ANEURIN BEVAN HEALTH BOARD HEALTHCARE INSPECTORATE WALES SAFEGUARDING AND PROTECTING CHILDREN IN WALES: A Review of the arrangements in place across the Welsh National Health Service ACTION PLAN RECOMMENDATION ACTION TAKEN ACTION REQUIRED LEAD TIMESCALE 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. Nurse Director with lead for child protection in place. Appointment of Safeguarding Lead for Health Board. Establishment of a Child Protection Committee. Named Nurse and Named Doctor for Child Protection in place. Develop clear reporting structures to inform the Board of issues in regard to the safeguarding agenda. Clarity in relation to the relationship between the ABHB and the Child Protection Service (CPS). Denise Llewellyn, Director of Nursing February 2010 2. Child protection training is made mandatory for all staff groups. Update training should be provided at least every 3 years. The Welsh Assembly Government (WAG) should ensure that all nationally agreed contracts reflect this requirement. Level 1 Child Protection training part of the mandatory induction training for all ABHB staff. Child Protection Strategy in place. Level 2 Child Protection training mandatory for staff working directly with children and families. In place Named Professionals Ongoing CPS have developed best practice guidance which is used in the delivery of training for independent contractors.
3. The new Local Health Boards (LHB) further engage with primary care contractor groups to ensure they receive the necessary training and support in respect of child protection and safeguarding 4. 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. See Rec. 2. A child protection training model for contractor services in Caerphilly is in place. Child protection is provided by the CPS in the other Gwent Local Authority areas. All 6 organisations have adopted the All Wales Child Protection Procedures (AWCPP) and local policies ratified by the Local Safeguarding Children Boards (LSCBs). The ABHB to work with the CPS to provide a national strategy for contractor services. Review all the existing child protection policies of the merged organisation to ensure they comply with the AWCPP. All new child protection procedures to be scrutinised by the Child Protection Committee. ABHB CPS June 2010 ABHB Child Protection Committee June 2010 5. 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. ABHB continue to have representation at this forum and this recommendation should also link to the LSCBs. Denise Llewellyn, Director of Nursing 6. CSPs ensure robust and well managed family centred, substance misuse care pathways into and out of children and family services. 7. CSPs ensure that information sharing agreements are in place for their local area and that these cover the protection of vulnerable people. 8. All assessment, Care Programme Approach (CPA) monitoring, 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. As above ABHB involved in the development of a Gwent multiagency Information Sharing document. All CPA Assessment and WARRN Risk Assessment has been amended. They now contain a prompt that requires the assessor to specifically consider the risks to children from the service user. Audits of MDT Minutes and CPA/WARRN documentation are currently being undertaken to ensure that this is taking place. Multi-agency Ongoing Kelly Jones February 2010 (MDT Minutes) CPA Audit March 2010. 2
Additionally the MDT format has been amended also. This has resulted in the risks to children being discussed by any of the following:- New Service User Those service users being discharged from hospital. Those service users in the community whose risk is thought to be increasing. 9. If the service user has or may resume contact with children, this should trigger an assessment of 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. These meetings are held weekly and all minuted. During these meetings the care plans are amended accordingly. All CPA and UA documentation contain prompts that remind staff to ask relevant questions where there are children in the service user s network. The WARRN risk assessment process contains a prompt to ask relevant questions. Audit to ensure compliance Kelly Jones/ Julie Kendall/ Claire Thomas March 2010 The MDT format contains a prompt to consider any child protection issues. If following an MDT meeting a service user is considered to be a risk then this would prompt the care coordinator to conduct a new assessment. Specific attention would be given to the pertaining risks and subsequent management plan. 3
10. Referral 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. All Locality Managers have been issued with the names and arrangement procedures of their respective Lead Nurse for Safeguarding Children Gary Hicks A referral must be made: If service users express delusional beliefs involving their child and/or if service users might harm their child as part of a suicide plan. 11. 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. All Teams have been instructed on the procedure to be taken when identifying a child at risk. In addition to this all teams have been issued with:- Names of respective lead nurses for safeguarding children Child protection procedures All Locality Managers have been issued with the names and arrangement procedures of their respective Lead Nurse for Safeguarding Children All clinicians in the teams will be made aware of the contact details and arrangements should they need to make a referral. Gary Hicks Child Protection Procedures will be made available to all clinical areas All clinicians to attend Child Protection training Session raising awareness of referral protocols available throughout Gwent Claire Thomas/ Linda Brown Invite Named Nurse to Medical Post Graduate Training to promote and provide awareness on the Referral Protocols for Child Protection through out Gwent. Claire Thomas /Linda Brown/ Danny Antebi 4
12. A consultant psychiatrist should be directly involved in all clinical decision making for service users who may pose a risk to children. Liaise with Post Graduate Organiser to ensure Child Protection training is incorporated in medical staff induction. All Locality Managers have been issued with the names and arrangement procedures of their respective Lead Nurse for Safeguarding Children Claire Thomas/ Linda Brown/ Julia Lewis Gary Hicks/ Danny Antebi All clinicians in the teams will be made aware of the contact details and arrangements should they need to make a referral Team Managers will co-ordinate training for team members locally with the Lead Nurses for Safeguarding Children. 13. 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. Child Protection Procedures will be made available to all clinical areas. All staff within the Mental Health and Learning Disability Division will undertake the relevant Child Protection training as outlined below: Level 1: on-line for all staffupdated very 3 years Audit to ensure compliance with training Kelly Jones/ Julie Kendall/ Claire Thomas Level 2: Health Professionals Roles and Responsibilities in Child Protection Recognition and Referral- all staff who work with families and children- updated every 3 years Level 3: Working with Families with Learning Disabilities or Mental Health Problems 5
