Safeguarding Children Policy and Procedure. (Draft V 1.1)

Safeguarding Children Policy and Procedure (Draft V 1.1) 1 SUMMARY 2 RESPONSIBLE PERSON: This policy demonstrates how NHS Haringey Clinical Commissioning Group meets its corporate accountability for safeguarding children. It provides guidance to NHS Haringey Clinical Commissioning Group employees to enable to them to fulfil their safeguarding children responsibilities. Provides guidance in our commissioning roles to drive continual improvement of services for children in terms of equity, effectiveness, safety, timeliness, efficiency and child centeredness. Karen Baggaley - Designated Nurse David Elliman Designated Doctor 3 ACCOUNTABLE DIRECTOR: 4 APPLIES TO: Director Quality and Integrated Governance All staff employed within NHS Haringey Clinical Commissioning Group 5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY: 6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL: Named GP Named Nurse for Child Protection Primary Care Haringey CCG Governing Body Children s Lead Haringey CCG Children s Commissioner Quality Committee Haringey Health Leadership Group for Safeguarding 7 EQUALITY IMPACT ANALYSIS Policy Screened 10.12.12 Template completed 10.12.12

COMPLETED: 8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL: NHS Haringey CCG Governing Body January 2013 9 VERSION: 1.0 10 AVAILABLE ON: Intranet Website 11 RELATED DOCUMENTS: 12 DISSEMINATED TO: 13 DATE OF IMPLEMENTATION: 1 st April 2013 14 DATE OF NEXT FORMAL REVIEW: April 2015

DOCUMENT CONTROL Date Version Action Amendments 01/04/13 1.0 Policy first implemented N/A.

Safeguarding Children Policy and Procedure April 2013

Table of Contents 1 Introduction... 7 2 Policy Aims... 8 3 Senior and Strategic Health Leads... 8 4 Designated and Named Professionals 9 5 Looked-after Children...12 6 Commissioning... 13 7 Serious Case Reviews... 15 8 Training Requirements...16 9 Resolving Interagency Disagreement Policy......17 10 NHS Haringey Clinical Commisioning Group Governing Body Assurance..18 11 Local Safeguarding Children Boards...19 12 Employment Practice.20 13 Allegations against Staff.20 14 References 21 15 Appendix 1 Safeguarding contacts...22 5 of 33

16 Appendix 2-Mandatory Child Protection Haringey CCG Training Strategy..24 17 Appendix 3 - Resolving Interagency Disagreement Policy..30 18 Appendix 4 Haringey CCG Safeguarding Structure...33 6 of 33

NHS Haringey Clinical Commissioning Group Safeguarding Children Policy and Procedure 1 Introduction 1.1 NHS Haringey Clinical Commissioning Group will be established on 1 April 2013. This policy and procedure will replace the NHS North Central London Safeguarding Children Policy which is current until 31 st March 2013 1.2 NHS Haringey Clinical Commissioning Group fully recognises its responsibility for protecting and safeguarding the welfare of children. We acknowledge our responsibility to take all reasonable steps to promote safe practice and to protect children from harm, abuse or exploitation and to work with service providers to continually drive up quality. 1.3 This policy and procedure applies to all employees and members of Haringey Clinical Commissioning Group 1.4 For the purposes of this document, as in the Children Acts 1989 and 2004 respectively, a child or young person is anyone who has not yet reached their 18 th birthday 1.5 To comply with national safeguarding children requirements, NHS Haringey Clinical Commissioning Group commissioners have a duty to ensure that safeguarding is reflected within all partnership agreements. NHS Standard Contracts require providers to comply with the local Commissioner s Safeguarding Policies. 1.6 This policy should be read in conjunction with national and local guidance primarily but not exclusively: Working Together to Safeguard Children 2010 DfCSF (https://www.education.gov.uk/publications/) London Child Protection Procedures (edn4) 2011 London Safeguarding Children Board (www.londonscb.gov.uk/procedures/) App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 7 of 33

1.7 NHS Haringey Clinical Commissioning Group has a legal duty under Section 11 of the Children Act 2004 to make appropriate arrangements to safeguard and promote the welfare of children. 1.8 NHS Haringey Clinical Commissioning Group is accountable for its own safeguarding children structures and processes and those in agencies from which we commission services. 2 Policy and Procedure Aims 2.1 To demonstrate how NHS Haringey Clinical Commissioning Group meets its corporate responsibility for safeguarding children. 2.2 To provide guidance to NHS Haringey Clinical Commissioning Group employees to enable them to fulfil their safeguarding children responsibilities. 2.3 The policy is specifically aimed at the continual improvement of services for children in terms of equity, effectiveness, safety, timeliness, efficiency and child centeredness. 3 Senior and strategic health leads 3.1 NHS Haringey Clinical Commissioning Group s Chief Officer is the executive lead for safeguarding and has the responsibility for ensuring the contribution by health services to safeguarding and promoting the welfare of children is discharged effectively across the whole local health economy. This is operationally delivered through local commissioning arrangements. The Chief Officer is a member of Haringey CCG Governing Body. 3.2 The Director of Quality and Integrated Governance (who reports to the Chief Officer) is responsible for: ensuring that the monitoring of safeguarding across Haringey takes place through the Quality Committee of the Haringey Clinical Commissioning Group s Governing Body and the Haringey Local Safeguarding Children Board; reporting any appropriate safeguarding children risks or achievements to the Chief Officer and draft corporate media responses when required. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 8 of 33

