REPORT TO MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

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1 REPORT TO MERTON CLINICAL COMMISSIONING GROUP GOVERNING BODY Date of Meeting: 24 th September 2015 Agenda No: 6.4 Attachment: 08 Title of Document: Report Author: Jo Norman, Designated Nurse Safeguarding and Children Looked After Maria Ellery, Designated Nurse Safeguarding and Children Looked After Lynn Street, Director of Quality Purpose of Report: Approval Lead Director: Lynn Street, Director of Quality Executive Summary: This is the third Annual Safeguarding Children Report for NHS Merton Clinical Commissioning Group. Its purpose is to provide assurance to the Governing Body and members of the public that Merton Clinical Commissioning Group (CCG) is fulfilling its statutory duties in relation to safeguarding children in Merton; it takes account of national changes and influences and local developments and activity. The CCG confirms that it has fulfilled its statutory obligations detailed within the National NHS Accountability and Assurance Framework including: Training 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 LSCBs, and health and wellbeing boards Ensuring effective arrangements for information sharing Securing the expertise of designated doctors and nurses for safeguarding children and for looked after children and a designated paediatrician for unexpected deaths in childhood Review of safeguarding activity in 2014/15 demonstrates that Merton CCG has made significant progress in developing a robust framework through which it quality assures the safeguarding activity of providers of commissioned services. The report summarises the key areas that the CCG will focus on in 2015/16. Key sections for particular note (paragraph/page), areas of concern etc: The Governing Body is asked to note: Section 2: Statutory Responsibilities details the framework in which the CCG operates Section 3.2: Section 11 Self-Assessment audit to detail the effectiveness of the arrangements for safeguarding children at a strategic level within the organisation, as detailed in Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (2013). Section 4: Working in partnership detailing the close collaboration between Merton CCG and Merton Safeguarding Children s Board Section 7: Priorities and Planned Improvements 2015/16 Recommendation(s): Merton Clinical Quality Committee is asked: To Agree the Annual Report To endorse the priorities for 2015/16 Page 1 of 2

2 Committees which have previously discussed/agreed the report: Merton Clinical Quality Committee 11 September 2015 Financial Implications: N/A Implications for CCG Governing Body: The Governing Body is assured that Merton CCG is fulfilling its statutory Obligations to safeguard children in Merton. How has the Patient voice been considered in development of this paper: Work continues across the health economy to ensure that the voice of the child is listened to and taken into account. Engagement with Children and Young People and their families continues to inform service and pathway development. Other Implications: (including patient and public involvement/legal/governance/risk/diversity/ Staffing) Risk Register 1009: Merton CCG has a responsibility to ensure all children looked after (CLA) are safeguarded. Merton CCG CLA could be assessed as inadequate by the CQC 4 x 3 = 12 Risk Register 1012: If the CCG fails to establish appropriate systems and processes for safeguarding children, vulnerable children may be at risk of harm 3 x 3 = 9 Equality Assessment: Merton CCG is required by the Equality Act 2010, to identify, remove or minimise discriminatory practice in the nine named protected characteristics of age, disability, sex, gender reassignment, pregnancy and maternity, race, sexual orientation, religion or belief, and marriage and civil partnership. It is also intended to use the Human Rights Act 1998 and to promote positive practice and value the diversity of all individuals and communities. Information Privacy Issues: N/A Communication Plan: (including any implications under the Freedom of Information Act or NHS Constitution) The report will be published on the public website following approval by Merton CCG Governing Body Page 2 of 2

3 Safeguarding Children Annual Report: 2014 / 2015 Merton Clinical Commissioning Group s role in safeguarding and promoting the welfare of children and young people in Merton September 2015 Page 1

4 Foreword Children, young people and their families are at the heart of decision making in Merton Clinical Commissioning Group (CCG), with health and safety outcomes that matter most to them taking priority This is the third annual Safeguarding Children Report to Merton Clinical Commissioning Group s Governing Body and builds on the commitment to Safeguard Children and Young People stated within the Safeguarding Children Declaration on our website: Merton Clinical Commissioning Group (MCCG) is fully committed to our responsibility for protecting and safeguarding children and young people. We have taken all reasonable steps to promote safe practice and protect children and young people from harm, abuse and exploitation and are fully engaged in the work of the Merton Safeguarding Children Board. Expectations of healthcare providers are clearly outlined within MCCG Safeguarding Children through Commissioning Policy and Standards (2014) and are embedded within all contracts. These also apply to those services commissioned by healthcare provider organisations. MCCG ensures that organisations commissioned to provide healthcare services have systems in place that safeguard children in line with Section 11 of the Children Act This includes clear accessible policy and procedures, safer recruitment, training and governance systems, which are monitored by MCCG Designated Nurse and Doctor through the MCCG performance framework, and supervision of named professionals for safeguarding children September 2015 Page 2

5 Contents 1 Executive Summary 2 Merton Clinical Commissioning Group s Statutory Responsibilities for Safeguarding Children 2.1 Introduction 2.2 Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (NHS Commissioning Board 2013). 2.3 Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (DfE March 2013) 2.4 Promoting the health and well-being of looked after children: Statutory Guidance for local authorities, clinical commissioning groups and NHS England (March 2015) 2.5 Intercollegiate Document: Safeguarding children and young people: roles and competences for health care staff (March 2014) 2.6 Child Safeguarding Inspection Programme 2.7 Pan London Child protection Procedures 5 th Edition 2.8 Further Guidance 3 Demonstrating Assurance 3.1 Merton CCG Governance arrangements 3.2 Section 11 Self-Assessment 3.3 Commissioned Services in Merton 3.4 Assurance of Commissioned Services 3.5 Children Looked After (CLA) 3.6 Child Death Overview Panel (CDOP) and Response to Sudden Unexpected Deaths 3.7 Learning Lessons from Serious Incidents and Child Deaths 3.8 Training and development 4 Working in Partnership 4.1 Merton Safeguarding Children s Board 4.2 NHS England 4.3 London Borough of Merton 4.4 Multi-Agency Risk Assessment Committee (MARAC) Multi-Agency Public Protection Arrangements (MAPPA) 4.5 Multi Agency Safeguarding Hub (MASH) 4.6 Family Nurse Partnership Sutton & Merton Community Services 5 Views of Children and Young People 6 Conclusion September 2015 Page 3

6 7 Priorities and Planned Improvements 2015/ Assurance 7.2 Training 7.3 Engagement 7.4 Children Looked After/Complex needs 7.5 Preparation for Inspection 7.6 Information Sharing 7.7 Recruitment 8 Reference Sources 9 Glossary 10 Appendices Appendix 1 Children Looked After Summary Report Appendix 2 Child Death Overview Panel Annual Report Appendix 3 Child Death Overview Panel Newsletter September 2015 Page 4

