Safeguarding Children and Adults across Kent and Medway Compassion Courage Respect

Transcription

1 Safeguarding Children and Adults across Kent and Medway Compassion Courage Respect Safeguarding Children & Adults Within North Kent Clinical Commissioning Groups April 2015 Page 1 of 56

2 Contents Page 1 Introduction 4 2 Local context NHS Medway CCG NHS Dartford, Gravesham & Swanley CCG NHS Swale CCG 6 3 Summary of Progress & Key achievements 8 4 Governance & Accountability arrangements 11 5 National Legislation & Guidance Safeguarding Children Working Together to Safeguard Children Intercollegiate document Female Genital Mutilation Child Sexual Exploitation Safeguarding Adults The Care Act Multi-agency safeguarding assurance Safeguarding Children Section 11, The Children Act Local Safeguarding Boards Kent Safeguarding Board (KSCB) Kent County Council Ofsted Changes to Common Assessment Framework process in Kent Medway Safeguarding Children Board (MSCB) KSCB/MSCB Sub-groups Child Death Review Service in Kent Medway Child Death Overview Panel (CDOP) Safeguarding Adults Kent and Medway Safeguarding Vulnerable Adults Board Kent Adult Social Services (KASS) and Central Referral Unit (CRU) Care Homes and Safeguarding Domestic abuse Domestic Homicide Review (DHRs) Deprivation of Liberty Safeguards 34 7 Serious Case Reviews 35 8 North Kent Safeguarding Team Assurance Development 36 9 Other multi-agency quality assurance mechanisms CQC Safeguarding and Looked after Children Review Health Providers across Kent and Medway CCGs Medway NHS Foundation Trust Medway Community Healthcare 40 Page 2 of 56

3 10.3 Dartford & Gravesham NHS Trust South East Coast Ambulance Trust / Kent & Medway NHS & Social Care Partnership Trust Sussex Partnership Foundation Trust South London & Maudsley NHS Trust Kent Community Health NHS Foundation Trust (KCHFT) Safeguarding Areas for Development 2015/ Future Plans going forward in 2014/ Key Challenges Measuring Safeguarding outcomes 48 APPENDIX 1 The Child Death Review Service Kent 50 Page 3 of 56

4 1. Introduction 1.1 This report provides the North Kent Clinical Commissioning Groups (CCGs) Governing Bodies (GB) with an overview of safeguarding across health services within NHS Dartford Gravesham and Swanley CCG (DGS CCG), Medway CCG and Swale CCG during The report reviews the work from 1 st April 2014 until 31 st March 2015, giving assurance that the CCGs have discharged their statutory responsibility to safeguard the welfare of children and adults across the health services that they commission. 1.2 CCGs 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. This includes specific responsibilities for looked after children (LAC) and for supporting the Child Death Overview process, to include sudden unexpected death in childhood. Local authorities have the same responsibilities in relation to the public health services that they commission. 1.3 Prior to the authorisation of CCGs in Kent and Medway on the 1 st April 2013, a hosted model for safeguarding children and adults, as well as the LAC statutory functions, as set out in the NHS Accountability and Assurance Framework (2013) 1, was established. This model allowed for the eight CCGs in Kent and Medway to share a joint team of designated professionals (nurses) hosted by Medway CCG. (Note: Designated Doctors were directly contracted by CCGs and are not included within the historic hosted model). 1.4 Each CCG is a statutory organisation with safeguarding accountabilities which are discharged at a Governing Body level through the Chief Nurse (CNO). Safeguarding accountability is via the designated professionals to the CNOs. The safeguarding team was line managed at an operational level by an Associate Director (AD) for Safeguarding who reported to the Accountable Officer for Medway CCG and had accountability and responsibility to the CNOs of each CCG. The Designated nurses were line managed on a day to day basis by the AD of safeguarding. A Safeguarding Partnership Board was in place to monitor safeguarding arrangements across Kent & Medway CCGs. 1 Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (2013) NHS Commissioning Board. Page 4 of 56

5 1.5 Through the Partnership Board it was agreed that Ashford and Canterbury CCGs could exit the hosted safeguarding model and on 31st December 2014, they withdrew from the hosted model. Within the hosted model, the eight CCGs contributed to share the costs on a 1/8th basis; the departure of Ashford and Canterbury CCGs meant cost implications for the remaining CCGs, and also provided the opportunity to review models of working to ensure the CCGs continued to meet their statutory responsibilities. The Safeguarding Partnership Board undertook a review of working arrangements and with agreement from the GBs made the decision to disaggregate the hosted team. From 1 st January 2015, designated professionals for safeguarding children and adults have been directly employed by their respective CCGs. A shared resource for LAC and Child Death across the CCGs is hosted within Swale CCG. From 1 st January 2015 the role of Associate Director, Head of Safeguarding, across Kent was removed. 1.6 The North Kent Safeguarding Team consists of two designated nurses for Safeguarding Children and one designated nurse for Safeguarding Adults. There is also 0.51WTE Band 7 vacancy in adult safeguarding, the functions of this role are under review. In the wider team is the designated nurse for LAC and Specialist Nurse for Child Death. 1.7 This annual report will focus on safeguarding children and adults. A separate report on Looked after Children will be produced by the designated nurse for LAC. 2. Local Context 2.1 NHS Medway CCG sits within the area covered by Medway Council and is an emerging city set around the River Medway within the Thames Gateway Growth Area. There are 5 main towns in the area: Chatham, Gillingham, Rochester, Strood and Rainham, as well as significant rural areas. NHS Medway CCG is a group of 56 GP member practices from across the Medway towns, responsible for planning and buying local NHS services, serving a practice population of 283,000. Medway has a higher proportion of under 20 year olds compared to the rest of the South East and England and Wales, but a lower proportion of over 60 year olds. Page 5 of 56

6 According to the office for National Statistics, in 2007, 7.8% of the population were from non-white ethnic groups; this is an increase from the 2001 census which stood at 5.4% of the Medway population. Medway is within the 41% most deprived areas nationally, but also has some areas of affluence. Average life expectancy is 77.3 years for men and 81.6 years for females. This remains below the national average. 2.2 NHS Dartford, Gravesham and Swanley CCG sit within the Thames Gateway Growth Area which is part of Kent County Council. The CCG area covers the same area as Dartford Borough Council and Gravesham Borough Council, as well as the Swanley area of Sevenoaks District Council. Dartford, Gravesham and Swanley Clinical Commissioning Group (DGS CCG) covers patients from 34 practices, with a registered practice population of just fewer than 255,000. The child 0-19 population is 62,659 which is approximately 24.5% of the total population. The population of Dartford, Gravesham and Swanley is projected to increase by 5% over the next five years and 11% over the next 10 years. This population growth does not take into account the Government s recent announcement of 15,000 new homes in the Ebbsfleet Village. The population projections predict the largest increases in the over-65s (13 %) and over-85s (26%). The next largest increase is in the under-4. Dartford and Gravesham accounts for just over 23% (24,900) of Kent s black and minority ethnic populations. Areas of Dartford and Gravesham have been identified as being in the bottom 20% on the national deprivation scale. This level of deprivation has been shown to lead to lower life expectancy. The average life expectancy in the DGS area is 80.2 years as compared to 80.9 years for Kent overall and 80.6 years for England. 2.3 NHS Swale CCG covers patients from 22 practices, with a registered practice population of 106,579; this equates to 7% of Kent s total registered practice population. Page 6 of 56

7 The registered practice population is drawn mainly from Sittingbourne, the Isle of Sheppey and the area east of Faversham within the Swale Borough Council boundary. It is important to recognise that patients resident in the CCG area cannot be presumed to be registered exclusively with Swale primary care teams. Residents of Iwade, Lower Halstow and Upchurch are as likely to be registered with Medway practices. Similarly large numbers of people resident in Teynham and Lynsted wards are registered with the Faversham practices (Canterbury & Coastal CCG), reflecting the hinterland of Faversham as a market town. The population pattern of Swale CCG is broadly similar to that for Kent and Medway, although there is a slightly larger proportion aged 0 to 9 years which may have an impact on services commissioned for children. Using resident populations for the district of Swale, the population aged 65+ is predicted to increase by 68.1% from 2011 to 2031, i.e. from 22,600 to 38,000. This increase is greater in the 85+ group, being predicted to increase 142.3% during the same period (from 2,600 to 6,300) census data around ethnic populations show that 1.03% of the population of Swale are from a black or minority ethnic (BME) group. Anecdotal evidence suggests that a greater number of Eastern Europeans are migrating to Kent. Data from the 2011 census has provided a better understanding of the populations within Kent; for the first time this included the gypsy and traveller communities of which Swale has a higher proportion compared to the England percentage, this data is presented in the tables below. *(Please note that the data is produced at a local authority level, NOT CCG level). Life expectancy from birth is 79.7 years, the same as Medway CCG and the second lowest of the eight Kent CCGs. This compares to 80.9 years for Kent and Medway. Swale is the third most deprived district within Kent and is ranked 70 out of the 326 deprived districts in England. Looking at practice level deprivation (derived from weighted population deprivation), no practices are within the 40% least deprived and eight practices are in the 20% most deprived. Page 7 of 56

