Children Board (TSCB) holds quarterly meetings, is independently chaired and provides an annual report in keeping with guidance. The TSCB has the following sub committees reporting into it: Performance, Management and Audit Committee (attended by Designated Nurse) Serious Case Review Committee (chaired by Designated Nurse, attended by Designated Doctor) Policy and Practice Committee (attended by Designated Nurse) Training and Development Committee (attended by Named Nurse) All the above meetings have representation by the health safeguarding children team as described. In addition, the TSCB is served by the TSCB steering group whose main function is to agree the agendas for the TSCB The TSCB is currently working with the Trafford Adult Safeguarding Board to 19 Safeguarding Children Supervision audit, Safeguarding Children Health Team (2013) 20 Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (2013) HM Government, chapter 3 12

13 agree terms of reference and membership for a sub committee (of both Boards) which will seek to address issues of commonality between adults and children (for example, domestic abuse, parental mental health, parental drug and alcohol misuse) Child Death Review process: Since April 2008 there has been a statutory requirement for all child deaths to be reviewed. This includes all child deaths up to the age of 18 years and excludes babies who are stillborn and planned terminations of pregnancy carried out within the law The LSCB is responsible for: a) collecting and analysing information about each child death with a view to identifying any case giving rise to the need for a review any matters of concern affecting the safety and welfare of children in the area of the authority; any wider public health or safety concerns arising from a particular death or from a pattern of deaths in that area; and b) putting in place procedures for ensuring that there is a coordinated response by the authority, their Board partners and other relevant persons to an unexpected death 21 Each death of a child normally resident in the LSCB s area is reviewed by a Child Death Overview Panel (CDOP). There are four CDOPs in Greater Manchester -Trafford joins with Tameside & Glossop and Stockport to form a tripartite approach to reviewing child deaths in those given areas. This is attended by the Trafford Designated Paediatrician for child deaths The following table demonstrates the deaths of Trafford children from 01/04/ /03/2013 Ages(years) Number Of the 15 deaths, 11 were expected with 4 being unexpected. None of the unexpected deaths were of a nature that would trigger a referral to the Serious Case Review Committee (see section 3.7 of this report) and will be reviewed at CDOP in the usual way The chair of the CDOP is responsible for providing and annual report to the 21 Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (2013) HM Government, chapter 5 13

14 LSCB and this has been achieved for Trafford. Findings from the most recent CDOP report were presented to the NHS Trafford (then pathfinder) CCG Quality, Finance and performance Committee in January Integrated Inspection Ofsted, the Care Quality Commission (CQC), Her Majesty s Inspectorate of Constabulary (HMIC), Her Majesty s Inspectorate of Probation and Her Majesty s Inspectorate of Prisons are committed to the introduction of a new joint inspection of multi-agency arrangements for the protection of children in England. These inspections will focus on the effectiveness of local authority and partners services for children who may be at risk of harm, including the effectiveness of early identification and early help. The inspectorates intend to begin these new inspections by June 2013 and to publish the arrangements for the inspections by April 2013 The principles of the new inspection programme is that inspections will: be unannounced, be operating on a 3 year cycle, be multi-agency and lasting for two weeks have a focus of Inspectors tracking the experiences of individual children and young people which will include observing practice and the effectiveness of the help and protection that is given 22 The Inspection relates to the statutory functions of the Local Authority as the lead agency for the protection of children. In addition to evaluating the effectiveness of the LA the inspection will also evaluate the contribution that other agencies make to the help and protection that is available to children, young people and families and the effectiveness of shared arrangements (for example, that of health visitors, school nurses, A&E departments, mental health provisions and GPs). The last multi-agency joint inspection took place in April 2010, therefore it is anticipated that Trafford will experience its next inspection under the new arrangements some time in In that regard, a series of meetings have been scheduled to ensure that the Local Authority and partner agencies are in a position to demonstrate a high standard of safeguarding children practice. Trafford Safeguarding Children Peer Review: The Children s Improvement Board (CIB) commissions safeguarding children peer reviews as a national programme available to all councils at a time that makes sense for them. If councils ask for their review to be co-ordinated with a Local Government Association (LGA) corporate peer challenge, the principal adviser will discuss this with the council chief executive and the peer review team. Peer reviews are complementary to the peer challenge arrangements agreed in each region. Peer challenge can be focused on any aspect of children s services and the methodology is agreed locally. 22 Proposal for the joint inspection of multi-agency arrangements for the protection of children (July 2012), Ofsted (ref: ) 14

