Safeguarding Children Policy and Child Protection Procedures

Transcription

1 Safeguarding Children Policy and Child Protection Procedures Policy Reference Number WAC012 Status Ratified Version 6 Implementation Date October 2002 Current/Last Review Dates June 2006, June 2008, June 2011, July 2016, Nov 17 Publication Date November 2017 Next Formal Review July 2018 Sponsor Director of Nursing Sponsor Signature Author Named Nurse for Safeguarding/Safeguarding children Team Where available Hard copy in all clinical area in the Child and Adult protection Folder and on ADAGIO Target audience All Trust staff Ratification Record Date PDSG Sept 2016 Approval Record Committee Name Chairperson Date Safeguarding Committee Director of Nursing Sept 2010 Safeguarding Committee Director of Nursing June 2016 Consultation Date Director of Nursing 2008, 2010,June 2016 Head of Midwifery 2008, 2010,June 2016 Named Nurse Safeguarding Children 2008, 2010,June 2016 Governance 2008, 2010,June 2016 Regulators Requirements CQC Standard 7 National Service Framework Children (2004) Document Control / History Version No Reason for change 4 Biennial review Update in line with Kent and Safeguarding Children Board Procedures New Appendix 8 added November 2012 Appendix 16 added December Biennial review July Page 18 updated re Emergency Department

2 Contents Section Page Document Summary 1. Introduction 5 2. Purpose 5 3. Scope and duties (roles and responsibilities) 5 4. Context 6 5. Definitions 6 6. Local arrangements for addressing child protection 9 7. Support for Staff 9 8. Confidentially and sharing information 9 9. Training and Implementation Equality Impact Assessment Monitoring Compliance with this Procedural document Associated Policies and Procedures References 12 Appendices: Appendix 1. Child Protection Contact Names and Numbers 14 Appendix 2. Child Protection Procedures 15 Introduction 1. What to do when you have a concern and how to contact Social Services 2. Record keeping and recording of basic information 3. Referrals for medical examination 4. Child sexual exploitation 5. Management of suspected sexual abuse and subsequent care in hospital 6. The management of suspected fabricated or induced illness 7. Management of domestic abuse 8. Management of mental health issues 9. Female genital mutilation 10. Child death procedures 11. Safeguarding children and young people against radicalisation and extremism 12. Differences of professional opinion 13. Case conference/strategy meetings 14. Discharge from hospital 15. Indicators of good practice relating to the ED 16. Indicators of good practice relating to orthopaedics 17. Flowchart for Child or young person attending A&E with a fracture Dartford and Gravesham NHS Trust Page 2 of 69

3 18. Allegations against staff 19. Management of DNA s (Did not attend appointments) Appendix 3 Child Protection Training Definitions and Competencies 37 Appendix 4 Interagency referral form for Children s Social Care 58 Appendix 5 Child Death Checklist (Actions to be Taken in the Event of a Child or Young Person's Death) 66 Dartford and Gravesham NHS Trust Page 3 of 69

4 Document Summary The Trust will support staff in the identification and management of issues relating to Safeguarding Children. The child s welfare will be seen as paramount and staff will put the child s safety as the first consideration. Safeguarding and promoting the welfare of children is defined in Working Together to Safeguard Children (2015) as protecting children from maltreatment, preventing impairment of children's health or development, ensuring that children grow up in circumstances consistent with the provision of safe and effective care and taking action to enable all children to have the best outcomes. In order to reflect the scope of this definition there are two parts to this overall document: Safeguarding Children s Policy and Child Protection Procedures. Staff will work collaboratively with other agencies involved in safeguarding children. The handling of Child Protection / Safeguarding Children issues will be based on national and local guidelines and best practice. This document is written in conjunction with: Kent & Medway Safeguarding Children procedures (2016), When to suspect child maltreatment (NICE July 2008) RCPCH Child Protection Companion (2006) Standards for Radiological Investigations of Suspected Nonaccidental Injury (March 2008) Working together to Safeguard Children (2015) Child protection training will be attended initially at Trust induction for all staff and then clinical and non-clinical staff will receive further training, in separate modules, at levels 2 or 3 according to their role. All Designated and Named Doctors in Child Protection and all Consultant Paediatricians must be revalidated in the diagnosis and treatment of deliberate harm and in the multi-disciplinary aspects of a Child Protection investigation. (Paragraph Recommendation 84) Safeguarding supervision is a national requirement and will be provided to staff by members of the Safeguarding Children s Team as necessary, according to role and clinical need. Clinical supervision will be provided to members of the Safeguarding Children s Team via group sessions within the community. Dartford and Gravesham NHS Trust Page 4 of 69