7 1. Executive Summary 1.1 This is the third Annual Safeguarding Children Report to NHS Merton Clinical Commissioning Group s Governing Body. Its purpose is to assure the Governing Body and members of the public that Merton Clinical Commissioning Group (CCG) is fulfilling its statutory duties in relation to safeguarding children in Merton; it takes account of national changes and influences and local developments and activity. The CCG confirms that it has fulfilled its statutory obligations detailed within the National NHS Accountability and Assurance Framework including: Training 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 LSCBs, and health and wellbeing boards Ensuring effective arrangements for information sharing Securing the expertise of designated doctors and nurses for safeguarding children and for looked after children and a designated paediatrician for unexpected deaths in childhood 1.2 On reviewing the safeguarding activity in 2014/15, it is clear that Merton CCG has made significant progress in developing a robust framework in which it can quality assure the work of the providers it commission healthcare from. The report summarises the key areas that the CCG will focus on in 2015/16 and how there will be an embedded quality improvement programme within the organisation. 2. Merton Clinical Commissioning Group s Statutory Responsibilities for Safeguarding Children The purpose of this report is to assure the Governing Body and members of the public that the Clinical Commissioning Group (CCG) is fulfilling its statutory duties in relation to safeguarding children in Merton This report outlines the responsibilities of the Clinical Commissioning Group in respect of all the services they commission with regard to promoting the safety and welfare of children and young people. It provides an update of the planned work undertaken during 2014/15 and outlines the areas for development during 2015/16. September 2015 Page 5

8 2.1 Introduction The statutory safeguarding duties of CCGs have in this reporting period (April 2014 March 2015) are clarified through the following national and local guidance documents: 2.2 Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework (NHS Commissioning Board 2013) This describes the roles and responsibilities of NHS England, Clinical Commissioning Groups, NHS providers and various other bodies in the health system During 2014/15 the CCG continued to take full account of the framework when agreeing its safeguarding arrangements to include: Meeting Pan London guidance with over 80% of staff trained to Level 1 in Safeguarding Children, with tailored training delivered to the Governing Body in 2015; Clear governance and accountability arrangements including regular reporting to the Governing Body through Merton Clinical Quality Committee; there is direct access by the Designated Professionals to the Chief Officer; Working in partnership with the London Borough of Merton, Executive CCG representation at Merton Safeguarding Children s Board (MSCB), the Health and Wellbeing board supporting The Best Start in Life and membership of Merton Children s Trust Board; The CCG ensures information is shared appropriately through Multi Agency Safeguarding Hub (MASH) arrangements and as a signatory to MSCB Information Sharing Agreement supported by all partners; Merton CCG has access to expert advice and support from Designated Professionals for Safeguarding Children and Children Looked After. The Designated Nurse sits on the MSCB quality assurance business and audit groups to support implementation of learning from Serious Incidents and Serious case reviews both locally and nationally. In this reporting period nationally there have been: reviews of the NHS safeguarding and accountability assurance framework; health service reviews as part of the Jimmy Savile investigation; and national reviews following investigations into Child Sexual Exploitation to include Rotherham, Greater Manchester and Oxford; September 2015 Page 6

9 2.2.8 The Designated Doctor fulfills the role of Chair of the Child Death Overview Panel for Merton supported by a Single Point of Contact manager; There is ongoing quality assurance work with our providers. All CCG contracts for commissioned services include safeguarding children standards. Performance monitoring of all safeguarding action plans and oversight of safeguarding audit programmes are reported through our contracting mechanisms with oversight from the Designated Professionals Following consultation in early 2015 the revised Accountability and Assurance Framework was published in July Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (DfE March 2013) This document highlights the expectations of health services in meeting their requirements to safeguard and promote the welfare of children. Merton CCG completed an action plan to implement the changes in Working Together 2013 by October 2014 and has reviewed arrangements in the light of the updated document, including; Clinical commissioning groups (CCGs) will be the major commissioners of local health services and will be responsible for safeguarding quality assurance through contractual arrangements with all provider organizations. CCGs should employ, or have in place, a contractual agreement to secure the expertise of designated professionals, i.e. designated doctors and nurses for safeguarding children and for looked after children (and designated paediatricians for unexpected deaths in childhood) Staff working in healthcare settings - including those who predominantly treat children - should receive training to ensure they attain the competences appropriate to their role and follow the relevant professional guidance. September 2015 Page 7

10 2.4 Promoting the health and well-being of looked after children: Statutory Guidance for local authorities, clinical commissioning groups and NHS England (March 2015) The guidance has been updated to reflect reforms to the NHS following the Health and Social Care Act CCGs should: Recognise and give due account to the greater physical, mental and emotional health needs of looked-after children in their planning and practice Give equal importance (parity of esteem) to the mental and physical health of looked-after children Agree multi-agency action to meet the health needs of looked-after children in the area Ensure that sufficient resources are allocated to meet the identified health needs of the looked-after children population, including those placed in their area by other local authorities, based on the range of data available about their health characteristics Take into account the views of looked-after children, their parents and carers, to inform, influence and shape service provision, including through Children in Care Councils and local Healthwatch where they are undertaking work in this area Arrange the provision of accessible and comprehensive information to lookedafter children and their carers. 2.5 Intercollegiate Document: Safeguarding children and young people: roles and competences for health care staff (March 2014) This third edition of the Safeguarding children and young people: roles and competences for health care staff has been updated to emphasise the crucial safeguarding role of Executive Teams and Board members, whilst also taking into account the structural changes which have occurred across the NHS. The framework sets the standards and requirements expected of all health staff All health 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. They must also clearly understand their responsibilities, and should be supported by their employing organisation to fulfil their duties. September 2015 Page 8