15 Trafford council was the host council for the week long peer review commencing on The fundamental aim of any review is to assist councils and their partners to reflect on and improve safeguarding services for children and young people. Of note, a review is not an inspection and should not be conducted as such by either the peer team or the host council. Rather it is designed as a process which should be supportive but challenging in order that councils and their partners recognise their strengths and identify their own areas for improvement. The review is an interactive exercise and during the process the peer review team examined evidence from a number of sources for example: Performance data A variety of documentation On line questionnaire by frontline staff A wide range of interviews exploring standard themes and other key lines of enquiry chosen by the council/partners Following the review, a feedback letter covering the main points of the review is sent to the host council. The review team for the Trafford peer review consisted of: Strategic Director, Community Wolverhampton City Council (review team leader) Former Cabinet Minister, Devon County Council Managing Director, Griffin Care Assistant Director Children, Services, London Borough of Brent Designated Nurse Safeguarding Children (Independent Consultant) Independent Consultant, Specialist LSCB Local Government Association representative Themes and lines of enquiries explored: Effective practice, service delivery and the voice of the child (core) Outcomes, impact and performance management (core) Working together including the health and well being board (core) Capacity and managing resources (core) Vision, strategy and leadership (core) Equality and diversity visibility and practice Early help strategy and CAF Child in need process How to evidence outcomes and impact Impact and awareness of TSCB The overall feedback from the peer review team was very positive with some of the main strengths identified as: Passion and commitment across the partnership Strong commitment to improving outcomes for vulnerable children Huge progress in integration Learning organisation 15

16 Strong and stable workforce Arrangements for safeguarding Integrated commissioning The areas for consideration as perceived by the peer review team were all areas which have been locally identified prior to the review and where a considerable amount of work is already underway and these include (thematic areas): Further development of implementation of CAF and family CAF to strengthen the multi-agency early help response Participation Raising the profile of the Trafford Safeguarding Children Board (TSCB) and strengthening the scrutiny role of the TSCB A CYPS action plan held at Director level is in development in order to ensure that the safeguarding peer review areas for consideration are further strengthened. 3.7 SCRs/DHRs Regulation 5 of the Local Safeguarding Children Boards Regulations 2006 sets out the functions of the LSCBs. This includes the requirement for LSCBs to undertake reviews of serious cases in specified circumstances, namely: 5(1) (e) undertaking reviews of serious cases and advising the authority and their Board partners on lessons to be learned (2) For the proposes of paragraph (1) (e) a serious case is one where: a) abuse or neglect of a child is known or suspected; and b) either i) the child has died; or ii) the child has been seriously harmed and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons have worked together to safeguard the child 23 On a Trafford family were involved in a house fire which is believed to have been started deliberately by the mother s ex partner. As a consequence, a 15 year old boy and his mother died. In addition, the 4 year old and 18 year old siblings sustained serious injuries. As a result of this incident, Trafford completed a Serious Case Review and joint Domestic Homicide Review 24 which were presented to the TSCB and Safer Trafford Partnership Board in July 2012 It is the responsibility of the TSCB Serious Case Review Committee (SCRC) to oversee progress against the action plans arising from the local SCR with a view to sign off prior to providing the TSCB Performance Management and Audit (PM&A) Committee with written confirmation of completed SCR action plans 25. The action plans are on target for completion and will be considered in terms of readiness for the TSCB chair and PM&A Committee in June Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (2013) HM Government, chapter 4 24 Multi-agency statutory guidance for the conduct of Domestic Homicide Reviews (2011), Home Office 25 TSCB Performance Management and Audit Committee: Terms of Reference (May 2012) and TSCB SCRC: Terms of Reference (March 2013) 16