5 1. Introduction.effective safeguarding of children can only be achieved by putting children at the centre of the system, and by every individual and agency playing their full part, working together to meet the needs of our most vulnerable children (Working Together 2015). This ultimately means listening to what children are saying and timely, effective sharing information between professionals and agencies. All Healthcare Professionals/Trust Employees, including those working primarily with children, have a professional responsibility and duty to safeguard and promote the welfare of children and must familiarise themselves with the Trust and Local Authority Policies. This document sets out the procedures to be undertaken by any employee of Dartford & Gravesham NHS Trust if they suspect that a child (or an unborn child) has suffered or is suffering any form of abuse, or are in need of services from Children s Social Care. 2. Purpose This Policy applies equally to all Trust staff, clinical, support and administrative, who have contact with children and their families. The Policy also applies to agency staff and other staff not employed directly by the Trust, e.g. volunteers. Although the Policy cannot formally be applied to patients and visitors, the principles enshrined in the Policy will be upheld. The aims of this policy are to: Advise staff on what you should do if you have concerns about children, in order to safeguard and promote their welfare, including those suffering or at risk of suffering, significant harm, or when the child has specific needs. Explain what will happen once you have informed someone of those concerns Explain what further contribution you may be asked or expected to make to the process of assessment, planning, working with children, and reviewing that work, including how you should share information. Provide basic information and background about the legislative framework within which children s welfare is safeguarded and promoted. 3. Scope and duties (roles and responsibilities) CHILD PROTECTION AND SAFEGUARDING IS EVERYBODY S RESPONSIBILITY The Trust s Policy and Procedure will be reviewed and amended in line with National and Local Guidelines by the Trust Safeguarding Committee. The Trust Board: The Trust Board of Dartford and Gravesham NHS Trust has a statutory duty under section 11 of the Children Act 2004 to ensure the Trust functions are discharged with regard to the need to safeguard and promote the welfare of children. The Trust will ensure that the Safeguarding Children Policy and Child Protection Procedures are implemented and staff members are fully guided and supported by procedure and training. To advise the Trust Board of Safeguarding Children issues a Committee has been developed consisting of relevant members of Trust staff who have responsibility for Safeguarding Children and Child Protection within the Trust. See Terms of Reference. The Director of Nursing is the Executive Lead for Safeguarding. The Named Professionals: The Trust has a Named Doctor, Named Midwife and Named Nurse for safeguarding children, with responsibility for taking a professional lead within the Trust on safeguarding and child protection matters (including advice and support to staff, Dartford and Gravesham NHS Trust Page 5 of 69

6 training and conducting the Trusts internal management reviews). The named professionals will present an annual report to the Trust Board on child protection activity, plus other updates to other committees as required. These roles will have allocated times and responsibilities set out in their job descriptions. The Named Professionals will liaise with the Designated Doctor (CCG) and Nurse (CCG) and with representatives from other health Trusts while working in conjunction with other statutory and voluntary agencies such as Children and Young Peoples Services, NSPCC, Police, Probation and Education. See appendix 1 for Child Protection contact names and numbers. Managers: Managers are responsible for ensuring that all employees who come into contact with children receive regular up to date child protection training, this should be monitored through their Person Development Plan. Staff should have access to supervision and advice via the named child protection professionals/ supervisor or peer support. HR will ensure that professional registration is checked before employment and verified annually. HR is responsible for ensuring that all employees who come into contact with children are subject to an enhanced formal police check (Disclosure and Barring Scheme). Managers are responsible for complying with Trust policy with regard to referring staff to the LADO if required. Staff will be made aware of national, LSCB and local child protection guidelines at corporate induction. Staff: All staff employed by the Trust should be alert to the possibility of child abuse or neglect, and are responsible for acting if you have reason for concern, or reason to suspect that a child is at risk of harm, or in need of protection. All staff will exercise their own professional accountability to safeguard children and promote their welfare. Staff should alert appropriate personnel and refer to the Child Protection procedures for further guidance in how to proceed. New staff to the Trust will be signposted to this document at their induction. It is the responsibility of staff of all disciplines to be familiar with and to comply with the national, local and internal procedures, which must be read in conjunction with the Kent and Medway Safeguarding Children Procedures (2015) or Pre- Birth Procedures, which are available online or on Kent Safeguarding Children Board website.. 4. Context This Policy applies equally to all Trust staff, clinical, support and administrative, who have contact with children and their families. The Policy also applies to agency staff and other staff not employed directly by the Trust, e.g. volunteers. Although the Policy cannot formally be applied to patients and visitors, the principles enshrined in the Policy will be upheld. This policy applies to all children on Trust premises who have not yet reached their 18 th Birthday. 5. Definitions It is recognised that the categories are not always clear and may change at any time. A child is: Anyone who hasn t yet reached their eighteenth birthday. A child in need: Children Act 1989 Section 17 He/she is unlikely to achieve or maintain or have the opportunity of achieving or maintaining a reasonable standard of health or development without the provision for him/her of services by the local authority and/or His/her health or development is likely to be significantly impaired or further impaired without the provision for him/her of such services and/or He/she is disabled Dartford and Gravesham NHS Trust Page 6 of 69

