Safeguarding Children Annual Report

Safeguarding Children Annual Report 2016-17 June 2017

CONTENTS: 1 Introduction Page 3 2 Background Page 3 3 Safeguarding Context Page 4 4 Safeguarding Children Governance and Statutory Arrangements Page 6 5 Local Context Page 7 6 Key Professionals Page 8 7 Haringey Safeguarding Children Board (HSCB) Page 8 8 Child Death Overview Panel (CDOP) Page 11 9 Safeguarding Children Assurance data Page 13 10 Haringey Looked After Children (LAC) Page 16 11 Safeguarding Monitoring of Haringey General Practices Page 19 Safeguarding Monitoring of Haringey Clinical 12 Page 21 Commissioning Group (HCCG) 13 Reviews and Audits Page 20 14 Serious Case Reviews (SCRs) Page 22 15 Progress against Objectives 2016-17 Page 23 17 Key Objectives 2017-2018 Page 31 18 Appendices Page 32 2

1 Introduction 1.1 This annual report 2016/17 demonstrates how the Governing Body of Haringey Clinical Commissioning Group (HCCG), in discharging its functions as a commissioner of healthcare services in 2016/17, has been assured that the arrangements to safeguard children and young people are in place. The report outlines how the CCG monitors provider outputs to ensure effective and compassionate services, and, most importantly, that providers deliver services that are child focussed. 1.2 The purpose of this report is to provide an update on compliance regarding the duties and responsibilities as outlined by existing legislation, guidance and frameworks; Children Act (1989) and (2004). Working Together to Safeguard Children (2015) Promoting the Health and Well-being of Looked after Children (2015) Safeguarding Vulnerable People In the NHS Accountability and Assurance Framework (2015) Safeguarding Children and Young People: roles and competences for Health Care Staff, Intercollegiate document (2014). 1.3 National Guidance and References A number of additional references and national guidance documents were published in this financial year which the CCG refers to and follows. These are listed in Appendix 1. 1.4 Key areas of priority were established in the Haringey CCG Safeguarding Children Annual Report 2015-16 and progress against these priorities is detailed in the three year Action Plan. 1.5 This report will summarise positive progress and activity undertaken in 2016-17 and also highlight areas where we are planning further work in the coming year 2017-18. 2. Background 2.1 Safeguarding is embedded within the wider duties of all organisations across the health system, with provider organisations charged with the duties and responsibilities of delivering safe and high quality care and commissioners being charged with the responsibilities and duty to be assured of the safety and quality of the services commissioned. 2.2 The annual report 2016/17 will give an overview of the performance of each provider highlighting achievements, risks and actions for 2016/17. 3

3. Safeguarding Context 3.1 National Context 3.2 Section 11 (s11) of the Children Act (2004) provides statutory guidance on the arrangements required to safeguard and promote the welfare of children which all agencies need to take account of when creating and maintaining an organisational culture and ethos that reflects the importance of safeguarding and promoting the welfare of children. At an organisational or strategic level, these key features are ensuring: Senior management commitment to the importance of safeguarding and promoting children s welfare A clear statement of the agency s responsibilities towards children; available for all staff A clear line of accountability within the organisation for work on safeguarding and promoting the welfare of children Service development that takes account of the need to safeguard and promote welfare and is informed, where appropriate, by the views of children and families Staff training on safeguarding and promoting the welfare of children for all staff working with or (depending on the agency s primary functions) in contact with children and families Safe recruitment procedures in place Effective inter-agency working to safeguard and promote the welfare of children 3.3 Safeguarding and promoting the welfare of children is defined in Working Together to Safeguard Children (2015) as: Protecting children from maltreatment Preventing impairment of children s health or development Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care Taking action to enable all children to have the best outcomes 3.4 Effective safeguarding arrangements must be underpinned by two key principles: Safeguarding is everyone s responsibility: for services to be effective each professional and organisation should play their full part A child-centred approach: for services to be effective they should be based on a clear understanding of the needs and views of children 3.5 Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (2015). It defines the safeguarding responsibility and duty of Clinical Commissioning Groups (CCGs) as follows: CCGs as commissioners of local health services need to assure themselves that the organisations from which they commission have effective safeguarding children arrangements in place. CCGs are responsible for securing the expertise of Designated 4

Professionals on behalf of the local health system. The Designated Professionals undertake a whole health economy role. It is crucial that Designated Safeguarding Children Professionals play an integral role in all parts of the commissioning cycle, from procurement to quality assurance if appropriate services are to be commissioned that support adults at risk of abuse or neglect, and children, as well as effectively safeguard their well-being Safeguarding forms part of the NHS standard contract (service condition 32) and commissioners need to agree with their providers, through local negotiation, what contract monitoring processes are used to demonstrate compliance with safeguarding duties CCGs must gain assurance from all commissioned services, both NHS and independent healthcare providers, throughout the year to ensure continuous improvement. Assurance may consist of assurance visits, section 11 audits and attendance at provider safeguarding committees CCGs are also required to demonstrate that they have appropriate systems in place for discharging their statutory duties in terms of safeguarding children. These include: A clear line of accountability for safeguarding children, properly reflected in the CCG governance arrangements, i.e. a Named Executive Lead to take overall leadership responsibility for the organisation s safeguarding arrangements Clear policies setting out their commitment and approach to safeguarding children, including safe recruitment practices and arrangements for dealing with allegations against people who work with children, as appropriate Training their staff in recognising and reporting safeguarding children issues, appropriate supervision and ensuring that their staff are competent to carry out their responsibilities for safeguarding Effective inter-agency working with local authorities, the Police and Third Sector organisations including appropriate arrangements to cooperate with Local Authorities in the operation of Local Safeguarding Children Boards (LSCB) and Health and Wellbeing Boards (HWBs) Ensuring effective arrangements for information sharing Employing, or securing, the expertise of Designated Doctors and Nurses for Safeguarding Children and for Looked After Children and a Designated Paediatrician for unexpected deaths in childhood The role of CCGs is also fundamentally about working with others to ensure that critical services are in place to respond to children and adults who are at risk or who have been harmed, and it is about delivering improved outcomes and life chances for the most vulnerable. CCGs need to demonstrate that their Designated Clinical Experts (children), are embedded in the clinical decision making of the organisation, with the authority to work within local health economies to influence local thinking and practice. 3.6 Haringey CCG fulfils and is compliant with these safeguarding children responsibilities and duties and this Annual Report will demonstrate how the 5

