NHS WIRRAL SAFEGUARDING CHILDREN ANNUAL REPORT

NHS WIRRAL SAFEGUARDING CHILDREN ANNUAL REPORT 1 st APRIL 2011 31 st MARCH 2012 BACKGROUND All NHS bodies have a statutory duty to make arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004. NHS bodies are statutory members of Local Safeguarding Children Boards under section 13 of the 2004 Act. With the passage of the Health and Social Care Bill, statutory responsibility will transfer from Primary Care Trusts and Strategic Health Authorities to Clinical Commissioning Groups (CCGs) and the NHS Commissioning Board. The statutory responsibilities of NHS providers for safeguarding children will not change. PURPOSE The purpose of this report is to provide the NHS Cheshire, Warrington and Wirral Cluster Board with an annual review of the work undertaken during 2011-2012 in relation to safeguarding children and young people. This includes providing assurance on how NHS Wirral has met its safeguarding responsibilities, specified under section 11 of the Children Act (2004). Specific areas that require further development during 2012-13 are highlighted and reflect key changes in legislation and guidance that have come into force in the last 12 months. LEGISLATIVE BACKGROUND TO SAFEGUARDING CHILDREN The national strategy of Every Child Matters (2003) underpinned by the Children Act (1989, 2004) shifted the emphasis from protecting children from harm to that of early intervention. Safeguarding Children and the requirements upon health are enshrined in statute, with roles and responsibilities of all those involved set out in Working Together to Safeguard Children (March, 2010). The Children Act 1989 and 2004 provides the legislative 1

framework for safeguarding children and is supported by the statutory and supplementary guidance in Working Together (March, 2010). Safeguarding and promoting the welfare of children is defined in Working Together to Safeguard Children (2010) as protecting children from maltreatment, preventing impairment of their health and development, ensuring they are growing up in circumstances consistent with the provision of safe and effective care and undertaking that role so that it enables children to have optimum life chances and to enter adulthood successfully. LOCAL AND NATIONAL DRIVERS FOR CHANGE AND IMPROVEMENT Ofsted and Care Quality Commission announced inspection In March 2011 Ofsted and Care Quality Commission reported on their Announced Inspection of Wirral Safeguarding and Looked After Children Services that took place in January 2011. Inspections are focused on multi agency arrangements and how well services work together to produce good outcomes for children and young people. Safeguarding was graded as good, with the contribution of health agencies to keeping children and young people safe graded as outstanding. Care Quality Commission identified two actions for health which NHS Wirral, as commissioners, led on the formulation of the health action plan. One action related to looked after children and has been completed. The one remaining action relating to a supervision audit is underway. The Munro Review The Munro Review of child protection was commissioned by the coalition government in June 2010. The final report A child-centred system was published in May 2011. In July 2011 the Government responded and accepted Professor Eileen Munro s fundamental arguments and analysis. The report contained 15 recommendations which were all accepted or accepted in principle, subject to further consideration. Professor Munro was clear that there should not be any cherry picking of recommendations. There is a need for system wide reforms, and to work in partnership with a strong role in sector led practice improvement. 2

The main focus of the review has been on the role and impact of social care in keeping children safe and reducing bureaucracy in order to increase the time practitioners are able to work with families to improve outcomes for children. The focus of our work must be child centred. While there are some implications for the health community, the reviews main focus has been on social care. Professor Munro s review recommended that the Government should review both Working Together to Safeguard Children (2010) and the Framework for the Assessment of Children in Need and their Families (2000). The aim is to radically reduce the volume of centrally issued guidance and to give professionals freedom to exercise their own judgement and to encourage Local Authorities and their partners to develop innovative approaches to safeguarding and improving their ability to respond to the varied needs of individual children, young people and families. The review of Working Together is underway and we expect to the consultation document to be available in July 2012. In addition a consultation exercise was completed in April 2012 to identify what national data needs to be collected to support the new ways of working. It is expected that the framework will be published in May 2012 and will come into effect in 2014. The health community will need to pay particular attention to: proposed changes to the Common Assessment Framework to make it less bureaucratic and more supportive of multi-agency assessment future inspection will include all agencies involved in safeguarding being inspected by Ofsted, including a review of local standards and indicators for performance ensuring that all professional groups and agencies mitigate the impact of the NHS reforms on current arrangements changes to the Serious Case Review process supporting Universal Services to manage complex cases in order to reduce the increasing volume of referrals to children s social care. A Munro Review progress report is expected during 2012. 3

