Safeguarding Children Annual Report

Transcription

1 Safeguarding Children Annual Report June

2 CONTENTS: 1 Purpose of Report Page 3 2 Safeguarding Context Page 3 3 Key Professionals Page 5 4 Governance and Statutory Arrangements Page 6 5 Haringey Safeguarding Children Board (HSCB) Page 8 6 Child Death Overview Panel (CDOP) Page 10 7 Safeguarding Monitoring of Haringey Providers Page 11 8 Haringey Looked After Children (LAC) Page 12 9 Safeguarding Monitoring of Haringey General Practices Page Safeguarding Monitoring of Haringey Clinical Commissioning Group (HCCG) Page Reviews and Audits Page Serious Case Reviews (SCRs) Page HCCG Safeguarding Strategy Page Progress against Objectives Page Key Objectives Page 30 2

3 1. Purpose of Report 1.1 The purpose of this annual report is to: Set the context for safeguarding children in Haringey Provide an overview of the arrangements in place to safeguard and protect children across health services in Haringey Demonstrate how Haringey Clinical Commissioning Group (HCCG), is fulfilling its safeguarding children statutory responsibilities Report on governance and accountability arrangements within the HCCG and the provider health organisations including representation to and involvement in the Haringey Safeguarding Children Board (HSCB) Identify progress made against recommendations from Serious Case Reviews (SCRs) Highlight service developments and significant issues and report on progress of the team s 2015/16 objectives Agree the safeguarding team s objectives for 2016/ The report will cover the period from 1 st April 2015 to 31 st March Safeguarding Context 2.1 National Context 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 are growing up in circumstances consistent with the provision of safe and effective care Taking action to enable all children to have the best outcomes Effective safeguarding arrangements must be underpinned by two key principles: Safeguarding is everyone s responsibility: for services to be effective each professional and organisation should play their full part A child-centred approach: for services to be effective they should be based on a clear understanding of the needs and views of children Section 11 (s11) of the Children Act (2004) provides statutory guidance on the arrangements required to safeguard and promote the welfare of children which all agencies need to take account of when creating and maintaining an organisational culture and ethos that reflects the importance of safeguarding and promoting the welfare of children. At an organisational or strategic level, these key features are ensuring: Senior management commitment to the importance of safeguarding and promoting children s welfare A clear statement of the agency s responsibilities towards children; available for all staff A clear line of accountability within the organisation for work on safeguarding and promoting the welfare of children Service development that takes account of the need to safeguard and promote welfare and is informed, where appropriate, by the views of children and families 3

4 Staff training on safeguarding and promoting the welfare of children for all staff working with or (depending on the agency s primary functions) in contact with children and families Safe recruitment procedures in place Effective inter-agency working to safeguard and promote the welfare of children Effective information sharing Safeguarding Vulnerable People in the Reformed NHS - Accountability and Assurance Framework (2013) was revised during 2014/15 and published on 2 nd July 2015 entitled: Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (2015). It defined the safeguarding responsibility and duty of Clinical Commissioning Groups (CCGs) as follows: CCGs as commissioners of local health services need to assure themselves that the organisations from which they commission have effective safeguarding children arrangements in place. CCGs are responsible for securing the expertise of Designated Professionals on behalf of the local health system. The Designated Professionals undertake a whole health economy role. It is crucial that Designated Safeguarding Children Professionals play an integral role in all parts of the commissioning cycle, from procurement to quality assurance if appropriate services are to be commissioned that support adults at risk of abuse or neglect, and children, as well as effectively safeguard their well-being Safeguarding forms part of the NHS standard contract (service condition 32) and commissioners need to agree with their providers, through local negotiation, what contract monitoring processes are used to demonstrate compliance with safeguarding duties CCGs must gain assurance from all commissioned services, both NHS and independent healthcare providers, throughout the year to ensure continuous improvement. Assurance may consist of assurance visits, section 11 audits and attendance at provider safeguarding committees CCGs are also required to demonstrate that they have appropriate systems in place for discharging their statutory duties in terms of safeguarding children. These include: A clear line of accountability for safeguarding children, properly reflected in the CCG governance arrangements, i.e. a Named Executive Lead to take overall leadership responsibility for the organisation s safeguarding arrangements Clear policies setting out their commitment, and approach, to safeguarding children including safe recruitment practices and arrangements for dealing with allegations against people who work with children as appropriate Training their staff in recognising and reporting safeguarding children issues, appropriate supervision and ensuring that their staff are competent to carry out their responsibilities for safeguarding Effective inter-agency working with local authorities, the Police and Third Sector organisations including appropriate arrangements to cooperate with Local Authorities in the operation of Local Safeguarding Children Boards (LSCB) and Health and Wellbeing Boards (HWBs) Ensuring effective arrangements for information sharing 4

