Powys teaching Health Board Action Plan

Powys teaching Health Board Action Plan Safeguarding & Protecting Children in Wales: a review of the arrangements in place across the Welsh National Health Service This action plan takes forward the recommendations set out in Health Inspection Wales (HIW) recent review of safeguards in NHS Wales. The Health Board was asked to read the review in conjunction with specific relevant actions for Powys set out in the Health Care Standards Report for 2008-2009. The action plan thus incorporates specific issues arising for Powys. The action plan also takes into account recent inspections findings in relation to the Local Safeguarding Children Board and Child and Adolescent Mental Health Services. Powys Local Safeguarding Children Board was restructured this year to ensure a greater focus on child protection and the most vulnerable children. Wider safeguarding work (particularly prevention and early intervention) is being embedded in the core business of other partnerships such as the Children and Young People s Partnership (CYPP) and the Community Safety Partnership (CSP) for which the LSCB will hold them to account. Powys was a pilot site for LSCB self-assessment and development. The aim is to ensure wide ownership of the responsibility for safeguarding; prevent duplication; and clarify accountabilities. Safeguarding and child protection improvement actions are being driven forward in a number of plans including: Health Care Standards Action Plan CAMHS LDP ( Child and Adolescent Mental Health Service Local Delivery Plan) Workforce Plan CYPP (Children and Young People Partnership) Business Plan LSCB (Local Service Children s Board) Business Plan & SCR (Summary Care Record) Action Plan Youth Offending Services (YOS) Business Plan Corporate Parenting Working Group Action Plan NSF (National Service Framework) action plans 1

This plan will be signed off by HIW and Regional Office and will be built into the performance arrangements for the Health Board. The Board s Lead Director for Children (LDC) will take responsibility for reporting progress to the Board. An attempt has been made to ensure that improvement actions are SMART. As the organisation moves towards a shire structure the LDC will ensure there is clarity about which lead director and officers are responsible for taking action forward. [In the table below green=complete; orange= on course; and red = robust plans not yet in place. (Actions marked orange include those where the substantive policy change has taken place, but has not yet been confirmed through audit.) HIW Recommendation Recommendation 1 -The structures and arrangements to be put in place across the new health service structures to support the child protection agenda are clarified as a matter of urgency. These arrangements need to take full account of the requirements of the Children Act 2004 and the recommendations arising from Lord Laming s report of March 2009. Which partnership/plan Corporate Plan Workforce Plan Commentary Improvement actions Lead Director and Support Officers CEOs letter setting out arrangements within PtHB PtHB Lead independent Board Member Lead Officer Board Member Designated Doctor Designated Nurse Named Doctor Named Nurse Named Midwife 2 WTE nurse specialists for safeguarding children The funding for 2 WTE Looked After Children (LAC) nurses is uncertain due to changes in grant funding; and noncompliance by LHBs and PCTs of Origin. The LHB continues to face considerable risk in relation to vulnerable children Ensure WAG and partner organisations are aware of arrangements within new PtHB Lead Director for Children to ensure PtHB in clear about arrangements in new neighbouring Health Boards caring for Powys children Audit through NSF 1.6 wte Specialist Nurse LAC Permanent post. 0.4wte Specialist Nurse LAC post for review January 2011 - Agree revised exit strategy from grant funding - Seek WAG/RO assistance to ensure compliance with TSLBF - follow-up with Corporate Chief Executive (CL) Lead Director for Children Lead Director for Children (CL) Lead Director for Children (CL,AC) When Performance Review of 0.4 wte LAC post January 2011 CEO letter sent d regularly in relation to changes within other Health Boards complete ongoing 2