KEY ACHIEVEMENTS 2011-12 Safeguarding children and young people has remained a high priority for NHS Wirral. During the year the: Safeguarding Children and Vulnerable Adult Policy is included in contracts with the main providers Designated Professionals have been members of the Social Care Institute of Excellence Case Review pilot Service specification for health visiting has been developed and includes safeguarding standards Business plan has been developed and agreed to provide a nurse liaison post for Walk in Centres to improve communication and share information on the attendances of children in Walk in Centres. The post will also support the Child Death Overview Panel process. The post will be part of the Wirral Community NHS Trust Safeguarding Service. KEY FEATURES OF SAFEGUARDING ARRANGEMENTS Senior management commitment to the importance of safeguarding children Leadership and management for commissioning safeguarding are provided at Chief Executive and Director level and through the Designated Professionals (Nurse and Doctor). This is now linked into the clustering arrangements for NHS Cheshire, Warrington and Wirral. The Executive Director of Nursing, Performance and Quality is the Executive lead for safeguarding children and young people and has provided updates to the Board during 2011 / 12. Local Safeguarding Children Boards are the key statutory mechanism for agreeing how the relevant organisations in each local area will cooperate to safeguard and promote the welfare of children in Wirral and for ensuring the effectiveness of what they do. The Executive Director of Nursing, Performance and Quality is a member of Wirral Local Safeguarding Children Board. The Designated Professionals are also Local Safeguarding Children Board members in their capacity as Designated Professionals. Primary Care Trusts are required to have a designated doctor and nurse whose responsibility it is to take a strategic, professional lead on all aspects of the health service contribution to safeguarding children across the local health economy. The Designated Professionals are in place to provide expert advice on matters relating to safeguarding children for other professionals, the Primary Care Trust, health providers, Local Authority children s services and the Local Safeguarding Children Board. In the changing landscape of the NHS the Designated Professionals will support the Clinical Commissioning Groups, ensuring their readiness for statutory safeguarding 4

responsibilities in April 2012. The Designated Nurse for Western Cheshire has provided the Designated Nurse function for NHS Wirral since May 2012. The roles, responsibilities and capacity of the two Designated Nurses serving the cluster have been subject to a safeguarding review, undertaken by NHS Cheshire, Warrington and Wirral in line with the changing organisational structures in health. The Designated Doctor has three sessions per week. These sessions are provided and commissioned through Wirral University Teaching Hospital NHS Foundation Trust. There are safeguarding leads at Executive level and Named Professionals within each individual health provider organisations locally as required. A clear statement of the agency s responsibility towards children is available to staff The Commissioning Safeguarding Children and Vulnerable Adult Policy, incorporating service delivery standards (2012) has been updated on a North West basis by NHS North West and appropriate local information such as the contact details of safeguarding leads and Wirral Local Safeguarding Children Board contact details have been included. The policy details the roles and responsibilities of NHS Wirral as a commissioning organisation and that of its employees. However, it also provides clear service standards against which healthcare providers and NHS Wirral will be monitored to ensure all service users are protected from abuse and the risk of abuse. The policy has been approved by NHS Cheshire, Warrington and Wirral and is included in Section 4A and schedule 5 of national provider contracts. Individual audit standards appropriate to independent contractors: general practice, dental practice, and pharmacy and care homes are included in the policy. The main health providers will complete an annual self assessment audit and provide evidence of compliance with the policy standards. The newly developed service specification for health visiting that has been drawn up by NHS Wirral commissioners, includes clear safeguarding service standards consistent with the requirements of the Children Act 1989 and 2004. Service development takes account of the need to safeguard and promote the welfare of children and is informed by the views of children and families This is an area that needs further consideration and development as we move forward. This will be an area of in future Ofsted inspections. It is important that we listen to the views of children and that they are taken seriously. The new Ofsted inspection process will pay particular attention to the journey of the child. Commissioners of services will need to consider this when commissioning services. Staff training on safeguarding and promoting the welfare of children for all staff working with or in contact with children and families 5

