Safeguarding Children & Young People

Safeguarding Children & Young People Author: Responsibility: Helena Hughes, Designated Nurse Dr Wendy Kuriyan, Designated Doctor Dr Abdullah Khan, Named GP All Staff Effective Date: January 2014 Review Date: January 2015 Reviewing/Endorsing committees Approved by Governance and Risk Sub Group Integrated Safeguarding Adults & Children Meeting 20 January 2014 Date Ratified by CCG Board February 2014 Version Number Version 2 Safeguarding Children & Young People FINAL 20/01/14 Page 1

POLICY DEVELOPMENT PROCESS Names of those involved in policy development Name Designation Email Helena Hughes Designated Nurse Helena.Hughes@bedfordshireccg.nhs.uk Dr Wendy Kuriyan Designated Doctor Wendy.Kuriyan@bedfordshireccg.nhs.uk Dr Abdullah Khan Named GP Abdullah.Khan@nhs.net Names of those consulted regarding the policy approval Date Name Designation Email December Anne Director of Nursing Anne.Murray@bedfordshireccg.nhs.uk 2013 Murray & Quality December 2013 Mel Gunstone Head of Patient Experience & Safeguarding Mel.Gunstone@bedfordshireccg.nhs.uk Equality Impact Assessment prepared and held by Date Name Designation Email January 2014 Mel Gunstone Head of Patient Experience & Safeguarding Mel.Gunstone@bedfordshireccg.nhs.uk Committee where policy was discussed/approved/ratified Committee/Group Date Status Risk management Group 20 January 2014 Approved Executive Team February 2014 Ratified Equality Impact Assessment Bedfordshire Clinical Commissioning Group is committed to promoting equality in all its responsibilities as commissioner of services, as a provider of services, as a partner in the local economy and as an employer. This policy will contribute to ensuring that all users and potential users of services and employees are treated fairly and respectfully with regard to the protected characteristics of age, disability, gender, reassignment, marriage or civil partnership, pregnancy and maternity, race, religion, sex and sexual orientation. Safeguarding Children & Young People FINAL 20/01/14 Page 2

Content Page 1. Introduction 4 2. Policy Statement 4 3. Purpose 4 4. Definitions 5 5. Policies 5 6. Roles and Responsibilities 5 7. Statutory Requirements 9 8. Safeguarding Children Supervision 9 9. Duties within the organisation 10 10. Serious Case Review / Serious Incidents 11 11. Local Authority Designated Officer 11 12. Training Requirements 12 13. Monitoring 12 14. Related Documents 13 15. Documents Replacements 13 16. References 13 Appendices 1. CCG LADO Flow Chart 14 2. Designated & Named Professional Contact Details for Bedfordshire 15 Safeguarding Children & Young People FINAL 20/01/14 Page 3

1. Introduction Bedfordshire Clinical Commissioning Group (BCCG) is the major commissioner of local health services, and needs to be assured that the organisations from which it commissions, provide good quality services. The CCG also needs assurance that organisations have a responsibility for ensuring the health contribution to safeguarding and promoting the welfare of children, is discharged effectively across the whole health economy through commissioning arrangements. Where arrangements are in place within the five localities to undertake commissioning of services, this should be done in partnership with BCCG who must ensure all safeguarding duties are fulfilled. In discharging these statutory duties/responsibilities, account must be taken of; Working Together to Safeguard Children 2013 (HM Government 2013) Statutory guidance on making arrangements to safeguard and promote the welfare of children under Section 11 of the Children Act 2004 The Policies and Procedures of the Local Safeguarding Children Boards BCCG commissions services for children and young people, and has a statutory responsibility as a member of the Local Safeguarding Children Boards, to work closely with partner organisations to safeguard and promote their welfare. BCCG has a responsibility when discharging its functions, to ensure that the development and implementation of effective safeguarding practice is evident across all commissioned services. Although BCCG is not directly responsible for commissioning Primary Medical Care, it has a duty to support improvements in the quality of Primary Medical Care and to work closely with partner agencies to commission and provide coordinated, integrated services. 2. Policy Statement BCCG will work in partnership with other agencies and fully recognise their responsibility for protecting and safeguarding the welfare of children and young people. As the commissioner of services for children and young people, Executive Directors and Senior Managers have a responsibility to ensure contracts reflect safeguarding arrangements and practice to protect them from harm, abuse and exploitation. Contracts should ensure that rigorous systems are in place to proactively safeguard and promote the welfare of children: this should include ensuring that providers/independent contractors have comprehensive single agency policies and procedures in place. These should be informed by Local Safeguarding Children Boards (LSCBs). 3. Purpose This policy details the roles and responsibilities of BCCG as a commissioning organisation, and sets out a framework to underpin monitoring of safeguarding arrangements across the health economy. It is expected that all service providers have their own Safeguarding Children Policy. The purpose of this policy is to support BCCG in demonstrating how it meets its corporate accountability for safeguarding children and young people, that it follows national guidance, promotes best practice, and works effectively with its partner agencies. Safeguarding Children & Young People FINAL 20/01/14 Page 4

