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Children in Need and Child Protection

Health CP Procedures

This Protocol is intended to apply to all health providers in Bath & North East Somerset. This protocol should be read alongside guidance to staff with respect to child protection and the health care needs of looked after children.

The following sections outline areas of concern about children and young people in the home and the community that would identify a child (and/or their family) as “in need” (i.e. of additional support or service provision), action that should be taken and tables of indicators of need that will apply when making as assessment under the Framework of Assessment of Children in Need and their Families.

It is important to remember when assessing level of need that child protection procedures still apply for children thought to be at risk of significant harm. These are often referred to as safeguarding procedures.

The B&NES Child Protection procedures follow this protocol.

Please remember:

  • Health professionals are often the first to become aware of the needs of children or that some carers/families are experiencing difficulties looking after their children. They should consider what help might benefit those children/carers/families.
  • Health Professionals have a responsibility to help families to stay healthy. They also have a responsibility for identifying the need for other Health Service provision if a child’s health or development is challenged, or if a child is otherwise vulnerable.
  • If a child’s needs cannot be met by Health Service provision alone, then referrals to other agencies e.g. Education/Social services/Voluntary Organisations should be made.
  • Assessment of a vulnerable child can be a challenge to practitioners. Due to the range, scope, type and nature of health service provision many health professionals will become involved in the assessment of a particular child and their family

Eligibility/triggers for considering a child as potentially in need.

  • Disabled Children;
  • Children with a developmental delay or a behaviour problem
  • Children with a mental health need or whose parents have a mental health need
  • Children exhibiting conditions and states which give rise to a general concern (e.g. neglect, inappropriate sexualised behaviour etc.)
  • Children looked after by the Council. All children in this group are children in need. Where a health professional becomes aware that a child is looked after by the Council the procedures known as the “Looked after Children procedures “apply. For these children Social Services Departments will often request help and advice for the completion of their health needs assessment.
  • Children thought to be at risk of significant harm must be referred and immediate protective action should be taken if necessary

Action

Following an initial consideration of the level of a child/family’s needs, there are three possible outcomes and further actions:

  • The health professional, in consultation with their professional adviser or line manager, considers the need can be adequately met within the NHS services that they provide. No referral to Social Services is required if the need is adequately met by this response. Clearly there would need to be consultation if the child was already allocated to a social worker.
  • If identified need(s) cannot be met solely through current provision consideration should be given to making a referral to alternative appropriate Services. The criteria for making a referral to these services and internal service procedures will need to be considered.
  • Consultation with Social Services is appropriate when the action required to meet the need is outside of the services of the NHS or the needs are unclear. Consultation with Social Services may lead to a Social Services investigation.

A referral to Social Services should always be made where a child protection/safeguarding concerns exist.

The assessment framework for children in need. (See Below)

The needs assessment framework(DOH/DFee/Home Office 2000) is a framework which guides professionals towards looking at all aspects of a child’s life and the factors which can affect their well being. When an agency decides to initiate a core assessment, professionals from their own and other agencies will be consulted about possible needs and it is helpful to consider input into the core assessment using the triangular framework. (See Diagram in Section 2.3)

Child’s developmental needs

Factors to consider in the area include:

  • Chronic health problems
  • Emotional and behavioural difficulties
  • Lack of school or nursery attendance
  • Physical disability
  • Learning difficulties
  • Failure to thrive
  • Inappropriate feeding
  • Neglect of health/care needs
  • Failure to attend appointments offered as part of routine health surveillance
  • Witnessing domestic violence

Parenting Capacity

Factors to consider in the area include:

  • Lack of registration with a GP
  • Potentially harmful parental lifestyles e.g. Drugs/alcohol misuse/ mobility
  • Parents with mental or physical illness
  • Parents with a learning disability
  • Bonding and attachment problems
  • Inadequate supervision or left home alone
  • Poor parenting skills
  • Resistance to support
  • Previous child protection concerns

Family and environmental factors

Factors to consider include:

