ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
REPORT TO THE TRUST BOARD
Paper Title:
Safeguarding children annual report March 2013
Sponsoring Director:
Alison Robertson, Chief Nurse and Director of
Operations
Authors:
Caroline Beazley, Named Nurse for Safeguarding
Children, Community Service
Geraldine Fraher, Named Nurse for Safeguarding
Children, the Acute Service
Marion Louki, Named Midwife for Safeguarding
Children
To review the activity for safeguarding children
across the trust
Purpose:
Action required by the board:
For information
Document previously considered by:
Executive summary
1. Key messages
 Safeguarding children and promoting their welfare is a priority.
 The Trust’s commitment to safeguarding children has been demonstrated by the positive
feedback from the Wandsworth Safeguarding Children Board Section 11 audit of July
2012 report which highlighted St George’s Healthcare NHS Trust as an agency with
strong evidence of safeguarding activity and outcomes
 The recent unannounced inspection by the CQC which found the trust to be complaint
with the standard for safeguarding which is a further endorsement of the trust’s
safeguarding children arrangements
 There is an appropriate structure of dedicated practitioners who provide a team approach to
safeguarding children and promoting their welfare.
 The safeguarding children training programme has been revised for 2013 and an action
plan is underway to address the shortfall in training targets for staff at all levels
 Meeting the health needs of looked after children is a priority for the Trust while the
revision of the service provided is kept under review
 Actions from serious case reviews (SCR), individual management reviews and a serious
incidents are being addressed and learning shared
 The trust is actively represented in the wider safeguarding arena and is committed to
integrated working with our colleagues from other agencies.
2. Recommendation
To note the report for information and to receive this as assurance that focus is given to
safeguarding children and young people.
Key risks identified:
None
Related Corporate Objective:
Reference to corporate objective that this
paper refers to.
1 – Maintain and further improve patient safety
Related CQC Standard:
Outcome 7
Reference to CQC standard that this paper
refers to.
Equality Impact Assessment (EIA): Has an EIA been carried out? ( Yes )
If yes, please provide a summary of the key findings
If no, please explain you reasons for not undertaking and EIA.
Appendix A:
1. EQUALITY IMPACT ASSESSMENT FORM – INITIAL SCREENING
Headline outcomes for the Equality Delivery System (EDS)
 Better heath outcomes for all
 Improved patient access and experience
 Empowered, engaged and well-supported staff
 Inclusive leadership at all levels
Service/Function/Policy
Directorate /
Department
Assessor(s)
New or Existing
Service or Policy?
Date of
Assessment
1.1 Who is responsible for this service / function / policy?
Chief Nurse and Director of Operations, Medical Director
1.2 Describe the purpose of the service / function / policy?
To ensure that the organisation complies with any statutory guidance and legislation and to have
effective systems in place to safeguard children and young people.
1.3 Are there any associated objectives?
There is a broad range of local and national guidance and legislation which must be taken into
account.
1.4 What factors contribute or detract from achieving intended outcomes?
That staff are not aware and do not feel confident to know what to do if there are concerns about the
safety and wellbeing of children and young people.
1.5 Does the service / policy / function / have a positive or negative impact in terms of the
protected groups under the Equality Act 2010. These are Age, Disability ( physical and mental),
Gender-reassignment, Marriage and Civil partnership, Pregnancy and maternity, Sex /Gender,
Race (inc nationality and ethnicity), Sexual orientation, Religion or belief and Human Rights
The function is aimed at all of our patients/service users.
1.6 If yes, please describe current or planned activities to address the impact.
1.7 Is there any scope for new measures which would promote equality?
1.8 What are your monitoring arrangements for this policy/ service
1.9 Equality Impact Rating [low,]
2.0. Please give you reasons for this rating
1
Safeguarding Children Report
April 2012 – March 2013
Introduction
This is the annual report to the Board concerning safeguarding children and young people and
child protection arrangements within St George’s Healthcare NHS Trust for the year ending April
2013. This report highlights how the trust responds to and reports on allegations of abuse and
neglect and how we ensure that safeguarding children is integral to everyday practice. While the
safeguarding children team in the acute, the community service and the maternity services work
closely together, there are some areas of practice that are specific to individual aspects of the
service and as such will be reported separately.
1 Safeguarding Children Organisational Structure
The Trust has an established organisational structure in place for safeguarding children which
demonstrates good governance arrangements and a clear line of accountability. The structure
of the team remains unchanged while two members of staff have been appointed in the
community to vacant posts. The safeguarding children team continues to provide consistent
support and advice for staff while ensuring that our practice is safe and grounded in evidenced
based practice.
2 Clinical Policies, Procedures and Guidance
2.1 The statutory guidance Working Together to Safeguard Children 2013 has just been
published and the key changes to practice are being assessed by the safeguarding team. The
contents of the revised document will be instrumental in identifying which of our internal policies
and procedures will need to be updated. The safeguarding team will be working with the
Wandsworth Safeguarding Children Board (WSCB) to identify aspects of practice and
procedures that will be affected by the new guidance and how these changes will impact on the
current practice within Health.
