Child Protection Annual Report

Child Protection Annual Report From 1 st April 2010 to 31 st March 2011

Introduction Within NHS Lanarkshire the following diagram illustrates the accountability framework for Child Protection within the organisation. Chief Executive Director of NMAHP Board Member with portfolio For Child Protection Medical Director Divisional Director of Nursing Primary Care Associate Director of Nursing Public Health Nursing Nurse Consultant, Child Protection And Vulnerable Children Lead Paediatrician Child Protection The NHS Lanarkshire Child Protection team members are: Juliet Norman Nurse Consultant Child Protection & Vulnerable Children Shirley Clark Child Protection Advisor Marina McLaughlin Child Protection Advisor Lillias Renwick Child Protection Advisor Maureen Scott Child Protection Advisor Dr Linda Hunter Dr Lila Agrawal Dr Kamala Ray Dr Mustafa Mulla Lead Paediatrician Child Protection Consultant Paediatrician Associate Specialist Community Paediatrician Associate Specialist Community Paediatrician Admin members of the team: Fiona Milton John Boylen Secretary to the Nurse Consultant for Child Protection & Vulnerable Children Audit/Secretarial Support 2

In addition, we have three Child Protection Link Nurses, one at each of the three large acute hospital sites: Gaynor McCluskey Elsie Donnelly Maggie Scoular Hairmyres Hospital Monklands Hospital Wishaw General Hospital Each of the Child Protection Link Nurses is a Charge Nurse within the Emergency Department/See and Treat. They had one day per week dedicated to child protection work, but during the latter part of the year they are now also using this time for Adult Support and Protection work, not just within the emergency department but within their hospital. The role of the Link Nurse is that of a human signpost to support staff in identifying where and from whom to access relevant information. In addition, the Link Nurses across the three hospitals provide child protection awareness training for acute health professionals. Should you wish an update session for your department please contact the Link Nurse for your hospital. NHS Lanarkshire membership of North and South Lanarkshire Child Protection Committees (CPCs) is as follows: North Lanarkshire Child Protection Committee Dr Linda Hunter Juliet Norman Geraldine Queen Lead Paediatrician Child Protection (Vice Chair) Nurse Consultant, Child Protection & Vulnerable Children Associate Director of Nursing (Public Health Nursing) South Lanarkshire Child Protection Committee Juliet Norman Dr Linda Hunter Geraldine Queen Nurse Consultant Child Protection & Vulnerable Children (Vice Chair) Lead Paediatrician Child Protection Associate Director of Nursing (Public Health Nursing) Co-located Unit of North and South Lanarkshire CPCs and Multi-Agency Public Protection Arrangements (MAPPA) The nursing and admin members of the NHSL CP team are all based at Regent House in High Patrick Street. Co-location has afforded us the opportunity to work even more closely with the CP Co-ordinator for North CPC, Lead Officer for South CPC, Social Work, Education and the Police Family Protection Unit colleagues from North and South Lanarkshire, MAPPA and all admin support teams. Some of the benefits of co-location have been, easier access to sharing information, seeking other professional s views/perspectives on cases and less duplication of work. Adult Protection colleagues along with Service Co-ordinators (Domestic Abuse) are also co-located. 3

Corporate Objectives for Child Protection 1.11 Deliver continuous improvement in Child Protection arrangements across NHS Lanarkshire: P Wilson (R Lyness, C Sloey, A Lawrie) Blue Child Protection self-evaluation is overseen by the organisation s Child Protection Programme Board. Internal audit evaluated the effectiveness of child protection structures and systems and produced a report at the end of August 2010. The HMIe Child Protection Inspections took place during August and September in South Lanarkshire and during November and December in North Lanarkshire. The South area report was published on 2 December 2010 and the North area report on 3 March 2011, both of which were extremely positive. NHS Lanarkshire has taken the opportunity to review our own action plan in relation to self-evaluation following the HMIe Inspections. Both HMIe reports identified that partner agencies need to fully involve appropriate health professionals in child protection investigations. (PW) (see 1.11.3). 1.11.1 Review NHS Lanarkshire s arrangements for child and adult protection in the light of the multiagency public protection arrangements December 2010 P Wilson (R Lyness, C Sloey, A Lawrie) Blue The NHS Adult Protection and Child Protection groups will merge in January 2011. Temporary funding in place for Band 7 post for Adult Protection advisory, governance, performance and support structure but recurring funding for this post still to be identified from October 2011. A draft term of reference for the proposed Child & Adult Protection Programme Board has been formulated. To share learning from Child Protection and Adult Support and Protection one of the Child Protection Advisors is a member of the Adult Support and Protection meeting. In addition an Adult Support and Protection Advisor links with the NHS Lanarkshire Child Protection Team and multiagency co-located Public Protection Unit in Hamilton. (PW) 4

1.11.2 Implement improvements to the health care delivered to looked after and accommodated children through multi-agency review and partnership working. 1.11.3 Full participation in multi-agency preparation for future HMIe inspections of Child Protection services due in 2010/11. March 2011 Ongoing to March 2011 C Sloey, A Lawrie P Wilson Blue the partnership work with both Councils is ongoing and aimed at improving outcomes for all LAAC. Specifically CEL 16 2009 has been implemented and a system has been set up to ensure that all children taken into care receive a health assessment within 4 weeks of their admission. CAYP service has been expanded and service provision has been broadened out to include foster carers in North and South Lanarkshire. (SK for CS) Blue - NHS Lanarkshire has been an active partner in the multi-agency self- evaluation, service improvement and preparation for inspection for the 2 HMIe Child Protection Inspections that were held in 2010. South Lanarkshire Council Area HMIe Report published 2 December 2010 and the North Lanarkshire Council Area HMIe Report was published on 3 March 2011 Blue Completed Green On target Amber Delayed, but expected to recover in-year Red Delayed, not expected to recover in-year 5