8 3. Summary of Progress and Key Achievements NHS Kent and Medway in the Annual Safeguarding Report set out priorities for the year. Below is a summary of how those priorities have been implemented: Ensure achievement against actions required from NHS England following their assurance process. Completed - action plans submitted and assurance given. Deliver recommendations from the recent CQC review of safeguarding services and services for Looked after Children within West and North Kent. Completed - Monitoring tool in place to assure CCG and CQC. Majority of actions are closed and the remainder in progress. Implement Service Level Agreements, Job Plans and JDs for all designated doctors across Kent and Medway, securing this statutory provision. Complete see below. Area Teams are responsible for recruitment to Named GP in Medway and North Kent locality, to ensure collaborative working. In progress NHS England are planning to set up an SLA to discharge this responsibility via the CCGs. Review policies, strategies and guidance in line with recent key national documents, national and local SCR/DHR/Case Reviews and legislation. Complete and published on CCGs internets. Transfer the Child Death Function into a CCG. Complete - hosted by Swale CCG. Deliver training for CCG employed staff and Governing Bodies. Complete - Induction programme in place across North Kent, all three Governing Bodies have had face to face training and been part of an immersive learning event delivered by Kent Safeguarding Children Board. Consolidate Designated Nurse s alignment to CCGs and chief nurses. Complete - as part of disaggregation of hosted team. Page 8 of 56

9 Build on work already completed to develop robust arrangements and relationships. Ongoing - Bi-monthly safeguarding meetings with safeguarding leads and named nurses arranged with designated nurses. Continued attendance and influence at KSCB and MSCB sub-groups. Ongoing full attendance at all sub-groups across Kent and Medway is achieved by all CCGs being represented as outlined in the safeguarding MOU. Implement Safeguarding Work plans for all CCGs 14/15. Complete The safeguarding work plan for the North Kent CCGs is incorporated in the Quality and Safety Team work plan. Continue to develop robust arrangements and relationships with provider organisations including standardisation of data collation and safeguarding representation at local operational meetings. Complete safeguarding metrics have been agreed and are incorporated into all provider contracts. Key Achievements in 2013/14 CCG North Kent CCGs secured the additional allocation of one whole time Designated nurse for safeguarding children. All safeguarding designated posts (3) were successfully appointed to when vacancies occurred with no gap in delivery of service. Consistent Safeguarding input at key CCG meetings and KSCB, MSCB and Safeguarding Adult Board (SAB) sub-groups. Development of robust networks and relationships with designated nurse across CCG to ensure robust arrangements and application of thresholds to protect children. Collaboration achieved through a Memorandum of Understanding (MOU). Initiation and delivery of safeguarding training across CCGs to Primary Care. This has included an immersive learning event facilitated by KSCB. All Governing Bodies have received bespoke safeguarding children and adult training. All safeguarding policies and procedures, including the CCG safeguarding declaration, have been reviewed and updated in line with current legislation. Page 9 of 56

10 Successful multiagency working to protect and safeguard children and young people. CCG led scoping exercise across provider health organisations to review their preparedness to recognise sexual exploitation. CCG led request for provider health organisations to review compliance with recommendations made in the Savile report. Provision of advice and support to GP staff and other primary care professionals. KSCB Section 11 assessment of CCGs completed and submitted. Agreed robust safeguarding metrics which are now in all North Kent contracts for Safeguarding assurance gained across the North Kent CCGs and is demonstrated in a reduction of safeguarding risks on the CCG s risk register. Successful integration into the Quality & Safety Team which has allowed a joint safeguarding, quality and safety focus. Safeguarding input at key CCG meetings and SAB and SAB sub-groups. Collation and completion of Health IMR for Domestic Homicide Review. Commissioning health participation into multi-agency information provision and development of safeguarding adults experience under Making Safeguarding Personal Project. Hosting of (Mental Capacity Act) MCA Implementation Programme pan-kent following the recommendations of the House of Lords Select Committee report. Supporting local networks and groups of safeguarding adults professionals to come together to share expertise, ideas and best practice by the development and hosting of the safeguarding leads forum pan-kent. Ensuring that CCGs were sighted on emerging adult safeguarding risks, including compliance with the Mental Capacity Act, and the implications of the Supreme Court judgement on the Deprivation of Liberty. Embedding legislation and recommendations from the Care Act 2014 and Counter Terrorism and Security Bill 2015 into all CCG Safeguarding Adults documents. Partnership working with social care partners in order to encourage and improve quality and safety in the care home sector has involved the development of multi-agency Care Home Forums in each CCG. Page 10 of 56

11 4. Governance and Accountability Arrangements In March 2013, the NHS Commissioning Board (now known as NHS England) published the Accountability and Assurance Framework: Safeguarding Vulnerable People in the Reformed NHS (currently under review), which sets out the safeguarding accountabilities of CCGs and include: Plans to train staff in recognising and reporting safeguarding issues; A clear line of accountability for safeguarding properly reflected in the CCG governance arrangements; Appropriate arrangements to co-operate with local authorities in the operation of Local Safeguarding Children Boards (LSCBs) and SABs Securing the expertise of a designated doctor and nurse for safeguarding children and for looked after children and a designated paediatrician for unexpected deaths in childhood; Have a safeguarding adult lead and a lead for the Mental Capacity Act, supported by the relevant policies and training. This accountability and assurance framework was commissioned by NHS England in order to set out clearly the responsibilities of each of the key players for safeguarding in the future NHS. It has been developed in partnership with colleagues from the Department of Health (DH), the Department for Education (DfE) and the wider NHS and social care system. The Mandate from the Government to the NHS Commissioning Board, now known as NHS England, for April 2013 to March 2015 (published in November 2012) states: We expect to see the NHS, working together with schools and children's social services, supporting and safeguarding vulnerable, looked-after and adopted children, through a more joined-up approach to addressing their needs. The Mandate also sets NHS England a specific objective of continuing to improve safeguarding practice in the NHS, reflecting also the commitment to prevent and reduce the risk of abuse and neglect of adults. The Accountability and Assurance Framework: Safeguarding Vulnerable People in the Reformed NHS is currently being revised and is out for consultation. Page 11 of 56

12 Safeguarding accountability sits within the portfolio of the Chief Nurse, who provides strategic direction on child and adult safeguarding, including Looked after Children, and has direct or delegated representation on the local Safeguarding Children s Board and the Adult Safeguarding Board for Kent and Medway. Governance is achieved for DGS CCG and Swale CCG via the Quality Committee which is established in accordance with North Kent Clinical Commissioning Group s Constitution, Standing Orders and Scheme of Delegation. There is a sub-group of the quality committee known as the Safeguarding Committee, the role of which is to ensure the CCGs are assured about their own and their commissioned provider safeguarding accountabilities, understand safeguarding processes and systems and performance. There is not an expectation that the Safeguarding Group will replicate existing multi-agency statutory fora, therefore membership is limited initially to health commissioners. For Medway CCG, Goverance was achieved via the quality committee but is now from the Safeguarding Committee directly to the Governing Body. The purpose of the Safeguarding Group is to assist GB in an assurance role to enable the CCGs to deliver their statutory responsibilities for safeguarding Designated nurses for Safeguarding Children and Adults North Kent CCGs have 2 designated nurses for safeguarding children and one designated nurse for safeguarding adults in July All posts have been recruited to throughout the year. Designated Doctors for Safeguarding Children Clinical Commissioning Groups need to secure the expertise of a designated doctor and nurse for safeguarding children to provide strategic and clinical leadership and advice, not only for themselves but also for the local authority. The role of these designated professionals is to assist the CCGs in fulfilling their responsibilities as commissioners of services to safeguard children. Page 12 of 56

13 NHS Medway CCG The designated doctor for unexpected child death function is shared by a consultant paediatrician and a consultant neonatologist employed by Medway Foundation Trust (MFT). The designated doctor for safeguarding children has been in post for a number of years. The service is commissioned through the block contract between the CCG and MFT. NHS DGS CCG Both the designated doctors for safeguarding and child death are in place and contract variations have been agreed and signed. The designated doctor for unexpected child death function is delivered by a consultant paediatrician employed by Dartford and Gravesham Hospital for many years. The designated doctor for safeguarding children function is delivered by a consultant paediatrician employed by Kent Community Health Foundation Trust. NHS SWALE CCG The designated doctor for unexpected child death function is delivered by a consultant paediatrician employed by East Kent Hospital Trust who has been in post for many years. It has been identified that Swale CCG has previously not been financially contributing to this post. This has now been rectified and Swale CCG will be paying for 1 PA per month for this role from April The expertise of a designated doctor for safeguarding children for Swale CCG has been negotiated and East Kent Hospitals will supply this role from April National legislation and Guidance. 5.1 Safeguarding Children Working Together to Safeguard Children 2015 This statutory guidance clarifies the responsibilities of professionals towards safeguarding children, and strengthens the focus away from processes and onto the needs of the child. Last published in 2013, following consultation the government has updated and replaced Page 13 of 56