5 Employing, or 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 The role of CCGs is also fundamentally about working with others to ensure that critical services are in place to respond to children and adults who are at risk or who have been harmed, and it is about delivering improved outcomes and life chances for the most vulnerable. CCGs need to demonstrate that their Designated Clinical Experts (children), are embedded in the clinical decision making of the organisation, with the authority to work within local health economies to influence local thinking and practice Haringey CCG fulfils and is compliant with these safeguarding children responsibilities and duties and this Annual Report will demonstrate how the CCG has ensured this, during the period of 01/04/15 to 31/03/16, within its own organisation and across the organisations from which it commissions NHS England conducted a series of deep-dive exercises across CCGs arrangements and in 2015, one of the areas of focus was safeguarding. The results of this process was reported in February 2015 and they acknowledged the extent of focus and commitment to safeguarding within Haringey CCG. A more detailed breakdown of the results of this deep dive exercise can be found in the Review, Inspections and Audits section of this report. 2.2 Local Context Haringey is an exceptionally diverse and fast-changing borough with a population of 267,540 according to 2014 Office for National Statistics Mid-Year Estimates. 51.1% of the population are male and 49.9% are female. Almost two-thirds, and over 70% of young people, are from ethnic minority backgrounds, and over 100 languages are spoken in the borough. The population is the fifth most ethnically diverse in the country The borough ranks among the most deprived in the country with pockets of extreme deprivation in the east. Haringey is the 30th most deprived borough in England and the sixth most deprived in London There are approximately 63,400 children and young people under 20 living in Haringey (approximately one third of the total population). The wards with the largest number of people aged under 20 in Haringey are: Seven Sisters, Northumberland Park, White Hart Lane and Tottenham Hale. There are more children in the east of Haringey, which has higher levels of deprivation than the west For more information about Haringey s population visit: Haringey s Joint Strategic Needs Assessment (JSNA) 2014/2015 describes the health, care and wellbeing needs of the local population. This helps the CCG and Haringey Council commission the best services to meet those needs. 3. Key Professionals 3.1 Haringey CCG Safeguarding Team and Arrangements Between 01/04/16 and November 2015 the Haringey CCG Safeguarding Children Team consisted of: 5

6 Assistant Director of Safeguarding and Designated Nurse Safeguarding Children (full-time) Designated Doctor Safeguarding Children and Unexpected Death in Childhood (5 sessions per week) Deputy Designated Nurse Safeguarding Children (full-time) Named GP Safeguarding Children 3 sessions per week From 02/11/15 a restructure within the CCG s Quality Directorate saw the following changes to the HCCG Safeguarding Children Team: The Assistant Director of Safeguarding and Designated Nurse Safeguarding Children role was deleted An Assistant Director of Quality and Nursing (full-time) was created A full time Designated Nurse for Safeguarding Children was created. Vacancies within the team were covered by an Interim Assistant Designated Nurse Safeguarding Children whilst the new substantive post was recruited. The substantive Designated Nurse Safeguarding Children commenced in post in March The period started with the team having a full-time administrator. The team administrator left the organisation in May The Safeguarding Team was supported by Directorate administrative staff shared with the Governance team; thus requiring a prioritisation of the deployment of this resource and safeguarding administrative functions The progress of the team s workplan related to the HCCG Safeguarding Strategy (originally ratified by the HCCG Quality Committee in December 2013) was reviewed quarterly by the HCCG Safeguarding Team throughout ; and six-monthly within this period by the HCCG Safeguarding Children Assurance Meeting and HCCG Quality Committee. 4. Governance and Statutory Arrangements 4.1 Haringey CCG (HCCG) HCCG is the major commissioner of local health services across the borough and is responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. Designated Professionals, as clinical experts and strategic leaders, are a vital source of advice to the CCG, NHS England, the Local Authority and the Haringey Local Safeguarding Children Board (HSCB). They also provide advice and support to multi-agency health professionals The Chief Officer for HCCG is the Executive Lead for Safeguarding and is responsible for ensuring that the health services contribution to safeguarding and promoting the welfare of children is discharged operationally and effectively across the health economy via local commissioning arrangements The Executive Nurse and Director of Quality and Integrated Governance HCCG reports appropriate safeguarding children risks and achievements to the Chief Officer and is responsible for ensuring that safeguarding monitoring across Haringey takes place through the Quality Committee of the HCCG Governing Body; the Clinical Quality 6

