SAFEGUARDING CHILDREN STEERING GROUP FINAL ANNUAL REPORT

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SAFEGUARDING CHILDREN STEERING GROUP FINAL ANNUAL REPORT 2012 2013 Report of Paper prepared by Purpose of Paper Action/Decision required Link to Health Care Standards: Link to Health Board s Strategic Direction and Corporate Objectives / Legislative and Regulatory Framework Acronyms and abbreviations Cardiff and Vale University Health Board Safeguarding Children Steering Group Named Nurse and Doctor Cardiff and Vale University Health Board The purpose of this report is to inform and update the Committee of the current status in meeting the UHB requirement to safeguard children. The Board is asked to RECEIVE and NOTE the information provided in this paper. Revised Standards for Health in Wales, Standard 11. To demonstrate action in providing a patient safety environment and culture with particular reference to statutory responsibilities delivered through partnership working with key agencies. Cardiff and Vale University Health Board UHB Emergency Unit EU Local Safeguarding Children Boards LSCB MultiAgency Risk Assessment Committee MARAC Quality and Safety Committee Q&SC Procedural Response to Unexpected Death in Childhood PRUDiC Routine Enquiry in relation to domestic abuse RE Safeguarding Children Steering Group SCSG Serious case review SCR Sexual Assault Referral Centre SARC Welsh Government WG Draft Annual Report Page 1 of 10 Safeguarding Children Steering Group

Safeguarding Children Steering Group 2012-2013 SUMMARY Healthcare Standard 11, Safeguarding, has been self assessed this year at a corporate and divisional level, providing evidence of continued activity, as outlined within this report, aimed at improvement in what is a complex and demanding area of practice. This year s self assessment has concluded a level 4 (rating 1 5) maturity rating, which broadly concludes that the UHB can demonstrate clear practice against the regulatory requirements of the legislation. Key developments during the last year have included: Working towards merger of the UHB children and adult safeguarding steering groups from April 2013 Leading key aspects of the forthcoming merger of Local Safeguarding Children Boards (Cardiff and Vale of Glamorgan LSCBs) including chairing the newly established Executive Board for LSCB. Completion and publication of 5 Serious case reviews with implementation of health and multiagency recommendations Policy, procedure and guidance development (multi-agency and Health): for example Guidance on baby and infant safe sleeping, new Child Practice Review arrangements from January 2013, and PRUDiC (child death) process, In relation to safe recruitment the development of the UHB Disclosure and Barring Service Policy, and Policy for the Management of Allegations of Abuse of Children/Vulnerable Adults by Professionals and Members of Staff (Professional Abuse Policy) Contribution to the All Wales Safeguarding Children NHS Network work on all Wales guidance on safeguarding supervision, training and quality assessment framework. This work is alongside a full training programme and provision of safeguarding supervision to Nurses, Midwives, Health Visitors, Doctors and others involved in safeguarding cases with the aim of supporting staff, facilitating learning and promoting best practice. The new UHB Board Safeguarding Steering Group will continue to monitor compliance with the requirements set out in the legislative framework as well as providing continued scanning of the legislative arena to anticipate any changes in safeguarding legislation which may impact upon the work of the Health Board. SAFEGUARDING CHILDREN ARRANGEMENTS WITHIN THE UHB This is the Annual Report of Cardiff and Vale University Health Board Safeguarding Children Steering Group ending March 2013.In measuring the arrangements in place within the Health Board against the requirements set out within the legislative frameworks identified above, it is considered that the Draft Annual Report Page 2 of 10 Safeguarding Children Steering Group

