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The role of designated and named professionals in child safeguarding
SYMPOSIUM: CHILD ABUSE
The role of designated and named professionals in child safeguarding
Children and Families Act 2014 The Children’s Home (England) Regulation 2015 Children and Social Work Act 2017 Digital Economy Act 2017 Working Together to Safeguard Children 2015
Peter Green
Box 1
Abstract
Legal framework for child safeguarding
Safeguarding and promoting the welfare of children is defined in ‘Working Together to Safeguard Children 2015’ as: protecting children from maltreatment; preventing impairment of children’s health or development; ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and taking action to enable all children to have the best outcomes. The child safeguarding process requires healthcare professionals’ involvement in delivery of the best possible health, development of understanding of a healthy lifestyle and, where necessary, removal of children into alternative family and caring arrangements including those provided by non parent relatives, fostering, residential care and adoption. In these latter interventions, the children are referred to as Looked After Children. Statutory guidance in the Working Together to Safeguard Children 2015 document stipulates that: .effective safeguarding systems are those where the child’s needs are paramount, and the needs and wishes of each child, be they a baby, infant, or an older child should be put first, so that every child receives the support they need before a problem escalates
The processes of safeguarding children and young people are guided by international convention and described in legislation. The key documents are summarised in Box 1.
Overview of health contributions to child safeguarding including definitions of abuse
All practitioners in the health service have clearly described roles and responsibilities with regard to the protection of children from harm and the improvement of their welfare. This article will focus on the parts played by the two tiers of leading clinical responsibility. These posts are required by statutory guidance and their expertise is thereby available across the health economy, and influential within child safeguarding partnerships. Nearly all failures of child safeguarding involve failures of communication between partners. The health service is the largest and most complex institution for colleagues in social care, the police and education to deal with. It also has a language and culture that is well established and that is growing and developing all the time. It is vital that this hurdle to communication is not forgotten, and for health practitioners of all standards to bear that in mind when communicating with partners.
Keywords
child;
named;
professional;
role;
safeguarding;
designated
Historically, state intervention in the lives of children has been focussed on the risk or reality of significant harm being done to children. This is rooted in legislation that was developed throughout the 20th century. An important change was signalled in the Children Act 2004 when the concept of promoting the welfare of all children was first introduced into UK law. It was a concept that had already found its voice in Article 24 of the UNCRC in which all children were given the right to the best possible health. With this legislation Local (multiagency) Safeguarding Children Boards (LSCBs) were introduced to hold agencies to account in their safeguarding practice, and to provide local audit and initiatives to promote child welfare. Practice is slowly edging towards further and earlier intervention to improve the well being of all children, but child protection remains at the forefront of practice. It is therefore important to describe the various forms in which children can be harmed (Box 2). It is well established that children who have been the subject of neglect or harmful treatment commonly suffer from health conditions that have not been given the benefit of healthcare interventions. As a consequence, when children are being assessed for injuries, either physical or sexual, it is important that a full medical assessment by a paediatrically trained practitioner
The key International convention and National legislation underpinning the legal framework for child safeguarding in the UK United Nations Convention on the Rights of the Child (UNCRC) Children Act 2004 Children (Leaving Care) Act 2000 Adoption and Children Act 2002 Female Genital Mutilation Act 2003 Sexual Offences Act 2003 Children and Adoption Act 2006 Children and Young Persons Act 2008 Safeguarding Vulnerable Groups Act 2006 Protection of Freedoms Act 2012
Peter Green DMJ FFFLM (Fdn) FACLM FCLM is a Specialist in Forensic and Legal Medicine, Designated Doctor for Child Safeguarding with Wandsworth CCG and the States of Jersey, Consultant for Child Safeguarding at St George’s University Hospital. Conflict of interest: none declared.
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SYMPOSIUM: CHILD ABUSE
Fabricated or induced illness Occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.
