` Safeguarding Children and Young People Annual Report 2011-2012 Trish Newcombe Senior Nurse Safeguarding Children On behalf of the Solent NHS Trust May 2012 1
1. Executive Summary 2. Background and Introduction This report presents an overview of safeguarding children activity undertaken by the Solent NHS Trust Safeguarding Children Team between 1 st April 2011 and 31 st March 2012. The safeguarding teams across Solent continue to integrate policy, principles and key objectives. However, it is recognised that activity across the East and West will differ according to the commissioned services of the respective PCT s, the priorities of Portsmouth and Southampton Safeguarding Boards, Children Trust s and Corporate Parenting Boards Safeguarding Children across the two cities continues to reflect the national picture of continuing scrutiny and additional demands for services. Nationally, the trend during 2011/12 has been a continued increase in the number of referrals to children s social care services 1 and children entering the care system. The numbers of children who become the subject of a child protection plan locally and nationally remains fairly static. These factors impact by increasing the demand on health services, and whilst the Safeguarding Children Team s activity data evidences the increased numbers of concerns about the welfare and safety of children, it is important to recognise that these increases also impact on many of our staff; children and family teams (especially health visitors and school nurses), community paediatricians, child and adolescent mental health services and those caring for parents with mental health and/or substance abuse needs. There have been significant challenges to the team as the Designated Nurse posts move across to commissioned services, as well as other changes amongst key staff. This movement has inevitably placed considerable demands on the remaining team members. The aim of this report is to provide assurance that safeguarding children activity within the organisation meets national safeguarding children standards and demonstrates a model of continuous improvement. The objectives set for the year provide a useful means of benchmarking activity. The strategic objectives for 2011/12 are:- To review the provision of specialist safeguarding children clinical supervision across Solent NHS Trust, to ensure that professional practice is child centric, that needs are identified at an early stage and appropriate support is in place. To ensure that Solent NHS Trust assessment processes relating to children and families; identify children who may be vulnerable to poor outcomes, 1 Munro (2010) The Munro Review of Child Protection. Part One A Systems Analysis. London. Crown. 2
assess needs and strengths using the Common Assessment Framework (CAF), plan the right responses, providing help or services to meet the needs. This may lead to single service or multi-agency support and better outcomes for children. To ensure that recommendations arising from Portsmouth and Southampton Safeguarding Children Board Serious Case Reviews are implemented. 3. Key Changes in Personnel 2011-2012: Solent NHS Trust Safeguarding Team Name Role Left Appointed Dr Catherine Designated Nurse Moved to SHIP Powell Solent East December 2011 Lindsay Voss Designated Nurse Moved to SHIP April 2012 Sue Donald Designated Nurse Resigned Children Looked February 2011 After SNT Karen Littlewood Named Nurse Solent East Resigned October 2011 Linda Jenkins Named Nurse December 2011 Solent East Katherine Designated Nurse May 2012 Elsmore Children Looked After SNT 4. Progress and activity against joint strategic objectives 2011/12 Objectives for 2011-2012 I) To review the provision of specialist safeguarding children clinical supervision across Solent NHS Trust, to ensure that professional practice is child centric, that needs are identified at an early stage and appropriate support is in place. The Named Nurse for Solent West has completed an evaluation of safeguarding supervision across the health visiting and school nursing service. The report is able to evidence ways in which safeguarding supervision supports and moves practice forward, to ensure timely assessments and interventions for children and young people. The key findings will inform the development of a Trust wide safeguarding supervision policy and alternative supervision models. The Solent NHS Trust clinical supervision policy clearly identifies that clinical supervision must address and challenge safeguarding issues that may impact on the welfare and safety of a child, young person or a vulnerable adult. This 3
policy includes consideration of the welfare of the child / young person if the primary client is an adult. A mapping exercise of safeguarding supervision across Solent NHS Trust services is currently underway and has highlighted the need for a specific safeguarding supervision policy to be developed for key Solent staff. The safeguarding network meeting held bi- monthly and chaired by the Named Nurse is a key forum for service leads to come together and discuss complex cases on a group basis. This ensures that key messages are cascaded to throughout the organisation. ii) To ensure that Solent NHS Trust assessment processes relating to children and families; identify children who may be vulnerable to poor outcomes, assess needs and strengths using the Common Assessment Framework (CAF), plan the right responses, providing help or services to meet the needs. This may lead to single service or multi-agency support and better outcomes for children. A key element of the work of the team has been to build capacity in relation to promoting early intervention and the application of integrated working tools and principles including the Common Assessment Framework ( CAF ); Lead Professional and TAC meetings. This work involves helping practitioners to undertake assessments, a joint home visit, chairing a TAC for complex cases and providing individual face to face supervision on request. Solent NHS Trust Safeguarding Children Policy has been reviewed and updated to ensure staff are aware of their responsibilities in undertaking timely assessments to ensure the right support at the right time is offered to children / young people and families. The safeguarding