11 2.5.3 Chief Executive officers and independent contractors such as GPs, in particular have a responsibility to ensure that all staff across their organisations have the knowledge and skills to be able to meet this requirement. 2.6 Child Safeguarding Inspection Programme Ofsted, the Care Quality Commission (CQC), Her Majesty s Inspectorate of Constabulary (HMIC), Her Majesty s Inspectorate of Probation and Her Majesty s Inspectorate of Prisons will roll out their joint inspection of multiagency arrangements for the protection of children in England from April These inspections will focus on the effectiveness of local authority and partners services for children who may be at risk of harm, including the effectiveness of early identification and help. Merton CCG was not subject to inspection by the CQC, in conjunction with OFSTED. Merton was last inspected in Pan London Child protection Procedures 5 th Edition Merton Safeguarding Children Board refers to the Pan London child protection procedures for guidance in all circumstances of child abuse and neglect. Work has been undertaken through the MSCB Policy sub group to ensure that the guidance fits Merton specific processes. CCG representation at the sub group during 2014/2015 was by the Director of Quality as chair and Designated Professionals. 2.8 Further Guidance There are a number of publications that inform and support professionals to protect children and young people from harm. The role of the MSCB Policy Sub Group (formally the Policy and Communications Sub Group) and chaired by the Designated Nurse from Merton CCG, is to review national and local guidance to ensure that it is taken into consideration when commissioning and delivering services. Such guidance includes Child Sexual Exploitation, Female Genital Mutilation and Prevent, as part of the Government s Counter-Terrorism and Security Act Demonstrating Assurance 3.1 Merton CCG Governance arrangements The CCG has the required safeguarding arrangements in place that comply with legislation and statutory guidance (Children Act, 2004; Working Together, 2013). This includes: a Board Lead and Executive Lead for Safeguarding September 2015 Page 9

12 Children, a Designated Nurse 1.0 WTE and Designated Doctor 0.2 WTE (designated professionals). The designated professionals receive training, supervision and support from within the CCG and externally to maintain competencies. During 2014/15 NHS England assumed the responsibility for fulfilling the Named GP requirements for Merton CCG (these responsibilities passing to CCGs from April 2015) For the first two quarters of 2014/15 the role of the Designated Nurse for safeguarding children was filled by a substantive post holder. Designated Nurse responsibilities for Children Looked After were commissioned through Sutton and Merton Community Services. Since October 2014 the post has been filled by two interim designated nurses who fulfil the role of Designated Nurse for Safeguarding Children and Children Looked After within Merton CCG Merton Clinical Quality Committee is a subcommittee of the Governing Body; both have a responsibility to provide assurance that the CCG has the required safeguarding systems in place to fulfil statutory responsibilities. The Executive Management Team provides scrutiny for the operation aspects of Safeguarding Children and Children Looked After (Figure 1) The designated professionals are members of the quarterly Pan-London Designated Professionals Forum chaired by NHS London. They are also members of the South West London Designated Professionals Group (bimonthly) and the Designated Nurses across South West London also meet periodically. These structures and networking opportunities ensure governance arrangements and best practice is shared and reflective practice and decisionmaking is grounded through peers During 2014/15 the CCG explored the option of introducing a Safeguarding Executive Group. Initial meetings were held to discuss areas of work and draft Terms of Reference. This is a priority for development for the coming year. 3.2 Section 11 Self-Assessment The Section 11 self-assessment aims to assess the effectiveness of the arrangements for safeguarding children at a strategic level within an organisation, as detailed in Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (2013) Merton CCG completes the pan London Self-Assessment Tool to demonstrate compliance. The self-assessment was updated in May 2015 to reflect September 2015 Page 10

13 safeguarding activity undertaken during 2014/15 in preparation for peer review led by MSCB in June Figure 1: Governance The self-assessment provides the opportunity to rate performance in eight standards as Red, Amber or Green. In areas where the self-assessment has not been rated Green outstanding actions are detailed. Merton CCG has selfassessed themselves as Green in three areas, with the remaining areas assessed as Amber. Standards: 1. Senior management have commitment to the importance of safeguarding and promoting children s welfare Self-assessment: Amber Outstanding Actions: Strengthen the challenge in respect of reported activity by Designated Professionals and Safeguarding Executive Group through membership of Merton Safeguarding Children Board and sub groups Quality Assurance Business and Quality Assurance Audit Quarterly monitoring of safeguarding standards and incorporate into an annual reporting cycle Recruitment of Named GP for Merton CCG September 2015 Page 11

14 2. There is a clear statement of the agency s responsibility towards children and this is available to all staff Self-assessment: Amber Outstanding Actions: Design programme to capture views of Children and Young People to inform commissioning intentions and service development to include feedback from complaints Strengthen the Merton CCG induction programme to ensure safeguarding children training is offered to all new staff within 4 weeks Offer the Administrative support staff within the quality directorate who support the designated professionals training to fulfil the role effectively. 3. There is a clear line of accountability within the organisation for work on safeguarding and promoting welfare Self-assessment: Green 4. Service development takes into account the need to safeguard and promote welfare and is informed, where appropriate, by the views of children & families Self-assessment: Amber Outstanding Actions: Young people will be invited to be present on interview panels for key positions in the organisation. 5. There is effective training on safeguarding & promoting the welfare of children for all staff working with or, depending on the agency s primary functions, in contact with children & families Self-assessment: Amber Outstanding Actions: Undertake a Training Needs Analysis Maintain rolling programme for CCG staff Continue to provide updates on safeguarding issues as they arise via Staff Briefings that are circulated monthly and the monthly staff meeting. September 2015 Page 12

15 6. Safer recruitment procedures including vetting procedures and those for managing allegations are in place Self-assessment: Amber Outstanding Actions: Consider how staff involved in the recruitment process undertake safer recruitment training. 7. There is effective inter-agency working to safeguard & promote the welfare of children Self-assessment: Green 8. There is effective Information Sharing Self-assessment: Green 3.3 Commissioned Services in Merton Merton CCG commissions health services for approximately 47,499 children and young people under the age of 18, and for children with complex needs up to the age 25. Children and young people under the age of 20 years make up 23.9% of the population of Merton with 64.5% of school children are from a minority ethnic group The health and wellbeing of children in Merton is generally better than the England Average with infant and child mortality rates similar to the England average. The level of child poverty is better than the England average with 17.5% of children aged under 16 years living in poverty. The rate of family homeless is better than the England average There is variation in the experience and environment of children and young people across the borough. The highest proportion of young people are found in the wards in the east of the borough. Despite overall levels of poverty and deprivation in Merton being below national levels, deprivation affecting children is greater in the east of the borough. 1 file:///i:/downloads/childhealthprofile2014-merton%20(3).pdf September 2015 Page 13

16 3.3.5 The health landscape is complex for Merton with 25 GP practices (reduced to 24 from April 2015) and five key providers of health care to the Merton population (see Figure 2): St Georges University Hospital NHS Foundation Trust Epsom and St Helier University Hospital NHS Trust Kingston Hospital NHS Foundation Trust South West London and St Georges Mental Health NHS Trust Royal Marsden - Sutton and Merton Community Services There is a private hospital, Parkside, within Merton and Out of Hours services for Merton residents are provided through CareUK Merton CCG hosts the Sutton and Merton Community Services contract. During 2014/15 work commenced in preparation for the reprocurement of this service, with a new contract for community services to be awarded from April 2016 for Merton only services. The Director of Quality and Designated Nurses have provided advice and support through working groups to develop the specifications for the service to ensure services for children and young people meet their statutory safeguarding responsibilities. 3.4 Assurance of Commissioned Services The National NHS Accountability and Assurance Framework is a fundamental requirement in all contracts and Merton CCG receive quarterly reports on safeguarding performance from all providers, with the exception of Kingston Hospital, which provides assurance through exception reporting of safeguarding concerns that involve Merton children Merton CCG gains assurance of performance against contractual requirements through contractual monitoring mechanisms and specifically through Clinical Quality Review Groups (CQRGs) where information is scrutinised, to include compliance with training rates for safeguarding children within commissioned services. During 2014/15 Merton implemented a new assurance mechanism with a process requiring providers to submit quarterly safeguarding data and a narrative to explain differentials and to summarise safeguarding activity in an annual report. September 2015 Page 14