7 A child in need of protection: Children Act 1989 Section 47 The local authority (LA) is under a duty to make enquiries, or cause enquiries to be made, where it has reasonable cause to suspect that a child is suffering, or likely to suffer significant harm The threshold that justifies compulsory intervention in family life in the best interests of children Significant harm: Whether the harm is significant is determined by comparing the child s health and development with what could reasonably be expected from a similar child Under Section 31 (9) of the Children Act 1989, as amended by the Adoption Act 2002: harm means ill-treatment or impairment of health or development including, for example, impairment suffered from seeing or hearing the ill-treatment of another development means physical, intellectual, emotional, social or behavioural development health means physical or mental health; ill-treatment includes sexual abuse and forms of ill-treatment which are not physical Children of Concern: Domestic violence Parental mental ill health Parental substance and alcohol misuse Parental physical ill-health Significant health concerns of child, e.g. chronic illness, disability and mental health The inability of parents to meet the child s physical, social, health or developmental needs Poor attachment / bonding Family dysfunction Inappropriate uptake of health provision / frequent visits to A&E Social / environmental concern Injuries that are not consistent with the story given. Child Abuse: Children may be abused or neglected by inflicting harm, or by knowingly not preventing harm. Children may be abused in a family, an institutional setting or, more rarely, by a stranger. The Children Act (1989), The Assessment Framework (2000) and Working Together to Safeguard Children (2015) provide the framework for safeguarding children and Dartford and Gravesham NHS Trust will adopt all the definitions, principles and procedures of this legislation and guidance. The Impact of Abuse and Neglect The sustained abuse or neglect of children physically, emotionally or sexually can have major long-term effects on all aspects of a child s health, development and well being. Sustained abuse is likely to have a deep impact on the child s self image and self-esteem and on his or her future life. Difficulties may extend into adulthood; the experience of long term abuse may lead to difficulties in forming or sustaining close relationships, establishing ones self in the workplace and to extra difficulties in developing the attitudes and skills needed to be an effective parent. It is not only the stressful events of abuse that have an impact but also the context in which they take place. Any potentially abusive incident has to be seen in context to assess the extent of harm to a child and appropriate intervention. Often, it is the interaction between a number of factors which serve to increase the likelihood or level of actual significant harm. Dartford and Gravesham NHS Trust Page 7 of 69

8 For every child and family, there may be factors that aggravate the harm caused to the child and those that protect against harm. Relevant factors include the individual child s means of coping and adapting, support from a family and social network and the impact of any interventions. The effects on a child are also influenced by the quality of the family environment at the time of abuse and subsequent life events. An important point, sometimes overlooked, is that the way in which professionals respond has a significant bearing on subsequent outcomes. Categories of Abuse Physical abuse May involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. It also includes fabricated or induced illness and female genital mutilation (FGM). Physical abuse can lead directly to neurological damage, physical injuries, disability or in extreme circumstances, death. Harm may be caused to children both by the abuse itself and by the abuse taking place in a wider family or institutional context of conflict and aggression. Physical abuse has been linked to aggressive behaviour in children, emotional and behavioural problems and educational difficulties. Neglect - The persistent failure to meet a child s basic physical and/or psychological needs, likely to result in the serious impairment of the child s health or development. It may involve a parent or carer failing to provide adequate food, shelter and clothing, failing to protect a child from physical & emotional harm or danger, or the failure to ensure adequate supervision or access to appropriate medical care or treatment. It also includes maternal substance misuse in pregnancy and failure to access antenatal care. Severe neglect of young children is associated with major impairment of growth and intellectual development. Persistent neglect can lead to serious impairment of health and development and long-term difficulties with social functioning, relationships and educational progress. Neglect can also result, in extreme cases, in death Sexual Abuse - Involves enticing or forcing a child to take part in sexual activities. Activities may involve physical contact, assault by penetration & non-penetrative acts (kissing, touching outside clothes). Non-contact activities include making children take part in or watching sexual activity, encouraging inappropriate sexual behaviour & grooming in preparation for abuse. Disturbed behaviour including self-harm, inappropriate sexualised behaviour, sadness, depression and a loss of self-esteem have all been linked to sexual abuse. Its adverse effects may endure into adulthood. The severity of impact on a child is believed to increase the longer abuse continues, the more extensive the abuse and the older the child. A number of features of sexual abuse have also been linked with severity of impact, including the extent of premeditation, the degree of threat and coercion, sadism and bizarre or unusual elements. A child s ability to cope with the experience of sexual abuse, once recognised or disclosed, is strengthened by the support of a non-abusive adult carer who believes the child, helps the child understand the abuse and is able to offer help and protection. A proportion of adults who sexually abuse children have, themselves, been sexually abused as children. They may also have been exposed as children to domestic violence and discontinuity of care. However, it would be quite wrong to suggest that most children who are abused will inevitably go on to become abusers themselves. Emotional Abuse Is the persistent emotional maltreatment of a child as to cause severe and persistent adverse effects on the child s emotional development. It may involve conveying to children that they are worthless, unloved, inadequate, making fun of what they say, inappropriate expectations, overprotection, limitation of development, seeing the illtreatment of another. It also includes serious bullying, exploitation and corruption. Dartford and Gravesham NHS Trust Page 8 of 69