Health Board has robust arrangements in place to demonstrate that it is meeting its responsibilities. The Executive Nurse Director is the identified Lead Executive Officer responsible for providing strategic leadership for this complex agenda. During the last year the Executive Nurse Director has chaired the UHB Safeguarding Children Steering Group and Safeguarding Adults Steering Group providing written assurance reports on the activities being undertaken to the Quality and Safety Committee. Both groups are multi-professional, reflecting the ethos of safeguarding being everybody s business. These arrangements will change from April 2013, in line with new ways of working and accountability within the Health Board and also the national approach being advocated by Welsh Government, to bring together these two specific areas of safeguarding. As such, from April 2013, the two groups will merge and become a Health Board Safeguarding Steering Group covering all aspects of safeguarding activity (children, adults, and domestic abuse). The new group will continue to be multi-professional in its membership and will be chaired by the Assistant Director of Nursing, who will be responsible for providing the Lead Executive with assurance that the safeguarding agenda is being progressed in line with legislative requirements and best practice. In line with the legislative requirements the Health Board has also had an identified Independent Member with lead responsibility for safeguarding who, as a member of the Safeguarding Steering Groups for Children and Adults, has provided scrutiny of the work being taken forward. In addition to this the Health Board Safeguarding teams have co-located to support improved joint working across adult and child protection cases. Work has also taken place to look at ways of enhancing support to Divisions on this complex and challenging agenda through allocation of a specialist safeguarding children nurse to act as an expert resource for the Divisional team as they become Clinical boards. DOMESTIC ABUSE A Domestic Abuse sub-group is being set up as part of the Safeguarding Steering Group which will be responsible for driving the domestic abuse agenda within the UHB and will deliver a work plan and report to the Safeguarding Steering Group. Numbers of referrals (PPD1s) to the safeguarding team has stabilized over the last 2 years with 3,134 in 2011/12 and 2,981 this year. It was acknowledged by the Cardiff MARAC Steering Group that the UHB Safeguarding Children Team had attended every meeting, all actions had been completed within time frame or a reason given, and there were no outstanding actions. HEALTHCARE STANDARD 11 Healthcare Standard 11, Safeguarding, has been self assessed this year at a corporate and divisional level, providing evidence of continued activity, as Draft Annual Report Page 3 of 10 Safeguarding Children Steering Group

outlined within this report, aimed at improvement in what is a complex and demanding area of practice. This year s self assessment has concluded a level 4 (rating 1 5) maturity rating, which broadly concludes that the UHB can demonstrate clear practice against the regulatory requirements of the legislation. Examples of good practice demonstrated this year include: In Unscheduled care a new paediatric consultant has been appointed who is working with the safeguarding team. In response to the rise in alcohol attendances in the under 16s, the Paediatric Emergency Unit (EU) has appointed a staff nurse leading on the alcohol attendances who has been trained in alcohol brief interventions. In addition each Monday one of the children s substance misuse nurses runs a clinic with appointments for young people as well as some training for staff. The StaySafe partnership has been further strengthened with 2 EU staff regularly involved in StaySafe evenings. In Mental health there will be a rolling programme of identifying Safeguarding Children Champions in each clinical area i.e. Community Mental Health Teams, Acute Admission Wards and Crisis and Home Treatment teams supervised by the safeguarding team. This role will develop specialised knowledge in safeguarding children in order to ensure that practice identified in the Safeguarding Protocol for Mental Health is routine. It will also involve liaison with other agencies to establish better interagency working. Cardiff Child Protection Systematic Review Group, led by Professor Alison Kemp, won the BMJ Child Health Care Team of the year 2013. A decade ago there were no evidence-based standards or national clinical guidelines to inform the clinical assessment of suspected child abuse or neglect. The research programme has changed the recognition and investigation of suspected child abuse, with an evidence base which helps child protection professionals demonstrate that their conclusions and opinions are based on validated models and methodologies. Improved evidence presented in court means that abused children are more likely to be protected from future harm, underpinning improved expert evidence in courts around the world. Cardiff and Vale UHB has made a significant contribution to the team. http://www.core-info.cardiff.ac.uk/ TRAINING The Safeguarding Children Training Group is a sub-group of the Safeguarding Children Steering Group chaired by the Safeguarding children trainer. The report of the group is attached as Appendix 2 Cardiff and Vale UHB Contributed to the All Wales Expert Working Group on safeguarding children training set up following the Aylward report. The Health Board is working towards the implementation of the Intercollegiate Document Safeguarding Children and Young people: roles and competences for health care staff 2010 which was accepted by the Welsh Government late 2012. Draft Annual Report Page 4 of 10 Safeguarding Children Steering Group