17 Figure 2: Health Landscape The information is shared with MSCB through the Quality Assurance sub group. The process of embedding this reporting mechanism has carried on throughout the year with data sets being refined in conjunction with MSCB The Designated Nurse was included in writing the updated and new contracts to ensure that safeguarding was clearly identified as a quality measure within the contracts, service level agreements and specifications MCCG and all NHS Trusts have updated and published their safeguarding children declarations on their web pages. This provides assurance to the public that safeguarding children arrangements meet statutory requirements. Also, that there is clear accountability structures, performance monitoring systems, appropriate levels of training; safeguarding supervision and checks with the Disclosure and Barring Service (Criminal Records Bureau). September 2015 Page 15

18 3.4.6 All providers for Merton have named nurses in post and Merton CCG is assured that supervision arrangements for these staff is in place. Merton CCG interim designated nurses provide safeguarding supervision for some, of the remainder assurance is gained through information obtained from designated nurse counterparts in neighbouring CCG s: Kingston; Wandsworth; Sutton; Richmond. A record of supervision is maintained to ensure compliance with statutory guidance. 3.5 Children Looked After (CLA) The Merton CCG 2014/2016 Operating Plan and Commissioning Intentions includes Children and Maternity Service as one of the six key delivery areas. Priorities within this area relevant to Children Looked After are: To work more with young children to ensure we listen and respond to their needs and improve their health outcomes To review and develop our service for children who are looked after or require safeguarding To work towards more integrated Children s Services ensuring that services are commissioned as jointly when possible To focus on transition as a key area to ensure children with complex needs move seamlessly into adult services Children looked after by Merton were most likely to have come into care as the result of abuse or neglect (46%), followed by family dysfunction or acute stress (30%) and absent parenting (13%). This is similar to the national picture, in that abuse or neglect and family dysfunction are the primary causes for children coming into care Total numbers of Children Looked After has remained relatively stable over recent years (see Table 1) however, levels of absent parenting as a cause for coming into care were higher than national and London averages (6% and 2% respectively). This is likely to be linked to the increasing proportion of unaccompanied asylum seekers in care in Merton In June 2014 the Director of Quality for Merton CCG commissioned an external review of Children Looked After in Merton. The review was undertaken across the latter part of June and carried on into August. A report detailing the findings and relevant analysis from the review, together with 17 recommendations, was finalised in October The recommendations were presented to the Executive Management Team (EMT) in November September 2015 Page 16

19 Table 1: Total numbers of Children Looked After Total Number of Children Looked After at 31 March 2015 (Rate per 10,000 children under 18 years) MERTON 135 (32) 10,970 LONDON (62) 64,470 ENGLAND (57) (31) 10,410 (58) 65,500 (58) 130 (30) 10,270 (57) 67,070 (59) 140 (31) 10,080 (54) 68,060 (60) 150 (33) 10,110 (54) 68,840 (60) % change % (3%) -8% (-13%) 7% (5%) An action plan to address the recommendations was approved by EMT in December A working group was established to implement the recommendations and monitor progress which consisted of key members of CCG staff including the interim Designated Nurses for Safeguarding Children and Children Looked After, Director of Quality, Director of Commissioning and Planning and the Children s Commissioning Manager Following the review, there has been a transformation of the CAMHS service. It is now contractually required to prioritise CLA for their increased emotional and psychological needs. Two CAMHS workers are collocated with the Local Authority Children Looked After team to provide advice to carers and social workers to support tier 1-3 interventions In partnership with the Service Manager and Assistant Director of Children s services within the Local Authority, a joint protocol for CLA has been developed and ratified A Health Needs Analysis for CLA was commissioned in January 2015 through Public Health to be completed by August 2015 and inform targets for 2015/16 and beyond The review provided a benchmark against which to direct Merton CCG to fulfill their responsibilities to Merton CLA and to children from other Boroughs placed in Merton, following a gap in the strategic oversight of services for CLA since the induction of the CCG model. The full summary report detailing progress against the recommendations can be found in Appendix 1. September 2015 Page 17

20 3.6 Child Death Overview Panel (CDOP) and Response to Sudden Unexpected Deaths Membership of the Child Death Overview Panel in Merton consists of: Director of Public Health (Chair) Consultant in Public Health Medicine (Co-Chair) Designated Doctor for Child Deaths Manager & Single Point of Contact There were 14 child deaths in Merton during 2014/15. There were 8 expected and 6 unexpected child deaths. Of the 6 child deaths classified as unexpected reviewed in this period, 4 were considered to have no modifiable factors and 2 had modifiable factors identified Of the unexpected child deaths, three died in an intensive care unit. One child had a life limiting condition. Two died in a public place. One of the cases was the subject of two rapid response meetings and has been referred to MSCB for consideration and further directive. The Health and Safety Executive has conducted an investigation with reference to the incident. The outcome is not known at the time of this report Of four cases that have been subject of a rapid response meeting no safeguarding concerns were identified. Confirmation that the Coroner has discontinued the Inquests is pending. Death certificates have confirmed the deaths were from natural causes in two cases Seven neonatal deaths were reviewed in this period. None of the deaths had modifiable factors (factors that may have prevented a death) identified. In 7 cases no recommendations were made by the Panel. For future panel reviews of neonates under 23 weeks gestation, it has been recommended that one CDOP meeting will be neonate focused The manager of the panel has designed and published a newsletter that is sent to health and social care professionals twice yearly, keeping staff updated with current issues relating to child death (Appendix 2). 3.7 Learning Lessons from Serious Incidents and Child Deaths During 2014/15 Merton CCG has had contributed to a Serious case review (SCR) for a neighboring Borough and responded by commissioning an September 2015 Page 18