Progress Report on Key Areas of Work Key Action Area / Topic Status Commentary HMIe Child Protection Blue This inspection took place during August Inspection South and September 2010 and the report, which Lanarkshire was very positive, was published on 2 December 2010. Overall we had four areas of work evaluated as very good and two as good. The Inspection team commented on the positive impact that use of the GIRFEC practice principles was having on our earlier intervention work with vulnerable children and their families. There were two areas identified for improvement: 1. Lead and direct improvements in joint investigations ensuring the early involvement of health staff. 2. Further strengthen links between services reviewing their work and making improvements. Both these recommendations are being progressed by all the agencies working in the South Lanarkshire council area. Initial Referral Discussions Amber A key area for development highlighted during the HMIe Child Protection Inspections for both South and North Lanarkshire. Multiagency staff pan Lanarkshire have explored with 3 neighbouring areas how they manage this process and have agreed a proposed Lanarkshire wide model. Learning pilots for both South and North Lanarkshire have been identified and the proposed start date for the Learning Project is July 2011. To support this work, NHS Lanarkshire identified: 1. NHSL Child Protection Team will be in the next cohort of Releasing Time to Care commencing November 2010 to identify any additional capacity that can be used to support Initial Referral Discussions. 2. A temporary increase in admin. Support for 2 days per week until the end of March 2011 to support the exploration of both Releasing Time to Care and exploring how to offer a tripartite discussion/early involvement of Health service

HMIe Child Protection Inspection North Lanarkshire CEL 16 (2009) Implementation of Action 15 of the Looked After Children and Young People: We Can and Must Do Better Report (Health Needs Assessment of all Looked After Children and Young People) Blue Blue This inspection took place during November and December 2010 and the report, which was very positive, was published on 3 March 2011. All six of the areas of work that were evaluated were found to be very good. This Inspection team also commented on the very positive impact that use of the GIRFEC practice principles was having on our work with vulnerable children and their families. There was only one area for improvement identified: 1. Implement plans to fully involve appropriate health and medical staff in planning investigations. Work is underway pan Lanarkshire to progress this area for improvement, please see section above: Initial Referral Discussions. A multi-agency, pan Lanarkshire approach to implementing a Health Needs Assessment for all Looked After Children and Young People has been agreed and implemented from 1 September 2010. The NHS Lanarkshire Child Protection Team has operated a Central Point of Contact for notification by Social Work of all Children and Young People who become Looked After. The NHS Lanarkshire Child Protection Team then contact the relevant Public Health Nursing Team to ensure a current valid assessment is in place or if not, this to be completed within 4 weeks of the Public Health Nursing Team receiving notification. The Central Point of Contact for Looked After Children was implemented on 1 st September 2010 and regular reports are given to the Associate Director of Nursing for Public Health Nursing and the responsible Director (Mr. Colin Sloey) Further work is underway to ensure that NHS Lanarkshire are informed of all children and young people in Lanarkshire who are accommodated or subject to a supervision order. Copies of HMIe Joint inspection of services to protect children and young people in both South and North Lanarkshire council areas are available on the Child Protection website within FirstPort. 7

High Level Review of Child Protection Processes A high level review of Child Protection processes was undertaken by NHSL Audit Department during the summer of 2010. Brief highlights from the report are as follows: Based on the information and testing conducted NHSL have established processes in place for the Child Protection Service. The reporting structures were demonstrated from the evidence made available and this was further supported by the Organisational chart mapping out the accountability lines. From the information provided for testing and the contribution and input from this review, it was the opinion of the Audit Department that the NHSL HMIe narrative and supporting documentation were comprehensive and robust. A copy of the full report is available from the Child Protection Team if required. Child Protection Medical Team Maintaining the Medical Child Protection service has continued to be a challenge this year. The service is maintained by our four child protection doctors and some locum cover for on call sessions. The work continues to be challenging and stressful due to the nature of the job and work related to it e.g. medico-legal report writing and court appearances with a shortage of, or lack of, concrete evidence. A high level of expertise in Child Sexual Abuse examinations continues to be maintained. The medical team regularly attend regional peer review meetings at Yorkhill and on occasion present cases for teaching purposes. We continue to provide support for Dumfries and Galloway Police Force in conducting Joint Paediatric Forensic Medicals Examinations where there are allegations of Child Sexual Abuse. West of Scotland Managed Clinical Network Lanarkshire continues to be actively involved in the network; Dr Linda Hunter leads this work for NHS Lanarkshire. Child Protection Training and Staff Development The Child Protection training DVD for doctors, recorded by Dr Hunter continues to be used across the three hospital Emergency Departments. The medical team are involved in delivering: NHS Lanarkshire s Level 2 Child Protection training programme University of the West of Scotland Post Graduate Child Protection Certificate North and South Lanarkshire Social Work Child Protection Training Royal College of Paediatrics Recognition and Response to Child Protection Training 8

