Safeguarding Children & Young People Annual Report

Transcription

1 Safeguarding Children & Young People Annual Report Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

2 Contents Section Page 1. Introduction 3 2. Key Achievements in Audit Activity 6 4. Serious Case Reviews 8 5. Management of Allegations Against Staff 8 6. Inspections 8 7. Training 9 8. Key Actions for Conclusion Appendices 11 Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

3 1. Introduction 1.1 The Trust s statutory responsibilities for safeguarding children and young people are set out in Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children (HM Government 2010) As part of these recommendations it is expected: Representation on the Local Safeguarding Children s Board is at an appropriate level of seniority A Named Doctor, Nurse and Midwife for Safeguarding House are in place Staff in emergency care settings should be able to recognise abuse, specialist paediatric advice should be available at all times and information on attendances are shared with GPs and the health visitor or school nurse Accountability is to the commissioning Primary Care Trust. Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004 [DFES 2010] expects: Senior management commitment to the importance of safeguarding and promoting children s welfare A clear statement of the Trust s responsibilities to safeguard children is available to all staff There is a clear line of accountability within the Trust for work on safeguarding and promoting the welfare of children (individual/professional/organisational) All staff working with children and their families are provided with safeguarding training Safer recruitment practices are in place Effective inter-agency working is in place Systems are in place for effective information sharing to safeguard children and young people 1.2 Whilst the Trust was compliant with the requirements of Working Together full compliance with Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004 remained difficult to achieve as not all staff access Safeguarding Children training (refer to section 7). 1.3 Safeguarding accountability to commissioners was provided using the NHS East Midlands Safeguarding Governance Tool Markers of Good Practice. The Trust was compliant with twenty five of the thirty three relevant markers and partially compliant with the remaining eight. Partial compliance was due to the following reasons: Inability of staff to attend all multi-agency meetings when invited [clinical pressures/late notifications from Children s Social Care] The ongoing challenge of ensuring all staff working with children, young people and their families undertake Safeguarding Children Training. Forced Marriage guideline have been developed, but are going through the ratification process [Clinical Policy and Guideline Review Group May 2012] Safeguarding Children s Policy requires minor amendments (Clinical Policy and Guideline Review Group May 2012) Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

4 A need for additional work on ensuring the Voice of the Child is heard Not all relevant staff have undertaken the Multi-Agency Assessment Referral Conference (MARAC) Training for Domestic Abuse (training is ongoing) MARAC information sharing protocol to be agreed between Trust Information Governance and partner agencies (SFHFT have raised concerns re content) 1.4 Evidence was also provided for compliance with Outcome 7 (regulation 1): Safeguarding people who use services from abuse (CQC 2010). 1.5 The Safeguarding Children processes were assessed against the 19 recommendations made by Lord Laming [TSO 2003] that are relevant to SFHFT. As recommendations 70, 71 and 73 require compliance to be monitored they were subject to audit in /12 [see 3.6]. There continued to be non-compliance with recommendation 78 i.e. that in a single health care establishment professionals work from a single set of records. 1.6 The Children Act 1989 sections 85/86 require that the Local Authority is notified of children who are accommodated within health settings for three months or longer. During /12, four notifications to the Local Authority were made of babies being cared for on the Neonatal Unit. 1.7 Throughout the Safeguarding Children and Young People Governance Meeting (SC&YPGM) continued to meet bi-monthly. In response to concerns over attendance (see appendix B) the terms of reference and membership of the meeting were reviewed. To broaden the representation a Children s Social Care Manager and the Head of Service for Health Visiting and School Nursing were invited to attend the meeting. 2. Key Achievements in / A comprehensive work plan was undertaken during /12 (Appendix C). As well as the reviewing and updating of existing safeguarding processes and undertaking the planned audit programme, there were several new developments during /12, which included: Inclusion of a Safeguarding Children Clause into new staff contracts Implementation of an electronic Missing Children Alert system Development of Safeguarding Children Competency Packages for paediatric, neonatal, emergency department, minor injuries unit and genito-urinary nurses and community midwives Production of a patient information leaflet for alcohol and drug using mothers attending the Pregnancy, Alcohol and Drug Antenatal Clinic [PANDA] Clinic Development of SFHFT guidance on Forced Marriage and Female Genital Mutilation Development of a Safeguarding Children Supervision Policy Purchase of the National Paediatric Toolkit software to facilitate the inclusion of children s reviews on service provision and development. Initiation of MARAC training for midwives Information Sharing Guidance for Substance Misuse Workers jointly developed with Nottinghamshire Healthcare Trust. Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