21 independent author for an Individual management review (IMR) involving a Merton Primary Care Practice Merton CCG participated in a Learning Review for a child with complex needs where allegations were made against members of staff in a residential facility concerning the use of restraint Merton CCG concerns were: The safety of the child The potential for criminal proceedings in relation to care Escalation process for safeguarding and management concerns within the mental health trust Commissioning of outreach Tier 3 CAMHS for Out of Borough (OOB) placements and oversight of these children The resulting action plan led to a review of CAMHS processes on managing challenging behaviour involving the use of restraints for children and young people. These concerns have been resolved and the action plan completed the last action leading to a CAMHS OOB policy which has been ratified alongside the redesign of the CAMHS service Two Serious Incidents: i) A child who presented at St Georges Hospital A&E with unexplained factures. A multi-agency meeting took place in January The case awaits its final review. ii) A Greenwich mother and child were placed in Merton with a Greenwich foster carer. The child died and the cause of death was determined as Sudden Unexpected Death in an infant. The case has been processed through Greenwich CDOP and is due for review September Merton CCG will ensure that it monitors the progress on this case The Designated Leads for Safeguarding facilitate and oversee the learning from child deaths and serious incidents through the dissemination of lessons learnt within the CCG, monitoring of provider actions, providing support for primary care and via face to face learning with all Merton CCG staff The key lessons shared from reviews during the reporting period have included: Keeping the child at the centre September 2015 Page 19

22 The understanding and embedding of Early Help and helping families at an early stage Communication and information sharing Supervision and management oversight The need for clear escalation processes across all services and within CCG The engagement of health partners in early help assessments has improved during 2014/15 which has, in turn, improved the range of responses to children when concerns are first identified. The CCG, with health system partners, will continue to ensure continued support to improve the early help offer to children and families. 3.8 Training and development The Designated Professionals have continued to champion competency based learning for all staff and practitioners across the health system and review and endorse safeguarding training modules both within the CCG and with providers The Designated Nurses have delivered a series of face to face updates for all CCG staff to support meeting their competency requirements at level one This approach has contributed to achieving an overall 80% compliance rate across all mandatory safeguarding training for staff in the CCG Further activity to support learning and improvement in 2014/15 included: Working collaboratively with Merton health providers to support competency up to level four Established the level of training and awareness that exists across primary care and are currently offering sessions to general practitioners on level 3 training. 4 Working in Partnership 4.1 Merton Safeguarding Children s Board The independently chaired Merton Safeguarding Children s Board (MSCB) has been the key mechanism for agreeing how organisations in Merton cooperate to safeguard and promote the welfare of children, and for ensuring the September 2015 Page 20

23 effectiveness of what they do. It also has a role in ensuring that arrangements are in place for working collaboratively to improve outcomes for children and young people Merton CCG discharges safeguarding responsibilities, and fulfils the section 11 requirements of the Children Act 2004, through partnership working with Merton Safeguarding Children Board and membership of its sub groups including; MSCB This is a key forum for senior members of all the partner agencies to share challenges and achievements in safeguarding and to support the growth and development of seamless services. The Chief Officer, Director of Quality and designated professionals contribute to this work. Business Implementation Group A forum for the chairs of the sub groups and executive leaders of the member agencies to ensure the work identified by the main board is achieved. The Director of Quality, as Executive Lead for safeguarding in Merton CCG is a member of this group. Quality Assurance Business Group This is a strategic group to monitor the implementation of action plans and audits within services. The designated professionals represent the CCG at this group. Policy sub-group (Formally the Policy and Communications Group). The group reviews and provides action plans to maintain the policy and procedural guidance for safeguarding children and ensures that the workforce are up-to date with any contextual changes. It will nominate task and finish groups for pieces of work to update and implement policy, for 2014/15 this included female genital mutilation and child sexual exploitation. This group is chaired by the designated nurse for Merton CCG. Promote and Protect Young People Service Group Develops strategies to support young people in meeting their specific safeguarding needs outside of the family or carer provision. This links with the child sexual exploitation work and is attended by the designated nurses. Training sub group The Designated Nurse has been involved in quality assuring of MSCB of multi-agency training and sits on the training subgroup. September 2015 Page 21

24 4.1.3 The terms of reference for these meetings have been updated and made consistent for 2015 and are available on the London Borough of Merton web site The theme for the MSCB annual conference 2014/2015 was Working the frontline. The purpose was: To reflect on evidence based research and practice in engaging in direct work with children young people and their families. To hear from children and young people about their experiences in order to help improve frontline practice in safeguarding. Learn about the MSCB plans and challenge the board on how it supports best practice in safeguarding and engaging young people It was led by Young People and attended by all member agencies; it highlighted the need for creative thinking around communicating with Children and Young People and how to use social media to communicate. This has informed the priorities for the coming year MSCB held two away days that have focused on improving joint working, sharing the work of the sub-groups and enabling challenge amongst partners Both the conference and away days have been supported by the CCG through attendance of the designated leads and Directors Child Sexual Exploitation MSCB tool and launch: Health professionals are in a key position to recognise children and young people who are suffering sexual exploitation (CSE) and identify concerns about adults who may be perpetrators. 67 children were identified as being at risk of sexual exploitation in the year 2014/2015 in Merton. The MSCB tool lists risks associated with sexual exploitation of children and the pathway identifies vulnerabilities, and risk indicators. If a child is perceived to be suffering or at risk of child sexual exploitation, a referral is made securely to MASH for multi-agency intervention. September 2015 Page 22

25 The Designated Nurses were involved in the planning of the launch via a Borough wide CSE awareness day on 18 March 2015 and delivered a key note presentation to a multi-agency audience of professionals representing partner agencies. The Designated Nurses have been actively involved in the MSCB response to CSE at the Board level, within relevant sub groups and in protocols for referral to the MASH. There is varying degrees of compliance against the CSE audit requirements and the Designated Nurses are reviewing the implementation of the CSE risk assessment tool in order to address gaps through training, mainly within primary care as a priority for the forthcoming year Children and young people who are identified as being victims of sexual abuse or assault are assessed by Community Paediatricians at Epsom and St Helier Hospital or referred to The Haven for specialist care and paediatric forensic examination Any follow up services such as sexual health, counselling and therapeutic services are accessed from Barnardos, Jigsaw4U within Merton. 4.2 NHS England General Practice General practice is commissioned by NHS England. The General Medical Council (GMC) has provided guidance to all GPs outlining GPs individual responsibilities in achieving and maintaining their professional competences. As independent GP contract holders, monitoring of compliance with these professionals standards is a function of NHS England through the GP revalidation process. In meeting the requirements of registration with the CQC a number of Merton GP practices have already been subject to inspections. Following these visits reports are made publicly available and allow the public to see if GP practices and other primary medical services are meeting the essential standards. Support has been available to any practice who does not meet the CQC standards required around safeguarding. September 2015 Page 23