7 Review Groups (CQRG) for each of the three main provider Trusts; and in conjunction with the Haringey Safeguarding Children Board (HSCB) HCCG s Governing Body Lead General Practitioner for children is responsible for ensuring that the Governing Body takes account of safeguarding children when making decisions regarding the commissioning of services. He chairs the HCCG Safeguarding Children Commissioning Group, which reports on a quarterly basis to the Quality Committee The HCCG Safeguarding Team produced a joint Safeguarding Children and Adult Briefing for each of the bi-monthly Quality Committees informed by the safeguarding work across the organisation and with Provider organisations through the Designated Professionals attendance at the Providers Safeguarding Children Committees. This briefing and the HCCG safeguarding arrangements and leadership were discussed and monitored via the quarterly HCCG Safeguarding Children Assurance Meetings The Designated Doctor and Assistant Director Safeguarding / Designated Nurse Safeguarding Children (newly established Designated Nurse Safeguarding Children from November 2015) provide support and assurance that safeguarding arrangements, training and supervision is in place across the health community The Assistant Director Safeguarding / Designated Nurse Child Protection provided individual supervision for the: Interim Assistant Designated Nurse Safeguarding Children Deputy Designated Nurse Named GP Safeguarding Children Haringey Community Services Named Nurse The Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) and North Middlesex University Hospital Trust Named Nurses receive supervision from the Enfield CCG Designated Nurse. The Designated and Named Doctors employed by Whittington Health receive monthly supervision facilitated by Dr Sebastian Kraemer Hon Consultant CAMHS Haringey s Designated Doctor and Named GP attended monthly peer review/support sessions facilitated by a child and adolescent consultant psychiatrist The Designated Professionals and Named GP attended quarterly peer supervision sessions with Pan-London Designated Professional colleagues facilitated by NHS England (London). The Assistant Director Safeguarding / Designated Nurse Safeguarding Children chaired this Pan-London group until her change in role in November The Assistant Director Safeguarding / Designated Nurse Child Protection, Interim Designated Nurse Safeguarding Children and the Deputy Designated Nurse participated in additional six-weekly peer supervision and information sharing sessions with the Designated Nurses of Barnet, Enfield, Camden and Islington The Designated and Named Professionals also met with: Partners from the Local Authority Children and Young Peoples Services (CYPS), the Police Child Abuse Investigation Team (CAIT) and Community Paediatricians to discuss key safeguarding issues effecting safeguarding across the partnership Named Professionals across the Health economy and Looked After Children (LAC) Designated Professionals for health safeguarding children meetings to consider the effectiveness of the Health response to safeguarding children across the borough, prepare for safeguarding inspection and enable peer support and supervision 7

8 Child Protection Lead GPs 5. Haringey Safeguarding Children Board (HSCB) 5.1 The Assistant Director Safeguarding / Designated Nurse Safeguarding Children, Designated Doctor, and Named GP were full and active members of the HSCB; regularly attending and contributing to the bi-monthly meetings. The Assistant Director Safeguarding / Designated Nurse Safeguarding Children and Designated Doctor were also full and active members of the HSCB Executive. 5.2 The Assistant Director Safeguarding / Designated Nurse Safeguarding Children briefed the Executive Nurse and Director of Quality and Integrated Governance regularly to ensure that she, in turn, could keep the Chief Officer and Governing Body appraised of HSCB developments and key issues. 5.3 The HCCG Safeguarding Team ensured that there was an HSCB update included in the Safeguarding Briefing to the bimonthly Quality Committee. 5.4 The following Haringey healthcare providers were expected to provide Director-level representation on the HSCB: Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) North Middlesex University Hospital Trust (NMUH) Whittington Hospital NHS Trust (Whittington Health) (WH) The following illustrates the attendance of the respective Provider Trust Directors (Executive Leads for Safeguarding) at the HSCB Board Meetings across the period reviewed:- (Yes) indicates did attend or did send a representative (Rep). (No) indicates did not attend or did not send a rep Figure 1: Health Attendance at HSCB meetings 2014/15 (7 meetings held): Health Representation Haringey Health Services 2015 Meetings Attendance 2016 Meetings Attendance Total Attendance * 13/05 08/07 16/09 07/10 18/11 28/01 27/04 Number % Attended Attended HCCG Assistant Director Safeguarding & Designated Nurse for SG children Yes (Rep) Yes Yes Yes Yes Yes Yes Seven 100% HCCG Designated Doctor NHSE (London) Named GP Yes Yes No Yes Yes Yes Yes Six 86% **No No No Yes Yes No Yes Three 43% BEH-MHT (Director / Rep) Yes (Dir) Yes (Dir) No No No Yes (Rep) Yes (Rep) Four 57% 8

9 NMUH (Director / Rep) Yes (Rep) Yes (Rep) No Yes (Rep) No Yes (Rep) *** No Four 57% WH (Director / Rep) No (Rep) No (Rep) Yes (Dir & Rep) No (Reps x2) No (Rep) Yes (Rep) Yes (Rep) Seven 100% *07/10/15 was an Extraordinary LSCB Board Meeting* **2015 Named GP obtained Post GraduateTeaching Certificate in Primary care (contact days coincided with the LSCB meetings) *** Non-attendance due to Junior Doctors Strike 5.5 The Designated Doctor Safeguarding Children, Assistant Director Safeguarding / Designated Nurse Safeguarding Children, Interim Assistant Designated Nurse Safeguarding Children and Deputy Designated Nurse were members of the following HSCB sub-groups which supported the HSCB during 2015/16: Figure 2: Designated Professional Coverage of Haringey Safeguarding Children Board Subgroups: HSCB Subgroup HCCG Representative Quality Assurance and Best Practice - name of group changed in June 2015 to Performance and Practice Outcomes Interim Assistant Designated Nurse Safeguarding Children Serious Case Review (SCR) Child Death Overview Panel (CDOP) Assistant Director Safeguarding / Designated Nurse Safeguarding Children Designated Doctor Safeguarding Children Interim Assistant Designated Nurse Safeguarding Children Designated Doctor Safeguarding Children Child Sexual Exploitation (CSE) Assistant Director Safeguarding / Designated Nurse Safeguarding Children (Chair until March 2016) MASH Board Interim Assistant Designated Nurse Safeguarding Children Training & Development Deputy Designated Nurse Safeguarding Children 9