3.3 NHS Haringey Clinical Commissioning Group Governing Body Children s Lead General Practitioner (GP) has specific responsibility for safeguarding children within his portfolio of responsibilities when considering commissioning services for the residents of Haringey. 3.4 NHS Haringey Clinical Commissioning Group has a public health responsibility to actively promote the health and well-being of all the children in Haringey and this is executed through the Director of Public Health in Haringey who is a member of the Governing Body. 4 Designated and Named Professionals 4.1 The terms designated professionals and named professionals denote professionals with specific roles and responsibilities for safeguarding children and for looked after children. 4.2 NHS Haringey Clinical Commissioning Group is required to have access to a senior paediatrician and senior nurse to undertake the role of designated professionals for safeguarding children. NHS Haringey Clinical Commissioning Group has retained the services of the Designated Nurse and Doctor for Child Protection in Haringey. The job descriptions for designated professionals meet the standards and requirements outlined by the Royal College of Paediatrics and Child Health and Royal College of Nursing 1. 4.3 The term designated doctor or nurse for looked after children or children in care denotes professionals with specific roles and responsibilities for looked after children including the provision of strategic advice and guidance to service planners and commissioning organisations. 23 The commissioning aspects of the role of the Designated Doctor and Designated Nurse for Looked after Children in Haringey are 1 Safeguarding Children and Young People: roles and competences for health care staff (September 2010) 2 Statutory guidance on Promoting the Health and Well-being of Looked After Children: DCSF; DH (2009) 3 Looked after children: knowledge, skills and competences of health care staff (May 2012) App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 9 of 33

delivered via a service level agreement with their employer currently Whittington Health NHS Trust. 4.4 The role of doctor for unexpected death in childhood is held by the Designated Doctor for child protection. This role is held by a consultant paediatrician whose role is to provide advice on the commissioning of paediatric services from paediatricians with expertise in undertaking enquiries into unexpected deaths in childhood and the medical investigative services such as radiology, laboratory and histopathology services and the organisation of such services (Working Together to Safeguard Children sec. 7.29 p.214) 4.5 The Designated Nurse and Designated Doctor for Child Protection are employed (either directly or via a service level agreement) by NHS Haringey Clinical Commissioning Group to act as a vital source of professional advice on safeguarding children matters to Haringey Clinical Commissioning Group Governing Body (via the Chief Officer and Clinical Commissioning Group Governing Body Children s Lead GP), health professionals, particularly named safeguarding health professionals, local authority children s services departments and the Local Safeguarding Children Boards (LSCB). They provide: advice to ensure the range of services commissioned and contracted by Haringey CCG take account of the need to safeguard and promote the welfare of children; provide advice on the monitoring of the safeguarding aspects of the contracts; provide advice, support and clinical supervision to the named professionals in each provider organisation; provide skilled advice to the LSCB on health issues; play an important role in promoting, influencing and developing relevant training, on both a single and inter-agency basis, to ensure the training needs of health staff are addressed; provide skilled professional involvement in child safeguarding processes in line with LSCB procedures; and review and evaluate the practice and learning from all involved health professionals and providers commissioned by the CCG, as part of Serious Case Reviews. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 10 of 33

4.6 Designated professionals are accountable to the Director of Quality & Integrated Governance who has delegated responsibility for safeguarding children as part of his/her portfolio of responsibilities. 4.7 Designated professionals will participate regularly in support/supervision groups or peer support networks for specialist professionals at a local, regional and national level according to professional guidelines. Attendance will be recorded. 4.8 NHS Haringey Clinical Commissioning Group will ensure establishment levels of designated and named professionals are proportionate to the local resident populations 4. For large community providers, NHS Trusts and Foundation Trusts which may have a number of sites, a team approach can enhance the ability to provide 24 hour advice and provide mutual support for those carrying out the designated and named professional roles. If this approach is taken it is important to ensure that leadership and accountability arrangements are clear. 4.9 NHS Haringey Clinical Commissioning Group has retained the posts of Named GP for Child Protection and Named Nurse for Child Protection Primary Care. Named Professionals have a key role in promoting good professional practice within their organisation (in this case Primary Care), and provide advice and expertise for fellow professionals. 4.10 The Named GP and Named Nurse for Child Protection Primary Care will support Haringey Clinical Commissioning Group in its clinical governance role by ensuring that audits on safeguarding are undertaken and that safeguarding issues are part of the Governing Body s clinical governance system. 4.11 The Named GP and Named Nurse for Child Protection Primary Care will ensure that a safeguarding children training strategy is in place and delivered including supporting GPs to share information appropriately and engage in the child protection process fully. 4 Safeguarding Children and Young People: Roles and Competences for Health Care Staff (Intercollegiate Document 2010) App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 11 of 33