Along with Working Together (2010) the Intercollegiate Document (2010) provides health staff with the safeguarding children training framework. Safeguarding children training remains a key focus and important area for NHS Western Cheshire. Safeguarding children and young people level 1 and 2 modules are accessible to staff and are provided via e-learning for Healthcare. The modules are accessed via the National Learning and Management System. Completion of the modules is recorded by the Workforce Redesign and Performance Team. The following table demonstrates the current safeguarding children training compliance for NHS Wirral staff. Table 1: Safeguarding Children Training Compliance Intercollegiate Document (2010) - Level of training % of staff completed Level 1 91.6% Information is not currently available for levels 2 5 (Intercollegiate Document, 2010). Further work is required to review the training requirements of all staff to enable more accurate and robust monitoring to take place. Recording processes should be able to differentiate between levels of training for different staff groups as identified in the Intercollegiate Document (2010). Safeguarding children training is mandatory for all staff. The Local Safeguarding Children Board provides multi agency training and is accessed by staff across the health economy One focus of the training provided is to ensure staff understand when and who to discuss a concern about a child s welfare with. Staff need to be aware of when to make a referral to Children s Social Care and to understand how and what information can be shared in order to safeguard children. NHS organisations have flow charts based on National Guidance What to do if you are Worried a Child is Being Abused (DoH, 2006). This is made available to all staff and should be displayed in service areas to make sure that frontline staff can act quickly if they have a concern. The flowchart identifies the safeguarding professionals and children s social care contact details. The flowchart is updated as required to reflect any changes in contact details. Safeguarding children and child protection involves making difficult professional judgments. The work is increasingly demanding and can be distressing and stressful. All those involved have access to advice and support from the Designated and Named 6

Safeguarding Professionals. The Designated Nurse obtains supervision through the Cheshire and Merseyside Designated Nurse Professional Network. The Designated Nurse provides continuing support and supervision to the Named Nurses and Midwife in Wirral Community NHS Trust, Wirral University Teaching Hospital NHS Foundation and Cheshire and Wirral Partnership NHS Foundation Trust. This year a safeguarding supervision agreement has been implemented detailing the agreed arrangements for supervision sessions. Safeguarding Children Governance The responsibility for safeguarding children rests ultimately with the Chief Executive supported by the Executive Director of Nursing, Performance and Quality who is the Cluster Board Lead for Safeguarding. A process is in place to ensure that outstanding safeguarding issues and risks including those identified by serious case reviews and action plans are brought to the attention of the Board by the Board lead. Safeguarding Children in Primary Care Wirral Community NHS Trust Safeguarding Service provides support and training to independent contractors. Level 2 sessions delivered to GPs and level 1 sessions delivered to ophthalmologists have received very good feedback. The Safeguarding Service is reviewing training programmes and is planning a level 3 programme. This work is being completed in collaboration with the Designated Professionals. The training is delivered by the Named GP, the Head of the Safeguarding Service and the Named Nurses. Dental practices are now registered with Care Quality Commission and have been required to keep their own training records as evidence for registration. General practice will be required to register with Care Quality Commission in 2013 and will also be required to keep training records as part of the evidence for registration. The Named GP has received 33 safeguarding children enquiries from GP practices during 2011 (1 st January 2011 31 st December 2011). Eight GPs have attended child protection case conferences during 2011 (1 st January 2011 31 st December 2011). 7