placed in the area from other counties (COLA). (This has been thoroughly documented and is the subject of a LSCB multiagency group involving CSSIW). The number of children looked after by Powys County Council (PCC) and received from other local authorities is increasing Parenting Group Secure GP representation on the LSCB (Local Service Children s Board) Ensure more involvement of adult mental health services in the LSCB (Local Service Children s Board) Ensure sustainable funding of LSCB recommendations to LSCB and Board Lead Director for Children (PG &JP) Lead Director for Children Lead Director for Children (CL & MA group) 30.9.10 Despite several emails, there has been no response from GPs re this 30.9.10 Mental health services are now managed by 3 LHBs. There is mental health representation in Powys(t) HB CP forum 31.10.10 Current review of LSCB and its partnership with the CYPP in order to gain resources Recommendation 2 staff training and awareness Child protection training is made mandatory for all staff groups. Update training should be provided at least every 3 years. The Welsh Assembly Government should ensure that all nationally agreed contracts Workforce Plan LSCB and CYPP Plans Child Protection training is mandatory. It is the responsibility of the professional and line manager through EKSF to ensure that this takes place. Level 1 is covered at the corporate induction. Level 2 is multi agency PtHB should analyse the training needs relating to the protection of children and vulnerable adults of all staff providing services to its patients and service users. On the basis of the analysis a comprehensive training programme should be developed and a database HR (LL & SN) complete EKSF Database used Training needs analysis completed and ongoing, further training is being offered in house to ensure that all staff have 3

reflect this requirement. Recommendation 3 staff training and awareness The new LHBs further engage with primary care contractor groups to ensure they receive the necessary training and support in respect of child protection and safeguarding. Annual Quality and Review Process (QOF) training, which is organised through partnership working. Powys LSCB leaflet A Quick Guide to Child Protection: Protecting and Caring for the Children and Young People of Powys has been issued to all staff. Lead GPs have access to level 3 training. Training has been offered to pharmacists and optometrists. Training is offered by the Safeguarding Children s Team and 3 yearly by the NPHS. Powys LSCB leaflet "A Quick Guide to Child Protection: Protecting and Caring for the Children and Young People of Powys" has been sent to all primary care staff. maintained to ensure staff receive update training. This should be reported annually to the Board Monitor and audit through QOF Provide up-date training NPHS to feedback on training undertaken with primary care staff with the Head of Safeguarding, to build into report for the Board (see recommendation 2 above) Primary and Communit y Care Public Health Wales and safeguarding team Public Health Wales d yearly complete access to training. E learning package has been developed by the LSCB This is undertaken yearly and reported through the Powys(t)HB Child Protection forum Database of GP training is held by Safeguarding team. Training is reported back on request Develop e-learning packs LSCB complete complete The HCS report for Powys identifies that not all administrative staff in primary care have appropriate CRB checks. HR to write to all restating requirements. Primary Care to monitor through QOF HR Primary Services (PG) ongoing complete Letter sent 2009 Yearly through QOF 4

Recommendation 4 Substance Misuse Services Service providers put policies in place that are in line with the All Wales Child Protection Procedures to ensure staff are aware and understand all safeguarding policies and procedures and their relevance to their area of work. CAMHS LDP The LSCB has recently approved a series of policies and procedures with the Powys Drug and Alcohol Council, in line with All Wales Child Protection Procedures Substance misuse services are provided by Powys Drugs and Alcohol Centre (PDAC) within Powys. However, a case highlighted areas to be strengthened within the Child and Adolescent Mental Health Services (CAMHS team). PDAC and commissioners to audit and submit period returns to the LSCB Ensure all cases taken to supervision within the CAMHS team; ensure robust child protection procedures within CAMHS; ensure robust audit of referral and allocation processes; ensure PtHB policy covers the complex area of consent and harm reduction for children adequately. General Manager W&C directorate (AC) PDAC, CSP General Manager W&C directorate (AC) on-going ongoing Ongoing Group Child Protection Clinical Supervision is given to CAMHS staff Recommendation 5 - Substance Misuse services Community Safety Partnerships (CSPs) review all service level agreements to ensure that statutory requirements in relation to safeguarding are included and that review mechanisms are in place to demonstrate compliance by providers. CSP A multiagency review of the services commissioned from PDAC (Powys Drugs and Alcohol Centre) has been undertaken, with a specific regard to safeguarding see 4 above PDAC and commissioners to audit and submit period returns to the LSCB Planning (PR) Monitor through Service Level Agreemen t Monitor through SLA Recommendation 6 - Substance Misuse services CSPs ensure robust and well managed family centred, substance misuse care pathways into CSP PtHB CAMHS and adult mental health services to ensure that pathways into and from NHS services are adequately dovetailed with PDAC and PCC Children s General Manager women and children s directorate 30.9.10 5

