LCCG Safeguarding and LAC Working Group 20 th June 201, 14:00-1:30 Lower Marsh, Lewisham & Greenwich Room Present NAME ORGANISATION Alison Barnwell AB Consultant Community Paediatrician & Designated Doctor for Safeguarding, GSTT Debbie Saunders DS Head of Safeguarding Children Nursing team, GSTT Naeema Sarkar NS AD Quality CSC, LBL Paul Archer PA Named Nurse for Safeguarding Children, SLaM Maria Burton MB Business Manager, LSCB Margaret Hill MH Named Nurse, Lambeth Community GSTT Ayanda Jolobe AJ Named Doctor Community, GSTT Abdu Mohiddin AM Public Health Consultant, Lambeth & Southwark Alison Davidson AD Named GP for safeguarding children, Lambeth CCG Avis Williams McKoy AWM Designated Safeguarding Nurse, Lambeth CCG Tracey Lewis TL CAMHS Service Manager for Lambeth & Southwark Shirazul Islam SI Commissioning Support Officer, LCCG Absent Rosalinda James RJ KCH Named Nurse-Safeguarding Children, KCH Maria Millwood MM Integrated Director Commissioning, Children & Young People Emma Stevenson ES Assistant Director Children & Maternity Joint Commissioning Lambeth CCG/ LB Lambeth Pasquale Brammer BP Senior Commissioning Manager, Lambeth CCG Adam Curtis AC Named Nurse for Lambeth Community Efun Johnson EJ Designated LAC Doctor, Lambeth CCG Cathy Donoghue CD Designated Nurse for Looked After Children - GSTT/LCCG/LBL David Grafton DG CAMHS Transformation Implementation Officer, LCCG No. 1 1.1 2 2.1 Welcome and Introductions Apologies for Absence Apologies had been received in advance of the meeting from: AB Maria Millwood, Chair, Commissioning Director for Children s Services, Lambeth CCG/London Borough of Lambeth Pasquale Barnwell, Senior Commissioning Manager, Lambeth CCG Barbara Hills, General Manager Efun Johnson Designated LAC Doctor, Lambeth CCG Cathy Donoghue, Designated Nurse for Looked After Children - GSTT/LCCG/LBL Emma Stevenson, Assistant Director Children & Maternity Joint Commissioning Lambeth CCG/ LB Lambeth NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 1 of 11
3 3.1 Declarations of Interest No interests were declared in relation to the agenda items for this meeting. 4 Minutes of previous meeting held on 15 h March 201 and s/matters Arising and Chair items The below adjustments was needed to be made on the previous minutes. Barbara Hills job role is General manager. The minutes were otherwise agreed as an accurate record Lisa Humphrey was the AD for CSC. An interim manager is in place named Sue Butcher. DG to send SLAM/CAMHS report to AWM and will be distributed to the working group members. (Completed) Regarding 5.12. No one was able to give up on this. This will be followed up later. Re 8.15: DG to liaise with Michelle Marsden to circulate the data once it has been (Completed) Re: 11.5 (Clarification is required with regards to sexual health commissioning and support services for CSA and FGM. Both of these were picked up in the recent NHS England Deep Dive. ES and PB are to up.) SI follow this up Re: 12 (SCR). The LSCB is holding a briefing regarding Child J and the lessons learnt from this. Booking for this is done via the LSCB website. Re: 15.5 (DG - A list has been circulated around whose who, in the pilot team. DG to send the document to SI who will circulate to the group.) (Completed) 5 5) Looked After Children (LAC) Health Ups /Reports EJ/ CD sent their apologies. The working group is asked to review and note an up. All health (GSTFT) single agency actions from Child J have been completed. DS-. Internally GSTFT have a vulnerable persons committee, which is a joint adults and children s committee. There a subgroup called safeguarding operational group. GSTFT are in process of convening a LAC sub-group within the organisation. ) GSTT Performance and Quarterly Reports and Multi Agency Safeguarding Hub (MASH) DS -Presented/discussed the GSTFT quarterly reports. There is more information contained in the reports than what was needed for this meeting. The data presented is Trust-wide with some Southwark comparison. The main report will be tabled for discussion at the vulnerable persons committee. The reporting is based on the section 11 NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 2 of 11