Training delivered by the NHSL CP Team includes the following: Corporate Induction Child Protection Awareness for Clinical Staff (One day) Clinical Support Workers Administration staff Community mothers Training for pre-registered students of nursing and midwifery at University of the West of Scotland Briefing/Development Sessions: ecare Child Protection Messaging Child Protection for Midwives Induction for newly qualified/returning to practice PHNs and PHNs joining NHSL from other health authorities Child Protection Documentation Significant Case Review briefings Child Protection briefings in the Acute Sector delivered by the Child Protection Link Nurses The Child Protection team in collaboration with the Reachout Service have developed briefings for Adult Mental Health colleagues which have been co-delivered during the year. The Nurse Consultant for Child Protection & Vulnerable Children provides the input to the Post Graduate Certificate in Child Protection, both by delivering two of the sessions and by acting as a mentor for some of the students. The programme of training available within NHS Lanarkshire is available on FirstPort. Training and Development for NHSL Child Protection Team includes: Shirley Clark and Marina McLaughlin commenced course leading to Master of Science in Applied Studies in Child Welfare and Protection. Fiona Milton commenced NHSL Introduction to First Line Management. Child Protection Messaging Child Protection Messaging was developed and successfully piloted in Lanarkshire in 2005 and since then there has been ongoing roll out to partner agencies across Lanarkshire including appropriate NHSL Primary Care and Acute Services. Child protection Messaging Alerts support existing Child Protection procedures. Child protection messages, linked child and linked adult messages are generated and viewed on the Social Work IT application, sent to the Multi Agency Store (MAS) and are viewed and acknowledged by partner agency practitioners with agreed permissions. The Unborn Child Message has been agreed where there are pre birth concerns leading to an assessment and/or a pre birth case discussion. Social Work will generate the unborn child message, which will be attached to the mother s record. 9

A pilot with three GP practices has provided the business requirements for the new replacement IT system for GP s. Planning is in place to deliver the messaging to GP practices via the new system. Violence Against Women The Violence Against Women Co-ordinating Group meets quarterly. The meeting provides the opportunity of sharing the Multi-agency work which is progressing and being delivered within Lanarkshire. This work has a strong relationship with ensuring that the needs of children living in a household where there is violence against women are actively considered. One of the Child Protection Advisors is a member of this group. Adult Support and Protection The Multi-agency meeting provides the opportunity for agencies to share the work which is progressing within Lanarkshire. The Child Protection Team has shared the processes and procedures which are in place in NHS Lanarkshire for children and young people. The Child Protection Advisors are also involved in short life working groups. From next year the Child Protection Programme Board and the Adult Support and Protection Board are to be combined and will be chaired by the Executive Director of Nursing, Midwifery and Allied Health Professions bringing together the governance arrangements for these two important work streams. GIRFEC Over the last year the CP team has continued to be actively involved in the GIRFEC agenda. This has included contributing to the developments of the Core Components including Chronology of Significant Events, Single Agency Part I and Part 2, the Integrated Assessment as well as the Business Process map. The Child Protection Team contributes to the Health Reference Group and North Lanarkshire GIRFEC Implementation group as well MIDiS developments. CP Team Communication The methods of communication used by the CP team to disseminate and highlight relevant information to staff include: Firstport Staff briefing Pulse Inter-agency Child Protection newsletter In addition child protection is discussed at a range of meetings including the following: The Child & Adult Protection Programme Board (chaired by the Executive Director of Nursing, Midwifery and Allied Health Professionals. The NHS Lanarkshire Child Protection Self Evaluation & Service Improvement Group (chaired by the Associate Director of Nursing, Primary Care. The Child Protection Acute Forum (chaired by the Associate Director of Nursing & Midwifery. 10

The Child Protection Action Group (chaired by the Nurse Consultant, Child Protection & Vulnerable Children). The NHS Lanarkshire Child Protection Link Nurse Meetings (chaired by the Nurse Consultant, Child Protection & Vulnerable Children) A range of locality and service specific meetings. Substance Misuse Specialist Midwives Role Development of multi agency locality meetings to discuss vulnerable families: The antenatal period is a critical time to engage with women and their families to identify additional needs and support them to achieve the best possible outcomes for their child and family. The substance misuse specialist midwives role includes improving and promoting good relationships, joint working and service delivery within each locality by improving communication and sharing of information through provision of a joint forum for practitioners from health and key agencies. These multi agency meetings ensure information is shared, collated and documented, lead professional identified and feedback provided to appropriate caseload holder to ensure prompt and seamless access to health and social care services e.g. pre/post birth case discussions/conferences, multi agency case discussions etc, to ensure development of joint care planning process. The forum meets the needs of working with children and families with substance misuse protocols, GIRFEC principles and Pathway of care for vulnerable families (0-3). NB: In North Lanarkshire there is a pilot (Airdrie & Coatbridge) introducing MAST (Multi Agency Support Teams) meetings, which are replacing these meetings, but with similar remit/purpose, with membership from team leaders from all agencies attending monthly. There are no plans currently to change the meetings in South Lanarkshire. Child Protection Case Supervision Child Protection Case Supervision for Public Health Nurses is delivered by the Child Protection Advisors and the Child Protection Supervision Policy identified that CP Supervision should be delivered on a six-monthly basis. However, this is influenced by the needs of the Practitioner and the capacity of the Child Protection Advisors. The capacity of the Child Protection Advisors is influenced by the number of court attendances required and the number of ongoing Child Protection Reviews. The Child Protection Supervision Policy was reviewed and revised at the end of the year. Case Supervision Sessions Apr-Jun 2010 Jul-Sep 2010 Oct-Dec 2010 Jan-Mar 2011 Total 86 69 58 22 235 Case Support Sessions Apr-Jun 2010 Jul-Sep 2010 Oct-Dec 2010 Jan-Mar 2011 Total 34 25 21 15 95 11

