Safeguarding children policy

Date: April 2022

Review date: April 2024

Version 4.8

Introduction

The Tavistock and Portman NHS Foundation Trust (the Trust) is committed to promoting the safeguarding of children and young people and protecting them from the risks of harm as required by section 11(2) (a) Children Act 2004: safeguarding children is everyone’s responsibility. The Trust’s approach to safeguarding and child protection has been developed in line with the London Child Protection Procedures (2017), including amendments 2018 2019; Working Together to Safeguard Children 2018; When to Suspect Child Maltreatment, 2009, (which superseded “What to Do If You Are Worried a Child is Being Abused, 2006”); NICE NG76, 2017; the Inter-Collegiate Document, 2019 and the strategy work of the Camden Safeguarding Children Partnership.

Scope

2.1 This policy is intended to be used for all staff at the Trust. They are supplementary to local, (Camden Safeguarding Children Partnership); regional, (London Child Protection Procedures, 2017) and national procedures, (Working Together to Safeguard Children, 2018). Note, by dint of the Children and Social Work Act 2017, Local Safeguarding Children Boards are now defunct. The partnership strategic management of safeguarding children is now governed under the auspices of Local Safeguarding Children Partnerships.

2.2 This policy applies to all children and young people (0-17), the unborn; parents/carers and the families of the aforementioned.

2.3 In addition, those clinicians assessing and treating adults have a duty to be competent regarding child development, family functioning and parental capacity and crucially have the same duty of care to safeguard and protect children.

2.4 Throughout this document, a child means those children aged between1- 12 years. A young person relates to 13 – 17 year olds.

Roles and responsibilities

Chief Executive

3.1.1 The Chief Executive is the Accountable Officer who has overall responsibility for ensuring the implementation of effective Safeguarding Procedures.

Executive Medical Director

3.2.1 The Executive Medical Director has overall responsibility for this procedure in his leadership role regarding safeguarding within the Trust.

Named Doctor/Named Professional

3.3.1 The Named Doctor and Named Professional will take the professional and statutory lead within the Trust for safeguarding and child protection matters. They should have expertise on children’s health and development, the nature of child abuse, local arrangements for safeguarding children and promoting their welfare.

3.3.2 They provide a source of advice and expertise to fellow professionals, support the interface with other agencies and play an important role in promoting good professional practice in safeguarding children.

3.3.3 They are also responsible for overseeing the effective conduct of the Trust’s internal case reviews and will ensure investigation and response to child protection complaints on behalf of the Trust.

3.3.4 They review the Trust’s policy and procedures, practices and multi-agency working. They ensure that appropriate child protection standards are kept.

3.3.5 The accountabilities of the Named Doctor and Named Professional will be clearly identified in their job descriptions along with their responsibilities in relation to this policy.

Director of Human Resources

3.4.1 The Director of Human Resources is responsible for:

Ensuring the Trust’s Recruitment and Retention Policies comply with relevant legislation and guidance relating to the safe employment staff working with children and other vulnerable people and includes ensuring enhanced Disclosure and Barring Service (DBS) checks are expedited in a timely manner regarding all staff, trainees, relevant students, honorary workers and volunteers.
Ensuring that the Trust’s induction, INSET and mandatory training programmes include safeguarding and child protection training as defined by the training needs analysis (refer to the Staff Training Policy).

The Case Consultant

3.5.1 The Case Consultant has responsibility for individual cases and must ensure that they are mindful of this policy in their own work and supervision of any staff, trainees, relevant students and honorary workers.

3.5.2 Where an incident or serious incident has occurred staff will also follow the requirements set out in the Trust Serious Incident Policy.

3.5.3 The Trust has increased safeguarding capacity within the Trust (across children and adult services) by introducing Safeguarding Service Leads, who are responsible for providing additional support and knowledge within their services.

Divisional Directors, Service Managers, Team Managers and Heads of Discipline

Divisional Directors, Service Managers, Team Managers and Heads of Discipline are responsible for:

Promoting working practices that ensure the welfare of the unborn, children and young people
Ensure staff attend all relevant training in respect of safeguarding and child protection: induction, mandatory and INSET training as required by the Trust
Ensure staff who are affected in any way by child protection issues receive the appropriate help and support they require, either within the team or by referral to the Staff and Student Advisory Service or by direct referral to Occupational Health via Human Resources
Ensure recruitment practice is mindful of Safer Recruitment protocols and all recruiting staff have undertaken Safer Recruitment training.

Trust Safeguarding Structure

Service line Safeguarding Leads – with responsibility for initial response to all local service line safeguarding enquiries:

Safeguarding Lead for CAMHS
Safeguarding Lead for Complex Needs Children
Safeguarding Lead for GIDS
Safeguarding Lead for GIC.

See paragraph 17 of this policy document for more information.