  • Temporary accommodation or poor housing conditions
  • Poverty and deprivation
  • Language or communication difficulties
  • Parent in prison
  • Family are asylum seekers or belong to ethnic community which may be isolated
  • Domestic violence
  • Frequent child bearing

Locality children’s health services – how to refer for information, advice or medical assessment

  • When primary care health professionals identify that a child may be in need, and secondary health care provision may be able to meet that need, a referral to the locality children’s health services should be made through the single point of entry process. (SPE)
  • If either primary or secondary health care professionals identify the need to consult with or refer to social services they should do so. If the needs appear to be for child protection/safeguarding concerns a referral should always be made, within the framework of standard information sharing protocols.
  • When a referral through the single point of entry (SPE) process is received by the health intake team, the team will consider whether the child appears to be in need, and whether the need is such that referral to social services may be required. If the SPE referral is passed straight to a particular health professional, that professional should consider whether the child is in need.

Initial assessments and Core Assessments

  • Following referral to Social Services an initial or core assessment may be undertaken by all the professionals involved with the family. The statutory timescales for these assessments are short and it is therefore important that health professionals respond to any requests for information in a timely fashion.
  • If an initial assessment is undertaken, the health visitor,/school nurse and GP will generally be asked for information by social services. The single point of entry clerk should be phoned (tel: 01225 731500) to see if there is health involvement, in which case the involved health professional(s) can be asked directly for input to the assessment.
  • If a core assessment is started a single point of entry (SPE) referral should always be made by the social worker requesting input to the assessment. If the social worker believes specific health assessments or interventions may be required, the SPE referral should specify this. If the core assessment includes child protection enquiries (under section 47 of the children act) this will require a more rapid response, and this request for information should be made initially by telephone.
  • A referral for input to the core assessment will be considered by the multidisciplinary health team. If health professionals are already involved with the child they will provide input to the core assessment. Otherwise the intake team will consider whether involvement may be appropriate, in which case full input will be provided to the assessment, or whether simply to provide background information – any previous referrals, what is known about the child’s immunisations, developmental assessments etc..

Looked after children

  • If a child starts to be looked after this should be indicated on the single point of entry referral form by the social worker and the form should be faxed or emailed to ensure a rapid response. A health assessment will be arranged.

These procedures set out how health service professionals should work together with other agencies to promote the welfare of children and to protect them from abuse and neglect.

All health professionals, in the NHS, private sector, and other agencies play an essential part in ensuring that children and families receive the care, support and services they need in order to
promote children’s health and development. Due to the universal nature of health provision, health professionals are often the first to be aware that families are experiencing difficulties in looking after their children.

The involvement of health professionals is important at all stages of work with children and their families.

Health Service staff include:

  • Community staff including, health visitors, midwives, doctors, professions allied to medicine
  • Hospital medical, nursing, midwifery staff, radiographers
  • Paediatricians
  • General practitioners and any attached practice nurses and ancillary staff
  • Dentist and dental nurses and hygienists
  • All mental health medical and nursing staff
  • Pharmacists
  • Family planning staff
  • CAHMS
  • PALS
  • Allied health professionals, therapists, counsellors administrative staff
  • Walk in centre, minor injury units, staff involved in provision of services to the homeless and drug treatment services.
  • All staff involved in out of hours provision

A number of statutory provisions, duties and guidance apply with regard to safeguarding and protecting children from harm. This policy and these procedures have been developed in accordance with, and with regard to, this legislation and guidance, the most important of which are:

1.1 Legislation

  • Section 17 of the Children Act 1989. This places a duty on local health authorities to safeguard and promote the welfare of children within their area who are in need and to provide a range of services appropriate to those children’s needs.
  • Section 27 of the Children Act 1989. This specifies that a local authority may request help from health professionals when the local authority is providing support and services for children in need. Health professionals whose help is requested in these circumstances have a duty to comply with the request provided it is compatible with their other duties and functions.
  • Section 47 of the Children Act 1989. This places a duty on health professionals to help a local authority with its enquires in cases where there is reasonable cause to suspect that a child is suffering or likely to suffer significant harm.

