Safeguarding Update
Contents 1. Foreword from Director of Nursing for NHS England and Deputy Chief Nursing Officer for England 2. Introduction 3. Our achievements 4. Our sub groups successes 5. Our regional update 6. Safeguarding reforms 7. Priorities for 2017/2018 8. Glossary Gateway Ref: 07030 Equality and Health Inequalities Statement Promoting equality and addressing health inequalities are at the heart of NHS England s values. Throughout the development of the policies and processes cited in this document, we have: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities Safeguarding helps all children and adults who are at risk of abuse. It protects children from harm and neglect and provides them with the best chance of developing into happy, well-adjusted and successful adults. It brings kindness, respect, dignity and support to vulnerable adults, however challenging their lives may be, and protects them from harm. It falls to all of us in the NHS to give our best efforts to these endeavours. Dr Peter Green, Chair, National Network of Designated Health Professionals and Designated Doctor for Child Safeguarding, NHS Wandsworth CCG 3
In 2016, I spent a couple of days at the Calais refugee camp known as The Jungle. It taught me more than a thousand lessons could ever do, I saw humanity at its best, but I also saw how easily young girls and boys, living through unimaginable trauma, were being lured into the hands of criminals. Their hopes of a better life were being openly and shamelessly exploited in a place with no rules or protection. The experience has haunted me since. It highlighted my own powerlessness. In the UK, we are fortunate to have some of the strongest laws in the world to combat the exploitation of children, young people and vulnerable adults. Yet, even here, as we know scandals surface regularly in the media from the sexual exploitation of young people in Rotherham to the abuse of Syrian refugees and most recently, the grooming of young would-be footballers. What this demonstrates is that laws alone are not enough. Protecting those at risk in our society requires constant vigilance and a readiness to act where we suspect abuse, exploitation or neglect. Safeguarding is everyone s business. NHS England is dedicated to raising awareness of the risks, identifying and intervening to help victims, and ensuring that the principles and duties of safeguarding are consistently and conscientiously applied. We have made excellent progress in the past two years. We secured over 10 million in funding, launched mandatory training in safeguarding for all NHS England staff, set out the roles, duties and responsibilities of all NHS organisations in relation to safeguarding, held a series of awareness-raising events and continued the work of our five sub-groups covering issues from Female Genital Mutilation to Modern Slavery. There is much to celebrate but much still to do. Our future objectives are set out in this report. The landscape of Safeguarding is always changing and we will change with it. As an organisation with a vital role to play in protecting the vulnerable, we are committed to responding quickly and flexibly to new demands as they arise. Above all, we are committed to ensuring that we listen to the voices of the vulnerable and act upon what we hear. Foreword Hilary Garratt Director of Nursing for NHS England and Deputy Chief Nursing Officer for England 4 5
Introduction This Safeguarding update demonstrates our achievements since our last update in 2015 and our future plans for the months ahead. Safeguarding means protecting people s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect. It is fundamental to highquality health and social care. NHS England is dedicated to ensuring that the principles and duties of safeguarding adults and children are holistically, consistently and conscientiously applied. We ensure people are supported and have access to health care and monitor their wellbeing. The wellbeing of all is at the heart of what we do. The Children Act 2004 and the Care Act 2014 clarified the expectations of the health and social care sector when safeguarding children and vulnerable adults. Following amendments to the NHS Act (2012), NHS England has a statutory responsibility to ensure their interests are protected in the NHS. We have set out the roles, duties and responsibilities of all organisations commissioning NHS healthcare in relation to safeguarding in the Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework, published on the 2nd July 2015. This policy has also been supplemented by the Safeguarding Policy, Managing Allegations Against Staff Policy and the Alerts Policy. Details of NHS England s safeguarding policies can be found at: www.england.nhs. uk/ourwork/safeguarding/ These responsibilities are overseen by the National Safeguarding Steering Group (NSSG), chaired by Hilary Garratt, Director of Nursing for NHS England and Deputy Chief Nursing Officer for England. The NSSG comprises 5 sub-groups: Female Genital Mutilation (FGM) Mental Capacity Act (MCA) Child Sexual Exploitation (CSE) Looked After Children (LAC) Prevent Under the leadership of the NSSG, it is the responsibility of the five sub-groups to ensure policies are implemented and to provide overall assurance that NHS England is performing its statutory duties. Our budget We secured a national budget in excess of 10 million over two years to embed safeguarding across the NHS in England. Each of the four English NHS regions was allocated funds to deliver the priorities identified by the national sub-groups along with local safeguarding priorities for their region. Task & Finish Groups Networks Sub groups Hillary Garratt - National Safeguarding Steering Group Chair Val Nugent Child Protection Information Sharing Moya Sutton Independent Inquiry into Child Sexual Abuse The NSSG oversees the delivery of the safeguarding leadership across the Health economy with focus on key issues using a risk based approach NSSG is chaired by Hilary Garratt, Director of Nursing for NHS England and Deputy Chief Nursing Officer for England.. Vanessa Lodge Female Genital Mutilation Susan Warburton Mental Capacity Act Peter Green National Network of Designated Healthcare Professionals (NNDHP) Lisa Cooper Child Sexual Exploitation Joanne Harrison Looked After Children To Be Appointed Adult Safeguarding Network Susan Warburton Prevent 6 7