This policy will ensure that Health Providers, including the independent healthcare sector with which BCCG has commissioning arrangements, have policies and standards in place to safeguard and promote the welfare of children and young people. 4. Definitions For the purpose of this policy A Child is anyone who has not reached their 18 th birthday (NSPCC Legal definition 2013). If a child has learning disabilities or is a care leaver their needs may extend to their 21 st birthday (Section 9 of the Children Act 2004). In addition, this policy covers children in the wider community that come to the attention of staff, including travellers, asylum, migrant children, and young offenders. Safeguarding and promoting the welfare of children is defined in Working Together 2013 as; Protecting children from maltreatment Preventing impairment of children s health and development Ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and Taking action to enable all children to have the best outcomes Child in need of protection is defined when; There is reasonable cause to suspect that a child is suffering or is likely to suffer, significant harm, to enable them to decide whether they should take any action to safeguard and promote the child s welfare. Children in need are defined as; A Child who is unlikely to reach or maintain a satisfactory level of health or development, or their health and development will be significantly impaired, without the provision of services, including those who are disabled. 5. Policies This policy underpins the policies and procedures for both Central Bedfordshire s LSCB and Bedford Borough s LSCB. This policy applies to all employees and members of BCCG, regardless of role or location of work. Agency/locum staff, independent contractors (and their staff), and volunteers, will be made aware of the safeguarding children polices and advised of necessity for compliance in order to ensure that statutory, NHS and best practice standards are met. All policies should be adhered to, or the reasons for non-adherence documented. 6. Roles & Responsibilities Corporate Responsibility The Children Act (2004) section 10 places a statutory duty on CCGs and NHS England to cooperate with local authorities in making arrangements to improve the wellbeing of all children in the authority s area, which includes protection from harm and neglect. Safeguarding Children & Young People FINAL 20/01/14 Page 5

The Children Act (2004) section 11 places a statutory responsibility to safeguard children upon all NHS organisations including CCGs, NHS England, NHS Trusts and Foundation Trusts The Children Act (2004) section 13 requires NHS organisations to cooperate and fully engage with partner agencies as competent members of their Local Safeguarding Children Boards (LSCBs) The Children Act (1989) section 17 requires NHS England, CCGs, NHS Trusts and Foundation Trusts to cooperate with Local Authority in helping children in need of support The Children Act (1989) section 47 requires NHS England, CCGs, NHS Trusts and Foundation Trusts to cooperate with Local Authorities in their enquiries regarding children at risk of significant harm The Department of Health (DH) (2012) stated that CCGs would be required to meet safeguarding duties including; Having regard to the need to safeguard and promote the welfare of children Following the requirements around employing members of staff Being a member of the Local Safeguarding Children Board (LSCB) Working Together to Safeguard Children (2013) states; Clinical commissioning groups (CCGs) will be the major commissioners of local health services and will be responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. CCGs should employ, or have in place, a contractual agreement to secure the expertise of designated professionals, i.e. designated doctors and nurses for safeguarding children and looked after children (and designated paediatricians for unexpected deaths in childhood). In some areas there will be more than one CCG per local authority and LSCB area, and CCGs may want to consider developing lead or hosting arrangements for their designated professional teams, or a clinical network arrangement. Designated professionals, as clinical experts and strategic leaders, are a vital source of advice to the CCG, the NHS Commissioning Board, the Local Authority and the LSCB, and of advice and support to other health professionals; The role of the CCG is about more than just managing contracts and employing expert practitioners. It is about working with others to ensure that critical services are in place to respond to children who are at risk or who have been harmed, and it is about delivering improved outcomes and life chances for the most vulnerable (NHS Commissioning Board 2013). CCGs must ensure that the contracts clearly specify safeguarding expectations and responsibilities for all health providers of services they commission as set out in this policy. Effective safeguarding arrangements in every local area should be underpinned by two key principles; 1. Safeguarding is everyone s responsibility; for services to be effective each professional and organisation should play their full part. Safeguarding Children & Young People FINAL 20/01/14 Page 6