2.2 Aside from the changes to the trust’s safeguarding children policies and guidance that will
result from the issue of Working Together 2013, the guidelines that are about to be revised are
those related to information sharing and legal aspects of safeguarding children.
2.3 In response to the new guidance in Working Together to Safeguard Children the London
Child Protection Procedures will be revised during 2013. All health providers will be invited to
contribute and comment during this process which is likely to produce the final version in 2014.
2.4 The safeguarding children site on the intranet provides staff with up to date information
about safeguarding children as well as easy access to policies, guidance, documentation and
training.
3. Representation and Partnership
3.1 The Trust is represented on the Wandsworth Safeguarding Children Executive Board
(WSCB) by the Chief Nurse and Director of Operations, while the named doctor and nurses
2
attend the Wandsworth Safeguarding Children Board and the named midwife represents the
Trust on the Merton and Sutton Safeguarding Children Board.
3.2 The Trust’s safeguarding team are actively involved in several inter-agency groups and
committees and continue to work with our partner agencies on the broader safeguarding
children agenda.
3.3 There are strong links with other health providers such as the Mental Health Trust and the
local GP network. The Clinical Commissioning Groups are now in place and the safeguarding
children team looks forward to working with the commissioners on the safeguarding children
agenda.
3.4 Specific areas targeted for multi-agency working are as follows:
 Child sexual exploitation
 Gang activity
 The introduction of the signs of safety approach
 Learning from case reviews
3.5 The Community Services are focussed on children living in Wandsworth, children registered
with a Wandsworth GP and those attending the borough’s schools. The quarterly Wandsworth
Safeguarding Children Board meetings are attended by the associate director of children and
families and the named nurses for the community and the acute service.
3.6 Community operational managers in specialist and universal children’s services meet
quarterly with operational managers in Wandsworth Children’s Specialist Services (WCSS)
where updates and issues are discussed. In addition the community named nurse or child
protection/safeguarding advisor spend a session a week in WCSS Referral and Assessment
team which supports liaison about new referrals. The named nurse for community now attends
the Missing Children Group, SEMAP (Sexual Exploitation Multi Agency Panel), MARAC (Multiagency Risk Assessment Conference), the Multi-agency Audit Group, Serious Case review subgroup, Domestic Violence Forum, Training sub-group, CLA Overview Group, Gangs and Sexual
Exploitation and Signs of Safety Steering Group. The Child Protection/safeguarding Advisor will
be attending the Private Fostering group.
The London Borough of Wandsworth Children’s Specialist Services is taking forward plans to
implement the Signs of Safety Framework and the health safeguarding team are involved in the
strategic planning of this which includes having commissioned health specific training for health
professionals both in the acute and community divisions of St George’s.
4 Clinical Governance, monitoring and performance
4.1 The Trust continues to ensure that arrangements are in place to meet the Section 11 of the
Children Act 2004 (HMSO 2004) requirements. The inspection in May 2012 by the Care Quality
Commission (CQC) and Ofsted came to the conclusion that the local arrangements were ‘good’
and that there were only minor actions for the trust to address. The CQC unannounced
3
inspection in January 2013 of the St George’s Hospital site demonstrated that the standard for
safeguarding children and adults was met.
4.2 The Wandsworth Safeguarding Children Board (WSCB) Section 11 audit in May/June 2012
was reported in January 2013. The trust was identified by the auditor as an organisation that
had provided a detailed audit with good evidence of activity and outcomes. The result of the
audit has highlighted areas where all partner agencies could make improvements as follows:

How clearly are the agency’s/organisations
communicated to all staff?

How effectively does service development take into account need to safeguard? How
effectively informed by views of children and families? How can you demonstrate
improved outcomes?

How effective is inter-agency working by your organisation? How do you demonstrate
improved outcomes as a result?
responsibilities
towards
children
The acute service has an action plan in progress to address the specific areas that the audit
raised for the trust.
4.3 The WSCB Task and Finish Group and the Monitoring Sub Group are both instrumental in
holding partner agencies to account although at this time there are no specific issues for the
trust. The trust is represented on these two groups and active participation will ensure that the
trust is challenged to produce evidence of safeguarding activity and outcomes.
4.4 The Acute Service Children and Young People’s Safeguarding Committee meets every six
weeks and functions as the operational body for safeguarding children. Information from this
meeting is reported to the strategic committee chaired by the Chief Nurse and Director of
Operations. The acute service safeguarding children training group, community safeguarding
committees and information from other multi-agency meetings are also reported into the
strategic meeting so that there is a central point of governance and challenge.