In addition, there are two networks (for safeguarding professionals) and two working groups. The two working groups are known as Task and Finish groups. Task and Finish Groups: Child Protection Information Sharing (CP-IS) - Valerie Nugent Independent Inquiry into Child Sexual Abuse (IICSA) Moya Sutton Networks: Children s Safeguarding Network, known as the National Network of Designated Health Professionals (NNDHP) Adults Safeguarding Network Our partners Good partnership working is critical to embedding safe safeguarding practice across the health economy. NHS England works with a range of partners and stakeholders to support the delivery of the safeguarding agenda. We have increased leadership capability across the health sector. We collaborated with the Royal College of GPs to provide training for over 90 Named Safeguarding GPs. In addition, more than 350 senior staff have been trained in Safeguarding on a two day Executive Leadership course. In January 2016, NHS England made basic safeguarding training for all NHS England staff mandatory. Over 4,600 staff have completed and passed the e-learning package to date. We organised training for staff at the Customer Contact Centres (CCC) in Redditch and Leeds in how to identify safeguarding issues, how to act when a concern is received or a risk identified, and how to deal with scenarios that the CCC may receive. Training has now included the Patient and Insight team. We rolled out the national Child Protection Information Sharing Programme (CP-IS) to ensure information about vulnerable children is shared across social care organisations, local authorities and the NHS which can help protect them from harm. As of March 2017, 44 local authorities and 35 NHS Trusts are now using CP-IS. The programme is on target to have 50% of all child protection plans live by 31st March 2017. Our Achievements We contributed to a multi-agency tool kit to ensure care commissioned for people with mental health problems is compliant with the Mental Capacity Act. We produced 50,000 copies of a Safeguarding adults pocket guide, backed by training in all the regions. We delivered 500,000 copies of a pocket guide on Child Sexual Exploitation to front line staff to help them identify children at risk. We raised awareness of the new legal duty to report under 18s with FGM to the police, began mapping service provision and organised conferences attended by over 2000 staff. Mental Capacity Act NHS England funded a Mental Capacity Act Conference for Acute Hospitals in January 2017 at University College London NHS Foundation Trust. It was the largest conference held at the Trust with attendees from a wide range of professions. 88 per cent declared it a success and requested a repeat next year. NHS England hosted, sponsored or actively engaged in a number of national, regional and multi-agency conferences over the past 18 months to spread learning: We held the 3rd National Safeguarding Conference in October 2015 in London, attended by over 350 delegates from NHS England, CCGs and Provider Trusts. The 4th National Safeguarding Conference will be held on the 21st April 2017. 8 9
NHS England North hosted the National CSE Conference for over 300 delegates in March 2016, as part of CSE Awareness Day, which focused on the importance of listening to young people and responding to what they say. We launched a video on Modern Slavery and raised awareness in conferences and via other social media of its impact and how the NHS can play a part in identifying vulnerable people. We supported the health sector to deliver its statutory duties and obligations for Prevent and helped build the evidence base on how to support practitioners in identifying where there may be radicalisation taking place. The Looked After Children work stream is part of the Leading Change Adding Value work programme that is working with Right Care to reduce unwarranted variation in health outcomes for these children by ensuring guidance is comprehensively implemented across England Modern Slavery The Modern Slavery awareness raising video contains a call to action for all NHS staff from Hilary Garratt, Director of Nursing for NHS England and Deputy Chief Nursing Officer for England, as well as examples of what to look out for from staff working across the NHS. This video can be found on the NHS England YouTube channel here: https://youtu.be/crskjqpgsns Mental Capacity Act (MCA) sub group The National Mental Capacity Act and Deprivation of Liberty Safeguards sub group works to support the health sector in protecting individuals who may lack the mental capacity to make their own decisions about their care and treatment, such as those with dementia or a learning disability. The group developed an MCA toolkit, with