14. All CAMHs 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 relevant agencies with whom it should be shared. Child Protection Training is a standing agenda item on the Divisional Learning Group and Learning Disability Quality Improvement Board Multi-agency information protocols already exist between Health and Local Authority agencies. A multi-agency Information Sharing documents is being developed. Next meeting 5 th January 2010. Identify Lead LSCB to develop Information Sharing Protocol with local NHS CAMHs on behalf of Gwent/Aneurin Bevan region. Suggest Newport as Consultant Psychiatrist already sits on this group. ABHB Specialist CAMHs Newport LSCB April/June 2010 15. 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. A&E RGH Response All new medical staff undergo child protection training on induction. Rolling programme for nursing staff in place on child protection training. All middle grade staff trained in APLS or EPLS and so 24/7 presence of staff member with both child protection training/paeds resus skills on duty RGH. Nursing staff have training in PLS as part of rolling education programme. Need to maintain provider status in APLS and ongoing updates for child protection training as part of PDP for medical staff. Agree training programme and complete. Lead Clinician Senior Nurse Ongoing March 2010 RCN advice constantly available via paediatric wards. Three members of staff (RSCN) working in A&E. Recently appointed (Feb 2009) consultant with accreditation in paediatric emergency medicine. Review required to address capacity. Further recruitment and support to enrol current nursing staff in appropriate training. April 2010 6
A&E Nevill Hall Hospital Response Guidance noted. Senior medical staff have this training and are generally rostered to be present 9.00 am 11.00 pm weekdays. Review of medical staffing to be addressed. N Jenkins/ M Webberley 16. All LHBs should, where there are concerns about a child attending A&E (including minor injuries units) follow the All Wales Child Protection Procedures and child s health visitor/school nurse and GP notified. 17. The WAG takes further steps to ensure that the profile and level of expertise for child protection with GP practices is raised. 18. The WAG puts national arrangements in place to ensure that A&E attendance records and Child Protection Registers are shared between A&E departments. Dedicated paediatric liaison safeguarding post in place This links to Rec. 2. See Rec. 2 This recommendation needs careful consideration as it is written. For this to be robust, A&E departments would need access to all 22 Local Authority Child Protection Registers and those processes in place for the identification of at risk children in England. All A&E departments are able to contact Local authority Social Services to check if a child s name is on the Child Protection Register. Further clarity from HIW. Needs to be discussed. 19. 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. A pilot project is in place for the amalgamation and integration of the Child Health Record and the Acute Record to ensure all relevant documentation is available to the treating clinician. Resources to undertake this on a wider scale unless the records are made available electronically through scanning will be quantified following the conclusion of the pilot phase. Dr Heather Payne, Community Paediatrics; Cynthia Henderson, Head of Health Records. June 2010 7
20. 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. Meeting arranged with former primary care advisor (LHB) to discuss requirements and existing arrangements including ISP s. From meeting with former Primary Care Advisor to develop action plan and develop revised ISP (if necessary). Richard Howells June 2010 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. 21. 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 12th October 2009 and all NHS organisations must ensure that they have the necessary systems and procedures in place to ensure compliance with the scheme. 22. The WAG revisits the recommendation we made in 2007 in relation to ensuring that age specific adolescent facilities are made available across Wales for all specialities. 23. The new LHBs take steps to ensure that dedicated areas for the triage and treatment of children and young people are made available in all A&E departments. A business case has been developed. An action plan has also been developed to underpin the implementation of ISA over the 5 year period from November 2010 2015. The new ISA barred lists have been introduced. Updates are put onto the Intranet Would welcome progress in this area. RGH have dedicated separate triage, assessment and treatment areas between 10.00 02.00. Out side these times children are managed in adult areas due to insufficient staff to man the paediatric area overnight. CDMH does not have separate facilities. Require Executive Team to consider the business case and implications for ISA implementation. Implement the Action Plan ABHB wide. Raise awareness of ISA and regulations. Put in place changes internally. Update CRB Policy Joint business case with child health to seek funding for additional nursing staff previously written, submitted and unsuccessful. Support required for resubmission. CDMH issues should be addressed in new build hospital YYF Julie Chappelle / Evelyn Frank / Liz Long Manager Child Health previous owner Denise Llewellyn, Director of Nursing 2011 Registration Start Date: 01 November 2010 Completion Date: 2015 8
NHH Recommendation noted. The geographical layout of the existing department does not allow us to comply with this recommendation. If changes were made to the geography this would have a knock on effect in requiring adequate staffing to staff these areas. 24. All NHS and primary care contractor staff must wear visible identification badges when on duty. 25. All mental health wards should implement a Policy for the Visiting of Psychiatric Patients by Children. Discussion will be undertaken to identify a solution to this recommendation. Policy in place.. A policy for Children Visiting Wards is in place and follows national guidance. Chair of the Divisional Policy Group 26. 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 are made to ensure the comfort and safety of that child and for maintaining the privacy and dignity of other patients on the ward. All staff have access to the policy for Children Visiting Wards and are aware of the necessary arrangements to be made. Chair of the Divisional Policy Group 9