The lower number of supervision and case support sessions in the final quarter of the year may be explained by the review of the existing policy and work undertaken in relation to multi-agency tripartite discussions/initial referral discussions. The Year Ahead The team will be fully involved in the continual child protection self evaluation and quality improvement both single and multi-agency. The team look forward to the challenge of implementing the Learning Project for Initial Referral Discussions, taking forward the HMIe recommendation in relation to fully involving appropriate health staff in planning child protection investigations. The CP Team will continue to evaluate the CP supervision delivered to PHNs and will ensure the best use of the Child Protection Advisor resource in this area of work. The National Guidance for Child Protection was published in December 2010 and the Scottish Government anticipated an incremental implementation process. Multi-agency work has been undertaken pan Lanarkshire and briefings are planned for the summer. The revised West of Scotland multi-agency procedures will also be available and included in the briefings. The NHSL Child Protection team will be involved in the roll out of the multi-agency briefings The Central Point of Contact Service will continue to be available alongside the Learning Project for Initial Referral Discussions for those areas not involved in the Learning Project. Report compiled by: Juliet Norman Nurse Consultant Child Protection & Vulnerable Children 10 th May 2011 On behalf of the NHSL Child & Adult Protection Programme Board & NHSL Child Protection Team 12

Child Protection Annual Report From 1 st April 2010 to 31 st March 2011 Appendix 1 13

Appendix 1 Summary Report of Child Protection Activity for NHS Lanarkshire for the period 1 st April 2010 to 31 st March 2011 The statistics outlined below in relation to attendance at Case conferences/case Discussions highlight in the main Public Health Nurse involvement with children in the child protection system. These figures are not exhaustive, consideration is currently being given as to how all Child Protection Activity can be reflected. Health Professionals Referrals to Social Work for Serious Child Care/Child Protection Concerns (figures not representative of all health professionals, referrals mainly from PHNs with a small number from other disciplines): Health Professional Referrals to Social Work from Primary Care (received by Child Protection Team) Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 10 9 2 3 24 Bellshill 10 6 9 1 26 Coatbridge 9 10 7 6 32 Motherwell 7 (9) 8 4 5 26 North 7 3 1 0 (2) 13 Wishaw 12 8 6 (7) 6 33 C lang/rutherglen 7 5 1 5 18 Clydesdale 9 20 5 5 39 East Kilbride 2 4 5 7 18 Hamilton 23 21 16 10 70 Total 98 94 57 50 299 Total extracted from CP Stats for PH Teams 96 80 68 70 314 Amended figures in brackets Health Professional Referrals to Social Work from Acute Division (received by Child Protection Team) Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Hairmyres 20 7 11 6 44 Monklands 25 35 34 35 129 Wishaw General 12 26 21 14 73 Total 57 68 66 55 246 14

Health Professional Referrals under Working with Children and Families affected by Substance Misuse Protocol - Information To Forms Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 1 2 2 3 8 Bellshill 1 2 - - 3 Coatbridge 2 1 4 1 8 Motherwell 1 2 - - 3 North 1 2 1-4 Wishaw 2 1 - - 3 Cambuslang/Rutherglen 1 - - - 1 Clydesdale 3 9 1-13 East Kilbride 1 3 2-6 Hamilton 8 7-1 16 Total 21 29 10 5 65 Total extracted from CP Stats for PH Teams 26 23 9 9 67 Information To forms do not have a date field which may lead to a discrepancy in above figures for each quarter and in addition a copy of this form is not routinely sent to the Child Protection Team. Health Professional Referrals under Working with Children & Families Affected by Substance Misuse Protocols: (Acute) No Information To referrals received by NHS Lanarkshire Child Protection Team NHS 24 Referrals Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Total 23 10 19 15 67 Children Placed on Child Protection Register 1 Apr 2010 31 Mar 2011 extracted from NHSL Activity Report Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 3 3 8 8 22 Bellshill 10 11 15 1 37 Coatbridge 7 15 8 4 34 Motherwell 3 7 6 7 23 North 14 6 9 11 40 Wishaw 28 8 7 11 54 Cambuslang/Rutherglen 18 10 5 16 49 Clydesdale 6 7 8 9 30 East Kilbride 21 5 9 6 41 Hamilton 4 24 10 17 55 Total 114 96 85 90 385 15