and out of children and family services. Services (AC) (SM) Recommendation 7 - Substance Misuse services CSPs ensure that information sharing agreements are in place for their local area and that these cover the protection of vulnerable people. CSP It is a statutory requirement that the CYPP (Children and Young People Partnership) agrees an information sharing policy which is in place Planning to ensure/contribute to the multiagency CSP consideration of whether existing information sharing policy is adequate. Planning (PR) Information sharing policy has been agreed by partner of Children and Young People Partnership (CYPP) Recommendation 8 adult mental health services All assessment, Care Programme Approach (CPA) monitoring, review, and discharge planning documentation and procedures should prompt staff to consider if the service user is likely to have or resume contact with their own child or other children in their network of family and friends, even when the children are not living with the service user. Recommendation 9 - adult mental health services If the service user has or may resume contact with children, this should trigger an assessment of Mental Health LDP HCS Mental Health LDP HCS Mental health services have responded to the National Patient Safety Association (NPSA) Rapid Response Report Preventing Harm to Children from Parents with Mental Health Needs and have developed the Care Programme Approach (CPA) in line with the recommendations. The documentation was amended to include questions relating specifically to child contact. The documentation was amended to include questions relating specifically to child contact. This documentation and the accompanying risk Post-transfer of mental health services to ABMUHB, BCHB and ABHB on December 1st the Mental Health Planning and Performance Department will monitor the Care Programme Approach (CPA) documentation of the three providers to oversee compliance with this recommendation. Audit information will be reported to the PtHB Child Protection Forum. Post-transfer of mental health services to ABMUHB, BCHB and ABHB on December 1st the Mental Health Planning and Performance Department Planning (SM/CS) Operations (SM/CS) complete The mental health services have responded to the NPSA Rapid response report Preventing harm to children from parents with mental health needs and have developed the Care Programme Approach in line with the recommendations. The ongoing audit will be reported to the CP forum 30.9.10 The mental health services have responded to the NPSA Rapid response report Preventing harm to 6

whether there are any actual or potential risks to the children, including delusional beliefs involving them, and drawing on as many sources of information as possible, including compliance with treatment. Recommendation 10 - adult mental health services Referrals should be made to children s social care services under local safeguarding procedures as soon as a problem, suspicion or concern about a child becomes apparent, or if the child s own needs are not being met. A referral must be made: If service users express delusional beliefs involving their child and/or if service users might harm their child as Mental Health LDP HCS assessment will trigger action from the care coordinator. The risk assessment will trigger action from the care coordinator. Personnel have attended child protection training and are aware of the current policies and reporting procedures. All Wales Child Protection Procedures issued within the organisation. Child protection clinical supervision provided by the PtHB safeguarding team on an individual and will monitor the Care Programme Approach documentation of the three providers to oversee compliance with this recommendation. Audit information will be reported to the PtHB Child Protection Forum Post-transfer of mental health services to ABMUHB, BCHB and ABHB on December 1st the Mental Health Planning and Performance Department will monitor the Care Programme Approach (CPA) documentation of the three providers to oversee compliance with this recommendation. Audit information will be reported to the PtHB Child Protection Forum Director SM/CS Planning (SM/CS) children from parents with mental health needs and have developed the CPA in line with the recommendations. The ongoing audit is reported to the CP forum Training in relation to children of parents with mental health problems is being held by LSCB. Powys (t) Health board has a policy for children whose parents suffer mental health problems, which includes a risk assessment and referral processes Powys procedures and guidance was developed for mental health staff Regular attendance at CP forum from mental health re feedback Adult mental health receive regular group child protection clinical supervision from Powys(t)HB safeguarding team Training in relation 7

part of a suicide plan. group basis. to children of parents with mental health problems is being held by LSCB. Powys (t) Health board has a policy for children whose parents suffer mental health problems, which includes a risk assessment and referral processes Recommendation 11 - adult mental health services Staff working in mental health services should be given clear guidance on how to make such referrals, including information sharing, the role of their organisation s designated lead for child protection, and what to do when a concern becomes apparent outside normal office hours. Mental Health LDP HCS Child protection procedures have been distributed to all staff. Personnel have attended child protection training and are aware of the current policies and reporting procedures. Supervision provided as above Post-transfer of mental health services to ABMUHB, BCHB and ABHB on December 1st the Mental Health Planning and Performance Department will monitor the Care Programme Approach (CPA) documentation of the three providers to oversee compliance with this recommendation. Director SM/CS Planning (SM/CS) 30.9.10 Arrangements in place in PtHB. The mental health services have responded to the NPSA Rapid response report Preventing harm to children from parents with mental health needs and have developed the CPA in line with the recommendations. The ongoing audit will be reported to the CP forum Training in relation to children of parents with mental health problems is being held by LSCB. Powys (t) Health board has a policy for children whose parents suffer mental 8