10 5.6 The Assistant Director Safeguarding / Designated Nurse for Safeguarding Children continued in the capacity of Vice Chair of the HSCB throughout this period, as well as chairing the CSE Subgroup (which developed the borough s CSE Strategy and Action Plan) and Vice Chairing the Violence Against Women and Girls (VAWG) Strategic Group; with the Interim Assistant Designated Nurse and latterly the Deputy Designated Nurse attending the VAWG Commissioning and Harmful Practices Groups. 6. Child Death Overview Panel (CDOP) 6.1 As the year in question has only just closed, this is a preliminary report and, as such, subject to change. The system was piloted in 2007/8 and fully functional from 2008/9. A full report on the scheme from 2008/9 will be prepared later in the year. In 2015/16, there were 24 deaths of children, normally resident in Haringey. For many of these, final post mortem reports, inquests or other proceedings are still in progress. The table below describes the children who died by their age and provisional diagnosis. These have not yet been confirmed by the CDOP. Table 1 Age <28 days 28 days <1 year Cause of Death Deliberately inflicted injury, abuse or neglect 1 year <5 years Malignancy 1 2 Acute medical or surgical condition Chronic medical condition Chromosomal, genetic and congenital anomalies Perinatal/neonatal event Sudden Unexplained Infant Death 2 4 As yet unascertained TOTAL years <18 years This youth was fatally stabbed just short of his 18 th birthday. He was known to social services and the youth justice system. A serious case review is being undertaken. 2. This infant died from cardiac disease secondary to unrecognised vitamin D deficiency. His older sister had already been treated for this condition. His mother misunderstood information given about vitamin D deficiency and only took supplements herself. The importance of vitamin D deficiency and the availability of free supplements, to those who need them, is being emphasised to healthcare professionals and the leaflet for parents has been revised. Coincidentally, national information is being put in all red books (Personal Child health Records). 3. A young person ingested a constituent of food to which she was known to be allergic and subsequently died. The exact circumstances are yet to be made clear. 4. In one instance the mother was known to have taken up smoking after delivery, having ceased during the pregnancy. During the year, there were eight rapid response meetings in relation to unexpected deaths, as well as three meetings of the CDOP panel itself. 10

11 7 Safeguarding Monitoring of Haringey Providers 7.1 All health providers are required to have effective arrangements in place to safeguard vulnerable children and to assure the CCG, as commissioners, these are working. These arrangements included: Safe recruitment Effective staff training Effective supervision arrangements Working in partnership with other agencies All providers ensuring they have a Named Doctor and a Named Nurse for Safeguarding Children (and a Named Midwife if the organisation provides maternity services) GP practices to have a lead for safeguarding, who should work closely with the Named GP and Designated Professionals. 7.2 Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (2015) defines the safeguarding responsibility and duty of Health Providers as follows: All staff, whether they work in a hospital, a care home, in general practice, or in providing community care, and whether they are employed by a public sector, private or not-for-profit organisation, have a responsibility to safeguard children at risk of abuse or neglect in the NHS Health providers are required to demonstrate that they have safeguarding leadership, expertise and commitment at all levels of their organisation and that they are fully engaged and in support of local accountability and assurance structures, in particular via the LSCBs and in regular monitoring meetings with their commissioners Health providers must ensure staff are appropriately trained in safeguarding children, Prevent and Domestic Violence at a level commensurate with their role and in line with the Intercollegiate Document (2014). It is strongly recommended that safeguarding forms part of any mandatory training in order to develop and embed a culture within their organisation that ensures safeguarding is acknowledged to be everybody s business from the board to the floor All health providers are required to have effective arrangements in place to safeguard children at risk of abuse or neglect and to assure themselves, regulators and their commissioners that these are working. 7.3 The three main Provider Trusts all held internal bi-monthly Safeguarding Children Committees which were all attended by a member of HCCG Safeguarding Children Team. 7.4 BEH-MHT proposed a change for the Safeguarding Children bi-monthly Committee, by joining the children and adult agendas to form one quarterly Joint Safeguarding Committee. The first Joint Safeguarding Committee meeting will be held April The effectiveness of the Trust Joint Safeguarding Committee will be monitored as part of the terms of reference (TOR) annual review. 7.5 The meetings provide an opportunity for information sharing on all aspects of safeguarding children. Any issues arising that required escalation were discussed with HCCG Senior colleagues and within the Haringey CCG Safeguarding Children Assurance meeting as appropriate. 7.6 The Provider safeguarding children dashboards/metrics/balanced scorecards were monitored quarterly at the Clinical Quality Review Groups (CQRGs) and by exception 11

