HEALTHCARE INSPECTORATE WALES SAFEGUARDING AND PROTECTING CHILDREN IN WALES: A Review of the arrangements in place across the Welsh National Health Service ACTION PLAN - UPDATED August 2010 RECOMMENDATION ACTION TAKEN ACTION REQUIRED LEAD TIMESCALE 1. The structures and arrangements to be put in place across the new health service structures to support the child protection agenda are clarified as a matter of urgency. These arrangements need to take full account of the requirements of the Children Act 2004 and the recommendations arising from Lord Laming s report of March 2009. Nurse Director with lead for child protection in place. Assistant Nurse Director for Safeguarding and Public Protection Appointed Establishment of a Children & Young People Safeguarding Sub -Committee chaired by the Aneurin Bevan Health Board s Non Officer with the lead for Safeguarding. Terms of reference agreed. Director of Nursing Designated Professionals members of sub committee. Named Nurse and Named Doctor for Child Protection in place.
Senior corporate and locality representation at the Local Safeguarding Children Boards. Child protection training undertaken with Board members 23 rd June 2010. To clarify by way of a flow chart how the Board is aware of issues in regard to the safeguarding agenda. This to be included in the Aneurin Bevan Health Board s Governance structure which is currently being finalised Named Professionals Head of Organisational Learning Oct 2010 2. Child protection training is made mandatory for all staff groups. Update training should be provided at least every 3 years. The Welsh Assembly Government should ensure that all nationally agreed contracts reflect this requirement. Level 1 Child Protection training part of the mandatory induction training for all Aneurin Bevan Health Board staff. Child Protection Strategy in place. In place Named Professionals Level 2 Child Protection training mandatory for staff working directly with children and families. The National Public Health Service has developed best practice guidance which is used in the delivery of training for independent contractors. The Aneurin Bevan Health Board Safeguarding team provides an annual programme which includes level 2 and 3 training. Staff are also released to attend the Local Safeguarding children Board multi-agency training. The Child Protection Strategy advises that staff should attend 3 yearly update child protection training as appropriate to their post. Line Managers are responsible for monitoring adherence with 2
training requirements through the appraisal process. Child protection training is linked to eksf 3. The new Local Health Boards further engage with primary care contractor groups to ensure they receive the necessary training and support in respect of child protection and safeguarding. See Rec. 2. A child protection training model for contractor services in Caerphilly is in place. A course evaluation form that asks participants to rate how useful the course was, the appropriateness of content, and the usefulness of the scenarios used. Participants are asked if they require more detailed training and provided with opportunity to offer other comment on the training provided. A review of the current contractor services and their training requirements across Gwent is being undertaken, reporting to the sub-committee in September 2010. Aneurin Bevan Health Board s Safeguarding Team Sept 2010 4. Service providers put policies in place that are in line with the All Wales Child Protection Procedures to ensure staff are aware and understand all safeguarding policies and procedures and their relevance to their area of work. Child protection training is provided by the National Public Health Service in the other Gwent Local Authority areas. All 6 organisations have adopted the All Wales Child Protection Procedures and local policies ratified by the Local Safeguarding Children Boards. Any policies and procedures are received by the Sub-committee and placed on the Aneurin Bevan Health Board s Intranet. Aneurin Bevan Health Board Child & Young People Safeguarding Sub- Committee Bulletins and memos re policies are sent to clinical areas and raised at staff meetings. 3
All level 1 and 2 training is based on and includes reference to, the All Wales Child Protection Procedures. Other policies such as Fabricated and Induced Illness, Professional Abuse form part of specific training on these subjects Aneurin Bevan Health Board have a team of Child Protection Lead Nurses (reporting to the Named Nurse) who link with defined clinical areas/localities to provide staff with clinical advice and supervision in relation to child protection matters. The lead nurses play a key role in supporting staff to understand and implement the Child Protection Policy in their day to day work. 5. Community Safety Partnerships review all service level agreements to ensure that statutory requirements in relation to safeguarding are included and that review mechanisms are in place to demonstrate compliance by providers. Aneurin Bevan Health Board is represented on the five Community Safety Partnerships operating within its catchment area (Caerphilly, Blaenau Gwent, Torfaen, Monmouthshire, and Newport) through Locality based personnel. The Service Level Agreements for Community Safety Partnerships regionally commissioned services include the statutory requirements related to safeguarding Aneurin Bevan Health Board Corporate Planning Team are to review Aneurin Bevan Health Board representation at the Community Safety Partnerships as part of review of engagement with partner agencies 4
