Date: 29/10/2015 Agenda Item: 2.3

TRUST BOARD IN PUBLIC Date: 29/10/2015 Agenda Item: 2.3 REPORT TITLE: Safeguarding Children Annual Report 2014 / 2015 EXECUTIVE SPONSOR: Fiona Allsop, Chief Nurse REPORT AUTHOR: Vicky Abbott and Sally Stimpson Named Nurses for Safeguarding Children Patient Safety & Risk Committee 15/07/15 REPORT DISCUSSED PREVIOUSLY: (name of sub-committee/group & date) Trust Safeguarding Children Committee 04/06/15 Safety and Quality Committee 06/07/15 Action Required: Approval () Discussion () Assurance () Summary of Key Issues The Annual Report for Safeguarding Children provides the board with assurance regarding statutory compliance with Section 11 of the Children Act (2004) and enables the Board to review safeguarding activity across the Trust. Areas discussed include: Annual comparison trends for information shared with other agencies and referrals to children s services Key activities implemented in 2014/15 Evidence of progress made in relation to ongoing work plans. Priorities for children s safeguarding in 2015/16 Surrey and Sussex Section 11 Self Assessments and review CQC Inspection Key points to note are: 8.5% increase in information shared with members of the multiagency team Commencement of 6 monthly Level 3 multi-professional Safeguarding Children Training at East Surrey Hospital which has increased our training compliance for Level 3 training to 72%. Hospital Link Social Worker from Surrey Social Services in attendance at Weekly Safeguarding Meetings held at the Trust. 1

Relationship to Trust Strategic Objectives & Assurance Framework: SO1: Safe -Deliver safe services and be in the top 20% against our peers SO3: Caring Ensure patients are cared for and feel cared about SO4: Responsive Become the secondary care provider and employer of choice for the catchment populations of Surrey & Sussex Corporate Impact Assessment: Legal and regulatory implications Financial implications Patient Experience/Engagement Risk & Performance Management NHS Constitution/Equality & Diversity/Communication Attachments: Nil Yes Yes Yes Yes Yes 2

Executive Summary Safeguarding activity across the organisation is increasing, demonstrated by the increase in safeguarding referrals and daily contact through the safeguarding office. Safeguarding principles are well ingrained in hospital practice throughout the Trust. Staff from a range of specialities consistently demonstrate they have considered vulnerable children in relation to any patients attendance at East Surrey Hospital, regardless of their age. They enthusiastically embrace new themes and key messages from the Safeguarding children team, most recently Child Sexual Exploitation awareness. Since the introduction of in house training at level 3 the percentage of staff being appropriately trained is currently at 72%. This is a very significant achievement for a second year for which the Safeguarding Children Team should be commended. The CQC inspected West Sussex Safeguarding in February 2015, and as part of that spent a day reviewing cases and safeguarding children practices at East Surrey. We are still awaiting the formal report from the CQC; however we have had feedback that the inspectors were very impressed with the safeguarding activity they audited at the hospital. We have been involved in one serious case review for Surrey Safeguarding Board which is due for publication in July 2015. Any actions identified from the report will be embedded into our overarching action plan to ensure progress against the action is monitored closely. We are not anticipating any significant areas for action from this serious case review. 3

1.0) Introduction This annual report demonstrates how the organisation is discharging its statutory duties in relation to safeguarding children under Section 11 of the Children Act (2004). 1.1) The aim of this report is: a) To provide assurance that the Trust fulfills safeguarding activity to meet national safeguarding children standards. Key to this is the implementation of actions from the Section 11 Audits and Serious Case Review recommendations. b) To provide an update on service developments in relation to safeguarding children. c) To demonstrate continuous improvement in safeguarding children systems. d) To address any existing or potential areas of risk in relation to statutory responsibilities. 1.2) Safeguarding and promoting the welfare of children is defined as: Protecting children from maltreatment Preventing impairment of children s health and development Ensuring children grow up in circumstances consistent with the provision of safe and effective care Taking action to enable all children to have the best outcomes (Working Together 2015) 1.3) During 2014/15 the Safeguarding Children Team has worked with many internal and external partners across both Surrey and Sussex in a variety of activities to ensure that children are appropriately safeguarded. These activities range from attendance at child protection conferences, child death reviews, strategy meetings with police and social services, training, external and internal safeguarding meetings and supervision; alongside daily management of child protection and safeguarding cases throughout the hospital. 2.0) Section 11 of the Children Act (2004) 2.1) Improving the way key people and bodies safeguard and promote welfare of children is crucial to improving outcomes for children. Section 11 of the Children Act 2004, places a duty on key persons and bodies to make arrangements to ensure that in discharging their functions, they have regard to the need to safeguard and promote the welfare of children. 2.2) Section 11 compliance is a statutory requirement for Surrey and Sussex Healthcare NHS Trust. Compliance is assessed and monitored by the safeguarding boards in both Surrey and West Sussex by the submission of a RAG rated Self-Assessment Audit. Outstanding actions (appendix 1) identified from the audit are uploaded to the overarching Trust Safeguarding Children Committee action plan. This action plan is and reviewed bimonthly at the Trust Safeguarding Children Committee meeting and activity around the actions is recorded providing a clear governance structure. Surrey & Sussex Healthcare NHS Trust last submitted their Self-Assessment to Surrey Children Safeguarding Board on 19/08/14 and is attached as Appendix 1. 4

