Child Safeguarding Annual Report 01/016
Child Safeguarding Annual Report Report Aim The report is to: Provide assurance that UCLH has processes in place to meet its commitments under section 11 of the Children Act 004 Assess the continuing work of the Child Safeguarding Committee and the child safeguarding team Identify key objectives for the coming year. 1 Safeguarding strategy This is unchanged and all staff members within the Trust are required to work in accordance with the UCLH Safeguarding Children Policy with the underpinning values that: Every child matters and the welfare of children is paramount All UCLH staff share the responsibility to safeguard children and promote their wellbeing. Staff are enabled to meet this requirement by receiving training in child safeguarding at the appropriate level and frequency. Executive Summary Summary of key achievements 1. Training: Compliance with level 1 and training is greater than 9%.. Section 11 audit: Action plan completed (Section 11 is a 004 addition to the children act which stipulates what an organisation must have in place to meet their safeguarding responsibilities). 3. Chaperones: Trust-wide guidance is completed and being submitted for approval. Plans are in progress to recruit and train volunteer staff to support national guidance recommendations around the chaperoning of children undergoing any intimate examinations. Summary of key risks Electronic flagging: The risk to the system of duplicated hospital numbers remains. Training: although level 3 training compliance has improved in year it is still well below the Trust target of 9%. Security on UCH Wards T11/T1: Following on from an incident when a 9 month old baby (suspected non-accidental injury) was removed from T11 by her parents we are reviewing our security arrangements for our inpatient areas for children and young people. 3 UCLH Child Safeguarding Commitments 3.1 Lines of Accountability Lines of accountability remain unchanged (see diagram 1). Annual reporting to the Trust Board of Directors and biannually reporting to the Quality and Safety Committee continues. There has been a change to the maternity safeguarding team which is now being led by
Cheri Barry (Appendix 1). The executive board lead and named professionals meet monthly to monitor action plans and training compliance, plan for external inspections and scrutiny. The Trust Child Safeguarding Committee meets quarterly to agree policy and procedures learn from case reviews and share good practice. Regular safeguarding meetings continue within key areas. Diagram 1: UCLH Children's Safeguarding Organisational Chart 3. Safe Recruitment The employee checking arrangements we follow for all staff are extensive and in line with NHS employment check standards and best practice. Our new starting at UCLH policy which was published in September 01 links directly to these standards to ensure that any changes are replicated immediately in policy. The recruitment team conduct face to face identity checks with staff, utilising identity checking software to check authenticity of documents. Since October 01, at the identity check appointment, the recruitment team take a photograph which is then used for their security pass to ensure that the person seen at the identity check is the person who starts in post. These enhancements have delivered high levels of compliance in this area as evidenced by the external bi-annual and monthly in-house audit results on identity, eligibility to work and Disclosure and Barring Service checks. The audit results are monitored by the Trust s Workforce Policy Management Group. Processes are in place to manage allegations against staff including joint working with Camden Safeguarding Board via the Local Authority Designated Officer (LADO). The Lampard review of the Jimmy Savile cases was recently published. One of the recommendations included introducing a 3 yearly repeat DBS (a criminal record) check for 3
all staff. We have secured funding and are introducing this to staff in the most vulnerable areas including: Critical care ED Paeds Women s Health We will report progress against this to the Camden Safeguarding Children Board. (CSCB) 3.3 Policies and Procedures There are no major changes to the UCLH Child Safeguarding Policy and Child Death Procedures. A new policy for missing and absconding patients has been ratified which includes procedures for managing the risk of removal of a child against medical advice or children and unborn who are subject to child protection investigation procedures. In addition to this we will be trialing out of hours lock down of the child and adolescent floors in response to a recent incident on T11 where a family under child protection investigation left the ward. 3.4 Training Level and frequency of training remains unchanged (see table 1). Level 1 and elearning packages and level 3 classroom training have been restructured to reflect updated intercollegiate guidance for child safeguarding and looked after children. Minimum Level and frequency of Child Safeguarding training Level 1 once Level 1 three yearly Level three yearly Level 3 three yearly Staff groups All non-clinical, non-front facing staff All front facing non-clinical staff, All clinical staff All nurses and consultants in A&E, Obstetrics, Neonatology, Paediatrics and Paediatric Dentistry and Orthodontists, AHP s working in paediatric or neonatal areas, Paediatric surgeons and anaesthetists Table 1: Training level and frequency required by UCLH staff 4