Children Removed from Child Protection Register 1 Jul 2010 30 Sep 2010 extracted from NHSL Activity Report Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 5 9 1 10 25 Bellshill 1 14 11 7 33 Coatbridge 5 3 2 4 14 Motherwell 5 5 4 12 26 North 17 5 10 10 42 Wishaw 0 9 5 4 18 C lang/rutherglen 8 10 1 18 37 Clydesdale 5 8 12 13 38 East Kilbride 12 10 1 12 35 Hamilton 21 13 17 3 54 Total 79 86 64 93 322 Initial Case Conferences Held: Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 8 (7) 5 (5) 7 (5) 9 (4) 29 (21) Bellshill 8 (9) 3 (3) 7 (7) 3 (3) 21 (22) Coatbridge 6 (5) 6 (3) 7 (4) 4 (4) 23 (16) Motherwell 5 (5) 4 (4) 3 (2) 7 (6) 19 (17) North 14 (14) 4 (4) 8 (7) 8 (7) 34 (32) Wishaw 8 (8) 3 (4) 9 (7) 7 (6) 27 (25) Cambuslang/Rutherglen 9 (6) 6 (5) 6 (5) 4 (2) 25 (18) Clydesdale 3 (2) 5 (5) 11 (11) 5 (5) 24 (23) East Kilbride 11 (11) 9 (9) 7 (7) 9 (9) 36 (36) Hamilton 6 (6) 15 (14) 12 (12) 10 (10) 43 (42) Total 78 (73) 60 (56) 77 (67) 66 (56) 281 (252) PHN Attendances in brackets Review Case Conferences Held: Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 9 (6) 8 (5) 6 (5) 10 (9) 33 (25) Bellshill 9 (7) 13 (10) 6 (6) 8 (6) 36 (29) Coatbridge 9 (7) 1 (4)* 7 (3) 11 (9) 28 (23) Motherwell 4 (4) 6 (5) 13 (13) 19 (19) 42 (41) North 10 (9) 11 (13) 18 (16) 15 (15) 54 (53) Wishaw 5 (5) 11 (9) 9 (8) 5 (4) 30 (26) Cambuslang/Rutherglen 26 (23) 30 (23) 14 (11) 23 (19) 93 (76) Clydesdale 15 (15) 13 (13) 9 (9) 12 (10) 49 (47) East Kilbride 15 (12) 8 (6) 17 (14) 25 (24) 65 (56) Hamilton 23 (22) 16 (16) 15 (15) 23 (23) 77 (76) Total 125 (110) 117 (104) 114 (100) 151 (138) 507 (452) PHN Attendances in brackets * PHN s attended Review Case Conferences for children who have moved outwith Lanarkshire 16

Case Discussions Held: Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 4 (2) 4 (5) 2 (1) 1 (0) 11 (8) Bellshill 5 (1) 9 (8) 8 (8) 9 (7) 31 (24) Coatbridge 4 (4) 6 (5) 2 (2) 7 (6) 19 (17) Motherwell 3 (3) 4 (4) 4 (4) 7 (6) 18 (17) North 11 (7) 9 (9) 4 (4) 10 (7) 34 (27) Wishaw 10 (6) 14 (10) 7 (5) 12 (9) 43 (30) Cambuslang/Rutherglen 7 (5) 8 (3) 8 (5) 5 (1) 28 (14) Clydesdale 5 (5) 1 (1) 3 (3) 11 (10) 20 (19) East Kilbride 5 (5) 11 (5) 14 (1) 10 (7) 40 (18) Hamilton 17 (16) 17 (16) 15 (10) 18 (17) 67 (59) Total 71 (54) 83 (66) 67 (43) 90 (70) 311 (233) PHN Attendances in brackets Prebirth Case Conferences held: Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 0 1 (1) 1 (1) 0 2 (2) Bellshill 0 1 (1) 0 3 (3) 4 (4) Coatbridge 2 (2) 0 0 0 2 (2) Motherwell 0 0 1 (1) 1 (1) 2 (2) North 0 1 (1) 1 (1) 1 (1) 3 (3) Wishaw 0 1 (1) 1 (1) 0 2 (2) Cambuslang/Rutherglen 2 (1) 0 2 (1) 2 (1) 6 (3) Clydesdale 1 (1) 0 0 0 1 (1) East Kilbride 2 (2) 0 0 3 (0) 5 (2) Hamilton 2 (2) 2 (2) 3 (3) 1 (0) 8 (7) Total 9 (8) 6 (6) 9 (8) 11 (6) 35 (28) PHN Attendances in brackets Prebirth Case Discussions held: Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 0 0 2 (2) 0 2 (2) Bellshill 0 0 0 2 (1) 2 (1) Coatbridge 0 0 0 4 (2) 4 (2) Motherwell 1 (0) 0 0 1 (0) 2 (0) North 1 (1) 0 0 1 (1) 2 (2) Wishaw 2 (2) 2 (2) 0 0 4 (4) Cambuslang/Rutherglen 0 5 (3) 1 (1) 2 (0) 8 (4) Clydesdale 0 1 (0) 0 0 1 (0) East Kilbride 2 (2) 1 (1) 6 (0) 1 (0) 10 (3) Hamilton 5 (5) 1 (1) 5 (5) 2 (2) 13 (13) Total 11 (10) 10 (7) 14 (8) 13 (6) 48 (31) PHN Attendances in brackets 17

Child Protection Training Training Level 1 CP Awareness Support Staff Admin Staff Induction Level 1 and 2 A/E, Paediatricians, Psychiatric SHOs, GPs Student Nurses/Midwives Level 2 Child Protection Awareness (Clinical Staff) Level 3 (Inter-agency) Risk Assessment & Risk Management Handling Childrens Behaviour Emotional Abuse & Neglect Professional Dangerousness Raising Awareness of Child Sexual Abuse Apr-Jun 2010 16 130 Jul-Sep 2010 29 102 Oct-Dec 2010 30 167 Jan-Mar 2011 15 80 Total 90 479 13 13 85 82 95 95 357 9 9 18 6 10 8 24 6 9 5 20 5 5 2 2 Domestic Abuse Child Protection 2 2 Supervisors Course 3 8 11 Sub Total 254 227 332 208 1021 Additional Training Training Apr-Jun 2010 Jul-Sep 2010 Oct-Dec 2010 Jan-Mar 2011 Total CP Messaging 13 23 7 43 Child Protection Multiagency Seminar 47 47 HMIe Briefing 232 270 55 557 GP Medical Education Event 178 178 Total 533 688 410 215 1846 The total number of staff attending training in relation to Child Protection for the period 1 st April 2010 to 31 st March 2011 was 1846 18