9 Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone. There is increasing evidence of the adverse long-term consequences for children s development where they have been subject to sustained emotional abuse. Emotional abuse has an important impact on developing a child s mental health, behaviour and self-esteem. It can be especially damaging in infancy. Underlying emotional abuse may be as important, if not more so, than other more visible forms of abuse in terms of its impact on the child. 6. Local arrangements for addressing child protection. The Trust will manage information sharing in respect of child protection concerns in accordance with the guidance set out in HSC 2003/7 : LAC(2003)11 What To Do If You re Worried A Child Is Being Abused. Procedurally, all services will follow the Local Safeguarding Children Board (LSCB) procedures covering each locality. The Trust will issue additional internal guidance on decision-making in respect of the management of disclosure of child protection-relevant information. 7. Support for Staff It is recognised that staff may find it difficult or stressful to be involved in child abuse reporting or investigation. In this situation Managers should assess the risk to the member of staff and offer support for example through child protection supervision or referral to Occupational Health or other services. Staff should be followed up at regular intervals to ensure they have recovered or are recovering from the experience. This should be recorded in supervision notes. Child protection supervision is available via the Children s Safeguarding Team and named professionals within the Trust on a one to one and group basis as required. Legal advice and support is available for any member of Trust staff who may be involved in a court case. 8. Confidentially and sharing information Personal information about children and adults held by health professionals is normally subject to a duty of confidence and would not normally be disclosed without the consent of the subject (common law duty of confidence, Human Rights Act 1998 and the Data Protection Act 1998). However, the law allows disclosure of confidential information necessary to safeguard the welfare of children (Children Act 1989, DOH 2015) further guidance is available within the Kent & Medway Child Protection Procedures (2016) or via linked or named professionals. Information sharing posters are displayed in all paediatric area within the Trust, which informs parents and children what information about them will be shared and with whom. In addition DOH guidance for information sharing pocket guide Ref DCSF is very helpful. Professionals routinely share information with the parents or carer of a child as part of family centred care. However when enquiries are made about a child over the telephone, the resident parent or carer should be asked to take the telephone call in order to communicate information. If a situation arises where parents are separated or there is discord between Dartford and Gravesham NHS Trust Page 9 of 69

10 parents e.g. one parent does not want information given out about their child, then the professional should exercise common sense. The resident parent should be asked to come to the phone and discuss the request of the caller. If they refuse, the professional should explain this to the caller, and not disclose any information, and then this should be documented in the child s medical or nursing notes. In addition Trust staff can get further advice from the Trust Information Governance\Data Protection Officer Ext Training and Implementation Safeguarding Children is a fundamental part of patient care and as such must be included in many aspects of staff training and development throughout the organisation. This policy will be incorporated into local training programmes, along with Trust Induction for all clinical staff. A Training Needs Analysis will be undertaken at regular intervals (6 monthly to yearly) by the Named Nurse for Safeguarding Children, Senior Nurse for Education and Assistant Director of Education and Development to take account of changing staff and changing recommendations. This policy requires all staff to have basic child protection awareness skills. These skills are identified as Level 1 skills and Level 2 skills for all clinical staff (Safeguarding Children and Young People: Roles and Competencies for Health Care Staff, RCPCH 2014) See appendix 3. For areas working directly with unborn children, children, young people, parents or carers (i.e. A&E, Paediatric Wards, Day Care, SCBU, Outpatients, Maternity), all staff should acquire more in depth child protection awareness skills. These skills are identified as Level 3 (Safeguarding Children and Young People: Roles and Competencies for Health Care Staff, RCPCH 2014) For key staff in Child Protection and safeguarding (i.e. Paediatric Ward Sisters, Link Nurses, Named Nurses, Lead Midwives for Child Protection), advanced child protection awareness skills should be developed and encouraged via further training (i.e. Level four courses, Post- Graduate Certificate in Child Protection.) These skills are identified as Level 4 (Safeguarding Children and Young People: Roles and Competencies for Health Care Staff, RCPCH 2006) All Trust staff will have child safeguarding awareness training at induction and as per training needs analyses via the Trust safeguarding children training programme. All staff working in health care settings require basic safeguarding/child protection training. This will be a minimum of two hours over a three year period at Level 1 All non-clinical and clinical staff who have any contact with children, young people, parents and/or carers require 3-4 hours of Level 2 training over a three year period All clinical staff working with children, young people, parents and/or carers, who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child and parenting capacity, where there are safeguarding/child protection concerns require a minimum of six hours training, at Level 3 (core skills) over a three year period. Those staff requiring specialist knowledge and skills must have a minimum of twelve to sixteen hours of Level 3 training over a three year period Named safeguarding professionals, paediatric consultants, identified link nurses from clinical areas require a minimum of twenty-four hours of training over a three year period at Level 4. Dartford and Gravesham NHS Trust Page 10 of 69