4.5 The community meetings
The community division has a Divisional Governance Safeguarding Meeting which covers both
children and adult services in the community; this meets three times a year. The named nurse
attends the community Children and Families Management Team meetings which are held
monthly; this has a standing agenda item on safeguarding and feeds into the Divisional
Governance Board and the Safeguarding Children’s Committee for the trust.
The Safeguarding team meets quarterly. A safeguarding supervisor’s business meeting has
been meeting bi-monthly although this is under review for 2013/14.
The community team now has representation at the maternity antenatal meeting and the A&E
safeguarding meeting to ensure good communication with community staff and maternity/A&E
staff regarding relevant cases.
4.6 The maternity meetings
A multidisciplinary antenatal safeguarding team meeting is held fortnightly with representatives
from children’s specialist services (CSS), mental health, midwifery genetics neonatal, and
liaison health visiting to discuss current and future cases. A monthly supervision meeting is
4
held with the safeguarding team, as well as a monthly safeguarding team meeting including the
mental health specialist midwife and a representative from the Jade (Teenage) Team.
The Acute Service
4.7 The volume of cases managed in the acute service continues to be significant and is
demonstrated by the information provided in the grid below.
Safeguarding children activity in the acute service April 2012 – 2013
Aspect of safeguarding activity
Number of cases
Children with Child Protection plans - admissions
Children looked after - admissions
Child protection referrals – admissions
Child in need referrals - admissions
Child & Adolescent Mental Health referrals
Child protection medicals – out patient
Sexual abuse medicals – out patient
Adult issues (parents/carers) - admissions
Total number
Number of cases documented by named nurse
(excluding Emergency Department cases not admitted)
36
37
123
78
75
67
5
30
486
466
4.8 The acute service has a vital and pivotal role in managing safeguarding particularly as the
issues tends to be diverse, ranging from teenagers who are suicidal, to small babies with
fractures and then a broad spectrum of children and families with low level concerns who
require services.
4.9 Ensuring that the paediatric staff, both doctors and nurses and those specialist teams such
as orthopaedics or plastic surgeons, are supported and able to follow through on the
established processes for the purpose of safeguarding children, continues to be a challenge for
the named professionals, mainly due to the rotation of staff but also the sheer volume of cases.
The planned identification of safeguarding children ‘leads’ for each of these specialist areas will
have a positive impact on this and should increase the team approach to managing
safeguarding situations in both the inpatient and outpatient areas.
4.10 The Emergency Department (ED) has seen an increase in children attending the
department as a natural consequence of the transition of the walk in centre to the urgent care
centre and consequently the numbers of children presenting with safeguarding issues has risen.
The ED safeguarding children meeting which includes the named nurse, the liaison health
visitor, the adult psychiatric liaison service, children’s specialist services and paediatric ED staff,
continues to oversee the safeguarding activity of the whole ED, ensuring that actions are
followed through and that cases are not missed.
4.11 The number of cases discussed at the safeguarding meeting during the last year was
approximately 1,400.
4.12 A safeguarding Children Newsletter has been introduced to the ED and is a means of
raising awareness and sharing learning from actual but anonymised cases.
5
4.13 There are now five ED consultants who are focusing on safeguarding children and who are
keen to review processes and establish specific protocols for some aspects of care such as the
provision of child and adolescent mental health support for children who attend the ED out of
hours. Regular meetings are held with the various consultants who are now in safeguarding
children lead roles, to tackle both specific aspects of children’s safeguarding and the functioning
of the ED generally.
4.14 The provision of a child protection medical service for five days per week had previously
been identified as an area which needed to be addressed as the present service standard is for
three days. The designated doctor has been working on a plan to train the five ED consultants
who have a special interest in paediatric safeguarding to provide a five day service which would
be available in the ED. Although the training is almost complete it has been recognised that
initially it will not be possible for the ED consultants to cover the five days without additional
input and so further discussion is needed.
4.15 Adults presenting in the ED with problems that may impact on their parenting such as
domestic abuse and mental health issues will be identified by the adult ED teams and it is
expected that staff will make referrals for the children in the care of the adult as well as for the
adult themselves. Level 3 safeguarding children training in now the standard requirement for all
ED staff and this training includes specific raising awareness about adult issues and the impact
on children.
4.16 Domestic abuse continues to be a significant feature in the volume of adult trauma cases
and consequently a business plan for a nurse specialist practitioner for domestic abuse for the
acute service who would be based in the ED has been put forward to the commissioners.
4.17 The key performance indicators (KPI) were revised in consultation with the designated
nurse and subsequently approved by the Children and Young People’s Safeguarding
Committee. The KPI data in the new format (January 2013) contributes towards the monitoring
of safeguarding children activity as reported to the various safeguarding children committees.
4.18 A number of audits are taking place which are linked mainly to action plans from serious
case reviews and individual management reviews. The results of these audits are reported to
the acute services children and young people’s safeguarding committee. The Wandsworth
Safeguarding Children Board has requested that the audit activity of partner agencies is shared
which is being auctioned by the named professionals.