Recommendation 12 - adult mental health services A consultant psychiatrist should be directly involved in all Mental Health Local Delivery Plan Healthcare Commissioning Services Head of Safeguarding and the Mental Health Planning and Performance Manager to ensure that, with the move of services to neighbouring Health Boards, the requirement to follow the procedures for Powys is clear. A series of visits will take place to the main Health Boards providing mental heath services for Powys to ensure the child protection implications of providing services for adults from the county are being addressed. Mental Health Planning and Performance Department will monitor the three providers to oversee compliance with this Planning (SM & PG) Lead for Director Children Planning SM/CS ongoing complete health problems, which includes a risk assessment and referral processes. Supervision as above Checks currently is in place in relation to provider Organisations awaiting responses from other health boards Ongoing Arrangements in place in PtHB. Checks currently is in place in relation to provider Organisations awaiting responses from other health boards Meetings with named professionals and regular contact. Copies of current training strategies and programmes have been circualted 30.9.10 Awaiting feedback. 9

clinical decision making for service users who may pose a risk to children. recommendation. Recommendation 13 - adult mental health services Safeguarding training that includes the risks posed to children from parents with delusional beliefs involving their children or who might harm their children as part of a suicide plan is an essential requirement for all staff. Attendance, knowledge, and competency levels should be regularly audited, and any lapses urgently acted on. Mental Health Local Delivery Plan - Workforce Plan LSCB (Local Safeguarding Children Board) Business Plan Training in relation to children of parents with mental health problems is being held by LSCB. P(t)HB has a policy for children whose parents suffer mental health problems, which includes a risk assessment and referral process. Powys LSCB leaflet A Quick Guide to Child Protection: Protecting and Caring for the Children and Young People of Powys has been issued to all staff. Further training needs to be developed with the mental health service, in collaboration with the Health Boards providing adult mental health services for Powys residents. Planning (SM/CS) 30.9.10 Arrangements in place in PtHB. Checks currently is in place in relation to provider Organisations awaiting responses from other health boards Recommendation 14 CAMHS Child and Adolescent Mental Health Services All CAHMS teams should work with their LSCB to develop information sharing protocols. These protocols should set out clearly the type of information that should be shared, the circumstances in which information should be shared and the relevant CAMHS LDP The Planning and Performance Manager for Adult Mental Health is a member of the PtHB Child Protection Forum. It is a statutory requirement that the Children and Young People Partnership (CYPP) agrees an overarching information sharing protocol, which has been done. PtHB Child and Adolescent Mental Health Services (CAMHS) information sharing protocol to be completed. General Manager W&C directorate (AC) And LSCB Audit Subgroup Group) Information sharing protocol agreed, CAMHS / LSCB information sharing flow chart submitted to LSCB June 2010 10

agencies with whom it should be shared. Recommendation 15 A & E New LHBs ensure that at least one member of staff trained in paediatric medicine and child protection is on duty in A&E departments at all times. Recommendation 16 A&E /MIU All LHBs should, where there are concerns about a child attending A&E (including to minor injuries NSF SCR Action Plan PtHB does not have any A&E Departments within the county. PtHB monitors the safeguards of children in A+E Departments through the NSF audit (including a return against flagged key core standards from neighbouring English DGHs.) Standard 7.20 requires that paediatric advice, at a senior level, must be available to A&E with referral to the named professional if there are concerns. Child protection policies and procedures for Minor Injuries Units (MIU) have been agreed and are the subject to audit. - Re-confirm compliance with flagged key core standards through NSF audit - Establish the extent to which at least one member of staff trained in paediatric medicine is on duty in A&E Departments at all times Minor Injuries Unit compliance to be the subject to further audit beginning 31.10.09 Lead Director for Children (CL) Lead MIU Nurse SJ, Asst director of Nursing PLL ongoing Audited Ongoing All Minor Injury Unit staff have child protection training to level 3. MIU guidelines advise on what staff should do in respect of all care of children and young people- this policy is audited. Paediatric advice is provided by neighbouring District General Hospitals (DGH) if required. Powys Policy for bruising in babies under 1 yrs states referral to DGH and Social Services. MIUs have children s assessment triage and treatment areas Re-confirm through National Service Framework audit Audit d yearly 11