compliance. Serious case reviews- There are no new SCR for this quarter. There is potentially a new SCR with Medway. The background report has been completed at this stage and no further information has been requested. SCR Child I: One action remains outstanding for child I. Geraldine Joyce is completing an audit for supervision of midwives. The survey monkey has been completed. The results have been finalised and the report is to be completed which was then go to the next safeguarding Children s committee. Chid J. Some of the joint SCR s or where Children s social care has been involved have not been progressed significantly. Our KPIs are still poor regarding timely receiving notifications. Allegation management- There are no new allegation in this quarter. We are finding that the allegation process is lengthy. A RCA is expected to be completed within 28-30 days. Some allegation investigation and disciplinary cases have been opened for - 7 months. Staffing -The safeguarding team is now fully staffed. There is unfortunately a gap in capacity due to staff sickness. There will be disinvestment from the LA for PH spending. In response a new board (disinvestment board) has been set up which meets on a monthly basis to assess the impact this will have on the health vising and school nursing service The safeguarding team is involved in this group. They will assess (via KPIs) if the changes occurring will have any negative impact on the safeguarding. Currently it is business as normal. Page 42 shows the breakdown of Lambeth safeguarding nursing supervision data for January to March 201. One of the indicators that we will review going forward is the number of children who are not reviewed between the supervision sessions. For example if a practitioner reviews a child and then they are not seen again in 3-4 months then this would need to be reviewed again. MASH -The Quarterly MASH report shows that activities are increasing: (page 50 of 357). It is important to note that those in child in need or child protection need to be flagged and can be picked up easily by any replacements to ensure they are not forgotten about. 7 All Agencies to ensure that their internal Quality Assurance and Auditing activity includes reviews of cases where there is chronic neglect, parental learning disability or parental hostility page 47. No agencies audit has been completed in relations to this. 10 cases as part of multi agencies have been completed. KCH Performance and Quarter report. RJ was absent for this meeting. This will be carried onto the next meeting. The Group has been asked to review the report and feedback to be raised at the next meeting. SLaM and CAHMS Performance and Quality Reports ALL RJ 8 PA- Presented CAHMS/SLaM Report: A Considerable amount of work has been NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 3 of 11
9 undertaken to further strengthen the safeguarding policies i.e. FGM policy. This has been now ratified and is live. Currently the Trust is rewriting the following policies: domestic abuse policy, chaperone policy and e-safety policies. The e-safety policies were derived from the Saville review. This policy would not be Trustwide policy (due to complexity) and is only for CAMHS inpatient units only. DBS- Compliance is approximately 95%; the remaining 5% are on maternity leave, long-term sicknesses leave etc. Training- Investments have been put into the safeguarding trainings. In September the training strategies was rewritten. The delivery of level 1, 2 and 3 would also be changed. The delivery of the prevent programme was started in August and approximately 40% of the workforce have had their training. The frequency of the training is one day training per month in which about 100 staffs attend. Training is an area of vulnerabilities; we are unable to provider a trainer (to delivery level 1 and 2) as there are no funds for this post. However, a business case (for a safeguarding trainer) has been sent to the director of finance. Currently awaiting final agreement around this. A Trust-wide family conference was recently held where the learning s from SCR Child J was shared. Senior managements from the Trust have agreed to hold a looked after child study day. Progressions around this will be brought to the next meeting Audits-Various multi-agency audits across various boroughs such as threshold, DNA, CAHMS & GP s correspondences, and supervision audits have been completed. SLaM s new template for safeguarding children will be signed off on Friday and will be live as of Wednesday. This will need to be relayed to other users and over the course of the next few quarters more data can be