6. Community Safety Partnerships ensure robust and well managed family centred, substance misuse care pathways into and out of children and family services. Aneurin Bevan Health Board is represented on the five Community Safety Partnerships operating within its catchment area (Caerphilly, Blaenau Gwent, Torfaen, Monmouthshire, and Newport) through Locality based personnel. Aneurin Bevan Health Board Children & Young People Safeguarding Sub-Committee need to review how this recommendation is being progresses in the other local authority areas Lead Nurse Child and Family Division Jan 2011 7. Community Safety Partnerships ensure that information sharing agreements are in place for their local area and that these cover the protection of vulnerable people. The Caerphilly Community Safety Partnerships established a task and finish group to consider the recommendations identified in Hidden Harm. The Caerphilly Social Services Drug and alcohol Team have a joint working protocol with Children and Family Services in Aneurin Bevan Health Board. Aneurin Bevan Health Board involved in the development of a Gwent multi-agency Information Sharing document, however progress is delayed until policy guidance is issued by the Welsh Assembly Government. Multi-agency Ongoing 8. All assessments, Care Programme Approach monitoring, and discharge planning documentation and procedures should prompt staff to consider if the service user is likely to have or resume contact with their own child or other children in their network of family and friends, even when the children are not living with the service user. Information continues to be shared under the Children Act and Crime and Disorder Act All Care Programme Approach Assessments and the Wales Applied Risk & Research Network risk assessments have been amended. They now contain a prompt that requires the assessor to specifically consider the risks to children from the service user. Audits of Multi-disciplinary Team minutes and Care Programme Approach/ Wales Applied Risk & Research Network documentation are currently being undertaken to ensure that this is taking place. Clinical Audit and CPA Lead Audit undertaken Ongoing Audit is part of the Annual Operating Framework data collection of Care Programme 5
9. If the service user has or may resume contact with children, this should trigger an assessment of whether there are any actual or potential risks to the children, including delusional beliefs involving them, and drawing on as many sources of information as possible, including compliance with treatment. Additionally the Multi-disciplinary Team format has been amended also. This has resulted in the risks to children being discussed by any of the following:- New Service User Those service users being discharged from hospital. Those service users in the community whose risk is thought to be increasing. These meetings are held weekly and all minuted. During these meetings the care plans are amended accordingly. All Care Programme Approach and Unified Assessment documentation contain prompts that remind staff to ask relevant questions where there are children in the service user s network. Audit to ensure compliance Clinical Audit and CPA Lead/ Lead Nurse for Learning Disabilities/ clinical Governance Manager Approach Wales Applied Risk & Research Network audit is ongoing March 2010 The Wales Applied Risk & Research Network risk assessment process contains a prompt to ask relevant questions. The Multi-Disciplinary Team format contains a prompt to consider any child protection issues. If following a Multi-Disciplinary Team meeting a service user is considered to be a risk then this would prompt the care coordinator to conduct a new assessment. 6