partner organisations, for Clinical Commissioning Groups to use to ensure the care they commission for people with mental health problems is compliant with the Mental Capacity Act. Our sub groups successes MCA Training Frontline staff including GPs received training on their duties around MCA. Adult Safeguarding Boards were given the opportunity to take part in bespoke training and carers were invited to awareness sessions on the Mental Capacity Act. 85 Best Interest Assessors were trained to complete assessments following best practice guidance in the North region. Over 4,200 primary care teams were offered e-learning safeguarding licences that provided basic training to all members of their practices. Take-up was over 45% in the South Region. NHS England supported the Seen and Heard Campaign with the Department of Health and the Childrens Society 10 11
Looked After Children (LAC) sub-group Children s early experiences have a significant impact on their development and future life chances. Looked After Children are 4 times more likely than all other children to experience poor health and well-being in the long term. NHS England has made it a priority to reduce unwarranted variation in access to good health assessments and support for these children. The Looked After Children sub-group is responsible for working to support the NHS in delivering good quality services to this vulnerable group. The group contributed to expert guidance published by the DfE and DH in March 2015 on a standard approach to health assessment. The guidance has been rolled out over the past 18 months. It shared podcasts, leaflets and DVDs in various languages to help professionals working with Unaccompanied Asylum Seeking Children. The group set standards for accredited training for those working with Looked After Children in partnership with Health Education England. We produced best practice guidance for commissioners of Looked After Children services, including sample job descriptions and standard contracts for health assessment funding. Child Sexual Exploitation (CSE) sub-group The sexual exploitation of children and young people has been identified throughout the UK. It robs children of their childhood and can have serious long term consequences. The Child Sexual Exploitation Health Sub- Group was established to provide national leadership and support to the NHS to enable healthcare staff to respond to this challenge. The group developed and distributed 500,000 copies of a CSE pocket guide to support frontline staff in identifying children and young people at risk of, or experiencing, child sexual exploitation. A video was also produced. A further 12,000 copies of the National Working Group pocket guide were distributed to Sexual Health and School Nursing staff working directly with children and young people in the community. A review of current screening methods for child sexual exploitation was commissioned from Salford University and Pennine Acute NHS Trust. The review is due to be published in September 2017. We supported the launch of national e-learning resource for frontline staff to spot signs and symptoms of CSA/CSE in partnership with Department of Health and The Childrens Society (https://www. seenandheard.org.uk/) Gang-related CSE The London and South regions worked with the police and other partners in relation to gang-related CSE. NHS England has supported the Child House (CH) model, designed to provide a child who has been sexually abused with all the services they need under one roof. The prevalence of CSE was mapped to ensure consistent provision of support to sexually exploited children and their families. This work has resulted in a greater understanding of the needs of these children for mental health services and a fast track programme has been introduced. Female Genital Mutilation (FGM) sub-group FGM involves removing or damaging healthy female genital tissue, and interferes with the natural function of girl s and women s bodies. The Female Genital Mutilation sub-group was established to ensure that the NHS meets its responsibility to provide services for women and girls. This group has continued to work closely with the Department of Health, Home Office, clinicians, survivor groups and Royal Colleges to ensure policy changes are embedded within NHS services. The group has achieved: Training to front line practitioners to help them ask the right questions in difficult circumstances. Communicated the new legal duty (2015) on staff to report under 18s with FGM to the police. Working with the Department of Health, Royal Colleges and the police, the group used blogs and short film clips. See: https://www. gov.uk/government/publications/fgmmandatory-reporting-in-healthcare. Produced a new FGM Pocket Guide for Health Professionals highlighting key FGM policy and legislation is now available nationally to aid front line practitioners. Mapped current provision of FGM services and developed networks to share best practice. This mapping allowed the group to develop their work plan for the next 12 months. Held conferences across the North region attended by more than 2000 staff, in partnership with the Police, Department of Health, Health and Social Care Information Centre, Barnardo s, the Crown Prosecution Service and third sector organisations, There were 5,700 newly recorded cases of Female Genital Mutilation (FGM) reported in England during 2015-16, according to the first ever publication of annual statistics in July 2016. FEMALE GENITAL MUTILATION Pocket guide for health care professionals Vanessa Lodge, National FGM Lead collecting her award for Contribution to Supporting Pregnant Women Who Have Experienced FGM 12 13