4.19 Support in managing safeguarding children issues continues to be available to all
paediatric areas and supervision of cases on a case by case basis is offered by the named
professionals and safeguarding leads. The named doctor and designated doctor have
introduced a supervision programme for the paediatric consultants alongside the weekly
safeguarding children lunchtime meetings. A recent audit of staff safeguarding children
supervision and support in the ED has been carried out the results of which are awaited.
4.20 Managing allegations about staff in respect of child safeguarding issues has been an area
of practice that has been brought to the attention of all acute services staff with the introduction
of the policy. There have been 4 cases where this policy could have applied but current
information identifies just one case that has been investigated under this remit and resolved.
6
4.21 Following the Savile investigation the trust has reviewed certain aspects of patient care
and has identified two actions. The two actions are to ensure that the training of managers
includes specific training on safeguarding children and vulnerable adults and also to review the
pathways whereby persons who are not staff, might be able to access children who are patients.
The named nurse and the divisional director for nursing and governance are addressing these
actions.
Community Services Wandsworth
4.22 In the community service a corporate handout/leaflet which includes information on how to
refer and key contacts in the organisation is given out at induction and all safeguarding children
training.
4.23 A regular safeguarding briefing is sent out to all staff in the community division advising of
both local and national updates for safeguarding legislation, guidance, and information.
Feedback received has been good regarding this initiative.
4.24 A performance matrix is completed quarterly; this includes information about training
uptake, supervision uptake and attendance at child protection conferences.
Maternity Services
4.25 Maternity safeguarding continues to expand. A senior band 6 midwife in antenatal clinic is
now case loading the Ivory team (out of area) women with safeguarding concerns which are not
addressed by the mental health or domestic abuse and substance abuse specialist midwives.
She now forms part of the safeguarding team, and attends the monthly team and supervision
meetings. There is a proposal for the maternity safeguarding team to be located in an office
together to enhance mutual support and awareness of cases of concern
4.26 Closer links are being forged with named midwives at neighbouring trusts for the purpose
of information sharing and dissemination of information about women who may deliver at St
George’s Healthcare but go home to other areas. The named midwife will be attending the
Merton Local Safeguarding Board meetings.
4.27 The new Consultant in Perinatal Mental Health now attends the fortnightly psychosocial
meeting, as does the Consultant Geneticist and a representative from the neonatal unit
4.28 Level 3 safeguarding children training will be offered to all midwives as soon as the training
package has been revised. Level 2 safeguarding training is now offered to maternity care
assistants at their study days. Action learning sessions to reflect on live cases are also being
held, and ad hoc teaching takes place in clinical areas
4.29 In light of some recent challenging cases, awareness has been raised of women who are
asylum seekers, and have no recourse to public funds. A new flowchart has been devised for
midwives to use with women who present as asylum seekers. Meetings have been held with
the overseas patients representative and children’s specialist services, and a new registration
form has been introduced which will clarify at an early stage women’s immigration status so that
early help can be offered.
7
5 Serious Case Reviews (SCR) and Individual Management Reviews (IMR)
For information: a serious case review is conducted at the request of the local safeguarding
children board (LSCB) when a child has died or been significantly harmed. It is a multi-agency
review of how the agencies have worked with the child/ family as well as how the agencies
worked together to support the child/family.
An individual management review can be recommended by LSCB when a case under review
does not meet the criteria for a SCR but issues for one or more individual agencies has been
identified. The agency identified will then conduct a single agency review in order to learn
lessons.
5.1 The acute service is currently contributing towards two serious case reviews and has
identified early action plans prior to the overview reports being written and the formal action
plans being agreed. A third SCR is planned by WSCB and the details of this are awaited.
5.2 The community service are contributing towards one local IMR and it is possible that a SCR
from another locality will request an IMR from the community service as there was some
involvement with the family
5.3 The maternity service has contributed towards one IMR which is ongoing due to the
complexity of the case and pending psychiatric report.
6 The Child Death Overview Panel
6.1 The function of the Child Death Overview Panel (CDOP) is to provide an overview of all
child deaths in the Wandsworth area to ensure that there is a rapid response meeting by a
group of key professionals for the purpose of enquiring into and evaluating each unexpected
child death. The rapid response meetings will also identify what actions may be appropriate to
support bereaved families and the recent appointment of a bereavement counsellor to the panel
will prove to be a most useful resource.
7 Training
7.1 The safeguarding children training strategy describes the requirements in relation to
safeguarding children for all staff throughout the trust. The acute, community and maternity
safeguarding children teams promote training at various levels to suit the needs of the workforce
and aim to provide training that is effective and accessible in both the hospital and community
settings. Inter-agency training is encouraged and both named nurses as well as the designated
professionals are involved in planning and delivering training with other local agencies. The
Signs of Safety approach has been adopted by Wandsworth Children’s Specialist Services as
the system to be employed in their work with children and families. Consequently health service
staff members are also being trained in this approach in order to ensure that our staff can make
a full and informed contribution to multi-agency working with families.
