- - Roma Boobyer, Named Nurse Child protection

Transcription

1 - - Roma Boobyer, Named Nurse Child protection Audit Period: February/March 2013 Report Date: June 2013

2 Executive Summary Why the audit was undertaken The Safeguarding Children Case-file Audit is one of a number of audits conducted within the Leicestershire Partnership NHS Trust (LPT) in order to provide assurance that safeguarding duties are appropriately recognised and fulfilled throughout the organisation. This is not solely in our work with children, but also with adults who have contact with children and young people. The Safeguarding Children Case File Audit focusses on the work of health visiting and school nursing teams within the Families, Young People and Children s (FYPC) Division. These universal services touch the lives of all children at key points, but for children at risk of maltreatment they can be instrumental in targeting for additional support or responding to protection needs through referral and multi-agency intervention. The audit criteria are derived from a number of sources that underpin safeguarding practice. The legislative framework is provided by the Children Acts (1989, 2004) and national statutory guidance Working Together to Safeguard Children. At a local level safeguarding practice for LPT employees is outlined within the Local Safeguarding Children Board (LSCB) procedures and LPT policy and practice guidance. Additionally, the learning from Serious Case Reviews is used to amend practice with the objective of improving outcomes for children. How the audit was carried out A sample of 50 health visitor and school nursing case files were audited. These were the case records of children subject to a child protection plan at some point during 2012 and form an approximate 5% sample of the total number. The audit was conducted by the Named Nurse Team using the tool previously employed in 2011/12. This allows comparison to be made between the 2 years. Key findings and actions Areas of good practice For children subject to a Section 47 investigation or already subject to a child protection plan there is good evidence that health visitors and school nurses are making a strong contribution to multi-agency information sharing, decision making, action planning and intervention. With specific regard to the health needs of these children there is evidence these needs were assessed and met in 96% of cases audited. Of the remainder only 1% had un-assessed or unmet health needs. Areas for improvement CAF action plans in place for only 9% of sample. ACTION: Safeguarding training to emphasise the impact of early identification and intervention e.g. CAF in improving outcomes for children. LPT practitioner present at only 28% of recorded strategy meetings and 50% of Safeguarding Information Sharing Meetings (formally discharge planning meetings). 2 of 21 Executive Summary Error! No text of specified style in document.

3 ACTION: Strengthen contribution to risk assessment and action planning through increased (LPT) health practitioner attendance at strategy meetings and UHL Safeguarding Information Sharing Meetings Evidence of need to strengthen early identification and intervention with vulnerable families and effective intervention for children at risk of significant harm. ACTION: Re-enforce the need for safeguarding supervision in accordance with the Safeguarding Children Supervision Policy. Evidence of SMART actions in only 76% of practitioner action plans audited. ACTION: Support through education and training the use of SMART principles in all action planning to improve outcomes for children and their carers. Culturally aware and culturally sensitive practice evidenced in 30% of cases audited. ACTION: Promote the recognition of cultural influences on the lives of children and families and consider how these are impacting on the care and well-being of individual children. Take forward the development of further deep dive audit/s focussed on specific aspects of safeguarding practice. Re-audit date Re-audit using this audit tool is not planned (see Key actions above) Take forward the development of further deep dive audit/s focussed on specific aspects of safeguarding practice e.g. early intervention, compliance with Safeguarding Children Supervision Policy. The author would like to thank Janie Chan, Clinical Audit Officer and her colleagues in the Clinical Audit Team for their invaluable advice and assistance throughout the audit process. 3 of 21