5 Guideline for Pregnant and recently delivered women who attend the Emergency Department was implemented between the Emergency Department (ED) and the maternity ward. (There have been some difficulties maintaining this process and the plan is to review it again in 2012/13 in line with the Clinical Negligence Scheme for Trust requirements). Template for Local Authority Initial Child/Review Child Protection Conferences were reviewed and updated. Guidelines for Health Professionals Advising Parents on Safe Sleeping Practices for their Baby were reviewed and updated to ensure they were fit for purpose. Prompts were introduced into the Adult Nursing Care Booklet on the patient s caring responsibilities for a child or children and whether the patient s condition could impact on their ability to care for them adequately. 2.2 To monitor key performance indicators for Safeguarding Children within SFHFT (Appendix A), a Safeguarding Children and Young People Governance Meeting was developed which is piloting a Safeguarding Children s Dashboard. This is currently in its infancy and will be developed further during 2012/ Audit Activity 3.1 Seven Safeguarding Children audits were scheduled for /12. Six have been undertaken and completed; one audit is in process with completion due in Q1 of 2012/13. Audit of the child protection supervision process including adherence to the supervision contract and the standard of documentation and record keeping. The aim of the audit was to assess compliance with the recommendations in the SFHT Child Protection Supervision Policy July, including adherence to the supervision contract and the standard of documentation /record keeping. There were sixteen audit criteria; 100% compliance was reached in two criteria, the compliance of the remaining audit criteria was variable but not poor; as a result some changes have been made to the documentation and the audit will be repeated in 2012/13. Overall the results were considered positive as many of the supervisors were newly trained in and this was their first year of implementing safeguarding children supervision. Audit of documentation of Safeguarding Children Alerts within the Midwifery Service at SFHFT. This audit indicated 100% compliance with recording safeguarding information on the midwifery electronic record, placing written safeguarding alerts in the medical records and ensuring the safeguarding midwife receives a copy of the alert. Although there was an overall improvement on the same audit in 2010/11 there continues to be <100% compliance with the insertion of the other safeguarding documentation (i.e. white sticker, red divider, chronology sheet). In response, the filing instructions for safeguarding children documentation were reviewed and example sets of records made available to staff. All staff were provided with a training update. The audit will not be repeated in 2012/13 as a new Safeguarding Children Paediatric Dashboard that provides quarterly reports on documentation has been developed and implemented. Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

6 Audit of domestic abuse enquiry and documentation on the electronic maternity pathway within the midwifery service at Sherwood Forest Hospitals NHS Foundation Trust. This audit was undertaken to ensure all staff are following the Trust guidance and performing routine domestic abuse enquiry and documenting this correctly on the electronic maternity pathway, antenatally and postnatally. The results for postnatal enquiry were positive with 90% compliance, although antenatally the results were disappointing with only 77% of women having routine enquiry once during their antenatal care. There was generally poor compliance with documenting whether the woman was accompanied or unaccompanied at their appointment or whether they were given domestic abuse information. All staff have been reminded of the importance of documenting this information and the audit will be repeated in 2012/13. Audit of Midwifery and Health Visiting communication. This audit was undertaken by sending a questionnaire to all midwives and health visitors and produced a >70% response. Although the results were variable and in some cases responses from midwives and health visitors using the same communication process in the same health centre differed, the overall results did show an improvement in the frequency of meetings between midwives and health visitors and excellent postnatal communication [70% of midwives and health visitors felt that there has been an improvement overall in communication within the last six months]. The audit did however indicate that methods of communicating information between the midwives and health visitors antenatally, where safeguarding children concerns are present, required improvement. An action plan to overcome the barriers and problems highlighted in the audit will be developed in 2012/13. Audit to determine whether recommendations 70, 71 and 73 of the Laming Inquiry are being adhered to when deliberate harm is suspected in paediatric inpatients. This audit indicated that compliance with recommendation 70 [no child is discharged without consultant in charge/ or STR4 and above agreement] was 92%. Compliance with recommendation 71 [on discharge information/follow up in place] was a mean of 92%. Compliance with recommendation 73 [enquiries are made about admissions to other hospitals] was 41%. The results of the audit were shared with the consultant paediatricians, in particular the need to ask about admissions to any other hospitals and the need to document the response. The Child Protection Medical Proforma is also to be changed to address this issue. This audit will be repeated in 2012/13. Use of the Paediatric Referral Criteria in the Emergency Department at King s Mill Hospital for Children and Young People under the age of 16 years. 308 records of children were included within this audit. Of these, 81 [26%] were identified as meeting the paediatric referral criteria i.e. their presentation required additional communication with their health visitor or school nurse to ensure their safety and wellbeing. Of these 81 children only 26 [32%] were correctly identified by ED staff. Paediatric referral criteria have been in place in ED in excess of seven years, staff training has been provided and the criteria are available to all staff. Results were presented to ED; the department is to undertake quarterly audits. Refresher training is currently being undertaken. Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