training programme ensures that staff understand their role in the identification of safeguarding at the earliest opportunity to ensure children and young people have optimum life chances. The further development and training of staff in the use of the risk assessment tool for underage sexual activity across the trust has ensures that the tool has been embedded into the unscheduled care service ensuring a timely and appropriate response to identified risks The introduction of the electronic recording system, RIO has presented some challenges for staff in accurately recording data collated from assessment tools, particularly the use of the Family Health Assessment Tool. This issue has been highlighted in a recent Serious case review and work is being undertaken to ensure information is recorded accurately. A shared ante-natal assessment tool is being developed for use amongst midwives, health visitors and social care, to ensure a consistent and timely response to concerns iii) To ensure that recommendations arising from Portsmouth and Southampton Safeguarding Children Board Serious Case Reviews are implemented. 4
The recommendations and subsequent action plans from all Internal management reviews are monitored quarterly by the Solent NHS Trust Safeguarding and Dignity group as well as the Serious Case Review Sub Committee of the Safeguarding Children Boards across the cities. Solent East are currently in the process of finalising an Individual Management review for a recently commissioned Serious Case Review. The action plan for a previous Individual management review, Child C is currently rated as green for all actions. Solent West has undertaken and completed within timescales, two Individual management reviews and one case file analysis commissioned by the Southampton Safeguarding Children Board. The judgements for both reviews are pending.. Amongst the developments in practice implemented as a result of the reviews are; A child specific domain being incorporated into the Unscheduled Care Service, (Walk in Centres and Minor Injury Unit) assessment documentation that is specific to the child. Training in the use of the really useful guide to recognising neglect which will enable to staff to evidence neglect and therefore provide support and help at the earliest opportunity. One of the individual management reviews, Child G, has highlighted some of the difficulties staff initially had in the use of the RIO system and recording data in a way that gives a clear overview of current concerns, for instance the use of the Family Health Assessment Tool by health visitors to gather comprehensive detail of the family history and functioning and the impact on the child. The SCR will ensure that this recording issue is audited and the outcome monitored both within Solent and by the SSCB Safer Sleep focus group and Safer sleep messages cascaded as part of the Child C SCR. The SCR s have identified an emerging theme in current practice that will be addressed in the current year. The analysis of the information gathered at the time of an assessment process and the impact on the child. The training programme for 2012-2013 has incorporated workshops to address this issue and support staff in practice. 5. As well as the Strategic objectives, the priorities of the safeguarding team are set by objectives within the continuous improvement work plan:- i) Ensure that Solent NHS Trust (Solent Healthcare) has a safeguarding children learning and development strategy in place The Solent NHS Trust Safeguarding Learning and Development Strategy (2010) is currently in place until October 2012.The strategy reflects statutory 5
guidance 2, and the Intercollegiate Document 3. The strategy is supported by Solent NHS Trust Learning and Development Team who have a responsibility to ensure that safeguarding children training at level one is incorporated within the mandatory corporate induction programme and essential training updates are available for all staff. There is a requirement for all employees to complete safeguarding children training at this level to ensure compliance with the Care Quality Commission standards (outcome seven) and the National Service Framework. All clinical staff are expected to undertake Level two and three training over a three year period. It has been a challenge to collate data to accurately reflect the amount of training that has taken place across services within the Trust in the past year. This issue will be a key objective to take forward in the in the forthcoming year. The Learning and Development team are currently developing existing training databases to ensure that all safeguarding training undertaken by staff is recorded. Dedicated support from the Learning and Development department for safeguarding training has now been agreed to support staff attending group 2/3 training. More work needs to be undertaken in terms of linking with other processes i.e. Individual Performance Review recording (against Core elements of the Key Skills Framework) and the Electronic Staff Record. Attendance at the level one, two and three Safeguarding Children Training. Mandatory Corporate Induction and Essential Training Update for Solent NHS Trust (East and West) for the year 2011-2012 Solent NHS Trust Attendance Percentage Achieved Corporate Mandatory 601 95.4% Induction (East & West) Essential Training Update 2498 78.5% (East & West) Level 2/3 (group 2-8) East 216 13.9% West 353 32% Attendance at level 2/3 over a three year period 2009-2012 Solent NHS Trust Attendance Percentage Achieved East 615 39.6% West 1414 127.73% The Named Nurses are responsible for ensuring safeguarding children training opportunities are available for staff who work directly with children or who deliver services to parents and therefore have a responsibility to consider the needs of 2 HM Government (2010) Working Together to Safeguard Children: A Guide to Inter-agency Working to Safeguard and Promote the Welfare of Children. London: DCSF 3 Royal College of Paediatrics and Child Health (2010) Safeguarding and Protecting Children and Young People: roles and competences for health care staff 6