CCG has ensured this, during the period of 01/04/16 to 31/03/17, within its own organisation and across the organisations from which it commissions. 4. Governance and Statutory Arrangements 4.1 Haringey CCG (HCCG) 4.2 HCCG is the major commissioner of local health services across the borough and is responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. Designated Professionals, as clinical experts and strategic leaders, are a vital source of advice to the CCG, NHS England, the Local Authority and the Haringey Local Safeguarding Children Board (HSCB). They also provide advice and support to multi-agency health professionals. 4.3 The Chief Officer for HCCG is the Executive Lead for Safeguarding and is responsible for ensuring that the health services contribution to safeguarding and promoting the welfare of children is discharged operationally and effectively across the health economy via local commissioning arrangements. 4.4 The Executive Nurse and Director of Quality and Integrated Governance HCCG reports appropriate safeguarding children risks and achievements to the Chief Officer and is responsible for ensuring that safeguarding monitoring across Haringey takes place through the Quality Committee of the HCCG Governing Body; the Clinical Quality Review Groups (CQRG) for each of the three main provider Trusts; and in conjunction with the Haringey Safeguarding Children Board (HSCB). 4.5 HCCG s Governing Body Lead General Practitioner for children is responsible for ensuring that the Governing Body takes account of safeguarding children when making decisions regarding the commissioning of services. He chairs the HCCG Safeguarding Children Commissioning Group, which reports on a quarterly basis to the Quality Committee. 4.6 The HCCG Safeguarding Team produce a joint Safeguarding Children and Adult Briefing for each of the bi-monthly Quality Committees informed by the safeguarding children activity across HCCG and the Providers Internal Safeguarding Children Committees attended by the HCCG Designated Professionals. 4.7 The Safeguarding Briefing and the HCCG Safeguarding arrangements and leadership are discussed and monitored via the quarterly HCCG Safeguarding Children Assurance Meetings. 4.8 The Designated Nurse and new Interim Designated Doctor Safeguarding Children (who started in post November 2016) provide support and assurance that safeguarding arrangements, training and supervision is in place across the health community. 4.9 The Designated Nurse Child Protection provided individual/group and planned and/or adhoc supervision for the: Haringey Community Services Named Nurse Haringey CCG Named GP Haringey Acute Services Named Nurse and Midwife 6

4.10 The Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) and North Middlesex University Hospital Trust Named Nurses receive planned supervision from the Enfield CCG Designated Nurse. 4.11 The Designated and Named Doctors employed by Whittington Health receive monthly supervision facilitated by Dr Sebastian Kraemer Hon Consultant CAMHS. 4.12 Haringey s Designated Doctor and Named GP attended monthly peer review/support sessions facilitated by a child and adolescent consultant psychiatrist. 4.13 The Designated Professionals and Named GP attended quarterly peer supervision sessions with Pan-London Designated Professional colleagues facilitated by NHS England (London). 4.14 The Designated Nurse Safeguarding Children and Young People participated in additional six-weekly peer supervision and information sharing sessions with the Designated Nurses of Barnet, Enfield, Camden and Islington. 4.15 The Designated and Named Professionals for Safeguarding Children across the Health economy met: 5. Local Context to consider the effectiveness of the health response to safeguarding children in the Haringey borough prepare for safeguarding inspection and enable peer support and supervision 5.1 Haringey is an exceptionally diverse and fast-changing borough with a population of 267,540 according to 2014 Office for National Statistics Mid-Year Estimates. Almost two-thirds, and over three quarters of our young people, are from ethnic minority backgrounds, and around 200 languages are spoken. Our population is the fifth most ethnically diverse in the country. 5.2 The borough still ranks among the most deprived in the country but has seen improvement in its ranking for all domains in the English Indicies of Deprivation 2015. over the past six years. Haringey is the 30th most deprived borough in England and the sixth most deprived in London with the tenth highest level of child poverty in London. Seven of haringey s 19 wards are within the most deprived 10% nationally. All of these wards are in the east of the borough. 5.3 There are approximately 63,400 children and young people under 20 living in Haringey (approximately one third of the total population). The wards with the largest number of people aged under 20 in Haringey are: Seven Sisters, Northumberland Park, White Hart Lane and Tottenham Hale. There are more children in the east of Haringey, which has higher levels of deprivation than the west. 5.4 For more information about Haringey s population visit: http://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needsassessment-jsna 7