1.2 Guidance

  • Working together to Safeguard Children. This is a guide to inter-agency working to safeguard and promote the welfare of children. (Dept of Health/DfEE/Home Office 1999)
  • Framework for the Assessment of Children in Need and their Families. This is a standardised comprehensive assessment tool, and a systematic way of analysing, understanding and recording what is happening to children and young people and the wider community. (Dept of Health/DfEE/Home Office 2000)
  • What to do if you’re worried a Child is Being Abused. This is practice guidance to assist practitioners to work together to promote children’s welfare and safeguard them from harm. (Dept of Health publications 2003)

In addition, regard has been taken of the recommendations made in the Laming Report and the Bichard Inquiry, where they relate to health and multi-agency working.

2.1 Health professionals are involved in:

  • Contributing to enquiries about a child or family
  • Assessing the needs of children and the capacity of parents to meet their children’s needs
  • Assessment of a child’s health and development
  • Assessment of parenting capacity
  • Assessment of risks posed by adult patients, including those receiving treatment for substance misuse, those with mental health and/or learning difficulties
  • Seeing children at A&E departments
  • Planning and providing support to vulnerable children and their families
  • Participation in strategy meetings
  • Participating in child protection conferences and core groups
    Providing support for children at risk of significant harm
  • Providing therapeutic help to abused children and parents under stress
  • Contributing to case reviews

2.2 All health services staff must be:

  • Alert to the possibility of child protection concerns
  • Able to recognise and know how to act upon indicators that a child’s welfare or safety may be at risk
  • Able to take responsibility for child protection issues affecting their every day work.
  • Familiar with the local Child protection procedures and any additional local procedures
  • Aware of the need to consult with senior colleagues and the child protection named professionals
  • Capable of making prompt referrals to social services departments
  • Prepared to have an enhanced police check on appointment and at regular intervals as required by their employers.

2.3 Training in child protection

All staff in health services should have basic information about the importance of child protection in their induction training.

Staff who regularly comes into contact with either families or children during the course of their work should attend basic multi-agency training on appointment and update child protection training on a 3 yearly basis.

2.4 Because of the universal nature of health provision, health professionals are often the first to be aware that families are experiencing difficulties in looking after their children.

Good practice calls for:

  • Effective co-operation between different agencies and professionals
  • Sensitive work with parents and carers in the best interests of the child
  • Careful exercise of professional judgement,
  • Thorough assessment
  • Critical analysis of all available information.

Effective information sharing is crucial in the protection of children from significant harm.

2.5 Primary care trusts

Primary care trusts (PCTs) are responsible for improving the health of the local population, developing primary and community health services and commissioning hospital and community health services.

The PCT is accountable for its own child protection structures and processes as well as for those in agencies from whom it commissions services:

These responsibilities include:

  • Providing the strategic lead in inter-agency planning within the PCT area
  • Ensuring that health services and health care workers contribute to inter-agency working
  • Co-ordinating the health component of serious case reviews
  • Including clear standards in commissioning statements
  • Appointing designated professionals
  • Identifying a named public health professionals for children in need and those in need of protection who is responsible for the management of the designated functions.

Working together requires each PCT to appoint a Designated doctor and nurse (usually a consultant paediatrician and senior nurse)

2.6 Designated professionals

Designated Doctors and Nurses take a professional lead on all aspects of the health service contribution to safeguarding children. Designated professionals are a vital source of professional advice on child protection matters to other professionals and to social services departments. They will play an important role in promoting and influencing relevant training, skilled professional involvement in child protection processes in line with LSCB protocols and participation in case reviews.

In some PCT’s one person will hold both the named (see para 2.8), and designated roles.

2.7 NHS Trusts

NHS Trusts are responsible for the provision of acute and community health services with a wide range of staff coming intact with children and families in the course of their duties. Staff must be trained to be alert to the potential indicators of abuse and neglect in children and know how to act upon those concerns in line with local LSCB procedures.

2.8 Named Medical and Nursing staff

Every NHS Trust (hospital, community and PCT) should have a named doctor and nurse who take a professional lead on child protection. These professionals are a source of advice, support, supervision and expertise for fellow professionals, and can be contacted to discuss any presentation of concern.