All Staff

All staff are required to work to promote children’s rights as detailed in Article 3 of the United Nations Convention on the Rights of the Child 1989. This is in line with the requirements of the Human Rights Act 1998. All Trust staff (employed and trainees) or students, honorary workers or volunteers have a duty to safeguard and promote the welfare of children (section 5, Children Act 2004). To meet their responsibilities, all individual staff must ensure:

They attend training provided by the Trust in respect of safeguarding and child protection;
Check their Electronic Staff Record (ESR) to ensure they are compliant with expected training
are aware of how to obtain help and advice in relation to safeguarding and child protection matters;
follow the London Child Protection Procedures, 2017; Working Together to Safeguard Children, 2018; the Camden Safeguarding Children Partnership (CSCP) Safeguarding Procedures or local procedures as applicable and the Trust Safeguarding Procedures when there are safeguarding and/or child protection concerns;
understand the sharing of personal information about children and families held by them should not be disclosed without the consent of the data However, the law permits disclosure of confidential information necessary to safeguarding children and young people in circumstances of significant harm, i.e. protecting children and young people will override the child/ young person or parents/carers’ right to confidentiality.
Staff should take advice from the Named Professionals in complex cases and ensure that any confidential information shared is undertaken in the child’s or young person’s best interests;
seek advice initially from the Case Consultant, team safeguarding resources, Service Safeguarding Leads or the Named Professionals in all complex cases and understand that safeguarding and child protection issues should never be managed by a single professional;
staff are encouraged to consider the construct of ‘Think Family’ i.e. both adult and children clinicians must consider the implications of presenting symptoms and/or pathology and their impact on children and other vulnerable persons;
report any allegation of child protection regarding a member of staff to the Service Manager, who will escalate to include the Executive Medical Director, who will determine the process thereafter.

Procedures for dealing with suspected abuse

Recognition of Abuse

4.1. To assist staff a summary set of guidelines on recognising abuse is shown at Appendix B. This should only act as a guide to staff as child abuse/maltreatment can manifest in a way that may not at first be understood as abuse. Staff are reminded to remain vigilant and to be open to evidence of safeguarding and child protection either through their direct care of the child or through learning of possible safeguarding and child protection concerns from others e.g. parent/carers and other professionals.

Opportunities to Identify Safeguarding Issues

4.2.1 Safeguarding and child protection cases may arise in the following ways:

at the point of referral
concerns which arise during the course of an assessment and/or treatment

4.2.2 Any physical, neglect, emotional, exploitation and sexual abuse disclosed by a child or young person to member of staff/ trainee/honorary worker or volunteer worker should be immediately reported to the Case Consultant, and in their absence the Team Manager or Service Manager or in the aforementioned absence, the Trust Safeguarding Named Professionals. An urgent internal discussion should take place and a referral should be made to the Children Social Care in the area the child or young person currently resides. When there is a critical emergency regarding ‘life or limb’ scenarios, where there has been injury on site, the police and/or ambulance services should be called. If any injury is apparent or reported that requires GP care, please advise the patient or their carer to seek appropriate care.

4.2.3 If a member of staff/ trainee/ honorary worker or volunteer worker observes signs indicative of possible abuse, they should ask the child and parent/carer. If the explanation given is not plausible or consistent and raises concern as to possible abuse, the staff member/trainee/honorary worker/volunteer should indicate a need to discuss this further and inform the Case Consultant immediately.

4.2.4 If a child appears to be suffering from neglect, the staff member/trainee/clinical associate/honorary member/volunteer should gain relevant information from the parent/carer/child and discuss with the Case Consultant. The parent/carer should be informed if a referral to Children Services is made unless it would not be in the child or young person’s best interests for such a disclosure to be made.

4.2.5 If a child or young person appears to be suffering from emotional abuse, which may cause significant harm, the Case Consultant must be informed.

4.2.6 In all cases where the Case Consultant considers that a child or young person is likely to be at risk of further abuse and/or silencing these concerns must not be discussed with the parents/carers before contacting Children Social Care. Thereafter, Children Social Care might instigate either a section 17 (Child in Need Assessment) or a section 47 (Child Protection investigation) according to the referral made under the statutory instruments of the Children Act 1989 further to any information or written referral.

4.2.7 In cases where there is some doubt about whether to refer to Children Social Care contacting the appropriate MASH Team Manager to discuss concerns may assist in progressing matters. In all circumstances where a referral to Children Social Care is being considered clinicians must inform the case consultant/team leader/or other senior clinician and advise either the Named Doctor or the Named Professional.

Trust safeguarding children pathway

NB: See link as to the Children Social Care management of safeguarding and child protection referrals, Chapter 16, Working Together to Safeguard Children, 2018.

Understanding the Obstacles to Recognising Child Maltreatment

There are obstacles among healthcare professionals in recognising child maltreatment and accepting that child maltreatment commonly occurs. Some of these obstacles relate to the healthcare practitioners’ professional and personal experiences (including maltreatment) or lack of training. Other obstacles include the following:
1. concern about missing a treatable disorder	7. uncertainty about when to mention suspicion, what to say to parent(s) or carer(s) and what to write in the clinical file
2. healthcare professionals are used to working with parents and carers in the care of children and fear losing the positive relationship with a family already under their care	8. losing control over the child protection process and doubts about its benefits
3. discomfort of disbelieving, thinking ill of, suspecting or wrongly blaming a parent or carer	9. child protection processes can be stressful for professionals and time-consuming
4. divided duties to adult and child /patients and breaching confidentiality	10. personal safety
5. understanding the background and reasons why the maltreatment might have occurred, especially when there is no perceived intention to harm the child	11. fear of complaints, litigation and dealings with professional bodies
6. difficulty in saying that a presentation is unclear and there is uncertainty about whether the presentation really indicates significant harm	12. fear of seeking support from colleagues

Recording information

4.4.1 Detailed contemporaneous records (within 24 hours, must be kept by all involved and must clearly differentiate between fact, reported information and opinion. (Keeping fact and opinion in separate pages or paragraphs in records is advised).