Specific attention would be given to the pertaining risks and subsequent management plan. 10. Referral should be made to children s social care services under local safeguarding procedures as soon as a problem, suspicion or concern about a child becomes apparent, or if the child s own needs are not being met. All Locality Managers have been issued with the names and arrangement procedures of their respective Lead Nurse for Safeguarding Children General Manager for Mental Health & Learning Disabilities A referral must be made: If service users express delusional beliefs involving their child and/or if service users might harm their child as part of a suicide plan. 11. Staff working in Mental Health Services should be given clear guidance on how to make such referrals, including information sharing; the role of their organisation s designated lead for child protection, and what to do when a concern becomes apparent outside normal office hours. All Teams have been instructed on the procedure to be taken when identifying a child at risk. In addition to this all teams have been issued with:- Names of respective lead nurses for safeguarding children Child protection procedures The necessity to refer as soon as a problem, suspicion or concern about a child becomes apparent or if the child s own needs are not being met, along with the referral process, are reinforced through Child Protection Training (detailed in Recommendation 2). All Locality Managers have been issued with the names and arrangement procedures of their respective Lead Nurse for Safeguarding Children System to be introduced in the Autumn for all child protection referrals to be entered onto the Datex electronic system. The number and nature of referrals will be subject to analysis and scrutiny by the Aneurin Bevan Health Boards Safeguarding Children and Young People Sub-Committee. This will also facilitate analysis of practice in individual services in the organisation, and will be used to prompt detailed audit and review of practice when indicated. Line Managers will be responsible for monitoring adherence with training requirements through the appraisal process and where appropriate through the eksf tool. Named Nurse Head of Organisational Learning General Manager for Mental Health & Learning Disabilities Dec 2010 7
All clinicians in the teams have been made aware of the contact details and arrangements should they need to make a referral. Child Protection Procedures have been made available to all clinical areas 12. A Consultant Psychiatrist should be directly involved in all clinical decision making for service users who may pose a risk to children. All clinicians have attended child protection training sessions raising awareness of referral protocols available throughout Gwent The Named Nurse has attended Medical Post Graduate Training to promote and provide awareness on the Referral Protocols for Child Protection through out Gwent. Liaise with Post Graduate Organiser to ensure Child Protection training is incorporated in medical staff induction. The Multi-Disciplinary Team format has been amended to ensure that Multi-Disciplinary Team members (includes Consultant Psychiatrists) discuss any risks to children when considering the care arrangements for: Clinical Audit and CPA Lead / Named Nurse Child Protection Clinical Audit and CPA Lead /Named Nurse Child Protection/ Divisional Director Clinical Audit and CPA Lead / Named Nurse Child Protection/ Consultant Psychiatrist General Manager for Mental Health & Learning Disabilities / Divisional Director New service users 8
Service users being discharged from hospital. Service users in the community whose risk is thought to be increasing. Multi-Disciplinary Team meetings are held weekly, formal minutes are taken, and the care plans of individual service users are amended accordingly. 13. Safeguarding training that includes the risks posed to children from parents with delusional beliefs involving their children or who might harm their children as part of a suicide plan is an essential requirement for all staff. Attendance, knowledge and competency levels should be regularly audited and any lapses urgently acted on. All staff within the Mental Health and Learning Disability Division will undertake the relevant child protection training as outlined below: Level 1: on-line for all staffupdated very 3 years Audit to ensure compliance with training Training Monitored on a quarterly basis and is currently 89.5% for Community Learning Disability Teams. Clinical Audit & CPA Lead/ Lead Nurse for Learning Disabilities/ Clinical Governance Manager May 2010 Level 2: Health Professionals Roles and Responsibilities in Child Protection Recognition and Referral- all staff who work with families and children- updated every 3 years Level 3: Working with Families with Learning Disabilities or Mental Health Problems Child protection training is a standing agenda item on the Divisional Learning Group and Learning Disability Quality Improvement Board. 9