Central Point of Contact requests from other Agencies North Lanarkshire Locality Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 Airdrie 4 9 1 2 16 Bellshill 2 2 Coatbridge 2 3 2 7 Motherwell 1 1 2 North 1 3 4 Wishaw 3 2 5 FPU North 5 4 2 8 19 Total 13 19 9 14 55 South Lanarkshire Locality Apr-Jun Jul-Sep Oct-Dec Jan-Mar Total 2010 2010 2010 2011 C lang/rutherglen 13 13 9 16 51 Clydesdale 8 9 11 12 40 East Kilbride 10 20 19 9 58 Hamilton 7 17 19 16 59 FPU South Total 38 59 58 53 208 Looked After and Accommodated Children (LAAC) North Lanarkshire Locality Nov Dec Jan Feb Mar Total Airdrie 6 3 2 11 Bellshill 1 9 10 Coatbridge 1 5 1 7 Motherwell 0 North 2 2 Wishaw 12 12 Total 7 1 3 5 26 42 LAAC South Lanarkshire Locality Nov Dec Jan Feb Mar Total C lang/rutherglen 21 21 Clydesdale 3 25 28 East Kilbride 3 7 10 Hamilton 17 17 Total 0 0 0 6 70 76 19

Telephone calls to Child Protection Team for advice Apr-Jun 2010 Jul-Sep 2010 Oct-Dec 2010 Jan-Mar 2011 Total 110 164 139 131 544 Telephone calls to Child Protection Medical Helpline 64 calls Child Protection Website (FirstPort) Below is a snapshot of the visits to the Child Protection Website within FirstPort. The total number of hits represent a ten month period in the financial year 2009-10. The number of hits for 2010-11 represents 12 months. The Child Protection Policies, Guidelines and Documentation are available to view and download if required. The Child Protection Training including Multi-agency Training is also available to view. If training cannot be accommodated on the date requested staff may ask for their name to be placed on a waiting list for future courses The usage of the site has more than doubled in the last financial year Child Protection Documentation No of visits No of visits Webpage 2009-10 2010-11 Child Protection Homepage 4866 17839 Case Conference Outcome 168 366 Case conference template 300 509 Child protection documentation - stationery items 164 340 Child protection documentation awareness proforma 63 367 Child protection guidance for health professionals working in hospitals (pathway) 20 185 Follow up of health professional referral form to social work 97 188 Guidance for completion of case conference 64 223 Guidance for use of health professional referral form to social work 84 216 Sharing information about children at risk 103 210 Child protection - doctors responsibilities BMA 19 66 Child protection - responsibilities of doctors in child protection cases 27 40 GMC_0-18yrs guidance 15 26 20

Child Protection Policies & Guidelines 1. Intro section 41 146 2. West of Scotland interagency guidance 57 217 3. Health guidelines for the west of Scotland contents 46 114 4. Health guidelines for the west of Scotland 53 142 5. Health guidelines useful telephone numbers 43 96 Child Protection Additional Policies & Guidelines Webpage 21 No of visits 2009-10 No of visits 2010-11 0. Additional Policies Front Cover and Contents 47 145 1. Information Sharing Policy 53 213 2a. Policy for Reporting Mechanisms 52 194 2b. Procedure for Reporting Mechanisms Child Protection 47 183 3. Monitoring Contact of Children on the Child Protection Register 56 203 4. Guidance for Unseen Child 56 186 5. Attendance at Case Conference Case Discussions 61 161 6. Retention of Child Health Records - Family Records for Missing Families 37 140 7. Guidelines for Legal Proceedings in Relation to Child Protection Issues 43 165 8. Process For Addressing Practice Issues 43 150 9. Child Protection Significant Incident Review (CPSIR) 126 10. Vulnerable Children Policy 172 11. Child Protection Supervision 104 Inter-agency Guidance Lanarkshire significant case review protocol 59 Lanarkshire Vulnerable Children and Young People Good Practice Guide 27 105 Risk management for children and young people with problem sexual behaviours 104 Transfer of children s records cross authority - agreed principles 63 When parents - carers of children are arrested 34 61 Working with hostile and unco-operative families 70 80

Consent to share information 27 67 Flyer - Obtaining Consent - Good Practice Guidance 18 40 Lanarkshire Information Sharing Protocol - Good Practice Guidance 39 164 The Lanarkshire Partners Guide to Information Sharing Leaflet 24 64 Positive examples of child Protection Messaging - flyer 17 23 Z-Card - A Guide to Sharing Information for Young People 20 37 Working with Children and families Affected by Substance Misuse Webpage No of visits 'Information to' form 106 69 Working with children and families affected by substance misuse protocol 101 134 HMIe Webpage No of visits HMIE guidance note 119 How well do we protect children and meet their needs 270 How well do we protect Scotland's children 94 22

CHILD PROTECTION MEDICAL AUDIT CONDENSED ANNUAL REPORT NHS LANARKSHIRE APPENDIX 2 APRIL 2010 MARCH 2011 BY DR. KAMALA RAY ASSOCIATE SPECIALIST DATA PROVIDED BY DR K. RAY, DR L. HUNTER, DR L. AGRAWAL, DR M. MULLA & DR M. MERCY (SENIOR DOCTORS PROVIDING CHILD PROTECTION MEDICAL SERVICES) 23