collected. SCR- We have a number of SCR across whole of SLaM that we are involved with. Child R, S and W (joint SCR between Lewisham and Croydon) will be published soon. A learning review is being undertaken in Croydon in relations to a poisoning of a young child. Serious incidents there have been no incidents (graded A or B) from a safeguarding children s perspective that have been graded as a serious incident in the last quarter. Child Death Over View Panel AM- Verbal Up-. The annual report is currently in progress. Nine deaths have been reviewed but there are about 25 or more to be reviewed in total. The Alan Wood review suggests the role of CDOP should continue but talks about changing it from DFE to DH. CDOP have reviewed a number of deaths where sickle cell disease (SCD), management was a feature. Additionally, The Sickle Cell Society has written to the CEO to raise concern about the quality of care being offered to patients/clients with SCD. Suicides-There have been a number of suicides that have been reported to CDOP SE London LA/CCGs which are predominantly from Bromley, Lewisham and Greenwich. A NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 4 of 11
10 11 12 13 suicide summit was held last week Chaired by PH Lewisham for commissioner and clinicians. They are trying to share good practices across the partnership. AD- Independent Contractor: Page 87/357- details shows the number of data regarding child protection training for GP s and practice nurses in Lambeth. 5 Level 3 training days have been offered so far this academic year, further training is booked for 4th July. There have been 5 lead GP safeguarding forums since September 2015. A lead GP is invited from each Lambeth surgery, and usually 15-20 GPs attend. The forum is 2 hours long and ranges of topics are discussed. Recently case notes reviewed for the LSCB Neglect audit, in light of SCR I, preliminary findings advised stronger links between GPs, school nurses and midwives, also for GPs to be more proactive rather than reactive in their safeguarding role. The section 47 audits is about to start. LSCB Executive minutes The LSCB minutes shared for information the group was asked to review and action the as appropriate in particular to read the government s response to Alan Wood CBE review. Serious Case Review J LSCB Training - Lessons learnt from this Serious Case Review. The LSCB training programme includes two briefing sessions to set out the lessons arising from Child J s death. The briefings are scheduled for: 4th July, 1.00-4.30pm & 18th October, 1.00-4.30pm. Both will be held in the Lecture Theatre at International House, Brixton. Named safeguarding leads are advised to encourage to attend and agency trainers and team leaders to sign up of the training as training across partners to be cascaded, using the LSCB presentation. CQC/Ofsted Inspection DS mentioned that there was a couple of things for Guys and St Thomas s to do, some of which included, 1. Updating Policies and Procedures to make sure Working Together 2015 is in there 2. Updating Restraining Policy 3. Keeping going with the training compliance to achieve 100% across organisation 4. School Nursing provision PA mentioned that in relation to SLAM CQC inspection from safeguarding prospective, there were two main things, one was in and around their Safeguarding Data and the other one was around their HR Processes. They are writing an up paper to LSCB which will be presented to the next meeting. FGM- Log from FGM reviewed: AWM mentioned that the Task and Finish FGM Working Group ended in January, the remaining actions are to be followed up and NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 5 of 11
14 implemented by the provider trusts and will be monitored by both Southwark and Lambeth safeguarding strategic CCG commissioning groups. AWM Highlight the recent Multi-Agency Statutory Guidance of FGM (April 201) attached AOB The guidance has 3 functions: 1. To provide information on FGM, including the law on FGM in England 2. To provide strategic guidance on FGM 3. To provide advice and support to front-line professionals Page 54 of the guidance details the Female Genital Mutilation Risk Indication System (FGM RIS). This is a national IT system for health that allows clinicians across England to note on a girl s record within NHS Summary Care records that they are potentially at risk of FGM. FGM RIS allows for confidential