4 Contents Executive Summary... 2 Why the audit was undertaken 2 How the audit was carried out 2 Key findings and actions 2 Re-audit date 3 Contents... 4 Abbreviations 4 Background... 5 Criteria & standards... 5 Method... 6 Sample & data source 6 Audit type 6 Service areas / teams included 7 Findings... 7 Responses received 7 Pre-Referral (Section A of audit tool) 7 Post-Referral (Section B of audit) 8 Page Page Multi-Agency Working (Section C of audit tool) 8 The Child Protection Process (Section D of the audit tool) 9 Improved Outcomes for the Child (section E of the audit tool) 9 Comments Areas of good practice 13 Areas for improvement 13 Lessons learnt 15 Ethical / professional issues 16 Where results to be presented or discussed. 16 Recommendations References Appendix 1 Audit tool Safeguarding Children Case File Audit 2012/ Appendix 2 Distribution list Appendix 3 Action plan Abbreviations CAF IARF LPT LSCB SMART Section 47 FYPC RAG Common Assessment Framework Inter-agency referral form Leicestershire Partnership Trust Local Safeguarding Children Board Specific Measureable Achievable Realistic Timely That Section of the Children Act 1989 that relates to investigation of child protection concerns. Families, Young People and Children Red/Amber/Green traffic light rating system 4 of 21

5 Background Audit of records for children subject to a child protection plan has been in place since the introduction of a peer supervision model in The frequency of audit and the tools used have been altered and refined over the intervening period to reflect changes in safeguarding knowledge and practice, however, the current tool (attached) is unchanged from that used in Services working with children and their families must hold in mind and support young people to achieve the five outcomes identified under Every Child Matters. This includes stay safe. The provision of timely and effective services is identified as key in managing and reducing the risk of significant harm. This is best achieved through partnership with other agencies but most notably through effective intervention and support with families and the young people themselves. The Safeguarding Children Case-file Audit is designed to review the work done with children we know to be at risk and who are amongst our most vulnerable to poor outcomes, both in the short and long term. It examines our contribution to safeguarding and the effectiveness of that most crucial partnership working. Aim To ensure the quality of safeguarding practice and promote continued improvement by a cycle of audit, action planning and review. Objectives 1. The Organisation, Commissioners and partner agencies to receive assurance that the Leicestershire Partnership Trust, and its employees, are adequately discharging their safeguarding duties. 2. To assess practitioner s contribution to the identification of children and families in need and the provision of early intervention services. 3. To measure compliance with Local Safeguarding Children Board procedures and relevant LPT safeguarding policies and practice guidance for children in need of protection. 4. To examine practitioner s contribution to multi-agency safeguarding meetings and case work. 5. To review the extent to which practitioner s seek advice on safeguarding matters and measure compliance with the LPT Safeguarding Children Supervision Policy. Criteria & standards 1) Practitioners will act in accordance with LSCB Child Protection Procedures 100% 2) Practitioners will act in accordance with LPT safeguarding policies and practice guidance. 100% 5 of 21

6 Thresholds of compliance Key: Acceptable compliance 95% Partial compliance 90% to <95% Minimal compliance < 90% The above key applies to all criteria numbered between 8 and 35. Attendance at safeguarding supervision (criterion 36) is a requirement in all cases where a child is subject to a child protection plan, therefore, the threshold of compliance for this criterion is set at 100%. Method 50 SystmOne electronic case files were randomly selected from the cohort of all children in Leicester, Leicestershire and Rutland who were identified as having been subject to a child protection plan at some point between January 1 st and December 31 st The cohort was selected using the safeguarding icon on SystmOne as the identifier. The sample was then selected by administrative staff having no direct knowledge or involvement with the subject children. In order to maintain independence and objectivity the Named Nurses previously based in the County were as far as possible allotted the files of city children and vice versa. Where this was not possible the Named Nurse did not audit any file in which they had direct involvement e.g. supervision, attendance at conference etc. The data was collected using the audit tool attached (Appendix 1) then processed and analysed by the Clinical Audit Team using Microsoft Excel. The outcomes and report have been written by the Project Lead who is a Named Nurse. Client identifiable data was anonymised prior to data processing and analysis. The identity of individual children is known only to the allocated auditor and the project lead. Individual children cannot be identified from the final report. Provision was made that issues related to unsatisfactory or unsafe practice would be incident reported immediately. The auditor would ensure any urgent remedial action was taken to safeguard the child. The practitioner and the relevant manager would be informed and appropriate action taken on a case by case basis. In the event one case was referred to the Project Lead for further investigation. Sample & data source The sample was taken from the population of all children across Leicester, Leicestershire and Rutland who have been subject to a Child Protection Plan between 01/01/2012 and 31/12/2012. Using random selection methods 50 SystemOne electronic records were identified. Audit type This is a retrospective audit of electronic case files. See 0 for a copy of the audit tool. 6 of 21