The Acute Service
7.2 Safeguarding children training within the acute service continues to be provided at level 1
(MAST), level 2 and level 3, level 3 being the required level for those working more directly with
children.
8
7.3 The safeguarding children training team within the acute service plan and deliver in-house
training while the named nurse and deputy named nurse are also involved in multi-agency
training as well as taking part in planning local training as members of the Wandsworth Local
Safeguarding Children Training Group.
7.4 The training presentations and contents at level 2 Induction and level 2 for clinical staff has
been revised (2013) and the questions for the electronic MAST safeguarding children training at
levels 1 and 2 have also been prepared by the named nurse. Level 3 training is about to be
revised by the named nurse and the focus for this training will be neglect, the vulnerability of
young children and domestic abuse. In line with other healthcare organisation, there have been
changes to the Induction Programme so that this will no longer comprise of full two days but will
be condensed into a half day programme which does not include face to face safeguarding
children training. A mechanism for assessing staff is being introduced which will test their level
of safeguarding children knowledge and also enable the training and education department to
record and verify details of previous safeguarding children training achieved.
7.5 The named doctor and designated doctor are largely responsible for the delivery of
safeguarding children training for the medical staff at levels 2 and 3. The named doctor and
designated doctor also hold a weekly safeguarding children meeting which is also a vehicle for
training sessions on specific topics as well as supervision of specific cases.
7.6 The statistical data about staff training has been a focus of activity for quite some time. In
the past 6 months the trust’s training and education department have employed a new system
called WIRED which has the facility of providing data about training achievement for individuals
as well as groups of staff. The information available to the acute service safeguarding children
training team was entered onto this system so that a more accurate and constantly updated
report of safeguarding children training achievement could be accessed. The initial statistics
demonstrated that training in safeguarding at all levels was well below the standard required of
at least 80% of the staff being trained at an appropriate level. Consequently and action plan is in
place to address shortfall and additional training dates at level 3 are being provided.
7.7 The WIRED system was due to go live throughout the trust in April 2013 but this has been
delayed until July 2013. One of the benefits of WIRED is that it will allow all staff to enter the
system and check their own training record. It is also designed to inform staff of the level and
type of training they need to undertake as well as sending out reminders when a mandatory
training is due to be updated. Once the system is ‘live’ all staff will be notified and will be asked
to check the data that the system holds about them as individuals, (e.g. dates when they
undertook training, checking that the level of safeguarding training they have been entered onto
the system as requiring is correct) and to inform the Education and Training Department if the
data is not correct or incomplete. It is anticipated that the information received from staff will
result in more accurate data and that this in turn may demonstrate improved figures as missing
data in entered and inaccuracies corrected. There has been uncertainty for quite some time that
safeguarding children data on the previous system (ESR) that was transferred onto WIRED,
was not complete due to safeguarding children training not being entered consistently.
7.8 The effectiveness of training is an area of practice that is being addressed. In order to
evidence if staff have found the training effective, the staff who were trained at level 3 in
safeguarding children training during 2012 have been sent a questionnaire testing their retained
learning from the session. This process/audit is currently underway and will be reported on in
early May.
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7.9 Acute service staff are encouraged to take part in multi-agency training but this can be
limited due to the volume of mandatory training that acute service staff are expected to access.
Safeguarding Children Training Data for the whole Trust as provided by WIRED
Level of training
No of staff who require level 1 training or MAST
No of staff who are compliant with level 1 training
% of staff trained at level 1
No of staff eligible at level 2 training
No of staff who are complaint with level 2 training
% of staff trained at level 2
No of staff eligible at level 3 training
No of staff who are complaint with level 3 training
% of staff trained at level 3
Across all three levels % of staff compliance trust wide
March
2013
1920
1828
96.11%
3547
1265
35.66%
2094
523
24.98%
47.94
Community Services Wandsworth
7.10 Safeguarding children training across the organisation has been reviewed and aligned
between the acute and community divisions. A new integrated training strategy has been
approved. The strategy identified which staff members require training and specifies the level of
training required in 2012/13 in line with Working Together (2010) and the Intercollegiate
Guidance (2010). This has resulted in training at Level 2 for clinical staff not working regularly
with children being shorter in duration. The level 3 courses for staff working regularly with
children and parents have been increased in length and more specific training has been
delivered to teams for example sexual health and minor injuries unit.
7.11 There is a regular quarterly Safeguarding Children Forum for staff in the community service
and external speakers from other agencies contribute to this forum.
7.12 Specific level 3 training on domestic violence and abuse has been implemented and is
being delivered to support joint working with first response to police notifications.
