BOD 75 /2012
BOARD OF DIRECTORS – 11 July 2012
SAFEGUARDING CHILDREN ANNUAL REPORT
This report is for publication
EXECUTIVE SUMMARY
This report presents the Annual Report on Safeguarding Children 2011/12 for
CNWL NHS FoundationTrust.
THE BOARD/COMMITTEE IS ASKED TO
Note the report
Regulatory framework
This report provides evidence in respect of Care Quality Commission registration
standards in relation to safeguarding children.
LEAD DIRECTOR……………………………………………………..Robyn Doran
DATE…………………………………………………………………….18 June 2012
CNWL NHS FOUNDATION TRUST
SAFEGUARDING CHILDREN
ANNUAL REPORT
2011 – 2012
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1. Introduction
1.1
This Annual Report details the work of CNWL NHS Foundation Trust in Safeguarding
Children between April 2011 and March 2012. The report includes a review of the
action plans for the previous year as well as the action plan for the year ahead to
ensure that areas of improvement which have been identified will be robustly
monitored for completion.
1.2
The term “safeguarding children” is defined in Working Together 2010 as: “The
process of protecting children from abuse or neglect, preventing impairment of their
health and development and ensuring that they are growing up in circumstances
consistent with the provision of safe and effective care which is undertaken so as to
enable children to have optimum life chances and enter adulthood successfully.”
1.3
The Trust has continued to invest considerable resources in achieving the goal of
providing excellent safeguarding children practices and the three year strategy sets out
how this will be achieved. CNWL NHS Foundation Trust recognises that any strategic
developments can only be implemented with the support and assistance of partner
agencies.
1.4
2011/2012 was the year of adapting safeguarding with the integration of community
provider services, mental health and allied specialties. This increased the resources
and expertise available to the organisation in terms of safeguarding, provides new
opportunities to improve safeguarding practice and increases the risk of incidents
given the nature of community provider with vulnerable families. This is within the
context of a financially challenging climate, the introduction of Working Together 2010
and recommendations from the Munro Review.
2. National Guidance
The Children Act (1989) provides the core legislative framework for safeguarding children,
and is supported by the statutory duty on agencies to cooperate in making arrangements to
safeguard and promote the welfare of children under section 11 of the Children Act (2004).
There are substantial amounts of additional statutory and supplementary guidance in
“Working Together to Safeguard Children” (2010) and other documents. A review of
children’s safeguarding by Professor Munro was published in 2011 and identified the
amount of statutory guidance as potentially burdensome. The Government’s response is
anticipated in July and may result in changes to statutory guidance.
Working Together to Safeguard Children (2010) has been revised and is currently under
consultation which closes in September 2012. The length of the guidance has been
significantly reduced in size in line with Eileen Munro’s recommendation that supplementary
guidance be removed. The recommendations from the Munro report regarding timescales
for initial assessments are being piloted; the first reports from pilot areas are due in March
2012.
There are also plans to merge the CRB and ISA processes under one organisation in the
next year and details on this are still awaited.
Key legislation, guidance and reports to inform practice are:
 Children Acts 1989 and 2004
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The London Child Protection Procedures (4th Edition, 2010) and other London
Safeguarding Board associated guidance
Working Together to Safeguard Children (2010)
Common Assessment Framework for Children and Families (2005)
Every Child Matters (2004)
Children’s NSF (2004)
Essential Standards of Quality and Safety, Care Quality Commission, 2010
Quick reference guide: When to suspect child maltreatment, National Institute for Health
and Clinical Excellence (2009)
The Protection of Children in England: A progress Report (Laming, March 2009)
The Protection of Children in England Action Plan: The Government Response to Lord
Laming (May, 2009)
The Munro Report 2011
Sir Ian Kennedy’s Review (2010) ‘Getting it Right for Children and Young People:
Overcoming Cultural Barriers within the NHS so as to meet their needs’
3. Safeguarding Activity across the Trust
3.1
During 2011/12, the Trust contributed to four Serious Case Reviews, two of which
were not concluded by the year end. The lessons learned have been shared with the
relevant staff and discussed in the quarterly meetings. There was one new SCR
involving CNWL initiated in the past year.
3.2
There were no complaints made during the year about the Safeguarding Children
practices in CNWL.