14 the current statutory guidance Working Together to Safeguard Children revised and published in The revisions include changes to: 1. The referral of allegations against those who work with children; 2. Notifiable incidents involving the care of a child; and 3. The definition of serious harm for the purposes of serious case reviews Safeguarding Children and Young People: roles and competencies for health care staff: Intercollegiate Document 2014 All staff that come into contact with children and young people have a responsibility to safeguard and promote their welfare and should know what to do if they have concerns about safeguarding issues, including child protection. This responsibility also applies to staff working primarily with adults who have dependent children that may be at risk because of their parent/carer s health or behavior. To fulfil these responsibilities, it is the duty of healthcare organisations to ensure that all health staff have access to appropriate safeguarding training, learning opportunities, and support to facilitate their understanding of the clinical aspects of child welfare and information sharing. All health staff must have the competences to recognise child maltreatment and to take effective action as appropriate to their role. They must also clearly understand their responsibilities, and should be supported by their employing organisation to fulfil their duties. Chief Executive officers and independent contractors, such as GPs, in particular have a responsibility to ensure that all staff across the organisation have the knowledge and skills to be able to meet this requirement. The latest version of intercollegiate document jointly published by the Royal Colleges and professional bodies was updated in April 2014 to emphasize the crucial role of the Executive Team and Board members, whilst also taking into account the structural changes which have occurred across the NHS. The framework is applicable across all four countries of the UK and sets the standards and requirements expected of all health staff. While the responsibility of ensuring staff have access to appropriate safeguarding training and learning opportunities rests with healthcare organisations, the emphasis in the framework continues to be upon maximising flexible learning opportunities to acquire and Page 14 of 56

15 maintain knowledge and skills, drawing upon lessons from research, case studies and serious case reviews. The framework will be reviewed again in Female Genital Mutilation (FGM) HM Government has issued multi-agency practice guidelines regarding FGM and the Department of Health has issued guidance for GPs on recording FGM. Mandatory anonymous reporting from September 2014 for acute and community providers, including GPs monthly returns must be completed and clinical staff must now record in patients healthcare record that they have had FGM identified and ideally the type coded as well. There is a specialist FGM clinic based at University College London Hospital which is offering medical and psychological support to women. The Home Office is championing a proactive approach in order to embed best practice and has launched a free online FGM training package. This course is useful for anyone who is interested in gaining an overview of FGM, particularly frontline staff in healthcare, police, border force and children s social care. To register for free to access the home Office e- learning learning, follow the link: ( All provider organisations have been asked to review their FGM procedures and identify any gaps. FGM is now to be included in any training delivered to staff. The Designated nurses have delivered training which has included FGM to General Practice. The Designated nurses will seek assurance from all those providers that are required to notify cases that they have processes in place to do this. Page 15 of 56

16 5.1.4 Child Sexual Exploitation (CSE) In recent years the issue of CSE has gone from being largely hidden and rarely acknowledged to the subject of significant media and political attention and concern. CSE is a safeguarding issue and there is a strong need to improve health professionals understanding of child sexual exploitation, in order to protect victims and support them to recover well. Additionally there is a need to improve the evidence base in order to improve the overall response from health. Sexually exploited children may suffer from a range of significant health vulnerabilities, including physical injury from violence, sexual health problems, pregnancy, terminations, drug and alcohol misuse, depression, low self-esteem, self-neglect, self-harm and attempted suicide. CSE can only be tackled through collaboration between senior managers and safeguarding professionals to provide direction through the Joint Health and Wellbeing Strategy, the Local Safeguarding Children s Board and partnership working. Health professionals should be proactively contributing at every stage of the commissioning cycle and delivery of services along the care pathway for children who are sexually exploited. Children who are victims of CSE should have easy access to health services not just for sexual health, but also for their physical and mental health, reflecting the broad range of health problems they may have. CSE is tackled effectively from prevention to protection, enforcement, securing justice and long term recovery, when there is clear and committed leadership that imparts unambiguous messages, stressing the importance of doing this work. This requires leadership, joint working and accountability from NHS England, Public Health, CCGs Inspectorates, Commissioning, Health and Wellbeing Boards, the use of Sexual Assault Referral Centres and the consideration of commissioning specialist support e.g. specialist CSE voluntary sector. Page 16 of 56

17 At a national level, the government produced its strategy Tackling Sexual Exploitation (March 15). It responds to the numerous reports and subsequent enquiry in sexual exploitation by the Office of Children s Commissioner. The document is available at: Dealing with CSE and should be read in conjunction with Information Sharing Letter Locally CSE protocols for Kent and Medway are finalised. This document supplements those produced by the Kent and Medway CSE and trafficking sub group. The strategy is due to be reviewed in July 15 and it is anticipated that the protocol will be refreshed at this time. Kent and Medway multi agency partners are in the process of developing a Multiagency Sexual Exploitation team (MASE) which will co-ordinate soft intelligence, data and safeguarding responses to victims of CSE. The first scoping meeting will be in June Sally Allum from NHS England will be representing health in this forum. A CSE action plan has been devised by both LSCBs and all multi-agency providers will provide assurance and organisational action plans where gaps are identified. This agenda will be delivered via the MASE. 5.2 Safeguarding Adults National context The Care Act 2014 The Care Act 2014 received Royal Assent (became law) in May It is the most significant reform of adult social care for more than 60 years, replaces No Secrets guidance and introduces many new principles and procedures. The Act will come into force in two stages in April 2015 and April 2016, supported by various regulations and statutory guidance, which was published in October Adult safeguarding is the process of protecting adults with care and support needs from abuse or neglect (hereafter referred to as adults ). It is an important part of what many public services do, but the key responsibility is with local authorities in partnership with the Page 17 of 56

18 police and the NHS. The Care Act 2014 puts adult safeguarding on a legal footing and from April 2015 each local authority must: make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to stop or prevent abuse or neglect, and if so, by whom; set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the police and the NHS (specifically the local Clinical Commissioning Group/s) and the power to include other relevant bodies; arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has substantial difficulty in being involved in the process and where there is no other appropriate adult to help them; co-operate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect. It also updates the scope of adult safeguarding: Where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there): a) has needs for care and support (whether or not the authority is meeting any of those needs), b) is experiencing, or is at risk of, abuse or neglect, and c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. In effect this means that regardless of whether they are providing any services, councils must follow up any concerns about either actual or suspected adult abuse. SABs will be strengthened and have more powers than the current arrangements set up by No Secrets, but they will also be more transparent and subject to greater scrutiny. All organisations who are involved in adult safeguarding will need to reflect the statutory guidance, good practice guidance and ancillary products that have been developed when devising their training and implementation plans for staff. Policies and procedures should be based on the processes laid out in the statutory guidance. Page 18 of 56

19 The statutory guidance enshrines the six principles of safeguarding: 1. empowerment - presumption of person led decisions and informed consent; 2. prevention - it is better to take action before harm occurs; 3. proportionality - proportionate and least intrusive response appropriate to the risk presented; 4. protection - support and representation for those in greatest need; 5. partnerships - local solutions through services working with their communities; 6. accountability - accountability and transparency in delivering safeguarding. The Care Act 2014 essentially signals a major change in practice - a move away from the process-led, tick box culture to a person-centred approach which achieves the outcomes that people want. The Care Act also recognises the key role of carers in relation to safeguarding, and makes it clear throughout the need for preventing abuse and neglect wherever possible. Observant professionals and other staff making early, positive interventions with individuals and families can make a huge difference to their lives, preventing the deterioration of a situation or breakdown of a support network. The Act introduces new categories of adult abuse; Organisational - previously akin to institutional abuse but now includes neglect/poor care in an institution or own home Modern slavery Domestic abuse Self-neglect The Care Act recognises that local authorities cannot safeguard individuals on their own; it can only be achieved by working together with the police, NHS and other key organisations as well as awareness of the wider public. Fears of sharing information must not stand in the way of protecting adults at risk of abuse or neglect. The Act includes new duties for SABs to work more closely together and share information. The statutory guidance also introduces Designated Adult Safeguarding Managers (DASMs) in organisations concerned with adult safeguarding, including CCGs. Page 19 of 56

20 The NHS is a key component of safeguarding and the local CCG is one of the three statutory core partners of the Safeguarding Adults Boards. The CCG is in the best position to ensure that NHS providers meet their responsibilities through its commissioning arrangements with them. 6. Multi-Agency Safeguarding Arrangements 6.1 Safeguarding Children CCGs have a statutory duty to be members of the LSCB working in partnership with local authorities to fulfil their safeguarding responsibilities. Kent and Medway have separate safeguarding boards, both are chaired independently. These statutory duties fall under Section 11 of the Children Act 2004 and apply to a range of organisations as well as the health economy Section 11 the Children Act 2004 Section 11 (s.11) of the Children Act 2004 places a duty on key persons and bodies to make arrangements to ensure that whilst doing their jobs they have regard to the need to safeguard and promote the welfare of children. The health service is one such key body, This section also states that these key bodies must take any guidance given to them by the Secretary of State and have clear reasons for not doing so. However this duty does not give any other health professional any new functions, nor does it override their existing functions. Simply it requires them to carry out their existing functions in a way that takes into account the need to safeguard and promote the welfare of children. LSCBs have a responsibility to assess whether their local partners are fulfilling their statutory obligations under section 11 of the Children Act Both Medway and Kent Safeguarding Children s Boards do this every two years via a multi-agency audit. 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 safeguarding arrangements; Page 20 of 56

21 a culture of listening to children and taking account of their wishes and feelings, both in individual decisions and the development of services; arrangements which set out clearly the processes for sharing information, with other professionals and with the Local Safeguarding Children Board (LSCB); a designated professional lead (or, for health provider organisations, named professionals) for safeguarding; safe recruitment practices for individuals whom the organisation will permit to work regularly with children, including policies on when to obtain a criminal record check; appropriate supervision and support for staff, including undertaking safeguarding training: employers are responsible for ensuring that their staff are competent to carry out their responsibilities for safeguarding and promoting the welfare of children and creating an environment where staff feel able to raise concerns and feel supported in their safeguarding role; staff should be given a mandatory induction, which includes familiarisation with child protection responsibilities and procedures to be followed if anyone has any concerns about a child s safety or welfare; and all professionals should have regular reviews of their own practice to ensure they improve over time; clear policies in line with those from the LSCB for dealing with allegations against people who work with children. All health organisations in Kent and Medway including providers and CCGs have been required to submit an s.11 self-assessment with final submissions to KSCB in March The designated nurse for safeguarding children has submitted assessments on behalf of NHS Swale and NHS DGS CCGs during this year. Scrutiny of all self-assessment submissions has already been completed for MSCB and will be undertaken by KSCB with professional support from the designated nurses. Individual provider compliance is outlined in section 8. NHS DGS CCG and Medway CCG were fully compliant with the s.11 self-assessment and NHS Swale CCG was not compliant in one area. This was to secure the expertise of a designated doctor for safeguarding children. Compliance has now been achieved. Page 21 of 56