7.13 All training is reviewed and updated on an annual basis although any pertinent updates are
included on an ongoing basis. All training is evaluated and feedback incorporated into future
sessions where appropriate.
Training uptake community service
Training
No. eligible staff require Safeguarding Children training - Level 1 - updates on eMAST
or MAST
% eligible staff up to date with training -Level 1
No. eligible staff require Safeguarding Children training - Level 2
% eligible staff up to date with training - Level 2
No. eligible C&F staff require Safeguarding Children training - Level 3
% eligible staff up to date with training - Level 3
10
Q4
1311
95.20%
1131
82.30%
289
77.50%
8 Supervision and support
8.1 Supervision is an essential aspect of ensuring that staff are confident and supported in their
work with vulnerable children and families. The safeguarding team of doctors and nurses are
available to offer guidance and advice in both the acute and community settings. The details of
contact numbers of the safeguarding children team have been widely distributed and all staff at
induction are given this information as a handout. Although supervision of community staff and
acute staff will differ in approach because of the differing roles of staff, e.g. health visitors hold
caseloads whereas acute staff members generally do not, the principles remain the same.
The Acute Service
8.2 A guideline for safeguarding children supervision for acute services staff has been approved
and distributed. In the acute service supervision continues to be provided on a case by case
basis which is facilitated by daily ward rounds by the named nurse and also by the availability of
the named nurse, named doctor and named midwife for support and advice. In addition there
are safeguarding children leads in specific areas such as neonates and maternity providing
direct supervision on a case by case basis. The Emergency Department (ED) safeguarding
children meeting and the daily presence of the named nurse in the paediatric ED provides
support and advice for ED staff as well as the supervision by the 5 leading consultants. The
paediatric staff in all areas can also access individual supervision by the named professionals
and the staff members from these key areas are invited to access one to one supervision on a
regular basis, the recommended timeframe being annually.
8.3 The named doctor and the designated doctor have introduced a series of supervision
sessions for paediatric consultants with the expectation that all of the consultants working in
paediatrics will attend.
Community Services Wandsworth
8.5 All staff working predominately with children in Community Services Wandsworth receives a
minimum of quarterly safeguarding children supervision as per the Supervision Policy.
Supervision is offered on a one to one basis and in a group format depending on the discipline.
From a combination of the Clinical Team leaders and the safeguarding team.
8.6. The supervisors are then required to attend bi-monthly group supervision which addresses
their supervisory role and uses action learning to look at difficult cases.
8.7 The uptake of supervision continues to be monitored through clinical governance structures
in Community Services. Children’s therapies uptake of supervision has been a concern and an
action plan has been implemented with heads of service to improve the uptake of supervision
with this staff group. This is currently an extended 6 month pilot of group supervision facilitated
by the safeguarding team following a 3 month pilot which was very positively evaluated by
users.
8.7 The uptake of supervision continues to be monitored through clinical governance structures
in Community Services. Children’s therapies uptake of supervision has been a concern and an
action plan has been implemented with heads of service to improve the uptake of supervision
with this staff group. This is currently an extended 6 month pilot of group supervision facilitated
by the safeguarding team following a 3 month pilot which was very positively evaluated by
users.
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The uptake of supervision is monitored quarterly for relevant staff groups – see table below
Supervision
No. of Health Visitors requiring quarterly supervision
No. of Health Visitors supervised
No. of School Nurses requiring termly supervision
No. of School Nurses supervised
No. of Community Nurses requiring quarterly supervision
No. of Community Nurses supervised
No. of PAMs requiring quarterly supervision
No. of PAMs supervised
No. of Nursery Nurses requiring quarterly supervision
No. of Nursery Nurses supervised
Q1
Q2
Q3
Q4
61
65
35
14
10
6
0
85
20
23
15
64
40
14
7
7
3
69
25
23
13
67
39
13
8
9
2
78
37
23
8
47
13
9
7
1
84
44
23
3
58%
62%
22%
47%
35%
9 Domestic abuse and safeguarding children
Domestic Abuse and Safeguarding Children – Acute Service
9.1 The acute service domestic abuse working party has provided an active platform for
addressing the issues associated with violence towards adults and the impact of this on
vulnerable children. The membership of this working party included the named nurse for
safeguarding children and the named nurse for safeguarding adults as well as key personnel
dealing with both adults and children. The working party is a short term arrangement which
concluded in January 2013. One of the recommendations from this working party was the post
of a nurse specialist for domestic abuse should be introduced and consequently, a business
case and job description has been presented to the commissioners. A decision about this post
is pending with the deputy chief nurse taking the project forward.
Domestic Abuse and Safeguarding Children – Community Services
9.2 Community Services receives police notifications known as Merlin’s from the Metropolitan
Police Service many of these reports refer to domestic violence and abuse incidents.
Approximately 100 reports are received each month for pregnant women and households where
there are children under 5ys. The Tooting health visiting team continues to receive the highest
number of police notifications.