The fundamental principle which underpins all health professional practice is that the welfare of the child is paramount.

Health professionals who have concerns about the well being or safety of a child or children should discuss their concerns without delay with the named nurse or doctor and where appropriate the senior professional within the department to clarify the nature of their concerns, how and why they have arisen, and what is their assessment of the needs of the child and family.

Health professionals who have concerns about the well being or safety of a child or children should discuss their concerns without delay with the named nurse or doctor and where appropriate the senior professional within the department to clarify the nature of their concerns, how and why they have arisen, and what is their assessment of the needs of the child and family.

3.1 Staff must liaise with other health professionals who have a working knowledge of the child and family, particularly Primary Health Care Team members.

3.2 Staff must contact the Child Protection Register (CPR -See Appx A) to:

  • Establish whether a child’s name is on the CPR
  • Obtain any information about child’s siblings held by CPR

3.3 Staff must consider issues of consent to referral.

Where possible seek the agreement of the family when making a referral to social services. Seeking the families agreement should only be done where such discussion and agreement will not place the child at increased risk of significant harm. If a family does not agree to a referral to Social Services this should not prevent the referral being made when there are child protection concerns.

3.4 Staff must document clearly in the health records

  • Any concerns about a child’s welfare and actions taken.
  • All discussions about a child’s welfare including details of telephone conversations

3.5 Referrals to the local authority social services department.

Health professionals who telephone the referral should confirm referrals in writing within 48 hours. Following the referral actions should be documented, including by whom the action is to be taken and the time scale.

3.7 If a child discloses abuse they should be told of the need to share the information with other agencies. The health professionals should endeavour to ask open questions and obtain only enough information to satisfy the requirements of making the referral.

4.1 Community health practitioners

A wide range of community based professionals come into contact with children, parents and carers and should follow the general protocol above.
In addition each professional has an individual responsibility to ensure that they:

  • Are alert to the possibility of child abuse or neglect and are familiar with the way in which children suffering from, or at risk from physical abuse, emotional harm, neglect and sexual abuse present within their speciality.
  • Are aware of local procedures and have consistent access to this guidance.
  • Know the names and contact details of the PCT named child protection professionals

Named nurse contact number: 01225 731595
Named Doctor contact number: 01225 731500

If a community practitioner suspects that a child may have suffered from harm, or is at the risk of harm, the concerns should be discussed with the named nurse or doctor or an appropriate senior professional within their department who has had this responsibility identified in their role. Having considered the risk to the child, a referral should be made to Social services either by telephone or using the referral form according to the level of urgency. Any telephone referrals should be followed up in writing within 48 hours. A copy of the written referral should be sent to the child protection named professionals.

The child’s GP and relevant members of the primary health care team must be informed.

If the child is seen at a location which is the responsibility of another agency, the referrer must ensure that the person in charge is informed of any concerns

The health professional must contribute to whatever actions are needed to safeguard the child and promote his or her welfare, assisting in the completion of the initial and core assessments and membership of a core group if required. The outcome for the child must be regularly reviewed against the child protection plan and inform the named professionals should be informed of any issues in the implementation of the plan.

4.2 General Practitioners (GPs) have a duty to:

  • Be alert to the potential indicators of abuse neglect or emotional harm.
  • Be aware of the concept of significant harm
  • Be alert to the risks which individual abusers or potential abusers pose to children and young people
  • Be particulalry alert where:
    • Domestic violence is disclosed
    • A child has a disability
    • A parent has a mental illness
    • There is drug or alcohol misuse in the family

General Practitioners should:

  • Have the ability and training to recognise when a child is potentially in need or at risk of significant harm and what procedures to follow
  • Develop and maintain clinical expertise in the identification and appropriate response to child protection issues.
  • Be aware of how to access advice and support
  • Share and analyse information with other health professionals involved with the child and family in order that an informed assessment can be made of the child’s health and circumstance
  • Contribute to whatever actions are needed to safeguard the child and promote his or her welfare, including referral to Social services or the police where there are concerns.
  • Ensure that staff employed in the Primary Health Care team are aware of the potential risks to children and are familiar with how to deal with them
  • Ensure their practice has child protection protocols and systems which are in line with the LSCB procedures
  • Perform police checks on staff coming into post who will have contact with children

4.3 Action to be taken by GPs.

If a GP believes a child may be suffering or at risk of suffering significant harm then he/she should always refer his/her concerns to the Social Services department.