children in their work. Bespoke training is available on request. This is developed and delivered by the safeguarding children team to meet the learning needs of a specific service. A training calendar is available for staff in each locality area. A range of single agency, learning opportunities for all staff groups is provided across the Trust, including a generic session and a number of workshops which address specific aspects of safeguarding work including key messages from learning outcomes from Serious care reviews. Topics covered for the period of review are; Children and domestic violence Fabricated and induced illness Neglect Recording and assessment Working with highly resistant families Child death Messages from Serious Case Reviews Bruising Protocol Safeguarding Supervision Child Sexual Abuse Risk Assessing Underage Sexual Activity Evaluations of training include comments such as: This was one of the best most useful training days I have ever been on. (Health Visitor 20.3.2012) Very informative and relates to current practice (Speech and Language Therapist 13.10.2011) Very good presentation and content. Very easy to take in and process Good interaction with group. (Community Children s nurse 7. 9.2011) The Named Nurses are in the process of reviewing current evaluation tools to ensure evidence of learning is embedded in practice Ensure Solent NHS Trust staff can easily access information, policy and guidance to support safeguarding children practice Safeguarding information is available on the Trust Website ensuring that all pertinent national and local legislation and guidance, training calendars and information relating to contemporary safeguarding children issues is easily accessible to staff. The site is regularly updated and users report that they welcome the easy access to the page that includes all relevant forms in relation to safeguarding processes. There is a dedicated safeguarding children intranet page for each locality covered by Solent NHS Trust. This allows the user to access the local contact details for the safeguarding children team, the Police and Children s Social Care. It also provides links to the Portsmouth and Southampton Safeguarding Children Board Website and each City s Children s Trusts website. Ensure Solent NHS Trust Safeguarding Children Policy is compliant with national and local requirements and clearly states organisational and individual employee responsibilities 7
The Safeguarding Children Policy has been revised and updated in March 2012 in line with updated national and local policy and guidance, in particular the Trust commitment to early identification of support for children, young people and families using a common assessment process. The policy content outlines the expectations Solent NHS Trust places on employees in relation to safeguarding children and young people. The principles are incorporated into all training programmes. The policy is available via Solent NHS Trust Intranet HR and Safeguarding Children pages. 6. Activity across Solent East and West Safeguarding Teams 6.1 Safeguarding Advice and support (Nurse led) Providing expert advice and support to all staff groups across Solent NHS Trust is a core function of the safeguarding children and young people team. The service is available 9-5pm Monday to Friday and is highly valued across the Trust and ensures all safeguarding concerns are dealt with in a prompt manner. Advice Calls 2011/2012 1400 1231 1200 1000 800 664 Advice Calls 2011/2012 600 400 200 0 East West Chart indicating a typical breakdown of calls received in Solent East in any given month Discipline of Contacts March 2012 Primary Care 2% 0% 10% 5% 5% 12% 7% 0% 2% 5% CAMHS Care Serv Comm Paed AMH Sub Mis. C&F T. 47% 5% L&D CSC Sexual H. 8 PHT
Breakdown of advice calls taken by the Safeguarding Team in Solent West Solent West Safeguarding Team - Enquiries 2011/12 427 29% 116 8% 919 63% Solent NHS Trust Primary Care Service Other Percentage of advice calls according to category of abuse Solent West Safeguarding Team - Categories of Enquiries 2011/12 79 182 16% 37% Sexual 98 20% 131 27% Neglect Emotional Physical 6.2. Nursing Support to the Child Protection Medical Service In Solent West the safeguarding nurses have been supporting the single point of contact (SPC) for child protection medicals to ascertain (in conjunction with a paediatrician) whether a child protection medical is needed. A Clinical nurse 9
specialist, based at the Magnolia Suite at University Hospital Southampton provides support to this service, and is able to ensure that any support and follow on care is arranged for the children and young people. 224 children were seen throughout 2011-12. The Single Point of Contact child protection medical service- Southampton 2007-2012 No Children referred to Single Point of Contact 50 45 40 35 30 25 20 15 2007-8 2008-9 2009-10 2010-11 2011-12 10 5 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 6.3. Evidence of improved practice / Quality Assurance Solent NHS Trust can demonstrate compliance compliance with CQC Essential outcome 7. In March 2012, Solent NHS Trust completed a self assessment tool to indicate compliance with Section 11 of the Children Act 2004 for Portsmouth and Southampton Safeguarding Children Boards. Identified actions to take forward are: Safeguarding supervision policy to be developed by October 2012 Specific workshops for staff in the use of and analysis of information gained from assessment tools Improve integrated working 10
Ensure consistent recording of client ethnicity and disability on the electronic RIO system Audits have been completed in the following activities:- Ensuring clinical services have a protocol in place to support the identification of children who are vulnerable due to non attendance at health service appointments Timeliness of the transfer of records between health visiting and school nursing service of vulnerable children Safeguarding supervision held within stated time period Evaluation of health visitor and school nurse supervision.. 