Safeguarding Children Policy - East Cheshire NHS Trust by pengxuebo

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									Safeguarding Children Policy




                               1
Policy Title:
                                    SAFEGUARDING CHILDREN
Executive                East Cheshire Trust is committed to the welfare and
Summary:                   safeguarding of children. This policy details the
                        safeguarding arrangements and responsibilities for all
                                     staff of East Cheshire Trust
Supersedes:            Safeguarding Children in East Cheshire Trust March
                       2011
                       Safeguarding Children in Central and Eastern
                       Cheshire Health 2010
                       No Access at Home Visits Policy.
Description of         Safeguarding Policy for ECT and CECH merged to
Amendment(s):          meet new requirements of the Trust
This policy will impact on: The work of all staff working with children at East
Cheshire Trust
Financial Implications: Non Known
Policy Area:                              Document
                                          Reference:
Version            4                      Effective Date:      2011
Number:
Issued By:         The Community          Review Date:         April 2013
                   Business Unit

Author:            Mel Barker             Impact               9/11/09
                   Danuta Jones           Assessment           08/03/11
                                          Date:                20/02/12

                            APPROVAL RECORD
                            Committees / Group              Date
Consultation Phase:         Cheshire, Halton &              Aug 2008
                            Warrington for Local
                            Safeguarding Children’s
                            Board                           Oct 2008
                            Women & Children’s              Jan 2011
                            Business Unit
                            SQS                             Oct 2008
                            Designated Dr/Nurse             Oct 2008 March
                                                            2012
                            Quarterly Safeguarding          April 2012
                            Children Meeting
Received for                IT Dept & Legal Services        Nov 2008
information:




                                                                              2
                      Safeguarding Policy and Protocols

Index                                                                        Page No
Safeguarding Children                                                           6
Safeguarding Children Team                                                      7
Section I
Safeguarding Children Policy
Introduction, scope and Principles                                                8
Definitions                                                                       9
Roles and Responsibilities                                                        9
Information sharing                                                              12
Confidentiality                                                                  14
Disagreement between professionals or agencies                                   14
Request for change of worker                                                     14
Allegations of abuse made against a worker and any serious untoward              14
incident against a child
Confidential counselling service                                                 15
Categories of abuse and vulnerable children                                      15
Sources of stress for children and families that may require extra support       16
and supervision
The management of sexually active young people under the age of 18yrs            17
Alerts re missing unborn/ children and families                                  18
Private fostering                                                                18
When a child dies                                                                18
Training framework                                                               19
Non attendance of appointments and no access visits                              24
Continuum of need and how we work together                                       26
The Common Assessment Framework                                                  27
Dissemination and Implementation                                                 27
Audit and Key Performance indicators                                             27
References and internet links                                                    28
Glossary                                                                         28

Appendices
Appendix 1. Principles to safeguard the service and the Staff                    30
Appendix 2. The process for undertaking a common assessment (CAF)                32
Appendix 3. Flowchart for DNA and No Access Visit                                33
Appendix 4. Principles of care for when a child s admitted to Hospital and       34
child Abuse is suspected – including:


                                                                             3
When a child is referred to the Hospital for possible child abuse
Process for children attending the hospital who are not registered with a
GP
The Process for the transfer of a child from Hospital to Hospital when there
is a safeguarding concern
Process for when a child is to be discharged from hospital into the care of
the Local Authority
Process for children who spend more than 3 months in hospital
Appendix 5. Principles of Care for when a Child is seen in the Accident            38
and Emergency Department for who there are Safeguarding Concerns –
including:
Special register
When an adult attends A+E with injuries which are suspected to be
inflicted personally or by another person
Appendix 6. Emergency Department flowchart for Child protection                    40
Appendix 7. Antenatal Pre Birth Safeguarding Principles                            41
Appendix 8. Summary Discharge Letter for where there have been                     43
Safeguarding concerns raised in the antenatal period
Appendix 9. Flow chart for What to do if you are worried a child is                44
being abused