Where there are suspicions that the child may have suffered physical abuse or sexual abuse and where an examination may be indicated then the child should be referred for examination to a consultant paediatrician.

Referrals should be made to:

In office hours: Child Health Department : Tel 01225 731500

Out of hours: bleep paediatric registrar at RUH: Tel 01225 428331

If there are no apparent injuries or immediate risk to the child, but there is concern about harm then concerns should be discussed with other primary health care team colleagues who may know the child and the family. Advice from the named child protection professionals, duty social worker or police child protection team may also be sought.

GPs should do their best to attend Child protection conferences particularly if they initiated the referral. If unable to attend a written report should be submitted preferably using the Social Services Department proforma (the CP5)

Contact numbers for referrals to Social services for primary care and community staff

Bath and North East Somerset

Referral and assessment team Tel 01225 396313/4 (Office hours)

Emergency Duty Team (EDT) Tel 01454 615165 (Out of hours)

Enquiries to the register Tel 01225 396111 (Office hours) Out of hours contact EDT

Mendip

Intake team Tel 01373 461162

Emergency Duty Team Tel 01458 253241

Enquiries to the register Tel 01823 355221

4.4 Accident and Emergency Services, out of hours provision and walk in centres

Injured children/young people attend at a variety of settings including:

  • Accident and Emergency departments
  • Minor injuries units
  • Walk in centres
  • Out of hours primary care service

Clinicians and practitioners responding to children in these settings have a vital role in recognising and referring child protection concerns.

When an injured child attends for accident and emergency services the medical and nursing staff should always consider the possibility of child protection concerns.

Particular indicators in these settings include:

  • The demeanour of the child
  • The nature and location of the injury
  • Injury inconsistent with age and developmental level of the child
  • Inconsistent/changing explanations for the injury
  • Delay in seeking help
  • Presentation at an unusual time of day/night
  • Frequent attendances
  • Previous child protection concerns about this child or siblings
  • Unusual behaviour of the parents

If there are child protection concerns practitioners should:

In the walk in centre, minor injury unit, or out of hours service, refer to Accident and emergency department or Primary Health Care Team- depending upon the nature and urgency of the concerns.

  • In A&E refer to the Paediatric Registrar on call.
  • Make an inquiry of the child protection register
  • Make a referral to Social Services via the referral and assessment team duty Social worker, or out of hours via Emergency Duty Team.
  • Ensure that accurate, comprehensive, and contemporaneous records are kept of the history, physical examination, investigations and management plan.
  • Inform the GP and Health Visitor/School nurse within 24 hours.

4.4 Hospital Nursing staff

All nursing staff who care for children must be familiar with the features shown by children suffering from or at risk of suffering from physical harm, sexual harm, emotional harm or neglect.
Child protection concerns can be identified by nursing staff either on admission, in outpatient settings or during an inpatient stay. Nurses should be alert to the possibility of child protection concerns when caring for all children and their families.

If the nurse suspects that a child may have suffered from or at risk of suffering from harm she should carry out the following:

  • Discuss with manager or senior colleague responsible for child protection. Inform the named nurse for child protection at the earliest opportunity
  • Discuss the issues with the Doctor responsible for the clinical care of the child, and discuss with them the need to refer to the Consultant Paediatrician on call
  • Check the previous A&E attendance and hospital records for previous admissions (except where to do so would delay referral)
  • Check to see if child’s name or siblings name(s) are on the Child Protection register
    In the interests of working in partnership with parents, the parents should be made aware of professional concerns except where to do so would increase the risks to the child or interfere with police action.