22 6.1.2 Local Safeguarding Children Boards LSCBs were established in law by the Children Act 2004 (section 13) and have two main responsibilities: To co-ordinate what is done by each person or body represented on the Board for the purpose of safeguarding and promoting the welfare of children in their local community. To ensure the effectiveness of what is done by each such person or body for those purposes. Kent and Medway local authorities have complied with this regulation and each have a safeguarding children board which is chaired by an independent person. Executive leads for safeguarding represent their organisations at board meetings. Many groups of children in Kent and Medway are vulnerable and the table below indicates those children that are subject to a child protection plan in Kent and Medway. Children subject to a child protection plan (October 2014) relative to the child population of Kent (2013 estimates) Kent District 0-17 October 2014 Rate per population 10,000 population Dartford Gravesham Sevenoaks * Swale figures Feb 2015 Feb 2015 Medway LA Source: MIU, ONS *Swanley data is reported to Sevenoaks District Kent Safeguarding Children Board (KSCB) There are approximately 322,700 children and young people living in Kent, making up 22% of the population. Kent Safeguarding Children Board is a partnership, working to safeguard and promote the welfare of children. It places a statutory responsibility on all agencies in Kent, including CCGs Page 22 of 56

23 to provide assurance that they are working to ensure that all children and young people in Kent stay safe and are adequately protected. It is responsible for co-ordinating and ensuring the effectiveness of Kent services in protecting and promoting the welfare of children and young people and provides the vital link between various statutory and voluntary organisations. The Board is made up of senior representatives from all main agencies and organisations. CCGs are represented, by agreement, by one Chief Nurse from the Kent CCGs who will represent the interests of all CCGs. The sub-groups are formed to tackle the various area of concern to the KSCB on a more targeted and thematic basis. Health providers across Kent are members of all sub-groups and the designated nurses for safeguarding children are active members who give the strategic health expertise and oversight of the whole health economy. KSCB develops an annual Business Plan which sets out what it intends to achieve and how its success will be measured. KSCB set four strategic priorities for 2014/15 which should be familiar to the CCG GB and should be reflected in any commissioning decisions they make: Priority 1 Co-ordinate, monitor and challenge the effectiveness of local arrangements of the quality and appropriateness of early help and preventative services. Priority 2 Ensuring multi-agency and joined up working which protects and supports children with specific vulnerabilities, including the provision of timely and appropriate services This will include focus on the following groups of vulnerable young people: Missing young people CSE young people Those being trafficked Those affected by gangs Those affected by on line safety and those at risk of on line threats Priority 3 Develop a family focused approach in relation to substance misuse, mental health problems and domestic abuse. Priority 4 Provide evidence assurance to the KSCB through robust monitoring, scrutiny and challenge, that multi-agency safeguarding practices are improving and there is ongoing learning and development for staff. Page 23 of 56

24 Key threads that run through all priorities: Voice of the Child Multi-agency partnership working (including the voluntary and community sectors) Lessons are identified and learned from case reviews and multi-agency audits undertaken to monitor the implementation of recommendations. Knowledge and understanding of the children s workforce Children with disabilities, including those with autism Victims of sexual abuse Victims/perpetrators of domestic abuse Those bullying or being bullied Victims of FGM Implementation of the Learning and Improvement Framework Response to Ofsted Review Framework Reporting from each KSCB Sub Group Feedback to staff Kent County Council Ofsted thematic inspection Child Sexual Exploitation (CSE) Ofsted undertook a thematic inspection of practice in protecting children and young people in relation to issues of child sexual exploitation (CSE) across eight local authorities of which Kent was one. The aim of the inspection was develop their understanding of the factors which facilitate or hinder good quality practice and effective protection of children and young people relating to issues of child sexual exploitation. The inspection was completed in October 14 via a programme of small group meeting interviews with key individuals, and tracking of a selected number of cases. In addition, Ofsted Inspectors spoke to colleagues from the KSCB Trafficking and Sexual Exploitation sub-group and health representatives which included the designated nurses for safeguarding children Changes to the Common Assessment Framework (CAF) process in Kent Following the review of the Common Assessment Framework (CAF) process, the Early Help and Preventative Services (EH&PS) was piloted from 1 st September 2014 using a phased approach. The assessment process replaced the CAF whose name was changed to the Kent Family Support Framework. Page 24 of 56

25 The Kent Family Support Framework (KFSF) revised model has three interacting service delivery areas and processes: The Identification Notification and Decision Making The Assessment The Plan, Delivery and Review A key element to providing effective Early Help and Prevention is the consistent use across the children s workforce of procedures and processes to identify and address the risks and needs of vulnerable children, young people and their families and reduce the demand for social care services. The KFSF provides a streamlined process which includes: Early Help advice and support from an Early Help co-ordinating team. Request for access to EH&PS support from Kent Integrated Family Support Service (KIFSS) and Kent Integrated Adolescent Support Service (KIASS) by completing and uploading a notification form. A simplified triage process for all notifications to ensure effective decision making and allocation to access appropriate advice and support including Early Help and Troubled Families commissioned services. A closer working relationship with social care to ensure more effective step up and step down processes. The use of revised assessment, plan and review tools to ensure high quality interventions are made to achieve better outcomes for the child and family. An identified key worker to be a single point of contact for families and schools. More details of the pilot including a KFSF flowchart diagram are available on the following webpages ( Medway Safeguarding Children Board MSCB The Medway Safeguarding Children Board is a strategic group that ensures the child protection and safeguarding objectives are co-ordinated, monitored and effective. It is made up of senior strategic managers of partner agencies. It is the key group that, whilst operating in the context of the local children s trust arrangements and developing a strong Page 25 of 56

26 relationship with the wider strategic partnerships within Medway, has a statutory role in safeguarding and promoting the welfare of children. MSCB develops an annual Business Plan which sets out what it intends to achieve and how its success will be measured. In order to do this in a way that is responsive to safeguarding priorities across Medway, the MSCB invites single agencies each year to identify their own safeguarding objectives and report on how these have been achieved throughout the year. Individual partner agencies are also asked to identify overarching objectives and priorities for the Board, which are then considered by the Board and worked into the plan. The plan also contains how recommendations from inspections, SCRs and other reviews and changes in government guidance will be implemented as well as priorities identified through the MSCB s annual safeguarding needs analysis contained within the annual report. Main aims were: To ensure the effective co-ordination of local work to safeguard and promote the welfare of children. To ensure the effectiveness of the work of local partners to safeguard and promote the welfare of children. To protect and promote the well-being of vulnerable groups of children. In 2015 a new chair was appointed and a new manager. MSCB was subject to peer review in February The CCG as a partner of MSCB has a responsibility to engage fully and contribute to the multi-agency safeguarding partnership and contribute to the improvement recommendations made by the peer reviewers. There were a number of key recommendations which fall into five categories; actions already undertaken since the review are summarised below: Serious Case Review (SCR) Action Plans - There were two outstanding action plans resulting from SCR undertaken in Medway. The final action plans have been completed and presented to the Board for final sign off. Evidence of Challenge - The Peer Reviewers commented that the Board needs to more effectively evidence its challenge of it member partners. As a result, the MSCB Page 26 of 56

27 Executive has introduced a challenge log to evidence how it demonstrates challenges to partners on their responsibilities, and members of the Board have been encouraged to adopt a more direct approach at meetings. Multi-agency Early Help As part of its duties to assess the effectiveness of early help services being provided in Medway, the Board has endorsed the Early Help strategy, and will receive regular progress reports including an update report at the Board meeting in September Voice of Children and Young People During , the MSCB Board meetings have started with a voice of the child item and MSCB has facilitated a number of forums and workshops to engage young people. In order to embed the engagement of young people further into the work of MSCB, the Board has championed the proposed establishment of a Young Person s Safeguarding Panel to enable young people to have a platform where they can raise issues and concerns around safeguarding. Implementation of Quality Assurance Framework The MSCB is in the process of updating its Quality Assurance Framework from the model developed by David Warlock. The revised framework addresses the ways in which MSCB ensures effectiveness using outcomes based accountability approach. In addition to the programme of agency annual reports presented to the Board, Section 11 Audits, Case Reviews and the MSCB dataset, the framework sets out the programme of multi-agency themed audits. Medway Council remain subject to an improvement plan following the 2012 inadequate OFSTED inspection. The Improvement Board, which was formed to provide strategic leadership and scrutiny of the action plans, is now in the process of transferring key responsibilities to the MSCB. All the MSCB Board meetings will have a standing agenda item on the work of the Improvement Board and from mid-summer onwards some of the routine functions of the Improvement Board will begin to transfer to the MSCB KSCB/MSCB sub-groups The Safeguarding Children Boards are required to have sub-groups to carry out the business of the Board. They are made up of all organisations that provide a service to children locally. The Designated nurses for safeguarding children are active members of the sub-groups and offer their expertise on all issues relating to the whole health economy. Page 27 of 56