2.3) The Self-Assessment for Sussex was last submitted on 30/04/14 and reviewed at the Section 11 Scrutiny Panel in August 2014. We have responded to the review and provided additional clarification and information as requested by 30 th September 2014. The Self- Assessment is attached as Appendix 2. Appendix 3 shows our current action plan with actions embedded. It should be noted that the Trust demonstrates compliance with section 11 and this was further endorsed by the CQC inspection. As with any standard there will inevitably be work and actions which are generated but these are monitored and actioned through the Trust Safeguarding Children Committee. 3.0) Care Quality Commission Inspection February 2015. 3.1) An inspection was carried out in February and the feedback from the inspectors was extremely positive, with them taking away safeguarding template documents and criteria as examples of best practice. There will be a formal report in the coming months which will be disseminated via the Trust Safeguarding Children Committee. 4.0) The Safeguarding Children Team 4.1) The Children Act (2004) requires each acute Trust to appoint Named Professionals to take the lead on children and young people safeguarding matters within the Trust, and to advise all staff employed by the Trust on awareness and processes related to safeguarding children. 4.2) The Safeguarding Children Professionals at East Surrey Hospital for 2014 are Vicky Abbott Named Nurse (job share) Sally Stimpson Named Nurse (job share) Miranda Johnson Named Midwife* Salli Alihodzic Specialist Midwife** Dr Yekta Dymond Named Doctor (job share) Dr Katie McGlone Named Doctor (job share) Laura Lewis Administrative Assistant to Safeguarding Team *Miranda Johnson is currently covering the Named Midwife post for Janice Blythman **Salli Alihodzic is currently covering the Specialist Midwife post for Maureen Royds-Jones. The Executive Lead for Safeguarding Children is the Chief Nurse, Fiona Allsop 4.3) Designated Doctor and Nurses. The Designated Professionals for Surrey and Sussex CCGs provide supervision for the Trust s Named Nurse, Midwife and Doctor who meet with the designated person for supervisory sessions and personal review. The Designated CCG professionals for Surrey and Sussex NHS Trust (SaSH) are: Designated Doctor Surrey Sussex Dr Kate Brocklesby Vacant post since August 2014, Dr Jamie Carter, Designated Doctor from Brighton providing some cover. 5

Designated Nurse Surrey Amanda Boodhoo Sussex Sarah Smith 4.4) The safeguarding team continue to work closely with key staff at SaSH Joanne Farrell - Matron for Children and Young People Ingrid Marsden Neonatal Matron Sarah Muller - Paediatric ENP Emergency Department Fiona Crimmins - Vulnerable Adults Lead 5.0) Safeguarding Referrals from East Surrey Hospital 5.1) Any member of Trust staff can raise a concern about a child or family to the safeguarding children team. We currently have a two tier referral system a) An Information Sharing form for low level risk, these forms are mainly shared within health b) Direct referral to Children s Social Services using a multi-agency referral form (MARF) The Trust Intranet has been updated to enable easy access of forms by all staff. Guidance for staff regarding the completion of safeguarding referral forms is given during their annual statutory and mandatory update. 5.2) All referrals are discussed in detail at Multidisciplinary Weekly Safeguarding Meetings and all are recorded on a specified database. The weekly meetings are held within the Neonatal Unit, ED and Outwood / Child Assessment Unit. The Maternity Department have monthly Safeguarding Meetings. The majority of referrals continue to be generated through the Emergency Department. 5.3) Following the success of the Emergency Department completing all their referrals electronically, all areas now complete Information Sharing Forms and referrals to Children s Services electronically. The electronic completion of referral forms is to be rolled out in the maternity department in 2015. Electronic referrals have been welcomed by Health Visitors, School Nurses, GP s and Children s Services across both Surrey and Sussex. 5.4) The total number of Information Sharing Forms completed by the Trust in 2014 was 4872; in addition 1296 referrals were sent to social services regarding vulnerable children and families. This demonstrates an 8.5% increase in Information Sharing activity and a 9% decrease in referrals to social services from the previous year. The hospital has seen a 5.6% increase in attendances this year from the previous year and therefore we would expect to see a similar increase in activity though the safeguarding children office. For our increase to be higher than the overall attendance increase demonstrates that staff are identifying vulnerable families at an earlier stage and sharing information appropriately which could explain the decrease in referrals to social services. 5.5) Identifying and referring vulnerable children and families is a key role for all clinical and non-clinical staff across the hospital. This ensures that vulnerable children do not pass through the hospital undetected and the Trust, as an organization, does not fail in its statutory duty to share concerns. Training is essential to continue to raise staff awareness 6