CLINICAL GOVERNANCE At the time of writing, 87 of 8708 patient safety incidents across the UHB during this timeframe were considered to be related to Safeguarding children (10%). Themes identified include training needs of staff, clarification of when to make a child protection referral, the need for secure electronic sharing of patient information when faxed referral goes astray and management of safeguarding issues in relation to young people admitted on adult wards. Audits completed during 2012/13 include: 1. Compliance by GP practices with A Guide for Safeguarding Children and Young People in General Practice issued by Public Health Wales in 2012. 91% of designated GP leads had attended level 3 training. The GPs appreciated both the training and communication links they have with the UHB (staff and resources). It is commendable that all the GP s except for one, had attended safeguarding children training during the last 3 years and in fact the majority had attended 2 different sessions in that time. 2. Domestic Abuse Routine Enquiry (RE) Pathway to ascertain whether all women are asked about Domestic Abuse in the Ante-natal period. Results have improved, from 17% in 2010 to 31% of women in 2012 documented as being asked once during pregnancy. However this is still only a third of women being asked, and it is expected that women will be asked twice. Action plan developed in response to recommendations include: A clear process to be available for all midwives. The target is 50% of RE asked once, and 30% twice during pregnancy. 7 training sessions have been organised. Approximately 50 midwives have attended to date. PPD1's received by community midwives to be acted upon within 5 days of notification. Awareness raising for all women attending antenatal clinics. Further monitoring and review of the process through Audit by Sept 2013 3. Training audits: Evaluation of Level 2 training: District nurse compliance with level 2 training: only 10% district nurses were compliant with level 2 safeguarding children training in the last 3 years. Historically it has been difficult for District nurses to access the training which has often been scheduled in the morning when service demands are at their highest. Last year saw the introduction of several afternoon and one day (adult and children) training sessions; however this has not yet increased the uptake of training in district nursing. The proposed solution is to enable District nurses to access a level 2 e- learning package being developed by Cardiff and Vale UHB for Draft Annual Report Page 5 of 10 Safeguarding Children Steering Group

Wales. Safeguarding lead nurses regularly provide updates at District Nurse Team Leader forums. Anaesthetist s compliance with level 2 training: 21% had received Level 1 training and 20% Level 2 training. The audit highlighted the need for training in safeguarding children, providing easy access to this training and ensuring that competencies are met by staff. A re audit is to take place in a year. 4. Sharing of child protection conference reports by health professionals prior to conference. During the 6 month period up to June 2012, 485 child protection case conferences were held. Health visitors shared 33% of their reports with the family, School health nurses 13% and midwives 6%. None of the health professionals were consistently sharing reports with parents. Possible reasons for the results could be time constraints and busy work loads for staff, or a lack of understanding and appreciation as to why this is important. The audit has been shared with the Directorates and staff reminded during supervision. In relation to the issue of safe recruitment both the UHB Disclosure and Barring Service Policy, and Policy for the Management of Allegations of Abuse of Children/Vulnerable Adults by Professionals and Members of Staff (Professional Abuse Policy) have been developed. http://nww.cardiffandvale.wales.nhs.uk/pls/portal/docs/page/news_po ST_BOX/NEWS_2010_2015/2013/DBS%20POLICY%20BRIEFING%20SHE ET.PDF Child deaths and PRUDiC process Good practice was acknowledged by Cardiff and Vale UHB in the Public Health Wales report Evaluation of the Implementation of the Procedural Response to Unexpected Death in Childhood (PRUDiC) by NHS Wales both in relation to the Senior Nurse, Bereavement Service who provides strategic bereavement support across the UHB and advice and support to bereaved families and also the health contribution to Cardiff and Vale LSCB Baby and Infant Safe Sleeping Guidance following several deaths in similar circumstances (co sleeping and sleeping on sofa). This has been shared with other LSCBs via the Safeguarding Children NHS Network. For the 12 months of this report there were 12 child deaths requiring the multiagency PRUDiC process. A flow chart has been agreed to clarify the process within the UHB. http://nww.cardiffandvale.wales.nhs.uk/pls/portal/docs/page/cardiff_and _VALE_INTRANET/TRUST_SERVICES_INDEX/CHILD_HEALTH/CHILD_PR OTECTION_CP/CLINICAL%20GUIDANCE/PROCEDURAL%20RESPONSE %20TO%20UNEXPECTED%20DEATH%20IN%20CHILDHOOD.DOC PARTNERSHIP WORKING Health Draft Annual Report Page 6 of 10 Safeguarding Children Steering Group