WIRRAL LOCAL SAFEGUARDING CHILDREN BOARD Local Safeguarding Children Board s were set up as statutory bodies in April 2006 in compliance with Section 13 of The Children Act 2004. Over the last year the Local Safeguarding Children Board has further developed its scrutiny role of all agencies delivering services in the area. Constructive challenge has been used to improve our services to children. NHS Wirral is represented on the Board by the Executive Director of Nursing, Performance and Quality. The Designated Professionals are members of the Board in an advisory capacity and are members of a number of the sub groups. A GP representative from the Clinical Commissioning Group joined the Board in February 2012. Wirral University Teaching Hospital NHS Foundation Trust, Wirral Community NHS Trust and Cheshire and Wirral Partnership NHS Foundation Trust also have representatives on the Board and sub groups. Information regarding the Local Safeguarding Children Board can be accessed via the following link: http://www.wirral.gov.uk/my-services/childrens-services/localsafeguarding-childrens-board This year Wirral Local Safeguarding Children Board has commissioned Tri.x to update the procedures manual. The policy and procedure sub group review the updated procedures which are then included on the website. A useful feature of the site is an amendments page detailing all changes made since the previous update. The procedures can be accessed electronically via the following link: http://wirrallscb.proceduresonline.com/index.htm CHILD DEATH REVIEW PROCESS In line with Chapter 7 of Working Together to Safeguard Children (2010) a Child Death Overview Panel (a sub group of the Local Safeguarding Children Board) is in place. The overall principle of the process is to learn lessons, identify modifiable factors, and reduce the incidence of preventable child deaths. The panel will produce a full report for 2011 12 later in 2012. Consideration is being given to Wirral amalgamating with the Merseyside Child Death Overview Panel. This is already in place for neonatal deaths. At this time Wirral Child 8

Death Overview Panel continues to meet. The Panel is chaired by a member of the Public Health Team. A lead designated paediatrician responsible for unexpected child deaths is in place. This role is undertaken by a Consultant Paediatrician. NHS Wirral has agreed the funding for a specialist nurse to support the work of the panel. Roles and responsibilities will include supporting the work of panel following a child death. The specialist nurse will join the Wirral Community NHS Trust. SERIOUS CASE REVIEWS The purpose of a Serious Case Review is for agencies and individuals to learn lessons to improve the way in which they work both individually and collectively to safeguard and promote the welfare of children. Independent management reviews are completed by the Named Professionals for Safeguarding Children in the provider services. Action plans to improve practice are developed in response to the analysis and findings of the review. The resulting multi agency action plans are monitored by the Serious Case Review Group. Lessons from Serious Case Reviews are incorporated into safeguarding children training. In the past year the Local Safeguarding Children Board has not commissioned any Serious Case Reviews. However, following Ofsted evaluation the Executive Summary of two Serious Case Reviews for Child A, B, C and D and Child E have been published on the Local Safeguarding Children Board web pages. Both reviews resulted in health action plans. The majority of actions are now complete. Completion of the action plans are monitored by the Executive Group of the Local Safeguarding Children Board. The Designated Nurse follows up the progress of health organisations plans. The actions plans are followed up by NHS North West until fully completed. The Munro Review has commented on the Serious Case Review model. The Social Care Institute of Excellence is trialling a new approach to Serious Case Reviews. Wirral Local Safeguarding Children Board has been involved in the piloting the Social Care Institute of Excellence (SCIE) case review model. SOCIAL CARE INSTITUTE OF EXCELLENCE (SCIE) CASE REVIEW PILOT Wirral Local Safeguarding Children Board has taken part in a pilot completed by the Social Care Institute of Excellence (SCIE) to trial a new approach to Serious Case Reviews. A case that had similarities to previous cases was chosen to demonstrate the learning that had been achieved following the implementation of identified actions. The review 9

was carried out using the SCIE Learning Together model, which is based on a systems approach to analysis. This approach was recommended to the Government by Professor Eileen Munro during her review of safeguarding completed in 2011. It is considered to be a more appropriate way to learn lessons. The process is now complete and the findings have been reported to the Local Safeguarding Children Board. An extraordinary meeting reviewed the findings of the case and multi agency recommendations to improve practice have been considered. The Designated Professionals were Review team members. COMMON ASSESSMENT FRAMEWORK AND TEAM AROUND THE CHILD The Common Assessment Framework is a tool to enable early and effective assessment of children and young people who need additional services or support from more than one agency. It is a holistic consent-based needs assessment framework which records, in a single place and in a structured and consistent way, every aspect of a child s life, family and environment. Support for agencies and families involved in the Common Assessment Framework and the Team Around the Child process is provided by 11 multi-agency areas teams located across Wirral. These teams monitor the Common Assessment Frameworks and Team Around the Family initiated in their area. The variety of data collected provides agencies and practitioners with rich data, including information about areas or groups with particular needs. During 2011 a total of 814 Common Assessment Frameworks have been completed. 17% were completed by health professionals including health visitors, school nurses and Child and Adolescent Mental Health Service professionals. During the year 440 practitioners were trained to use the process. The main reasons why Common Assessment Frameworks are completed have been identified as: behavioural concerns, parenting issues, health issues and attainment at school. The data is useful for agencies to use to assess provision and can also be used in the commissioning of services. This year has seen an improvement in the quality of completion. A web page has been developed and includes model Common Assessment Frameworks to support practitioner learning. SAFEGUARDING CHILDREN ACTIVITY Wirral has a total population of 93,300 (30.3% of the population) children and young people aged 0 19 years (Chi Mat, 2012). The tables below demonstrate the safeguarding activity in Wirral. 10