11 It is the responsibility of all Directorates or Departments to ensure that: staff are aware of any new or newly revised policies. patient identification policy is appropriately filed and that old ones removed and destroyed (keeping one copy for archiving purposes) This document has been disseminated to all clinical and administration staff via adagio and is available on the trust web site. 10. Equality Impact Assessment The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This policy was found to be compliant with this philosophy. 11. Monitoring Compliance with this Procedural document The Trust Safeguarding Committee is the overarching committee for monitoring implementation of this policy and adult protection procedures. In line with the Laming report, it is appropriate and essential that audit of compliance to this Policy is carried out. The Committee reviews the ongoing audit plan and any issues highlighted in the process or actions as a result of improvement to practice will be actioned and added to the audit plan if required, and monitored accordingly. The Trust Safeguarding Committee meets quarterly and reports to the Trust Quality and Safety Committee every six months as scheduled. What will be monitored Audit of Child Protecti on docum entatio n Child Protection Concerns How/Metho d Audit tool Individual cases Frequen cy Ongoing basis Ongoing basis Lead Named Nurse Safegu arding team Named Nurse Director of Nursing Reporting to Trust Safeguardi ng Committee Trust Safeguardi ng Committee and information shared with multi agency Deficiencies / gaps recommendati ons and actions Actions monitored on committee minutes Actions monitored committee minutes. on Implementation of any required change As per audit work plan Lessons learnt from closed cases communicated to senior managers of wards /departments and any actions/risks added to risk registers as necessary Dartford and Gravesham NHS Trust Page 11 of 69

12 Safeguarding Children and Child protection Report Annual Director of Nursing Trust Board Responsibility for actions will lie with identified nominated leads and other committees as appropriate Safeguarding children training Learning Managemen t System database Feedback from evaluation forms Quarterly Staff Develo p- ment Monthly to Senior Managers Quarterly to Human Resources Steering Group(HR SG), Trust Safeguardi ng Committee Quality and safety & Trust Board Evaluation on content of training identified will be addressed by trainers (Safeguarding Children s Team) Deficiencies on attendance by Senior Managers & HRSG As stated 12. Associated Policies and Procedures This policy is to be read in conjunction with:- NMC Code (2015) Kent and Medway Safeguarding Children Procedure (2015) Victoria Climbie Enquiry / The Laming Report (2003) Working Together to Safeguard Children, Department of Health (2015) GMC Good Medical Practice (2013) National Service Framework for Children Standard Five (2004) Safeguarding Children and Young People: Roles and Competencies for Health Care Staff (2014) DVH Whistleblowing Policy and procedures (2016) DVH Incident Reporting Policy (2015) DVH Supporting Staff Involved in Complaints, Claims and Incidents Policy (2009) DVH Security Management Framework in Maternity and Paediatrics (2016) DVH Domestic Abuse guidelines for maternity staff (2014 WAC 066) DVH Substance and Alcohol Misuse guidelines (2013 WAC 007) DVH Female Genital Mutilation (FGM) guideline (2014 WAC155) DVH Safeguarding Supervision Policy (2016) DVH Perinatal Mental Health guidelines (2015 WAC 066) DVH Data Sharing Policy and Procedures (2016) DVH Data Protection Policy (2015) 13. References Department of Health (2015) Working together to safeguard children: A guide to interagency working to safeguard and promote the welfare of children. London: The Stationary Office Department of Health (2000) Framework for the Assessment of Children in need and their families. London: The Stationary Office Dartford and Gravesham NHS Trust Page 12 of 69

13 Department of Health (2015) What to do if you re worried a child is being abused. London: The Stationary Office Department of Health (2004) National Service Framework for Children: Standard Five Kent Safeguarding Children Board (2015) Kent and Medway Safeguarding Children Procedures Laming, L (2003) The Victoria Climbie Inquiry. London: The Stationary Office Parliament (1989, 2004) The Children Act. London: HMS0 Royal College of Paediatrics and Child Health (2014) Safeguarding Children and Young People: Roles and Competencies for Health Care Staff RELEVANT WEB SITES Kent Safeguarding Children Board Bexley Safeguarding Children Board Victoria Climbie Report NSPCC Department of Health Dartford and Gravesham NHS Trust Page 13 of 69

14 Appendix 1 CHILD PROTECTION CONTACT NAMES AND NUMBERS Named Doctor Telephone No: Dr S Khan or air called via switchboard at Darent Valley Hospital On-call Paediatrician Contact via switchboard at Darent Valley Hospital Named Midwife Deborah McAllion or air called via switchboard at Darent Valley Hospital Named nurse Lynn Brooks Bleep 548 or via switchboard at Darent Valley Hospital Senior Sister, Safeguarding Children Jackie Ayers Bleep 925 or via switchboard at Darent Valley Hospital Sue Govier GeriColbourne Lilley Paediatric Liaison Sonya Cox Safeguarding Nurse Supervisor of Midwives on call Contact via switchboard at Darent Valley Hospital Social Services Contact Numbers Kent Central Duty Team ( ) Out of hours Bexley Dartford and Gravesham NHS Trust Page 14 of 69