12 at the HCCG Safeguarding Children Assurance Meeting and HCCG Quality Committee. 7.7 In addition to each Trust having specifically-tailored safeguarding children training, there were several sources of more general and subject-specific training available for Haringey health professionals: Multi-agency one-day courses via HSCB Lunchtime learning sessions via HSCB E-learning via HSCB E-learning produced by the Royal College of Paediatrics and Child Health 7.8 The availability of these opportunities was disseminated via a range of methods including s, HSCB website and HCCG intranet; with provider organisations also further considering methods of dissemination to attempt to achieve increased completions, compliance and learning. 8.0 Haringey Looked After Children (LAC) 8.1 CCGs have an ongoing responsibility for ensuring that the health needs of LAC are met. In Haringey the statutory Initial Health Assessments (IHAs) and the Review Health Assessments (RHAs) are carried out by a specialist team the Children in Care (CiC) Team who are employed by Whittington Health and commissioned by Haringey CCG. 8.2 Children In Care Team (CIC) The Designated Doctor and Nurse in the Children in Care team host the 2015 reconstituted Monthly Operational group (MOM). The MOM was reconstituted to improve collaboration across the agencies in relation to Children in Care. Together with Social Care, the Vulnerable Children s Commissioner and First Step psychological service, the group reviews relevant Children in Care pathways and outcomes, and works towards implementing changes. It provides a forum to raise systemic challenges and explore innovative ways of working The current priority is to improve the emotional health of Children in Care. The progress of the Child and Adolescent Mental Health Service ( CAMHS ) transformation plan is discussed at each MOM meeting and the following actions have been agreed: A handbook for Social Workers with information and contact details for relevant mental health services is in development. Specific training for Social Workers and Foster Carers in recognising mental health concerns, services available and information on how to refer to services is in development. This will be for existing staff and future training is to be part of the Social Worker & Foster Carers induction programme. The emotional needs of children should be considered when plans are made for long term placement and permanency for the children. The Independent Reviewing Officers (IRO s) have been asked to read any First Step reports and are encouraged to liaise with them especially when there are concerns regarding the young person s understanding of their life story and whether they need additional therapeutic input. First Step plus is a new service being piloted to work with children and their carers in unstable placements who have experienced three or more placement moves. 12

13 8.2.3 The Designated Nurse for CiC attends the Corporate Parenting Committee and the CSE subgroup. At the Corporate Parenting Committee, the Designated Nurse for CiC meets with members of Aspire 1 and councillors. Performance and statistics are shared and scrutinised. Plans are underway to work with Aspire to increase the number of children and young people involved in service development, to ensure that the views of Children in Care are considered CSE subgroup - the focus is to discuss CSE but the remit of the group has been increased to consider a wider range of vulnerabilities and risk factors in recognition of the interconnectedness and particularly risks associated with young people who are missing from placement or have run away, trafficking, gangs and serious youth violence. All members of the Children in Care health team attend CSE meetings in relation to children with whom they are involved. 8.3 Initial Health Assessments (IHA) The IHAs are all carried out by paediatric staff. The national standard is for all children and young people to have their IHA within 20 days of children entering care. This has not always been possible due to a variety of reasons such as: a delay in being notified of a child entering care the Social Worker cancelling a booked appointment some young people refusing to attend During the year there had been an improvement in receiving notifications of children entering care and moving placement. During quarter 4 not all notifications were received and we became aware of children new into care by scrutinising the monthly returns received from the Information analysis via social care. We have discussed this with the Operational group and will continue to monitor, escalate where necessary and report back to the CCG Safeguarding and Assurance Committee The Children in Care Team are working towards ensuring that every child has a Strength and Difficulties (SDQ) questionnaire completed at the point of entering care. Support is given by the carers in completing this to ensure that the information is available as early as possible for First Step IHA s were completed this year and 3 out of borough assessments. A service level agreement has been drawn up with the placing Clinical Commissioning Group and payment received for conducting the out of borough assessments. Overview health reports are now compiled for young people that refused to attend or did not attend, to ensure that concerns regarding health are identified and risks assessed. The Children in Care Team may attend a multi-agency meeting if necessary in order to develop a protection plan. In addition, 25 children were seen with an adoption care plan. The medical advisor meets any prospective adopters of Haringey children to ensure that they are apprised of developmental or learning needs, and will also incorporate information about their emotional health. The medical advisor attends the monthly Haringey adoption panel where prospective adopters are approved and matches of Haringey children are approved. 8.4 Review Health Assessments (RHA) 1 Aspire is a youth-led group for young people in care and leaving care in Haringey. 13