6.4. Serious Case Reviews (SCR) Portsmouth Safeguarding Children Board (PSCB) commissioned 1 SCR during 2011-2012, currently being written. Southampton Safeguarding Children Board (SSCB) commissioned 2 SCR s and 1 partnership review which are all completed. The gradings for the SCR s are pending. The Named Nurses provide the Internal Management Review (IMR), recommendations and action plan on behalf of Solent NHS Trust. The action plan will be monitored by the respective Safeguarding Boards, although the Trust Safeguarding Children Group will oversee its completion. The work generated by the IMR s is considerable for the Named Nurses, and can have a significant impact on the team s ability to deliver the normal daily service. The team regularly review cases that result in a risk event or a cause for concern about practice. Practitioners are then provided with an opportunity to reflect and learn from the findings. There is evidence to demonstrate that this systematic review is well received and is encouraging a cultural shift from one of blame to one of learning. 6.5. Supervision Supervision continues to be a core function of the safeguarding team and is delivered in the following ways:- Solent East. The Named Nurse provides small group, supervision sessions at six weekly intervals for the Clinical Team Leaders for the Children and Family Service and the Community Children s Nursing Service. The Named Nurse also provides supervision on a one to one basis for the young person s worker at the Sexual Assault Referral Centre, the Specialist Practitioner and the Health Visitor working at the Independent Sector Treatment Centre. One 11
to one supervision is available on request from any practitioner in the organisation. In addition the Named Nurse has provided supervision training across the children s services to build competencies in those staff responsible for providing supervision for others. The Specialist Practitioner provides group supervision to staff in the Children s Community Nursing continuing care team, the acute adult mental health teams and the CASH service. The Designated Nurse leads a quarterly Safeguarding Health Forum for safeguarding children s champions from across the health economy in Portsmouth. The forum ensures that contemporary national and local safeguarding children practice and key messages from serious case reviews are cascaded throughout frontline services. Solent West. The safeguarding nurse specialists continue to provide one to one support to the health visitors on a locality basis, as well as undertaking an annual observed visit with each practitioner. The model of structured, reflective supervision and locality working has been useful in enhancing communication and support to staff, in conjunction with the health visiting locality managers, at a time of increased pressure and demand upon frontline services. Data gathered show that there were individual supervision sessions held and 50 group supervision sessions held to a range of services such as; Family Nurse Partnership Psychologists Children Community Nurses ( Diabetes nurses, Enuresis nurses) COAST Contraception and Sexual Health Nurses Occupational therapists Unscheduled care services It has been identified that the supervision model needs to be extended to other key services within Solent NHS Trust. These are Physiotherapists, Jigsaw and CAMHS. A review of the current supervision model is currently taking place to ensure that all children s services acknowledge safeguarding within clinical supervision processes. Group supervision also takes place at the Trust wide Safeguarding Network meeting held bi- monthly and led by the Named Nurse, which ensures that all children s services and unscheduled care services have a lead for safeguarding. The network ensures that all national and local safeguarding issues and key messages from reviews are cascaded throughout frontline services. The Named Nurses receive bi-monthly safeguarding supervision from the Designated Nurses. The Nurse specialists receive monthly peer group supervision led by the Named Nurse. 6.6. Training The Named and Specialists Nurses are able to access national, regional and local training and education. Examples include:- Bascpan conference 12
Child Death / Rapid Response Training National conference Munro Review- Messages from practice Strategic Health Authority: Leadership and Development Course MAPPA Training 6.7. Sexual Health and Learning Disabilities The Specialist Safeguarding Children Nurse for Sexual Health and Learning Disabilities in Solent West has been working in conjunction with the Solent East Safeguarding Team to implement the Risk Assessment Tool for underage sexual activity which supports practitioners to assess the vulnerabilities of young people engaging in sexual relationships. This work is particularly pertinent at a time when sexual exploitation has been highlighted as a factor in serious case reviews involving a number of young people. The roll out of training in Solent east will ensure that the risk assessment of sexual activity is consistent across Solent NHS Trust. The Nurse specialist also holds a small clinical caseload of young people with learning disabilities and complex needs in need of support with their sexual health needs. 6.8. Health Visitor Liaison The liaison Health Visitor is a member of the safeguarding children team (West). Her role involves ensuring that information about the health needs or potentially vulnerability of children who attend, or are admitted to, Southampton General or Princess Anne Hospitals and Walk in Centres is effectively disseminated to relevant health professionals in the community. This system also allows for analysis and interpretation of the type of admission to the Emergency Department. A recent audit completed by the Liaison Health Visitor, recommended that concern forms should also be sent to GPs and that additional information on the forms would allow for a more in depth breakdown of presentations Concern form statistics for Solent NHS Trust area, generated by the Emergency Department, Southampton General Hospital. 2011/2012 Age 0-4 5-15 16-17 18+/Adult Total April 39 44 24 7 114 May 35 51 18 15 119 June 49 58 13 14 134 July 42 58 22 21 143 August 41 40 23 21 125 September 38 31 20 17 106 October 37 44 16 16 113 November 41 41 13 26 121 December 47 32 13 25 117 January 39 50 12 17 118 February 35 48 10 15 108 March 52 62 15 14 143 Total 495 559 199 208 1461 13