28 Their function is to tackle various areas of concern to the LSCB on a more targeted and thematic basis. They report into and are accountable to the Board. CCG representation at Board level is achieved by the Chief Nurse. Some of the sub-groups are joint ventures between both boards. Health is represented on all sub-groups. These include: Policy and Procedures Sub-group Trafficking Sub-group Each Safeguarding Board will also have common sub-groups which include: Serious Case Review Sub-group Learning & Development Sub-group Child Death Overview Panels (CDOP) - each CDOP produces an annual report which can be found on and Additional MSCB Sub-groups: Executive Performance Monitoring and Quality Assurance (PMQA) Lessons Learned Additional KSCB Sub-groups: Quality & Effectiveness Sub-group Health Safeguarding Group Health Reference Group The Child Death Review Service - Kent The Child Death Review Service works in partnership with Kent s Health Economy to ensure that the statutory requirements of Regulation 6 of the Local Safeguarding Children Board Regulations, 2006, made under section 14(2) of the Children Act 2004, are met. Page 28 of 56

29 The statutory guidance in Chapter 5 Working Together to Safeguard Children 2013 states that every child s death occurring within the boundary of Kent Safeguarding Children Board (KSCB) and/or any death of a child normally resident within the boundaries are reported to KSCB within 1 working day of the child s death. For full report please see APPENDIX 1 DGS and Swale CCG During 2014/15, the Swale area has experienced 7 unexpected child deaths. Currently, 2 cases were explained unexpected cases that were neonates. There have been 2 cases of sudden unexpected deaths in infancy which amounts to 50% of the cases in Kent. Despite safe sleeping advice being given, parents continue to co-sleep or use unsafe sleeping choices. Smoking also featured as a factor in both cases. DGS has had the largest number of deaths within Kent 2014/15 (19 deaths) 7 cases were neonatal and 7 were children with life-limiting conditions. Only 4 cases were unexpected and related to overwhelming infections (although there are some outstanding post-mortem results) None of the cases have met the criteria for Serious Case Review Medway Child Death Overview Panel (CDOP) There were 32 child deaths reported to the MSCB in 2014/15. Of these, 13 were deaths of children resident in other LSCB areas. There were 16 children normally resident in Medway who died in Medway, and 3 who died out of area. The Medway CDOP is responsible for reviewing all deaths of Medway resident children wherever they died and therefore there were 19 reported deaths in 2014/15 to review. Of these deaths, 11 were expected and 8 were unexpected The majority of the deaths reviewed during 2014/15 were caused by a perinatal/neonatal event, in 82% of the cases reviewed prematurity or preterm labour was cited as the/one of Page 29 of 56

30 the causes of death. The second most common cause was chromosomal, genetic and congenital anomalies (18.6% of cases). There were no Serious Case Reviews (SCRs) published or instigated by the MSCB in 2014/ Safeguarding Adults Kent and Medway Safeguarding Vulnerable Adult Board (K&MSVAB) SVAB covers all eight Kent and Medway CCGs and both local authorities. This Board is chaired by Kent County Council Corporate Director for Families and Social Care. All Ken CCG Chief Nurses are invited to be present on the Board to represent the CCGs. All health provider leads for adult safeguarding are also Board members. Designated nurses for adult safeguarding attend Board meetings and are represented on the sub-group structure; Serious Case Review Panel Learning and Development Quality Assurance Policy and Protocols Mental Capacity Act and Deprivation of Liberty Safeguards (currently this is a standalone Board and further discussion and agreement is required) Kent Adult Social Services (KASS) and Central Referral Unit (CRU) Kent Adult Social Services (KASS) operate a Central Referral Unit (CRU), which is a multiagency hub that evaluates and assesses safeguarding for both children and adult concerns, bringing together the information held within the multi-agency environment, evaluating the level of risk and planning the necessary action through strategy discussions. The CRU is made up of staff from different agencies including Police, Social Services, Health and Probation. The Families and Social Care (KCC) part of the CRU is the County Duty Team (CDT). The Central Referral Unit covers the KCC boundaries; Medway has different arrangements for evaluating and assessing adult safeguarding. Page 30 of 56

31 KASS provides a weekly update on sanctions on care homes in Kent, this information can be filtered by CCG, and designated nurses are able to provide information to their individual CCGs. We do not currently receive the same level of information from Medway Council. Sanctions AP2 AP3 PP1 PP3 An Adult Protection alert is being investigated and it is possible that other service users may be at risk of significant harm due to abuse, or poor practice. Some or all service users are being assessed in relation to these concerns. An adult protection alert is being assessed and/or investigated and there is evidence of significant risk to other service users due to abuse or poor practice. KASS and CHC placements on hold. Poor practice concerns have been identified and are being investigated. There is a low risk of harm, abuse or neglect to service users. Serious poor practice concerns have been raised and are being investigated. There is a significant risk of harm, abuse or neglect to service users. KASS and CHC placements on hold Care Homes and Safeguarding The Designated nurse has developed a system to efficiently receive and process all serious safeguarding alerts regarding those providers from whom they commission services, from the local authorities. Alerts are sent to a Single Point of Access NHS mailbox, and all alerts are triaged for seriousness. The Designated nurse works closely with the local authorities, provider organisations and care homes to support the adult protection investigation process. The Designated nurse provides Mental Capacity Act and safeguarding advice and guidance for complex cases and works jointly with local authority safeguarding leads to progress investigations into complex cases, produces specialist reports, attend case conferences and develop actions plans for quality improvements Domestic abuse Domestic abuse is defined as: any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. Page 31 of 56

32 The NICE guidance (February 2014) Domestic violence and abuse: how health services, social care and the organisations they work with can respond effectively makes a number of recommendations for CCGs, including developing an integrated commissioning strategy through local strategic partnerships and commissioning integrated care pathways - Domestic Violence and Abuse Service and Swale Action to End Domestic Abuse. The Kent and Medway Domestic Abuse Strategy Group, a multi-agency group, is responsible for setting the strategy, and is accountable to the Community Safety Partnerships. The Domestic Abuse Strategy ( ) and Delivery Plan is available on the Kent and Medway Domestic Abuse website On 1 st April 2013, NHS England became responsible for commissioning health services for people who experience sexual assault or rape. This includes responsibility for overseeing the commissioning of services from sexual assault referral centres (SARCs). NHS England is committed to ensuring that all victims can access safe, confidential and high quality support, health care and forensic examinations from a local SARC. NHS England s Kent and Medway Area Team and the Police Crime Commissioner s Office have been working in partnership with Kent Police and other partner organisations to establish a new sexual assault referral centre (SARC) for Kent and Medway and to improve the services that are available to support victims of sexual assault. They have worked at pace to develop a new high quality service as quickly as possible and have now commissioned a new SARC service, which will be delivered by Kent and Medway NHS and Social Care Partnership Trust (KMPT). The service has been commissioned in line with the national service framework which has been developed by NHS England and various partners to ensure the highest quality support for victims and equity of provision Domestic Homicide Review (DHRs) DHRs were established on a statutory basis under section 9 of the Domestic Violence, Crime and Victims Act (2004). This provision came into force on 13 th April Revised guidance has been issued, applicable from August A DHR is a review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, Page 32 of 56

33 abuse or neglect perpetrated by: (a) a person to whom he/she was related or with whom he/she was or had been in an intimate personal relationship, or (b) a member of the same household as himself/herself, held with a view to identifying the lessons to be learnt from the death. An intimate personal relationship includes relationships between adults who are or have been intimate partners or family members, regardless of gender or sexuality. DHR No* The table below shows the eleven DHRs for Kent and Medway. Published reports can be found at: Locality CCG Date CSP notified Submitted to Home Office Returned from Home Office Identifier 1 Rochester Medway August March 2012 July 2012 Mrs A/2011 no Chatham Medway Sept 2011 July 2013 Oct 2013 Cydney/2011 yes 3 Gravesend DGS Sept 2011 Oct 2013 Pending Alan Margate Thanet Oct 2011 Nov 2013 Pending Christopher/ Canterbury C4G Nov 2011 Jan 2013 June 2013 FL/2011 yes 7 Ashford Ashford May 2012 July 2013 Pending B/ Dover SKC May 2012 Sept 2013 Nov 2013 BC/2012 yes 9 Margate Thanet Oct 2012 In progress NA NA 11 Broadstairs Thanet Nov 2013 In progress NA NA Published *DHR4: subsequent to the notification this case was found not to be a homicide *DHR10: Due to a lack of any agency involvement a decision taken not to conduct a DHR was relayed to the Home Office in January Deprivation of Liberty Safeguards (DoLS) The MCA DoLS came into force from 1 st April 2009 and are part of the Mental Capacity Act The safeguards were introduced after a case called HL v the UK (also known as Bournewood) went to the European Court of Human Rights. This case resulted in the MCA DoLS to ensure that people who lack capacity are protected from being deprived of their liberty unlawfully in a hospital or care home. The intention of DoLS is to ensure that any decision to deprive someone of their liberty is made following defined processes and in consultation with specific authorities. They provide a proper legal process and suitable Page 33 of 56

