CHILD PROTECTION ANNUAL REPORT

APRIL 2007 – MARCH 2008

Prepared by Carol Sawkins.

Named Nurse Child Protection on behalf of the Trust Safeguarding Children Steering Group.

Carol Sawkins14th July 2008

Safeguarding Children Annual Report- Executive Summary.

2007/2008

Executive Lead:

Lindsey Scott

Chief Nurse and Director of Governance

Board Lead for Children and Young People / Safeguarding Children

Author:

Carol Sawkins

Named Nurse Child protection, on behalf of the Trust Safeguarding Children Steering Group.

Purpose of Report:

This report provided the Board with an overview of the Trust’sposition regarding Safeguarding Children in 2007/08. It provides information on structure, achievements and progress against planned objectives and core standard requirements in 2007/08. It includes proposals for future developments, action plans for 2008/09 will be detailed in the assurance framework.

Executive Summary:

The Trust has declared compliance for 2007/08 with the requirements for child protection as specified for the Healthcare Commission Core Standard 2, as part of the Annual Health Check. The Trust Safeguarding Children Steering Group has, on behalf of the Trust Board, ensured that safeguarding policy and practice has been monitored and reviewed quarterly, through the assurance framework to maintain compliance.

The Trust has also declared compliance with the Strategic Health Authority Review of the National Service Framework for Children and Young People (2004) Standard 5, relating to safeguarding and promoting the welfare of children.

The focus of the Named Professionals in this reporting period has remained on the development and delivery of Mandatory Child Protection training across the Trust, resulting in some improvement in compliance. However it is acknowledged that there is room for further improvement; training will therefore remain a key area for improvement in the next reporting period.

Policies, procedures and guidelines continue to be developed and reviewed as required. For example this year saw the development of a policy for Children who Do Not Attend outpatient clinic appointments, following the death of a child related to neglect (Serious Case Review.)

The Trust has also actively supported the Bristol South Multi Agency Risk Assessment Conferences for high risk victims of Domestic violence.

Statutory Duty:

The Trust has a statutory Duty to Safeguard Children and key responsibilities as stated in Section 11 of the Children Act 2004, underpinned by the Children Act 1989 and Working Together to Safeguard Children 2006.

CONTENTS

  1. Introduction…………………………………………..……………………..Page 4
  1. Current Management Arrangements for Safeguarding Children…………………………………………………………...…………Page 4
  1. Trust Key Activity and Achievements 2007-2008……………..…….Page 4 – 9

3.1 Trust wide

3.2 Named Professionals Activity

3.3Mandatory Child Protection Training

3.4Women’s Services

3.5Emergency Service

3.6School Health Nursing Service

3.7Consultant Community Paediatricians

3.8 Hospital Social Work Team.

  1. Trust Governance and Risk Management……………………..………Page 9
  1. Action Plan for 008/09 …………………………………………….……..Page 10
  1. Conclusion …………………………………………………………………Page 11
  1. Recommendation………………………………………………………….Page 11

3.References ………………………………………………………..……….Page 11

  1. Introduction:

This annual report relates to the period 1st April 2007 to 31st March 2008. It will address the following areas:

-Current management arrangements for Safeguarding Children.

-Key activities and achievements 2007-08

-Governance and Risk Management

-Challenges and Action Plan for 2008-09

  1. Current management arrangements for Safeguarding Children across the Trust.

The Trust has a clearly defined statutory responsibility to Safeguard Children (Children Act 2004), and well established pathways of accountability remain in place. The Trust Board continues to hold ultimate accountability for ensuring safeguarding responsibilities are met, supported by the Safeguarding Children Steering Group. The group is chaired by the Chief Nurse and Director of Governance, as Executive Lead for Children and Young People and Child Protection. Membership of the group maintains strong links to Safeguarding Vulnerable Adults, Domestic Abuse and Children and Young Peoples Service. The group reports to the Clinical Risk Assurance Committee and meets quarterly.