26 Merton CCG, in its duty to support improvements in the quality of primary care and its safeguarding function, has provided support to general practice in 2014/15. Designated Nurses have engaged with GP s in being involved in Multi- Agency audits, by supporting their contribution via and telephone contact. Designated Nurses have begun planned visits to practices, starting in the East of the Borough which has the highest number of vulnerable children..a training needs analysis of primary care practices was undertaken with a 30% response, The intention is to provide training for the 24 practices where required at level 1-2 and to offer level 3 training, prioritising Child Sexual Exploitation and Information Sharing. All practices have a safeguarding lead, in accordance with the Intercollegiate document Safeguarding Children and Young People roles and competencies for health care professionals Quality Assurance Merton CCG has worked in partnership with NHSE in ensuring children are safeguarded. During the reporting periods they have provided named GP support to complete an IMR, provided advice in relation to individual serious incidents and, through attendance at the South London Quality Surveillance Group by the Director of Quality, supported the sharing of information and clarification of reporting mechanisms for safeguarding concerns following the review of the National Serious Incident Reporting Framework. This resulted in an agreement that safeguarding concerns that meet the definition of a serious incident should be reported through the incident reporting mechanism. 4.3 London Borough of Merton Merton Children s Trust Board Merton s Children s Trust was designed to deliver the outcomes of Every Child Matters. The Children s Trust Board is made up of representatives at the highest level of agencies and organisations working with children and families and provides strategic overview and accountability for performance across Merton. The board brings together the work of a range of partnerships and groups September 2015 Page 24

27 including the Corporate Parenting Group and Early Childhood Partnership. Merton CCG Director of Commissioning and Planning is a member of the Board Merton Health and Wellbeing Board Merton CCG s Chief Officer, Clinical Chair, Locality Lead for East Merton and the Director of Commissioning and Planning are members of Merton Health and Wellbeing Board (HWB). The HWB has a key role in ensuring joined-up services across health and social care in Merton. The Health and Wellbeing strategy identifies priorities for Merton which include Best Start in Life and Community Participation and Feeling Safe. The focus on prevention, education and tackling inequalities all have the aim to safeguard children and young people from harm. 4.4 Multi-Agency Risk Assessment Committee (MARAC) and Multi-Agency Public Protection Arrangements (MAPPA) The scale and prevalence of domestic violence has been highlighted within national reports. Research demonstrates that domestic violence is a common feature within SCR s. The Designated Nurses are arranging to represent the CCG on both of these groups in order to quality assure the health response to both the victims of domestic violence, their children and the perpetrators of domestic violence; ensuring access to Mental Health and drug and alcohol services. 4.5 Multi Agency Safeguarding Hub (MASH) Merton CCG leads (and quality assures) the health system to become a full and successful partner in the Merton Multi-Agency Safeguarding Children Hub (MASH); The Designated Nurses are members of the MASH strategic group and monitoring happens bi-monthly through this group. The CCG commissions the health navigator element of the MASH provider team and this health visitor sits within the SMCS safeguarding team, supervised by the team lead, who meets regularly with the Designated Nurses. The Information Sharing agreement was agreed and signed by Merton CCG. 4.6 Family Nurse Partnership Sutton & Merton Community Services Merton CCG supported and monitored the development of the Family Nurse Partnership Programme along with Sutton and Merton Community Health Services and Merton Local Authority; The Family Nurse Partnership is fully functional and the designated nurses attended the regular monitoring meetings, which inform the national programme. September 2015 Page 25

28 5 Views of Children and Young People 5.1 Safeguarding practice around vulnerable children is complex and is frequently under review. In order to ensure work is effective practice must be child centred and organisations need to promote a culture where the voices of vulnerable groups are heard. 5.2 Merton CCG has a strong communication team who are supporting the safeguarding team in improving consultation and communication with children and young people. 5.3 The Designated nurses met in October 2014 with the participation officer for LBM to explore how to establish a forum for regular consultation with Children and Young people including CLA. The intention was to attend Children in Care council but due to the agenda of these meetings being appropriately in the control of CYP an invitation is still awaited. 5.4 The Community Services Specialist Nurse consults with CYP and meets with the Designated Nurses regularly and informs them of any issues raised. She also provides an evaluation questionnaire following a Review Health Assessment asking for feedback regarding the service. 5.5 The Designated Nurses consulted with the communications team and patient participation workers to developed safeguarding children pages on the CCG public website; the web page includes safeguarding children under the governance section and includes contact details for the public. They are exploring strategies to increase inclusion and to devise a Children and Young person complaints process accessible on a web page. This will inform next year s priorities. 5.6 The Designated Nurses have planned to jointly visit children and young people in residential units and will begin this work in the next annual reporting timescale. 5.7 The Director of Quality will ensure the presence of a young person on interview panels for key posts within the CCG. 6 Conclusion There has been significant progress against the identified priorities for 2014/15. Merton CCG has taken seriously the fulfillment of its statutory duty in relation to September 2015 Page 26

29 safeguarding children in Merton. It remains committed to working in partnership with MSCB to ensure continuous improvements are made in safeguarding and child protection services for the children and young people of Merton 7 Priorities and Planned Improvements 2015/ Assurance Maintain the MCSB and CCG reporting framework. a) During 2014/15 the MSCB Quality audit Group findings have presented some common challenges across the health system and where work to achieve these is ongoing they will continue to form part of our priorities or key performance indicators for 2015/16 to include: Service developments informed by views of children and young people, this is currently inconsistent and forms a priority area for 2015/16. Monitoring and effectiveness of safeguarding supervision. b) To meet regularly with South West London Designated Professionals to provide a coordinated approach to health economy assurance c) Monitor and manage risks identified in the organisation to safeguarding through the Safeguarding Executive Group d) Update the Section 11 self-assessment audit and engage in peer reviews. e) Monitor and review provider Section 11 Audits. f) Lead on embedding and implementing learning in serious case reviews and serious incidents g) Seek assurance on the implementation of new policies, procedures and guidance Child sexual exploitation strategy Female Genital Mutilation strategy Radicalisation (including the Prevent strategy) September 2015 Page 27

30 h) Seek assurance all services have escalation processes and comply with procedures for allegations against staff. 7.2 Training a) To maintain a rolling programme for CCG staff to level 1 Safeguarding Training. b) To support safeguarding training to all levels to primary care staff. c) To provide level 4 safeguarding training to clinical service providers. 7.3 Engagement a) To contribute to the MSCB participation strategy b) Capture the views of children and young people looked after of Merton including those out of borough. c) Capture the views of children and young people to inform commissioning intentions in service development. d) Participate in the care leavers and health equalities project. 7.4 Children Looked After/Complex needs a) Seek assurance from providers that there are transitional plans in place for children moving into adult services. b) Continue to implement and monitor the recommendations from the review of Children Looked After. 7.5 Preparation for Inspection a) To continue to gather and build the file evidence for MCCG against CQC lines of enquiry. b) Prepare evidence from commissioned services 7.6 Information Sharing September 2015 Page 28