Safeguarding Children Guidance’s                                                   45
Guidance 1 – Transfer of Information                                               46
Guidance 2 – Transfer of Information outside PCT                                   47
Guidance 3 - Resolving Differences of Professional Opinion                         48
Guidance 4 - Request for a Change of Health Professional                           49
Guidance 5 – Notification of Children and Families where safeguarding              50
concerns have been identified
Guidance 6 – Missing families                                                      51
Guidance 7 – Checking whether a child has a child protection plan                  52
Contact Numbers for making enquiries about child protection plans
Guidance 8 - Concealed Pregnancy                                                   54
Guidance 9 – Referral to children’s Assessment team (Social Care)                  55
Guidance 10 - Child Protection Case Conferences                                    57
Storage and disposal of case conference minutes
Guidance 11 - Record Keeping and safeguarding children                             60
Guidance 12 – Completion of Cafcass Report                                         61
Guidance 13 – Request for Police/Guardian Ad Litem Interviews/                     62
Statement for Children & Young People
Guidance 14 – Writing Court Statement                                              63




                                                                               4
                              Safeguarding Children



The aim of these policies/procedures/protocols is to set out a clear framework for East
Cheshire Trust staff to work effectively with Children who are in need or at risk.

These policies / procedures and protocols should be used in conjunction with the two local
Safeguarding Children Board Procedures

http://www.cheshireeast.gov.uk/health_and_social_care/children_and_families/
lscb_-_safeguarding_children/child__protection/child_protection_manual.aspx

http://www.cheshirewestandchester.gov.uk/children_and_young_people/child_
protection/manual_of_child_protection_pro.aspx


HM Government Working Together to Safeguard Children March 2010 Inter-Agency
Guidance

HM Government Statutory guidance on making arrangements to Safeguard and promote
the welfare of children under section 11 of the Children Act 2004

Department of Health, Department for Education and Employment and the Home Office
(2000) Framework for the Assessment of Children in Need and their Families. The
Stationery Office, London HM Government (2006b)

HM Government (2006) - The Common Assessment Framework for Children and Young
People: Practitioners' Guide DfES London
    (in full not CAF abbreviation)

HM Government (2006) Information Sharing: Practitioners' guide. DfES
    London.

Nursing and Midwifery Council (2009) Record Keeping guidance The NMC Code of
Professional Conduct: Standards for Conduct, Performance and Ethics. London, NMC




                                                                                     5
                                            Safeguarding Team


Designated/Named Nurses Safeguarding/Looked after               Designated Doctors Safeguarding
                   Children                                            Dr Baljinder Singh
                                                                   Mid Cheshire Hospitals Trust
            Moira McGrath -Designated                                  Tel: 01270 275369
            Universal House, Middlewich                               Mobile: 07875 382169
              Mobile: 077215510920                                   baljinder.singh@nhs.net
                mmcgrath@nhs.net
                                                                        Dr Katina Marinaki
             Danuta Jones - Named                               Macclesfield District General Hospital
            Bevan House, Barony Road                                    Tel: 01625 661431
               Nantwich CW5 5RD                                        kmarinaki2@nhs.net
               Tel: 01270 275302
              Mobile: 07887 712663                                         Named Doctor
              danuta.jones@nhs.net                                        Dr David Wright
                                                                Macclesfield District General Hospital
            Melanie Barker – Named                                      Tel: 01625 661431
        Macclesfield District General Hospital                        Davidwright2@nhs.net
                Tel: 01625 661770
               Mobile 07795520986
              melaniebarker@nhs.net                                        Named GP's
                                                                          Dr. Bill Forsyth
                                                                    Universal House, Middlewich
          Nurse Specialist Safeguarding                                 Tel: 01606 544421

                    Ruth Tucker                                   Dr Liz Finch / Dr Shelly Maund
                Tel: 01270 275219                                  Waters Green Medical Centre
               Mobile: 07909 527814                                      Tel: 01625 428081
                ruth.tucker@nhs.net
                                                              Paediatric Liaison Nurse Specialists
                    Judy Wood                                              Clare White
          Tel: 01270 275275 (Nantwich)                            Based at Leighton Hospital
         Tel: 01625 661783 (Macclesfield)                              Tel: 01270 612075
               Mobile: 07769 913931                                clare.white@cecpct.nhs.uk
                 j.wood3@nhs.net
                                                                        Elaine Burgess
                    Tina Bowen                            Based at Macclesfield District General Hospital
                Tel: 01625 661775                                     Tel: 01625 661012
               Mobile 07717 088932                                    eburgess@nhs.net
               tina.bowen@nhs.net