14 RHAs were completed, and 12 out of borough assessments for children placed in Haringey. 17 RHA s were not completed (10 young people refused and the remaining 7 are planned for April) The Designated professionals attend Whittington Health Safeguarding meetings as required, and also work across borough with Islington and Hackney to ensure that systems and processes are peer reviewed and of an agreed quality. 9.0 Haringey GP Practices 9.1 Safeguarding Monitoring of Haringey General Practices From 1 April 2013 NHSE assumed responsibility for commissioning and performance monitoring of Primary Care Services. CCGs maintained a duty to support NHSE with the quality assurance of these services HCCG Safeguarding Children Team continue to drive improvements in the quality of Primary Care safeguarding children services offering advice and support to independent practitioners. Technology such as the HCCG Intranet, the GP Bulletin and practice s were used to highlight and disseminate learning. Practice visits and face-to-face or phone advice and support were used as opportunities to reinforce understanding and improve the quality of safeguarding children practice Level 1 and 2 training was available via e-learning and Haringey Safeguarding Children Board The Level 3 annual two and half hour bespoke GP training programme continued and was led by the Named GP supported by the HCCG Safeguarding Children Team. This offers bespoke face-to-face training to all Haringey GPs in groups with a maximum of 30 participants. The training programme is developed new each year and is run in yearly cycles from autumn to the following summer. The sessions covered local and national issues and alerted GPs awareness to lessons learned from Haringey Serious Case Reviews. The training specifically related learning to a Haringey/Islington SCR review: Child O, particularly the child protection significance of self-harming children, personality disorder in adults and its impact on children. In 2016/17 HCCG Safeguarding Children Team intend to continue the training programme Promoting effective safeguarding children in GP practices requires understanding of the current landscape of General Practice and providing appropriate motivation, information and support with context in mind. It is positive that GPs in the level 3 training sessions are informed and interested. It remains a concern the low number of reports from GPs to child protection conference. An audit in 2015 found of those GPs invited to conference 31% provided a report and 91% of GPs were invited to the conference. The quality of reports was reviewed and less than half, 38%, were considered adequate or better. Various actions have been taken as a result of this audit. The information has been presented at all 4 collaborative meetings, Level 3 GP training sessions and in HCCG briefings. The information relevant to Children and Young People services was shared with them. Practices with a low submission of reports were contacted directly and asked to review their systems and practice. The audit will be repeated in 2016 to assess impact of the feedback The bi-monthly GP Child Protection Leads meetings, originally commenced in November 2013, continued and were facilitated by the Named GP and either the Designated Doctor or Assistant Director for Safeguarding / Designated Nurse. They were interactive sessions during which cases/issues were brought for discussion. The last meeting was in May 2015 and had poor attendance. GPs were canvassed about whether the meetings added value and the feedback has been overwhelmingly positive 14

15 but it was flagged the timing of meetings and location were important for regular attendance. The meetings are planned to restart in June 2016 and will rotate through the four collaboratives to encourage attendance of Lead child protection GPs as well as other interested GPs across the borough. 10 Safeguarding Monitoring of Haringey Clinical Commissioning Group (HCCG) 10.1 The HCCG Safeguarding Children Designated Doctor and Nurses and Named GP met 1-2 monthly. This provided an opportunity to share good practice, update each other on any developments and monitor the implementation of work plans Training data for Figure 3: HCCG Safeguarding Training Compliance across the required levels as of 31/03/16: Training Type & Level Numbers Requiring Training Numbers Trained Percentage Compliance Safeguarding Children - Level % Safeguarding Children - Level % Safeguarding Children - Level % Safeguarding Children - Level % 11 Reviews and Audits 11.1 NHS England Safeguarding Deep Dive During 2015/16 NHS England conducted a series of Deep Dive assurance exercises and one of the priority areas focused upon was safeguarding. The HCCG Safeguarding Team prepared evidence prior to attendance by the HCCG Chair, Governing Body Lead for Children, Executive Nurse & Director of Quality and Integrated Governance and Assistant Director of Quality and Nursing at a meeting to discuss HCCG evidence in response to Key Lines of Enquiry (KLOEs) regarding safeguarding arrangements and assurance. The following results were received from NHS England in February 2016: - Governance, Systems, Process - Overall Outcome - Good - Workforce - Overall Outcome - Good - Capacity Levels in CCG - Overall Outcome - Good - Assurance - Overall Outcome - Good 11.2 Haringey Safeguarding Children Board Multi-agency Audits The HCCG led the Health involvement within the following HSCB Multi-agency themed audits: - Q1 - Voice of the Child - Q3 - Child Sexual Exploitation (CSE) Diagnostic Exercise (comprising audit, focus groups, case discussion and visit to Haringey MASH) 15

16 - Q4 - Neglect (postponed from Q2 due to preparation for intensive CSE Diagnostic Exercise) The implementation of recommendations from these audits will be monitored by HSCB. 12 Serious Case Reviews (SCRs) 12.1 Over the period of this report, three SCRs were published by the Haringey Safeguarding Children Board. These were: Child CH SCR concerned the murder by CH then aged 15, of a young man (Mr Z) who was unknown to him, in a residential street. Child O related to the death of a 15 year old young person who took her life on a train track. A multi-agency HSCB-led learning event is planned focusing on the journey of the child through mental health services Child D related to the abuse of a young child 12.2 Outlined below are learning and actions as a result of recent SCRs: Child CH has highlighted the need to ensure that all Child Protection Conferences receive an effective report from the child s GP The post-audit actions to increase awareness and learning and to improve submission rates and quality of GP reports to conference have included the following: Distribution and report to GPs the findings of the audits Highlight practices with systems in place that enabled increased rates of report submission Inclusion of the audit and its findings within the GP L3 Safeguarding Children Training Programme Provision of model GP reports to Child Protection Conference to ensure clarity regarding expectations of timeliness and quality of completion The HCCG Safeguarding Team plans to re-audit in to measure the impact of the awareness raising and training on the provision and quality of GP information shared with Child Protection Conferences Child T (an SCR published in 2013) highlighted the need to strengthen GP / Health Visitor Liaison Meetings. The HCCG Safeguarding Children Assurance Meeting and the Whittington Health have received a very positive audit indicating an improved position regarding GP/Health Visitor Liaison meetings and impact on communication and information sharing Child O identified delays in the commissioning of services and in follow up and coordinated action on multi-agency risk assessment. The SCR has also highlighted the need to better educate and enable staff to work with children and young people who self-harm and address the impact on them and their families. As well as the planned multi-agency HSCB-led learning event focusing on the journey of the child through mental health services there has been joint work and discussion, monitored via the HCCG Safeguarding Children Assurance Meeting to clarify the escalation mechanisms 16