Table 2: Child Protection Plans in Wirral Q1 Q2 Q3 Q4 Number of children/young people with a child protection plan 292 294 320 375 Table 3: Category of abuse for children with a child protection plan Category Q1 Number of CP Plans Q2 Numbers of CP Plans Q3 Numbers of CP Plans Q4 Numbers of CP Plans Emotional 3.8% 11 13 18 Neglect 42.6% 166 167 179 Physical 34.4% 108 131 161 Sexual 5% 9 11 18 Neglect and physical abuse are the main reasons for child protection plans, physical abuse seeing the greatest rise. All of the above results in increased demands on health visitors, school nurses, midwives, acute and primary care services as demonstrated below: Table 4: Child Protection Case Conferences Number of Child Protection Case Conferences attended by Safeguarding Professionals Wirral Community NHS Trust (1 st January 2011 31 st December 2011) Wirral University Teaching Hospital NHS Foundation Trust (1 st April 2011 31 st March 2012) 184 34 When children become subject to a child protection plan, generally there will be a health visitor (for unborn / children under 5 years) and school nurses (for children aged over 5 years) who become core group members. Core groups continue to take place until the child protection plan is discontinued. 11

SAFEGUARDING CHILDREN SUPERVISION SESSIONS Wirral Community NHS Trust Named Nurse Safeguarding Children provides safeguarding children supervision for health visitors. One Named Nurse provides safeguarding children clinical supervision for the Family Nurse Partnership Supervisor. During 2011 the Named Nurses provided supervision to between 14 and 31 practitioners each month. During the year between 63 and 145 families were discussed each month. In Wirral University Teaching Hospital NHS Foundation Trust nine supervision sessions have been provided by the Safeguarding Professionals. Table 5: Statements, Reports and copy records Number Wirral Community NHS Trust (1 st January 2011 31 st December 2011) Wirral University Teaching Hospital NHS Foundation Trust (1 st April 2011 31 st March 2012) 60 3 PLANNED IMPROVEMENTS FOR 2012 13 Moving into the 2012 13 NHS Wirral: Support the GP Clinical Commissioning Group as they develop and take on their statutory responsibilities for safeguarding children and young people to ensure the safeguarding responsibilities of the organisation remain robust and embed in the developing organisation. Focus on outcomes for children and young people building on the key achievements of 2011 12 to ensure services are outcome focussed and meet the needs of children and young people. Consider the views of children and young people in health service planning and developments to ensure they have a high quality journey when in contact with health services and in readiness for future Ofsted inspections. Support and be involved in the safeguarding aspects of the Family Nurse Partnership project. Continue to support the Local Safeguard Children Board and sub groups to achieve the strategic priorities for 2012 13. 12

Review the training requirements of all staff to enable more accurate and robust monitoring to take place. Recording processes should be able to differentiate between levels of training for different staff groups as identified in the Intercollegiate Document (2010). CONCLUSION NHS Wirral has worked in partnership with the Local Safeguarding Children Board and partner agencies, to ensure safeguards are in place and strengthened in the services commissioned and provided by health organisations for children and young people in Wirral. NHS Wirral takes its duty to ensure functions are effectively discharged with regard to safeguarding and promoting the welfare of children. This annual report demonstrates how we are striving to fulfil our duty to safeguard children and young people and identifies the planned improvements for 2012 13 to maintain and develop the safeguards already in place. 13