4.4.2 The reasons for any decisions made must be recorded clearly, including the decision(s) and reason(s) why the child was or was not referred to Children Services.

4.4.3 Recording on CareNotes must be undertaken in a timely manner as well as being mindful regarding who (principally the data subject) may have access to the records.

4.4.4 See the Trust’s Healthcare Records procedure for guidance regarding standards for record-keeping.

1 The importance of sharing information with other agencies is fundamental.

5.1.1 Sharing Information effectively enables:

improved communication between professionals;
a better understanding of what should be shared, with whom and under what circumstances, and the dangers of not doing so;
building confidence and trust with partners and families;
better knowledge of other agencies services;
less duplication for service users.

Confidential information

5.2.1 Confidential information is personal, identifiable information not normally in the public domain or readily available from another source, has a degree of sensitivity and value; all staff have a duty to maintain confidentiality.

Common Law Duty of Confidence

5.3.1 A breach of confidentiality occurs when a person shares information with another in circumstances where it is reasonable to expect that the information will be kept confidential. However, all health professionals have a duty to disclose information where failure to do so would result in a child, or children or others suffering from neglect or physical, sexual, exploitation or emotional abuse.

Public Interest and Proportionality (PIP)

5.4.1 The public interest ‘test’ (PIT) can be used to make judgments about how to manage confidential information and when consent to share information has been refused. If any of the following apply, it is ‘a public interest matter’:

the protect children and other people from harm;
to promote the welfare of children;
to prevent crime and disorder;
alternatively, non-disclosure may also be, in some circumstances, in the public interest.

5.4.2 The public interest test is undertaken using three steps:

identify the relevant public interest considerations in favour of disclosure
identify the relevant public interest considerations against disclosure
determine the weight of the public interest considerations in favour of and against disclosure and where the balance between those interests lies.

5.4.3 In other words, certainly within the sphere of clinical work where confidentiality is a de facto requirement with the caveat that where there are public interest concerns, each case will be assessed using the public interest test. The ‘public interest tool’ as above, (paragraph, 5.4.2) should be use to ‘stress test’ any decision-making process as to whether or not to ‘share information’ beyond the therapeutic boundary.

5.4.4 Clinicians should not make decisions related to PIT in isolation and should always consult with their supervisors, managers, service safeguarding leads and in the absence of the aforementioned with the Named Professionals, and when necessary the Caldicott Guardian.

5.4.5 Safeguarding is an exempt domain regarding the data-processing law (Data Protection Act, 2018 and the General Data Protection Regulations, (GDPR) 2016). For further information, contact Information Governance.

The Law

5.5.1 The law does not prevent individual sharing of information with other practitioners to assist a child or young person if:

those likely to be affected have given consent;
the public interest in safeguarding the child’s welfare overrides the need to keep the information confidential;
disclosure of patient data is required under a Court Order or other legal obligation. Trust staff should always see for themselves any reported Court Order requiring disclose of patient records.

Communicating with Children, Young People and Parents

5.6.1 Sharing information should be a considered response, which should seek to be inclusive regarding the views and feelings of children, young people and their parents/carers, so long as doing so is judged to be in the child or young person’s best interests.

5.6.2 Young people aged 16 or 17, or a child or young person under 16 who has the capacity to understand and make their own decisions, may give, or refuse consent to sharing information. There should always be a clinical judgement as to the efficacy of trying to seek consent from a minor and their understanding of any given situation.

5.6.3 Children aged 12 or over may generally be expected to have sufficient understanding in some aspects of their care. Younger children may also have sufficient understanding dependent on the circumstances. When assessing a child’s understanding you should explain the issues to the child in a way that is suitable having regard to their age, their developmental abilities, language and likely understanding including the consequences of their decision(s).

5.6.4 The following criteria should be considered in assessing whether a particular child/young person on a particular occasion has sufficient understanding to consent, or refuse consent, to sharing of information about them:

Can the child understand the question being asked of them?
Does the child have a reasonable understanding of:

– What information might be shared?

– The main reason or reasons for sharing the information?

– The implications of sharing that information, and of not sharing it?

Can the child:

– Appreciate and consider the alternative courses of action open to them?

– Weigh up one aspect of the situation against another?

– Express a clear personal view on the matter, as distinct from repeating what someone else thinks they should do?

– Be reasonably consistent in their view on the matter, or are they constantly changing their mind?

5.6.5 In most cases, where a child cannot consent or where a clinician has assessed that they are not competent to consent, a person with parental responsibility should be asked to consent on behalf of the child or young person, if this is necessary to ensure the child or young person’s best interests are paramount.

6. 6 Where parental consent is required, for example, when making a referral related to the child’s developmental needs under the auspices of s.17, the Children Act 1989, the consent of one parent is sufficient. In situations where family members are in conflict, clinicians should discuss with supervisors, managers and/or Service Safeguarding Leads and in the absence of the aforementioned the Named Professionals to decide whose consent should be sought. If the parents are separated, the consent of the resident parent would usually be sought but this might be additionally complicated by the implications of the Children and Families Act 2014.

5.6.7 The matter of consent can also be conflictual and ethical according to the potential short/medium and long-term consequences. In these circumstances, staff are advised to engage with the Named Professionals and their senior clinical leads.