2. A child centred approach; for services to be effective they should be based on a clear understanding of the needs and views of children (Working Together to Safeguard Children 2013). This means there is a responsibility within the health economy to ensure that; All health professionals working with children and young people have a clear responsibility to ensure that safeguarding and promoting children and young people s welfare is a central and integral part of the care they offer. Health professionals who come into in-direct contact with children, through working with parents or carers, also need to be fully informed about their responsibilities to safeguarding and promote the welfare of children and young people. Commissioning of health services for children takes into account the safeguarding and promotion of welfare of children and young people, and safeguarding children standards are included in all contracts. Accountable Officer / Chief Operating Officer Responsibilities Accountability for safeguarding children lies with the Chief Operating Officer with the responsibility to ensure that health services contribute to safeguarding and promoting the welfare of children: this is discharged effectively across the whole health economy through the organisations commissioning arrangements. Ensure that the organisation not only commissions clinical services but exercises a public health responsibility in ensuring that all service users are safeguarded from abuse or the risk of abuse. Safeguarding is a key priority area in all strategic planning processes. Ensure that all health agencies with which it has commissioning arrangements, are linked into the LSCBs, has representation at an appropriate level of seniority, and that health services and health care workers contribute to multi-agency working. CCG Governing Body Members (Executives and Non-Executives) Maintain a continued awareness of current safeguarding issues and CCGs responsibilities/accountability Maintain a knowledge base through reporting arrangements, newsletters and training and development sessions Promote the welfare of children in CCG activity and comply with all organisational and LSCBs policies, relating to safeguarding children Safeguarding Children Champions (SCC) This role is held by the Director of Nursing and Quality who will demonstrate leadership, be informed about, and champion the importance of safeguarding and promoting the welfare of children throughout the organisation: they are also responsible for monitoring the actions of their staff to safeguard and promote the welfare of children. The SCC is the Executive Lead for safeguarding children for BCCG and represents the CCG on both LSCBs. The safeguarding team consists of a Designated Doctor, Designated Nurse and Named GP. This team leads on providing analytical reports for the BCCG regarding effectiveness of safeguarding arrangements, and supports and challenges commissioners and providers to improve the outcomes of children across the health economy. Safeguarding Children & Young People FINAL 20/01/14 Page 7

Designated Doctor and Nurse for Safeguarding Children Provide advice to ensure the range of services commissioned by BCCG takes account of the need to safeguard and promote the welfare of children Provide advice on the monitoring of safeguarding aspects of BCCG contracts and are involved in contract monitoring meetings 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 to health staff are addressed Provide skilled professional involvement in child safeguarding processes in line with LSCB procedures Review and evaluate the practice and learning from all involved health professionals and providers commissioned by BCCG, as part of Serious Case Reviews (SCR), other multi-agency or single agency health reviews following serious incidents Designated Professionals for Looked After Children BCCG has arrangements in place for a Designated Doctor and Nurse for Looked after Children (LAC) who take a strategic lead in the health aspects of children in care: this includes advising commissioners regarding the needs of this population; monitoring the quality of health assessments, (medical and nursing), and CAMHS services available to the children and young people; work with Local Authorities to improve the outcomes for this group. Designated Paediatrician for Unexpected Child Deaths BCCG is required to have a Designated Paediatrician for Unexpected Child Deaths. This role is currently provided by South Essex Partnership NHS Foundation Trust. The role of the paediatrician is to; Ensure that relevant professionals (i.e. coroner, police and local authority) are informed of the death Take a lead on coordinating the team of professionals (involved before, and/or after the death) which is convened when a child dies unexpectedly Convene multi-agency discussions after the initial and final post mortem results are available Named GP BCCG has a Named GP who provides advice and support to GPs and their practices, and takes a strategic professional lead on all aspects of the GPs contribution to safeguarding children across BCCG areas. This role is not a statutory requirement but is one which is seen as good practice. All Employees All employees and members of the CCG, partner practices and contracted support services e.g. CSU, must be mindful of their responsibility to safeguard children. Therefore, all staff must be up to date with the appropriate level of safeguarding children training as set out in the Intercollegiate Document (Department of Health 2010). Safeguarding Children & Young People FINAL 20/01/14 Page 8