Nurses must keep full, contemporaneous and comprehensive documentation, paying particular attention to presenting history and interactions within the family. Explanations for any injuries or presentations of the child should be recorded verbatim. The identity of the person who brought the child in, visiting patterns, parenting skills, liaison telephone conversations should all be documented.

It is particularly important in child protection work to record clearly conversations with other professionals (including areas of disagreement) and any agreed actions and timescales.

It is usual for the Doctor responsible for the care or a Consultant Paediatrician to make the referral to Social Services and/or the Police. However it is reasonable for a nurse exercising her independent responsibility and using her professional accountability and judgement to inform Social Services of her concerns that the child may have suffered or is likely to suffer significant harm, even if there is no clear agreement with other senior health professionals.

4.6 Hospital Medical Staff

All medical staff who care for children should be familiar with the features shown by children who present with, or are at risk from physical harm, neglect, emotional harm, sexual abuse.

If a doctor suspects that a child may have suffered from or be at risk of harm he/she should:

  • Report the concerns to the doctor responsible for the clinical care of the child, discuss with them the need to involve the consultant paediatrician on call
  • Check the child’s previous accident and emergency department attendance and check hospital records for previous admissions or outpatient attendance
  • Check to see if child’s name is on the child protection register (see para 4.3)

If the concern persists that the child has suffered or is at risk of significant harm, the case should be referred to the consultant paediatrician on call. A child protection examination may then be undertaken in order to:

  • Establish relevant history and physical findings
  • Arrange treatment where necessary
  • Carefully document findings and where indicated include photographic or video evidence
  • Aid liaison with the Police and or Social services

Consent for examination should be obtained in writing, either from the person with parental responsibility and/or from the child if he/she is of an age where he/she can understand the situation and give informed consent. If consent is withheld the situation must be discussed urgently with Social services and consideration given to taking out an order under the Children Act 1989 to allow the examination to continue.

Where admission is indicated the doctor should brief the medical staff taking responsibility for the child.

It is usual for the doctor in charge of the case to make the referral to Social Services and/or the Police. However it could be any doctor or nurse, exercising independent responsibility, who will inform Social Services of their suspicions.

4.7 Removal of a child from hospital

If a legal order is in force and the parents try to remove the child then the nurse/doctor/other health professional in charge must inform the Police to prevent the removal. They must also inform:

  • Social Services
  • The consultant in charge of the case
  • The senior paediatric nurse on duty
  • The named professionals for Child Protection

Where there is no legal order and the parents try to remove a child where there are child protection concerns, the health professional will inform:

the consultant paediatrician who will discuss the case with:

  • Social Services referral and assessment team or the Emergency duty team
  • The child protection named professionals
  • The police – if necessary to prevent the removal.

4.8 Discharge from hospital

Where there have been issues of significant harm, hospital discharge will need to be agreed by the Consultant Paediatrician who has had responsibility for the Child Protection aspects of the child’s care.

Prior to discharge the nurse/doctor will:

  • Inform Social services (case co-ordinator) of the discharge and check that the discharge is in accord with any court directions.
  • Ensure that the child is registered with a General Practitioner. If they are not registered they cannot be discharged until this has been accomplished.
  • Inform the General Practitioner and the Health Visitor or school nurse within 24 hours
  • Inform the named nurse for child protection

4.9 Midwives

All midwifery staff should be familiar with the features shown by children suffering from or at risk of emotional harm, neglect, physical harm and sexual abuse.

The unborn baby

If the midwife suspects that an unborn baby may be at risk of harm they should:

  • Report the concerns to the team leader/senior midwife and where appropriate the named nurse for child protection and agree on the management of the case
  • Liaise with General Practitioner and Health Visitor.
  • Where appropriate make a telephone referral to Social services followed up in writing within 48 hours

It is good practice to share concerns with the pregnant woman unless this may place the unborn child and other children in the family at greater risk.

Midwives also have a key role in child protection plans following the birth. Where a child has been placed on the child protection register before birth or where there is a plan of protection following birth the midwife must promptly inform the case co-ordinator of the delivery.