units), follow the All Wales Child Protection Procedures and the child s health visitor/school nurse and GP notified. All MIU staff are up to date with level 2 training, and have been circulated the LSCB level 3 training. Further level 3 training will be added to the MIU training in 2010, which will include Core Info (research on child injuries) Local Safeguarding Children s Board (LSCB) provides locality training on Serious Case Reviews. Staff currently inform the HV/SHN and GP. If there are concerns they inform the Safeguarding team as per Minor Injuries Unit flowchart. An electronic link between neighbouring DGHs and the Powys Child protection Register (CPR) for routine checking of all A+E attendances is proving problematic, however, it is clear that where DGH staff have concerns they must telephone the Powys CPR number, which is available 24/7. (Please see recommendation 18 below.) Audit subgroup to review neighbouring District General Hospital requests in relation to child protection register Explore electronic link between DGHs and CPR LSCB complete This has been reviewed and legal advice was sought - the Child Protection Register is unable to be shared with between Powys LA and neighbouring District General Hospital at the present time LSCB complete This has been reviewed and legal advice was sought - the CPR is unable to be shared with between Powys LA and neighbouring DGH at the present time. 12

Recommendation 17 - WAG The Welsh Assembly Government takes further steps to ensure that the profile and level of expertise for child protection within GP practices is raised. Recommendation 18 - WAG The Welsh Assembly Government puts national arrangements in place to ensure that A&E attendance records and Child Protection registers are shared between A&E departments. Where there is no school nurse involved with the family the Safeguarding Team review the MIU (Minor Injuries Unit) attendance, but there is no school nurse to follow up actions identified Address follow-up arrangements for children outside school (without access to a Health Visitor or school nurse) through the implementation of the School Nurse Framework. Operations (AC) 30.9.10. Ongoing through the implementation of the School Nurse Framework For WAG WAG For WAG WAG Recommendation 19 Records The new LHBs continue to work towards the amalgamation of children s records and ensure that a project plan and timetable are put in place. Trusts should set a clear deadline for when they expect to complete this work. PtHB SCR Health Action Plan This is on the PtHB risk register. There is agreement that records should be amalgamated. A pilot of an integrated children s record will now take place in January. Records such as for CAMHS (Child and Adolescent Mental Health Service) are separate at present. - Agree realistic plan and deadline for completion. Operations (AC) Dec 2010 the pilot has not proceeded due to a lack of capacity in the IT and telecommunication s service to deliver the necessary IT and telephone links. The amalgamation of the paper record is creating more problems that it solves due to the need to get the 13

Pilot integrated electronic record and expansion of use of CHAAP (Community Health and Assessment Planning) by community staff. Operations (AC) Dec 2010 right sets of notes to the right people at the right time.. We are still committed to developing a single electronic patient record. As above Recommendation 20 Primary Care All GP practices across Wales should ensure that they comply with A Guide for Safeguarding Children and Young People in General Practice issued by the National Public Health Service in 2007. The new LHBs ensure that local information sharing protocols comply with the All Wales Child Protection Procedures and clearly set out the arrangements for sharing information between primary care and social service departments. QOF (Quality and Outcomes Framework) GP practices are audited through QOF (Quality and Outcomes Framework) in relation to safeguarding children. Ensure local information sharing protocols are compliant. Primary and Communit y Services d yearly Audited through QOF Information sharing protocol has been agreed and disseminated 14

Recommendation 21 HR The Safeguarding Vulnerable Groups Act 2006 provides for a new Vetting and Barring Scheme to replace the existing arrangements for safeguarding children and vulnerable adults from harm or risk of harm by employees (paid or unpaid) whose work gives them significant access to these groups. The scheme went live on 12 October 2009 and all NHS organisations must ensure that they have the necessary systems and procedures in place to ensure compliance with the scheme. Workforce plan A plan has been developed for compliance with the Vetting and Barring Scheme (attached 2) P(t)HB must have a system to ensure that Criminal Records Bureau checks are carried out systematically and regularly, including a data base to monitor compliance. Human Resources (CN) ongoing Its recent document The Coalition: Our programme for government, the Government set out its aim to review the criminal records and vetting and barring regime and scale it back to common sense levels. In order to deliver this promise and carry out the remodeling, the Vetting and Barring Scheme was halted on the 15 th June 2010. Although the Scheme is halted whilst the Government undertakes its review, new safeguarding regulations introduced in October 2009 continue to apply. These include: It is a criminal offence for barred individuals to apply to work 15