15 Child Protection Procedures Appendix 2 THESE PROCEDURES MUST BE READ IN CONJUNCTION WITH KENT SAFEGUARDING CHILDREN PROCEDURES (2015) which are available in all paediatric areas and on Adagio The Victoria Climbie Inquiry (2003) recommendations can be identified throughout the Child protection Procedures in bold italics. Introduction These Procedures are directed to all members of Dartford and Gravesham NHS Trust staff. It is the responsibility of all staff to be fully aware of Kent Safeguarding Children Procedures (2015) and appropriate guidance from the Department of Health, in particular Working Together to Safeguard Children (2015), Framework for the Assessment of Children in Need (2000), National Service Framework For Children (2004) Standard Five, What to do if you re worried a child is being abused (2003), and of relevant information provided by professional organisations. The purpose of these Procedures is to ensure that appropriate action is taken immediately a child is suspected of being at risk of potential or actual harm. The Procedures are designed to provide a framework for good practice, to promote multi-disciplinary co-operation and to protect and promote the well being of children and young people. Staff must bear in mind the particular vulnerability of children and young people and the wider picture raised by parental and family issues such as domestic violence or mental health problems. The safety of the child (and /or unborn child) is paramount and must be the first consideration of all staff. The Children Act (1989) requires the disclosure of information necessary to safeguard children, and Kent Safeguarding Children Procedures offers further guidance in relation to sharing information. This may be justified where failure to do so may expose the child to risk of serious harm or death. Additional advice can be sought from the Information governance department, or the Trust Caldicott guardian. Consent to disclosure should be sought where practical either from the parent/carer or child. Staff are expected to work in partnership with parents and carers; this includes open and honest discussion of concerns and any proposed action required to maintain the safety of the child. Staff must remember to keep the child in focus when working closely with parents, to avoid any undue risk to the child, in the form of collusion. Staff are expected to work in co-operation with statutory and voluntary agencies to protect children and to make referrals to the Social Services Department. The threshold for referral is reason to suspect likelihood of, or actual significant harm. The responsibility of safeguarding children investigations lies with the statutory agencies, i.e. Social Services. Health professionals must not investigate the incident but they have a duty to assist the local authority during Inquiry. Concerns may be discussed with Professional Lead / Managers and they should be kept informed. Further advice can be sought from the Named Personnel for Safeguarding Children (see page 15). If a member of staff has concerns about malpractice, illegal acts or omissions at work of colleagues relating to the care of a child, the Trust Whistle Blowing Policy/ Procedure should be used in order to protect the child. Dartford and Gravesham NHS Trust Page 15 of 69

16 1. What to do when you have to concern and how to contact Social Services All staff must ensure the well-being and safety of the child. If urgent medical treatment is not required but there are concerns about possible abuse, advice should be sought from the person in charge for the area where the child is. Following discussion with the most senior personnel in the relevant area, advice can be sought from the on call paediatric registrar or children s Safeguarding team as appropriate. The Named Doctor, Nurse or Midwife can also be contacted via the switchboard. Any member of staff must immediately report to the nurse or person in charge of the clinical area all cases arousing doubt, suspicion or concern in relation to a child s welfare. A team discussion must take place between all staff members caring for the child (to include person in charge of the relevant area, on call paediatric registrar and consultant, children s Safeguarding team) and the subsequent management decided upon. Staff may access Social Services to consult if a child of concern is known to Social Services, and to discuss the background of the case and any new concerns. Staff should make it clear that wish to speak to the Duty Social Worker and that the call is a consultation, and ask for a consultation number or reference. Advice may sought from Social Services in the form of a consultation, before making a decision whether to make a referral, however if there are clear safeguarding concerns about a child then they should be referred. With Social Services, staff will discuss and plan any further action to be taken. This may take place via a strategy meeting if deemed necessary by any agency. Social Service enquiries and referrals for children resident in Kent should be made to the Duty Social Worker via the Kent Central Duty Team: Tel: ( ) Tel: (out of hours) centraldutyteam@kent.gcsx.gov.uk Post: Central Duty Team Kroner House Eurogate Business Park Ashford TN24 8XU The Kent Safeguarding Children Board has a secure way of sending confidential referrals to children s social services via . Any referrals must be made by nhs.net account to centraldutyteam@kent.gcsx.gov.uk from a secure address All staff must note that it is prohibited to send confidential information s via insecure addresses such as wkpct.nhs.uk or to any other kent.gov address which does not have a gcsx.gov.uk. Social Service enquiries and referrals for children resident in Bexley should be made to the Duty Social Worker via the Bexley Duty Team from a secure address: Tel: (out of hours you will be redirected to the on call service) childrenssocialcare.admin@bexley.gcsx.gov.uk Dartford and Gravesham NHS Trust Page 16 of 69