7 Audit of the implementation of the Trust s Policy for the Management of children who fail to attend appointments [DNA]. This audit is currently being undertaken. 4 Serious Case Reviews [SCR] 4.1 A SCR is considered in the following circumstances: A child sustains a potentially life threatening injury or serious and permanent impairment of physical and/or mental health and development through abuse and neglect; Or has been seriously harmed as the result of being subjected to sexual abuse; Or a parent is murdered and a domestic homicide review is being initiated under the Domestic Violence Act 2004; Or has been seriously harmed following a violent assault perpetrated by another child or adult; And the case gives rise to concerns about the way in which professionals and agencies have worked together to promote the welfare and safety of children. 4.2 During /12 the Nottinghamshire Safeguarding Children Board [NSCB] initiated one SCR which included children/family members who had been patients at Sherwood Forest Hospitals Foundation Trust. Following a scoping and assessment of this contact it was agreed by the NSCB that an individual management review [IMR] was not required and that information report would suffice. This report was duly supplied [information reports are not included in the final Ofsted evaluation]. 4.3 The Health Action Plan from the SCR was disseminated to all Health organisations and contained one recommendation i.e. that children and young people have access to information about the boundaries to confidentiality of health services including signposting to alternative confidential support. This information was already available at SFH FT. 5 Management of Allegations against Staff 5.1 One case was being managed during /12. 6 Inspections 6.1 In May SFHT participated in the Nottinghamshire Safeguarding Children Peer Challenge. This was organised through the Local Government Improvement and Development Group as part of their progress towards exit of their Department for Education Improvement Notice [given following a previous Ofsted inspection where they were deemed inadequate]. The peer challenge team met with the Head of Nursing for ED, the ED Department Lead, the Divisional Nurse Director for Emergency Care and Medicine and the Named Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

8 Nurse for Safeguarding Children. There was no negative feedback followed this meeting. 6.2 As part of the Ofsted re-inspection of Nottingham Safeguarding Children s Board in September, the Named Midwife for SFHT was invited to be part of the Ofsted focus group for 'Health Practitioners'. This involved providing good examples of partnership or integrated working around children in need or child protection cases and how our service improves outcomes for children, young people and families. It also included a demonstration of the understanding of the early intervention strategy, multi-agency thresholds and the Common Assessment Framework [CAF] process. 7 Training 7.1 In response to Safeguarding Children and Young People: roles and competences for health care staff [Intercollegiate Document 2010], the Safeguarding Children Named Professionals have worked with the Training, Education and Development to ensure that appropriate Safeguarding Children training is available within SFHFT. 7.2 Although the overall uptake of training in /12 has increased from the previous year [see table 1] a trend continued from 2004/5 ensuring all relevant staff who are required to undertake training do so, remains challenging This has been particularly so in the case of Consultants/Senior doctors [currently 69 are up to date with their safeguarding training]. 7.3 Consultant/senior doctor training concerns were escalated to the trust Clinical Governance Committee in December and again in March. The Named Doctor for Safeguarding Children has also met with the medical consultant responsible for mandatory medical training to explore why compliance is low; training opportunities are readily available. 7.4 Priority was also given to ensuring training levels remained high in areas where services/care for pregnant women and children were provided i.e. Ward 25, Clinic 11, NICU, Maternity, Sexions, MIU&UCC and ED. It was however particularly difficult to maintain training levels in ED during /12: this was due to problems releasing staff. The department is now working to address this. Table 1 In-House Safeguarding Training 2010/11 /12 Orientation session (replaced by e- 312 (100%) learning module on 1 st October ) Orientation session (e-learning) 141 (89.4% have completed the module) Mandatory update (77%) Mandatory update (midwives) (96%) Safeguarding Training Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