The Trust continues to have a well established team of Named Professionals in post, consisting of the Named Doctor (Dr M. Bredow) since May 2005, Named Nurse (C. Sawkins) since December 2004 and Named Midwife (S. Windfeld) since 2002. The team support the Trust in implementing national and local guidance, providing training, supervision and monitoring of staff and processes, and advising the Trust Board.The Named Professionals continue to be supported by the School Health Nurse Child Protection Lead (K. Penney). It is hoped in the next reporting period this role will be expanded to include a Child Protection Supervisor.

The Named Professionals continue to work collaboratively with the Named and Designated Child Protection Professionals across the Bristol, North Somerset andSouth Gloucester, through the Child Protection Health Advisory Group which meets quarterly. The Trustcontinues to support the work of the Bristol Safeguarding Children Board,Lindsey Scott (Trust Board Lead for Children) remains a member of the main board and the Named Professionals continue to be on the Quality and Training Sub Groups. The Named Midwife, who is also the Trust Domestic Violence Lead, continues to play an active part within the Bristol Domestic Violence Strategy

  1. Key Activities and Achievements.

3.8Trust wide:

The following changes have taken place in response to implementation of the Steering Group Action Plan 2007 -08, to incorporate changes in legislation, guidance and best practice guidance. The move of all paediatric Services from SouthmeadHospital in April 2007 has contributed to an increase in child protection activity and referrals.

-Preparation towards the introduction of the Child Death Review process due to commence on 1.4.08, this includes the appointment of a Designated Doctor for Child Deaths (Dr James Fraser) training appropriate staff and the development of the Rapid Response team.

-The Multi –Agency Risk Assessment Conferences to discuss high risk victims of Domestic Violence and their children, has been fully established in Bristol for the last 18 months. The Trust is represented alternately by the Named Nurse and the Named Midwife. Approximately 25 victims are discussed per month, representing the 10% most high risk Domestic Violence incidents that month in South Bristol. A full evaluation of the process is due in the next reporting period.

-To maintain the Trusts commitment to the process a business proposal is due to be submitted to support the appointment of a nurse, solely to facilitate the process and to address some of the outstanding actions. A designated nurse has been successfully appointed in the Bristol Primary Care Trust; this has had many positive outcomes including an increased number of referrals from health professionals into the process.

3.8Named Professional Activity/ Trust Safeguarding Children Steering Group:

-The Trust policies for Safeguarding Children, Vulnerable Adults and Domestic Abuse have been ratified as one over-arching policy to incorporate all vulnerable patients and their carers. All child protection policies and guidelines are now available on the Trust intranet.

-The Trust policy for Children Who Did Not Attend Outpatient appointments, a Serious Case Review recommendation, has been ratified for use within the Women’s and Children’s Directorate. Followingan audit it is planned to introduce the policy Trust wide within the next reporting period.

-Formalisation of the process to inform the Local Authority when a child has been in hospital for more than 12 weeks, as specified by Section 85 of the Children Act 1989.

-The Clinical Assurance Framework continues to formalise Safeguarding Children activity across the Trust including audits and clinical risk activities.

-The Named Professionals have contributed to a number of Serious Case Reviews both locally and regionally. University Hospitals Bristol accepts serious injuries from the South West regionand Wales and has therefore been involved in a much higher number of Serious Case Reviews than average. (5 Serious Case Reviews undertaken this year, national average per Local Safeguarding Children Board is 1 – 2 per year) resulting action plans are incorporated into the Assurance framework and reviewed regularly by the Safeguarding Children Steering Group. Outstanding recommendations, such as the appointment of an Epilepsy Specialist Nurse remain on the agenda.

-It is proposed during the next reporting period that an ‘Operational Management Group’ will be introduced within the Women’s and Children’s Directorate. Membership of the group will be senior medical and nursing representatives with the authority to influence change in the culture of child protection within the division. The remit of the Group would be to ensure that the Safeguarding Children agenda is fully incorporated into all policies, procedures, as well as monitoring child protection activity and implementing best practice guidance.