                                                                 Safeguarding Team Secretaries

            Medical Advisor Adoption                                     Rachel Dutton
                  Dr Rimi Bhatia                                      Secretarial Supervisor
                Tel: 01270 275528                                     Based at Bevan House
               rimi.bhatia@nhs.net                                      Tel: 01270 275418
                                                                      rachel.dutton@nhs.net
            Medical Advisor Fostering
               Dr Baljinder Singh                                Lynn Tatlock / Jackie Webber
               Tel: 01270 275369                         Looked after Children Secretary / Administrator
             baljinder.singh@nhs.net                                    Tel: 01270 275464
                                                                      lynn.tatlock@nhs.net
       Nurse Specialist Cared for Children &
              Safeguarding Children                                      Jan Singleton
                 Bernie Astbury                                     Safeguarding Secretary
                Tel: 01270 275330                         Based at Macclesfield District General Hospital
             berenice.astbury@nhs.net                                  Tel: 01625 661774
                                                                     jansingleton@nhs.net
        Designated Nurse/Nurse Specialist                          Carol Eke / Katie Freeman
               Cared for Children                            Looked after Children Administrator
                 Sheila Williams                          Based at Macclesfield District General Hospital
               Tel: 01625 663146                                       Tel: 01625 663282 6
             sheilawilliams3@nhs.net                                   carol.eke@nhs.net
1. INTRODUCTION

East Cheshire Trust as with all other NHS bodies has a statutory duty to ensure that
it makes arrangements to safeguard and promote the welfare of children and young
people that reflects the needs of the children they deal with.

In discharging these statutory duties/responsibilities account must be taken of
statutory guidance on making arrangements to safeguard and promote the welfare of
children under Section 11 of the Children Act 2004. (HM Government 2007);
Working Together to Safeguard Children (HM Government 2010); Statutory
Guidance on Promoting the Health and Wellbeing of Looked after Children (DH
2009); and the policies and procedures of the Local Safeguarding Children Boards
(LSCB’s).

This policy is mandatory and should be read in conjunction with the Cheshire
Local Safeguarding Children Boards web based Procedures

http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx

http://www.cheshirewestandchester.gov.uk/default.aspx?page=892

1.1. SCOPE

This policy applies to all employees of the East Cheshire Trust including Locum,
Bank and Agency Staff plus volunteers.

It is recommended that this guidance is used by independent contractors.

1.2. PRINCIPLES

In developing this policy East Cheshire Trust recognises that safeguarding children is
a shared responsibility with the need for effective joint working between agencies and
professionals that have different roles and expertise if those vulnerable groups in
society are to be protected from harm. In order to achieve effective joint working
there must be constructive relationships at all levels, promoted and supported by:
   1. the commitment of senior managers to safeguarding children and vulnerable
      adults
   2. clear lines of accountability within the organisation for work on safeguarding
   3. service developments that take account of the need to safeguard all service
      users, which is informed, where appropriate, by the views of service users
   4. staff training and continuing professional development so that staff have an
      understanding of their roles and responsibilities, and those of other
      professionals and organisations in relation to safeguarding children and
      vulnerable adults.
   5. Safe working practices including recruitment and vetting procedures
   6. Effective interagency working, including effective information sharing




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1.3 Definitions

Children

In this policy, as in the Children Act 1989 and 2004, a child is anyone who has not
yet reached their 18th birthday. ‘Children’ therefore means children and young people
throughout.

Safeguarding Children is defined in the Joint Chief Inspectors’ report Safeguarding
Children (2002) as:

      1. All agencies with children, young people and their families take all reasonable
         measures to ensure that the risks of harm to children’s welfare is minimised;
         and

      2. Where there are concerns about children and young people’s welfare all
         agencies take all appropriate actions to address those concerns, working to
         agreed local policies and procedures in partnership with other agencies.