34 protection where deprivation of liberty appears to be unavoidable in the person s best interests. The supervisory body responsibility for authorising Deprivation of Liberty applications in health placements transferred from PCTs to Local Authorities on 1 st April CCGs remain accountable for commissioning health services that are compliant with the DoLS legislation. Supreme Court Ruling March 2014 The ruling provided clarification on the definition of what amounts to a deprivation of liberty. In the context of intense criticism of the system, and due to a surge of applications in the wake of the Supreme Court ruling, the Law Commission has been asked by the Government to review the legislation on which it is based and related guidance. A consultation paper is to be published by the Law Commission in the summer of 2015, with a final report in This project will also amend the legal framework to include certain settings beyond care homes and hospitals, for example supported living, which presently require a direct application to the Court of Protection to authorise a deprivation of liberty. The Supreme Court found that there is a deprivation of liberty for the purposes of Article 5 of the European Convention on Human Rights in the following circumstances: The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. (known as the Acid Test) The Supreme Court held that factors which are not relevant to determining whether there is a deprivation of liberty include: the person s compliance or lack of objection to their care arrangements; the purpose of the deprivation of liberty; the extent to which it enables them to live a relatively normal life. Page 34 of 56

35 It was also held that the relative normality of the placement, given the person s needs, was not relevant. This means that the person should not be compared with anyone else in determining whether there is a deprivation of liberty. 7. Serious Case Reviews (SCR) Children and Young People Both MSCB and KSCB have SCR sub-groups/panels which are independent from each other and have well established processes in place. The Case Review Sub Groups/Panels are responsible for reviewing cases where a child has died or has been seriously harmed in circumstances where abuse or neglect is known or suspected, and for co-ordinating and disseminating learning from these. The groups provide advice to the Independent Chair on whether the criteria for conducting a Serious Case Review (SCR) has been met and will support the Chair in establishing the initial scope for any SCR that is commissioned. The purpose of SCRs is to learn lessons and make improvements to services but also to consolidate good practice. They are carried out under the auspices of the LSCB and they should oversee the implementation of action plans. The revised Working Together guidance states that from 2015 a national panel of experts will be in place to advise LSCBs on the initiation and publication of SCRs. Medway Safeguarding Children Board last undertook a SCR in 2012 which was published on 8 th May 2013, but has not undertaken one in this reporting period. All previous SCRs can be found at There were no SCRs commissioned by KSCB. However, in 2014 the Case Review Group has undertaken and completed seven formal Management Reviews. These reviews have taken the form of: Practitioner events; Manager and practitioner learning events; Independent manager reviews. Page 35 of 56

36 All reviews have been chaired by members of the Case Review Group and findings and recommendations reported back to the Case Review Group. Learning from these reviews has been identified and integrated in to the existing KSCB training programme, or where new topics have been identified, new training has been commissioned and delivered. Key topics: Sexual Abuse Record Keeping Child Protection Conferences/Review Conferences Strategy discussions Self-Harm Voice of the Child Supervision Toxic Trio Working with Families 8. North Kent CCG Safeguarding Team Assurance Development Following disaggregation of the hosted safeguarding team, the designated nurses for safeguarding were TUPEd from Medway CCG to Swale CCG and became members of the Quality and Safety Team. safeguarding assurance. This has allowed closer relationships in quality, safety and This has been demonstrated in the joint working by the designated nurses and the Heads of Quality with providers commissioned by North Kent CCGs. Soft intelligence, data collection and scrutiny are shared within the team and have added to a collective picture of assurance and risk assessment. The safeguarding service has developed particularly since July 2014, as new designated nurses have joined the team. The changes in practice include: Page 36 of 56

37 The Designated nurses now meet with all provider named nurses/safeguarding leads on a regular basis. The Designated nurses are attending or having representation at the majority of provider safeguarding committees. Safeguarding metrics have been devised, negotiated and agreed for all provider contracts with the expectation that all providers will be providing safeguarding data on a regular basis. The Designated nurses now attend provider Clinical Quality Review Group (CQRG) meetings as part of the Quality and Safety Team to gain and formalise safeguarding assurance. Standalone safeguarding and quality assurance visits with the Heads of Quality have been undertaken with a number of providers. This has included workarounds, demonstration of procedures in practice, databases and information systems, talking to staff and observing practice. One Designated nurse has been assigned to review the risk register every month. This has ensured that risks are promptly identified and regularly reviewed. The Designated nurses submit monthly safeguarding provider risk reports to the Heads of Quality for insertion into reports for CCG quality and performance meetings. Safeguarding adult and children reports for North Kent CCGs have been amalgamated into one report rather than separate reports. This has allowed information to be streamlined so that joint adult and children safeguarding information is given on each provider and allows assurance or gaps to be identified. The Designated nurses have been delivering joint safeguarding children and adult training to be delivered to General Practice in North Kent CCGs. 9. Other multi-agency quality assurance mechanisms 9.1 CQC Safeguarding and Looked after Children Review In April 2014 the CQC undertook a Review of Health Services for Children Looked After and Safeguarding in Kent. The review was conducted under Section 48 of the Health and Social Care Act 2008, giving the CQC the authority to review the provision of healthcare and the exercise of functions of NHS England and Clinical Commissioning Groups. Page 37 of 56

38 The purpose of the CQC review was to evaluate the effectiveness of health services for looked after children and the effectiveness of safeguarding arrangements for health for all children living in communities served by West Kent, Swale, and Dartford, Gravesham & Swanley Clinical Commissioning Groups (CCG). The specific focus of the review was on the experiences of looked after children and children and their families who receive safeguarding services. The CQC inspection considered: the role of healthcare providers and commissioners. the role of healthcare organisations in understanding risk factors, identifying needs, communicating effectively with children and families, liaising with other agencies, assessing needs and responding to those needs, and contributing to multi-agency assessments and reviews. the contribution of health services in promoting and improving the health and wellbeing of looked after children including carrying out health assessments and providing appropriate services. if healthcare organisations were working in accordance with their responsibilities under Section 11 of the Children Act 2004 (including the statutory guidance, Working Together to Safeguard Children 2013). The CQC report on the findings of the inspection was published on 18 th June 2014 along with 14 overarching recommendations for West Kent CCG, Dartford, Gravesham and Swanley CCG, Swale CCG, NHS England and key service providers of children s services within the identified CCG areas. Quality Assurance and Governance arrangements following the review. The Designated nurses commenced a programme of quality assuring the responses, challenging and requesting further information. In addition, meetings have been undertaken with the providers and these have included site visits, shadowing of staff and meetings, demonstration of databases, and some case sampling has been undertaken as part of the assurance process. Page 38 of 56

39 All providers have updated their part of the action plan by the requested timescale. All providers have demonstrated good progress with evidence to support this. As of February 2015 North Kent Providers have no actions that are rated red, i.e. no progress, and all other actions are in progress or are closed. 10. Health Providers across Kent and Medway CCGs 10.1 Medway NHS Foundation Trust (MFT) The executive lead for safeguarding children, adults and looked after children (LAC) is the Chief Nurse, who has safeguarding in his portfolio. MFT has governance arrangements in place via their Children Services Committee and through Governance to the Quality and Risk Committee. There is a full time named nurse and a specialist midwife who supports and advises professionals in the acute setting. There are two named doctors who cover the community in Medway and Swale and a named doctor, who covers the in-patient areas. There is a midwife in place who is identified as the named midwife. She has been supported by a specialist midwife in safeguarding. There is a paediatric liaison nurse who liaises with community services and primary care when a child attends Accident and Emergency or when there is a child death. The Trust also invested into a safeguarding domestic abuse advisor, although this post is currently vacant. The Safeguarding adults lead also has the role of leading on the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). There was also a 1.0 WTE Safeguarding Nurse for Learning Disabilities in post until March Since the post-holder left, this post has not been advertised or filled and remains as a vacancy. MFT is represented on both Kent and Medway Safeguarding Boards and at the Health Safeguarding Group which is a sub-group of KSCB and SVAB. In 2014, MFT was required to submit a Section 11 (s.11) self-assessment to MSCB. MFT has assessed themselves as fully compliant in five out of eight standards. The standards that are partially met relate to having a child friendly Accident and Emergency Department, more Page 39 of 56

40 staff trained to provide supervision, and more staff trained in safer recruitment. There are action plans in place to address these. In addition, MFT has submitted their s.11 self-assessment in March 2015 as requested by KSCB. They have deemed that they are compliant in all areas except three. Areas that need action include: Audit of the views of staff receiving safeguarding supervision by September Extend supervision to all nursing staff in the emergency department by end of August Update adverts to include the Trust s commitment to safeguarding children. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance. Safeguarding metrics have been agreed for insertion into the 2015/16 contracts for both children and adult safeguarding Medway Community Healthcare (MCH) Medway Community Healthcare is a Community Interest Company (CIC) which provides a wide range of community health services for Medway residents; from health visitors and community nurses to speech and language therapists and out of hours urgent care. The executive lead for safeguarding is the Director of Clinical Quality who attends the Medway Safeguarding Children Board and Kent and Medway SVAB. There is now full establishment in their safeguarding team with two named nurses for safeguarding children and a safeguarding adults and MCA Lead, who are active members of MSCB and SVAB sub-groups. MCH also has a specialist health visitor for domestic abuse and a safeguarding adults advisor. MCH completed a Section 11 (s.11) audit with which they assessed themselves as compliant with no recommendations. MCH were not required to undertake an s.11 self-assessment by KSCB. Page 40 of 56