with children or vulnerable adults in a wide range of posts. Employers will also face criminal penalties if they knowingly permit barred individuals to engage in Regulated Activity; The three current barring lists (POVA, POCA and List 99) will be replaced by the creation of two new barred lists administered by the ISA. From 12 October 2009, checks of these two lists can be made as part of an Enhanced CRB check; Additional jobs and voluntary positions will be covered by the barring arrangements, including moderators of children s internet chat 16

rooms and a large number of NHS and prison service staff; Employers, social services and professional regulators have a duty to refer to the ISA any information about individuals who may pose a risk to children and vulnerable adults. In addition there are also a number of changes to the way that we apply for CRB checks. A check of the new ISA barred lists is only available as part of an Enhanced CRB check. Standard CRB checks are no longer available for posts working with children and vulnerable adults. For positions involving work with children and vulnerable adults, an 17

Enhanced CRB check will be required; Arrangements and progress will be monitored through the PtHB Child Protection Forum to ensure full compliance. Lead Director for Children / Director forhr (CN) Eligibility for Enhanced CRB checks extends to include anyone working in Regulated Activity with a Regulated Activity provider Regular reports to CP forum Recommendation 22 WAG The Welsh Assembly Government revisits the recommendation we made in 2007 in relation to ensuring that age specific adolescent facilities are made available across Wales for all specialities. For Welsh Assembly Government WAG WAG Recommendation 23 A&E The new LHBs take steps to ensure that dedicated areas for the triage and treatment of children and young people PtHB secures A&E services for children from neighbouring Health Boards and NHS Trusts in England. Monitor implementation through standard 7.24 in National Service Framework (NSF) audit, but ask, in addition, the extent to which a dedicated area is provided Lead Director for Children (CL) Powys has no A&Es but Minor Injuries Units (MIU) all have children s assessment triage 18

are made available in all A&E departments. Recommendation 24 HR All NHS and primary care contractor staff must wear visible identification badges when on duty. Recommendation 25 Adult Mental health All mental health wards should implement a Policy for the Visiting of Psychiatric Patients by Children. Recommendation 26 Adult mental health Staff working on adult mental health wards must enforce child visiting policies in line with national guidance. They must ensure that when agreement has been given for a child or young person to visit that appropriate arrangements Mental Health Development Plan Mental Health Development Plan The PtHB monitors compliance with this through the National Service Framework. There is a view that this is something that would require central agreement and direction between WAG and the Primary Care representative bodies at an all-wales level e.g. GPC Wales. PtHB has a policy in place. PtHB has a separate room for children wishing to visit adult mental health patients. Children are not allowed on the ward. in each A&E serving Powys. Human Resources to reaffirm exiting policy to staff. Directors and managers are responsible for spot checks. The Planning and Performance Manager for Adult Mental Health will ensure that the new providers for adult mental health services in Powys have appropriate policies in place. The Planning and Performance Manager for Adult Mental Health will establish a proportionate way of checking compliance with this requirement; and will review the policy periodically. Human Resources Planning (SM/CS) Planning (SM/ CS) As far as possible within LHB October 2010 October 2010 and treatment areas Photos of new starters are taken at Corporate Induction and badges produced in post room. Managers also borrow the camera if they need to get photos done sooner. It is part of local induction that staff are reminded to wear badges at all times Policy reaffirmed within LHB Arrangements in place in PtHB. Checks currently in place in relation to provider Organisations awaiting responses Arrangements in place in PtHB. Checks currently in place in relation to provider Organisations awaiting responses 19

are made to ensure the comfort and safety of that child and for maintaining the privacy and dignity of other patients on the ward. PtHB Powys Training Health Board CYPP - Children and Young People s Partnership LSCB Local Safeguarding Children Board YOS Youth Offending Services COLA Children from Other Local Authorities LAC Looked After Children CAMHS Child and Adolescent Mental Health Services LD Learning Disability WAG Welsh Assembly Government GPC General Practitioners Committee NSF National Service Framework QOF Quality and Outcomes Framework CPR Child Protection Register CHAAP Community Health and Assessment Planning CPA Care Programme Approach CSP Community Safety Parternship 20