7 Service areas / teams included The audit examined the work of health visitors and school nurses with caseload responsibility for the subject child. In some instances work may legitimately have been undertaken by, or delegated to, a colleague or member of the skill mix team e.g. annual leave cover, clinic attendance, behavioural or feeding advice. In these circumstances the file-holder with case responsibility remains accountable for the overall management of child s care. Findings Responses received A total of 50 responses were received and analysed. One file was found un-auditable (see Ethical/professional issues). Consideration was given to discounting this file or replacing with a substitute, however, it was agreed that there was learning from its inclusion and it remained part of the sample. It should be noted that this file is recorded as a fail for all items. The audit was conducted by 6 Named Nurses. This is a larger number of auditors than in 2011/12. It is apparent that there are some inconsistencies of interpretation and some items, notably in Section E, are subjective judgements. To address this future audits should use fewer auditors or provide briefing notes ahead of data collection. Pre-Referral (Section A of audit tool) At first view the findings of Section A are concerning, however, there is an element of design failure with the questions asked. Criteria 1 to 4 refer to the CAF process. CAF is a response to identified unmet need, therefore, not all children will require a CAF and its absence is not necessarily a concern. Items 2 to 4 apply only where the answer to 1 is yes however this was not consistently applied. Compliance was therefore calculated solely on the basis of the 3 eligible responses. It is recommended that no conclusions about the extent or quality of early intervention are drawn from these findings alone. This are should be considered for re-audit, possibly by the health visiting or school nursing services which play such a central role in delivering early intervention. Analysis of Criteria 4 shows that plans were present in a number of records, but reflect work at different stages and under a range of processes. CAF plans were present as step down actions following child protection of family support and are not solely an indicator of early intervention. 3 children had active family support plans. 3 further children had transferred in already subject to child protection plans elsewhere. It was not asked whether a child protection referral was made by an LPT employee, however, in 12 cases it is explicitly stated that the referral came from another agency and in 4 cases it is stated that the health worker was not made aware of any concerns prior to notification of initial 7 of 21

8 conference. This corresponds with the findings of previous audits where a relatively low percentage of referrals are generated by the health visiting or school nursing services. Criteria 5 and 6 returned minimal compliance, they did show a marked improvement from the previous audit with Criterion 5 Was the safeguarding referral discussed with parents/carers and child if age appropriate? indicating a 20% increase in compliance. Table 2 displays the current and previous rates of compliance and the level of progress that has been made between 2011/12 and 2012/13. Post-Referral (Section B of audit) The results for this section also generally fell below the level of acceptable compliance however this is in the context that the majority of referrals to children s social care do not originate from health workers. In this sample there is evidence of only 1 referral being instigated by an LPT practitioner with the remainder being 48 not applicable and 1 response left blank. In view of the small number of referrals made caution is advised in drawing any conclusion about overall compliance of these staff groups with LSCB procedural requirements. This said criteria 8, 9 and 10 were found to be minimally compliant with a 30% progress for criteria 9 and 10. Criterion 11 remained partially compliant at 92%; the same rate as the 2011/2012 audit. Criterion 12 Were Children s Services updated with any new information from the agency was found to be 95% compliant, which shows progress of 11% from the previous audit. The Criterion 8 Did the health professional contribute to any strategy meeting or discussion? fell by 23% from last year s audit and was shown to be only 28% compliant. This result must be treated with caution in the absence of establishing whether the health visitor or school nurse was contacted or invited to attend. Increased participation in strategy discussions requires the awareness and engagement of partner agencies, notably children s social care and the police (see action plan) Multi-Agency Working (Section C of audit tool) Criterion 16 Are multi-agency meetings recorded? was found to be 96% acceptable compliance and also showed progress from the previous audit. Criteria 14 and 20 were found to be partially compliant. The remaining criteria in this section were minimally compliant. Progress was identified for five of the seven criterions in this section however, with the greatest improvement being 25% for Criterion 19. Criterion 15 relates to the use of SMART principles in action planning and shows a disappointing 17% fall from 2011/12. This must be a concern given that a child protection plan offers no protection in itself, but is effective only if the actions within it are relevant, delivered and achieve the desired outcomes. Criteria 17 and 18 show positive change, but relate to the actions of family members and hospital staff. They do not relate to the staff group whose records are being audited and should be 8 of 21