5.5 Haringey s Joint Strategic Needs Assessment (JSNA) 2014/2015 describes the health, care and wellbeing needs of the local population. This helps the CCG and Haringey Council commission the best services to meet those needs. 6. Key Professionals 6.1 Haringey CCG Safeguarding Team and Arrangements 6.2 Between 01/04/16 and 31/05/16 the Haringey CCG Safeguarding Children Team consisted of: Designated Nurse Safeguarding Children and Young People newly appointed (full-time) Designated Doctor Safeguarding Children and Unexpected Death in Childhood (5 sessions per week) Deputy Designated Nurse Safeguarding Children (full-time) Named GP Safeguarding Children (3 sessions per week) Safeguarding and Care Homes Administrator (full time across three teams) 6.3 From May 2016, the HCCG Safeguarding Children Team saw the following changes: The period started with the team having a full-time Deputy Designated Nurse Safeguarding Children who left the organisation in May 2015. The creation of a fulltime Designated Nurse Safeguarding Children post in March 2016 resulted in the re prioritisation of the deployment of the resource and the Deputy Designated Nurse functions. Designated Doctor Safeguarding Children and Unexpected Death in Childhood (5 sessions per week) retired in October 2016 The Designated Doctor vacancy within the team was covered by an Interim Designated Doctor Safeguarding Children and Unexpected Death in Childhood (5 sessions per week) whilst the new substantive post was recruited. The substantive Designated Doctor Safeguarding Children comes into post in June 2017. 6.4 The progress of the team s workplan related to the HCCG Safeguarding Strategy (originally ratified by the HCCG Quality Committee in December 2016) and was reviewed quarterly by the the HCCG Safeguarding Children Assurance Meeting throughout 2016-17; and six-monthly within this period by the HCCG Quality Committee. 7. Haringey Safeguarding Children Board (HSCB) 7.1 The Designated Nurse Safeguarding Children, Designated Doctor, and Named GP were full and active members of the HSCB; regularly attending and contributing to the quatrely meetings. The Designated Nurse Safeguarding Children and Designated Doctor were also full and active members of the HSCB Executive. 7.2 The Designated Nurse Safeguarding Children briefed the Executive Nurse and Director of Quality and Integrated Governance regularly to ensure that she, in turn, could keep the Chief Officer and Governing Body appraised of HSCB developments and key issues. 7.3 The HCCG Safeguarding Team ensured that there was an HSCB update 8

included in the Safeguarding Briefing to the bimonthly Quality Committee. 7.4 The following Haringey healthcare providers were expected to provide Directorlevel representation on the HSCB: Barnet, Enfield and Haringey Mental Health Trust (BEH-MHT) North Middlesex University Hospital Trust (NMUH) Whittington Hospital NHS Trust (Whittington Health) (WH) 7.5 Figure 1 illustrates the attendance/representation of the respective Provider Trust Directors (Executive Leads for Safeguarding) at the HSCB Board Meetings across the period reviewed:- 7.6 Figure 1: Health Attendance at HSCB meetings 2016/17 (5 meetings held): - (Yes) indicates did attend or did send a representative. (No) indicates did not attend or did not send a rep Health Representation 2016 Meetings Attendance 2017 Meetings Attendance Total Number of meetings held Total Attendance Health Services 27/04 22/06 21/09 14/12 22/03 Five Number Attended % Attended HCCG AD for Quality & Nursing HCCG Designated Nurse for SG Children HCCG Designated Doctor NHSE (London) Named GP BEH-MHT Yes Yes No No No* Two 40% Yes Yes Yes Yes Yes Five 100% Yes Yes Yes Yes** Yes** Five 100% Yes Yes Yes Yes Yes Five 100% Yes Yes Yes Yes Yes Five 100% NMUH No No Yes Yes No*** Two 40% WH Yes Yes Yes Yes Yes Five 100% **Indicates no longer in organisation **Indicates attendance by new Interim HCCG Designated Doctor ***Official BMA Junior Dr s strike 9

7.7 The Designated Nurse Safeguarding Children, / Designated Doctor Safeguarding Children and Interim Designated Doctor were members of the following HSCB sub-groups which supported the HSCB during 2016/17: Figure 2: HCCG Safeguarding Children Team coverage of Haringey Safeguarding Children Board Subgroups: HSCB Subgroup HCCG Representative Performance and Practice Outcomes Designated Nurse Safeguarding Children Serious Case Review (SCR) Designated Nurse Safeguarding Children Designated Doctor Safeguarding Children until October 2016 Interim Designated Doctor (from Nov 2017) Child Death Overview Panel (CDOP) Designated Doctor Safeguarding Children Interim Designated Doctor Safeguarding Children (from Nov 2017) Child Sexual Exploitation (CSE) Designated Nurse Safeguarding Children (Chair) MASH Board Designated Nurse Safeguarding Children Training & Development JTAI/Performance Practice Outcome Designated Nurse Safeguarding Children Designated Nurse Safeguarding Children 7.8 The Designated Nurse for Safeguarding Children and Young People took over from the Assistant Director for Quality and Nursing as Vice Chair of the HSCB since October 2016, as well as Chair of the CSE Subgroup (which refreshed the borough s CSE Strategy, updated the CSE Integrated Action Plan and rolled out CSE champions model). 8. Child Death Overview Panel (CDOP) 8.1 The data presented is from April 1 st 2016 to 31 March 2017. During this time period 2 full CDOP panels were held - July 2016, and February 2017 - and one extraordinary meeting in March 2017. 8.2 Designated doctor for Child death retired in October 2016. 8.3 The new appointee came into post in November 2016, initially for an interim period and substantive from 1 June 2017. The previous post holder had been the Designated Doctor since the CDOP panel was instituted and had compiled a database of cases between 2008-2015 which has been collated and analysed 10