7. Partnership working To effectively safeguard children it is essential that the Safeguarding Children and Young People team also contribute to multi agency working in the development of policy, training and case management including, supporting staff with and attendance at, safeguarding meetings. The safeguarding nurse specialists attended and represented Solent staff at over 113 meetings in relation to safeguarding children. These multiagency meetings are essential in ensuring a holistic approach to child protection planning is achieved and they include; strategy meetings, professional planning meetings, child protection conferences and court attendances. The Designated and Named Nurses are pro active members of both Portsmouth and Southampton Safeguarding Children Board and their sub committees, as well as sub committees of the respective Children Trusts. The safeguarding teams have a pivotal role in the planning, delivery and facilitation of inter agency training across Portsmouth and Southampton. Training activity includes:- Integrated working and safeguarding programme Hidden Harm Domestic abuse and its impact on children Bruising workshop Working in partnership with police: Young People and sexual vulnerabilities 7.1 MARAC Specialist practitioners from the Safeguarding teams represent Solent NHS Trust every two weeks at a Multi Agency Risk Assessment Conference (MARAC) across the two cities.. The MARAC is concerned with serious cases of domestic abuse. The Specialist Practitioners provide written feedback action plans to relevant practitioners across Solent following each conference. The Named Nurse is a member of the Portsmouth MARAC steering group team and the Specialist Practitioner is the Chair of the DV Children s sub group. Both represent Solent NHS Trust on the main DV forum. 14
Number of MARAC held 2011/2012 789 800 700 642 600 492 500 400 323 East West 300 200 100 0 Number of Families Number of Children 7.2 Triage of the Hampshire Constabulary Children and Young People (CYP) at Risk notifications. The safeguarding team receive all the notifications of the Hampshire Constabulary Children and Young People at Risk at risk on a daily basis, via a secure email account. In Solent East the team received 8597 reports which are then disseminated via the safeguarding administration team to relevant practitioners across the Trust. In Solent West a total of 9097 CYP reports were received. The safeguarding nurses triage all the CYP notifications on a daily basis, to ensure the most appropriate health professional receives the information and alerting to any immediate actions that may be needed, depending on the level of risk assessed. 15
Table indicating the total number of Hampshire Constabulary CYP forms month by month. Youth at Risk Reports Solent East & West 2011/12 Months Mar Feb Jan Dec Nov Oct Sept Aug July June May Apr 436 488 485 523 600 515 864 871 1127 1061 1072 1055 0 200 400 600 800 1000 1200 Number of Reports Portsmouth Southampton From April 2012, the Solent West team will be part of a multi- agency hub including Police, Children Services Social care and Education Welfare System who will be triaging the CYP s together on a daily basis. The aim of this initiative is to enhance decision making and provide a timely and appropriate response to the Children, Young People and their families. It is proposed that this model will be rolled out across Hampshire, Isle of Wight and Portsmouth in the near future. 7.4. Child Death and Rapid Response procedures Throughout the period under review, the safeguarding team in Solent NHS Trust have further developed the processes for Child deaths and rapid response procedures, with the safeguarding nurses undertaking home visits alongside police colleagues if necessary and the health visitor liaison post in Solent West undertaking coordination of subsequent visits with the support of a rapid response administrator There has been 3 sudden unexpected child deaths in Solent East and 4 in Solent West during 2011-2012, prompting a Rapid Response visit. The Named Nurse and Specialist Practitioner have undertaken the senior health professional role with the Police in the Rapid Response to these deaths and the subsequent processes in line with Chapter 7 of Working Together. 4 4 HM Government (2010) Working Together to Safeguard Children: A Guide to Inter-agency Working to Safeguard and Promote the Welfare of Children. London: DCSF 16
1. Solent NHS Trust Children in Care Team This report presents data relating to the key performance indicators for Solent NHS Trust for those children who were in the care of Southampton and Portsmouth Local Authorities for a period of one year or more 1 April 2011 31 March 2012. The report compares outcomes with the previous year and provides objectives for the year ahead. The terms children in care, children looked after and looked after children are used interchangeably in this report. The national evidence base has consistently indicated that children and young people who enter the care system have frequently experienced serious abuse or neglect and are less healthy than their peers. Two thirds of children looked after have at least one physical health complaint and they experience higher levels of mental health problems and emotional and behavioural difficulties. Young people leaving care are a particularly vulnerable group who require support and health advice on moving to independence. The aim of the Solent NHS Trust Children Looked After service is to assess, monitor and promote the health status of children in the care of Portsmouth and Southampton Local Authorities. This is achieved through identifying and reviewing the health problems of the children and young people, promoting good long term health outcomes, increasing the likelihood of stable placements through support to foster carers, and reducing inequalities in health for care leavers. This is achieved through direct contact with the children and young people and by working in partnership with statutory and voluntary agencies in order to promote positive mental, physical and emotional health. The Designated Nurse now provides the managerial support and strategic overview for the service in both East and West Solent as well as continued clinical assessments for Southampton children. Despite a number of changes, the team have worked hard and overcome some challenges which have resulted in children and young people continuing to receive a high quality service and accessing their health assessments within the statutory timescales. 2. Current Service Activity The number of referrals has increased systematically over recent years as Table 1 below indicates. However, this increase in numbers has not been matched by a corresponding increase in resources to carry out the statutory health assessments etc (and various panels that the team cover, for example fostering panels). The service has reviewed the delivery of the work and has made some temporary arrangements to meet the increased demand; however, this affects other aspects of service delivery and also leads clinicians to undertaking admin activity outside of work hours. 17