National Prevent sub-group NHS England is responsible for overseeing the embedding of Prevent within safeguarding practice across the health sector. NHS England has ensured that compliance with the statutory duty is embedded in the existing architecture of delivery and assurance via inclusion in the NHS standard contract. Delivered four regional Prevent conferences attended by over 700 delegates. Produced resources including pocket guides with key messages for the health sector to raise awareness of the Prevent programme. Surveyed NHS staff in 170 provider organisations to assess how confident they are in how to make a referral to their Prevent Lead. The North region undertook a small research study to assess GP competence in recognising early warning signs of radicalisation Prevent NHS England continues to monitor training and referral data. This is shared with the Department of Health and the Home Office. 98% of NHS Trusts and Foundation Trusts that sit in Home Office designated priority areas provided data to demonstrate their compliance with the Prevent duty. National Network of Designated Health Professionals (NNDHP) (formerly the Children Safeguarding Network) The National Network of Designated Healthcare Professionals for Safeguarding Children was set up to provide professionals with a collective voice to influence policy makers on behalf of children and young people in receipt of NHS services. Agreed principles of working and governance arrangements, allowing the incorporation of partners onto the Board. Ensured the database of designated professionals was maintained and the database was extended to include a named GP and a safeguarding adults professionals database. Produced strategic proposals for NHS England and partner organisations on child safeguarding. Adult Safeguarding Network Adult safeguarding means protecting a person s right to live in safety, free from abuse and neglect. The Adult Safeguarding Network is in its infancy. The priorities will develop and evolve as the network establishes the scope of its remit to bring together Safeguarding professionals from across the country, to make their voices heard on the protection of adults. Child Protection Information Sharing (CP-IS) Sharing information across health and social services about the most vulnerable children who may attend for NHS treatment outside their Local Authority area can help prevent harm or abuse and encourage professionals to open conversations at the earliest opportunity, which research shows can improve outcomes for vulnerable children. Using technology, CP- IS will allow 152 Local Authorities to share information with every unscheduled care setting across England, improving its quality, accuracy and security by removing paper-based lists. 44 Local Authorities are now using CP-IS. 38 Healthcare Organisations are now live with CP-IS. 50% of all plans are now viewable on CP-IS Overseen the accreditation of over 90% of Social Care system suppliers. Commissioned an independent review of the benefits of implementing CP-IS. As of March 2017 14 15
Independent Inquiry into Child Sexual Abuse (IICSA) Our regional update The Independent Inquiry into Child Sexual Abuse was officially opened in July 2015. NHS England established a Task and Finish Group to ensure that the health sector is ready to meet the requirements of the (Inquiry) and support victims of abuse. Over the last 18 months, the NHS England team has held six regional events, attended by 600 delegates, to equip healthcare professionals with comprehensive understanding of the purpose and likely requirements of IICSA. Siobhan Pyburn speaker at last year s CSE Conference In 2015, NHS England s area teams were integrated into four regional teams: London, Midlands and East, North, and South. Each region supports the delivery of the national sub-group priorities (CSE, FGM, LAC, MCA and Prevent). London Region A Deep Dive review of the 32 London CCGs was carried out between October 2015 and January 2016 which showed that the capital s CCGs mostly had robust governance, systems and processes in place. The Safeguarding Adults at Risk audit tool, developed in 2013-14, has provided a consistent framework for organisations to monitor and improve their Safeguarding Adults arrangements. London hosted two inaugural summits on safeguarding children and safeguarding adults, attended by over 320 professionals. This is the best conference I have attended in 30 years as a social worker. The patient voice was central to the conference. High calibre of speakers including Former Crown Prosecutioner Nazir Afzal OBE. Using actors made it very real and thought-provoking. thanking (sic) you for highlighting issues of my communities. I will reflect on the conference as part of my Nurse Revalidation process. North Region The region developed an assurance tool to measure whether CCGs were meeting their statutory requirements which has been used in all CCGs, with positive responses. A training package including pocket guides and patient leaflets for care home staff to prevent pressure ulcers called React to Red was launched at the Pressure Ulcer Summit in Leeds in 2016. A Safeguarding Conference was held in 2016 attended by over 200 professionals. Midlands & East Region The region organised events and delivered training sessions for multiagency teams including general practice staff on safe sleeping (identified as a specific area of concern for the Northamptonshire CCGs), Prevent, FGM, Domestic Abuse and, CSE. 16 17