9.3 Police notifications are completed by police officers when they respond to any call where a
child is involved either directly or indirectly and where police officers believe one of the child’s
five key ‘Every Child Matters’ outcomes are adversely affected. The forms are forwarded to the
public protection desks who in turn forward the forms by secure email to Children’s Specialist
Services, Education Welfare Service and the Safeguarding Team office in Community Services.
The police notifications are now screened by the safeguarding team
9.4 Community Services has guidance on the management of police reports and guidelines on
information sharing for MARAC (Multi-Agency Risk Assessment Conference) and further
systems are being developed to ensure a robust and appropriate response from health services.
9.5 Training on domestic abuse is provided at Level 3 and is focussed on first response to
domestic violence and abuse the training is delivered with support from other colleagues and a
survivor.
12
10 The Paediatric Liaison Health Visitor - Community Services
10.1 The Paediatric Liaison service is provided by the community service and has been
refocused on unscheduled and urgent care settings in Wandsworth. The ED liaison post was
successfully recruited to from July 2012. A full time administration post has also been
successfully recruited to from October 2012. The service systems and processes are being
reviewed to ensure they are as robust as possible, with some new processes having been
implemented; this includes access to the iCLIP system.
April 2012 to March 2013 – Paediatric ED attendances
UNDER 5
5 TO 17
TOTAL
REFERRALS TO HV
16814
14599
31413
1464
The average breakdown of ED paediatric attendances by locality
Wandsworth
42.6 %
Sutton & Merton
29.4%
Lambeth
9.3 %
Croydon
5%
Kingston
2%
Hounslow Richmond
1%
Other
6.9%
Not recorded
3.8%
Total
100%
10.2 The ED at St George’s continues to have 80 – 120 children attending per day.
10.3 The minor injuries unit at Queen Marys Roehampton have approximately 70 attendances
for children per week. The Child Protection/Safeguarding Advisor visits the unit on a weekly
basis to offer liaison and advice. Approximately 50% of the attendees are from boroughs other
than Wandsworth.
10.4 The paediatric liaison health visitor attends the weekly safeguarding ED meeting and the
fortnightly psycho-social maternity meeting.
13
11 Looked After Children
11.1 In 2012/13 there were approximately 220 children at any one time who were being looked
after children (LAC) by London Borough of Wandsworth. There is roughly an equal split of 50%
of males to females. The ethnicity of LAC is split white 35% and black and minority ethnic 65%.
The age profile shows the majority (63%) of LAC are aged over 10. This is in line with the
national profile of looked after children. The majority of LAC are in family placements 100% of
under tens are in family placement and 70% of over tens.
11.2 There is a strategic multi agency overview group in Wandsworth which is attended by the
lead nurse for LAC and the Safeguarding named nurse. Work developed from this group
includes a health assessment form for young people 12 years and over which moves away from
the medical model of assessing health and is more holistic in supporting the emotional health
and well being of young people in care.
11.3 We are currently in the final consultation stage regarding the development of health
passports for care leavers; the aim is to provide those that are leaving care with a health life
story.
12 In summary
The trust has continued to prioritise safeguarding children and the safeguarding activity has
been positively reported by both the combined Ofsted/CQC inspection and the recent CQC
inspection. It is also noted that the WSCB Section 11 Audit Report was most favourable about
the evidence and outcomes of child safeguarding by St George’s Healthcare NHS Trust. The
community service, the maternity service and the acute service are working well together and
are actively engaged with our partner agencies. There are specific aspects of child safeguarding
which demonstrates new and progressive practice such as the sexual exploitation multi-agency
panel, the antenatal safeguarding meetings and the bid for a nurse specialist for domestic
abuse. The trust is determined to address the difficulties in achieving and evidencing training
and this continues to be a priority with the chief nurse overseeing the progress.
The trust wide action plan for safeguarding children 2013 - 2014 is included as appendix 2.