Table 1 - Solent Activity Children Looked After Health Assessments Total health assessments (Please note data 2007-2010 is calendar year, this data does not include Hampshire work). Year 2007 2008 2009 2010 2011/12 Southampton 252 307 416 501 571 Portsmouth 297 346 382 392 360 Total Numbers 549 653 798 893 948 3. Contemporary issues The continuing challenge for the team is that the number of children entering the care system in both Portsmouth and Southampton remain consistently high. There has been a drive by Southampton City Council fostering services to recruit more foster carers to cope with the increased numbers of children coming into care. This has required foster panels to be held on two half days per month (previously half a day per month). As Solent NHS Trust professionals are required to attend the panels to provide medical advice this has had an impact on the team. See Table 2. o Increase in complexity of medical / developmental profile of children coming into care requiring more frequent reviews / follow up. o Associated increase in time to read panel papers beforehand. Increase in Local Authority Adoption panel from 1 per month to 2 per month. Table 3. o Increased demand for medical attendance at panel. o Associated increase in medical workload to complete medical reports and counselling sessions for adoptive parents. o Partnership agreements indicate attendance at a minimum of 75% of adoption and foster panels. Non-attendance of children and young people / not brought to health assessments / reviews. Consent not obtained in time for assessments to be completed or not at all. Lack of parental consent for immunisation schedule to be completed / commenced. Impact of increasing workload on administrative workers within team. Increased requirement to collate specific statistics regarding certain aspects of health care plan. Table 2 - Solent Activity Foster carer application medicals. Year 2009/10 2010/11 2011/12 Southampton 99 167 166 Portsmouth 68 112 122 Total Numbers 167 279 288 18
Table 3 - Solent Activity Prospective adopter medicals. Year 2009/10 2010/11 2011/12 To date Southampton 67 59 83 Portsmouth 38 39 57 Total Numbers 105 98 130 4. Solent East Health Team: 1 session of medical time weekly for children new into care / reviews. 1 session of medical time weekly for review appointments. 1 session weekly to cover the entire adoption service. 1 session of designated doctor time. 48 ¾ hours of nursing time (18 ¾ hrs maternity leave) 12 hours admin support not dedicated to CLA but fits with Paediatric workload. Service Provision: Initial health assessment for children new into care. Review health assessments (6 monthly / annually dependant upon age) clinic / home visits / other venue if required. Health promotion Joint Local Authority drop in. Support to foster carers telephone support / training / home visits. Support to social workers telephone support / joint visits / attendance at team meetings. Attend supportive lodgings panel for care leavers. Support to children s homes recent joint work with nutritionist / health updates. Direct work with young people drop ins / youth clubs. Specialist advice e.g. complex disability / asylum seekers. Health advocate for CLA. Comprehensive adoption service adviser to panel (2-3 x month) / adoption medicals / counselling. 4.1 What we achieve: Number of children in care continuously for one year (end of March 2012) = 231 Table 4 - PAF C19 national indicator stats for children looked after continuously for 1 year. Portsmouth End of March 2011 Portsmouth End of March 2012 National Figures End of March 2012: Health 89.7% 95.7% 84% assessment Dental 89.7% 87.4% 82.4% Assessment Immunisations 91.5% 87.4% 79% 19
5. Solent West Health Team: 3-4 sessions of medical time weekly for children new into care / reviews. 0.5 sessions Designated Doctor time. 42 hours of nursing time. (Designated Nurse partly funded by Southampton City Council Children s Services / 12 hrs on secondment to Safeguarding Team) Admin support unable to quantify as the resource is spread across the community Child Protection and Children Looked After services. Service Provision: Initial health assessment for children new into care. Review health assessments (6 monthly / annually dependant upon age) clinic / home visits / other venue if required. Health promotion. Support to foster carers telephone support / training / home visits. Support to social workers telephone support / joint visits / attendance at team meetings. Health representative attendance at foster panel. Direct work with young people. Specialist advice e.g. complex disability / asylum seekers. Comprehensive adoption service adviser to panel (2-3 x month) / adoption medicals / counselling. Health reviews of Children Looked After from other local authorities. Health representative for weekly joint agency Therapeutic panel (therapy/mental health referrals). Health representative for Resource and Alternative care panel. Health representative at relevant Local Authority meetings e.g. Substance misuse group 5.1. What we achieve: Number of children in care looked after continuously 303 Table 5 - PAF C19 national indicator stats for children looked after continuously for 1 year. Southampton End of March 2011 Southampton End of March 2012 National Figures March 2012: Health 95% 85% 84% Assessment Dental check up 88% 79.5% 82.4% Immunisations 91% 83.5% 79% 6. Audit Completed Substance Use Audit record of discussions and action in CLA health records March 2012 Health outcomes of CLA health assessments Sept 2011 20