17 Delays with the coronial process and rescheduled inquest dates (now expected to commence February 2014) has resulted in a delay of publication of the SCR/DHR report and rolling out the learning across the partner agencies. However for health practitioners recommendations have been implemented into practice and training reviewed to incorporate themes from lessons learnt which impact specifically on health services. An example of this is the development and delivery of Domestic Abuse training for health practitioners (and audit) described in section 3.4 of this report. Any incidents which trigger a Serious Case Review are entered on STEISS (Strategic Executive Information System) by way of informing the CCG and Local Area Team (previously would have been the Strategic Health Authority) Of note (and unlike adult safeguarding reporting systems), safeguarding children incidents are reported where an action is perceived to be inappropriate, disproportionate or where there has been an omission For example, an incident should be reported where there is evidence of significant harm which does not result in a referral to Children s Social Care, or where significant information is known and not shared in the best interests of children Safeguarding children incidents are not routinely reported as an organisational risk every time a child is referred into Children s Social Care or following every child death. There is currently one Trafford safeguarding children STEISS case and this relates to the local Serious Case Review described in section 3.7 of this report. 4.0 Conclusion 4.1 Priorities for the year ahead has seen a continued commitment to the safeguarding children agenda across the Trafford health system at both operational and strategic levels The safeguarding children health team will continue to work with relevant providers and commissioners in borough and across Greater Manchester in order to strengthen existing systems and pathways In particular, the Designated professionals are working with partner agencies in order to demonstrate inspection readiness which by definition should indicate that health practitioners are delivering a high quality service with regard to safeguarding children across the threshold criteria Other priorities for the year are best described in the work plan 2013/2014 of the Trafford Health Safeguarding Children network (appx A) 17

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19 Trafford Health Safeguarding Children Network Annual Work Programme April 2013 to March 2014 Appx A Month/number 1. Nov 2012 Feb 2013 (meeting Feb 19 th ) Specific Work Programme Standing agenda items: New policies/procedures/protocols contribution and sign off/cdop update/scr update/serious Incidents/update from TSCB/Audit/CP data/area feedback/training data from service areas Development of list of areas for audit: Communication standard between HVs and GPs (Dec meeting) HV liaison protocol (Dec meeting) Initial Health Assessments (IHAs) within statutory time scales (from ) (Sept meeting) Quality of IHAs (Sept meeting) DNA process against protocol (Dec meeting) Section 47 medicals (Sept meeting) SCR action plans -embedding learning into practice (Sept meeting) Safeguarding children supervision audit (May meeting) Case conference audit (May meeting) Safeguarding children training evaluation (Dec meeting) Referrals to MARAT from A&E (Trafford) (May meeting) Routine enquiry (May meeting) Use of chronologies by health practitioners 19

20 Feb -May 2013 (Meeting May 21st) Standing agenda items: New policies/procedures/protocols contribution and sign off/cdop update/scr update/serious Incidents/update from TSCB/Audit/CP data/area feedback/training data from service areas Audit feedback: Case conference audit Referrals to MARAT from A&E (Trafford) Safeguarding children supervision audit Annual report (2012/2013) should be circulated and agreed by network members before end March June - September 2013 Standing agenda items: New policies/procedures/protocols contribution and sign off/cdop update/scr update/serious Incidents/update from TSCB/Audit/ CP data/area feedback/training data from service areas (Meeting Sept 3rd) 3. September - December 2013 (Meeting December 10 th ) 4. December 2013 March 2014 Audit feedback: Initial Health Assessments (IHAs) within statutory time scales (from ) Quality of IHAs Section 47 medicals SCR action plans -embedding learning into practice Standing agenda items: New policies/procedures/protocols contribution and sign off/cdop update/scr update/serious Incidents/update from TSCB/ Audit/CP data/area feedback/training data from service areas Audit feedback: Communication standard between HVs and GPs HV liaison protocol DNA process against protocol Safeguarding children training evaluation Standing agenda items: New policies/procedures/protocols contribution and sign off/cdop update/scr update/serious Incidents/Joint Commissioning Board update/update from TSCB/Audit/CP data/area feedback/training data from service are Annual report (2013/2014) 20

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