Comply with all CCG policies, procedures and guidance on safeguarding children Attend safeguarding training at the appropriate level, as outlined in the CCG Safeguarding Children Training Strategy and maintain a level of knowledge and skills appropriate to their role. Protect vulnerable children by recognising and responding to the possibility or existence of abuse and neglect. To know what action to take to make appropriate referrals, and where appropriate contribute to multi-agency activity as per LSCBs Access safeguarding advice and supervision at the appropriate level, for their role as outlined in the Intercollegiate Document: Safeguarding Roles and Competencies for Health Care Staff 2010 Know how to access the CCG Designated Professionals for advice and support as required Take part in audits and reviews regarding safeguarding as identified Take immediate and appropriate action regarding allegations against people who work with children, as outlined in Appendix 1 Primary Medical Care GP practices must have a lead for safeguarding (and a deputy) who must work closely with the CCG Named GP and Designated Professionals to address quality issues in relation to safeguarding children. GP Practices must maintain an up to date list of staff training in relation safeguarding children and young people. GPs must also ensure they contribute effectively to children in need of support or protection, including provision of reports for child protection conferences and engagement as appropriate at such forums. 7. Statutory Requirements The information below relates mainly to provider organisations that have contact with children and families. As a commissioner of services, BCCG will need to be aware of the processes and procedures to be followed and can refer independent contractors to this policy or any of the Designated Professionals for advice and support. All policies, protocols, guidelines and procedures will comply with the relevant statutory requirements, any subsidiary legislation and subsequent amendments, including the following acts; Children Act 1989 Children Act 2004 Working Together to Safeguard Children 2010 Section 11 of Children Act 2004 Safeguarding Vulnerable Groups Act 2006 8. Safeguarding Children Supervision Safeguarding/Child protection supervision is separate from other forms of management and clinical supervision although based on similar models. It is about the how of safeguarding/child protection practice, including discussing cases of actual or suspected Safeguarding Children & Young People FINAL 20/01/14 Page 9

child abuse, with varying levels of concern or early potential indicators, in order to ensure safe practice. For advice of supervision, contact the Designated Professionals as below: Designated Office Capability House Wrest Park Silsoe Beds MK45 4HR Secure Fax Number 01525 864425 Designated Nurse 01525 864430 ext. 5873 / 5888 07814 390908 Designated Doctor 07882 730724 9. Duties within the Organisation Staff should adhere to the LSCBs policies and procedures which include multi-agency Information Sharing Protocols which this policy underpins. Further information to support practice is available on the BCCG extranet https://www.bedfordshireccg.nhs.uk/extranet. Advice When advice is required, any of the designated professionals can be contacted on the above telephone numbers. If the Designated Professionals are not available, informal advice can be given by the Children Social Care Department as long as the name of the Child is not divulged. Making a Referral to the Children Social Care Department During normal working hours staff are expected to respond and refer in accordance with the LSCB Safeguarding Inter-Agency Procedures in the section relevant to the Health Service. Referrals can be made via the telephone if a child is at risk, but must be followed up in writing using the appropriate paperwork within 24 hours. Telephone number for Bedford Borough is 01234 718700 and Central Bedfordshire is 0300 300 8585. To make an out of hour s referral at weekends or between 5pm and 9am the following action should be taken; Telephone the Emergency Duty Team (EDT) on 0300 300 8123 for Bedford Borough AND Central Bedfordshire Any verbal referral must be followed up in writing using the Child Protection Referral form to Children s Social Services within 24 hours Child Protection Plan/Child in Need Plan When a member of staff from Bedfordshire has a child protection concern and needs to know whether the child has a Child Protection Plan the following procedure should be followed; During normal working hours the Initial Assessment Team should be contacted on 0300 300 800 (Central Bedfordshire) or 01234 718700 (Bedford Borough) Safeguarding Children & Young People FINAL 20/01/14 Page 10