information to be shared with health professionals across all care settings until the girl is 18 years old. s a) - Designated professionals, AB and RH to up CP medical proforma to include as appropriate FGM inquiry/information AB upd that on the Lambeth side, training has be upd so that people know what needs to go on the proforma, b) Named Safeguarding leads, KCH, GSTFT and SLaM, & GP practices to up practitioners on Mandatory FGM Guidance 201 and ensure FGMRIS is implemented locally. DS, RJ,PA. MH,& AD AWM requested that consideration/training should be given to practitioners as to how this is recorded in The personal child health record (also known as the PCHR or 'red book'). This is a national standard health and development record given to parents/carers at a child's birth. An online version - the eredbook - is now also available. The red book does not have overt information regarding FGM. It should be noted that the red book is a child record and not the mothers. NHSE has commissioned the paper Redbook with intention for it to go out directly from Midwifery. The PCHR is the main record of a child's health and development. The parent/carer retains the PCHR, and health professionals should up the record each time the child is seen in a healthcare setting. AWM highlighted that it is in the FGM guidelines for midwives/health visitors to record significant Family History (page 5), allows for this information to be appropriately and sensitively recorded e.g. Are there any other particular illnesses or conditions in the mother s or father s family that you feel are important? NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page of 11
15 AOB Safeguarding leads are asked to review the following attached reports: Bradbury Review and presentation for LCCG Governing Body, IICSA Checklist, Lampard Inquiry and the Multi Agency Statutory Guidance on FGM. The reports are to be discussed at the relevant safeguarding forums and actions to improve practice discussed. Provider agency /actions plans to be an agenda item to be discussed at the next SLAC DS PA RJ Future Meetings 1 LCCG/SLWG/015 Dates and times of future meetings Dates and times of future meetings and deadlines for the receipt of reports / papers are as below Meeting Date Time Papers due by Location / Time 19 September 201 14:00 1:30 09/09/1 Room 407,4th Floor Lower Marsh 12 December 201 14:00 1:30 02/12/1 Room 407,4th Floor Lower Marsh The agenda and minutes of this meeting may be made available to public and persons outside of NHS Lambeth Clinical Commissioning Group as part of the CCG s compliance with the Freedom of Information Act 2000. NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 7 of 11
Lead Due 1. MM to arrange a meeting with Ian Smith to discuss the following issues: MM - Representation from CSC and adult social care at these meetings By 31 Jan - Health surgeries 201 - Figures from the LAC health up AWM 2. MM to facilitate a meeting with the LAC Health Team to discuss and prepare a briefing for a meeting with and Ian Smith. To include The need for children with a disability to be known to health and to have a lead clinician MW, AWM. &CD EJ Before 18 Jan 201 3. All to let EJ know if they have any amendments to the choice of data included in the LAC health up All/EJ 04/03/201 4. BH, EJ & CD to continue to further develop the LAC KPI/Digest to include information on : -OOB Children -LAC Children from other LA resident in Lambeth -Analysis of spending on out-of-borough assessments. -With an introduction or appendix explaining what was being measured and why. EJ/CD/BH 09/09/201 5. DG to send the SLAM/CAMHS report to AWM once ratified. AWM to circulate to the group. DG/AWM 31/12/15. CDOP Annual report to be an agenda item at the next meeting on the 15 March 201. Report for the next meeting to AM 04/03/201 be sent to the SLAC administrator by Friday 4 March 201. 7. Next SLAC meetings to have a thematic/ in-depth discussion on SCR action plans implementation. All agencies to review and up single and multiagency plans for SCR J 8. Review the likelihood of an unannounced CQC inspection being carried out. MM/AWM 09/09/201 9. FGM KPI s and actions which relate to health professionals to be reviewed and monitored at the SLAC ALL 09/09/201 10. All reports from partners health agencies to be sent to SLAC administrator by midday 9th September 201 ALL 04/03/201 NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 8 of 11