The five forms of child maltreatment Physical A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. Sexual Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse Sexual abuse can take place online, and technology can be used to facilitate offline abuse. Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Emotional The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the illtreatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. Neglect The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: a provide adequate food, clothing and shelter (including exclusion from home or abandonment) b protect a child from physical and emotional harm or danger c ensure adequate supervision (including the use of inadequate caregivers) d ensure access to appropriate medical care or treatment
Box 2
is undertaken to demonstrate that the child is developing satisfactorily in line with the child’s age, and that other healthcare concerns are also described. For children who are to be taken into care, such an assessment (Initial Health Assessment) is a legal requirement under the terms of the statutory guidance laid out in ‘Promoting the health and well being of Looked after Children March 2015’, as are mandated and regular review health assessments. Sometimes the medical assessment of a child that is alleged to have been physically maltreated, can be used as supporting evidence for an Initial Heath Assessment. This has the advantage of reducing the number of times a child has to recite his/her health story to doctors. Medical interventions with regard to child safeguarding therefore lie at the heart of the process. The effective provision of such services needs supervision, and support. Similarly, support for concerns that professionals have about the children in their care, (e.g. sexualised behaviour, inappropriate aggression, signs of poor care, significant decline in educational attainment or development) all need supervision and support. At a more strategic level, policies and procedures for providers and commissioners alike, need expert advice and guidance - as well as performance and contractual monitoring support - to ensure that all parts of the health economy contribute to the child safeguarding culture. Within the NHS, the frontline leadership of child safeguarding is provided by two statutory positions, Designated and Named professionals. It is a requirement for each provider to have Named doctor and Named nurse positions established and for clinical groups to have access to designated doctors and nurses. The functions of the named professionals are summarised in Box 3.
Designated professional functions Both Designated Professional Roles require an enhanced Disclosure and Barring Service Check, and will be connected to Clinical Commissioning Groups. They will work with all the safeguarding professionals in the local health community and work to ensure that local health organisations meet their safeguarding responsibilities to children and young people. They are required to advise, support and supervise all named professionals in the health community and be responsible to, and accountable within, the managerial framework of their employing organisation. The designated nurse should have: a senior level, consultant equivalent, post completed specific training with substantial experience in the care of babies, children and young people
It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
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SYMPOSIUM: CHILD ABUSE
the implementation of recommendations Supervision Provide or ensure provision of effective safeguarding appraisal, support, peer review and supervision for colleagues in the organisation Contribute to safeguarding case supervision and peer review
The five essential functions of the named professionals Within their organisation Support all activities necessary to ensure that their employing organisation meets its responsibilities to safeguard and protect all children and young people (CYP) Be responsible to and accountable within the managerial framework of the employing organisation Work closely with the board-level executive lead for safeguarding within the organisation Support and advise the board of their employing organisation and contribute to the planning and strategic organisation of their safeguarding services. This work may involve other agencies e.g. care and forensic pathways Advise and support all the services within their organisation on the day to day management of children and families of child safeguarding concern Provide advice and signposting to other professionals about legal processes, key research and policy documents Ensure that their organisation has up to date safeguarding policies and procedures Help with the dissemination and implementation of organisational policies and procedures Encourage case discussion, reflective practice, and the monitoring of significant events within their organisation, and when required to, at a multi-agency learning events Interagency co-operation Participate in multi-agency subgroups of the LSCB, as well as their own organisation’s safeguarding committee Build relationships and liaise regularly with local police, children’s social care, education and other statutory and voluntary agencies to ensure that they are advised of health’s functions and support Assess and evaluate evidence, write reports and present information to child protection conferences Work closely with other professionals across the health community Ensure LSCB sub group advice is communicated to the safeguarding team and other staff Training Work with safeguarding professionals across the health community to determine training needs and priorities Develop and maintain a training strategy for their organisation that is in line with national/local expectations Contribute to the delivery of training for their organisation’s staff as well as multi-agency training and that meets the learning needs of the trainees Organise training evaluation and use that information to meet the training gaps Monitoring Advising their employers on, and contributing to, the implementation of effective systems of audit that will monitoring the quality and effectiveness of services Contribute to learning reviews whether they are serious case reviews, individual management reviews or other incident evaluations Disseminate lessons from such learning reviews and advise on