14. All Child & Adolescent Mental Health teams should work with their Local Safeguarding Children Boards to develop information sharing protocols. These protocols should set out clearly the type of information that should be shared, the circumstances in which information should be shared and relevant agencies with whom it should be shared. 15. New Local Health Boards ensure that at least one member of staff trained in paediatric medicine and child protection is on duty in Accident & Emergency departments at all times. Multi-agency information protocols already exist between Health and Local Authority agencies. A multi-agency Information Sharing document is being developed. Accident & Emergency Royal Gwent Hospital Response All new medical staff undergo child protection training on induction. Rolling programme for nursing staff in place on child protection training. All middle grade staff trained in Advanced Paediatric Life Support or European Paediatric Life Support and so 24/7 presence of staff member with both child protection training/paeds resus skills on duty at the Royal Gwent Hospital. Nursing staff have training in Paediatric Life Support as part of rolling education programme. Royal College of Nursing advice constantly available via paediatric wards. Three members of staff (RSCN) working in Accident & Emergency. Identify Lead Local Safeguarding Children Board to develop Information Sharing Protocol with local NHS Child & Adolescent Mental Health Service on behalf of Gwent/Aneurin Bevan region. Suggest Newport as Consultant Psychiatrist already sits on this group. Need to maintain provider status in Advanced Paediatric Life Support and ongoing updates for child protection training as part of Personal Development Plan for medical staff. Agree training programme and complete. Review required to address capacity. Further recruitment and support to enrol current nursing staff in appropriate training. Aneurin Bevan Health Board Specialist Child & Adolescent Mental Health Service Newport Local Safeguarding Children Board Lead Clinician Senior Nurse April/June 2010 Ongoing March 2010 Sept 2010 Recently appointed (February 2009) consultant with accreditation in paediatric emergency medicine. 10
Accident & Emergency Nevill Hall Hospital Response Guidance noted. Senior medical staff have this training and are generally rostered to be present 9.00 am 11.00 pm weekdays. Review of medical staffing to be addressed Consultant in A&E/Clinical Director for Emergency Medicine Sept 2010 Paediatric advice available from the paediatric ward. 16. All Local Health Boards should, where there are concerns about a child attending Accident & Emergency (including minor injuries units) follow the All Wales Child Protection Procedures and child s health visitor/school nurse and General Practitioner notified. Dedicated paediatric liaison safeguarding post in place. Liaison forms for all children under 16 years are completed at all departments / sites and there is a standard in place that they are sent out to the community practitioners within 7 working days. Any child about there has been identified concerns is brought to the attention of the paediatric liaison nurse A checklist is in place for Accident & Emergency staff of specific presentations eg children under 1 years, burns, self harm also for highlighting to the paediatric liaison safeguarding lead who then phones these attendances out to the community practitioners that day. 11
17. The Welsh Assembly Government takes further steps to ensure that the profile and level of expertise for child protection with General Practitioner practices is raised. 18. The Welsh Assembly Government puts national arrangements in place to ensure that Accident & Emergency attendance records and Child Protection Registers are shared between Accident & Emergency departments. An Accident & Emergency standard on how health visitors and school health nurses should respond to notifications of a child's attendance at Accident & Emergency is in place. Requires a response from the Welsh Assembly Government. This requires a response from the Welsh Assembly Government. Within Gwent Accident & Emergency departments are able to contact Local Authority Social Services to check if a child s name is on the Child Protection Register. 19. The new Local Health Boards continue to work towards the amalgamation of children s records and ensure that a project plan and timetable are put in place. Trusts should set a clear deadline for when they expect to complete this work. 20. All General Practitioner practices across Wales should ensure that they comply with A Guide for Safeguarding Children and Young People in General Practice issued by the National Public Health Service in 2007. A pilot project to support amalgamation and integration of the Child Health Record and the Acute Record was completed in June 2010. The aim of the project was to ensure all relevant documentation is available to the treating clinician and was considered to have been successful. All practices in Gwent will have received A Guide for Safeguarding Children and Young People in General Practice and the "All Wales Child Protection Procedures 2008". The completed report of the pilot project will be presented to the Children and Young People Safeguarding Committee. There needs to be consideration as to whether a local information sharing protocol is required in addition to that set out in the All Wales Child Protection Procedures Head of Health Records. Head of Information Governance June 2010 June 2010 The new Local Health Boards ensure that local information sharing protocols comply with the All Wales Child Protection The policy and process for information sharing is detailed in the All Wales Child Protection 12