7. Outstanding Achievements 2011-2012 Southampton City Council Fostering Services was inspected by OFSTED in December 2011. The overall quality rating was outstanding and the helping children to be healthy provision, provided by Solent NHS Trust CLA team, also judged as outstanding. The health of all young people entering the service was recognised as being given a high priority and the service provide by the Solent NHS Trust CLA team seen as extremely responsive to the changing needs of the young people in its care. Southampton City Council Adoption Service was inspected in August 2011. The overall quality rating was good. The judgement on protecting children from harm or neglect and helping them stay safe was good and comment was made of the proactive work undertaken by the Medical Advisor, collating and evaluating medical reports and ensuring that any specialist,medical care is arranged prior to placement. The Medical Advisor also works with adopters, to make them aware of the implications of any medical conditions, both their own and those affecting the child. Southampton City Council and Solent West NHS Trust recently underwent an Ofsted / CQC inspection of safeguarding and looked after children s services. The overall findings of this inspection have yet to be published. However, initial feedback for CLA team and health generally identified some key strengths. End of year 2011 update of self-assessment for children looked after services highlighted health outcomes as a key strength within the overall service. Good liaison and partnership working between health agencies and social work services was noted more specifically that the designated nurse team for CLA ensures that there is effective, consistent sharing of information on a case by case basis. 8. The Year Ahead 2012-2013 The CLA team aim to continue to improve their service by: Continue to look at innovative ways to engage teenagers and care leavers whilst continuing to provide a service that is flexible and enables the team to meet young people at a venue and time that suits them. The service currently offers the majority of assessments for teenagers at No Limits in conjunction with Barnardos Mis U service, DASH (drug and alcohol service) and Specialist Sexual Health Service. Future work planned with the Children in Care Council to find out views and capture the experience of young people in relation to their health assessments. Evening event arranged with Pathways team in June 2012. Monthly team meetings between East and West Solent NHS Trust CLA staff, incorporating regular reflective clinical supervision. Work with admin / IT / RiO to develop a robust, consistent, accurate and relevant data base system across Solent to provide necessary CLA statistics. Full utilisation and implementation of RiO electronic records within CLA team. 21
Utilisation of service user form to encourage children and young people to give feedback and help shape future services. Recent use of electronic devices (May 2012) to provide audit. Feedback not yet collated. Carry out annual audit of case files in order to assess the quality of the service provided. Continue to deliver health assessments to those children placed from out of area to maintain quality of review / assessment and subsequent action plan. Ensure that requests for health assessments for those children placed out of area are sent in a timely manner to avoid delays. Completed by:- Katherine Elsmore Designated Nurse: Children Looked After May 2012 Looking forward : Strategic Objectives for 2012-2013 It is important throughout the forthcoming year to strengthen accountability, governance and quality assurance frameworks. The newly appointed Senior Nurse for Safeguarding with the support of the Named Nurses and their teams will ensure clinical leadership in safeguarding practice across the Trust, to further enable the integration and consistency across systems, processes and structures. The existing overarching strategic objectives of the Safeguarding Children and Children in Care Continuous Improvement Work Plan has ensured that these recommendations are incorporated into the core work of the team as well as outlining priority development area for the Solent NHS Trust. The plan is regularly monitored, reviewed and updated at the Solent NHS Safeguarding Children group (Appendix 1). Objectives for 2012-2013 Ensure safeguarding supervision policy is in place across the Trust and continue to develop alternative supervision models across the trust Continue to develop a common assessment tool across all services. Review safeguarding learning and development strategy Be a key partner in the multi agency triage of the Hampshire Constabulary Child /Young People reports Consistent recording of all Safeguarding / CLA data activity across Solent East and West Continue to embed learning from Serious Case Reviews into daily practice. 22
Concluding Comments The report has evidenced the wide remit of the safeguarding Children and Young people, and Children Looked After teams across Solent NHS Trust. Despite some significant challenges, the commitment of the team has ensured that safeguarding Children and Young people remains a high priority across the organisation. Grateful thanks are owed to all members of the safeguarding team for their hard work, professionalism and commitment.. 23
Appendix 1 Safeguarding Children and Children in Care Team Continuous Improvement Work Plan 1 st January 2012 31 st March 2013 The purpose of this document is to outline priority development areas for the Solent Healthcare Safeguarding Children Team and to provide a tool by which progress may be monitored. The plan will be regularly monitored, reviewed and amended at the Solent Healthcare Safeguarding Group meeting. The work streams contribute to a programme of continuous improvement and have been informed by primary legislation; The Children Act 1989 and 2004, and the following statutory, professional and organisational guidance: HM Government Working Together to Safeguard Children (2010) Care Quality Commission Essential Standards National Health Service Litigation Authority Royal College of Paediatrics and Child Health: Safeguarding children and young people: roles and competencies for health care staff (2010) National Institute for Health and Clinical Excellence: When to suspect child maltreatment (2009) Promoting the quality of life of looked after children and