9 In-House Safeguarding Training 2010/11 /12 MARAC Training (midwifery) 22 Common Assessment 39 (87%) Framework (CAF) Training (community midwifery refresher) CAF Awareness Session (paediatric and 72 (85%) neonatal nurses) Safeguarding Supervision Training 11 Safeguarding (medical staff) e-learning module Total Key Actions for 2012/ In order to continue to ensure the well being and safety of children and young people who present to SFHFT in addition to maintaining the Safeguarding Children Named Professionals in conjunction with the SC&YPGM have identified the following key action for 2012/13: The continuing development and updating of Safeguarding Children policies/guidelines and processes in response to audit outcomes, actions from SCRs and changes in local and national practice guidance and legislation. Maintaining the Safeguarding Children audit programme. Ensuring Safeguarding Children information sharing processes between SFHFT and our partner agencies remain effective and robust. Implementation of the Safeguarding Children Role Development Assessment Package for Registered Nurses and Midwives in key areas. The development of a Safeguarding Children alert system for use in the Emergency Department. 9 Conclusion 9.1 It is important that the ethos of Safeguarding Children is everybody s business is clearly understood and accepted by all staff groups and supported by all levels of management. It is equally important that Safeguarding Children remains high on the Trust agenda. Report prepared by: Dr Vibert Noble, Consultant Paediatrician, Named Doctor for Safeguarding Children Susan Spanswick, Nurse Advisor/Educator [Safeguarding Children] Lisa Butler, Named Midwife for Safeguarding Children Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

10 10 Appendix A Draft Example of Safeguarding Children Dashboard Quarter Paediatrics Documentation in medical records When admitted with Child Protection concerns Community Paediatrics Child Protection Medicals Midwifery Documentation in medical records Attendance at meetings White Alert sticker Safeguarding Divider Chronology sheet Continuation sheet Safeguarding page in paediatric booklet completed Neonatal front sheet completed Initial report within 24hrs. Final report on completion of investigations On admission inquiries are made re admissions to other hospitals Discharged is agreed by consultant or doctor above the grade of STR4 Initial report provided within 24hrs Final report within 3 working days White Alert sticker Safeguarding Divider Chronology sheet Social and Domestic Alert Confirmation of referral ICPC attendance Report for ICPC Supervision sessions provided as per policy 1:1 supervision Community midwives Senior Midwives Named Professionals Ward leader [25] Ward leader [NICU] RAG Rating Assurance/actions required Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

11 Senior Nurse [Clinic 11] Group supervision Specialist Paediatric Nurses CASH [Nursing] CASH/GUM [medical] SExions ED MIU&UCC Paediatricians Training Currently under discussion SC&YPGM Attendance RAG Rating Paediatrics, Community Paediatrics, Midwifery, Supervision 100% Many elements of good practice are displayed and there are no major admissions 99%-80% Some elements of good practice are displayed 79% and below Few elements of good practice, significant omissions are identified Training 90% and above Many elements of good practice are displayed and there are no major admissions 89%-80% Some elements of good practice are displayed 79% and below Few elements of good practice, significant omissions are identified Attendance at SC&YPGM 70% and above Many elements of good practice are displayed and there are no major admissions 69%-50% Some elements of good practice are displayed 49% and below Few elements of good practice, significant omissions are identified Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

12 Appendix B Attendance at Safeguarding Children &Young People Governance Meeting Name April June Aug Oct Revised Membership Dec Feb 2012 Divisional Director of Nursing Cancelled Apologies Executive Nurse Director Apologies (Chair) [until June ] Non-Executive Director Non-Exec Director Named Doctor Named Doctor Named Nurse Named Nurse Named Midwife Named Midwife Apologies Head of Nursing for Children s Services Apologies[ represented by head of Midwifery] Head of Nursing for Children s Services Apologies Head of Midwifery and Head of Midwifery and Apologies Gynaecological Services Gynaecological Services Paediatric Liaison Facilitator [PLF] Mat leave Mat leave PLF Mat leave Apologies Rep from GUM Rep from ED Rep from GUM Rep from ED Nurse Advisor for Vulnerable Adults Nurse Advisor for Apologies Vulnerable Adults Head of Nursing Newark Hospital Head of Nursing Newark Hospital Rep from Diagnostic and Rep from Emergency Apologies Rehabilitation Care and Medicine Lisa Nixon Paediatric Liaison Facilitator (PCT) Rep from Diagnostic and Rehabilitation Rep from Planned Care and Rep from Children s Surgery Social Care Dr Helena Clements Rep from Notts CHP Apologies Dr Adenike Omokanye Rep from TED Apologies Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