5.6.8 In cases where there is conflict between the wishes of the parent and the child, particularly if the child/young person is older, clinicians should make a decision aimed at securing the best outcome for the child/young person. Acting in the best interests of the child/young person, may require overriding refusal to consent or consent that has been given by the child, young person and their parents or carers. The ability to override, should always be exercised when there are child protection concerns, i.e. s. 47, Children Act 1989 or other public interest matters related to risk, including forms of self-harm that are deliberate, where lethality and toxicity are central components and mental capacity issues might obscure the service user from giving consent at a particular point, which should always be subject to review. In addition, there are circumstances, where a child or young person has given consent but in some circumstances because of their age and understanding could not be reasonably expected to understand the import of their consent. In these circumstances, discuss with your Service Clinical Leads and the Named Safeguarding Professionals.

5.6.9 Trust clinicians should always record whether consent has or has not been sought, whether consent has been given or refused and should confirm these processes in writing to eligible children, young people and their parents. In addition, Trust staff should record the process of consent and any pro-formas used in the process.

5.6.10 The need to renew consent should be reviewed, and patients, who have previously provided consent should be kept informed of circumstances in which their data may be shared. Note the important caveat, the Trust seeks to work in partnership with all service users, however, when there are s.47 concerns related to significant harm, the Trust is no longer bound to seek consent but will endeavour to do so, as long as this is in the best interests of the child.

Sharing Information Checklist

5.7.1

1) Is there a legitimate reason to share information?

Is there a necessity to identify the individual?
If the information is confidential, has consent been obtained?
If consent to share information is refused, do the circumstances meet the ‘public interest test’.

Informing or referring to Children Social Care should be undertaken by the allocated clinician or Case Consultant.
Where the case is already known to Children Social Care, the allocated clinician or the Case Consultant will need to speak to the allocated social worker or their line manager, which if related to a s.17 or s.47 should always be subject to a formal referral.

6.3 Where the case is not known to Children Social Care, the allocated clinician or Case Consultant should refer to the local Multi-Agency Safeguarding Hub (MASH). In the case of Camden, the details are:

Contact Name

Duty Manager

Telephone 020 7974 3317. Out of hours: 020 7974 4444

E-mail LBCMASHadmin@camden.gov.uk

6.4 Referrals using email should be undertaken using secure email or when servers are not compatible, for example, currently NHS and Local Authority networks are not secure, when sending information between the two agencies. Always send information via encrypted email and send the password separately. In other words, do not send the document and password in the same document. Clinicians should always seek a ‘confirmation receipt’ of any referral within two days’. For urgent referrals, follow up should be immediately undertaken by seeking confirmation by email or telephone.

6.5 A private fostering arrangement is one that is made privately (without the involvement of a local authority) for the care of a child under the age of 16 years (under 18, if disabled) by someone other than a parent or close relative, in their own home, with the intention that it should last for 28 days or more. The local authority has a legal duty to assess any such arrangement. Therefore, all such cases should be referred to Children Social Care, please seek team/service based safeguarding resources and advise the Named Professionals.

Information Checklist when making a Referral to Children Social Care

6.6.1 1) Full Names, D.O.Bs and gender of children and adults living in the Household

2) Address of Family Home, GP and School(s)

3) Identity of Adult with PR (parental responsibility)

4) Ethnicity, First Language and Religion

5) Salient Events in Family History

6) Cause for Concern

7) Any Special Needs of Child or Parent

8) Child’s Current Whereabouts

9) Details of the Alleged Perpetrator and Relationship to the Child

10) Other Agencies currently, or in the Past, involved with the Family

11) Parental Agreement to the Referral obtained or not.

6.6.2 Referring clinicians must always specify the status of a referral, i.e. s17 or s.47 when applicable, and even when the pro forma online form does not stipulate for the referrer to do so. Secondly, the referrer must stipulate what outcome is sought.

6. 3 Tasks Usually Undertaken by Children Social Care When There are Child Protection Concerns

Children Social Care will:

Team Manager will hold strategy discussions by telephone);
Check whether there is already salient information about the child within the Local Authority and request checks for information from the The Local Authority should adopt a child-centred approach and to ensure that the wishes and feelings of the child are known under the Children Act 1989 as amended by section 53 Children Act 2004;
Consult with other agencies that have direct knowledge of the child and family;
Decide whether a meeting is necessary and if so whether it should be a Strategy Meeting or Professionals’ Meeting;
Convene a Strategy Meeting with local agencies, (in urgent situations the Children Social Care Plan who and when investigations/assessments will be done. This will include considering the part played by professionals in the local authority where the child is residing and any other authority involved; if the child is subject to a Care Order and work in conjunction with the police to achieve a best interview (ABE), if required; if it is clear there no child protection concerns, Children Services will record on the file the decision not to proceed and consider any other actions, which may be required to safeguard the child’s needs and
Alternatively, the Strategy Meeting/Discussion may decide to commence a child protection investigation under section 47, Children Act 1989.

Tasks for Trust Professionals

6.7.1 Trust clinicians need to be prepared to give information to the Police and Children Social Care within the context of professional meetings. If you have doubts, speak to your Service Leads

6.7.2 Attend Strategy Meetings and Conferences as necessary. This is not just important because we may be the referrers but Trust staff may be able to provide a major contribution in considering the issues concerning the child, e.g. development, mental health state, emotional vulnerability, functioning of the family and parental capacity.