within the last month. 8.4 Haringey s experience does reflect the national picture that deprivation is one of the most consistent factors associated with infant mortality and health inequalities. Preventative action by health services acting alone will have a limited effect. Not only is a multi-agency approach needed, but, in addition, national efforts to reduce inequalities are needed. In a time of increasing austerity it is important that childhood deaths are closely monitored, not only in terms of their numbers, but what the data informs us regarding trends and priority areas to address. 8.5 During the period of 1 April 2016 31 March 2017 there were 42 deaths reviewed by the CDOP panel. There were a number of cases open that the panel felt unable to close related to information outstanding from serious incident investigations by provider organisations. The timeliness of receiving such information has been discussed at the CDOP panel and responded to constructively by the providers involved. 8.6 Significant Deaths 1 April 2016 31 st March 2017 8.7 One death reviewed related to a stabbing and was published as an anonymised Serious Case Review Child F in 2017. 8.8 Two seminars were held during the year for front line practitioners from all agencies working with children and families to raise awareness and share learning details as follows: Sudden Unxpected Death seminar-although the number of deaths has declined over the years there remains a need to remind frontline practitioners of the prevention messages particularly potential risks of co-sleeping and smoking. Vitamin D seminar- this seminar was organised as there was a child death in 2015/2016 who was Vit D deficient. 8.9 There are a number of initiatives in respect of the organisation of CDOPs, both nationally and in London, following the Wood review. Our CDOP has engaged positively with the Healthy London Partnership initiatives. It is suggested that Haringey LSCB takes cognisance of their recommendations and, in particular, supports the proposal from the Healthy London Partnership to adopt a web-based data collection and case management system. Other proposals, such as amalgamating CDOPs and different ways of working are likely to be consulted upon in the coming 12-18 months. Haringey CDOP will actively contribute to these discussions. 8.10 The HCCG Designated Doctor is reviewing the processes particularly with regard to how support of and engagement with families can be improved. 9. Safeguarding Children Assurance data from Commissioned Services 2016/17 9.1 Haringey CCG requires organisations to submit information in regard to their safeguarding children arrangments and activity. The purpose of the reporting is to assure HCCG that the services commissioned are safe, have effective arrangements in place to achieve good outcomes for children and young people and comply with national guidance and statutory duties. 11

9.2 Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (2015) defines the safeguarding responsibility and duty of Health Providers: https://www.england.nhs.uk/wpcontent/uploads/2015/07/safeguardingaccountability-assurance-framework.pdf 9.3 These arrangements included: Safe recruitment Effective staff training Effective supervision arrangements Working in partnership with other agencies All providers ensuring they have a Named Doctor and a Named Nurse for Safeguarding Children (and a Named Midwife if the organisation provides maternity services) GP practices to have a lead for safeguarding, who should work closely with the Named GP and Designated Professionals. 9.4 The three healthcare providers submitting safeguarding children data to Haringey CCG are: Barnet Enfield & Haringey Mental Health Trust (BEH-MHT) North Middlesex University Hospital Trust (NMUHT) Whittington Health (WHHT) 9.5 The Provider safeguarding children dashboards/metrics/balanced scorecards were monitored quarterly at the Clinical Quality Review Groups (CQRGs) and by exception at the HCCG Safeguarding Children Assurance Meeting and HCCG Quality Committee. 9.6 Any issues arising that required escalation were discussed with HCCG Senior colleagues, within the Haringey CCG Safeguarding Children Assurance meeting and Haringey CCG Quality committee as appropriate. These include the following:- Whittington Health (WH)- Interim cover arrangements for Designated Doctor for Safeguarding which was agreed in November 2016 with the substansive post filled January 2017 LSCB attendance-nmuh attendance at LSCB requires improvement (see attendance sheet). This has been raised with the provider at LSCB Board level and aboard member now in place. WH-Health model in the multiagency Safeguarding Hub (MASH) required improvement. This has been flagged with the provider at the LSCB board level. Option appraisal paper presented by the HCCG Designated Nurse. Recommedations welcomed by HLSCB. WH agreed to take forward recommendations in collaboration with the CCG and Partners. 9.7 All Provider Internal commitees are attended by The HCCG Designated Nurse Safeguarding Team. 9.8 Barnet Enfield & Haringey Mental Health Trust (BEH-MHT) 12