9 removed from any re-audit. These areas would be more appropriate for multi-agency audit led by the LSCB. See Section C in Table 2 for further details. The Child Protection Process (Section D of the audit tool) Criteria 26 Are they attending/sending a report to core-group meetings? and 27 Has information been shared with involved professionals were both found to have acceptable compliance scoring 98% and 96% respectively. These figures were also an improvement on the previous audit. Criterions 25 and 28 were partially compliant scoring 92% and 91% respectively and showed similar levels of progress when compared with the 2011/12 audit. Compliance was minimal for five out of the nine criterions in Section D, however results indicated either progress or consistent results in seven of the criterions. Criterion 22 relates to evidence of a report to Initial conference and shows a 14% fall on 2011/12. Although not explained in all cases there is evidence that practitioners are not always invited to conference. This applies particularly to the school nursing service and has been recognised for some time. Criterion 24 relates to the presence of a child protection plan within the record. This achieved 88% however, in several cases the auditor noted the scanned file was too large to open within the electronic record. Additionally, a written copy of the child protection plan is not generally shared with partner agencies by City social care so the absence of a copy on file may reflect practice in a partner agency, not that within LPT. Criterion 25 requires a qualifying question to distinguish between staff groups. Health visitors will always have a role in the core group, however, school nurses operate an assessment pathway which can result in the case being inactive to them. In this instance it is entirely legitimate that they withdraw from the core group. Criteria 28 and 29 are affected in the same way. School nurses do not attend conferences in inactive cases as they have no contact with the child unless and until an unmet health need is identified. Improved Outcomes for the Child (section E of the audit tool) Acceptable compliance was found for Criterion 35 Were/are the child or young person s healthcare needs met? at 96%, however this result is 2% lower than in the 2011/12. Partial compliance was identified for Criterion 34 Did the child/young person receive a health assessment to identify needs? and Criterion 36 Did Safeguarding Supervision take place and was this recorded in the records? Both items achieved 94% compliance and displayed progress from the previous audit s findings. Criterion 32 Did we ascertain the child s view within the safeguarding process? fell below the threshold of acceptable compliance scoring 76%. This is a fall of 4% in comparison with 2011/12 and shows that although there has been progress sine the issue was highlighted by Lord Laming in 2003 there is further work to be done, especially in capturing the wishes, feelings and needs of pre-verbal children, those who do not use English or those with specific communication needs. 9 of 21

10 Criterion 33 Were healthcare services delivered in a culturally sensitive manner? scored only 30% compliance. This is 58% lower than for the 2011/12 audit and is the greatest level of negative progress in the re-audit. It is recommended that work is undertaken through the action plan to promote the recognition of cultural influences on the lives of children and families and consider how these are impacting on the care and well-being of individual children. Criterion 36 relates to safeguarding supervision and has a high level of compliance at 94%, a rise of 4% from 2011/12; however, the LPT Safeguarding Supervision Policy requires supervision to take place in all cases. For this item the standard is 100%. A reminder to staff is needed and individual failure to comply without compelling reasons will be referred to the Named Nurse and may be incident reported as supervision is absolutely central to assurance and quality in safeguarding practice. Table 1 - Audit results (comparison with 2011/12) Section A - Pre-referral Criterion 2012/13 Compliance Progress 1. Current CAF prior to referral? 9% -2% 2. Assessment framework used? 67% -15% 3. Lead professional identified? 33% -67% 4. Multi-agency action plan in the records? 100% 32% 5. Referral discussed with parents/carers & child (if appropriate)? 50% 20% 6. Discussed with line manager/named nurse prior to referral? 75% 18% Section B - Post-referral Criterion 2012/13 Compliance Progress 8. Did the health professional contribute to strategy meeting/discussion? 28% 23% 9. Telephone referral to specialist services recorded in child s health record? 50% 30% 10. Intra-agency safeguarding referral form sent to children s social care within 24 hours? 50% 30% 11. Was continued health support provided to child and family after referral? 92% 0% 12. Were children s social care updated with any new information from the agency? 95% 11% Section C - Multi-agency working Criterion 2012/13 Compliance Progress 14. Is there a safeguarding plan in place? 94% 22% 15. Does plan identify actions needed to improve outcomes for child/family (SMART?) 76% -15% 16. Are multi-agency meetings recorded? 96% 1% 17. Family attended/contributed to multi- agency meetings? 88% 5% 18. Was a discharge planning meeting held prior to transfer from hospital/camhs inpatient care to community? 50% 23% 19. If yes, Did health professional contribute to the discharge planning meeting? 75% 25% 20. Is there evidence of appropriate information sharing within multi-agency meetings? 90% -3% Section D - The child protection process 10 of 21