Figure 1 Compliance (%) against child safeguarding training requirements for all staff at UCLH NHS Trust Improvement has been made in in all levels of training compliance and level 1 and are now over the Trust target of 9%. Progress for level 3 training remains challenging and despite improvement in year this is still considerably below the target of 9%. Update training within midwifery skills week, half day updates introduced eighteen months ago and bespoke training for obstetric consultants has made an impact on the number of staff whose training has lapsed. This number is down to 30 at end of March 016 compared to 94 in 01. Of the 17 non-compliant level 3 staff only 4 have not completed level elearning and they are all new to the Trust and will be completing their training in May. (See table ). While new starters are waiting for face to face training sessions we ensure that they complete level elearning. a b Breakdown of level 3 non-compliance end March 01 Number of staff 01 Number of staff 016 Total number of staff who are not compliant with level 3 safeguarding training 18 17 69 Number of staff who we have no record of ever completing level 3 safeguarding training 91 97 66 c Number of staff who we have no record of ever completing level or level 3 safeguarding training 30 4 4 d Number of staff who have been non-compliant with level 3 for > 1 year AND staff who we have no record of ever completing level or level 3 safeguarding training 13 0 N/A Table : Level 3 non-compliance Training booked in 016
Division Completed Not Completed Cancer Services 1 Clinical Support Eastman Dental Hospital 6 1 Emergency Services 91 34 Gastrointestinal 1 Imaging 3 Infection 1 Medical Specialties Paediatrics Division 169 18 Queens Square Research and Development 1 RNTNE Hospital 36 3 Theatres and Anaesthetics 3 Women s Health 337 66 Workforce Grand Total 14 7 1 6 3 1 187 1 39 403 % 8.7% 96.% 7.8% 83.3% 90.3% 9.3% 60% 83.6% Grand Total 698 17 8 84.6% Table 3 Breakdown of level 3 non-compliance by division Additional training Key members of the safeguarding team have received bespoke training on providing safeguarding supervision which will be employed to further develop in-house supervision for community midwives. 3. Inter-Agency Working There has been a major change to Camden s hospital social work provision which has been reduced in size as part of a redesign of services and relocated off site at their headquarters in St Pancras Square. The impact has been a decrease in routine attendance at UCLH multi-disciplinary meetings with the exceptions of emergency department and maternity safeguarding meetings. There has also been a change to the allocation of Camden unborn cases which historically were held within the hospital social work team until discharge following birth. These are now assigned to the team who will hold the case long term, e.g. the Looked After Children s team if there are plans for removal. This has increased the number of social workers involved with our pre-birth caseload and we are working closely with team managers to maintain the close working relationship traditionally enjoyed between midwives and social workers within Camden. Individual staff members continue to represent UCLH on Camden Safeguarding Board and its sub groups. 4 External Review 4.1 CQC inspection This took place in March and included safeguarding provision and we await formal feedback. 6
4. Ofsted Joint Area Inspection Camden are preparing for inspections of arrangements and services for children in need of help and protection. This will include provision by health. 4.3 NCL Metrics Quarterly submissions of child safeguarding processes and activity continue Child Safeguarding Activity.1 Referrals to social care/family centres An apparent increase of 139 more referrals last year is due to new visibility of referrals sent directly to social care without notification to the UCLH safeguarding team. This has been possible by the merging of two data bases and we now have measures in place obtain any further missing data. 900 800 700 600 00 400 300 00 100 0 809 709 670 number of referrals 014 01 016 Figure : Annual referral rate Maternity services and the emergency department remain the key locations generating referrals and midwives and nurses continue to be the main referrers. There were 119 referrals sent to social care/family centres that were not copied to the safeguarding team and where there is inadequate information to tell where the referral was generated. The remaining referrals show that the split between those arising from adult and child attendances is similar to last year (416 adults and 98 children) 7