2.       SAFEGUARDING CHILDREN AND YOUNG PEOPLE

2.1      Roles and Responsibilities

2.1.1 Responsibility of East Cheshire Trust

      1. East Cheshire Trust through the Chief Executive Officer and the Trust board
         have a duty under Section 11 of the Children Act 2004 to ensure their
         functions are discharged with regard to the need to safeguard and promote
         the welfare of children and young people. Safeguarding children is an
         integral part of the Clinical Governance framework with a clear line of
         accountability within the organisation.

      2. East Cheshire Trust has a Board Level Director who has executive
         responsibility for safeguarding children as part of their portfolio of
         responsibilities (Working Together to Safeguard Children, HM Government
         2010).

      3. The Executive Director at East Cheshire Trust holding this responsibility is the
         Director of Nursing, Performance and Quality

      4. Engagement with the Local Safeguarding Children’s Board (LSCB) at
         strategic level is required of East Cheshire Trust. East Cheshire Trust is
         represented on the local LSCB

      5. East Cheshire Trust should ensure that systems are in place, which will
         enable all staff to comply with the two LSCB Procedures and the Children Act
         1989 and 2004.

      6. East Cheshire Trust has a named senior manager to whom allegations of
         abuse against adults who work with children and young persons should be
         reported in line with the procedures. The head of Children and Families
         Division holds this responsibility.



                                                                                       8
   7. East Cheshire Trust has LSCB safe recruitment and selection practices in
      accordance with Safe Recruitment – A Guide for NHS Employers (NHS
      Employers 2005) and should ensure that appropriate Criminal Records
      Bureau (CRB) checks are undertaken for new staff and volunteers including
      registered translators who have contact with children and vulnerable adults.
      Appendix 1 - Procedure to safeguard the service and staff.

   8. East Cheshire Trust will ensure the provision of training which meets the
      standards and objectives of and LSCB training requirements and has been
      accredited and endorsed by the LSCB training committee. All staff who are
      likely to come into contact with children or families in the course of their work,
      have access to and receive appropriate level of training, updating and access
      to professional advice and support.

   9. East Cheshire Trust will promote a culture of listening and engaging in
      dialogue with children and young people in the formulation of all Trust policy
      options and proposals, consideration should be given to the impact on
      children.

   10. Communicating with children will be appropriate to their age and
       understanding. When child abuse is suspected on a child admitted to East
       Cheshire Trust the medical condition must be treated as a priority. The child,
       parents and carers must be afforded the same degree of sensitivity and
       respect as others.

   11. East Cheshire Trust will respond proactively to antenatal family concerns
       which may inhibit or detract from the welfare of the baby.

2.1.2   Associate Directors

It is the responsibility of the Associate Directors to ensure that their areas of
management and accountability deliver safe and effective services in accordance
with statutory, national and local guidance for safeguarding children and that all
service specifications, invitations to tender and service contracts fully reflect
safeguarding requirements as outlined in this policy.

2.1.3   Senior Managers

It is the responsibility of managers to ensure that all their employees are aware of
their responsibilities under this policy, and that it is fully implemented within their area
of responsibility.

Employers have a responsibility to ensure that all staff, including administrative staff
are given opportunities to attend local courses in safeguarding and promoting the
welfare of children or ensure that safeguarding training is provided within the team

Managers responsible for recruitment and selection decisions must ensure that all
staff working with children apply for enhanced screening by the Criminal Records
Bureau prior to appointment.

Managers must ensure that staff involved in child protection have access to advice
and support. Clinical supervision should be available to all staff.




                                                                                          9
Where child abuse is suspected they must follow the LSCB guidance

2.1.4 Designated and Named Health Professionals – Doctor and Nurse

The Designated Doctor and Nurse are responsible for taking a strategic clinical lead
on all aspects of the health service contribution to commissioning safeguarding
services across the health economy which includes all providers.


Named Professionals

All NHS trust, NHS foundation trusts, and PCT’s providing services for children
should identify a named doctor and a named nurse – and a named midwife if the
organisation provides maternity services.