3.3
The Trust has carried out a number of audits (which are described in more detail
elsewhere in the report) and there are a number of which are on-going. Audits
include:
For Mental Health and Allied Specialties
 Audits in the Addictions Directorate
 Case Note Audits
 Advice Line Audit
 Audit of Attendance at LSCB meetings
 Induction Training Audit
 Supervision Audit
 Section 11 Audit
For Community Health Services:
 Section 11 Audit
 Rio Child Protection Record Keeping
 Client Satisfaction
There are some commonalities between the audit completed across the trustSection 11 Audits, record keeping, supervision and the sharing of information are key
parts of child protection. Some relevant headlines from the audits would be that there
has been an increase in the level of supervision in Addictions in the past year,
Section 11 Audit revealed the need for more multi-agency audits and good
attendance by CNWL staff at LSCB meetings, Case Conference and Core Group
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meetings. It has also highlighted that all relevant sub groups need CNWL
representatives to attend, and this has been addressed.
3.4
In 2011, CNWL took part in a multi-agency Section 11 Audit using the template
developed by Camden. The results of this were sent to all other LSCBs, Designated
Nurses in the Primary Care Trusts.
3.5
Criminal Record Bureau Checks
All staff since 2002 had an enhanced CRB check before commencing employment in
CNWL, whether as a paid worker or volunteer. Agencies supplying staff to Trust
services have been required to complete CRB checks of staff on their books. Where
appropriate, contractors have clauses inserted into contracts to ensure their
compliance in this regard. CRB checks for staff recruited from 2002 are now
repeated every 3 years.
NHS good practice guidance has suggested that all staff recruited prior to 2002
should complete CRB checks and this is an on-going process in CNWL.
Camden have commenced using e-CRB, an electronic way of applying for police
checks which speeds up the process and has the added benefit of staff completing
their applications on line so that central support is not necessary. The proposal for
2012/13 is that this will be rolled out across the whole of the Trust.
In 2011/12, the process of referrals to the Independent Safeguarding Authority (ISA)
remains in place. The Named Nurse and Human Resources Department discuss
each case and there is greater awareness of Trust staff in this area. The Trust has
made a small number of referrals of staff to the ISA who had been dismissed or
resigned from the Trust, so that their suitability for registration under the scheme
could be assessed. The Trust is not informed of outcomes from this unless the
person remains in post.
3.6
Relationships with LSCBs
Governance arrangements will be described in greater detail later in this report. An
audit of attendance at LSCB meetings showed that CNWL were represented at every
meeting in the last year. It showed a 100% attendance at main board meetings and
that the Trust had some representation on sub groups in each of the boroughs
served.
There have been some changes to LSCBs over the past year in a variety of ways.
There is now the tri-partite arrangement for the LSCB for Westminster, K&C and
Hammersmith & Fulham. Hillingdon meetings have been re-arranged so that the
LSCB and LSAB meetings occur on the same morning with joint issues discussed in
a middle section. These provide some benefits to CNWL staff who cover five main
localities in NW London by reducing the number of meetings and consolidation of
training opportunities, so places on training are not wasted, due to lack of take up.
3.7
Monitor Declaration
The Trust has still to revise the declaration to Monitor, which is on the CNWL public
website, showing compliance with the five key areas relating to safeguarding
children. This will be further revised in 2012, to be a whole CNWL declaration,
including the compliance of community services, mental health and allied specialties.
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3.8
Issues relating to Diversity
CNWL serves a richly diverse population. The following gives a flavour of the
diversity of backgrounds of some of the people accessing our services:
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Brent – most ethnically diverse Borough within London
Harrow – most religiously diverse Borough within London; home to the largest
Afghan community in the UK
Hillingdon – significant traveller community
K&C – large, well established, Arabic-speaking population of various origins. Most
marked health inequalities than anywhere else in the UK when comparing life
expectancy of the richest and the poorest
Westminster - centre of the UK Chinese Community is in Soho.
Migrant populations entering the UK through major gateways on our patch: Heathrow
(Hillingdon), St Pancras (Camden) and Victoria (Westminster)
A significant Lesbian, Gay, Bisexual and Transgender population that gravitates to
central London from across the UK
Students from all over the world attending London universities.
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3.9
Olympics
In relation to safeguarding children, the Trust has been planning for the Olympics
and issues that may arise around trafficked children and unaccompanied asylum
seekers in Hillingdon. For most other Boroughs awareness raising around the party
atmosphere and risks for young people around excessive drink, misuse of drugs and
potential consequences is being addressed with advertising of local services.