If there is reason to suspect that a child about whom there are concerns will be removed from the post natal ward/department against medical advice the midwife must contact Social services and the Consultant obstetrician and inform the appropriate manager. The case coordinator should be informed promptly of the planned discharge of all babies about whom there have been concerns, or who are on the child protection register.

In the event of disagreement with colleagues in other professions a Midwife has a duty to act independently in the best interests of the child. This may include making a child protection referral to Social Services without the agreement of other colleagues.

4.10 Dental Practitioners

General Dental Practitioners may see children who have been abused or neglected. Signs might include:

  • Facial bruising or injuries in and around the mouth, including broken front teeth.
  • Neglect of dental hygiene resulting in unmanaged dental caries, dental pain or gum infections
  • Inadequate and inappropriate nutrition resulting in calcium deficiency, dental caries etc.

Where there is uncertainty about symptoms or signs this may need to be discussed with colleagues experienced in working in child protection cases. This will usually be the PCT named Doctor or Nurse.

General dental practitioners should ensure that all their staff receive appropriate training in the recognition of Child Abuse and in the operation of the Child Protection procedures.

Staff dealing with children should be subject to appropriate police checks on appointment and throughout their employment.

5.1 Personal information about children and families which is held by health professionals is subject to a legal duty of confidence and should not normally be disclosed without the consent of the subject. However, the law permits the disclosure of confidential information necessary to safeguard a child or children in the public interest. i.e. the public interest in child protection may override the public interest in maintaining confidentiality.

(For detailed legal advice on confidentiality see Chapter 1 of this Handbook.)

5.2 Guidance from the GMC and UKCC on confidentiality is clear that information may and should be released to third parties, if necessary without consent, to assist in the prevention and detection of child abuse. This relates to information about:

  • Adults who may pose a risk to a child
  • Children who may be the subject of abuse.

Information may also be shared where not to do so would put staff at risk.

It is of great importance that all Health Professionals keep meticulous records in cases where there are safeguarding or children in need concerns. It is a requirement for professional to maintain a separate record from the Parent held child records (PCHR). This record should include a significant events profile. Records should be objective, factual and clear. They should be timed and dated, state who was present , where the contact took place what was observed, what was said and by whom and any agreed actions should be clearly recorded. All records should be made in black ink.

Following referral Social Services may need to take immediate action to ensure the safety of a child. If immediate action is not necessary then a decision on the next course of action will be taken within one working day. A strategy meeting may be convened. This is a meeting usually between Social Services, Police and Health to consider and analyse the information received and to plan the subsequent course of action.

8.1 If a case conference is arranged practitioners need to be aware of the need to provide reports in a timely way. Case conferences have to be arranged within 15 days of a strategy meeting, therefore advance notice of the conference may be limited.

8.2 A written report must be compiled and provided in advance to the child protection conference. This is made available to other conference members, including young people and other family members who attend the conference. This report must be provided whether or not a health professional is able to attend.

8.3 Information presented to the conference both verbally and in writing should include:

  • Details of the professional’s involvement with the family
  • Information about the child’s/children’s health and development
  • Information about the parent’s capacity to safeguard their children and promote their health and development
  • Any diagrams (for example centile charts or body maps detailing injuries.
  • Analysis of the information and the professional’s opinion on what needs to change to reduce the risks to the child/ren
  • Conclusions and recommendations. Remember that written and verbal information must distinguish between fact, observation, allegation and opinion.

8.4 Health professionals should make attendance at Child Protection Conferences a priority if they have a significant contribution to make.

8.5 Information contained within the report should be shared with the family before the conference. If necessary the report should also be discussed with a senior colleague.

8.6 It is important that all who attend conferences should be adequately prepared and supported. Clinicians invited to case conferences should discuss the conference and consider issues of significant harm and the child protection plan with the Named Nurse or Doctor or their identified child protection senior colleague.

8.7 As a child protection conference participant health professionals are expected to analyse other agencies information presented to the conference and contribute to a decision regarding child protection registration.

9.1 Health Professionals are frequently identified as members of the core group. The core group will develop and implement the child protection plan, ensuring that every registered child within a family receives individual consideration.