6.7.3 Prepare reports for Child Protection Initial and Review Conferences.

6.7.4 Requests or Court Directions for court reports should always be discussed with Case Consultants, Team Managers, Service Managers and the Caldicott Guardian.

6.7.5. If it is clear there are no child protection concerns, there must be a record on the patient’s CareNotes record as to why the decision to proceed no further has been made.

6.7.6 To assist and participate in any Serious Case Review (SCR) now amended as from 29^th September 2019 to Safeguarding Panel Review (SPR) and the Child Death Overview Panel (CDOP) is now Child Death Review (CDR) conducted under the auspices of Local Safeguarding Children Partnerships (LSCPs). Each local authority will have a (LSCP). The Trust is a member of the Camden Safeguarding Children Partnership (CSCP). See the link below to their website: https://cscp.org.uk/

Out of Hours Advice

6.8.1 If a concern arises after office hours (after 5 pm. or at the weekends) consideration must be given as to whether the local Children Services Out of Hours or Emergency Team should be informed at once rather than waiting until the next working day.

6.8.2 Camden Out of Hours or Emergency Team can be reached by phoning the local authority and asking for the Out of Hours or Emergency Team, (0207 974 4444). If you are dealing with a non-Camden child, you must contact the local authority where the child ordinarily lives.

6.8.3 If there are any difficulties in getting through, particularly in cases of emergency – where there are concerns about serious harm – call the police.

6.8.4 If a child or young person attends any Trust site and it is evident that they are in need of immediate medical care, Trust staff must alert either a Trust staff member, who is a nurse or doctor, or in their absence call an ambulance.

Allegations made against staff students honorary workers and trainees

7.1 If an allegation is made against a member of staff this must be taken as seriously as any other allegation and treated in the same way.

7.2 Staff who hear or witness abuse caused by a staff member/trainee/honorary or volunteer worker should record their concerns and report the matter immediately to their Team Manager, who must notify their Service Line Manager and Director, who should advise the Named Professional for Safeguarding Children.

7.3 If the allegation is against the Team Manager, the Service Manager and Divisional Director should be informed.

7.4 The staff member against whom the allegation is made should be informed of this by the Divisional Director and Service Manager.

7.5 The Trust’s designated senior officer (DSO), the Executive Medical Director should not investigate the matter or interview the member of staff, child or potential witnesses. The primary task of the DSO is to ensure there are written records, which are dated and signed by the person reporting the allegation and any potential witnesses.

7.6 Before any referral to the Local Authority Designated Officer (LADO) or Designated Officer (DO) is made one of the following criteria must be met, this should not be deterred by the staff member’s resignation:

behaviour that has harmed a child or may have harmed a child;
possibly committed a criminal offence against or related to a child;
behaved towards a child or children in a way that indicates they are unsuitable to work with children.

7.7 The relevant Clinical Director and the Named Professionals should be notified, if any of the above criteria are met. The Local Authority Designated Officer must be advised if the appropriate criteria are met. The LADO will provide over-arching guidance as to the management of any investigative processes.

7.8 Where there is not sufficient substance in an allegation to warrant a child protection investigation, there should be an internal inquiry to consider whether the behaviour of the professional or member of staff should be addressed by further training/supervision or disciplinary proceedings. The processes governing an allegation that is subject to investigation will be clearly segmented in the Trust Managing Allegations Against Staff Procedure, which is being drafted.

7.9 Either the Case Consultant, Team Manager, Service Line Manager or Divisional Director will meet with the parents/carers with or without the young person as appropriate, to inform them of the proceedings.

7.10 Note, this procedure relates to current allegations involving children, please refer to the London Child Protection Procedures, 2017 regarding non-recent/historical child abuse and contact the Named Professionals.

7.11 Staff should also be aware of the Trust’s Whistle-Blowing procedure, which can be found in the suite of policy documents on the Trust’s Intranet.

7.12 Staff can also raise concerns with the Trust ‘Freedom to Speak Up Guardian.

7.13 In addition, staff can access an independent charity (Public Concern at Work) whose lawyers can provide free confidential advice about how to raise a concern about malpractice at work: www.pcaw.co.uk.

8.1 The statutory responsibility for investigating any suspected child abuse lies with two agencies Local Authority Children Social Care and the Police Child Protection. Children Social Care has a duty to investigate where there is any cause for concern that a child or young person may have been abused and the Police have a responsibility to investigate criminal acts.

8.2 Investigations are carried out under section 47, the Children Act 1989 in

partnership with the parents/carers so long as such investigations do not prejudice the welfare of the child.

8.3 The following are the guidelines for their investigations:

The scope of the enquiry, including siblings and other children at possible risk of harm;
The need for any paediatric or specialist assessment;
How to meet the best interest of the child/ren or young person in the enquiry, taking into account any additional needs such as arising from disability or a need for an interpreter and speech and language difficulties;
How the child’s wishes and feelings will be ascertained so that they can be taken into account;
When, how and who will undertake interviews with the children and if an Achieving Best Evidence (ABE) interview will be required;
Any further action if consent for an interview or medical assessment is refused;
The needs of other children and young people in contact with the alleged abuser/s including all children and young people within the household;
Who other than the family should be interviewed, by whom, when and for what purpose;
Agree what other actions may be needed to protect the child or provide interim services and support, including securing the safe discharge of a child in hospital, what information may be shared, with whom and when taking in account the possibility of information sharing placing a child at risk of significant harm or jeopardising police investigations;
Any legal action required;
The need for further strategy meetings/discussions;
Timescales, agency and individual responsibility for agreed actions, including the timing of police investigations and relevant methods of evidence gathering.