See Appendix 1 for contact details of Safeguarding Children professionals and Appendix 4 for safeguarding team structure chart. 5 Looked After Children 5.1 Haringey Clinical Commissioning Group is responsible for ensuring that all Lookedafter-Children have their health needs assessed. This is achieved through the provision of service from the Children in Care (CiC) health team. 5.2 The Designated Doctor and Designated Nurse for Looked After Children: o Provide strategic and clinical advice and leadership to the CCG and Local Authority regarding how to improve the health of looked after children; o Assist the CCG in fulfilling its responsibilities as commissioner of services to improve the health outcomes for looked after children; App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 12 of 33

o Ensure all looked after children get their health assessments undertaken, resulting in health plans, and advise on their implementation; o Ensure looked after children are able to access universal services as well as targeted and specialist health services where necessary; o Provide training for health professionals about looked after children and other agencies in regard to health issues; o Support gathering and analysing the views of looked after children in regard to health and wellbeing, linking this to strategic and clinical advice and service development. This is done by asking every child and young person during their individual health assessment and by ensuring a yearly user survey is carried out. 6 Commissioning 6.1 Haringey CCG will work with Haringey Local Authority and other local CCGs to commission and provide co-ordinated and, wherever possible, integrated services. Service specifications drawn up by NHS Haringey Clinical Commissioning Group should include clear service standards for safeguarding and promoting the welfare of children, consistent with LSCB procedures. National contracts provide the means to prescribe the requirements for safeguarding children. By monitoring the service standards of all providers, NHS Haringey Clinical Commissioning Group will need to assure itself that the required safeguarding standards are being met in Haringey. 6.2 NHS Haringey Clinical Commissioning Group will ensure that all providers from whom it commissions services have comprehensive and effective single and multiagency policies and procedures to safeguard and promote the welfare of children, consistent with current London Child Protection Procedures. 6.3 The Joint Strategic Needs Assessment for Haringey should include health and wellbeing needs of all local children, which in turn should inform the Children and Young People s Plan or equivalent, and the LSCB business plan. When considering commissioning services for the health and wellbeing of children in need in it s area, NHS Haringey Clinical Commissioning Group will ensure this includes those who are temporarily resident in the area, such as children held in secure settings. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 13 of 33

6.4 NHS Haringey Clinical Commissioning Group will ensure that safeguarding and promoting the welfare of children is integral to the quality and safety of all provider and commissioning services and that there is evidence of robust audit arrangements. This will be reported through the local children s safeguarding board (LCSB), the CCG GB Quality Committee and the contract monitoring meetings. 6.5 NHS Haringey Clinical Commissioning Group will monitor the service standards of NHS Foundation Trusts and contracted service providers to ensure service providers meet the required safeguarding children standards. This will occur through the Clinical Quality Review Group meetings. 6.6 NHS Haringey Clinical Commissioning Group will seek assurance that primary care provision has robust systems and practices in place to ensure it can fulfil its role in safeguarding and promote the welfare of children. 6.7 Performance Management of primary care provision is the responsibility of the NHS Commissioning Board. 6.8 NHS Haringey Clinical Commissioning Group will ensure that it has in place a local Sexual Assault Referral Services (SARS) care pathway for children and young people. All SARS for children and young people, including services provided through Sexual Assault Referral Centres (SARCs), should comply with the standards for paediatric forensic medical services. NHS Haringey Clinical Commissioning Group will ensure that staff know their local services and are clear about the different agencies roles and responsibilities, so that they are not hesitant about responding appropriately. See London Child Protection Procedures sec.2.11 for more information. 5 6.9 Through its contracting arrangements, NHS Haringey Clinical Commissioning Group will ensure that independent and third sector providers deliver services that are in line with Borough level obligations with respect to safeguarding and promoting the welfare of children. 5 London Child Protection Procedures (4 th Edition 2011) http://www.londonscb.gov.uk/procedures/ App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 14 of 33

6.10 When contracting with the independent and third sector, NHS Haringey Clinical Commissioning Group will ensure it applies the same standards and requirements as for NHS providers. NHS Haringey Clinical Commissioning Group will ensure that appropriate links are established between independent and third sector providers and LSCBs. 7 Serious case reviews 7.1 NHS Haringey Clinical Commissioning Group is responsible for co-ordinating the health component of serious case reviews (SCRS) following current national and local guidance via the Designated Child Protection Professionals. 7.2 NHS Haringey Clinical Commissioning Group will ensure that the NHS Commissioning Board and the Care Quality Commission (CQC) are notified of all SCRs and with the involvement of the Communications and Governance team, will agree any responses to media interest. 7.3 All SCRs must be notified to the Director of Quality and Integrated Governance, the Chief Officer as executive lead for safeguarding children and the Chair of NHS Haringey Clinical Commissioning Group. 7.4 The Designated Professionals will inform the Patient Safety Manager (in the Commissioning Support Unit) of all potential and declared SCRs to ensure completion of initial notification to the NHS Commissioning Board on the Strategic Executive Information System (STEIS) and regular updates. 7.5 The Director for Quality & Integrated Governance, the CCG GB Children s Lead and a Non-executive Director will oversee and sign off Internal Management Reviews (IMRs) and/or Health Overview Reports for SCR s completed for Haringey Clinical Commissioning Group. 7.6 The Quality Committee will monitor the implementation of any actions arising from an IMR or SCR and will provide reports to the CCG Governing Body. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 15 of 33