Figure 3 Number of referrals to social care by department Reasons for referral to social care/family centres Referrals continue to be for varied reasons with a significant number again linked to issues of substance misuse, domestic abuse and mental ill health and family support. Housing continues to be a major concern for many families and pregnant women and it remains very difficult for all London boroughs to meet the growing demand. Monitoring of the teenage pregnancy referrals has not shown a continuation of the increase that was noted in quarter one and figures overall have been similar to previous years.. Child Death There were 3 expected child deaths at UCLH from 1 st April 01 31 st March 016. Of these 1 were within the neonatal service and 1 within paediatric oncology/haematology service and one in the emergency department. This is within the usual range for UCLH. There were no unexpected child deaths at UCLH..3 Serious Case and Individual Management Review Serious case reviews in progress at time of last reporting..a 16 year old former patient last seen in May 01 had committed suicide in January 014. Following submission of a chronology of involvement UCLH were not asked to contribute further to the review. The review has since been published and there were no recommendations for UCLH. UCLH had also submitted a chronology for the infant aged 10 weeks who died in the community. There were no further requests for information from UCLH. The review of two cases of infants suffering non-fatal but significant brain injuries in the community have now finished and actions are nearing completion. Outstanding actions are to re-audit the screening of domestic violence within the maternity service and to share information from acute adult mental health assessments with UCLH electronically. - New Cases 8
Two other cases have recently gone forward to the panel and decision made to carry out serious case review. Both are child deaths from significant head injuries in the community. 6 Review of Safeguarding Priorities for 01/016 Level 3 training: To ensure that level 3 compliance is 90% by March 016 with special focus on staff members who have never trained and have been in post for longer than one year As discussed above despite improvement in year, we only achieved 84.6% compliance and this will therefore remain a priority in 016/17. There are no longer any staff members who have been in post for over a year with no training. DBS rechecks: to agree timeframes and processes with Human Resources team and report progress to CSCB. Plans and finance is now in place to take this forward CQC inspection: To ensure key people and areas remain alert to new inspection plans when available The inspection has now taken place and we await feedback specific to child safeguarding Patients who repeatedly rearrange appointments: We aim to institute a mechanism to identify families that serially cancel/re-arrange appointments (we already have a system in place for patients who DNA appointments but this does not pick up patients who repeatedly cancel appointments well in advance and rearrange) We are still working on creating a useable report/process to highlight and action these types of cases and will therefore remain a priority in 016/17. Chaperones: To agree procedures for children undergoing an intimate examination. Guidance is in the final stages of agreement and ratification. To continue to progress actions and learning from Section 11 audit and all serious case and child death reviews Actions from Section 11 audit have been completed 7 Safeguarding Priorities for 016/017 i. Level 3 training: To ensure that level 3 compliance is 9% by March 017 ii. iii. iv. Chaperones: To implement chaperone guidance within children and young people s outpatient department Ofsted Inspection: to ensure key personnel remain alert to plans and timeframe DBS re-checks: to work with Workforce to plan the 3 year programme of rechecks so that key staff are prioritised v. In house supervision; group supervision sessions to be developed within the community midwife team vi. CQC Inspection: to action any recommendations 9
vii. viii. ix. Implement CP-IS: This is a national IT solution to identify children on a Child Protection plans presenting to an acute setting. We currently have a local system for identify and flagging patients from Camden and Islington only. This solution will allow us to see patients with child protection plans from all other boroughs. Now that more and more surrounding boroughs are using this system we will implement its use Security on T11 and T1: Following on from an incident when a 9 month old baby (suspected non-accidental injury) was removed from T11s by her parents we must review our security arrangements for our inpatient areas for children and young people. Patients who repeatedly rearrange appointments: Refine process to identify families that serially cancel/re-arrange appointments (we already have a system in place for patients who DNA appointments but this does not pick up patients who repeatedly cancel appointments well in advance and rearrange) x. Review capacity of safeguarding team to deliver level 3 training in context of workload Daniel Wood, Divisional Manager Paediatric and Adolescent Services and Polly Smith, Lead Nurse for Child Safeguarding 10
Appendix 1 Child Safeguarding Leads 11
Polly Smith Child safeguarding Lead University College Hospital 3 Euston Road London NW1 BU polly.smith@nhs.net www.uclh.nhs.uk