31 a) Be actively involved in the development of IT systems for sharing information and work with the local authority in applying the systems. 7.7 Recruitment a) Recruit to substantive post for Designated Nurse Safeguarding for Children and Looked after by the end of quarter 3 (2015/16). b) Recruit to named GP post or seek alternative arrangements by the end of quarter 3 (2015/16) 8 Reference Sources 1. Safeguarding vulnerable people in the reformed NHS accountability and assurance Framework NHS Commissioning Board. March Safeguarding Children and Young People: Roles and Competences for Health care Staff. Intercollegiate Document. Third Edition March Royal College of Paediatrics and Child Health updates/child-protection-updates 3. Child Sexual Exploitation and the Response to Localised Grooming. House of Commons, London. June home-affairs-committee/inquiries/parliament-2010/childgrooming/ 4. Working Together to Safeguard Children 2015 Department for Education Protecting Children and Young People : the responsibilities of all doctors. September 2015 Page 29

32 General Medical Council, London Merton multi-agency safeguarding board September 2015 Page 30

33 9 Glossary BAAF BIG CAMHS CDOP CLA CQC CQRG CSE CYP DoQ EMT GMC IMR MARAC MAPPA MASH MSCB NHSE SCR Section 11 SI SMCS British Agency Adoption and Fostering Business Implementation Group Children and Adolescent Mental Health Services Child Death Overview Panel Children Looked After Care Quality Commission Clinical Quality Review Group Child Sexual Exploitation Children and Young People Director of Quality Executive Management Team General Medical Council Individual management review Multi Agency Risk Assessment Conference Multi agency Public Protection Arrangements Multi agency Safeguarding Hub Merton Safeguarding Children Board NHS England Serious Case Review Section 11 of the Children Act 2004 annual audit against requirements Serious Incident The Royal Marsden Hospital Sutton and Merton NHS Community Services September 2015 Page 31

34 10 Appendices Appendix 1: Summary Report Children Looked After 1. Purpose and context 1.1 In June 2014 the Director of Quality for Merton Clinical Commissioning Group (CCG) commissioned an external review of Children Looked After (CLA) in Merton. The review was undertaken across the latter part of June and carried on into August. The report (Appendix 1) detailing the findings and relevant analysis from the review, together with a number of recommendations, was finalised in October The recommendations were presented to the Executive Management Team (EMT) in November An action plan to address the recommendations was approved by EMT in December A working group was established to implement the recommendations and monitor progress which consisted of key members of CCG staff including the interim Designated Nurses for Safeguarding Children and Children Looked After, Director of Quality, Director of Commissioning and Planning and the Children s Commissioning Manager. 1.3 Progress was monitored through EMT with oversight from Merton Clinical Quality Committee. 1.4 This paper revisits the original report and tracks progress against those recommendations. 2. Introduction 2.1 Merton CCG was established in April 2013, following the dissolution of Primary Care Trusts and the changes in legislation for the commissioning of health services brought about by the Health and Social Care Act As part of their commissioning responsibilities the CCG took on the responsibility for commissioning the healthcare of Merton CLA whether placed within or outside of the borough. To ensure clarity and aid the CCGs in carrying out those responsibilities the Department of Health produced Safeguarding Vulnerable Children in the Reformed NHS: Accountability and September 2015 Page 32

35 Assessment Framework March This document clarified the role of the Designated CLA doctor and Nurse in relation to the CCG. 2.2 Following the CCG taking over responsibility for the commissioning of CLA services concerns became apparent to the CCG in relation to the increase of children and young people being looked after by the London Borough of Merton (LBM) and whether the services commissioned met the needs of those children and young people who, by definition, are vulnerable young people often with considerable unmet health needs at the time of becoming looked after. The CCG also wanted to seek assurance that with recent changes within both the commissioning and provision of services they were compliant with legislation and statutory guidance. As a result the CCG commissioned an external review of CLA in Merton 2.3 The post of Designated Nurse for Safeguarding Children became vacant in September 2104 and, as a result of interim findings from the review, the Job Description was changed to include the strategic responsibilities for CLA. The title and responsibilities of Designated Nurse for CLA was then with the nurse providing the service, following national guidance that recommends, as it is a strategic role, it is best placed in commissioning to provide overview of the service and quality assurance. 2.4 The Director of Quality commissioned two experienced Designated Nurses for Safeguarding Children and Children Looked After to provide oversight of the implementation of the recommendations from the review and to continue to improve the strategic safeguarding service. This commenced in October The recommendations from the review were translated into an action plan to be led by the CCG. 2.6 A working group was established to implement the recommendations and monitor progress consisting of key members of CCG staff including the interim Designated Nurses for Safeguarding Children and Children Looked After, Director of Quality, Director of Commissioning and Planning and the Children s Commissioning Manager. 2.7 The following section revisits the recommendations from Section 8 of the review report and tracks progress against the actions. 3. Recommendations (Section 8) September 2015 Page 33

36 The commissioners need to carry out a needs assessment starting with the JSNA alongside the local authority children s social care and public health to identify the health needs of Merton s CLA. A Health Needs Assessment has been undertaken by Public Health with initial findings and recommendations completed in July There was a focus on out of borough placements, mental health and transitions and engagement with CLA and professionals. This will inform strategic planning for CLA and transitional arrangements for young people leaving care. Commissioning intentions will be based on the recommendations from the needs assessment and transferred into the Safeguarding Children and Children Looked After Strategy The Service specification for Epsom and St Helier needs to include the role of the Designated Doctor in more detail including a clear SLA with allocated time (2 sessions a week) and identification of who, within the CCG the Doctor is managerially and professionally accountable. It also needs to clearly identify the role of the Designated Doctor in coordinating the care of out of borough CLA with complex needs. The job descriptions and commissioning arrangements of the specialist Designated Doctor and responsibilities, have been detailed within the service level agreement for 2015/16 in line with the recommendations. The service level agreement is monitored through a monthly performance report submitted to the CCG and quarterly SLA meetings The post within the Royal Marsden NHS Foundation Trust be made a Specialist Nurse rather than the Designated Nurse role and a separate Designated Post be created at the appropriate band (Band 8 range). The Designated Nurse for CLA (in the provider service) post has now been renamed as Specialist Nurse Lead for CLA and with a job description to match, omitting the strategic element of the role. The Merton CCG two interim Designated Nurses for Safeguarding Children are currently covering the strategic responsibilities of CLA. A job description has been developed for a substantive post for a Designated Nurse for Safeguarding Children and Children Looked After at band 8c. The recruitment process has commenced and it is expected the post holder will be in place at the end of the calendar year. September 2015 Page 34