7.7 IMRs completed for Health Providers are signed off by the respective NHS Trust Executive Lead for Safeguarding Children, not Haringey Clinical Commissioning Group. 8 Training requirements Safeguarding Children Training is a mandatory requirement for all staff employed by Haringey CCG Appendix 2 8.1 The competences specifically needed by healthcare workers to promote children s safety within the healthcare system are described in Safeguarding Children and Young People: Roles and Competences for Health Care Staff (Intercollegiate Document 2010) 6 8.2 Safeguarding competences are the set of abilities that enable staff to effectively safeguard, protect and promote the welfare of children and young people. They are a combination of skills, knowledge, attitudes and values that are required for safe and effective practice. 8.3 Different staff groups require different levels of competence depending on their role and degree of contact with children, young people and families, the nature of their work, and their level of responsibility. 8.4 The Intercollegiate Document identifies six levels of competence, and gives examples of groups that fall within each of these. The levels are as follows: Level 1: Non-clinical staff working in health care settings. Level 2: Minimum level required for clinical staff who have some degree of contact with children and young people and/or parents/carers. Level 3: Clinical staff working with children, young people and/or their parents/carers and who could potentially contribute to assessing, planning, 6 Safeguarding Children and Young People: Roles and Competences for Health Care Staff (Intercollegiate Document 2010) App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 16 of 33

intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns. Level 4: Named professionals Level 5: Designated professionals Level 6: Experts 8.5 Staff should consult with their line managers to identify which level of competence they require, referring to the Intercollegiate Guidance in 8.1 (above) as required. 8.6 Sources of Training: Level 1 Induction, e-learning, level 1 sessions from CCG child protection team or Haringey Local Safeguarding Children Board (LSCB)(http://www.haringeylscb.org) and annual awareness briefing from CCG child protection team. Level 2 Level 2 sessions from CCG child protection team or LSCB Level 3 Level 3 sessions from CCG child protection team or LSCB Level 4 and level 5 External training as per the Intercollegiate Guidance (7.1 above) 8.7 Monitoring of Training The Essential Skills training (Safeguarding Training is included in this) will be managed and monitored through the Commissioning Support Unit (CSU). Attendance will be reported and monitored via twice yearly safeguarding children reports to the Quality Committee 9 Resolving Interagency Disagreement Policy 9.1 It is important that professionals are confident in the actions of colleagues. Where there is a difference of opinion there should be professional discussion and challenge. Professionals needing support with this should seek it from their line manager or the Named or Designated Professional. 9.2 Haringey LSCB has a clear escalation policy which should be used see Appendix 3 App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 17 of 33

10 NHS Haringey Clinical Commissioning Group Board Assurance 10.1 All organisations commissioning or providing healthcare, whether in the NHS or third sector, independent healthcare sector or social enterprises, will ensure there is board level focus on the needs of children, and that safeguarding children is an integral part of their governance systems (Working Together to Safeguard Children 2010:51). 10.2 To evidence compliance with safeguarding requirements, NHS Haringey Clinical Commissioning Group will receive an Annual Safeguarding Children Report and Annual Looked-after-Children/Children in Care report. 10.3 Reports will be provided to the NHS Haringey Clinical Commissioning Group Quality Committee (committee of the board) at six monthly intervals with more frequent papers being presented as required. 10.4 The implementation of action plans arising from inspections of safeguarding services will be monitored via the Quality Committee. 10.5 The Patient Safety Manager within the Commissioning Support Unit will be updated on any open serious incidents. 10.6 The Designated Professionals will ensure that NHS Haringey Clinical Commissioning Group is represented on each NHS Provider organisation s internal safeguarding children Committees to enable assurance with regard to Providers internal monitoring standards. It will also enable constructive challenge and appropriate safeguarding support for each organisation. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 18 of 33