17 for clinical and commissioning teams in the event of multi-agency disagreement in relation to treatment and commissioning decisions and options A proposal from the HCCG Designated Professionals regarding increasing the learning from Haringey SCRs in combination with a recent Local Authority (LA) review into historical SCRs has led to planned workshops for frontline staff across the borough which will roll-out across and positively focus on increasing their learning, engagement and involvement. 13 HCCG Safeguarding Strategy 13.1 The HCCG Safeguarding Team has reviewed the HCCG Safeguarding Strategy and produced a Draft HCCG Safeguarding Strategy: The process of review has included the following: Inclusion of updated and revised safeguarding children legislative framework and guidance Consideration of the layout/design of the Strategic document and how its strategic priority areas link with the more operational objectives within the Safeguarding Team Workplan 13.3 Whilst elements of the Strategy have been retained, the proposed Strategy looks different to the previous version to achieve the following: To consider the most optimal length, layout, accessibility and use of the document to ensure enhanced effectiveness To ensure that the document is strategic with the more operational aspects to be covered in the Workplan objectives that will be intrinsically linked and sit beneath the Strategic Aims and Priorities To ensure it is reflective of all relevant legislation and guidance (referencing these but not detailing elements of them within the document) To ensure that the Safeguarding Strategy is informed by and linked to the HCCG Vision as well as the priority areas identified by NHSE, CQC and the Haringey LSCB and SAB To acknowledge the background and context of the high profile national safeguarding reviews and their importance but to keep sight of the fact that all safeguarding concerns and incidents are significant and to maintain a forwardlooking approach To identify a manageable and achievable number of priority areas that each Workplan objective can be mapped and measured against in terms of how and when achieved The 3-Year Strategy will detail how it will be reviewed and a detailed annual work plan will be produced based on milestones and objectives The Safeguarding Team will map these and produce the final version for approval at the June 2016 Quality Committee prior to planned June 2016 launch and implementation. 17

18 14.0 Progress against Objectives Objectives Objective KPI / Measurement / Monitoring Progress 14.1 To ensure that all children in care are seen for their Initial Health Assessment (IHA) within 4 weeks of moving into care 14.2 To actively participate in collaboration with other agencies in the Local Authority-led review and strengthening of effectiveness of the 100% of children in care will be seen for IHA Exception reports will be completed for IHA completed outside this deadline with plan to address non-compliance IHA target will be monitored via the quarterly HCCG Safeguarding Children Assurance Meeting HCCG will ensure attendance and active participation in the recently re-established Haringey MASH Board HCCG will facilitate and monitor relevant provider Health attendance at the MASH Board and will agree Largely Met The Children in Care Team reported improvements within the Local Authority system regarding the timely notifications of children entering care and the achievement of those children receiving IHA within four weeks The Children in Care Designated Professionals submitted regular reports to the HCCG Safeguarding Children Assurance Meeting and Whittington Health Safeguarding Children committee updating on progress and compliance The IHA and RHA target will continue to be monitored via the quarterly HCCG Safeguarding Children Assurance Meeting Largely Met The HCCG was represented by the Interim Assistant Designated Nurse Safeguarding Children at the Haringey MASH Board 18

19 Objectives Objective KPI / Measurement / Monitoring Progress Haringey MASH and ensure appropriate Health representation within the daily MASH HCCG will ensure that expectations and operational protocols are clear for Health staff within the MASH and Health agencies referring into the MASH HCCG will monitor the MASH data to assess the impact of referral into MASH The HCCG ensured appropriate provider Health representation at the MASH Board; specifically following up with BEH-MHT to ensure mental health input from Summer 2015 and planning with the Named GP Safeguarding Children the updating and strengthening of GP Child Protection Lead information and contact details to be provided to the Whittington Health Safeguarding Advisors (Health Representatives) within the MASH. The Interim Assistant Designated Nurse Safeguarding Children reviewed the revised MASH Operating Protocol and has recommended (prior to MASH Board sign-off) a strengthening of the sections relating to; involvement of and feedback to Health staff within the MASH (as well as feedback across the wider partnership) and escalation. These recommended amendments are in line with learning from a Serious Case Review and the visit to the Haringey MASH by the review team that led the CSE Diagnostic Exercise completed in November 2015; this should increase clarity and consistency of understanding of the process within the MASH and how this fits with the revised Local Authority Children s Service Structure (now comprising of the Single Point of Access (SPA), the MASH and 19