17 Post: Civic offices Broadway Bexleyheath DA6 7LB If the child resides outside the Kent or Bexley area, the local Social Services of that area should be accessed, and the Duty Referral Service will provide you with the relevant telephone number. If you are in doubt ask switchboard to put you through to the Duty Social Worker who will advise you. Staff should clearly document their concerns in the nursing or medical notes and that a consultation or referral has been made and the outcome of discussion. Remember it is possible to speak to Social Services for a consultation prior to deciding whether a referral is needed. Following a verbal referral an Inter Agency Referral form should be sent or ed to the relevant address within 48 hours. This acts as a safeguard to ensure the referral reaches it destination. If the referral form cannot be ed, and a paper copy is to be sent, the referrer must ensure that the child s NHS number is written on each page of the referral. Parent/carers and if appropriate the child, should be consulted, informed and consent and co-operation sought with all referrals and decision-making. Staff should make it clear to parents/carers and child that confidentiality may not be maintained if the withholding of information will prejudice the welfare of the child. Staff must keep contemporaneous notes, written, signed and dated, which demonstrate the events and all details, decision and actions taken. Full details of the concern or injury, action taken, other professionals involved and any relevant history should be documented. Paragraph Recommendation 77: All doctors involved in the care of a child about whom there are concerns about possible deliberate harm, must provide Social Services with a written statement of the nature and extent of their concerns. If misunderstanding of medical diagnosis occurs, these must be corrected at the earliest opportunity, in writing. It is the responsibility of the doctor to ensure that his or her concerns are properly understood. In all cases, Dartford and Gravesham NHS Trust staff who are made aware of, suspect or identify a Child Protection or safeguarding issue, must report it verbally immediately to their professional manager or the children s Safeguarding team. Paragraph 4.59 Recommendation 21: When a professional makes a referral to Social Services concerning the well-being of a child, the fact of that referral must be confirmed, in writing, by the referrer within 48 hours. If other disciplines/agencies are involved with the child and a referral is necessary, agreement should be reached as to who makes the referral to Social Services. If agreement is not reached, or the referral is not made and in your professional opinion is necessary, then it is your professional responsibility to make that referral. If a child attends A&E and there are safeguarding or child protection concerns, then A&E should initiate the initial discussions and referral to Social Services. It is not acceptable to wait until the child is admitted to an inpatient area. The paediatric inpatient areas must ensure that a referral has been made by A&E, and if for any reason this has not been done, must initiate a referral themselves. If child protection or safeguarding concerns arise whilst Dartford and Gravesham NHS Trust Page 17 of 69

18 the child is a patient in an inpatient area, then it is the responsibility of that area to initiate a referral to Social Services. If there are concerns about dependent children of an adult attending ED, all ED staff are responsible for following Trust policy to highlight concerns. This includes referring to Social Services whether the child is present in ED or not, and informing the adult and children's safeguarding teams of concerns and action taken via the Trust Order Comms system. Remember you can phone Social Services to discuss the situation at any point. Make it clear whether you are telephoning for a consultation only (you will require parental consent) at this point or to make a referral. They will advise you about how to proceed. Remember to document accurately your actions, including informing the child and parent unless it puts the child at further risk. Where a child is considered to be in immediate danger of harm, Dartford and Gravesham NHS Trust staff should seek urgent medical attention and advice. The paediatric registrar on call should be contacted along with the Duty Social Worker and police if required, who should be contacted by phone. Named Personnel or the Children s Safeguarding team should also be contacted via switchboard. In circumstances when parental/carer/child co-operation is lacking and as a consequence the child is placed at immediate risk, the police should be contacted in order to help manage the situation and to protect the child. An Emergency Protection Order (EPO) may be necessary and Social Services will advise and work together with Health and the Police. In the event of parent / carers removing the child from the department, police and Social Services must be contacted immediately by the person in charge. The person in charge must inform all agencies involved in the incident of the outcome and record that this has been done. The Manager must also be informed for the appropriate clinical area. The initial referral to Social Services must be followed up via an Inter Agency Referral Form, which should be ed or sent by post within 48 hours. If a child is in need of urgent medical care at home, an ambulance should be called. If a medical officer or GP are present in the clinic or surgery, they should be consulted. If the parents/carers are uncooperative, or there is a risk of personal safety to the staff, the Police and the Duty Social Worker should be contacted. Parents/carers should be informed of any actions taken. Whilst parental consent for treatment is obtained whenever possible, the safety of the child must take priority. In cases where the child may be placed at further risk, the Duty Social Worker must be informed first and plans made as to how to inform parents. An EPO may be issued by the police in conjunction with Social Services, in order to protect the child. Following urgent medical treatment, a referral must be made to Social Services over the telephone, and confirmed via an Inter Agency Referral Form within 48 hours. NB: Unless admission is required for medical reasons Hospital is not a place of safety, i.e. children with suspected abuse should not be admitted routinely purely to facilitate the management or investigation of suspected abuse. In such cases, the Social Services Department should be contacted to assist and facilitate this process. However the child should not be denied treatment in circumstances where that is required. Dartford and Gravesham NHS Trust Page 18 of 69