11 Local Safeguarding Children Board 11.1 The Children Act 2004 Section 13 requires NHS Trusts to cooperate and engage fully with partner agencies as competent members of their Local Safeguarding Children s Board (LSCB). 11.2 NHS Haringey Clinical Commissioning Group must co-operate with the local authority in the establishment and operation of the LSCB and as partners, must share responsibility for the effective discharge of its functions in safeguarding and promoting the welfare of children. 11.3 Representation on the LSCB should be at an appropriate level of seniority. Haringey Clinical Commissioning Group will be represented by the Director of Quality & Integrated Governance, with delegated responsibility from the Executive Lead for safeguarding. 11.4 Haringey Clinical Commissioning Group s Governing Body GP Lead for Children will receive the Minutes and papers for the LSCB and will attend the meeting 2-3 times per year and more frequently if the need arises. 11.5 The Designated Nurse and Doctor participate in all aspects of the Haringey Local Safeguarding Board and its sub-groups. 11.6 NHS Haringey Clinical Commissioning Group is responsible for providing and/or ensuring the Haringey Clinical Commissioning Group availability of appropriate expertise and advice and support to the LSCB, in respect of a range of specialist health functions, e.g. primary care, mental health (adult, adolescent and child) and sexual health and for coordinating the health component of serious case reviews. 11.7 NHS Haringey Clinical Commissioning Group must ensure that all health organisations, including the third sector, independent healthcare sector and social enterprises with which it has commissioning arrangements, have links with a specific LSCB, and that health agencies work in partnership and accordance with their agreed LSCB plan. This is particularly important where Trusts App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 19 of 33

boundaries/catchment areas are different from those of LSCB s. This includes Ambulance Trusts. 12 Employment Practice 12.1 NHS Haringey Clinical Commissioning Group will have in place safe recruitment policies and practices for all staff and will require evidence of such arrangements from all provider Trusts and independent contractors. 13 Allegations against Staff 13.1 NHS Haringey Clinical Commissioning Group will have the procedures in place to respond to any allegations made against staff working with children and young people in accordance with Working Together to Safeguard Children 2010 and the London Child Protection Procedures, and will require evidence of such arrangements for all provider Trusts and independent contractors. This includes the requirement for all employing organisations to have a named senior officer responsibility for dealing with allegations and informing the relevant Local Authority Designated Officer (LADO) of all cases. 13.2 Any allegations made against independent contractors should be reported to the Designated Nurse and/or Doctor who will inform the relevant LADO and the NHS Commissioning Board lead for practitioner performance, and the Director for Quality & Integrated Governance. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 20 of 33

14 References Care Quality Commission (Registration) Regulations 2009 www.cqc.org.uk/_db/_documents/essential_standards_of_quality_and_safety_final_081 209.pdf Department of Health (2009) Improving safety, Reducing harm. Children, young people and domestic violence.a practical toolkit for frontline practitioners. www.orderline.dh.gov.uk Ref 292071 Health and Social Care Act 2008 (Regulated Activities) Regulations 2009 HM Govt (2010) Working Together to Safeguard Children www.education.gov.uk/publications HM Gov (2004) Guidance on the Children Act 2004.www.ecm.gov.uk/strategy/guidance London SCB (2010) London Child Protection Procedures www.londonscb.gov.uk/procedures Looked after children: knowledge, skills and competences of health care staff (May 2012) Royal College of Nursing and the Royal College of Paediatricsand Child Health.https://www.rcn.org.uk/ data/assets/pdf_file/0019/451342/rcn_and_rcpch_la C_competences_v1.0_WEB_Final.pdf NHS London Safeguarding Children Serious Case Review Policy November 2010 Safeguarding Children and Young People: Roles and Competences for Health Care Staff (Intercollegiate Document 2010) www.rcpch.ac.uk/sites/default/files/asset_library/health%20services/safeguarding%20chil dren%20and%20young%20people%202010.pdf App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 21 of 33

Appendix 1 SAFEGUARDING CHILDREN LEADS NHS HARINGEY CLINICAL COMMISSIONING GROUP LEAD TITLE LEAD NAME CONTACT INFORMATION Chief Officer (Governing Body Lead for Safeguarding) Sarah Price Sarah.price@nclondon.nhs.uk Tel: 020 8489 1213 CCG Governing Body Lead for Children (including Safeguarding Children) Director of Quality &Integrated Governance David Masters Jennie Williams David.masters@nhs.net 4th Floor River Park House jennie.williams@nclondon.nhs.uk Tel: 0208 489 4823 HARINGEY SAFEGUARDING CHILDREN LEADS LEAD TITLE LEAD NAME CONTACT INFORMATION Designated Nurse for Child Protection Karen Baggaley 1st Floor 48 Station Road Wood Green London N22 7TY T: 020 8489 3066 M: 07538 509598 F: 020 8489 1185 E: karen.baggaley@nclondon.nhs.uk Designated Doctor for Child Protection Dr David Elliman T: 020 7405 9200 ext 5137 E: ellimd@gosh.nhs.uk Named GP for Child Protection Named Nurse Primary Care Dr Julie Thomas Bridget Owen E: juliethomas5@nhs.net 1st Floor 48 Station Road Wood Green App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 22 of 33