Named Professionals have a key role in promoting good professional practice within
their own organization, and provide advice and expertise for fellow professionals.
They should have specific expertise in children’s health and development, child
maltreatment and local arrangements for safeguarding and promoting the welfare of
children.

Named professionals should support the organisation in its clinical governance role,
by ensuring that audits on safeguarding are undertaken and that safeguarding issues
are part of the trust’s clinical governance system.

They also have a key role in ensuring a safeguarding training strategy is in place and
is delivered within their organisation.

They are also responsible for providing effective support and supervision to staff
within their organisation.

Named professionals are usually responsible for conducting the organisations
internal management reviews, except when they have had personal involvement in
the case when it will be more appropriate for the designated professional to conduct
the review.

Named professionals should be of sufficient standing and seniority in the
organisation to ensure that the resulting action plan is followed.

The named professional e.g. nurse or doctor as appropriate should be included
within the induction programme of newly recruited staff to children’s, maternity and
the emergency department.

2.1.5 Responsibility of Consultant Paediatricians

The consultant paediatrician is responsible for giving advice on health aspects of
child abuse if approached by other health staff, social services, the police or other
professionals.

They are responsible for ensuring that they update regularly on child protection.

Where child abuse is suspected they must follow the LSCB guidance.

2.1.6 Responsibility of Paediatric Liaison Nurses



                                                                                    10
The Paediatric Liaison Service is responsible for ensuring that written notification
arrangements are in place at the two District General Hospitals for notifying health
visitor/school nurses of all visits by children aged less than 18 years to the
Emergency Department. All children who are highlighted by the Emergency
Department staff to the Liaison Service as requiring input from community services
will be notified by telephone in the first instance. This includes children who are non
East Cheshire residents. Delays in the passage of information must be minimised.

Communication must take place between the Paediatric Liaison Service and the
Named Professionals when a child presents with non-accidental injury or suspected
non accidental injury.

Where child abuse is suspected LSCB guidance should be followed.

2.1.7 Responsibility of all Employees

All Health employees should be alert to the potential indicators of abuse or neglect
for children and know how to act on those concerns in line with local guidance;

Be responsible for having knowledge of the LSCB Procedures. They should know
how to contact Named and Designated Professionals for guidance and support and
should be familiar with and follow their organizations policies/procedures for
promoting and safeguarding the welfare of children in their area.

All health employees are responsible for accessing training relating to safeguarding
children appropriate to their role so that they maintain their skills and are familiar with
procedures aimed at safeguarding children;
.
All health employees should understand the principles of confidentiality and
information sharing in line with local and government guidance and should contribute
to, when requested, the multi-agency meetings established to safeguard and protect
children.

All employees involved in direct child protection work should seek supervision and
peer review that is provided by their employer.

Comprehensive and contemporaneous records of all concerns, discussions and
decisions made including telephone conversations in relation to safeguarding
children should be maintained in line with East Cheshire Trust policy on records and
record keeping.

3. INFORMATION SHARING

Effective information sharing underpins integrated working and is a vital element of
both early intervention and safeguarding. It is important that frontline practitioners
understand when, why and how they should share information and follow:


3.1    Sharing Information as Part of Preventative Services

Explain to children, young people and families at the outset, openly and honestly,
what and how information will, or could be shared and why. And seek their
agreement.
Information must be accurate and up to date, necessary for the purpose for which it
is being shared and only shared with those people who need to see it.


                                                                                        11
3.1.1   Sharing Information to Protect a Child or Young Person

In some circumstances the sharing of confidential information without consent would
normally be justified in the public interest. These circumstances would be:

       When there is evidence that the child suffering or is at risk of suffering
        significant harm
       Where there is justifiable cause to believe that a child may be suffering or at
        risk of significant harm
       To prevent significant harm arising to children and young people including
        through the prevention, detection and prosecution of serious crime likely to
        cause significant harm to a child or young person

Information could also be shared without consent in the following circumstances:

    If the child or young person at greater risk
    If you or another health care professional is at risk
    If it would alert the perpetrator (in cases of sexual abuse or fabricated illness)
    If specific forensic evidence is needed
Consider the likely outcome of sharing or not sharing information

At all times the safety and wellbeing of the child or young person is paramount


Reasons for decisions to share, or not share must be recorded. Decisions require
professional, informed judgment.