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Box 3
appropriate registration with the NMC in the care of babies, children and young people completed specific post-registration Masters level training in safeguarding an understanding of legislation relating to children and young people, and have an understanding of forensic medicine proven negotiating and leadership skills The designated doctor should have: consultant status or equivalent undergone higher professional training in paediatrics or forensic and legal medicine, public health or psychiatry substantial clinical experience in the field of safeguarding substantial experience of the legislation relating to children and young people, and court processes some clinical responsibilities (or have held an active clinical position in the previous two years) in the field of child safeguarding have proven negotiating and leadership skills Inter-agency responsibilities The designated professionals should sit on the local child safeguarding children’s board (LCSB), and its subcommittees as appropriate. They are required to provide safeguarding health advice on policy and individual cases to all local agencies, including the Police and Children’s Social Care. They must also liaise with Local Education and Training Boards (LETBs) and others to ensure appropriate safeguarding content within undergraduate, pre-registration and postgraduate training. Expert advice and strategic thinking The essence of the designated professional’s work is the provision of expert advice and strategic thinking. This requires them to provide advice to health organisations regarding planning, strategy, commissioning and performance indicators with regard to safeguarding service provision and to help with the development and appropriate audit of practice guidance and policies for all health staff. They should also provide advice about safeguarding risk to health organisations, other professionals and health service providers. This includes offering advice on procedures and on the day-to-day management of CYP and families pertaining to all forms of child maltreatment including FII, child sexual abuse, honour-based violence, trafficking, detention and within the Prevent strategy. Clinical role Designated professionals should be able to help other professionals on the management of all forms of child maltreatment, including advice on relevant law and documentation. An
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SYMPOSIUM: CHILD ABUSE
as provide more general advice, support and supervision strategy for all levels of health staff within all local health organisations. This includes mentoring for Executive Leads as required.
important aspect of this is the ability to critically evaluate evidence, write reports and present information to child protection conferences and related meetings. They must also be able to provide advice and signposting to other professionals about legal processes, key research and policy documents. They are frequently asked to provide clinical advice, for example in complex cases or where there is dispute between practitioners. When designated doctors, in particular, continue clinical duties in addition to their clinical advice role in safeguarding, it is important that there is clarity about the two different roles with regard to job planning, appraisal and revalidation processes.
Personal development Named and designated professionals are required to meet organisational and professional body’s CPD requirements in order to maintain skills. They should also receive regular safeguarding supervision and/or peer review and undertake reflective practice. Ideally this should be funded by the employing organisation for designated professionals and conducted by someone with safeguarding expertise. They should also receive support for the emotional impact of the role. They should also receive annual appraisal with appropriate input from safeguarding colleagues, with the job plan process taking full account of the time that is spent on safeguarding work. Accountability to the organisational chief executive stands for both roles. Designated professionals will also be performance managed by the relevant safeguarding board level executive.
Co-ordination and communication It is important that designated professionals work with other designated professionals across organisations to agree team responsibilities and lead and support the work of any local health advisory group for safeguarding. They will need to liaise with the local authority child protection and safeguarding leaders and NHS England, as and when required. Governance Work with other designated professionals to ensure that the health components of the local safeguarding procedures of the LSCB are current. Work with local health organisations to ensure that appropriate policies, procedures, training, and audit are in place and that they are consistent with the policies of the LSCB and help with the development of quality assurance systems in the local health economy.