20 Objectives Objective KPI / Measurement / Monitoring Progress Early Help) With the Protocol in the final stages of sign-off the partnership will need to ensure across that there is a robust and visible communication and implementation plan to ensure that all staff working across the borough are clear and consistent in their understanding and practice within these systems 14.3 To request assurance from non NHS providers of children s services commissioned by HCCG that they have taken all required action in response to the findings from the Savile Inquiries In conjunction with the Children s Commissioner the Safeguarding Team will ensure the HCCG has assurance from all provider organisations against the initial Department of Health and subsequent 14 recommendations from Lessons Learned from NHS Investigations into Matters Relating to Jimmy Savile February 2015 Assurance will be based on receipt of response, strength of evidence provided with the response, clarity of policies and protocols across organisations Measurement of staff awareness and use of policies and protocols in practice will be assessed via provider audit Met The HCCG Safeguarding Team worked with the HCCG Commissioning Team to ensure that all non-nhs Providers provided responses and assurance against the Department of Health and subsequent 14 recommendations from the Lessons Learned from NHS Investigation into Matters Relating to Jimmy Savile (Lampard, February 2015) The HCCG was assured by what was submitted regarding policies and protocols now in place across these organisations. This was monitored via regular reviews of the HCCG Safeguarding Workplan 20

21 Objectives Objective KPI / Measurement / Monitoring Progress HCCG monitoring and assurance will be through quarterly HCCG Safeguarding Children Assurance Meeting and via commissioning meetings with providers Further audit work by in relation to impact on staff practice of these policies and procedures may be further assessed and measured by provider audits across Strength of policy to practice and impact of safeguarding arrangements were also considered within commissioning review meetings with Providers and there was evidence of effective joint working, support and challenge of Providers by the HCCG Safeguarding and Commissioning Teams Concerns following CQC Inspections and LADO cases involving Providers were also managed and followed up by the joint working of the HCCG Safeguarding and Commissioning Teams leading to increased scrutiny of the safeguarding practice and care provision of certain Providers; as well as the use of appropriate of contract levers 14.4 To work across the partnership to identify an effective response to reduce the risk of children experiencing FGM The HCCG will contribute to the achievement of the Harmful Practice Working Group Objectives: Development of a Haringey Multi-agency Harmful Met The HCCG were represented at the Harmful Practice Working Group by the Interim Assistant Designated Nurse Safeguarding Children and 21

22 Objectives Objective KPI / Measurement / Monitoring Progress Practices Action Plan Increase in staff awareness through attendance at FGM training Consider (with public health colleagues) the use of education to inform practicing communities of the adverse health impact of FGM to reduce the risk of this practice being perpetuated. then, by the Deputy Designated Nurse Safeguarding Children; working with the wider partnership to ensure increased clarity of arrangements, services and development of the Harmful Practices Action Plan (reporting to the Violence Against Women and Girls (VAWG) Strategic Group to address, prevent and respond to harmful practices (including FGM) across the borough Health staff awareness of FGM was increased via: - Inclusion of FGM in the GP L3 Safeguarding Children Training Programme ( and ) - Bespoke FGM training delivered to the Haringey Practice Nurses Forum - Establishment of the NMUH FGM (Iris) Clinic There was an increase in focus across the borough in the use of education to inform practicing communities of the adverse impact of FGM and awareness of the FGM Passport also increased during this period 14.5 To review and revise the Haringey CCG Safeguarding Children Review existing policy against revised Working Together to Safeguard Children (2015) and London Met The HCCG Safeguarding Children Policy was revised in line with the following: 22

23 Objectives Objective KPI / Measurement / Monitoring Progress Policy in line with national and Pan-London guidance; including consideration with the Named GP regarding policy and procedure implications for General Practices Child Protection Procedures (2015) Review by asking selection of HCCG staff for feedback on existing policy and what they want from a new policy to inform revisions Complete first draft by end of August 2015 Present draft revised policy to October 2015 HCCG Quality Committee for ratification Launch policy to HCCG staff following ratification - Working Together to Safeguard Children (2015) - London Child Protection Procedures (5th Edition, 2015) - Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (NHSE, 2015) - NHSE Safeguarding Policy (2015) - HCCG Incident and Serious Incident Policy (2014) - HCCG Information Governance Policy (2015) - HCCG Policy for Policies (2013) HCCG staff contributed to the review by considering the previous (2013) HCCG Safeguarding Children Policy and where they felt it could be strengthened The revised policy was ratified by the HCCG Quality Committee in December 2015, sent to the Haringey Safeguarding Children Board and launched and shared with HCCG staff via the CCG Intranet Site and staff briefing 14.6 To review and revise the Haringey CCG Safeguarding Children Training Strategy to Review current training strategy against revised 3 rd Edition of Intercollegiate Document (2014) Met The HCCG safeguarding children training strategy was reviewed against the 3 rd Edition of the Intercollegiate Document (2014) 23