and enable staff to recognise when a child is being, or is at risk of being abused to ensure that the relevant information is shared appropriately as soon as possible. 5.6) When children and young people make an allegation against a member of staff (employed within the Trust or employed externally) the information is shared with the Local Authority so they may investigate the incident. The Trust has a policy for allegations against staff whom are employed at SaSH. 6.0) Safeguarding Children Training This section is broken down into Safeguarding Training for Hospital Staff (not including doctors) and Safeguarding Training for Doctors. Explanation of the different levels of training as set out in the Intercollegiate Document (RCPCH 2014) Course Trust Frequency Government Recommendation Child Protection Level 1, required for all Trust Staff, both clinical and non-clinical. All staff at SaSH now receive Level 2 training. Annual Minimum 2 hours every 3 yrs. Child Protection Level 2, required for all staff with access to patients, both paediatric and adult Child Protection Level 3, required by those staff working in key paediatric areas e.g. maternity, paediatric ward and paediatric ED Annual (45minute session) Annual (1/2 day or full day depending on personal educational requirement) Minimum 3-4 hours every 3 yrs. Minimum 6-16 hours every 3 years 6.1) Safeguarding Training for Hospital Staff (not including doctors) Figures for the period up to 31/03/15 Required % Attained % To Achieve Level 2 3232 69% 85% Level 3 615 61%* 85% *following Level 3 course in May 2015, 75% of eligible staff will be trained Figures provided by the Training Department from OLM database. 6.2) Children's safeguarding training continues to be delivered as part of Trust Statutory and Mandatory training and meets the criteria outlined in the Intercollegiate Document (RCPCH, 2014) however following an audit by Sarah Smith Designated Nurse for Sussex 7

in November 2014, it was identified that the session should be 60 minutes instead of its current 45 minutes. The MAST program is currently being extensively reviewed and those involved in the review are aware of the timing issue. Level 2 training is now given to all members of SASH staff which exceeds recommendations. Compliance with training has been a challenge due to the availability of places on statutory updates. There is also an e-learning package for all three levels of safeguarding training which allow staff to complete some training online. This is to be used in addition and to complement the face to face training which is given to all staff members for example for new starters until they are able to access the relevant training days. 6.3) The Named Nurses are continuing to run Level 3 days and these have been well received and there is currently a waiting list for places. Sarah Smith Designated Nurse West Sussex audited the day in November 2014 and gave excellent feedback. We are awaiting confirmation from Amanda Boodhoo, Designated Nurse for Surrey, that the day meets the Safeguarding Board requirements for level 3. The Level 3 single agency update sessions continue to be provided by the Specialist Midwife and Named Nurse within the key areas. Safeguarding Training for Doctors 6.4) 182 junior doctors work across the various specialities in the trust all of whom require Level 2 safeguarding training. 32 (17%) receive face to face safeguarding training from the Named Doctor, the remaining 150 (83%) all complete the Trust e-learning safeguarding children level 2 package. The 21 junior doctors in paediatrics also receive face to face Level 2 safeguarding training in their departmental induction. The Named Doctor delivers level 2 safeguarding training for the Consultants Annual Mandatory Training Day. Anaesthetics and Emergency Dept trainees receive a safeguarding session as part of their education programme. Many Doctors across the Trust have attended the level 3 training days, but exactly who should receive this training from the Consultant workforce remains to be clarified. Surrey SCB are working on a Surrey Wide Training Strategy for medical staff which will address this very issue. 6.5) From January 2014 monthly SPEER (Safeguarding Peer Review) meetings take place to discuss and review recent safeguarding cases to improve areas of weakness in these cases and provide a forum for open discussion. These meeting have been very well attended by all Pediatricians. 6.6) The Named Doctor presented a case of Fabricated Illness at the Hospital Medical Grand Round in March 2015 to multi-specialty audience, this resulted in healthy debate and audience discussion. The paediatric department commenced weekly Simulation Teaching in April 2015 which incorporates Non Accidental Injury into some of the scenarios. These sessions have participants from a multidisciplinary audience including doctors, nurses and midwives. 7.0) Criminal Records Bureau 7.1) The Trust complies with NHS Employers Guidance on all pre-employment checks and with the Disclosure and Barring Service Code of Practice. Following changes to the DBS checks the Trust has recently undergone a review of which posts within the Trust require a DBS check and at what level. 8