13 Appendix C SC&YPGM Work Plan [as of April 2012] Outcome Action required Lead[s] Timescale Progress 1. Safeguarding Children Review Training Named Professionals By end of Training Strategy and Strategy May Training programme offered is congruent with the roles and competences set out in By end of the Intercollegiate Review Training Named Professionals May Document [2010] & SHA Programme Markers of Good Practice 2. The Training programme encompass diversity and inclusivity Review Training presentations to ensure compliance Named Professionals By end of May 3. Safeguarding Children Assessment of Competence Packages are available for key level 3 workers [as defined by Intercollegiate Document A Child Protection Supervision Policy is available 5. A policy is available on the Management of Children who fail to attend appointments Develop competence packages for: Paediatric nurses Neonatal Nurses ED/MI&UCC Nurses GUM Nurses/CASH and Midwives Develop and disseminate Child Protection Supervision Policy Develop policy from existing guideline Named Nurse Named Midwife End of September Named Nurse By end of July Named Doctor By end of June Packages developed. [Ratified April 2012] Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

14 Outcome Action required Lead[s] Timescale Progress 6. Guidance is available on Develop and Named Doctor By end of the Management of disseminate guidance October Perplexing Presentations 7. A Multi-Agency Risk Assessment Conference [MARAC] information sharing process is developed 8. Midwives understand the MARAC process and are able to make referrals when appropriate 9. Trust policy is available on Staff who are subject to Domestic Abuse Trust agree Information Governance Manager All midwives are provided with training Develop policy Launch policy By end of December Named Midwife By end of October Assistant Director of HR & Named Nurse End January 2012 of Initiated. Discussion being with NUH Not yet agreed. Trust IG department have raised concerns with process proposed by partner agency. Delayed due to lead partner agency s decision to review training. Training commenced in Jan 2012 [when new training available] Policy developed. [Now to be incorporated into all relevant HR policies rather than separate policy] 10. Trust guidance is available on Handling Cases of Forced Marriage 11. Trust Guidance is available on the management of Cases of Female Genital Mutilation Develop and disseminate guidance Develop and disseminate guidance Named Nurse, End of Midwife & November Nurse Advisor for Safeguarding Vulnerable Adults Named Midwife End of November Policy developed. [for ratification May 2012] Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

15 Outcome Action required Lead[s] Timescale Progress 12. All staff contracts Amend contracts to Assistant Director of End of April include a clause on their include clause HR responsibility to safeguard children 13. Assurance is provided that staff are aware of Trust Information Governance Policies/processes and Safeguarding Children Policy Audit developed and undertaken Information Sharing Governance Manager & Named Nurse End of September Not undertaken as assurance can be provided by IG mandatory training. Key aspects of Safeguarding Children Policy included in mandatory update 14. audit of records containing child protections issues Audit developed and undertaken Named Nurse By end of August 15. audit of community midwifery Safeguarding Children Supervision Audit developed and undertaken Named Midwife By end of January audit of midwifery documentation Audit developed and undertaken Named Midwife By end of September 17. audit of midwifery/health visitor communication Audit developed and undertaken Named Midwife By end of September Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

16 Outcome Action required Lead[s] Timescale Progress 18. audit of Audit developed and Named Nurse By end of Audit commenced, for compliance with DNA undertaken January completion first quarter of policy audit of routine inquiry antenatally and postnatally 20. A revised guideline on Holding Still and Restraining Children undergoing Health Interventions is available Audit developed and undertaken Guideline reviewed and disseminated Named Midwife By end of September Paediatric Manager Nurse End of September 21. A revised policy for the Admission and Discharge of Children where there are Child Protection Concerns is available Guideline reviewed and disseminated Named Nurse & Named Doctor End of May 22. A Missing Children RAPA is available Complete development Named Nurse By end of May 23. An update template for Initial Child Protection Conferences is available 24. A specific electronic safeguarding children alert template is available for midwifery staff Review and update template Complete development and train midwives Named Nurse/Midwife End of April Named Midwife By end of August Developed. Earliest IT implementation date June Safeguarding Children &Young People Annual Report /12 July 2012 BoD August

17 Outcome Action required Lead[s] Timescale Progress 25. Updated midwifery Review and update Named Midwife, By end of safeguarding documentation Named Nurse & June supervision Midwifery Team documentation is Leaders available 26. Patient information Complete development Name Midwife & By end of leaflet is available for alcohol and drug using Specialist Midwife June mother attending the PANDA Clinic 27. Children views on service provision and development are actively sought. Purchase of The National Paediatric Toolkit software to enhance process Paediatric Manager Nurse By end of August Safeguarding Children &Young People Annual Report /12 July 2012 BoD August