In addition to the overall plan the team will be prioritising the following:





14
Raising staff awareness and skill in using the Signs of Safety approach
Working with partner agencies to embed learning from SCR’s and IMR’s
Taking an active part in WSCB sub-groups
Meeting the health needs of looked after children
Focusing on specific areas such as child sexual exploitation & female genital mutilation
ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
Issue identified
Action required
To be addressed via
Timescale
Responsibility
Date action
completed/
progress
The Trust is compliant with
Section 11 requirements, CQC
standards and national and
local guidance
 Complete Section 11 audit
2013 if required
 Continue to ensure the
child safeguarding
standards are met
 Ensure the changes to
policy and procedures that
may result from the issue
of Working Together to
Safeguard Children 2013
are implemented
 The safeguarding team will
report to the Children and
Young People’s Safeguarding
Committee (CYPSC) as well
as WSCB
 Named Professionals to
review guidance
April 2013
– March
2014
Named Professionals
and safeguarding
team
The Trust ensures that the
workforce
is
appropriately
trained
in
safeguarding
children and that information
about
staff
training
is
accessible and transparent
 Ensure all training data is
entered onto WIRED
 Staff training will be
monitored by the Children
and Young People’s
Safeguarding Committee
(CYPSC) and the Acute
Service (AS) CYPSC
 Alert all staff and managers
to check data base
 An action plan is in progress
to address the shortfall in
staff training
December
2013
Named professionals
 Staff at all levels to be
appropriately trained
Ensure minimum
compliance for training is
80% at all levels is
achieved
 Ensure that the new
induction process captures
the safeguarding children
training needs for all staff
Training team to work with
Education and Training to
achieve this
 Identify the new process and
the professional leading
Training Team
Training and
Education
Department
ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
The Trust will ensure that the
service provided to meet the
needs of children who are
looked after is robust and in
line with NICE guidance.
 New post holder (Nurse
Specialist) appointed
 Revision of Children
Looked After policies and
procedures
 A permanent Designated
Doctor is required

The Trust will work with our
partner agencies to address
specific aspects in child
safeguarding and will take part
in multi-agency forums, audits
and action plan
 The Trust will be
represented in all multiagency forums
 The Trust will contribute
towards learning
opportunities from serious
case reviews, individual
management reviews and
multi-agency audits
 Lead professionals will be
identified for each case
 Reports, action plans and
progress will be monitored
both in house and with our
partner agencies
 6 monthly and yearly
reports to Trust Board
 Identify clear pathway to
share learning from
complex and serious cases

The Trust ensures that the
actions and learning from
Serious Case Reviews (SCR)
and Individual Management
Reviews are embedded in
practice
16
Complete revision by new
post holder
September
2013
Nurse Specialist LAC
April 2013
– March
2014
Named Professionals
April 2013
– March
2014
Named Professionals
 The Trust will appoint a
Designated Doctor





Feedback from the various
forums will be included as
agenda items (CYPSC)
Learning will be widely
shared and included in
training opportunities
Action plans and audits will
be monitored by the AS
CYPSC and the CYPSC
All reports – SCR or IMR will
be approved by the Chief
Nurse and shared with the
CYPSC
Action plans will be
monitored by the CPYPSC as
well as AC CYPSC
The training team and WSCB
training sub group will lead
on shared learning
St George’s
Healthcare NHS Trust
Management
Safeguarding Team
Safeguarding Team
ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
APPENDIX 1
St George’s Hospital Key Performance Indicators - Safeguarding Children
ED safeguarding children KPI data
No. children admitted with safeguarding concerns
No. referrals to CSS child protection
No. Of LAC - CSS informed
No of CPP list children referred/informed to Children Specialist Services
No. of children attending A&E due to self harming
No. of children attending A&E due to bullying/assault
No. of children attending A&E due to alcohol/harm
No. of children attending A&E with attempting suicide
No. of parents/carers seen in adult A&E where CSS referrals made
Adult issue – DV
Adult issue - mental health concerns
Adult issue - drug and alcohol misuse
Adult issue – other
No. of cases discussed at Safeguarding Children Meeting
No. of HV referrals
No. of SN referrals
Supervision is available to all staff on a case by case basis?
In patient safeguarding children KPI data
No. referrals to CSS Children in Need
No. referrals to CSS Child Protection
No of CPP list children admitted
No of CPP list children admitted
17
ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
No. child protection medicals completed
No. children admitted who are LAC
No of cases referred to CAMHS
No of discharge planning meeting
No of strategy meetings
Supervision is available on a case by case basis
Maternity safeguarding children KPI data
No. of referrals to CSS - Children in Need or CAF
No. referrals to CSS Child Protection (post delivery)
No. of pre birth conferences invited to
No. of pre birth child protection conferences attended by provider
No. of unborn referred/informed to CSS
No of cases discussed at antenatal safeguarding meeting
No of births subject to CP plan
No. of births
No. of women seen for antenatal booking
No. of concerns raised about FGM
No. of concerns raised about domestic violence
Supervision is available to all staff on a case by case basis?
General safeguarding children KPI data
No. of skeletal surveys - X-RAY DEPARTMENT
No. of children referred/informed to CSS - dental, outpatients & all others
Child deaths
No. of referrals /concerns raised re: Adults who are parents
No of young people age 16-18 admitted with safeguarding issues
No. of children referred to CSS - GUM DEPARTMENT
18
ST GEORGE’S HEALTHCARE NHS TRUST WIDE SAFEGUARDING CHILDREN ACTION PLAN 2013-2014
Cases escalated
No. SI’s involving children
No. allegations made against staff
No. allegations referred to LADO
No. of active IMRs of active SCR’s
Safeguarding Practice Audits
Section 11 Audits
LSCB Audits
19