Why does this matter? The children and social work act 2017 This new law removes the statutory authority of local safeguarding children boards (LSCBs) and introduces new local safeguarding partnership arrangements. Safeguarding responsibilities have now been placed on CCGs, Local Authorities and local police, the new so-called safeguarding partners. The safeguarding partners must decide on a set of arrangements which must include decisions about the geographical footprint, the funding and criteria of intervention. The arrangements will be governed as follows: They must include arrangements for scrutiny by an independent person of the effectiveness of the arrangements The safeguarding partners and relevant agencies for the local authority area must act in accordance with the arrangements. (Relevant agency is defined in the legislation and the subject of statutory regulation) At least once in every 12 month period, the safeguarding partners must prepare and publish a report on: (a) what the safeguarding partners and relevant agencies for the local authority area have done as a result of the arrangements, and (b) how effective the arrangements have been in practice. The safeguarding partners for a local authority area in England must also make arrangements: to identify serious child safeguarding cases which raise issues of importance in relation to the area, and for those cases to be reviewed under the supervision of the safeguarding partners, where they consider it appropriate. the purpose of a review is to identify any improvements that should be made by persons in the area to safeguard and promote the welfare of children. Where a case is reviewed under the supervision of the safeguarding partners, they mustd (a) ensure that the reviewer provides a report on the outcome of the review;
Training Designated professionals should advise about safeguarding training needs and delivery for all health staff within local health organisations and be involved in the planning and delivery of inter-agency training through LSCBs. Monitoring effectiveness Designated professionals must provide advice about how best to monitor the effectiveness of child safeguarding. This includes monitoring of training, of safeguarding elements of contracts, service level agreements and commissioned services and clinical governance and standards (to named professionals). Advice must also be provided directly to the chief executive of their employing health care organisation or their immediate subsidiary about their responsibilities to ensure that child safeguarding performance indicators are met, and to provide adequate resources for named and designated professionals to carry out their roles effectively. Learning reviews When contributing to learning reviews, designated professionals must work with one another, as well as partners in other agencies, to identify gaps in commissioning arrangements and information sharing between organisations and individuals. They must advise and support all safeguarding professionals in local health organisations when writing such reviews using the framework of Working Together 2018. Supervision Designated professionals should supervise all local named professionals, or ensure that they receive it from elsewhere, as well
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SYMPOSIUM: CHILD ABUSE
(b) ensure: (i) that the reviewer makes satisfactory progress, and (ii) that the report is of satisfactory quality; (c) provide the report to the Secretary of State and the Child Safeguarding Practice Review Panel. The safeguarding partners must publish the report, unless they consider it inappropriate to do so. Last, but by no means least, the oversight of the child death review process, currently the responsibility of the LSCB through it’s Child Death Overview Panel, will in future be shared between the local authority and local CCGs. The legislation states: The child death review partners for a local authority area in England must make arrangements for the review of each death of a child normally resident in the area The child death review partners may also, if they consider it appropriate, make arrangements for the review of a death in their area of a child not normally resident there The child death review partners must make arrangements for the analysis of information about deaths reviewed under this section The purposes of a review or analysis under this section ared (a) to identify any matters relating to the death or deaths that are relevant to the welfare of children in the area or to public health and safety, and
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(b) to consider whether it would be appropriate for anyone to take action in relation to any matters identified Where the child death review partners consider that it would be appropriate for a person to take action, they must inform that person The child death review partners for a local authority area in England must, at such intervals as they consider appropriate, prepare and publish a report ond (a) what they have done as a result of the arrangements under this section, and (b) how effective the arrangements have been in practice The guidance for all these changes has now been published, with implementation due by September 2019. It is expected that the voice of health, with its emphasis on a non-episodic approach to children and young people, will receive a new emphasis. Designated professionals will be explicitly featured as leads for child safeguarding (in its broadest sense as the protection, and promotion of well-being, of all children and young people) as well as the new child death review processes. And Named professionals will continue to provide the provider leadership for child safeguarding that gets more complex as providers reconstruct their relationships within Integrated Care Organisations.A