9.9 Barnet Enfield & Haringey Mental Health Trust held internal quatrely Joint Safeguarding Committees The effectiveness of the Joint Safeguarding Committee was monitored as part of the terms of reference (TOR) annual review. 9.10 The meetings provided an opportunity for information sharing on all aspects of safeguarding. 9.11 Data relating to the BEH compliance with safeguarding children training 2016/17 is captured in the table below. Data was reported in Q1 to Q4 and a compliance rate of 80% was achieved for Q1 and Q2. Table 1: Barnet Enfield and Haringey Mental Health Trust (BEH-MHT) Safeguarding Children Training Compliance 2016/2017 Level Quarter 1 Quarter 2 Quarter 3 Quarter 4 2016 2016 2017 Level 1 Children 88% 88% 89% 91% Level 2 Children 88% 88% 89% 91% Level 3 Children 77% 84% 52% 65% 9.12 The BEH-MHT Level 3 Safeguarding Children Training figures were reported to the HCCG Quality Committee as below compliance in Q3. Training levels have reduced from Q2 85% to 52% in Q3 and 65% in Q4. This is due to an increase in staff who require level 3 training from 442 in Q2 to 1028 in Q3. 9.13 Action taken to improve compliance with Safeguarding Children training targets include:- Detailed training plan in place with a trajectory to train 10% staff each month. From 1 Feb 2017, increased numbers of half day training sessions delivered and two E-learning courses on Child Sexual Exploitation (CSE) and FGM in place. Progress is being monitored via the BEH-MHT Internal Safeguarding Committee and attended by the HCCG Designated Nurse Safeguarding Children. 9.14 North Middlesex University Hospital Trust (NMUH) Safeguarding Children Training Compliance 2016/2017 Level Level 1 Children Level 2 Children Level 3 Children Quarter 1 2016 Quarter 2 2016 Quarter 3 2016 Quarter 4 86% 93% 91% 87% 83% 88% 87% 84% 80% 90% 88% 84% 9.15 NMUH Q1 to Q4 training compliance levels meet the required standard. 9.16 Whittington Health (WHHT) Safeguarding Children Training Compliance 13

2016/2017 Level Level 1 Children Level 2 Children Level 3 Children Quarter 1 2016 89% 70% 76% Quarter 2 2016 89% 91% 68% 72% 71% 75% Quarter 3 2016 Quarter 4 92% 76% 77% 9.17 The WH Level 2 and 3 Safeguarding Children Training is below compliance for Q1 to Q4. In December 2016, the Chair of the Haringey CCG Safeguarding Assurance Group escalated WH slow progress to improve training compliance. A way forward was agreed with Islington CCG and the Haringey CCG and Interim Islington CCG Director of Quality. 9.18 In January 2017 at the WH Safeguarding Children Internal Committee, WH agreed to undertake the following actions: 9.19 To resubmit an updated training action plan with timescales and a trajectory To add low training compliance for level 2 and 3 to their Internal Risk Register To escalate to their Director of Nursing and Human Resources 9.20 In February, WH was informed a contract notice would be considered by Islington CCG, if level 2 and 3 safeguarding children training levels continued below compliance. 9.21 The progress with above actions are monitored at the WH Internal Safeguarding Children Committee, Internal Risk Committee and the WH CQRG meetings. 9.22 At the WH Clinical Quality Risk Group (CQRG) meeting in March 2017, the WH Deputy Director of Nursing reported on the progress to improve Safeguarding children level 2 and 3 Training compliance. This included:- 9.23 A resubmitted updated WH training action plan with timescales and trajectory Escalation to WH Director of Nursing and Director of HR Planned data cleanse to ensure data is accurate. 9.24 The training action plan is being monitored at the WH Internal Safeguarding Children Committee. 9.25 In addition to each Trust having specifically-tailored safeguarding children training, there were several sources of more general and subject-specific multiagency LSCB training programmes on offer for Haringey health professionals: These included: Multi-agency one-day CSE Champoins training course via Safer London Safer recruitment one day level 4 training course 14

9.26 The availability of these opportunities was disseminated via a range of methods including emails, HSCB website and HCCG intranet; with provider organisations also further considering methods of dissemination to attempt to achieve increased completions, compliance and learning. 9.27 In January the LSCB reviewed single agency training offer to identify need across the Haringey partnership all health providers submitted returns. The following were prioritised to take forward into 2017-18: Training the Trainers Level 4+ training and peer support for safeguarding leads Neglect Briefing session and tools to support better quality referrals and responding appropriately to safeguarding concerns 10. Haringey Looked After Children (LAC) 10.1 CCGs have an ongoing responsibility for ensuring that the health needs of LAC are met. In Haringey the statutory Initial Health Assessments (IHAs) and the Review Health Assessments (RHAs) are carried out by a specialist team the Children in Care (CiC) Team who are employed by Whittington Health and commissioned by Haringey CCG. 10.2 Children In Care Team (CIC) 10.3 The Whittington Health Children in Care Health Team (CIC) are a specialist team who provide Statutory Health Assessments for Children in Care, and health advice to Children Social Care. 10.4 The CIC team consists of a Designated Doctor, Designated Nurse, Medical Advisor for Adoption & Fostering, and three Specialist Nurses. They are based at Bounds Green Health Centre and are supported by two Administrators. 10.5 There were 437 Children in Care on March 2017. Out of the 437, the breakdown of data includes :- Total number Comments 7 Remanded in custody, not CIC prior, not the responsibility of CIC team 36 Unaccompanied Asylum Seeker Children & Young People 371 Children over 2 years old 10.6 There has been a gradual increase in the number of children in care in comparison to the position at the end of March 2016 - Haringey s rate of CIC in 2015/16 was close to the rate of its statistical neighbours (69 per 10,000 population), although the current rate remained above the London (51) and national average (60). (Source Haringey Council) 10.7 Initial Health Assessments (IHA) 10.8 All children are seen for an Initial Health Assessment at Bounds Green Health Centre unless they refuse to attend. The CIC team continues to be flexible in offering health appointments elsewhere. The decisions are made on a case by case basis for example: 15