The region have trialled an electronic Safeguarding Self-Assessment Tool with a small number of CCGs; it will be considered for rolled out across the region following evaluation. A MCA capacity assessment tool kit and process charts were implemented to aid decision making and raise awareness for CSE champions. The region co-designed means of sharing and escalating safeguarding concerns between NHS England, fitness to practice and safeguarding teams and commissioners. South Region The region worked with colleagues across the country to improve the outcomes for Unaccompanied Asylum Seeking Children (UASC) in assessment units. This work also supported the delivery of a health and social care data base system for Looked After Children and UASC national dispersal system. A Safeguarding Reflective Tool (for use by primary care colleagues when undertaking supervision with their appraiser) has been shared and embedded nationally. During 2016, a supervision structure and tool kit to support nursing home leaders to deliver safeguarding supervision in nursing homes was rolled out in the region. NHS England Safeguarding App NHS England has supported the development of a Safeguarding App that supports front line practitioners to quickly review safeguarding guidance. 10,136 The number of police-recorded cruelty and neglect offences against children aged under 16 in the UK in 2014-15 60% The rise in police-recorded offences of cruelty and neglect in Northern Ireland between 2010-2011 and 2014-15. The increase is 48% in Wales and 46% in England. In Scotland, the figure has dropped by almost half in that time. 8 The number of invisible children suffering from abuse or neglect for every child on a child protection register, or subject to a child protection plan. Data from Community Practitioner, December 2016 By the end of 2016, there had been almost 10,000 downloads of the NHS Safeguarding App across the three platforms (Microsoft, Apple and Android). User feedback is overwhelmingly positive with many people complimenting the breadth of information and the ease of use. The app can be easily updated should information require changing, or if there are changes to hyperlinks to information on the internet. In 2016, Alan Wood CBE undertook a fundamental review of the role and functions of Local Safeguarding Children Boards and the Serious Case Review process. The review considered the effectiveness of current arrangements in holding partners to account. The Government response to the Wood Report was published in May 2016; supporting the findings of the report. The legislative process to remove Local Safeguarding Childrens Boards and the transfer of responsibility for the Child Death Overview Panels from the Department of Education to the Department of Health from current statute has commenced. The revised arrangements will be set out in the Children and Social Work Bill 2016-17; currently in the House of Commons and awaiting Royal Assent. NHS England is currently working closely with the Department of Health and Department for Education to influence the supporting regulation that will be completed later in 2017. Safeguarding Reforms Dr Sarah Robinson, Patient Experience and Quality Manager (East DCO Nursing Director) 18 19
Priorities for 2017/2018 Glossary In February 2017, the regional safeguarding leads and central safeguarding team came together to undertake a stocktake of the past 12 months of work against the Safeguarding business plan and to agree the key priorities for the next 12 months. The following were identified as key areas of focus in 2017/18: CCG CDOP CP-IS Clinical Commissioning Group Child Death Overview Panel Child Protection Information System Prevent: engage more closely with primary care and continue the work to enhance mental health services for those at risk of radicalisation or for those returning from areas of conflict; Safeguarding Reforms: influence policy development and prepare the health sector for the change ahead; Independent Inquiry into Child Sexual Abuse; engage with NHS providers and commissioners to understand the implications of the Inquiry as it progresses; Further development of guidance from NHS England to take account of the rapidly changing safeguarding landscape; Domestic Abuse: further work is required to understand the health impact of this type of abuse; Save Lives have recently produced a report that highlights the high cost to the health sector of domestic abuse; Looked After Children: this programme will continue to work towards its key deliverables in 2017/18; and MCA/DoLS: influence the DH and prepare the health sector for the impact of the proposed changes to legislation that was published by the Law Commission on the 13th March 2017. We will remain focussed on: FGM LAC CSE CP-IS UASC Modern Slavery We will build on our success to date. CSE DH DfE DoLS FGM GMC HSCIC LA LAC MCA NSPCC NSSG SCRs UASC Child Sexual Exploitation Department of Health Department for Education Deprivation of Liberty Safeguards Female Genital Mutilation General Medical Council Health and Social Care Information Centre Local Authority Looked After Children Mental Capacity Act National Society for the Prevention of Cruelty to Children National Safeguarding Steering Group Serious Case Reviews Unaccompanied Asylum Seeking Children 20 21
Notes 22
Get in touch england.safeguarding@nhs.net 0300 311 22 33 NHS England Quarry House Quarry Hill Leeds LS2 7UE @NHSEngland www.england.nhs.uk Other formats of this document are available on request Designed by Cube Creative 24