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The role of designated and named professionals in child safeguarding
Children and Families Act 2014 The Children’s Home (England) Regulation 2015 Children and Social Work Act 2017 Digital Economy Act 2017 Working Together to Safeguard Children 2015
Peter Green
Box 1
Abstract
Legal framework for child safeguarding
Safeguarding and promoting the welfare of children is defined in ‘Working Together to Safeguard Children 2015’ as: protecting children from maltreatment; preventing impairment of children’s health or development; ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and taking action to enable all children to have the best outcomes. The child safeguarding process requires healthcare professionals’ involvement in delivery of the best possible health, development of understanding of a healthy lifestyle and, where necessary, removal of children into alternative family and caring arrangements including those provided by non parent relatives, fostering, residential care and adoption. In these latter interventions, the children are referred to as Looked After Children. Statutory guidance in the Working Together to Safeguard Children 2015 document stipulates that: .effective safeguarding systems are those where the child’s needs are paramount, and the needs and wishes of each child, be they a baby, infant, or an older child should be put first, so that every child receives the support they need before a problem escalates
The processes of safeguarding children and young people are guided by international convention and described in legislation. The key documents are summarised in Box 1.
Overview of health contributions to child safeguarding including definitions of abuse
All practitioners in the health service have clearly described roles and responsibilities with regard to the protection of children from harm and the improvement of their welfare. This article will focus on the parts played by the two tiers of leading clinical responsibility. These posts are required by statutory guidance and their expertise is thereby available across the health economy, and influential within child safeguarding partnerships. Nearly all failures of child safeguarding involve failures of communication between partners. The health service is the largest and most complex institution for colleagues in social care, the police and education to deal with. It also has a language and culture that is well established and that is growing and developing all the time. It is vital that this hurdle to communication is not forgotten, and for health practitioners of all standards to bear that in mind when communicating with partners.
Keywords
child;
named;
professional;
role;
safeguarding;
designated
Historically, state intervention in the lives of children has been focussed on the risk or reality of significant harm being done to children. This is rooted in legislation that was developed throughout the 20th century. An important change was signalled in the Children Act 2004 when the concept of promoting the welfare of all children was first introduced into UK law. It was a concept that had already found its voice in Article 24 of the UNCRC in which all children were given the right to the best possible health. With this legislation Local (multiagency) Safeguarding Children Boards (LSCBs) were introduced to hold agencies to account in their safeguarding practice, and to provide local audit and initiatives to promote child welfare. Practice is slowly edging towards further and earlier intervention to improve the well being of all children, but child protection remains at the forefront of practice. It is therefore important to describe the various forms in which children can be harmed (Box 2). It is well established that children who have been the subject of neglect or harmful treatment commonly suffer from health conditions that have not been given the benefit of healthcare interventions. As a consequence, when children are being assessed for injuries, either physical or sexual, it is important that a full medical assessment by a paediatrically trained practitioner
The key International convention and National legislation underpinning the legal framework for child safeguarding in the UK United Nations Convention on the Rights of the Child (UNCRC) Children Act 2004 Children (Leaving Care) Act 2000 Adoption and Children Act 2002 Female Genital Mutilation Act 2003 Sexual Offences Act 2003 Children and Adoption Act 2006 Children and Young Persons Act 2008 Safeguarding Vulnerable Groups Act 2006 Protection of Freedoms Act 2012
Peter Green DMJ FFFLM (Fdn) FACLM FCLM is a Specialist in Forensic and Legal Medicine, Designated Doctor for Child Safeguarding with Wandsworth CCG and the States of Jersey, Consultant for Child Safeguarding at St George’s University Hospital. Conflict of interest: none declared.
PAEDIATRICS AND CHILD HEALTH 29:1
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Ó 2018 Published by Elsevier Ltd.
SYMPOSIUM: CHILD ABUSE
Fabricated or induced illness Occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.