Planning for children’s services has taken place to ensure that they will continue to
operate over the Olympics.
Inspections/Visits
In 2011/12, there were three unannounced Ofsted/CQC inspections involving CNWL
in Brent, Westminster and Camden. Feedback on CNWL CAMHS was
overwhelmingly positive and the results are tabulated below:
Hillingdon was a pilot site for the new Ofsted inspection model and was able to
feedback on issues arising from the methodology so that it can be more effective.
4. Safeguarding Updates by Specific Services
4.1
Mental Health Services
The progress against these priorities is attached as Appendix 1.
4.2
Offender Care Update
In 2011, the Trust commenced offering services at Holloway prison, which includes a
Mother and Baby Unit. In prisons the policies for safeguarding for staff to follow are
prison policies and it is their responsibility to train staff. However, the Trust has
provided additional training for staff to ensure a high standard of safeguarding is
delivered by our employees.
4.3
Addictions Update
4.3.1
Training
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The service line reports 84% completion of safeguarding adults training
and 96% in safeguarding children training for Group 1 and group 3 at the
time of writing.
4.4
4.3.2
National publications / emerging issues
The service line has been implementing the recommendations from the
interim report by John Strang (2011) Recovery – Orientated Drug
Treatment model. The model describes 12 principles to maximise
recovery from substance misuse, placing a strong emphasis on the
involvement of parents, families and partners in supporting and sustaining
recovery and social inclusion. This has fitted in well with the Think Family
agenda, which is a key to the care that is being offered to service users.
4.3.3
Audit
The service line has been conducting monthly ‘mini’ on site safeguarding
children audits across sites. Areas being regularly audited include
supervision record keeping, training and meeting attendance. In all of
these areas, there are positive evidence services are making monthly
improvement on the baseline.
The service line has completed an annual safeguarding children audit
across its services in February – March 2012. The results were analysed
and reported against the baseline audit conducted in February 2011. The
results showed positive improvements in the recording of safeguarding
children discussions and actions from multidisciplinary team in electronic
notes; recording of main carer and where the child is placed and of social
worker name and contact details.
The service line has implemented safeguarding children supervision for
all clinicians. The service conducted a staff survey of safeguarding
children supervision using Survey Monkey questionnaire. The survey
looked at frequency, quality and outcomes of safeguarding children
supervision structures and processes. The results showed that 86% of
staff received supervision, 94% found it supportive and 76% reported that
the supervision improved or significantly improved their practice.
Hillingdon
In Hillingdon, over the past two years there has been a significant increase in child
protection activity. In 2011-2012 there were:
 2800 referrals to children’s social care, an increase of 500
 2400 initial assessments
 870 core assessments
 End of year the number of children subject to Child Protection plan was 232,
same as previous year. This number does not accurately reflect activity- 200
children came off plans and 200 children went on in the year.
 Average time on a plan is 12 months
 10% of children subject to plans have been on more than 2 years (total of 20
children from 4-5 sibling groups)
This increase in child protection activity has taken place during a time when partner
agencies have had to contend with the planning and implementation of significant
budget reductions and, for NHS partners, major organisational change.
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Since the 1st November 2011 there has been an unprecedented rise in the number of
children subject to child protection plans in Hillingdon. In November and December
2011 there were 58 initial case conferences which is an increase of 100% on the
previous year.
4.5
Camden
In Camden, an audit shows that Camden receive about 2,000 by Childrens Social
Care, but the level of complexity appears to be increasing, indicated by the increase
in Child Protection Case Conferences and numbers of children subject to Child
Protection Plan - 312 at the end of August 2011.
When compared to the percentages for both of the two previous years, there
appears to have been a gradual increase in the percentage of children aged
between 1 and 4, and a gradual decrease in the percentage of children aged
between 5 and 9.
Other recent analysis showed that Bangladeshi children are over-represented with
Child Protection Plans, and white children under-represented. Bangladeshi children
are even more over-represented in the group of children whose protection plans last
18 months or more. This suggests that, as well as being most likely to be the
subjects of protection plans, Bangladeshi children are more likely to be the subject of
protection plans lasting eighteen months or more.
Although the figures so far this reporting year for repeat protection plans and
protection plans ending after two years or more are high when compared to last year
and the year before, they are still both within what the Department for Education
expects from a high achieving authority: between 10% and 15% for repeat plans, and
between 0% and 10% for protection plans ending after two years or more.