If in doubt this should be discussed with a designated / named professional for
safeguarding children or you may need to seek advice from the Trust’s legal
representatives.

Further guidance is available on the Trust website by following the links Safeguarding
Children and then Information Sharing

3.1.2   Recording and Sharing of Information

It is extremely important that the recording of information about child concerns is
written in a legible chronological order that reflect discussions with other
professionals and agencies and complies with ECT record keeping Policies.

The Child’s Health records should retain child protection initial and review reports

3.1.3 Transferring information between health professionals and services for
children within ECT.

 When Transferring records within ECT for children whom have a child protection
plan, who are requiring extra support or are Cared for Children see Guidance 1

3.1.4 For the transfer of Community Child Health Records out of area.

When transferring records for children who are Cared for Children, in pre adoptive
placements, or for children who are subject to a child protection plan, a CAF, child in




                                                                                       12
need plan or have been identified as vulnerable or requiring extra support see
Guidance 2

4.       CONFIDENTIALITY

Confidential information about a child or young person should never be used casually
in conversation or shared with any person other than on a “need to know basis”.

There are some circumstances when employees may be expected to share
information about a child, for example when child abuse is alleged or suspected. In
such cases individuals have a duty to pass information on without delay in line with
Local Safeguarding Board procedures. Disclosure should be justified in each case
and guidance should be sought from the Designated or Named Professionals or the
Trust’s legal representatives in cases of uncertainty. Employees must document
when, with whom and for what purpose information was shared.
The main restrictions within the legal framework to disclosure are:

        Common duty of confidence
        Human Rights Act 1998
        Data Protection Act 1998

The storing and processing of personal information about children and young people
is governed by the Data Protection Act 1998.

5.       DISAGREEMENT BETWEEN PROFESSIONALS OR AGENCIES

Designated professionals should be made aware of any professional or interagency
disagreements. If the matter cannot be resolved by mediation then a professional
meeting should be instigated according to LSCB Procedures.
See Guidance 3

6.       REQUEST FOR A CHANGE OF WORKER

Occasions may arise where relationships between parents’, or other family members,
are not productive in terms of working to safeguard and promote the welfare of their
children. In such circumstances, organisations should respond sympathetically to a
request for a change of worker, provided that such a change can be identified as
being in the interest of the child who is the focus of the concern.
See Guidance 4

7. ALLEGATIONS OF ABUSE MADE AGAINST A WORKER AND ANY SERIOUS
UNTOWARD INCIDENT AGAINST A CHILD

Allegations of this nature should be reported to the Head of Children & Families as
soon as possible. The management of such an allegation should follow the
procedures set out in East Cheshire Trusts Disciplinary Procedures (Section 11 Page
8)

http://trustnet/PoliciesNew08/ECT001281/ECT001281.HR.20100601.DisciplinaryPro
cedure.pdf

8. CONFIDENTIAL COUNSELLING SERVICE




                                                                                 13
Where a staff member is aware of any circumstances in their private life which may
adversely affect their ability to undertake their role within this health care organisation
any such difficulties or problems that may affect their working relationships and their
ability to safeguard children should be discussed with their line manager so that
appropriate support can be provided.


Staff Counselling is provided by the Staff Counselling Service Team at East Cheshire
NHS Trust. Referrals can be made confidentially by the member of staff themselves
or by their line manager or through occupation health by ringing the service directly
on 01625 661972 or by e-mailing carmel.kennedy1@nhs.net Information leaflets
about the service and self help information is also available on the Cheshire HR
Intranet at http://nww.ehr-eash.chehsirehr.nhs.uk

9. CATEGORIES OF ABUSE AND VULNERABLE CHILDREN

Abuse of children:
For children’s safeguarding, the definitions of abuse are taken from Working
Together to safeguard Children (HM Government, 2006)

Abuse and neglect: Abuse and neglect are forms of maltreatment of a child.
Somebody may abuse or neglect a child by inflicting harm, or by failing to act to
prevent harm. Children may be abused in a family or an institutional or community
setting, by those known to them or, more rarely, by a stranger. They may be abused
by an adult or adults, or another chid or children

9.1.1 Physical Abuse
Physical abuse may involve hitting, shaking, throwing, poisoning, burning, or
scalding, drowning, suffocating or otherwise causing physical harm to child. Physical
harm may also be caused when a parent or carer fabricates the symptoms of, or
deliberately induces illness in a child.