Safeguarding Administrator Buena Cordero London N22 7TY T: 020 8489 3133 M: 07538 509 596 E: bridget.owen@nclondon.nhs.uk Secure bridget.owen@nhs.net T: 020 8489 3201 E: buena.cordero@nclondon.nhs.uk Secure buena.cordero@nhs.net LOOKED-AFTER CHILDREN LEADS Designated Dr for Children in Care Dr Kim Holt Bounds Green Health Centre 1a Gordon Road Bounds Green London N11 2PA T: 020 3074 2840 E:kim.holt@nhs.net Designated Nurse for Children in Care Judy Mace Bounds Green Health Centre 1a Gordon Road Bounds Green London N11 2PA T: 020 3074 2800 E: judith.mace1@nhs.net App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 23 of 33

Appendix 2 Haringey CCG Mandatory Child Protection Training Strategy January 2013 Introduction: Child Protection (CP) is everybody s business. Skilled and competent staff, adequate managerial support and professional supervision are crucial elements in CP. Section 11 of The Children Act 2004 requires all health care organisations to ensure that their functions are discharged with regard to the need to safeguard and promote the welfare of children and young people (C&YP) and to co-operate with other agencies to protect individual C&YP from harm. Training is an integral part of this statutory duty. All health staff must have the competences to recognise child maltreatment and to take effective action as appropriate to their role. They must also clearly understand their responsibilities, supported by their employing organisation to fulfil their duties. This training strategy sets out how NHS Haringey Clinical Commissioning Group (CCG) will fulfil these responsibilities, by ensuring all health staff have access to appropriate safeguarding training, learning opportunities, and support to facilitate their understanding of the clinical aspects of child welfare and information sharing. NHS Haringey CCG CP Service is responsible for the CP training of Haringey Independent Practitioners: General Practitioners (GPs), Dentists, Opticians, Pharmacists and their staff and staff directly employed by NHS Haringey CCG. Staff groups have different training needs to fulfil their duties, depending on their degree of contact with C&YP and their level of responsibility and these have been taken from the intercollegiate document Safeguarding children and young people: roles and competences for health care staff, produced by the Royal Colleges (2010), and Working together to safeguard children by the former Department for Children Schools and Families (2010)which set out the skills and competencies required of staff when working with C&YP. A mandatory session of 1 hour (30 minute recommendation) is included in the general staff induction programme or within six weeks of taking up post within NHS Haringey CCG. This provides key CP information, including vulnerable groups, the different forms of child maltreatment, and appropriate action to take if there are concerns. Independent Practice staff that are new to Haringey are encouraged to access the Haringey Local Safeguarding Children Board (LSCB) Introduction to Child Protection elearning course and if they work with children the mandatory LSCB interagency Safeguarding Induction - a consequence of the Haringey Improvement Plan (February 2009). Interagency training is the foundation for improved collaboration in the future. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 24 of 33

Underpinning principles: Acquiring knowledge, skills and expertise in CP is a continuum. Staff will increase skill and competence as they progress through their professional careers Whilst classification of staff can be useful in thinking about what training is needed across the workforce, it should never be used as a substitute for an individual training needs assessment Training offered is flexible, encompassing different learning styles and opportunities multi-disciplinary and inter-agency, and delivered internally and externally. They include personal reflection and scenario based discussion, drawing on case studies and lessons from research and audit as appropriate Haringey CCG encourages GPs to consider encompassing safeguarding learning within regular clinical updating, clinical audit, reviews of significant events and peer discussions Those leading and providing training demonstrate knowledge of the context of health participants work and tailor sessions to the specific roles and needs of different professionals The effectiveness of training programmes and learning opportunities are regularly monitored by evaluation forms, staff appraisals, auditing, implementation and staff understanding Staff requiring competences at Levels 1 to 3 should also possess the competences at each of the preceding levels. For some staff it may be less clear which level of training they require and this should be decided by discussion with their line manager and/or a Named or Designated professional Refresher training is offered every three years as a minimum. Training and skills acquired previously or alternative forms of training that some staff receive is acknowledged. The need to repeat learning is prevented when evidence of up to date competence, knowledge and skills is demonstrated Haringey CCG circulate update briefings and literature as appropriate and an annual awareness briefing to all Independent Practitioners and CCG staff The Named Nurse (Primary Care) and Named GP conduct general practice visits to be better able to assist staff to meet their safeguarding and CP responsibilities. The two hour initial and one hour annual visit rationale is to ensure that all staff are familiar with Working Together to Safeguard Children and London Child Protection Procedures 2010, and that these are being adhered to. The self assessment tool and a devised checklist ascertains whether or not processes and guidelines are in place to protect C&YP and when needed a prompt to contribute to the planning and development of them reflecting best practice as informed by Serious Case Reviews (SCRs), Child App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 25 of 33