Procedures and clearly set out the arrangements for sharing information between primary care and social service departments. Procedures. All practices are required to adhere to this when information is requested by Social Services regarding a child protection issue. Compliance and understanding of the All Wales Child Protection Procedures is a requirement of the General Medical Service Contract and is monitored through the Quality and Outcome Framework. General Practitioner practices are required to nominate a General Practitioner lead for child protection. This individual acts as the main contact for practice staff who are raising child protection concerns and for Social Services staff requesting information. The General Practitioner lead is often supported in this function by the Practice Manager. 21. The Safeguarding Vulnerable Groups Act 2006 provides for a new Vetting and Barring Scheme to replace the existing arrangements for safeguarding children and vulnerable adults from harm or risk of harm by employees (paid or unpaid) whose work gives them significant access to these groups. The scheme went live on 12th October 2009 and all NHS organisations must ensure that they have the necessary systems and procedures in place to ensure compliance with the scheme. A business case has been developed. An action plan has also been developed to underpin the implementation of the Independent Safeguarding authority over the 5 year period from November 2010 2015. The new Independent Safeguarding authority barred lists have been introduced. Scheme has been put on hold by the Government awaiting new implementation date Implement the Action Plan - wide when above agreed Assistant Director of HR Operational/ Head of Recruitment / Senior CRB & Work Permit Advisor Registration Start Date: 01 November 2010 Completion Date: 2015 Updates are put onto the Intranet 13
22. The Welsh Assembly Government revisits the recommendation we made in 2007 in relation to ensuring that age specific adolescent facilities are made available across Wales for all specialities. 23. The new Local Health Boards take steps to ensure that dedicated areas for the triage and treatment of children and young people are made available in all Accident & Emergency departments. Requires a Welsh Assembly Government s response The Royal Gwent Hospital has dedicated separate triage, assessment and treatment areas between 07.00 02.00. Out side these times children are managed in adult areas due to insufficient staff to man the paediatric area overnight. Caerphilly District Miners Hospital does not have separate facilities. Nevill Hall Hospital The physical layout and available staff resource does not facilitate compliance with the recommendation. The strategic plan for children services is the development of a Critical Care Centre which would include a dedicated Accident & Emergency department for children. Caerphilly District Miners Hospital will be decommissioned when the new local general hospital (Ysbyty Ystrad Fawr) opens at the end of 2011. The Assistant Director of Nursing for Safeguarding and Public Protection and the Named Nurse for Child Protection will visit the Accident & Emergency department at Nevill Hall Hospital to ascertain how risks to children and young people who witness distressing situations or inappropriate behaviour in the Accident & Emergency department are assessed and managed by the clinical team. Manager Child Health previous owner Director of Nursing 2011 24. All NHS and primary care contractor staff must wear visible identification badges when on duty. Policy in place. To monitor compliance Audit to part of Aneurin Bevan Health Board internal audit programme for 2010-2011. April 2011 14
25. All mental health wards should implement a Policy for the Visiting of Psychiatric Patients by Children. 26. Staff working on adult mental health wards must enforce child visiting policies in line with national guidance. They must ensure that when agreement has been given for a child or young person to visit, that appropriate arrangements are made to ensure the comfort and safety of that child and for maintaining the privacy and dignity of other patients on the ward. A policy for Children Visiting Wards is in place and follows national guidance. Currently it is requested that children attend outside of the normal visiting times where an appropriate room is made available for the visit to take place Staff take into consideration the current risk the parent (patient) poses to the child. A record of the visit is entered into the patients notes detailing the interaction between patient and child All staff have access to the policy for Children Visiting Wards and are aware of the necessary arrangements to be made. Rooms are made available for visits to take place Aneurin Bevan Health Boards Children and Young Peoples Safeguarding Sub-Committee to request Lead Nurse Mental Health & Learning Disabilities to undertake an audit of compliance with said policy Safeguarding Sub Committee Jan 2011 As Above As above Jan 2011 15