41 MCH took part in the peer review of the Safeguarding Adults Assurance and Accountability Framework and submitted their review to the Safeguarding Vulnerable Adults Board. Recommendations to changes in policies and protocols were identified as a result of the implementation of the Care Act 2014 and the Supreme Court judgement on DoLS. The Designated nurses have regular meetings with the named professionals but are not members of the MCH internal Adult and Children Safeguarding Committee Dartford and Gravesham NHS Trust (D&G NHS Trust) The Director of Nursing provides executive lead at Trust board level and has safeguarding in her portfolio. Their safeguarding team is made up of a named nurse, named midwife, and named doctor with support from a lead midwife, senior sister, and safeguarding children paediatric liaison nurse. In addition, the named and lead midwives are supported by three community link midwives for safeguarding, one community link midwife for teenage pregnancy, and one specialist substance misuse midwife. The safeguarding adults lead is the lead for the Mental Capacity Act and the Deprivation of Liberty Safeguards. This post is supported by the addition of a 1.0 WTE (whole time equivalent) new post of safeguarding adults advisor. This post was recruited to in November 2014, and the post holder has experience in adult safeguarding, in particular in the learning disabilities setting. The adult safeguarding team is supported by the appropriate administration. The Designated nurses have regular meetings with the named professionals and attend the Adult and Children Safeguarding Committee. The Designated nurse for safeguarding children works closely with the designated nurse for safeguarding children from Bexley, as a third of patients accessing women and child services are from this area. Safeguarding children and adults metrics were devised and jointly negotiated with the Bexley Designated Nurse, and requests for information regarding assurance are jointly shared to ensure that duplication is minimised. D&G NHS Trust is required to report all cases of Female Genital Mutilation (FGM) in accordance with national guidance. Since the implementation of the FGM guidelines in June Page 41 of 56

42 last year, there has been an average of two cases identified per month, and has been a factor in 2.8% of referrals to social services. FGM procedures are in place and there is an identified FGM team. The FGM team continue to roll out training for midwives and has currently trained 55 midwives, with more sessions planned throughout the year. FGM training will now also be included in the Trust s level 3 mandatory safeguarding training. The team is meeting regularly with both Bexley and Kent s Children s Safeguarding Boards, who are fully aware of the guidelines and the on-going work undertaken by the team. D&G NHS Trust has developed a monthly professional multi-agency Safeguarding Midwifery Hub with good representation from Gravesham and Dartford Children s Social Care, the Early Intervention Teams, Mother & Infant Mental Health Service (MIMHS), Family Nurse Partnerships and specialist mental health and domestic abuse health visitors. This meeting provides the opportunity for multi-agency case discussions and care planning for women with complex social factors cared for at Darent Valley Hospital and demonstrates joined up working across agencies. Updates from the Hub are uploaded on to a shared drive which is available to midwives over a 24 hour period. More complex cases identified are fed back through the monthly Supervisor of Midwives meetings. D&G NHS Trust has submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas except 3. The areas to be addressed are: The executive lead for safeguarding is currently reviewing the named nurse resource and a business case has been written for possible options to support the current provision to the safeguarding children team. The safeguarding supervision policy needs to be ratified when resource implications have been resolved. A business case is being re-assessed by the executive lead for safeguarding. The safeguarding policy needs to highlight the importance of listening to children, especially where they are expressing concern about either their own or another child s welfare. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance. Page 42 of 56

43 D&G NHS Trust took part in the peer review of the Safeguarding Adults Assurance and Accountability Framework and submitted their review to the Safeguarding Vulnerable Adults Board. Recommendations to changes in training programmes, policies and protocols were identified as a result of the implementation of the Care Act 2014 and the Supreme Court judgement on DoLS South East Coast Ambulance Service (SECAmb)/111 NHS Swale CCG holds the contract for service provision by South East Coast Ambulance Service. The NHS 111 service for Kent is provided from two call centres, one in Ashford and one in Dorking. The 111 service in Dorking is provided by Care UK and the contract is managed by SECAmb. A safeguarding quality review has been undertaken on behalf of NHS Swale CCG by the designated nurses for safeguarding Adults and Children on the 111 service. Considerable time was spent in visiting both 111 sites and with meeting key individuals at 111 and SECAmb. Without the openness and willingness of these individuals to engage in this process, concerns could not have been explored and assurance gained. The organisations commitment to safeguarding was evident throughout the process and where issues were identified; there was an acknowledgement that further work was needed. The Designated nurses for Safeguarding are assured that SECAmb and 111 have satisfactory arrangements in place to meet statutory and national requirements for safeguarding, with the proviso that additional work is required in a number of areas. It is expected that progress will be reported back as part of the three times a year reporting at the Clinical Quality Review Group (CQRG) meetings and at meetings with the Designated nurses for Safeguarding. Safeguarding metrics have been agreed and inserted into the 2015/16 contract which will enable safeguarding assurance on statutory and local safeguarding requirements to be reviewed. Page 43 of 56

44 SECAmb have submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas except five. The outstanding areas which require additional work include the following: A specific SECAmb safeguarding strategy to support the organisational strategy is planned for Q Overarching policy and procedures to manage allegations against staff are in development which will be completed by May 2015 Specific reference within safeguarding procedures to safeguarding supervision of safeguarding lead and team is required. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance Kent & Medway NHS and Social Care Partnership Trust (KMPT) The trust provides adult mental health services and is commissioned by the CCGs across Kent. This includes an early intervention in psychosis service for people aged years old, and MIMHS, a mother and infant mental health service. The named nurses for safeguarding children are active in Kent and Medway in ensuring that practitioners recognise the Think Family agenda and have developed a checklist for practitioners to use with adult clients to ensure that children are considered in all assessments and consultations. The head of safeguarding is supported by the MCA and DoLS lead, who has worked closely with the local authority to embed the legislation within mental health services. The Trust also manages the service for the supply of Section 12 doctors for DoLS assessment. The head of safeguarding meets regularly with the designated nurses so that information can be shared and risks identified at an early point. Safeguarding metrics for children and adults have been agreed and inserted into the 2015/2016 contracts. KMPT has submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas except: Page 44 of 56

45 The need to update the Safeguarding Children Policy in line with the Intercollegiate document, change of named doctor role and Working Together to Safeguard Children 2013 which has been allocated to the named nurse for completion. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance Sussex Partnership Foundation Trust (SPFT) The Trust provides Tier 2-3 services (targeted and specialist support) which are commissioned by the CCGs, with West Kent CCG being co-ordinating commissioner. SPFT has a permanent and full time named nurse within Kent who has been very active in engaging the organisation in safeguarding activity and is a regular member of both Safeguarding Boards. The North Kent CCG Designated nurses for Safeguarding work with their West Kent CCG colleagues, through the safeguarding network arrangement, to gain assurance around safeguarding activity. All Designated nurses meet with the SPFT named nurse for safeguarding from time to time throughout the year. SPFT have submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance South London & Maudsley NHS Trust (SLAM) Tier 4 specialist in-patient CAMHS services are commissioned and funded by NHS England and provided by the South London & Maudsley NHS Trust (SLAM) across Kent. The Designated nurses meet regularly with the safeguarding team who are active in both Safeguarding Boards. SLAM has submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas. The Designated nurses in conjunction with KSCB will review all s.11 self-assessment declarations and call for evidence to support compliance. Page 45 of 56

46 10.8 Kent Community Healthcare Foundation Trust (KCHFT) Kent Community Health NHS Trust (KCHT) was formed on 1 April 2011 from the merger of Eastern and Coastal Kent Community Services NHS Trust and West Kent Community Health. KCHT is one of the largest NHS community health providers in England and became a Foundation Trust on the 1 st March. The Executive Lead with the responsibility for safeguarding in Kent Community Health Foundation Trust is the Director of Nursing and Quality, who is also a standing member of the Kent Safeguarding Children and Vulnerable Adults Boards. KCHFT actively participates at the Kent Safeguarding Children and Vulnerable Adults Board sub-groups. KCHFT provides the health support at the Central Referral Unit (CRU) for the Kent Health economy to improve information sharing and decision making in relation to preventive and reactive safeguarding work to protect children, young people and adults at risk. Safeguarding assurance within KCHT is provided by the Head of Safeguarding and her team, which includes named doctors and nurses. The North Kent CCG Designated nurses for Safeguarding work with their West Kent CCG colleagues, through the safeguarding network arrangement, to gain assurance around safeguarding activity as the West Kent CCG designated nurse for safeguarding children attends KCHFTs internal safeguarding committee. KCHFT has submitted their s.11 self-assessment as requested by KSCB. They have deemed that they are compliant in all areas. 11. Safeguarding areas for Development in 2015/ Future Plans - Going forward in 2014/15 Ensure achievement against actions required from NHS England following their assurance process. Page 46 of 56

47 Complete the action plan from the CQC review of safeguarding services and services for Looked after Children within West and North Kent. Implement and monitor Service Level Agreements, Job Plans and JDs for all designated doctors across Kent and Medway, securing this statutory provision. Assist in the recruitment to named GP within the North Kent CCGs and develop measures to ensure collaborative working. Review policies, strategies and guidance in line with recent key national documents, national and local SCR/DHR/Case Reviews and legislation. Build on work already completed to develop robust arrangements and relationships with providers and partner agencies. Continued attendance and influence at KSCB and MSCB sub-groups. Continue to develop standardised assurance and data collation. Continue to develop robust arrangements and relationships with provider organisations including standardisation of data collation and safeguarding representation at local operational meetings. To continue to develop communication pathways for dissemination of safeguarding issues/ lessons learnt from SCRs to its members and local health providers. To continue to develop systems to assure that safeguarding practice across the CCGs reflects learning from SCR. To ensure that CCGs are sighted on emerging adult safeguarding risks, including compliance with the Mental Capacity Act following the House of Lords Select Committee report, and the implications of the Supreme Court judgements on the Deprivation of Liberty Safeguards. Continue to develop GP awareness and response to adult safeguarding concerns, including their training levels and contribution to adult protection processes, working in partnership with NHS England. Implementing safeguarding and MCA provider metrics to capture meaningful safeguarding data and measurable outcomes from provider organisations. Continue to ensure that the CCGs are fully compliant with the NHS England Safeguarding Adults Accountability and Assurance Framework with key areas of work being; - Aligning designated nurse duties with the Designated Adult Safeguarding Managers (DASM) roles. Page 47 of 56