9.2 The child protection plan, together with more detailed plans determined by the core group, should set out what work needs to be done, why, when and by whom. Health professionals as members of the core group have equal responsibility for, and ownership of, the child protection plan and should co-operate to achieve its aims.

As a result of attendance at strategy discussions and Child Protection Conferences, health professionals will acquire copies of child protection records.

These records/notes must be securely stored and kept separate from any medical records held on the same child. The medical records/ notes must state that child protection records exist.

Should a young person whose name is on the child protection register move then the trust protocol for the transfer of health records should be followed.

When a young person’s name is removed from the child protection register, the trust protocol for the retention and destruction of records should be followed.

Allegations that an employee of a professional agency has abused a child will be investigated in accordance with the Child Protection Procedures.

The primary consideration will always be the welfare of the child and the child’s needs will take precedence over those of civil, criminal or disciplinary processes.

All cases of alleged or suspected abuse must be considered where allegations involve physical abuse, sexual abuse neglect or emotional harm.

This applies even where the nature of the alleged assault or ill treatment would not meet the normal threshold applied to children in their own homes. For example a report of a child being smacked by a parent/carer with no injury caused or no other indicators would be unlikely to require any response by police or social workers. However, a similar report of a child being smacked by a health care professional should be responded to because of:

  • The higher standards of conduct demanded by law and regulation of those caring for other people’s children
  • The position of trust enjoyed by such people.

Where a member of staff is made aware of an allegation of abuse against another member of staff the line manager of the “accused” person must be informed immediately. Any decision to inform the alleged abuser of the allegations should only be made in consultation with the police. The line manager is responsible for:

  • Ensuring the safety of the child
  • Recording the allegation and any action taken
  • Seeking advice from The Named Doctor or Nurse and Human resources department
  • Referring the allegation to Social Services

Any investigation will have three related strands:

  • Child protection inquiries relating to the safety and welfare of any children who are or may have been involved
  • A police investigation into a possible offence
  • Disciplinary procedures where it appears that the allegations may amount to misconduct or gross misconduct on the part of the member of staff

It is essential that the common facts of the alleged abuse are applied to each of the three strands of the possible enquiries or investigation.

It is essential to hold a strategy meeting in these cases. Those invited to the meeting should include:

  • The statutory agencies responsible for carrying out the investigation police and Social services
  • The manager of the member of staff against whom the allegations have been made.
  • Advisory staff such as Human Resources

The general guidance on strategy discussions should be followed in addition particular attention needs to be given to the following issues:

  • Whether the criteria are met for a criminal and /or child protection investigation. If the criteria are not met then the meeting will refer the matter back to the responsible manager to consider any remaining personnel issues
  • How the three strands of the investigation should be co-ordinated. Normally any Child Protection enquiries will precede disciplinary interviews.
  • How information can be shared between the three strands. It is good practice to advise those interviewed during the course of the investigation, that information may be shared between the three strands
  • Whether there are any risks to the children of the member of staff against whom the allegation has been made
  • The timescale for enquiries. It is in everybody’s interests to ensure that enquiries are completed as quickly as possible, consistent with a thorough assessment.
  • When to inform the suspect of allegations which are the subject of criminal proceedings
  • What information will be shared with the child’s parents/carers and when such information will be shared

Staff who are subject to allegations should be treated fairly and honestly and should be provided with support throughout the investigation process. Staff should be helped to understand the concerns expressed and the processes being operated. They should also be informed of the outcome of section 47 enquiries and the implications for disciplinary or related processes

Those undertaking the investigation should be alert to any sign or pattern which suggests that the abuse is more widespread or organised than it appears or that it involves other members of staff. It is important to consider occasions where boundaries have been blurred, inappropriate behaviour has taken place and matters such as fraud, deception or pornography have been involved.

It is important to reach a clear conclusion to the investigation. Among the issues to be considered are:

  • Will any criminal charges result and how will the timing of these influence any other action?
  • Is disciplinary action required? If so, the disciplinary policy of the employing organisation should be followed
  • Is there a need to refer to the relevant professional body