11 Criterion 2012/13 Compliance Progress 22. Case conference report for initial Conference within the child s records? 84% 14% 23. Health agency attended & contributed to ICPC? 89% 2% 24. Child Protection Plan within the record? 88% 3% 25. Health professional a member of the core-group? 92% 3% 26. Are they attending / or sending a report to core group meetings? 98% 9% 27. Information shared with involved professionals? 96% 3% 28. Health professional invited to Review Case Conference? 91% 3% 29. Health professional attended/or sent report to Review Case Conference? 87% 0% 30. Review case conference reports/safeguarding plans evidenced within record? 78% 10% Section E - Improved outcomes for the child 2012/13 Criterion Compliance Progress 32. Did we ascertain the child s view within the safeguarding process? 76% -4% 33. Healthcare services delivered in a culturally sensitive manner? 30% 58% 34. Child/young person received health assessment to identify their needs? 94% 3% 35. Were/are the child s or young person s health care needs met? 96% -2% 36. Did Safeguarding Supervision take place and was this evidenced in records? 94% 4% Table 2 - Audit results (in comparison with thresholds of compliance) Section A - Pre-referral % Criterion YES NO N/A BLAN K Complianc e 1. Current CAF prior to referral? % 2. Assessment framework used? % 3. Lead professional identified? % 4. Multi-agency action plan in the records? % 5. Referral discussed with parents/carers & child (if 50% appropriate)? Discussed with line manager/named nurse prior to referral? % Section B - Post-referral Criterion YES NO N/A BLAN K 8. Health professional contribution to strategy meeting/discussion? Telephone referral to children s social care recorded in child s health record? Intra-agency safeguarding referral form sent to children s social care within 24hours? Continued health support provided to child and family after referral? Children s social care updated with any new information from the agency? Section C - Multi-agency working Criterion YES NO N/A BLAN K % Complianc e 28% 50% 50% 92% 95% % Complianc 11 of 21

12 14. Is there a safeguarding plan in place? % 15. Plan identifies actions needed to improve outcomes for 76% child/family (SMART?) Multi-agency meetings recorded? % 17. Family attended/contributed to multi- agency meetings? % 18. Discharge planning prior to transfer from hospital/camhs inpatient care to community? % 19. If yes, health professional contributed to the discharge planning meeting? % 20. Evidence of appropriate information sharing within multiagency meetings? % Section D - The child protection process % Criterion YES NO N/A BLAN K Complianc e 22. Case conference report for Initial conference within the child s records? % 23. Health agency attended & contributed to Initial conference? % 24. Child Protection Plan within the record? % 25. Health professional a member of the core-group? % 26. Are they attending / or sending a report to core group 98% meetings? Information shared with involved professionals? % 28. Health professional invited to Review Case Conference? % 29. Health professional attended/or sent report to Review Case Conference? % 30. Review case conference reports/safeguarding plans evidenced within record? % Section E - Improved outcomes for the child % Criterion YES NO N/A BLAN K Complianc e 32. Did we ascertain the child s view within safeguarding process? % 33. Healthcare services delivered in a culturally sensitive manner? % 34. Child/young person received health assessment to identify their needs? % 35. Were/are the child s or young person s health care needs met? % 36. Did Safeguarding Supervision take place and was this evidenced in records? % e How compliance was calculated Compliance number of YES number of YESandNOandBLANK of 21