9.1.2 Emotional Abuse
Emotional abuse is the persistent emotional ill treatment of a child so as to cause
severe and persistent adverse effects on the child’s emotional development.

9.1.3 Sexual Abuse
Sexual abuse involves forcing or enticing a child or young person to take part in
sexual activities, including prostitution, whether or not the child is aware of what is
happening. The activities may involve physical contact, including penetrative or non-
penetrative acts. They may include, non-contact activities, such as involving children
in looking at, or in the production of, sexual online images, watching sexual activities,
or encouraging children to behave in sexually inappropriate ways.


9.1.4 Neglect
Neglect is the persistent failure to meet a child’s basic physical and psychological
needs, likely to result in the serious impairment of the child’s health or development.

   Reference: paragraphs 1.29 – 1.33 “Working together to safeguard children:” a
   guide to inter-agency working, to safeguard and promote the welfare of children.
   Department of Health, Home Office, Department of Education and Employment.
   December 20.




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9.1.5 Fabricated or Induced Illness
Fabricated or induced illness (FII) is a complex issue and individual suspected cases
typically require a lot of consideration and discussion before they are to be regarded
in child protection terms.

The characteristics of fabricated or induced illness are a lack of the usual
corroboration of findings with symptoms or signs, or – in circumstances of proven
organic illness – lack of the usual response to proven effective treatments.

There are three main ways of fabricating or inducing illness in a child. More than one
may be evident in individual cases: fabrication of signs and symptoms, including
fabrication of past medical history fabrication of signs and symptoms and falsification
of hospital charts and records, and specimens of bodily fluids. This may also include
falsification of letters and documents induction of illness by a variety of means

The signs and symptoms require careful medical evaluation for a range of possible
diagnoses. Parents should be kept informed of findings from any medical evaluation,
but at no time should concerns about reasons for child’s signs and symptoms be
shared with the parents if this information would jeopardize the child’s safety.

   For guidance on the Management of Children in whom illness is fabricated
   or induced refer to the LSCB procedures appendix18.


http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx

http://www.cheshirewestandchester.gov.uk/default.aspx?page=892


9.1.6 Guidance regarding sources of stress for children and families that
may require extra support and supervision

      All unborn children identified by midwife or where there has been a pre birth
       planning meeting
      Prematurity
      Failure to thrive
      Children looked after by the local Authority
      Sexual Exploitation
      Fabricated or Induced illness
      Female genital mutilation
      Frequent Accident and Emergency attendances
      Children living in prisons
      Forced marriage
      Young unsupported parents
      Impaired Parenting Capacity
      Mental ill health of parent or carer
      Substance misuse
      Domestic abuse
      Social exclusion – adverse environmental factors
      Parental learning difficulty
      Concealed pregnancy




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Ref: Working Together for Safeguarding Children (2010) Chapter 9 –
Lessons from Research

9.1.7 The management of children and families requiring extra support
See Guidance 5

9.1.8 Abuse of Disabled Children
Children with special needs may be especially vulnerable to abuse because they
may:
     they have fewer outside contacts than other children
     they receive intimate personal care, possibly from a number of carers which
       may both increase the risk of exposure to abusive behaviour, and make it
       more difficult to set or maintain physical boundaries
     have impaired capacity to resist or avoid abuse
     have communication difficulties which make it difficult to tell others what is
       happening
     be inhibited about complaining for fear of losing services they are especially
       vulnerable than other children to abuse from their peers


9.1.9 The Management of Sexually Active Young People under the Age Of 18

Children and Young People under the age of 16 years
It is well understood, that whilst the legal age of consent is 16, some young people
become sexually active before that age. It was not however the intention of Sir
Michael Bichard or of the Sexual Offences Act 2003 to prosecute consensual
teenage sexual activity between two young people of a similar age and
understanding.