3.8Mandatory Child Protection Training:

The promotion and delivery of child protection training, has beena priorityarea for the Child Protection team, with the support of the Paediatric Clinical Skills Trainer(Susie Gilbert). Last year’s Annual Report highlighted the need to improve compliance with Mandatory Child Protection training detailed in the Training Matrix (Available via the intranet))

Within this reporting period the following training has been delivered:

  • Level 1 training, is presently incorporated into the Vulnerable Group training as part of the Induction programme for all new starters
  • Level 2 : 27 update road showsdelivered ( attended by 365 staff)
  • Level 3: 8 delivered (whole day, what to do if you are worried about a child) (attended by 318 staff)
  • level 4 : 5delivered ( whole study day, Case Conferences and producing legal statements) (attended by 61 staff)
  • Domestic Violence study day x 4 delivered (attended by 64 staff) this incorporates a safeguarding children element.

This focus and increased training delivery has resulted in consistently positive course evaluations and an improvement in the Trust Compliance with level 2 and 3 training, Level 4 training will need to be addressed in the next reporting period.

  • Level 2 – 58% compared to 43% in the previous year.
  • Level 3 - 58% compared to 38% in the previous year
  • Level 4 – 32% compared to 34% in the previous year.

The Trust also piloted an on line child protection training package and whilst it is acknowledged this is not as effective as face to face training, it is a valuable tool for staff that may have difficulty accessing other training. It is proposed that in the next reporting period that the Trust will access the Strategic Health Authority on–line learning package for child protection developed by the NSPCC.

The Trust’s continued contributions to the Bristol Safeguarding Children Board allows for a number of places being made available to staff at a range of Multi-Agency Training. Although there has been an improvement in the uptake of places,attendance remains relatively low, only 27% ofplaces available to health were utilisedby Trust staff, with a relatively high staff Did Not Attend rate.

Child Protection training across the Trust will remain a high priority for the next reporting period, however due to increasing capacity issues for the Child Protection Named Professionals such asattendance at the Multi –Agency Risk Assessment Conferences and the increasing number of Serious Case Reviews; it is unlikely that the amount of training delivered in the next reporting period will increase any further.

Specific areas remain to be targeted, such as the poor uptake for Level 4 training and the Did Not Attend rate for all Child Protection Training. All the Child Protection Training delivered within the Trust is due to be reviewed and updated, in the next reporting period.

The introduction of the Common Assessment Framework (the early warning assessment tool for children and young people who may not be meeting one of the Every Child Matters five outcomes) in Bristol will also have implications for the Trust. Professionals who carry a paediatric a case load may be required to complete the two day training programme organised by the Children and Young Peoples Service. In this reporting period the majority of the School Health Nurses have completed the training and in the next reporting period further staff groups, such as Paediatric Clinical Nurse specialists, requiring training will be identified.

3.8Women’sService:

Safeguarding the unborn baby has remained a priority within Maternity Service, through the work of the Named Midwife, the Maternity Child Protection Group and the Domestic Violence Group. The Named Midwife continues to work closely with the Bristol Domestic Violence Forum.

There has been an increase in the number of referrals made by the Drugs Liaison Midwives, to Children and Young Peoples Service in this reporting period; 77 referrals were made from a total of 83 deliveries, compared to 60 in the previous year. The Maternity Drugs service has been involved in one Serious Case Review, which is due to be published in the next reporting period.

This year has also seen the successful appointment of a specialist midwife to care for teenage girls who become pregnant. Full data for this new post will be available in the next reporting period, however in a 4 month period this year 57 teenagers delivered, the majority of these were under the age of 18 years, and of these 20 were referred to the Children and Young Peoples Service.