ITEM DATE ACTION AGREED LEAD ACTION (RAG Rating) TAKEN/COMPLE TED 1 3/0/15 Public Health will lead on providing the sub group with demographic statistics for Lambeth and Southwark. FGM should be included in the HWB information and the JSNA in order to inform commissioning of services. Public Health to provide analysis of the local FGM profile London s and national profile. Lambeth & Southwark - AM DUE DATE Comments Paper provided with some statistics, further work required, although noted briefing (no more than 2 pages) would be needed for Health and Wellbeing Board. 2 3/0/15 Designated and Named Drs Lambeth and Southwark to review and up CP medical pro forma to include as appropriate FGM inquiry/information. 3 3/0/15 To review HV and School Nurse standards to include routine enquiry for all female children in line with universal contact from the HCP. Health education and health promotion information to be provided and conversations to be recorded in the PCHR (Red Book) and patients electronic records. Alison Barnwell & Ros Healy Named professionals/ HS & MH Changes in hand. Training given to teams about using existing proforma. CC/AWM to liaise HS and need to follow up with MH to up school nursing guidance. to be followed up at CCGs Safeguarding Meetings up requested 20/10/15. to be followed up and monitored at CCGs Safeguarding Meetings 4 11/0/15 KG and AF to look how FGM can become part of the corporate and business plan 5 11/0/15 Lambeth Education (GG) in conjunction with Named Professional GSTT - to develop a flagging system across education that alerts when a child is at risk of FGM. Southwark: Education Lead to develop a flagging in conjunction with Named Professionals GSTT to develop a system across education that alerts when a child is at risk of FGM. Lambeth KG Southwark AG Lambeth GG Southwark Education Lead AC NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 9 of 11 AWM to discuss with new business manager. Need to review in a year s time. completed by health. to be followed monitored at CCGs Safeguarding Meetings and at the LSCB Learning and Improvement Sub Working Group
It is important that there are systems and structures in place to support midwives in their work with women in FGM practising communities; these include a clear referral pathway for deinfibulation and psychological therapy. Midwives need to be familiar with the relevant clinical guidelines to enable them to deal appropriately with cases of FGM or suspected FGM. Clinical guidelines must be explicit, regularly upd and clearly state the expectations of practitioners in the antenatal period and during labour. Maternity units develop information for parents with infant girls which unequivocally explains the law on FGM that it is against the law to take a child outside the UK for the purpose of FGM or to carry out the procedure in the UK. That maternity units should develop systems for data collection and audit of services and use local population data for service planning and delivery. The provision of regular education, and evidence based ups on safeguarding of children in respect of FGM and an emphasis on the midwife s role in protecting children from harm. Midwives should appraise themselves of the legal framework on FGM in respect of Child Protection. Training and educational resources for both pre and post registration education and training programmes should be developed within a multi-- professional context with active involvement of the communities themselves. NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 10 of 11
AJ AM AWM CCH GG GJ MB MH PA RJ TL JK Ayanda Jolobe - Named Doctor Community GSTT Abdu Mohiddin Public Health Avis Williams-McKoy - Designated Nurse for Safeguarding, Lambeth CCG - CHAIR Corina Christos - School Nurse Team Leaders Graham Griffin - Safeguarding Manager, Universal Services & Named Senior Officer for Education Services Geraldine Joyce - Named Midwife Guys & St. Thomas Trust Maria Burton LSCB Business Manager for Lambeth Margaret Hill - Lambeth Named Nurse for Safeguarding Children Paul Archer Named Nurse Safeguarding Children SLAM Rosalinda James-Head of Nursing & Safeguarding Children Named Nurse KCH Tracey Lewis CAMHS Service Manager for Lambeth & Southwark Janna Kay - Lambeth Safeguarding Adults 03/0/2015 and 11/0/2015 Meeting Log NHS Lambeth CCG: Safeguarding and LAC Working Group 20.0.1 Page 11 of 11