8.4 In special circumstances, for instance, where a child or young person’s mental state is of concern, the child or young person has a disability or particular learning difficulties, or the child is very young, professionals from specialist child mental health services (CAMHS) may be asked to consult or undertake these interviews.

8.5 The investigation establishes the facts and assesses the level of risk to the child or young person and any other under 18 year olds or vulnerable persons in the same household.

8.6 Throughout the investigation all professionals should keep an open mind about the concerns.

8.7 The number of investigations/examinations of the child or young person’s should be kept to the minimum necessary to clarify the child or young person’s situation.

8.8 Parents/carers and other key family members are consulted and informed at all stages of the investigation unless it is clearly in the interests of the child that there should be some delay in doing so. This consultation /information giving must extend to all those with parental responsibility in so far as is possible.

8.9 Issues of gender, race, sexuality, culture, religion, language, and disability must be taken into account.

8.10 Interpreters should be used where English is not the language used by the family or where the child/young person or parent has specific communication needs. Note: Children and young people have the right under the Criminal Justice Act: Memorandum of Good Practice 1992 to be interviewed in their first language.

8.11 If the investigation is a part of an assessment in the course of court proceedings, leave of the Court must be sought in advance for any examinations.

8.12 Detailed contemporaneous records must be kept by all involved and must clearly differentiate between fact, reported information and opinion.

8.13 Professionals are advised to keep fact and opinion clearly delineated in the patient’s record.

Child protection conferences

9.1 Child Protection Conferences are convened under the procedures of the relevant local authority. The Initial Child Protection Conference decides whether the child or young person is at risk of abuse whether a child protection plan is required and, if so, the membership of the child protection core group.

9.2 Thereafter, the Review Child Protection Conference should review the

progress of the Child Protection Core Group focused upon the child or young person’s safety; the child or young person’s needs, the capacity of the parents/carers and their ability to meet the child or young person’s needs; parental/carer understanding of professionals’ concerns and their ability to change.

9.3 Parents/carers and other family members are invited to attend Initial and Review Child Protection Conferences unless there are valid reasons for excluding them.

9.4 It is essential that key Trust staff attend these Conferences.

9.5 Trust staff must be alert to a child being subject to a Child Protection Plan for more than two years and/or having a history of child protection plans and discuss these matters with the Case Consultant or the Named Doctor or Named Professional.

9.6 Subject to the Trust being in receipt of an invitation and the appropriate clinician is unable to attend, the Trust expects the conference process to be provided with a report.

Role of Trust staff during initial and review conferences

10.1 Following an Initial or Review Child Protection Conference, the Trust may continue to have a significant role with the child or young person and his/her family as part of the Child Protection Plan. Apart from continuing any existing treatment, this may include any of the following:

Contributing to the comprehensive assessment of the child, young person and family or adult
Carrying out further specified investigation
Providing therapeutic treatment
Providing reports for Court (subject to the Directions of the Court)
Attending Court (subject to the Directions of the Court)
Be available for consultation, by phone if need be, to discuss interviewing the child or young person to assist police and social work colleagues.

10.2 Legal advice and support in the preparation of Court Reports and the giving of evidence can be obtained from the legal team of the relevant Local Authority, and where specific advice is sought, speak to line managers.

10.3 In addition, staff have access to the Trust’s solicitors where specific advice is sought and when there is a legitimate concern about legal advice being given where they might be a conflict of interest.

10.4 Managing Professional Dissent (See London Child Protection Procedures, 2017)

10.4.1 Professionals providing services to children and their families should work co-operatively across all agencies, using their skills and experience to make a robust contribution to safeguarding children and promoting their welfare within the framework of discussions, meetings, conferences and case management.

10.4.2 All agencies are responsible for ensuring that their staff are competent and supported to escalate appropriately intra-agency and inter-agency concerns and disagreements about a child’s wellbeing.

10.4.3 Professionals should attempt to resolve differences through discussion and/or meeting within a working week or a timescale that protects the child from harm (whichever is less).

10.4.4 If professional differences remain unresolved, the matter must be referred to the heads of service for each agency involved.

10.4.5 In the unlikely event that the issue is not resolved by the steps described above and/or the discussions raise significant policy issues, the matter should be referred urgently to the LSCP for resolution. See also Local Safeguarding Children Partnership: Procedure, Monitoring and evaluation function. For those clinicians who work within Camden, please see the icon below regarding the Camden Escalation Procedure:

10.4.6 For Trust staff working in other boroughs, please revert to procedures local to your place of work, and if in doubt discuss with your supervisor, Team Manager, Service Safeguarding Lead, and if all the aforementioned are not available, revert to the Safeguarding Team.

10.4.6 Professionals in all agencies have a responsibility to act without delay to safeguard the child (e.g. by calling for a case to be allocated or for a strategy meeting/ discussion, for a core group meeting or for a child protection conference or review conference).

10.5 Management When There is a Threat of Violence

10.5.1The Case Consultants, Team and Service Managers should be informed whenever there is considered to be a risk of violence either to a child or young person or to any other person so that appropriate arrangements for security e.g. alerting Trust support staff. In the exceptional circumstances, where it is thought that there is a high risk of violence, to cancel appointments until there is a clear plan. However, this should be discussed with the Divisional Director prior to any appointment being offered.