If required in exceptional circumstances, the Doctor travels to the placement to conduct the assessment. When a child has been in a mother and baby unit, When a young person is not allowed to enter Haringey due to a court directive 10.9 The Children in Care Team continue to work in partnership with social care to meet the health needs of Children in Care. We strive to see children and young people for Initial Health Assessments within 20 days of entering care. 10.10 Any issues arising that required esculation were discussed with HCCG senior colleagues, within the Haringey CCG Safeguarding assurance Meeting, and CIC Operational Group and resolved. For example during this year the CIC team became aware that not all notifications of children in care were received. They became aware by scrutinising the monthly returns received from the Information analysis via social care. This resulted in late initial health assessments. The CIC team has escalated this issue which has now been addressed by Social Care 10.11 The CIC will continue to monitor, escalate where necessary and report back to the CCG Safeguarding and Assurance Committee and CIC operational group. 10.12 The CIC have asked for an automated system to be installed on Mosaic the Social Care data base which would alert the CIC team when a child enters care.the Head of Children in Care Service is leading this piece of work. 10.13 Review Health Assessments (RHA) 10.14 All the Review Health Assessments are completed by the Nurses, or a Doctor, when the care plan is adoption. The CIC team travel to see children who are based out of borough working across geographical areas liaising with out of borough health providers and General Practioners (GPs) to ensure Hariney Children in Care receive the health care required. The older young people can, on occasions, be difficult to book appointments with. The CIC team work hard to engage with non-attenders to ensure their unmet health needs are identified. 10.15 The Nurses have conducted 16 Review Health Assessments for Children in Care placed in Haringey this year. A service level agreement is drawn up with the placing Clinical Commissioning Group and payment received for conducting the out of borough assessments. 10.16 As of 31 st March 2017 CIC Review LAC assessments ar prioritised for those whom have failed to attend our cancelled appointments. Following the assessments, recommendations are drawn up and the nurses liaise with the allocated social worker to ensure they are aware of any health needs. 10.17 A new Medical Advisor has been appointed for the Adoption & Fostering Team. The Medical Advisor conducts health assessments, provides a report and meets any prospective adopters of Haringey children to ensure that they are appraised of development, learning and emotional needs. The Medical Advisor attends the Haringey Adoption Panel where prospective adopters and matches of Haringey children are approved. 16

10.18 The CIC complete a care leavers summary following the last health assessment prior to the young person s 18th birthday to ensure they are aware of their health history. The CIC team commenced a new drop in service for care leavers fortnightly, providing health information and advice to Young People, Care Leavers, Social workers and Personal Advisors. 10.19 They regularly attend professional meetings when concerns are raised. This can include children missing from care, at risk from child sexual exploitation, acute mental health difficulties, medical needs and special needs. The team contribute to ensure partners agencies are appraised of any health issues and vulnerabilities. 10.20 The Designated Doctor for CIC is Chair of the Operational group meeting where the CIC team, Social Care, the Vulnerable Children Commissioner and First Step (psychological assessment service) meet bi monthly. This has improved collaboration across the agencies and resulted in improved information sharing regarding Children in Care. We have reviewed relevant Children in Care pathways and we implement changes. Examples have included the leaving care drop in service. The Children in Care Team (CICT) work closely with First Step towards improving the emotional health of Children in Care. We have referred to First Step Plus when there are concerns regarding young people who have experienced multiple placement change and there is a need for psychological support. The progress of the Child and Adolescent Mental Health Service ( CAMHS ) transformation plan has been discussed at The Operational meeting. 10.21 The CIC Designated Nurse and Doctor attend The Corporate Parenting Committee where they meet with members of Aspire Counsellors Performance and statistics are shared and scrutinised. Plans are underway to work with Aspire to run a Health Day for Children in Care in July 2017. The Designated Nurse is a member of The Virtual School management Committee which provides support, oversight and scrutiny of the work of the Virtual School. 10.22 The CIC Nursing Team are now participating in WH Level 3 Safeguarding Children Training to ensure professionals are alerted to the vulnerability and health needs of Children in Care. The CIC Designated Nurse has provided training to student Health Visitors and School Nurses at Southbank University. The team also provides training to Foster Carers on Child Development and Health issues. 10.23 The CIC Designated Nurse is a member of the Child Sexual Exploitation ( CSE ) LSCB subgroup and the local authority Missing Persons panel. The Missing Persons panel considers a wider range of vulnerabilities and risk factors associated with young people who are missing from placement or have run away, are at risk of CSE, or are involved in gangs and serious youth violence. 10.24 The CIC Designated professionals attend Whittington Health and Haringey CCG Safeguarding meetings. The CIC designated Professionals work across the borough with Islington and Hackney to ensure that systems and processes are peer reviewed and joint audits undertaken. 10.25 There are plans for an away day learning event with Whittington health in August where CIC teams working in Hackney and Islington will join together to share 17