The five forms of child maltreatment Physical A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. Sexual Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse Sexual abuse can take place online, and technology can be used to facilitate offline abuse. Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Emotional The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the illtreatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. Neglect The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: a provide adequate food, clothing and shelter (including exclusion from home or abandonment) b protect a child from physical and emotional harm or danger c ensure adequate supervision (including the use of inadequate caregivers) d ensure access to appropriate medical care or treatment
Box 2
is undertaken to demonstrate that the child is developing satisfactorily in line with the child’s age, and that other healthcare concerns are also described. For children who are to be taken into care, such an assessment (Initial Health Assessment) is a legal requirement under the terms of the statutory guidance laid out in ‘Promoting the health and well being of Looked after Children March 2015’, as are mandated and regular review health assessments. Sometimes the medical assessment of a child that is alleged to have been physically maltreated, can be used as supporting evidence for an Initial Heath Assessment. This has the advantage of reducing the number of times a child has to recite his/her health story to doctors. Medical interventions with regard to child safeguarding therefore lie at the heart of the process. The effective provision of such services needs supervision, and support. Similarly, support for concerns that professionals have about the children in their care, (e.g. sexualised behaviour, inappropriate aggression, signs of poor care, significant decline in educational attainment or development) all need supervision and support. At a more strategic level, policies and procedures for providers and commissioners alike, need expert advice and guidance - as well as performance and contractual monitoring support - to ensure that all parts of the health economy contribute to the child safeguarding culture. Within the NHS, the frontline leadership of child safeguarding is provided by two statutory positions, Designated and Named professionals. It is a requirement for each provider to have Named doctor and Named nurse positions established and for clinical groups to have access to designated doctors and nurses. The functions of the named professionals are summarised in Box 3.
Designated professional functions Both Designated Professional Roles require an enhanced Disclosure and Barring Service Check, and will be connected to Clinical Commissioning Groups. They will work with all the safeguarding professionals in the local health community and work to ensure that local health organisations meet their safeguarding responsibilities to children and young people. They are required to advise, support and supervise all named professionals in the health community and be responsible to, and accountable within, the managerial framework of their employing organisation. The designated nurse should have: a senior level, consultant equivalent, post completed specific training with substantial experience in the care of babies, children and young people
It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
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SYMPOSIUM: CHILD ABUSE
the implementation of recommendations Supervision Provide or ensure provision of effective safeguarding appraisal, support, peer review and supervision for colleagues in the organisation Contribute to safeguarding case supervision and peer review
The five essential functions of the named professionals Within their organisation Support all activities necessary to ensure that their employing organisation meets its responsibilities to safeguard and protect all children and young people (CYP) Be responsible to and accountable within the managerial framework of the employing organisation Work closely with the board-level executive lead for safeguarding within the organisation Support and advise the board of their employing organisation and contribute to the planning and strategic organisation of their safeguarding services. This work may involve other agencies e.g. care and forensic pathways Advise and support all the services within their organisation on the day to day management of children and families of child safeguarding concern Provide advice and signposting to other professionals about legal processes, key research and policy documents Ensure that their organisation has up to date safeguarding policies and procedures Help with the dissemination and implementation of organisational policies and procedures Encourage case discussion, reflective practice, and the monitoring of significant events within their organisation, and when required to, at a multi-agency learning events Interagency co-operation Participate in multi-agency subgroups of the LSCB, as well as their own organisation’s safeguarding committee Build relationships and liaise regularly with local police, children’s social care, education and other statutory and voluntary agencies to ensure that they are advised of health’s functions and support Assess and evaluate evidence, write reports and present information to child protection conferences Work closely with other professionals across the health community Ensure LSCB sub group advice is communicated to the safeguarding team and other staff Training Work with safeguarding professionals across the health community to determine training needs and priorities Develop and maintain a training strategy for their organisation that is in line with national/local expectations Contribute to the delivery of training for their organisation’s staff as well as multi-agency training and that meets the learning needs of the trainees Organise training evaluation and use that information to meet the training gaps Monitoring Advising their employers on, and contributing to, the implementation of effective systems of audit that will monitoring the quality and effectiveness of services Contribute to learning reviews whether they are serious case reviews, individual management reviews or other incident evaluations Disseminate lessons from such learning reviews and advise on