37 Sufficient administrative support (probably a 0.5 whole time equivalent, WTE, post) be provided to support the Specialist Nurse and release her to carry out her clinical work. There is a WTE administrator post to support the Specialist lead Nurse The job description for the Specialist Nurse post (with the appropriate administrative support) should include the provision of CLA supervision to health visitors and school nurses and provide pro-active support for the health needs of care leavers. The new job description for the specialist nurse includes pro-actively engaging within care leavers and providing supervision to health visitors and school nurses deliver this. Assurance is gained through Supervision Audits undertaken by Sutton and Merton Community Services and reported through the Clinical Quality Review Group The Specialist Nurse receive the required training to make her proficient in carrying out Review Health Assessments for the under 5 year olds. This is still being developed and will be further worked up within the model of care in the new community contract (2016/17) to ensure that health reviews are carried out in the most effective and efficient way for under 5 s. A business case was developed to enhance the current provision by creating an addition specialist nurse post to carry out the health review for children under 5 s and allow the service to be more flexible in its delivery of health reviews. Despite this being agreed at EMT, the provider is reluctant to recruit into a fixed term contract until 2016/ The CCG ensure they have a process in place which enables them to access clinical advice when commissioning mental health services for CLA living out of borough or in specialist mental health/therapeutic assessments 2. An out of borough protocol has been developed to ensure that there is a clear process in accessing mental health services for CLA. Information on children placed out of borough is reported monthly. 2 Promoting the health and welfare of looked after children; statutory guidance for local authorities, clinical commissioning groups and NHS England 2009 September 2015 Page 35

38 The CCG have an agreed distance beyond which an out of borough assessment will be commissioned by the local provider. The service specifications for both the Royal Marsden and St Helier and Epsom NHS Trusts should include an agreement in relation to out of borough Initial and Review Health Assessments and PbR. A joint protocol has be developed by the London Borough of Merton (LBM) and CCG detailing the responsibilities of Merton s Health Services and Social Care Services in respect of promoting the health and wellbeing of Children Looked After with particular reference to the initial and review health assessments. This protocol provides information and guidance to health professionals and social care staff about the statutory requirements from health and social care services towards children in care in respect of statutory health assessments. The protocol call was launched in July The CCG agree a process with the local authority by which they are notified of all CLA living in Merton. A similar process be agreed with the provider organisations to ensure that the CCG are made aware. The Designated Doctor and Nurse will then be able to provide an overview and ensure their health needs are met appropriately in line with statutory guidance. It is the responsibility of the placing CCG to inform the CCG of children placed by other boroughs into Merton. The Designated Nurses have implemented a process for collecting this information directly from the Local Authority. The information ensures health and well-being needs can be met The Designated Doctor and Nurse be asked to complete an Annual Report for the CCG Board. This should include current statistics, KPIs, audits completed etc., whether CLA s health needs have been made and gaps in current service provision with suggested solutions. It should include the work carried out by all the providers. The Designated Nurses provide an overview annual report from all provider reports for the CCG and these will include statistical and narrative evidence A local information sharing agreement be agreed and improved access to secure to aid the sharing of information and also reduce the need for photocopying and posting. September 2015 Page 36

39 There is an information sharing agreement in place through Merton Safeguarding Children Board, which was signed up to by all members in March A process needs to be put in place to ensure that those young people who have had an Initial Health Assessment, but then go on not to be looked after, have any health needs identified during that assessment met. This requirement is included within the Joint Protocol which was developed between the LBM and CCG and was launched in July A process be agreed with the local authority so that where a child/young person with a child protection plan and is referred to a legal planning meeting are also referred for an Initial Health Assessment at the same time. This would be in line with current guidance 3. This requirement is included within the Joint Protocol. The joint protocol will be fully implemented in the 2015/16 period of reporting A training needs assessment be carried out and a plan of training be initiated. This should include training for: health staff in line with the Inter Collegiate Document 2012, training for local authority staff, social workers,team leaders, administrative staff and Independent Reviewing Officers. Foster carers and residential workers. Training is now delivered through a rolling programme. The Specialist Lead Nurse provides training to Local Authority staff and foster carers, community nurses and school nurses. The Designated Nurses include the health needs of CLA in safeguarding training delivered to the CCG. A strategy is being developed to provide training to primary care teams The leaflet and web-site currently being developed include information about the option of gender for CLA s health assessments and reference to the wider role of the nurse. There is work underway to develop a child friendly web site and leaflets, including a complaints procedure. The information will include reference to the role of the health 3 Promoting the health and welfare of looked after children; statutory guidance for local authorities, clinical commissioning groups and NHS England 2009 September 2015 Page 37

40 team and each child will have a contact number for a member of the team. The timeframe for completion is December A collaborative approach to agreeing KPIs so that Merton and neighbouring CCGs have an agreed list of KPIs to be reported upon. This work has been completed. The Designated Nurses have worked with the Local Authority to review the data collected and provide a much reduced number of KPI s in line with national guidance. The new KPI s for CLA are received monthly and reviewed at Health Strategy Meetings chaired by Designated Nurse. The Designated Nurses have reconvened the neighbouring partner CCG Designates meeting to share good practice and agree consistent approaches to data collection The introduction of a tool such as DUST could be introduced at Initial and Review Health Assessments with a clear pathway in place for those young people who have need for such services. A number of tools have been developed and are currently being rolled out to improve the health and well-being assessments, e.g. DUST, CSE risk, Prevent, Signs of Safety and FGM risk. The Designated Nurses sit on key provider meetings to assure the CCG of the appropriate use of risk assessment tools, and provide training for the use of these tools, with a focus on primary care. 4. Conclusion 4.1 The review provided a benchmark against which Merton CCG could measure their assurance in respect of CLA to fulfill their statutory responsibilities to CLA in Merton and to children from other Boroughs placed in Merton. 4.2 Gaps in assurance have been addressed through the development of an action plan with oversight through key strategic forums within the CCG. 4.3 The recommendations have been addressed through the action plan and the CCG will continue to work with providers and LBM to monitor performance, quality, health needs being met and CLA reported experience and develop the provision and model of care to meet the needs for CLA. 5. Recommendation September 2015 Page 38

41 5.1 It is recommended that the work from the CLA review is embedded and monitored into the Safeguarding Children and Children Looked After Strategy Appendix 2: CDOP newsletter September 2015 Page 39

42 September 2015 Page 40

43 September 2015 Page 41

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