learning in practice. 10.26 The Designated Doctor is leaving her post on 31.3.2017 and the CIC wishes to thank the Designated Doctor for hersupport in ensuring the Children in Care s voices are heard. 11. Safeguarding Monitoring of Haringey General Practices 11.1 Haringey GP Practices 11.2 From 1 April 2013 NHS England (NHSE) assumed responsibility for commissioning and performance monitoring of Primary Care Services. CCGs maintained a duty to support NHSE with the quality assurance of these services. 11.3 HCCG Safeguarding Children Team continue to drive improvements in the quality of Primary Care safeguarding children services offering advice and support to independent practitioners. Technology such as the HCCG GP website, the GP Bulletin and practice emails were used to highlight and disseminate learning. Practice visits and face-to-face or phone advice and support were used as opportunities to reinforce understanding and improve the quality of safeguarding children practice. 11.4 Level 1 and 2 training was available via e-learning and Haringey Safeguarding `Children Board. 11.5 The Level 3 annual two and half hour bespoke GP training programme continued and was led by the Named GP supported by the HCCG Safeguarding Children Team. This offers bespoke face-to-face training to all Haringey GPs in groups with a maximum of 30 participants per session. In training sessions, GPs overwhelming opinion was this is how they wanted training delivered. The training programme covers new topics and material each year and is run in yearly cycles from autumn to the following summer. The sessions covered local and national issues and alerted GPs to lessons learned from national and local safeguarding issues. The 2016-17 training specifically related learning to a Haringey Serious Incident. currently under review by Whittington Health. The case raised the issues of neglect and physical abuse and how this may present to GPs. Neglect is also an HSCB priority area. Training also included feedback from the follow up audit of GP reports to conference, unaccompanied children in GP surgeries and modern slavery, particularly in the context of how this should inform the registration process of children. Training sessions are evaluated, feedback from the participants has universally been excellent, rated very good to good. The particpants were asked to base their feedback on the training contents,presentation and would they recommend a colleague to attend the training sessions. The evaluation on administration and the venue were rated below good by some participants. 11.6 In 2017/18 HCCG Safeguarding Children Team intends to continue the training programme. 11.7 Promoting effective safeguarding children in GP practices requires understanding of the current landscape of General Practice. Several smaller practices have closed, some have combined, recruitment is an challenge and some practices have a high number of locums. The Haringey training is offered to any doctor working in Haringey including locums. We provide appropriate motivation, information and support with context in mind. It is positive that GPs in the level 3 18

training sessions remain informed and interested in safeguarding. It remains a concern, however, that there is a low number of reports from GPs to child protection conference. The re-audit in September 2016 found that of those GPs invited to conference, 44% provided a report. This was an improvement on the previous year s figure of 31% but is still not adequate. On a positive note, the quality of reports were considerably better than previously with 66% of the reports graded good and likely to inform the conference. Various actions have been taken in 2016-17 and again we have presented the data to GPs at the training. The CCG will continue to take forward with primary care to improve numbers of case conference report submission. All practices involved in the audit were asked to review their systems and practice. The audit will be repeated in 2017 to assess impact of the feedback. 11.8 In addition to the training, we have had two GP Child Protection Leads meetings. They originally commenced in November 2013, continued and were facilitated by the Named GP and either the Designated Doctor or Assistant Director for Safeguarding / Designated Nurse. They were interactive sessions where cases/issues were brought for discussion. GPs were canvassed about whether the meetings added value and the feedback has been overwhelmingly positive, but it was flagged that the timing of meetings and location were important for regular attendance. The meetings still had relatively low attendance so in the context of GPs having bespoke training these have not been continued. 12. Safeguarding Monitoring of Haringey Clinical Commissioning Group (HCCG) 12.1 The HCCG Safeguarding Children Designateded Doctor and Nurses and Named GP met once or twice a month. This provided an opportunity to share good practice, update each other on any developments and monitor the implementation of work plans. 12.2 Training data for 2016-17 12.3 Figure 3: HCCG Safeguarding Training Compliance across the required levels as of 31/03/17: Training Type & Level Numbers Requiring Training Numbers Trained Percentage Compliance Safeguarding Children - Level 1 81 73 90% Safeguarding Children - Level 2 23 22 96% Safeguarding Children - Level 3 14 14 100% Safeguarding Children - Level 4 3 3 100% HCCG training compliance levels meet the required standard 13. Reviews and Audits 13.1 Joint Targeted Areas Inspection 13.2 An independent partnership Domestic Abuse Diagnostic evaluation on the theme 19

of those living with Domestic Abuse was commissioned by partners in Haringey. This inspection took place from 19-21July 2016. 13.3 The review was based on the JTAI Area Inspection methodology programme led by Ofsted, the CQC, HMI Constabulary and HMI Probation. 13.4 The evaluation team was led by Malcolm Newsam, an experienced Director of Children s Services with extensive experience of providing diagnostics, two senior managers from children s social care and the HCCG Designated Nurse Safeguarding Children. This involved desktop analysis, audits on nine cases, focus groups and interviews with front-line health workers. They tracked domestic abuse (DA) cases, investigating the journey of the child and asked children and their carers about their experiences. The review involved interviews with the HCCG Strategic Leads for domestic abuse in response to JTAI evaluation criteria regarding safeguarding arrangements and assurance. Services reviewed were as follows: maternity services and Emergency department at NMUH, health visiting and school nursing of CLA WH community services. Mental health of BEH MHT and HCCG safeguarding children commissioning leafership team. 13.5 The report recognised need to strengthen the strategic focus on domestic abuse through tighter governance. The author acknowledged there has been significant work that was underway at the time of the diagnostic and that has progressed in relation to the development of the Violence Against Women & Girls Strategy and the LSCB and Haringey strategic partnership. 13.6 The recommendations are monitored at the Joint Targeted Area Inspection Improvement Group and the Haringey CCG Safeguarding Assurance Group meeting as part of the assurance framework. 13.7 The inspection highlighted good practice and many impressive strengths across the partnership in Haringey and a very significant commitment to address the impact of domestic abuse on children, families and communities. The inspection team made specifc reference to:- Frontline health visitors and midwives mindful of the impact of Domestic Abuse on children and families. Roll out of the IRIS (identification and referral) process to GP surgeries 13.8 Full recommendations of inspection are listed: Appendix 2 13.9 Alan Wood Review 13.10 During the year the Government commissioned Alan Wood to review the future of LSCBs. The review included the role and functions of Local Safeguarding Children Boards (LSCBs) and was published in May 2016, together with the government s response. Alan consulted extensively during his review and found a clear consensus in favour of reform. 13.11 As a result all LSCBs are seeking to introduce a stronger statutory framework 20