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Box 3
appropriate registration with the NMC in the care of babies, children and young people completed specific post-registration Masters level training in safeguarding an understanding of legislation relating to children and young people, and have an understanding of forensic medicine proven negotiating and leadership skills The designated doctor should have: consultant status or equivalent undergone higher professional training in paediatrics or forensic and legal medicine, public health or psychiatry substantial clinical experience in the field of safeguarding substantial experience of the legislation relating to children and young people, and court processes some clinical responsibilities (or have held an active clinical position in the previous two years) in the field of child safeguarding have proven negotiating and leadership skills Inter-agency responsibilities The designated professionals should sit on the local child safeguarding children’s board (LCSB), and its subcommittees as appropriate. They are required to provide safeguarding health advice on policy and individual cases to all local agencies, including the Police and Children’s Social Care. They must also liaise with Local Education and Training Boards (LETBs) and others to ensure appropriate safeguarding content within undergraduate, pre-registration and postgraduate training. Expert advice and strategic thinking The essence of the designated professional’s work is the provision of expert advice and strategic thinking. This requires them to provide advice to health organisations regarding planning, strategy, commissioning and performance indicators with regard to safeguarding service provision and to help with the development and appropriate audit of practice guidance and policies for all health staff. They should also provide advice about safeguarding risk to health organisations, other professionals and health service providers. This includes offering advice on procedures and on the day-to-day management of CYP and families pertaining to all forms of child maltreatment including FII, child sexual abuse, honour-based violence, trafficking, detention and within the Prevent strategy. Clinical role Designated professionals should be able to help other professionals on the management of all forms of child maltreatment, including advice on relevant law and documentation. An
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SYMPOSIUM: CHILD ABUSE
as provide more general advice, support and supervision strategy for all levels of health staff within all local health organisations. This includes mentoring for Executive Leads as required.
important aspect of this is the ability to critically evaluate evidence, write reports and present information to child protection conferences and related meetings. They must also be able to provide advice and signposting to other professionals about legal processes, key research and policy documents. They are frequently asked to provide clinical advice, for example in complex cases or where there is dispute between practitioners. When designated doctors, in particular, continue clinical duties in addition to their clinical advice role in safeguarding, it is important that there is clarity about the two different roles with regard to job planning, appraisal and revalidation processes.
Personal development Named and designated professionals are required to meet organisational and professional body’s CPD requirements in order to maintain skills. They should also receive regular safeguarding supervision and/or peer review and undertake reflective practice. Ideally this should be funded by the employing organisation for designated professionals and conducted by someone with safeguarding expertise. They should also receive support for the emotional impact of the role. They should also receive annual appraisal with appropriate input from safeguarding colleagues, with the job plan process taking full account of the time that is spent on safeguarding work. Accountability to the organisational chief executive stands for both roles. Designated professionals will also be performance managed by the relevant safeguarding board level executive.
Co-ordination and communication It is important that designated professionals work with other designated professionals across organisations to agree team responsibilities and lead and support the work of any local health advisory group for safeguarding. They will need to liaise with the local authority child protection and safeguarding leaders and NHS England, as and when required. Governance Work with other designated professionals to ensure that the health components of the local safeguarding procedures of the LSCB are current. Work with local health organisations to ensure that appropriate policies, procedures, training, and audit are in place and that they are consistent with the policies of the LSCB and help with the development of quality assurance systems in the local health economy.