13 Comments Areas of good practice Acceptable levels of compliance were identified for the following criteria: 12. Children s Services were updated with any new information from the agency 95% 16. Multi-Agency meetings were recorded 96% 26. Health professionals were attending/sending reports to core-group meetings 98% 27. Information was shared with involved professional 96% 35. The child s/young person s health needs were met 96% Each section provided the auditor with opportunity to detail any quality issues or additional information. An analysis of these comments identified the following areas of good practice: Use of Groups and Relationships noted good in a number of files; however, this was not consistent across the sample (see Areas for improvement below). Able to get a sense from record of the child as an individual. Behaviour, interaction and language, play well recorded. School nurses capturing child s demeanour, presentation, likes and dislikes as part of the health assessment. Evidence of persistence from practitioner in contacting social worker and other members of core group. GP also using SystmOne helpful to communication. Areas for improvement There are a number of criteria for which acceptable compliance was not found, those identified as having minimal compliance are listed below. Note: those marked with ** are commented on in under Findings and in isolation should be treated with caution. 1. **There was a current Common Assessment Framework (CAF) prior to referral 9% 2. Assessment framework was used 65% 3. **The lead professional was identified 53% 4. **A multi-agency action plan was in the records 70% 13 of 21

14 5. The safeguarding referral was discussed with parents/carers and the child if age appropriate 50% 6. The referral was discussed with the line manager/named nurse prior to referral 75% 8. **The health professional contributed to any strategy meetings or discussions 28% 9. **The telephone referral to children s social care recorded 50% 10. **Intra-agency referral form was sent to children s social care within 24 hours 50% 15. The plan identifies the SMART actions needed to improve outcomes for the child/family 76% 17. **The family has attended and contributed to multi-agency meetings 88% 18. **A discharge planning meeting was held prior to the child s transfer from hospital/camhs inpatient care to the community 50% 19. **The health professional contributed to the discharge planning meeting 75% 22. There is a case conference report for Initial Child Protection Case Conference (ICPC) within the child s records 84% 23. The health agency attended and contributed to the ICPC 89% 24. There is a Child Protection plan within the record 88% 26. Health professional attended/ sent a report to the Review Case Conference 87% 29. Review case conference attendance/report evidenced within the record 78% 32. We have ascertained the child s view within the safeguarding process 76% 33. The healthcare service was delivered in a culturally sensitive manner (evidenced within the child s record that language, religion and ethnicity was recorded) 30% Analysis of the comments also identified the following: Inconsistent quality of recording in SystmOne groups and relationships, omissions and failure to review and update. Difficult to understand how the individuals recorded actually relate to one another, genogram would be helpful. Use of first names only in the journal making it difficult to identify who individuals are and role i.e. family member, professional. Poor recording of the child s behaviour and demeanour and interaction, particularly as means of assessing child s response to safeguarding issues. 14 of 21

15 Supervision out of timescale due to lack of availability of supervisor. Inconsistent quality of school age health assessment, height and weight only in one case. Minutes of core groups not on record. Scanned documents too big to open. Category of maltreatment recorded the journal section of SystmOne. Inappropriate recording of third party information in the journal section of SystmOne. Unclear from record where case active or inactive to school nursing i.e. attending meetings but not seeing the child. Poor evidence or absence of liaison with GP. Noted that mother disabled and had communication problems, but these are not made clear. Impact on parenting capacity and effective delivery of services not examined. Mother also a child. Noted at primary that mother at risk of child sexual exploitation a year before, but no evidence of examination of current risk to mother or until initial conference at 4 months. Lessons learnt The current audit is too wide reaching. It attempts to encompass safeguarding practice across the spectrum from early intervention for vulnerable children and children in need ; to children at risk and in need of protection. The volume of data produced can cause areas of good practice and areas of concern to become subsumed into the mass creating the risk they are not given sufficient emphasis or even lost. In order to sharpen the focus consideration should be given to the audit of specific aspects of safeguarding practice. This will provide richer data, facilitate deeper analysis and understanding and promote more effective action planning. Where data collection is conducted by more than one person briefing notes should be produced to ensure the tool is applied consistently. Several questions relate to the practice of partner agencies or the behaviour of families e.g. 17, 18, 28. These are beyond the control of LPT and therefore cannot be addressed through our actions or action planning. It is more appropriate for these to be addressed through LSCB multi-agency audits processes The presence or absence of a safeguarding icon within an individual child s record is a useful indicator, but must be verified. The icon should not replace on-going professional assessment and decision making, particularly where a child may be in need or at risk. 15 of 21