7.2) DBS Report 92% are cleared. 8% forms with agency awaiting clearance. 8.0) External Meetings 8.1) The Surrey Safeguarding Children Board Health Group and the Sussex Safeguarding Board invite the Trust Executive Lead for Safeguarding Children to attend their quarterly meeting. Named professionals are invited to sub groups of the board across both Surrey and Sussex. 8.2) Multiagency work around Domestic Abuse is increasing and from May 2015 Trust Representatives from the Safeguarding Team will be attending the MARAC (Multi Agency Risk Assessment) meetings in Surrey. 8.3) The Surrey MAECC (Missing and Exploited Children Committee) will be attended by the Named Nurses to identify and safeguard children who are currently victims of CSE in Surrey. 8.4) The SASH / 0-19 team meeting continues and has made a positive difference to the working practices for the staff working on the frontline. 9.0) Named Staff Supervision and Training 9.1) The Named Nurses and Named Midwife receive formal supervision from the Designated Nurse from Surrey and Sussex CCGs. The Named Doctor receives supervision from the Designated Doctor. 9.2) Dr Yekta Dymond returned from maternity leave in February 2015 to the role of Named Doctor which she now job shares with Dr Katie McGlone. Both doctors are in the process of securing places on level 4 safeguarding training. 9.3) Vicky Abbott, Named Nurse has completed her PGCert / MSc (60 credits) in Safeguarding Children at Brighton University graduating in February 2015. Sally Stimpson, Named Nurse has taken on the role as Child Sexual Exploitation Champion and has rolled out a bespoke training program for all key areas at the hospital. Sally has also attended a Surrey Safeguarding Board Domestic Abuse training day. 9.4) The Maternity Matron is the Named Midwife for Safeguarding and oversees the Specialist Midwife, Salli Alihodzic. Within the Department, the Specialist Midwife for Safeguarding carries delegated responsibility for the role of the Named Midwife and she directly reports to the Named Midwife. Salli is planning on attending safeguarding supervision training and a level 4 safeguarding session when one becomes available. 10.0) Serious case reviews / Individual Management Reviews. (SCR / IMR). 10.1) The Safeguarding Children Team have been involved in a Serious Case Review following an incident in June 2014 and are awaiting the final report from the Safeguarding Board. Once published, the SCR will be shared through the Trust Safeguarding Children 9

Committee. Any identified actions will be monitored through the overarching Trust Safeguarding Children Action Plan. 11.0) Audit 11.1) There is an audit program in place for safeguarding (appendix 4). The completed audits are reported into the Trust Safeguarding Children s Committee where any identified actions are monitored through the action plan. 11.2) A deep dive audit of safeguarding notes by the CCG took place in February 2015 with good initial feedback. 12.0) Priorities for 2015-2016 12.1) The following are the priorities for the next twelve months: To continue working with the Training Department to improve compliance for Level 2 Training and ensure that the training compliance data is regularly received by the Trust Safeguarding Children Committee Working closely with the Emergency Department to ensure that safeguarding children paperwork is included in the development of electronic records. The templates should be available to use in Cerner from July 2015. Updating the skeletal survey protocol in line with Surrey Safeguarding Board guidance Securing a local agreement with a Paediatric radiologist to provide a second report on all skeletal surveys to improve the quality of our reports given that children s x- rays are complex to interpret To continue to provide training for Level 3 and ensure compliance is correctly recorded To adopt the Surrey Safeguarding Board Deliberate Self Harm pro-forma to improve the initial psychological assessment of children presenting to hospital. To review all safeguarding children policies and processes in line with new Working Together 2015. Redesigned the Maternity Information Sharing form to include a body map so the staff can document birth marks clearly to improve communication with community practitioners. To amend current invite letters for Paediatric outpatients to include a statement informing parents of Trust process of sharing information regarding non-attendance with the safeguarding team. 10

Appendix 1 Surrey Section 11 Audit 2014-3.xls Appendix 2 Sussex April 2014 review.doc Appendix 3 TSCC Action Plan April 2015.xls Appendix 4 Copy of Core Safeguarding Audit Pr 11