young people (2010) National and local serious case reviews and individual management reviews Solent Healthcare: First Year Business Plan 2010/11 This work plan provides information regarding the improvement and development role of the Team which is carried out in addition to the day to day work that is undertaken to safeguard and promote the welfare of local children. Safeguarding Children and Children in Care Team Continuous Improvement Work Plan 1 st April 2012 31 st March 2013 The purpose of this document is to outline priority development areas for the Solent NHS Trust Children Team and to provide a tool by which progress may be monitored. The plan will be regularly monitored, reviewed and amended at the Solent NHS Trust Safeguarding Group meeting. The work streams contribute to a programme of continuous improvement and have been informed by primary legislation; The Children Act 1989 and 2004, and the following statutory, professional and organisational guidance: 24
HM Government Working Together to Safeguard Children (2010) Care Quality Commission Essential Standards National Health Service Litigation Authority Royal College of Paediatrics and Child Health: Safeguarding children and young people: roles and competencies for health care staff (2010) National Institute for Health and Clinical Excellence: When to suspect child maltreatment (2009) Promoting the quality of life of looked after children and young people (2010) National and local serious case reviews and individual management reviews Solent NHS Trust: r Business Plan 2011/12 This work plan provides information regarding the improvement and development role of the Team which is carried out in addition to the day to day work that is undertaken to safeguard and promote the welfare of local children. April 2012: Aim / Objective & relevant report Action Progress Made Evidence Further Action Required By Whom Target Date 1. Ensure Solent NHS Trust has a safeguarding children learning and development strategy in place Learning and Development Strategy in place Strategy completed and approved. SNT safeguarding team have agreed training calendar for 2012-2013 Currently in use Strategy to be reviewed September 2012: Trish Newcombe Linda Jenkins Ceri Conner head of learning and development October 2012 2. Ensure SNT staff can easily access information, policy and guidance to support safeguarding practice In place Completed. Intranet page established Page will require regular updating. Linda Jenkins and Karen McGarthy Completed 25
Aim / Objective & relevant report Action Progress Made Evidence Further Action Required By Whom Target Date 3. Ensure SNT Safeguarding Children Policy is compliant with national and local requirements and clearly states organisational and individual employee responsibilities (Working Together and LSCB requirements). In place Updated and reviewed march 2012 Available on SNT intranet for staff To be submitted to LSCB s for verification. Will need to be reviewed once updated Working Together 2012 is publised. Trish Newcombe December 2012. 4 Ensure risk assessment of underage sexual activity is consistent across the SNT Review and update current guidance and ensure dissemination across all services. Guidance to be made available on SNT intranet site. RAT has been successfully embedded in to the WiC and MIU Training has been rolled out across some services in Solent East. Training plan. Further training required across newly contracted SNT Sexual health services. Linda Jenkins Emma Cooper April 2013 26
Aim / Objective & relevant report Action Progress Made Evidence Further Action Required By Whom Target Date 5. Ensure safe sleep guidelines are available on the intranet and implemented consistently across SNT Review and update guidance and promote across SNT workforce. Guidance to be made available on Solent Healthcare Safeguarding intranet site. Staff have attended workshops held by CDOP Guidance on intranet sites Intranet site Audit to be completed August 2012 CDOP recommendations to be available on intranet Linda Jenkins Karen McGarthy Linda Jenkins August 2012 June 2012 6. Ensure that children who are not brought to appointments protocol is developed and implemented across all SH services. (CQC local policy, SCR requirement) Every clinical delivery unit to have a protocol in place to support the identification of children who are vulnerable due to non attendance at health service appointments Policy requirement has been included in SH Safeguarding Children policy Guidance for managers and staff is available. Phase 1 Audit completed December 2011. Further audit to be completed July 2012 All service managers to ensure that an operational protocol is in place. Linda Jenkins Louise Maddison July 2012
Aim / Objective & relevant report Action Progress Made Evidence Further Action Required By Whom Target Date 7. Ensure that CAF style referrals and assessments are in use by all child and family services (CQC, local IMR and Commissioning standard) Review referral and assessment process across child and family services to ensure consistent processes are in use. Initial audit of health visitor assessment tool undertaken Dec 2010, indentified a need for a further audit to be undertaken once RIO was in place. Electronic processes are currently being reviewed to incorporate comprehensive assessment tool template Audit Report Survey of all child and family service assessment tools to be undertaken (via clinical governance group) Implementation of Rio has impacted on the universal use of this tool amongst practitioners. Child G IMR recommendation has highlighted the need for a further audit of the FHNAT in June 2012. Trish Newcombe Linda Jenkins June 2012 A shared ante natal assessment tool is currently under development. Training workshops planned are Aim / Objective & relevant report Action Progress Made Evidence Further Action Required By Whom Target Date 8. Ensure all SH staff receive safeguarding supervision that is appropriate to their role and Review safeguarding supervision models across Solent Children s Services to achieve Supervision training event Feb 2011 for safeguarding leads across Solent (including colleagues Supervision Day ran successfully. Mapping exercise to be undertaken (via clinical governance group?) Trish Newcombe July 2012 28