16 Ethical / professional issues One file was identified as un-auditable and referred to the Project Lead. The file had been identified by the presence of the safeguarding icon in SystmOne, however, there was no evidence within the record of how that icon came to be applied or evidence of safeguarding activity. It was subsequently identified that since the icon was applied in 2010 the child had moved to special educational provision in an area covered by another SystmOne unit. The auditor was viewing the unit for the area in which the child was most recently educated not aware that the contextual information had been recorded in the unit where the child resided in 2010/11. The school nurse who applied the safeguarding icon in September 2010 had not been invited to the initial child protection conference and was informed about the plan by a headteacher. As this verbal information was incomplete the category of concern was not known and could not be recorded at the time, although it does appear subsequently. The school nurse acted appropriately by informing the relevant Named Nurse of the issues at the time. Once aware of the protection concerns the school nurse did see the child, attend core group meetings and review conference and accessed supervision. The child protection plan was discontinued in November The safeguarding icon remained active on the record. The young person is now 17 years old and has moved to a neighbouring area. In the absence of a share with the current health care provider it wa not possible to safely remove the icon. The Project Lead has now liaised with the patient s current GP and received confirmation that the icon has been removed and patient summary records ending of the child protection plan. Where results to be presented or discussed. See 0 for the distribution list. Recommendations See 0 for the action plan. References Every child matters (2003) HMG LPT Safeguarding Children Supervision Policy. LPT Safeguarding Children Policy. Working Together to Safeguard Children HMG (2010). Note: Current version at time work completed and audit data collection undertaken. 16 of 21

17 Appendix 1 Audit tool Safeguarding Children Case File Audit 2012/13 Child NHS number: SystmOne Unit: Name of auditor: Date: Section A - PRE-REFERRAL YES NO N/A 1 Was there a current Common Assessment Framework (CAF) prior to referral? 2 Was there assessment framework used? 3 Is the lead professional identified? 4 In there a multi-agency action plan in the records? 5 Was the safeguarding referral discussed with parents /cares and child if age appropriate? 6 Was the referral discussed with the line manager or named nurse prior to referral? 7 Quality Issue Additional information /Comments (please capture examples of good or poor practice as appropriate) What evidence is there of work undertaken with the child and family before the referral in relation to early intervention? Were there any previous concerns raised or referrals made? Section B - POST-REFERRAL 8 Did the health professional contribute to any strategy meeting or discussion? 9 Was the telephone referral to specialist service (formerly children s social care in the child s health record? 10 Was an intra-agency safeguarding referral form sent to specialist children service or CYPS within 24 hours? 11 Was continued health support provided to the child and family following the safeguarding referral? 12 Were Children s Services (formally children s social care) updated with any new information from the agency? 13 Quality Issue Additional information /Comments (please capture examples of good or poor practice as appropriate) Is there evidence of information sharing between the agencies throughout the Child Protection Process? Is there any evidence of any disagreements in relation to decision making through the process? What examples of safeguarding interventions and continued Support are there? 17 of 21 Error! No text of specified style in document. Appendix 1