AUDIT 1 TOTAL NUMBER OF CHILDREN SEEN RAY HUNTER AGRAWAL MERCY MULLA 2010 29 (27 ) 26 (30) 38 (35) 3 (4) 70 (4) 166 FIGURE IN BRACKET FOR YEAR 2009 Total number of children seen in previous years 2009 2008 2007 2006 2005 100 111 94 101 120 No. of children seen 180 160 140 120 100 80 60 40 20 0 2005 2006 2007 2008 2009 2010 Year CONCLUSION: TOTAL NUMBER OF CASES SEEN HAS GONE UP IN 2010 24

AUDIT 2 GENDER OF CHILDREN RAY HUNTER AGRAWAL MERCY MULLA TOTAL M F M F M F M F M F M F 12 17 9 17 21 17 2 1 42 28 86 80 29 26 38 3 70 166 GENDER OF CHILDREN 80 86 MALE FEMALE CONCLUSION: APPROXIMATE SEX INCIDENCE RATIO: MALE SLIGHTLY MORE 25

AUDIT 3 TYPE OF ABUSE TYPE RAY HUNTER AGRAWAL MULLA MERCY TOTAL SEXUAL ABUSE 7 8 6 3 2 26 PHYSICAL ABUSE 17 13 20 13 1 64 NEGLECT 2 11 20 33 EMOTIONAL ABUSE 2 3 5 OTHER 5 1 1 11 18 EMOTIONAL ABUSE & NEGLECT PHYSICAL ABUSE & NEGLECT 16 16 4 4 TOTAL 29 26 38 70 3 166 TYPE OF ABUSE CHART SEXUAL ABUSE PHYSICAL ABUSE 11% 3% 10% 2% 16% NEGLECT EMOTIONAL ABUSE 20% 38% OTHER EMOTIONAL ABUSE & NEGLECT PHYSICAL ABUSE & NEGLECT 26

AUDIT 4 TYPE OF MEDICAL CM / FM RAY HUNTER AGRAWAL MULLA MERCY TOTAL CM FM CM FM CM FM CM FM CM FM CM FM REF MED 9 20 16 10 18 20 49 19+2 3 92 72 2 29 26 38 70 3 166 CM: COMPREHENSIVE MEDICAL FM: FORENSIC MEDICAL REF MED: REFERRAL MEDICAL AUDIT 5 TYPE OF JOINT MEDICAL TYPE RAY HUNTER AGRAWAL MULLA MERCY TOTAL Sexual Abuse 5 5 4 3 2 19 Physical Abuse 15 5 13 13 1 47 Neglect 2 2 Other 1 3+2(REF MED) 6 TOTAL 20 10 20 21 3 74 27

AUDIT 6 AGE OF CHILDREN SEEN FOR SEXUAL ABUSE AGE RAY HUNTER AGRAWAL MULLA MERCY TOTAL 15 2 2 14 1 2 3 13 1 1 12 2 2 4 11 1 1 2 10 1 1 2 9 1 1 8 1 1 6 1 1 5 1 1 4 1 1 2 3 1 1 1 3 2 2 1 3 TOTAL 7 8 6 3 2 26 CONCLUSION: HIGHEST NUMBER FROM AGE 2-5 SECOND HIGHEST AGE 11-13 AUDIT 7 AGE OF CHILDREN FOR PHYSICAL ABUSE AGE RAY HUNTER AGRAWAL MULLA MERCY TOTAL 16 1 1 15 2 2 14 2 2 2 6 13 1 1 2 10 1 1 9 1 1 2 8 1 1 7 4 1 5 6 1 1 2 5 1 2 3 2 8 4 3 1 3 1 8 3 3 3 3 9 2 2 3 1 3 1 10 1 2 1 1 4 < 1 3 1 2 1 7 TOTAL 17 13 20 13+4=17 1 68 CONCLUSION: HIGHEST NUMBER OF PHYSICAL ABUSE SEEN IN 2-3 YEAR OLDS 28

AUDIT 8 SEXUAL ABUSE / SEX OF CHILDREN RAY HUNTER AGRAWAL MULLA MERCY TOTAL SEX FEMALE 5 8 6 2 1 22 MALE 2 1 1 4 TOTAL 7 8 6 3 2 26 CONCLUSION: MORE SEXUAL ABUSE CASES IN FEMALES AUDIT 9 PHYSICAL ABUSE / SEX OF CHILDREN RAY HUNTER AGRAWAL MULLA MERCY TOTAL SEX FEMALE 8 5 6 4 23 MALE 9 8 14 13 1 45 TOTAL 17 13 20 17 1 68 USED FOR SA CONCLUSION: MORE PHYSICAL ABUSE CASES IN MALES AUDIT 10 VIDEO COLPOSCOPY USED FOR SEXUAL ABUSE CASES RAY HUNTER AGRAWAL MULLA MERCY TOTAL YES 4 4 3 3 14 NO 3 2 3 8 NK 2 2 4 TOTAL 7 8 6 3 2 26 FOR PA NOT USED BY ANYONE FOR PHYSICAL ABUSE CASES REASON FOR NOT USING: 1. NO GENITAL CONTACT 2. HISTORICAL CASE 3. FOR INVESTIGATIONS ONLY 4. DID NOT AGREE AUDIT 11 FINDINGS FOR PHYSICAL ABUSE FINDINGS RAY HUNTER AGRAWAL MULLA MERCY TOTAL + VE 13 8 12 12 45 -VE 3 6 1 10 SUPPORTIVE 1 3 4 INCONCLUSIVE 4 1 2 2 9 TOTAL 17 13 20 17 1 68 CONCLUSION: SIGNIFICANT POSITIVE FINDINGS 29