Death Reviews (CDRs), audits, new legislation and guidance. A post visit action plan with action points is devised and certification offered. Levels of competence NB: 1 Programmed Activity (PA)/session is equivalent to 4 hours Level 1 / Group 1: All non-clinical staff working in healthcare settings who have infrequent contact with children, young people and/or parents/carers and who may become aware of possible abuse or neglect e.g. receptionists. Learning outcomes Recognise potential indicators of child maltreatment physical, emotional, sexual abuse, and neglect. Understand the impact a parent/carers physical and mental health can have on the well-being of a child. Know what action to take when concerned, including appropriately reporting concerns and seeking advice Understand the importance of sharing information (including the consequences of failing to do so). Demonstrate an understanding of the risks associated with the internet and online social networking. Source of Training Haringey LSCB e-learning 1hr Skills for Health Core Learning Unit e-learning 1hr Haringey CCG face to face session in annual staff mandatory training 1hr LSCB Learning Lunch 1hr Participating in Practice Visits from CCG child protection team (GP staff only) Level 2 / Group 2:All clinical staff who have regular contact or have a period of intense but irregular contact with children, young people and/or parents/carers e.g. health care students, pharmacists, dentists, dental care practitioners, opticians, nurses working in adult acute/community services (including practice nurses) It is expected that the knowledge, skills and competence for level 2 would have been acquired within individual professional education programmes. Over a 3 year period, professionals at level 2 receive refresher training equivalent to 0.5 PA. Training, education and learning opportunities offered include multidisciplinary and scenario based discussion drawing on case studies and lessons from research and audit. This is appropriate to the speciality and roles of participants, encompassing for example domestic violence and vulnerable adults. Haringey CCG encourages Dentists, Opticians, Pharmacists and Practice Nurses to consider encompassing safeguarding learning within regular clinical updating, clinical audit, reviews of significant events and peer discussions. Learning outcomes As outlined for Level 1 Uses professional and clinical knowledge to understand what constitutes child maltreatment to identify any signs of child abuse or neglect App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 26 of 33

Acts as an effective advocate for C&YP Recognises the potential impact of a parent s/carer s physical and mental health on the wellbeing of a child Clear about own and colleagues roles, responsibilities, and professional boundaries Able to refer as appropriate to role to social care if a safeguarding/child protection concern is identified Documents CP concerns in order to be able to inform the relevant staff and agencies as necessary, maintains appropriate record keeping, and differentiates between fact and opinion Shares appropriate and relevant information with other teams Acts in accordance with key statutory and non-statutory guidance and legislation including the UN Convention on the Rights of the Child and Human Rights Act Source of Training 7 LSCB Multi-agency face to face training: - Introduction to Child Protection 1 day (6hrs) - Working Together in Child Protection 2 days (12hrs) - Engaging Resistant Families 1 day (6hrs) - Child Protection Conferences 1 day (6hrs) - Child Protection Thresholds 1 day (6hrs) - Listening to Children 1 day (6hrs) - Domestic Violence 1 day (6hrs) - Violence in Adolescent Relationships 1 day (6hrs) - Sexual Exploitation 1 day (6hrs) - Learning Lunch 1 hr Level 3 / Group 2: All clinical staff working with children, young people and/or adults who are parents/carers and who could potentially contribute to assessing, planning, intervening and reviewing/evaluating the needs of a child or young person and parenting capacity where there are safeguarding/child protection concerns, e.g. paediatric dentists and GPs. GPs who have not attained the relevant knowledge, skills and competence required at level 3 are expected to have within a year of appointment, completed additional education equivalent to 2 Programmed Activities (PA)s/sessions of education and learning related to child protection, and those requiring specialist-level competences should complete 4 PAs/sessions. Over a 3 year period, professionals should receive refresher training equivalent to 1-1½ PAs/sessions for those at Level 3 core this equates to 0.5 PA per annum and 3 to 4 PAs/sessions for those at Level 3 requiring specialist knowledge and skill. Learning outcomes Identify signs of sexual, physical, or emotional abuse or neglect using child and family-focused approach. Know what constitutes child maltreatment including the effects of parental behaviour on children. 7 Training courses offered by Haringey LSCB may change. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 27 of 33

A clear appropriate understanding of forensic procedures in child maltreatment and how to relate these to practice to meet clinical and legal requirements. Undertake, where appropriate, a risk and harm assessment. Communicate effectively with C&YP and ensure that they have the opportunity to participate in decisions affecting them as appropriate to their age and ability. Contribute to, and make considered judgments about how to act to safeguard/protect a child. Contribute to/formulate and communicate effective management plans for children who have been maltreated. Understand the issues surrounding misdiagnosis in CP and how to effectively manage diagnostic uncertainty and risk. Ensure the processes and legal requirements for looked after children, including after-care, are appropriately undertaken. Appropriately contribute to inter-agency assessments by gathering and sharing information. Document concerns in a manner that is appropriate for CP and legal processes. Undertake documented reviews of own (and/or team) CP as appropriate to role (e.g. through audit, case discussion, peer review, and supervision and as a component of refresher training.) Contribute to SCRs/case management reviews and CDR processes. Deliver and receive supervision within effective models of supervision and recognise the potential personal impact of CP work on professionals. Additional specialist learning outcomes for paediatricians, paediatric intensivists, forensic physicians, child and adolescent psychiatrists, child psychologists, child psychotherapists, GPs, children s nurses, school nurses, child and adolescent mental health nurses, children s learning disability nurses, midwives and health visitors. Work effectively on an inter-professional and interagency basis when there are safeguarding concerns about children and their families. Advise other agencies about the health management of individual children in child protection cases. Apply the lessons learnt from audit and SCRs/case management reviews to improve practice. Advise others on appropriate information sharing. Work with children and families where there are child protection concerns as part of the multidisciplinary team and with other disciplines, e.g. adult mental health, when assessing a child. Obtain support and help in situations where there are problems requiring further expertise and experience. Participate in and chair multi-disciplinary meetings as required. Source of Training Single agency GP face to face training delivered by CCG CP team (2hrs) LSCB Multi-agency face to face training: - Learning Lunch 1hr - Working Together in Child Protection 2 days (12hrs) - Serious Case Review Lessons 1 day (6hrs) App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 28 of 33