19 2. Record keeping and recording of basic information Paragraph Recommendation 12: Staff who see children at Darent Valley Hospital must ensure that in each new contact, basic information about the child is recorded. This must be included the child s name, address, age, and the name of the child s primary school if the child is of school age. Gaps in this information should be passed onto the relevant authority in accordance with local arrangements. If a child of school age is not in school: A children missing from education referral form should be completed which can be found on Kent county Councils website ( or in the Safeguarding Children team office. The form should be sent to the Children Missing Education Team, Sessions House, Maidstone, ME14 1XQ In addition advice can be sought by calling or ing cme@kent.gov.uk from a secure address. If a child is not registered with a GP: The Safeguarding Team must be alerted to any child not registered with a GP so that followup and support can be offered to families by the health visitor or school nurse in the community Staff are expected to maintain contemporaneous, factual and accurate records of any concerns, actions taken and verbal and written referrals made relating to safeguarding children issues. All records should be dated, timed, signed and maintained to a professional code of practice. Names should be clearly printed, if not apparent from the signature, and position held stated. Records will be subject to regular audit. Paragraph 9.35 Recommendation 64 When a child is admitted to hospital and deliberate harm is suspected, the nursing care plan must take full account of this diagnosis. All observations and explanations involving concerns should be recorded as soon as possible. Records should include details of The child s appearance; where possible the child should be weighed with minimum undergarments on so as to afford the child privacy but allow the nurse an opportunity to see if the child has any bruising, scars etc that may be of significance. The child s behaviour Attitude of the parent / carer Details of any injury Interpersonal discussions All records dated, timed and signed Body maps should be completed when necessary. Any nursing and medical observations, assessment and examination must be accurately recorded with the use of diagrams as appropriate. All subsequent information and actions taken must be clearly recorded in the medical and nursing records. Agencies contacted and the content of the discussion must be clearly noted. Make sure all entries are dated and signed with full legible signature. Dartford and Gravesham NHS Trust Page 19 of 69

20 Paragraph 9.72 Recommendation 68 When concerns about the deliberate harm of a child have been raised, doctors must ensure that comprehensive and contemporaneous notes are made of these concerns. If doctors are unable to make their own notes, they must be clear as to what it is they wish to have recorded on their behalf. Paragraph Recommendation 78 Within a given location, health professionals should work from a single set of records for each child Paragraph Recommendation 76 When a child is admitted to hospital with concerns about deliberate harm, a clear decision must be taken as to which Consultant is to be responsible for the Child Protection aspects of the child s care. The identity of that Consultant must be clearly marked in the child s notes so that all those involved in the child s care are left in no doubt as to who is responsible for the case. When a child is admitted to hospital about who there are safeguarding concerns, the consultant paediatrician on call will be the consultant responsible for all aspects of the child s care, including child protection. For children about whom there are concerns who are under the care of another firm of doctors (e.g. surgeons), the child will be under the joint care of the paediatric consultant who will advise regarding the child s welfare and the specialist consultant who will care for the child s specialist complaint. Paragraph Recommendation 73 When a child is admitted to hospital and deliberate harm is suspected, the doctor or nurse admitting the child must inquire about previous admissions to hospital. In the event of a positive response, information concerning the previous admissions must be obtained from the other hospitals. The Consultant in charge of the case must review this information when making decisions about the child s future care and management. Staff must check and record previous attendances on paediatric wards, departments and A&E at Darent Valley Hospital and any other hospitals as part of the admission assessment. If no previous attendances are disclosed, but there is strong suspicion that there may have been attendances, surrounding hospitals should be contacted for information. Staff may also consider contacting other members of the child s primary care team for further information (e.g. health visitor, school nurse or GP) as these staff may have important information relating to the child and family. Paragraph 9.95 Recommendation 69 When concerns about the deliberate harm of a child have been raised, a record must be kept in the case notes of all discussions about the child, including telephone conversations. When doctors and nurses are working in circumstances in which case notes are not available to them, a record of all discussions must be entered in the case notes at the earliest opportunity so that this becomes part of the child s permanent health record. Medical and nursing handover of care must be documented in the child s medical/nursing notes. A verbal handover of care is not sufficient from one shift to the next. Paragraph Recommendation 80 When a child for whom there are concerns about deliberate harm is admitted to hospital, a record must be made in the hospital notes of all face-to-face discussions (including medical and nursing handover ) and telephone conversations relating to the care of the child and of all decisions made during such conversations. In Dartford and Gravesham NHS Trust Page 20 of 69