5. Training and Workforce
5.1
Context
Working Together (2010) guidance notes that all health care organisations have a
duty under the Children Act (2004) to promote the welfare and safety of children.
Chief Executives are required in law to enable staff to meet these requirements. It
states,
“All staff working with children should attend training in safeguarding and promoting
the welfare of children and should have regular updates as part of any postregistration educational programme. Employers have a responsibility to ensure that
all staff, including administrative staff, are given opportunities to attend local course
in safeguarding and promoting the welfare of children, or to ensure that safeguarding
is provided with in the team”.
5.2
Training Guidance on Safeguarding Children
The guidance from Working Together 2010 divides training up into different target
groups with suggested training content for each group. All groups should have a
refresher training every three years.
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In reviewing the document mental health services in the Trust has focused training
on two main groups, Group 1 and Group 3.
Group 1 training
This is for staff who have infrequent contact with children, young people or parents
who may become aware of possible abuse or neglect. These include admin staff and
other staff working in corporate or support roles within the organization.
Group 3 training
This is for members of the workforce who work predominantly with children, young
people and/or parents and who could potentially contribute to assessing, planning,
intervening and reviewing the needs of a child and parenting capacity where there
are safeguarding concerns. The document gives examples of professionals who
require this level of training for example, paediatricians, school nurses, all staff
working with children, staff working in mental health, learning disability services and
drug and alcohol services.
NHS Leadership Course
The Safeguarding Named Nurses in Hillingdon have completed this Leadership
course, in line with the recommendations of the Inter-Collegiate Document.
In the last year Mental Health and Allied Specialties devised a mandatory training
programme across the Trust, so that the training is focused and using appropriate
examples, depending on the areas where staff are working. These are monitored
and reported to commissioners, as required.
5.2
Multi-Agency LSCB Training
There was an increase in the numbers of Trust staff attending multi-agency training
provided by the LSCBs in each of the boroughs served by the Trust. The
Safeguarding Children’s Team facilitated improved links with the Trust Training
Department with the LSCB training teams to ensure that training was advertised to
relevant staff. The Trust has provided support to the LSCB training programme,
through co-facilitation of training and helping to design specific training packages.
5.3
Training statistics
Based on the training records the percentage of staff trained (at their appropriate
level) across mental health and allied specialties exceeds 87%, Camden 91% and
Hillingdon 95%. This figure is expected to increase close to 100% as mandatory
training follows a robust management approach to encourage staff to attend.
5.4
Diverse Training Methods
It is important to note that training continues to be delivered in diverse ways and not
only conventional teaching. The Trust has implemented a new updated e-learning
package and has provided training materials and information on the Trust Intranet.
Camden have also devised an e-learning package. Staff were also reminded of their
responsibilities through posters in all areas, weekly bulletin or articles in Trust
newsletters, supervision and the advice service for individual cases.
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5.5
Supervision
Supervision in Mental Health and Allied Specialties is monthly and should
incorporate child protection supervision. To provide assurance on this an audit was
commissioned to review child protection supervision by RMS Tenon, our internal
auditors. This report is not yet finalized, but early indications are that there is a mixed
picture in practice and more training and monitoring is required to embed this within
teams.
In Hillingdon all Health Care Professionals working directly with children, from birth to
18 years of age, have access to child protection supervision. This is supplementary
to clinical supervision and the rationale for this is as follows:
 Effective supervision is important to promote good standards of practice and
to support individual staff members.
 Supervision will help ensure practice is soundly based and consistent with
HCH procedures.
 It should ensure that practitioners fully understand their roles and
responsibilities.
 It should help identify the training and development needs of practitioners.
 Supervision encourages reflective practice, enables practitioners to develop
professionally and promotes confidence when working with vulnerable
children.
The Paediatric Liaison Health Visitor acts as a resource and source of information for
hospital staff regarding community services and vice versa thus developing and
supporting effective communication pathways between the staff groups. Supervision
is provided for staff when requested.
The named nurses receive supervision from the designated nurse every 6 weeks.
The named doctor receives supervision from the designated doctor every 6 weeks.
In Camden, 100% CNWL CPS staff attended Child Protection Supervision in the last
quarter
 Health Visitors (HV’s) and School Nurses (SN’s) every 3 months
 Group supervision HV’s and SN’s skill mix teams every 6 months
 Group supervision for sexual health staff every 6-8 weeks.