10.6 Supporting Staff Involved in Cases where there are Child Protection Concerns

10.6.1 The Trust recognises that involvement in any aspect of child protection can be stressful for staff. It is therefore committed to offering help and support for any staff member who have concerns. Staff are advised at Trust Induction events of the Staff and Student Advisory Service, which can be accessed by any member of staff, where a trained professional will offer one-to-one support. In addition, staff should raise concerns directly with the Case Consultant, Team or Service Manager, Service Safeguarding Leads or the Named Professionals.

Supervision

11.1 ‘Supervision can be described as the working relationship between professionals whereby supervisees are supported to offer an account of their work, reflect on it, receive feedback and guidance where appropriate. The purpose of supervision is to enable workers to make sense of their work, to gain in ethical competency, confidence and creativity to give the best possible service to their clients’,(Inskipp and Proctor, 1993).

11.2 All staff who have children identified as being in need, (EHCP & CIN) or are LAC or subject to child protection concerns, and where there are child protection plans, staff should receive specific safeguarding supervision from either the Case Consultant or the Team Manager, or a staff member with designated safeguarding supervision responsibilities. All child protection plans are to be subject to at least a quarterly safeguarding supervision session. Safeguarding supervision can be provided either on a one to one basis or via team based discussion. Supervisors should not be wholly reliant on team-based discussions in the management of safeguarding and child protection cases: there should be 1:1 oversight to maintain good and safe practice. Safeguarding supervision needs to be recorded onto patient notes using the relevant CareNotes form.

11.3 The supervising clinician must ensure the case file is up to date; the allocated clinician attends relevant meetings and conferences, and where there is dissent regarding any multi-agency decision-making this is accurately recorded on the case file. In circumstances, where clinical supervision occurs outside of the team or service management structures, it is the team or service manager’s responsibility to ensure that either they or via delegated authority, the supervising clinician must take responsibility. Any concerns regarding the supervisory management of a safeguarding or child protection matter should be escalated via the Named Doctor or Named Professional.

11.4 The supervising clinician needs to ensure all children in need and child protection conferences are provided with an up to date Trust report and that the Trust’s interventions are congruent with any developmental and or safety plans for the child or young person.

11.5 If a child or young person is subject to a child protection or child in need plan for more than two years’, this must be raised during multi-professional planning meetings to ensure cogent and safe care planning is extant and the Named Professionals should be informed.

11.6 It is the supervisor’s responsibility to ensure supervision and any relevant decision-making therein is recorded on the case file via CareNotes.

Assessing cases

12.1 Staff are required to complete appropriate Clinical Assessments Forms, including the Safeguarding and Risk Assessment Form. The aforementioned forms must also be refreshed regarding any change of circumstances. Always update CareNotes using a new form and do not edit existing forms because past information will be lost.

12.2 Staff must ask appropriate questions if there are any concerns highlighted through the referral process or matters that might arise during the assessment and treatment processes regarding the following:

12.3 Please inform, without delay, the Named Doctor and the Named Professional regarding any cases of known or confirmed FGM irrespective of age; email: Safeguarding@tavi-port.nhs.uk. If you are in doubt ring: 020 8 938 2906 or 020 8 938 2434 or 020 8938 2623.

PREVENT

13.1 Trust Staff must be alert and vigilant regarding any suspicions or disclosure of radicalisation into terrorism. From 1^st July 2015, there is a statutory duty to refer all concerns or disclosures to the Local Authority Prevent Lead. Staff should first undertake a referral by informing the Trust Prevent Lead and the Named Safeguarding Professionals.

Young carers

14.1 The Children and Families Act 2014 (s.96) and the Care Act 2014 (s.63) places a statutory duty on local authorities to take ‘reasonable steps’ to identify young carers in order for them to have a needs assessment. Please note, a young person who provides care via a contract or as a volunteer is exempt.

14.2 Statutorily, a young carer is defined as a ‘person under 18 who provides or intends to provide care to another person’. This includes ‘providing practical or emotional support’

which is ‘not under or by virtue of a contract or of voluntary work’ (Children and Families Act, 2014) More broadly, a carer is ‘somebody who provides support or who looks after a family member, partner or friend and who needs help because of their age, physical or mental illness or disability’ (Care Act, 2014).

14.3 Barnardo’s, for example, point to the mental health ill-effects of being a young carer. Trust staff need to be mindful to ask, when appropriate regarding any caring responsibilities children t0 young people might be exposed to within their family networks.

(See ‘Still Hidden, Still Ignored, 2017’ Barnardo’s Publication)

https://www.barnardos.org.uk/sites/default/files/uploads/Still%20Hidden%20Still%20Ignored%20Barnardo%27s%20young%20carers%20report.pdf

Child deaths

15.1 See Appendix E.

Lampard assurance

16.1 The Lampard Report has required reassurance from all NHS sites to ensure all visitors and service users are managed appropriately and take careful note that no-one because of their perceived celebrity or VIP status has unwarranted access to Trust service users or property.

Trust safeguarding structures

17.1 Safeguarding is a crucial and central part of all our practice and contributes to the high quality of all our interventions. We have been working to enhance safeguarding support throughout the Trust in the past year. Team supervisors and leaders will often be able to provide the required advice and support in these scenarios.