Cardiff and Vale UHB has been involved in the development and implementation of the All Wales Safeguarding Children NHS Network. Representation from UHB includes the Nurse Director, Assistant Nurse Director and Named Professionals. Priorities for the Network reflect the Welsh Government Programme Level Agreement with PHW and include all Wales guidance on training, a health quality assessment framework and safeguarding supervision. The UHB have taken the lead in development of Level 2 e-learning programme. Multiagency Cardiff and Vale UHB has led on key aspects of the forthcoming merger of Local Safeguarding Children Boards (Cardiff LSCB and The Vale of Glamorgan LSCB) including chairing the newly established Executive Board for LSCB and development of the governance arrangements (the Constitution) for the merged LSCB. From the NSPCC report How safe are our children? April 2013, there were 2,890 children on a child protection register on 31 March 2012 in Wales: an increase of 47% over the last 10 years. Health staff are having to respond to this increase in safeguarding activity evidenced by a 46% increase in legal requests from the 1 st quarter to the 4 th quarter of the year from health for care proceedings. SERIOUS CASE REVIEWS (SCRS)/ CHILD PRACTICE REVIEWS From January 2013, the procedure for reviewing serious safeguarding events (significant abuse or neglect resulting in harm and/or death) changed from being a Serious Case Review to a Child Practice Review. The Child Practice Review Framework, issued by Welsh Government, has been presented at the Safeguarding Children Steering Group and three individuals have received the training required to support implementation of the new review arrangements. The new arrangements are intended to have a much clearer focus on family involvement in the review process. The impact of the new arrangements is as yet unknown and will be monitored during the coming year. For the period 1 April 2012 to 31 March 2013, the UHB contributed to serious case reviews for Cardiff, Vale of Glamorgan, and Swansea Local Safeguarding Children Boards. Five have been completed and published in this time period. For Cardiff LSCB recommendations have been combined and an action plan is being monitored by the LSCB. The recommendations from the Health management reviews have been implemented by UHB. A further 3 SCRs and 3 management reviews are due to be completed next financial year. Issues addressed following the publication of the serious case reviews include: LSCB guidance on safe sleeping and risk of Sudden Infant Death Protocol to improve laboratory reporting and communication with clinicians to ensure significant results are known prior to discharge Draft Annual Report Page 7 of 10 Safeguarding Children Steering Group