- Attachment Theory in Child Protection 1 day (6hrs) - Engaging Resistant Families 1 day (6hrs) - Child Protection Conferences 1 day (6hrs) - Child Protection Thresholds 1 day (6hrs) - Listening to Children 1 day (6hrs) - Domestic Violence 1 day (6hrs) - Training for Trainers1 day (6hrs) Guidance includes: Intercollegiate Royal College of GPs Document Safeguardi Toolkit 2011.pdf Working Together 2010.pdf Section 11 of the Children Act 2004.pdf Contact Haringey CCG Child Protection Service Tel. 020 8489 3201 or email hgypct.childprotection@nhs.net regarding any queries. For LSCB training contact Haringey LSCB (Web: www.haringeylscb.org email: lscb@haringey.gov.uk. Tel: 020 8489 1472). The completed elearning application forms to elearning@haringey.gov.uk and the LSCB training brochure is downloadable: http://www.haringeylscb.org/index/training.htm App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 29 of 33

Appendix 3 RESOLVING INTER-AGENCY DISAGREEMENT Protocol for Resolution of Professional Disagreement Between Agencies Working with Children in Haringey Generally there is a good working relationship between agencies, but occasionally there will be a difference of professional views. This protocol is designed by Haringey Local Safeguarding Children Board s (LSCB) Quality Assurance and Practice Review sub-group, with the intention of simplifying the action required within Haringey. It summarises the relevant sections from the London Child Protection Procedures. Disagreements over the handling of concerns about children referred to children s social care generally occur for one of the following reasons: The referral does not meet the eligibility criteria for assessment by children s social care; Informal advice is sought and children s social care have concluded that a referral is required; Children s social care have concluded that the referrer should seek further information before the referral is progressed; Children s social care conclude that an initial assessment should be undertaken rather than initiate child protection procedures; Children s social care conclude that child protection procedures must be initiated; Children social care and police disagree about whether a referral should be handled as a joint Section 47 Investigation; Children s social care and police disagree about need to exercise powers of emergency protection An agency does not agree with the decision made by children s social care not to convene a child protection conference. What happens when agencies can t agree? Stage 1: App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 30 of 33

If professionals are unable to reach agreement about the way forward in an individual case then their disagreement must be addressed by more senior staff. In most cases this will mean the first line manager within children s social care (usually in the First Response team) discussing the issue of dispute with the following people in the 3 key agencies: A Detective Sergeant in the Child Abuse Investigation Team (CAIT) A senior Health Visitor / Nurse / GP/ Named Professional The Designated Staff Member for Child Protection in schools Stage 2: If the issue cannot be resolved at this level then the matter must be referred without delay to a Head of Service in children s social care to discuss with: The Detective Inspector of CAIT The Designated Doctor or Nurse in the health services The Head Teacher of the school Other relevant senior personnel Written records must be kept of all these discussions. What happens if an agency believes a child protection conference should be held and Children s Social Care disagree? The procedure outlined above in stage 1 should be followed. If concerns remain after this, the agency may formally request that children s social care convene a child protection conference. Children s social care should convene a conference where one or more professionals supported by a senior manager or named or designated professional, requests one. What happens if the disagreement is resolved but one agency remains concerned about the process or behaviour of another agency or feels there are wider learning points from the case? Providing Stage 1 and Stage 2 of the above procedures have been followed then the case can be referred to the Quality Assurance and Practice Review sub-group of Haringey Local Safeguarding Children Board. Information about how to make a referral can be obtained by emailing LSCB at lscb@haringey.gov.uk. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 31 of 33

This process should not be used for trying to resolve an ongoing dispute between agencies. Where a dispute between agencies is considered by the Quality Assurance & Practice Review sub-group written feedback will be provided to the relevant agencies and where appropriate an action plan drawn up so that learning from individual cases can be translated into revised protocols. App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 32 of 33

Appendix 4 App. 6.3 - Safeguarding Children Policy and Procedure (revised) Page 33 of 33