AUDIT 12 FINDINGS IN SEXUAL ABUSE FINDINGS RAY HUNTER AGRAWAL MULLA MERCY TOTAL +VE 2 2 1 5 -VE 2 3 6 2 13 SUPP 1 2 3 INCON 1 1 NO V/C USED 3 1(UNCOP) 4 TOTAL 7 8 6 3 2 26 CONCLUSION: AS EXPECTED MORE NEGATIVE OR NORMAL FINDINGS AUDIT 13 REFERRAL SOURCES REFERRED BY RAY HUNTER AGRAWAL MULLA MERCY TOTAL POLICE 23 17 4 19 2 65 SOCIAL WORK (SW) 3 7 5 12 1 28 GP 2 3 3 8 COMM PAED 1 1 PAEDIATRIC WGH 1 3 3 7 A & E 1 1 HEALTH VISITOR (HV) 2 7 17 26 GP & SW 1 1 GP & PHN 3 3 POLICE & SW 6 6 SCHOOL 4 4 HV & SW 3 10 13 NURSERY 2 2 MUM 1 1 TOTAL 29 26 38 70 3 166 30

AUDIT 14 TYPE OF INJURY IN PHYSICAL ASSAULT TYPE RAY HUNTER AGRAWAL MULLA MERCY TOTAL BRUISING 8 7 8 6 29 ABRASION 2 2 BURN 4 1 5 SLAP 2 1 3 BITE 1 1 2 FRACTURE RIB 1 1 2 SCRATCH 2 1 3 FRACTURE(SKULL & LONG BONE 1 1 2 4 BALD HAIR PATCH 1 1 TOTAL 17 10 12 12 51 CONCLUSION: COMMONEST TYPES OF INJURY: 1) BRUISE 2) BURN AUDIT 15 AREA AREA RAY HUNTER AGRAWAL MULLA MERCY TOTAL S. LANARKSHIRE 13 9 13 7 42 N. LANARKSHIRE 16 16 24 60 3 119 DUMFRIES 1 1 2 GLASGOW 1 1 RUTHERGLEN NOT KNOWN 2 2 TOTAL 29 26 38 70 3 166 CONCLUSION : LARGE NUMBER OF CASES SEEN FROM NORTH LANARKSHIRE 31

AM BEFORE NOON AUDIT 16 TIME OF MEDICAL EXAMINATION EARLY (BEFORE 3PM) PM LATE (AFTER 3PM) MEDICAL CONTINUING OR STARTED AFTER 5PM RAY 2 16 5 ALL 5 HUNTER 1 5 10 2 AGRAWAL 3 22 8 1 MULLA 14 38 12 MERCY TOTAL 20 81 35 8 (5+3) SAT SUN BANK HOLIDAY NOT KNOWN TOTAL RAY 4 1 1 29 HUNTER 1 1 6 26 AGRAWAL 4 38 MULLA 1 2 (one 3 70 started at 12) MERCY 2 1 (contd 3 until 1.30) TOTAL 12 5 1 9 166 MEDICAL FINISH TIMING NOT RECORDED BY ALL EACH MEDICAL TAKES APPROXIMATELY 2-6 HRS CONCLUSION: MOST CASES SEEN BEFORE 3 PM. CONSIDERABLE NUMBERS SEEN AFTER 3PM FEW CASES SEEN AFTER 5PM SIGNIFICANT NUMBERS SEEN OVER W/E THE ABOVE AUDIT DOES NOT INCLUDE THE TIME OF MEDICALS EXTENDING AFTER 5 PM 32

AUDIT 17 SEXUAL ABUSE CASES AREA AREA RAY HUNTER AGRAWAL MULLA MERCY TOTAL S. LANARKSHIRE 2 4 2 1 9 N. LANARKSHIRE 5 3 3 1 2 14 GLASGOW 1 1 DUMFRIES 1 1 2 TOTAL 7 8 6 3 2 26 CONCLUSION: MOST CASES SEEN FROM NORTH LANARKSHIRE AUDIT 18 CONSENT WRITTEN RAY HUNTER AGRAWAL MULLA MERCY TOTAL M 14 PARENT 56 120 D 3 15 29 3 CHILD 3 3 6 CHILD+MUM 6 7 13 VERBAL 2 2 9 13 OTHER 1 SW 1 NO 8 3(NO MEDICAL) 11 NOT KNOWN 1 1 2 TOTAL 29 26 38 70 3 166 Conclusion: written consent is obtained in all cases wherever it is available AUDIT 19 MEDICALS AS PER QUARTER BY EACH DOCTOR 1ST 2ND 3RD 4TH TOTAL RAY 11 5 6 7 29 HUNTER 10 5 3 8 26 AGRAWAL 3 5 15 15 38 MULLA 16 19 14 21 70 MERCY 1 1 1 3 Conclusion: Most medicals are in first & last quarters Nearly same numbers for all doctors in 2 nd quarter 33

19 AUDITS COMPLETED I WOULD LIKE TO THANK MY COLLEAGUES FOR PROVIDING ME WITH DATA TO COMPLETE THIS AUDIT FULL MEDICAL AUDITS REPORT IS AVAILABLE ON THE CHILD PROTECTION WEBSITE IN FIRSTPORT 34