Why does this matter? The children and social work act 2017 This new law removes the statutory authority of local safeguarding children boards (LSCBs) and introduces new local safeguarding partnership arrangements. Safeguarding responsibilities have now been placed on CCGs, Local Authorities and local police, the new so-called safeguarding partners. The safeguarding partners must decide on a set of arrangements which must include decisions about the geographical footprint, the funding and criteria of intervention. The arrangements will be governed as follows: They must include arrangements for scrutiny by an independent person of the effectiveness of the arrangements The safeguarding partners and relevant agencies for the local authority area must act in accordance with the arrangements. (Relevant agency is defined in the legislation and the subject of statutory regulation) At least once in every 12 month period, the safeguarding partners must prepare and publish a report on: (a) what the safeguarding partners and relevant agencies for the local authority area have done as a result of the arrangements, and (b) how effective the arrangements have been in practice. The safeguarding partners for a local authority area in England must also make arrangements: to identify serious child safeguarding cases which raise issues of importance in relation to the area, and for those cases to be reviewed under the supervision of the safeguarding partners, where they consider it appropriate. the purpose of a review is to identify any improvements that should be made by persons in the area to safeguard and promote the welfare of children. Where a case is reviewed under the supervision of the safeguarding partners, they mustd (a) ensure that the reviewer provides a report on the outcome of the review;
Training Designated professionals should advise about safeguarding training needs and delivery for all health staff within local health organisations and be involved in the planning and delivery of inter-agency training through LSCBs. Monitoring effectiveness Designated professionals must provide advice about how best to monitor the effectiveness of child safeguarding. This includes monitoring of training, of safeguarding elements of contracts, service level agreements and commissioned services and clinical governance and standards (to named professionals). Advice must also be provided directly to the chief executive of their employing health care organisation or their immediate subsidiary about their responsibilities to ensure that child safeguarding performance indicators are met, and to provide adequate resources for named and designated professionals to carry out their roles effectively. Learning reviews When contributing to learning reviews, designated professionals must work with one another, as well as partners in other agencies, to identify gaps in commissioning arrangements and information sharing between organisations and individuals. They must advise and support all safeguarding professionals in local health organisations when writing such reviews using the framework of Working Together 2018. Supervision Designated professionals should supervise all local named professionals, or ensure that they receive it from elsewhere, as well
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SYMPOSIUM: CHILD ABUSE
(b) ensure: (i) that the reviewer makes satisfactory progress, and (ii) that the report is of satisfactory quality; (c) provide the report to the Secretary of State and the Child Safeguarding Practice Review Panel. The safeguarding partners must publish the report, unless they consider it inappropriate to do so. Last, but by no means least, the oversight of the child death review process, currently the responsibility of the LSCB through it’s Child Death Overview Panel, will in future be shared between the local authority and local CCGs. The legislation states: The child death review partners for a local authority area in England must make arrangements for the review of each death of a child normally resident in the area The child death review partners may also, if they consider it appropriate, make arrangements for the review of a death in their area of a child not normally resident there The child death review partners must make arrangements for the analysis of information about deaths reviewed under this section The purposes of a review or analysis under this section ared (a) to identify any matters relating to the death or deaths that are relevant to the welfare of children in the area or to public health and safety, and
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(b) to consider whether it would be appropriate for anyone to take action in relation to any matters identified Where the child death review partners consider that it would be appropriate for a person to take action, they must inform that person The child death review partners for a local authority area in England must, at such intervals as they consider appropriate, prepare and publish a report ond (a) what they have done as a result of the arrangements under this section, and (b) how effective the arrangements have been in practice The guidance for all these changes has now been published, with implementation due by September 2019. It is expected that the voice of health, with its emphasis on a non-episodic approach to children and young people, will receive a new emphasis. Designated professionals will be explicitly featured as leads for child safeguarding (in its broadest sense as the protection, and promotion of well-being, of all children and young people) as well as the new child death review processes. And Named professionals will continue to provide the provider leadership for child safeguarding that gets more complex as providers reconstruct their relationships within Integrated Care Organisations.A
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