48 - Amending Awareness, Levels 1 and 2 Safeguarding Adults training to comply with the revised Multi-Agency Policy and procedures, all other relevant legislation and the proposed intercollegiate document. - Aligning all CCG Safeguarding policies and strategic objectives with relevant legislation. Ensuring both CCGs and provider organisations are focussed to meet the Making Safeguarding Personal agenda. Discharge of the duties of the House of Lords MCA Implementation Programme Key challenges The number of requests for assistance and support in investigating allegations of abuse in the care home sector and against GPs continues to rise. The Designated nurse for Adult Safeguarding provides support in complex cases in the care home setting, but cannot support investigations in general practice which should be led by NHS England. GP awareness of adult safeguarding is improving, albeit from a low baseline. Responsibility for GP training rests with NHS England (Kent and Medway Area Team). Ensuring that health organisations remain compliant with current statutory requirements and respond effectively to changes in legislation and best practice Measuring Safeguarding outcomes The CCGs are required to have effective systems for responding to abuse and neglect of adults and evidence the outcome measures used to give assurance that the systems and processes in place are effective. Currently there are no national safeguarding outcome measures that focus on people who have been supported by adult safeguarding services. This means that local authorities, who are statutorily the lead for safeguarding, do not know if adults at risk are satisfied with the safeguarding service or what difference it makes. They are also not able to make comparisons between councils as there is no national benchmark for adult safeguarding. The Health and Social Care Information Centre (HSCIC) has been exploring a new measure for inclusion in the Adult Social Care Outcome Framework (ASCOF). Page 48 of 56

49 Kent County Council and multi-agency partners, including the CCGs, are implementing the Making Safeguarding Personal agenda to ensure that adults at risk are engaged in the safeguarding process and that outcomes of an enquiry are person focused. The Designated nurses have supported the revised Kent Adult Social Care Safeguarding Adults form to ensure that the person s views and engagement are taken into consideration throughout the process. The CCGs recognise that defining and measuring outcomes is important and has to go beyond process-led approaches but is sometimes a difficult part of safeguarding adults work. In the absence of a national framework, the designated nurses use the following framework in all clinical work with NHS providers, care homes and other multi-agency partners to ensure that outcomes for patients and residents are person focused. This framework is based on the six key principles in The Statement of Government Policy on Adult Safeguarding (2013). Principles Empowerment presumption of person-led decisions and informed consent Prevention it is better to take action before harm occurs Proportionality Proportionate and least intrusive response appropriate to the risk presented Partnership local solutions through services working with their communities Protection support and representation for those in greatest need Accountability accountability and transparency in delivering safeguarding Outcomes We ensure that individuals: receive the right information, are consulted before action is taken, if the person lacks mental capacity to make a decision, that this is done in their best interests We work collaborative with partners to identify and report abuse and harm and seek assurance from our providers that staff are trained to take action when there is a safeguarding concern. We participate in multi-agency discussions to agree what action to take where there is a risk of significant harm before a decision is made. We actively participate in safeguarding planning meetings and case conferences, care home forums, MARAC and other multi-agency meetings including with CQC, to share information and agreed local solutions. We work closely with KCC, CQC and the police to assess and manage risks, including reporting any suspected criminal offence We take responsibility for providing clinical support and strategic input to the safeguarding process and the Safeguarding Adults Board. Page 49 of 56

50 APPENDIX 1 The Child Death Review Service - Kent The Child Death Review Service (CDR) works in partnership with Kent s Health Economy to ensure that the statutory requirements of regulation 6 of the Local Safeguarding Children Board Regulations, 2006, made under section 14(2) of the Children Act 2004, are met. The statutory guidance in Chapter 5 Working Together to Safeguard Children 2013 states that every child s death occurring within the boundary of the Kent Safeguarding Children Board (KSCB) and/or any death of a child normally resident within the boundaries are reported to KSCB within 1 working day of the child s death. In conjunction with this, health providers have a responsibility to report a child s death as a serious incident by the following criteria set out in the recent release of the NHS England Serious Incident Framework (March 2015). On Page 12 this states that: serious incidents are events in health care where the potential for learning is so great, or the consequences to patients, families and carers, staff or organisations are so significant, that they warrant using additional resources to mount a comprehensive response. Serious incidents therefore require investigation in order to identify the factors that contributed towards the incident occurring and the fundamental issues (or root causes) that underpinned these. Serious Incidents in the NHS include ( Page13) : Acts and/or omissions occurring as part of NHS-funded healthcare that result in: Unexpected or avoidable death of one or more people. This includes o suicide/self-inflicted death; and o homicide by a person in receipt of mental health care within the recent past. Actual or alleged abuse; sexual abuse, physical or psychological ill-treatment, or acts of omission which constitute neglect, exploitation, financial or material abuse, discriminative and organisational abuse, self-neglect, domestic abuse, human trafficking and modern day slavery where: o healthcare did not take appropriate action/intervention to safeguard against such abuse occurring or where abuse occurred during the provision of NHS-funded care. o This includes abuse that resulted in (or was identified through) a Serious Case Review (SCR) Health commissioners have a duty to employ, or have arrangements in place for Consultant Paediatricians with designated responsibilities (Health and Social Care Act 2012). Kent has 5 designated doctors, who provide strategic and clinical leadership and advice, not only for Page 50 of 56

51 themselves but also for the local authority. The role of these designated professionals is to assist the CCGs in fulfilling their responsibilities as commissioners of services. The Specialist Named Nurse for Child Death is now hosted within Swale CCG, as part of a shared resource, for all Kent CCGs. This arrangement changed recently in November 2014 and had previously been employed within Kent Community Health Trust. The Specialist Nurse role co-ordinates the service within the local health economy, on behalf of the Designated Doctor. (KSCB procedures 2013). When a child dies unexpectedly, on behalf of the Designated Doctor, the Specialist Nurse initiates an immediate multi-agency sharing of information, notification and planning discussion between lead agencies. Consideration is given to the circumstances surrounding death and the possibility of any safeguarding issues, failures of care and/or failures of service provision. Joint working with Health and other agencies provides an opportunity to thoroughly analyse all cases prior to the statutory case review by KSCB Child Death Overview Panel (CDOP). The involvement of the CDR Service, within the CDOP process, ensures lessons learnt from a review can be shared through multi-agency learning events. The CDR Service supports practitioners to signpost families to specialist agencies for bereavement support. Statistics During 2014/15, there were 78 child deaths in total within Kent. Of these, 70 cases were children within the KCHT/KSCB boundaries and 8 were out of area cases. A total of 36 cases were unexpected with the remaining being classified as expected or expected/explained cases, i.e. neonatal. Page 51 of 56

52 Expected v Unexpected Cases No Yes The largest group of child deaths was in the neonatal category (27 cases). In 2012, the Department of Education reported 45% of cases reviewed at CDOP were neonates. The Kent figures indicate 38.5% of cases were neonates, slightly under the national average. 13 children died as a result of a life-limiting condition and 10 cases are currently unclassified as they are awaiting post mortem results. 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Page 52 of 56

53 Sudden unexpected death in infancy/childhood accounted for only 4 cases this year compared with triple this figure in the previous two years (13 cases). In all cases the safe sleeping advice was given by midwifery and/or health visiting teams. However, parents continue to co-sleep and use unsafe sleeping practices, for example sleeping on the sofa. Parental smoking was also a factor in all cases and poor home conditions in 3 out of 4 cases. The numbers of adolescent deaths has increased this year from 7 in to 13 cases. Nationally the number of deaths in the age group account for 16% of total deaths. In Kent this year this percentage is slightly higher at 17.5%. However, there has been a significant difference in the causes of death. In all cases were life-limiting, road traffic accident or non-intentional trauma. This year, half the cases were due to life-limiting conditions or natural causes. However, the remaining cases account for suicide, homicide and deaths relating to drugs misuse. Age Comparison Day 29 days - 1 year 1-4 years 4-11 years years Page 53 of 56

54 Geographically, DGS CCG had the most cases (19) and Ashford CCG the least (4). Geographical Data Ashford CCG Cant & Coastal CCG Dart Grave & Swan CCG SKCoast CCG Swale CCG Thanet CCG West Kent CCG The total numbers of deaths are similar to the previous year, generating 4-6 cases most months. However, during the months of November to March, numbers increased to 7-9 per month. Case Load This year the Child Death Review team has been commended by Kent Safeguarding Children Board in reducing the total number of deaths that remain outstanding for review - see table below for figures relating to the management of the case load. The CDR Service has been able to close all cases prior to 2013, with the exception of the cases undergoing coroner s inquest. Remarkably, the team has also closed 41% of the cases before the end of March Open Cases June September December March / / / Total Page 54 of 56