6. Governance and Accountability Arrangements
The Board of Directors received regular updates on safeguarding children issues. The board
also had an annual presentation on safeguarding children issues as well as completing
annual training. In 2011, this training focused on the complexity where safeguarding children
and adults within the same family is an issue.
This quarterly Safeguarding Group is chaired by the Director of Operations and
Partnerships. Membership consisted of the Trust Named Doctor and Nurses, Director of
Nursing, Associate Director of Operations, key leads from community and addictions. This
group also covers safeguarding adults due to the commonality of themes and issues and
has appropriate leads also attending.
The Trust also takes a full and active role in working with LSCB’s where the Trust provides
services. The Trust is represented on the 5 LSCB boards where it provides universal
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services by the Associate Director of Operations. During 2011/2012, it has also increased its
representation with the attendance of the Deputy Service Director for Addictions attending
Boards where the Trust is providing Addiction Services.
Feedback from LSCB meetings is given to relevant Service Lines/Directors, the monthly
Mental Health Care Quality Management Group, in CAMHS Care Quality Management
Group as well as the Trust Safeguarding Group Meetings.
7. Priorities for 2012/13
Key action areas will include:
- Disseminate the new integrated Safeguarding Children Policy.
- Devise a Trust-wide Escalation Policy.
- Contribute to the consultation on the Working Together.
- Complete London-Wide Section 11 Audit
- Review the pre-2002 CRB checks across the Trust and ensure all staff are compliant
with CRB guidance.
- Implement any new national guidance from revised Working Together.
- Maintain training levels above the target.
- Improve partnership working with LSCBs.
- Implement action plans from Serious Case reviews and Inspections.
The Action Plan to address these priorities will be ratified by the Safeguarding Group.
Catherine Knights
Associate Director of Operations
APPENDIX 1
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Progress Against 2010/11 Priorities in mental health Services and Allied Specialties
There were ten key priority areas identified for mental health services and allied specialities in
2011/2012. The action and progress to date on each are detailed below:
1
Ensure staff are aware of who to contact when they have a concern about a child
New leaflets were distributed to all staff coming to work for the organization through the
induction process, so this is complete.
2
To develop and launch a new e-learning package for the organisation
A new e-learning package was launched in July 2011 in line with the guidance for training
laid down in Working Together 2010. This is now being used as part of mandatory training.
3
Monitor usage of the Advice Service as staff become better trained and more aware of
Safeguarding Children issues
An audit was completed on the calls received, numbers of suspected cases of abuse,
showing the steady increase in the number of calls received by the advice line. In the last
year, it was highly commended by the London councils in the London Safeguarding Children
Awards. One of the notable outcomes was the increase in the number of calls from the adult
Increased Access to Psychological Therapies, a new service, where staff were made aware
of the advice line for support.
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Safeguarding Children Policy Revised
An integrated policy has been drafted, which will be finalized in 2012/13. There will be an
overarching policy for the whole Trust, with guidance for the differing parts of the
organisation.
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To develop more joint working between community and mental health services to
make use of the broad range of skills now in CNWL
Work continues on the “adapt” agenda with Hillingdon and Camden, mental health and allied
specialties, to look at how safeguarding arrangements can be improved, overseen by the
Trust Safeguarding Group.
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To ensure that staff training is recorded on the Trust AT-learning system
Records of all training sessions are inputted onto the system, including sessions within
teams as well as Trust-wide training. The Trust is working to harmonise the systems for
recording training so that data can be provided by borough.
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To contribute to the SCIE model for carrying out Serious Case Reviews
Hillingdon LSCB completed a SCIE safeguarding review and Hillingdon community and
CAMHS contributed fully to the process. The effectiveness of the model has been
considered by the LSCB and contributed to the London evaluation.
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To work with LCSBs to provide support for training other agencies on Parental Mental
Health and Safeguarding
Staff from the safeguarding team have contributed to the development of the training
programme and co-facilitated sessions with LSCB trainers
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To ensure that new mandatory training programme for trust staff includes
Safeguarding Children
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Staff from the safeguarding team worked with the training department to develop the
programme as outlined. This was implemented for adult services in 2011/12 and for CAMHS
will start in 2012/13. Community health services have an established successful system for
mandatory training already in place.
10 To develop a protocol for working together between Mental Health Services in each
borough and partner agencies
The joint protocol was agreed in Brent at the end of 2011/12 and the Safeguarding Children
Nurse Advisor has been tasked with developing this with other boroughs.
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