Concerns remain that pre birth assessments for very vulnerable women, are being completed a very late stage by some locality Children and Young Peoples Service bases. Also some communication difficulties remain, with the transfer of important safeguarding information, from some regional offices, resulting in difficulties at the time of delivery. The named Midwife will continue to address these areas in the next reporting period.

3.8Emergency Departments:

The Emergency Departments remaincommitted and actively engaged in Safeguarding Children, demonstrated through the increasing number of referrals to the Children and Young Peoples Service.

The Emergency Department at the Bristol Royal Infirmary sees approximately 62,000 new patients a year over the age of 16 years and continues to identify child protection issues in everyday practice.

  • In this reporting period 137 child protection referrals were made to the Hospital Social Work department, the majority of these related topotential risk factors identified in adults responsible for caring for a child, such as parental mental health and substance misuse. Domestic Violence was identified in 50 (up by 11 from 2006/7) of the referrals.
  • The Children’s Emergency Department sees approximately 27,500 children a year underthe age of 16 years. Unfortunately for this reporting period data is available for 9 months only. In this period 374 child protection referrals were made, an average of 42 per month compared to38 per month in the previous reporting period.

3.8School Health Nursing Service:

In the Bristol area there are approximately 92,000 children (2001 census / Catcher in the Rye 2006), of which approximately73,000 are over the age of 5 years and may be receiving a School Health Nurse Service.

The figures from the Bristol Safeguarding Children Board fluctuate from month to month, but over the past year the Bristol Safeguarding Children Board report there has been a decrease in the number of children on the Child Protection Register. (280 children in March 2008 compared to 331 children in March 2007)

From 1st April 2008 these children will be said to be ‘subject to a Child Protection Plan’.

The School Health Nursing Service continues to incorporate changes in legislation and local needs into current practice. For example in this reporting period, Female Genital Mutilation training has resulted in an increased awareness of the potential risk and a number of referrals .The majority of School Health Nurses have also completed or are due to attended, the Common Assessment Framework training

  • At the time of writing this report 94 children were recognised by the School Health Nurses as being Vulnerable and in addition 91 children were on the Child Protection Register.
  • There have been 127 case conferences held in relation to school age children, 117 of these were attended by School Health Nurse and 21 by the Child Protection Supervisor. This remains on a par to previous years demonstrating the consistency of the service provided.

The transfer of all Child and Adolescent Mental Health Service and Community Child Health Services to a single organisation (most probably North Bristol Trust) is due to be completed by April 2009. The new organisation will incorporate the School Health Nurse Service currently employed by the Trust. It is acknowledged that the School Health Nurses providea vital and proactive role in safeguarding children, a high quality and invaluable service. It is hoped the development of the Bristol wide service will continue to incorporate the proven safeguarding strengths of the current School Health Nurse service.

3.8Consultant Community Paediatricians:

This reporting period has seen a further increase in the number of Child Protection work undertaken, reflected in the increase in Strategy discussions involving Health, Social Care and Police.

  • 739 Child Protection Strategieswere held compared to 677 in 2007 and 618 in 2006. In February 2008 a six month retrospective audit of the quality of the Strategy documentation was completed, this showed areas of good practice, such as a clear plan of action in the majority of cases, and highlighted some areas for improvement. A re-audit is planned
  • 135 Child Protection Medical Assessments were completed, comparable to previous years.
  • There have been 43 child protection hospital admissions, 4 of which were associated with the death of a child.(All of these children will be subject to a Serious Case Review).The On –Call Consultant Community Paediatrician plays a key role in all child protection admissions.
  • Attendance at Child Protection Case conferences by doctors remains an area of concern, with a very low rate again this year, 68 invitations receivedand only 1 conference attended.

The Consultant Community Paediatricians have been involved in providing evidence for the contestability process for the procurement of one community child health service for children in Bristol. The transfer of all Child and Adolescent Mental Health Services and Community Child Health Services to a single organisationis due to be completed by April 2009.