As part of the new Trust Safeguarding Structure we have identified Safeguarding Champions within many teams who have an important role in flagging issues and scenarios when safeguarding needs to be considered. Also, we have now nominated Safeguarding Service Leads who have greater interest in and experience of safeguarding issues in the context of local practice in operational teams.

17.2 In addition, the Trust has school premises – Gloucester House – that has the embedded structure of a Designated Safeguarding Lead (DSL). The school is also part of the Camden-wide provision and is also subject to local authority safeguarding assurances. The Gloucester House Safeguarding Procedure, 2021 can be found at Appendix F. of this document. See also the following link:

https://static1.squarespace.com/static/536222cbe4b00f49de2ae2b8/t/5f7b75248ab0a60fed36c51a/1601926445953/Safeguarding+and+Child+protection+policy+and+procedures+for+Gloucester+House.pdf

17.3 The Trust also has a Clinical and Professional Training Dept, which is required to be compliant with all Trust policies and procedures.

Safeguarding Structure Map

The Trust Safeguarding team can be contacted via email at safeguarding@tavi-port.nhs.uk .

Managing press involvement

18.1 If there is a possibility of the Press seeking information regarding a case where the Child Protection process is actually or potentially progressing then it is essential that legal advice is sought from the relevant Local Authority where the child resides. In these circumstances, staff should consult with the Case Consultant or Team/Service Management and the Named Professionals.

Implementation of policy and training requirements

19.1 This policy will be made available to staff via the Trust intranet and the content of the policy will be communicated through induction training and mandatory training sessions for all staff.

19.2 The Named Professionals will ensure that all child protection training programmes are reviewed and updated annually and in line with current legislation to provide practitioners with skills appropriate to their needs. The Trust will access Camden Safeguarding Children Partnership Training Programmes which provides Level 3 multi-agency training for practitioners who are directly working with children and families.

19.3 The Trust has determined via a training needs analysis process the following arrangement for staff training based on the Intercollegiate Safeguarding Children and Young People : Roles and Competences for Healthcare Staff January 2019 and has set out the following mandatory training requirements for staff.

Category	Intercollegiate group description	Trust group description	Frequency
Level 1	‘All non- clinical staff working in health care settings’	All staff	2 yearly as part of mandatory INSET training (training delivered by Safeguarding Lead)
Level 2	Level 2: All administrators who have contact no matter how brief with children and their families or cares	All Administrators with patient contact	Once and then 3 yearly refresher (training delivered by Safeguarding Lead)
Level 3	‘All clinical staff working with children, young people and adults and/or their parents/carers, who could potentially contribute to assessing, planning intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding concerns’	All clinical staff in CYAF, Adult and Portman services	Once and then three yearly refresher (training delivered by Safeguarding Lead or received by attending Camden Safeguarding Children Partnership or other trainings, subject to Trust agreement

19.4 Review of Training as Part of Annual Performance Review

Managers undertaking individual performance reviews of staff must include reference to mandatory safeguarding children training according to the appropriate level for their role and ensure that the individual’s Professional Development Plan incorporate appropriate training requirements and arrangements are made for staff to access relevant training.

19.5 Appraisees and Appraisers must ensure all required safeguarding children training is up to date and plan training attendance as part of any appraisal discussion.

19.6 If staff receive a request from HR to attend safeguarding children training, they must do so in a timely manner.

19.7 Transfer of Previous Training

Staff who have previously worked in health and social services and are employed in a clinical role where an advanced safeguarding child training is required must complete Trust-wide and local induction training. However, if in a previous role a member of staff has completed an advanced updating session within the previous twelve months then they will be exempt from further training for the first year of employment subject to documentary proof of training.

Process for monitoring compliance with this procedure

20.1 The Trust will monitor compliance with this policy and procedures in the following way:

the Staff Training and Development Committee will monitor uptake of child protection training as part of their continual monitoring of mandatory training and report compliance of this to the Corporate Governance and Risk group of the IGC. The group will refer training issues to the Management Committee if necessary;
the Named Doctor for Safeguarding will provide an annual report to the Patient Safety and Clinical Risk group of the IGC who will provide assurance of compliance it to the Board via the IGC. This report will address any externally imposed changes in relation to safeguarding children procedures. In addition, they will highlight any issues that have arisen in respect of either safeguarding children or the delivery and uptake of training in line with the requirements set out in the policy;
the Named Professional for Safeguarding Children will review any incidents relating to Safeguarding and report concerns/investigations/lessons learned to the Patient Safety and Clinical Risk Lead;
the Named Doctor will be responsible for adding any specific safeguarding children risks to the Operational Risk Register as they arise and this Risk Register will be monitored through the Trust’s Risk Management Procedures;
The Named Professionals will undertake a spot check audit of cases with Child Protection concerns to ensure that the records show that all relevant procedures have been followed. If this audit raises concerns the named professional will make recommendations to the Patient Safety and Clinical Risk Lead and an action plan will be developed and Any action plan will be monitored by the Patient Safety Sub Group.

References

Intercollegiate Document, 2019

London Child Protection Procedures, 2017

Working Together to Safeguard Children, 2018

Camden Safeguarding Children Partnership Safeguarding Arrangements, 2019

NICE Guidance, NG76, 2017

Child Death Review Statutory and Operational Guidance (England), 2018

NICE Guidance, 2016 Domestic Abuse

What to do if you’re Worried a Child is being Abused: Advice for Practitioners, 2015

When to Suspect Child Maltreatment CG89, 2009