Resolution of differences of opinion between professionals from different agencies Coordination and clarification of roles in relation to Multiagency management of children with a disability http://nww.cardiffandvale.wales.nhs.uk/pls/portal/docs/page/cardiff_ AND_VALE_INTRANET/TRUST_SERVICES_INDEX/CHILD_HEALTH/CHIL D_PROTECTION_CP/CLINICAL%20GUIDANCE/BABY%20AND%20INFAN T%20SAFE%20SLEEPING%20GUIDANCE%20JAN%2013.DOC SEXUAL ASSAULT Cardiff and Vale UHB hosts the multi agency Sexual Assault Referral Centre (SARC), Ynys Saff, in Cardiff Royal Infirmary. Since opening, the service has developed and matured, succeeding in delivering a comprehensive quality service for victims of sexual assault for adults and children in Cardiff and the Vale which meets the Public Health Wales Service Specification for children who may have been sexually abused. Since October 2008, over 2000 clients have been seen of which 40% were aged less than 18 years old: numbers are continuing to increase over time. (See table 1). TABLE 1 NUMBERS OF CLIENTS SEEN AT SARC 2009-10 2010-11 2011-12 2012-13 Total (under 190 / 34% 142 / 42% 197 / 42% 241 / 41% 18 years old) 16 17 years 32 / 22% 32 / 16% 52 / 22% 38 / 20% 13 15 years 52 / 37% 67 / 34% 72 / 30% 68 / 36% under 13 84 / 44% 58 / 41% 98 / 50% 117 / 48% years Funding remains vulnerable as many of the financial contributors have not yet confirmed their contribution for 2013/14 placing the service at risk. The outcome of the application to the Regional Collaboration Grant has been successful with funding for 3 years to develop a regional service. Out of hours emergency cases of children aged under 13 years old from across South Wales are now seen at Cardiff SARC. Work is ongoing in developing a networked regional model between Cardiff and Vale, Cwm Taf and Aneurin Bevan Health Boards. RECOMMENDATION The Quality, Safety and Experience Committee is asked to: Note the safeguarding work being undertaken within the Health Board and in collaboration with partner agencies. Confirm support for the direction being taken in relation to a single Safeguarding Steering Group to drive and embed the safeguarding agenda across the Health Board. Draft Annual Report Page 8 of 10 Safeguarding Children Steering Group

Financial Impact Quality, Safety and Experience Standards for Health Services Risks and Assurance Equality and diversity There are no Financial Implications of this Report Ensuring robust safeguarding arrangements are in place against the requirements of related legislation, is a key requirement. Ensuring application of these arrangements, will impact positively on the quality, safety and experience of those that require safeguarding. It is therefore important that the UHB provides assurance that the requirements of this statutory framework are being appropriately discharged under the leadership of the Executive Nurse Director. This Report is supported by Standard 11, Safeguarding. Over the last 2 months, corporately and at divisional level, a self assessment has been undertaken to assess the extent to which this Standard is being embedded in practice. [Standards can be obtained on the following link http://www.nhswalesgovernance.com/uploads/resources/mgl 7tpOP1.pdf] This report aims to provide assurance that the requirements of the legislation relating to safeguarding are being applied consistently across the UHB and that associated risks are being mitigated by the robustness of the arrangements in place. There are no equality and diversity implications of this report. However, the Standard and the UHB approach to this regulatory framework are broadly governed by the requirements of the Human Rights Act 1998. Health Improvement Workforce Financial Legal Equality Environmental The attached annual report outlines key areas of work which supports the statutory requirements for safeguarding children The UHB workforce will be trained to support the delivery of good practice within child protection requirements. To ensure safeguarding children is a priority for Divisions The work of the SCSG aims to protect UHB from adverse outcomes for children and reduce financial claims UHB has statutory obligations in relation to safeguarding children Safeguarding children across UHB helps to ensure recognition of children s rights Promote a child centred culture with recognition of Children s rights RISK ASSESSMENT Draft Annual Report Page 9 of 10 Safeguarding Children Steering Group

Clinical/Service Promote consistent response to safeguarding children across UHB Financial Implications if reduction in safeguarding team to fulfil statutory responsibilities. Reputational Heightened levels of staff engagement in safeguarding children agenda to ensure UHB meets its statutory requirements and avoid adverse media. Draft Annual Report Page 10 of 10 Safeguarding Children Steering Group