18 Section C - MULTI-AGENCY WORKING YES NO N/A 14 Is there a safeguarding plan in place? 15 Does the plan identify the actions needed to improve outcomes for the child/family, are they SMART? (specific, measurable, achievable, realistic and timely) 16 Are multi-agency meetings recorded? 17 Did the family attend and contribute to multi-agency meetings? 18 Was a discharge planning meeting held prior to child s transfer from hospital / CAMHS inpatient care to community? 19 If yes, did the health professional contribute to the discharge planning meeting? 20 Is there evidence of appropriate information sharing within multi-agency meetings? 21 Quality Issue Additional information /Comments (please capture examples of good or poor practice as appropriate) Which agencies are involved in the child s plan (including voluntary sector and adult services) and are these appropriate to the child s needs? Are there any cross authority issues and how have these been dealt with? Section D - THE CHILD PROTECTION PROCESS YES NO N/A 22 Is there a case conference report for Initial Child Protection Case Conference (ICPC) within the child s records? 23 Did the health agency attend and contribute to the initial child protection conference? 24 Is there a Child Protection plan within the record? 25 Is the health professional a member of the core-group? 26 Are they attending/ or sending a report to core-group meetings? 27 Has information been shared with involved professionals? 28 Was the health professional invited to the Review Case Conference? 29 Did the health professional attend/or send a report to the review Case Conference? 30 Are review case conference reports/ safeguarding plans evidenced within the record? 31 Quality Issue Additional information /Comments (please capture examples of good or poor practice as appropriate) What is the agency involvement within the child protection process? Are they undertaking actions within the child protection plan and are fully involved within discussions with Social Care? Are any disagreements with decisions made at conferences recorded? 18 of 21

19 Section E - IMPROVED OUTCOMES FOR THE CHILD YES NO N/A 32 Did we ascertain the child s view within the safeguarding process? 33 Were healthcare service delivered in a culturally sensitive manner? (evidenced within the child s record that language, religion & ethnicity are recorded) 34 Did the child or young person receive a health assessment to identify needs? 35 Were/ are the child s or young person s health care needs met? 36 Did Safeguarding Supervision take place and was this recorded within the records? 37 Quality Issue Additional information /Comments (please capture examples of good or poor practice as appropriate) Practitioner s should ensure that actions take account of children and young people s views, recognise behaviour as a means of communication, understand and respond to behaviour indictors of abuse, sensitively balance children s and young people s views with safeguarding their welfare. 19 of 21

20 Appendix 2 Distribution list Target audience FYPC Safeguarding Group LPT Safeguarding Committee FYPC Clinical Governance Committee Health visiting and school nursing team meetings FYPC Clinical Audit Group To (for action) Divisional Safeguarding Lead to table for discussion and approval of action plan Divisional Safeguarding Lead to table for information. Divisional Safeguarding Lead to table for information Project Lead to forward for information and discussion of action plan Project Lead to forward for information. Appendix 3 Action plan Objective Safeguarding audit to be focused on specific areas of knowledge or practice. Health care staff to contribute to strategy discussions for children and young people with whom they have active and current involvement Practitioner action plans for children subject to child protection plans will use SMART principles. To raise awareness of the impact of culture and identity on safeguarding risk and resilience Level of risk High/med/low M M M H Action to achieve objective By whom Completion by (date) Raise for discussion with FYPC Vicky Spencer August 2013 safeguarding Group as part of response to this audit report To be raised with Social Care Named Nurses September 2013 Managers (Roma Boobyer to To be discussed with LSCBs through action) the Safeguarding Effectiveness Groups. Supervisor Initial and Supervisor Update Level 3 training sessions to include exercise on SMART action planning Level 2 and Level 3 training programmes to be reviewed to include awareness of impact of culture, belief and identity on safeguarding i.e. Named Nurses (Jo Hackman/Pauline Blake to action) Named Nurses (Jo Hackman/Pauline Blake to action) September 2013 September 2013 Evidence of progress/outcome 20 of 21 Error! No text of specified style in document. Appendix 2 Distribution list

21 To ensure record keeping is conducted in accordance with NMC guidance and relevant LPT policy and practice guidance. To promote clinical and safeguarding supervision to support effective early intervention and improve outcomes for vulnerable and at risk children H M social norms, impact of subculture, concern re bias/prejudice. Supervisor Initial and Update to include awareness and impact of culture and belief. Issues related to record keeping and use of SystmOne to be collated and forwarded for incorporation in: record-keeping training S1 training Level 2 and 3 safeguarding children training pakages Promote early and timely supervision through Clinical supervision training Safeguarding children training (all Level 3 packages) Reminder in safeguarding briefing Filippa Howell Carolyn Corbett Jo Hackman/Pauline Blake Filippa Howell/Mandy Amin Jo Hackman/Pauline Blake Sue Troy September 2013 September of 21