which will introduce greater accountability on the three key agencies involved in safeguarding children, namely Local Authorities, the Police and the CCG. The arrangements will be more flexible and enable local areas to determine the best way to organise themselves. 13.12 The statutory requirements which the government intend to lay upon the partnership are as follows: work together to safeguard and promote the welfare of children jointly identify and respond to emerging needs and priorities produce and publish a plan which will set out how they will carry out this duty decide, among other things, how they will work with other agencies, what the resourcing for the arrangements will be how to share information and data how they will ensure there is independent scrutiny of their decisions new SCR arrangements to undertake local child safeguarding practice reviews and very few national SCRs shift over of CDOP to the Department of Health undertake rapid reviews into child deaths on a local basis 13.13 Whilst changes are unlikely to be required before late 2017 at the earliest,haringey LSCB are keen to plan ahead for future safeguarding children arrangements. All this, though, will be dependent upon decisions taken jointly by the Council, the CCG and the Police. 13.14 Haringey Safeguarding Children Board Multi-agency Audits 13.16 The multi-agency audit cycle was reviewed in light of the focus of the Independent partnership DA evaluation on services and is reported below. HCCG led the Health involvement within the following HSCB Multi-agency themed audits: Q1 - Looked After Children Care Planning & shared funding arrangements (S20 Audit) Q2 - Child s Voice/experience in relation particularly to mental health, violence, CSE and Missing. An audit of cases involving assault identified by NMUH was picked up in Q4 Q3 - MASH - the DA evaluation touched on the MASH and an audit of 10 cases has been undertaken in Q3 through the MASH Strategic Board which will report to the next LSCB Q4 - CSE & Missing- MASH Chairs are undertaking an audit of cases referred in Q4. 13.17 The implementation of recommendations from these audits will be monitored by HSCB. 21

14. Serious Case Reviews (SCRs) 14.1 Over the period of this report, two SCR were published by the Haringey Safeguarding Children Board. These were: 14.2 SCR Child R concerned a baby who was murdered by the father. A SCR was completed and published on the Hariney LSCB website in July 2016. 14.3 The case highlighted the need to ensure there are effective MASH arrangements in place. As a result the Multi-agency Safeguarding Hub (MASH) were thoroughly reviewed and refreshed, with changes to the working protocols. 14.4 Some weaknesses in convening strategy meetings at appropriate times, which aligned with a wider review of the arrangements for partnership involvement in strategy meetings. A health economy strategy meeting/discussion pathway is now in place. The HLSCB have received data demonstrating an improved position regarding an increased number of health attendance at strategy meetings. 15. SCR Child F 15.1 Late 2015, a 17 year old young person died of stab wounds. A SCR was completed and published anonymously as agreed by the SCR National Panel and LSCB chair in April 2017. Both action plans are monitored and reviewed at the SCR Sub-group. 15.2 The case higlighted the impact on a child s journey in cases where Haringey children and young people are referred to CAMHS services and the importance of tracked cases by the referrer to ensure proper and timely feedback of actions. Since the review there is now a CAMHS access policy in place This policy outlines arrangements for access to CAMHS within Haringey available for children and young people under the age of 18 with complex mental health and emotional difficulties. 15.3 These reviews resulted in recommendations which were formulated into action plans and are monitored via HSCB 22

16.0 Progress against Objectives 2016-17 Objectives 2016-17 Objective Key Milestones Progress 16.1 Health has appropriate representation on Safeguarding Children Boards (LSCB) and Subgroups which strengthens interagency working through contribution to the work of the board. HCCG Executive Lead and Designated Professionals attendance at the quarterly LSCB Board. HCCG will facilitate and monitor relevant Health provider attendance at the LSCB and its subgroups. Participation in LSCB sub-groups Participation in SCR reviews as required Largely Met The AD for Quality and Nursing is Vice Chair of the LSCB. The Designated Nurse is Chair of the CSE subgroup. Designated Doctor and Nurse has contributed to the development of the LSCB Business and strategic work plan. Designated Nurse and Doctor Safeguarding Children are members of the LSCB main board and Executive and contribute to the strategic direction of the LSCB. Designated Nurse was lead health reviewer for partnership diagnostic of Domestic Abuse (July 2016) Provider attendance is monitored, poor attendance escalated as appropriate. 16.2 HCCG to gain assurances of safeguarding arrangements within provider organisations through attendance at Attendance at the bi monthly trust internal safeguarding committees. HCCG will monitor provider compliance with NHSE revised Safeguarding Accountability and Assurance Largely Met Designated Nurse for Safeguarding Children attends all provider trusts internal safeguarding 23