Record Keeping It is a requirement for staff to commence records once a concern has been identified; Records must be accurate and written as soon as possible/immediately or within 24 hours They must be recorded in the child s nursing/medical notes as well as the family records They must be chronological, detailing what has happened in date/time order, which is placed in front of the notes Need to remove gap For those services that have contact with children and young people, there is a requirement to undertake audits to ensure compliance and quality of practice in regards to safeguarding and service user experience It is well recognised from past SCRs that missed appointments can be an early indicator of concern/neglect. All missed appointments are to be documented in records or on chronologies and be followed up by health professionals according to individual providers DNA policies 10. Serious Case Review / Serious Incidents One of the functions of the LSCBs is to undertake reviews of serious cases and advise the authority and their Board partners on lessons to be learnt. A serious case review (SCR) is one where; Abuse or neglect of a child is known or suspected; and Either the child has died; or The child has been seriously harmed and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons have worked together to safeguard the child The LSCBs have arrangements in place to review cases which may reach the threshold for a SCR. The Designated Doctor and Nurse represent health in these reviews and cooperate as partners in jointly planning and undertaking the SCR. This statutory guidance is found in Chapter 7 of the Working Together to Safeguard Children 2013. 11. Local Authority Designated Officer (LADO) Each organisation must have clear policies in place for dealing with allegations against people who work with children. These should be in line with those from the LSCBs (please see Appendix 1 for BCCG flow chart). An allegation may relate to a person who works with children who has; Behaved in a way that has harmed or may have harmed a child Possibly committed a criminal offence against or related to a child Behaved towards a child/children in a way that indicates they may pose a risk to children Each Local Authority should have a LADO involved in the management and oversight of individual cases. The LADO should provide advice and guidance to employers and Safeguarding Children & Young People FINAL 20/01/14 Page 11

voluntary organisations, liaising with the police and agencies, and should monitor the progress of cases to ensure that they are dealt with as quickly as possible, and consistently with a thorough, fair process. Any allegation should be immediately reported to a senior manager within the organisation, and the LADO informed within one working day. If the individual is removed from work because the person poses a risk of harm to children, a referral must be made to the Disclosure and Barring Service. 12. Training Requirements Safeguarding children training is mandatory for all BCCG employees and this is a key focus at Individual Performance Reviews and Appraisals. All commissioned services must have training in place which is informed by, and in line with, the Intercollegiate Document (2010). Compliance with Safeguarding Children Training should be reviewed annually as part of staff appraisals, in conjunction with individual learning and development plans. 13. Monitoring Contract Monitoring BCCG will gain assurance regarding the quality of safeguarding arrangements through contractual arrangements. This will ensure that through the scrutiny of compliance with contracts, the commissioned services, health services and healthcare workers will engage and effectively contribute to multi-agency safeguarding working. The above will include the requirement for sharing information with the CCG and LSCBs regarding safeguarding arrangements in all commissioning arrangements, contracts and/or service level agreements. Quarterly Reporting Safeguarding children s standards are included within provider contracts. Systems for collecting quarterly and annual evidence are in place with providers across the Community, Acute and Mental Health services. This will ensure there is both quantitative and qualitative data available. Annual Reporting BCCG and all NHS trusts, including those with Foundation Trust status, are required to publish an annual report for Safeguarding Children. These reports must include assurance that Section 11 standards are being met. Child Protection Medicals All providers of child protection medicals must have a policy/procedure relating to their ability to respond to requests for child protection medicals; these will include medicals including those that result from an allegation of sexual assault. As commissioners of care Safeguarding Children & Young People FINAL 20/01/14 Page 12

the CCG must ensure that each provider has a current policy relating to this issue and monitoring arrangements are in place via contracts. 14. Related Documents Whistleblowing Policy Incident Reporting Policy Records Management Policy Confidentiality Policy Complaints Policy Bedfordshire Local Safeguarding Children s Boards Multi-Agency Procedures 2010 Allegations of Abuse against Staff and Volunteers Policy 15. Document Replaces This document replaces the Bedfordshire CCG Safeguarding Children & Young People Policy 2012. 16. References Care Quality Commission (CQC) Essential Standard 7 Care Quality Commission Safeguarding Children a review of arrangements in the NHS for Safeguarding Children 2009 Children Act 1989, HMSO Children Act 2004, HMSO Data Protection Act 1998 Human Rights Act 1998 Health and Social Care Act 2012 Intercollegiate Document: Safeguarding Children & Young People, Roles and Competencies for Healthcare Staff (2010) The Functions of Clinical Commissioning Groups (DH 2012) Safeguarding Vulnerable People in the Reformed NHS; Accountability and Assurance Framework (NHSCB 2013) Information Sharing; Guidance for Practitioners and Managers 2008 LSCB Inter-Agency Procedures Safeguarding Children; Safer Recruitment and Selection in Education Settings 2005 Section 11 of the Children Act 2004 The Protection of Children in England: Progress Report 2009 The Protection of Children in England: Action Plan 2009 Working Together to Safeguard Children (2013) Safeguarding Children & Young People FINAL 20/01/14 Page 13

Appendix 1 Appendices CCG LADO Flow Chart ALLEGATIONS/CONCERNS AGAINST STAFF AND VOLUNTEERS Allegations/concerns identified in organisation to be reported to Designated Senior Manager Allegation/concern made direct to police or social care Local Authority Designated Officer (LADO) to be informed if alleged behaviour: harmed a child or may have; is a possible criminal offence; towards children indicates unsuitable to work with children Consultation between LADO and Designated Senior Manager Allegation is demonstrably false No further action, but refer to: Social care as child in need Police if allegation deliberately invented Allegation is a possible disciplinary matter Child suffering or at risk of suffering significant harm LADO refers to social care for strategy discussion No significant harm but allegation might constitute a criminal offence LADO refers to police for initial evaluation Social care and/or police investigation No social care or police investigation Share information Decide action Consider suspension pending investigation After completion (earlier if agreed with social care and police) Consider: No further action Professional advice Disciplinary process NB: In Bedfordshire there are 2 LADOs 1 in Bedford Borough and 1 in Central Bedfordshire Safeguarding Children & Young People FINAL 20/01/14 Page 14

Appendix 2 Capability House Wrest Park Silsoe Bedfordshire MK45 4HR 01525 864430 ext. 5888 Sova.bedfordshire@nhs.net Designated & Named Professionals for Safeguarding Children and Young People Contact List Designated Office for Safeguarding Children and Young People Designated Doctor Dr Wendy Kuriyan 01525 864430 ext. 5874 07767 003506 Wendy.Kuriyan@bedfordshireccg.nhs.uk Bedford Borough Council Safeguarding Children & Young People Tel: 01234 718700 Designated Nurse Helena Hughes 01525 864430 ext. 5873 07814 390908 Helena.Hughes@bedfordshireccg.nhs.uk Central Bedfordshire Council Safeguarding Children & Young People Tel: 0300 300 8000 Named GP Dr Abdullah Khan 07958 719073 Abdullah.Khan@nhs.net Out of Hours 0300 300 8123 (4:30pm 09:00am weekdays, weekends and bank holidays) Out of Hours - 0300 300 8123 (4:30pm 09:00am weekdays, weekends and bank holidays) SEPT Community Health Services Bedford Hospital SEPT Mental Health Services Named Doctor Dr Rishi Arora Tel: 07985 085200 Head of Safeguarding Dawn Andrews Tel: 01234 310107 Named Professionals for Safeguarding Children: Deborah Shulver (01234 310109) & Lisa Zeverona (01234 310289) Named Doctor Dr O Kwapong Tel: 01234 355122 bleep 200 Named Nurse Jackie Scott Tel: 01234 355122 bleep 257 Deputy Named Nurse-Andrea Anniwell Tel: 01234 3550122 bleep 472 Named Doctor Dr Hilary Gahan Tel: 01582 708162 Named Professionals for Safeguarding Children: Deborah Shulver (01234 310109) & Lisa Zeverona (01234 310289) NB: If you need an urgent response please contact your local Children s Services Social Care Department or the Police Safeguarding Children & Young People FINAL 20/01/14 Page 15