Nevertheless all sexual activity by young people under the age of 16 needs to be
taken seriously by all agencies involved both from a sexual health point of view and
also in ensuring that the young person is not being abused or exploited.
Whenever a sexually active young person under the age of 16 comes to the attention
of an agency or professional, that worker must undertake a risk assessment to
establish the level of risk, if any, to that young person and what type of support and
intervention might best meet their needs, including a possible referral to the police.

The Teenage Pregnancy Unit has produced a checklist to assist in the assessment,
and the checklist is reproduced in Recommendation 13 of Sir Michael Bichard’s
Report. This will be the common risk assessment tool used by all agencies and
professionals.

http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx

http://www.cheshirewestandchester.gov.uk/default.aspx?page=892


Young People Aged 16 and 17
   Even though the age of consent is 16, it is still important to protect 16 and 17 year
   olds from abuse and exploitation. Young people aged 16 and 17 fall within the
   LSCB Child Protection Procedures and there are particular measures within the
   Sexual Offences Act 2003 to protect them from prostitution, pornography and
   abuse by family members and those in positions of trust. Good practice would



                                                                                     16
   therefore indicate that the checklist be used to inform the risk assessment of a
   young person’s sexual relationship. Where there are concerns that a young
   person is being sexually exploited or a criminal offence is taking place, then a
   referral should be made to the Public Protection Referral Unit for further
   discussion and an agreed way forward.

9.1.10 Alerts re missing unborn/children/families

Missing families are when an outside Trust/Local Supervising Authority or children’s
social care etc contacts the Safeguarding Team via email regarding a family who has
gone missing from their area for whom there are safeguarding concerns.

  The Named Nurse will oversee that the following actions are undertaken:
    Check if the family are or have been known to the trust and respond to the
      alerting agency.
    If it is a child with no previous links to the trust the printed email is filed in a
      Missing Children’s folder and kept for 12 months

9.1.11 When Children go missing
See Guidance 6

9.1.12 Private fostering.

A private fostering arrangement is essentially one that is made privately (i.e. without
the involvement of a local authority) for the care of a child under the age of 16, under
18 if disabled, by someone other than a parent or close relative for 28 days or more,
in the carer’s own home.

      Under the Children Act 1989, private foster carers and those with parental
       responsibility are required to notify the local authority of their intention to
       privately foster; or to have a child privately fostered, or where a child is
       privately fostered in an emergency. East Cheshire Trust Employees should
       notify the local authority of a private fostering arrangement that comes to their
       attention where they are not satisfied that the local authority has been, or will
       be, notified of the arrangement.

9.1.13 When a Child Dies.
When a baby or child has died there are a number of questions you need to consider.
      Is the death unexpected?
      Should Social Services be informed?
      Are there any other children at risk of harm who need safeguarding?
      Have there been any concerns about the child/family expressed by any
       professional?
      Does the death fall within the coroner’s protocol for Sudden Unexpected
       Death in Infancy (SUDI)? For The Management of Sudden Unexpected
       Deaths in Infants (SUDI) and Children refer to the LSCB manual for child
       protection procedures appendix. 6

http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspxhttp://www.cheshirewestandchester.gov.uk/default.aspx?
page=892




                                                                                      17
10. TRAINING FRAMEWORK

All training is in line with the recommendations of the
Safeguarding Children and young people: Roles and Competencies for Health Care Staff (Intercollegiate Document September
2010) and Working Together to Safeguard Children Guidance March 2010

                            Target Group
Trust Statuary and          All employees of East Cheshire Trust
Mandatory Training          Method of Delivery
Level 1                     A presentation which will be supported with the use of a Safeguarding Children Induction Pack. This will be
                            given to each attendee at the Statutory and Mandatory training Day.
                            Training Content
                            All Employees will be aware of what to do if they are concerned about a child’s welfare or if a child is being
                            harmed, they will know who to contact for advice and supervision, they will be aware of the referral process
                            and the stresses for families that make children vulnerable. They will also know how to access Safeguarding
                            Children Policies and be aware of their responsibilities in Safeguarding Children and maintaining a child
                            focus
                            Frequency
                            Annual attendance is Mandatory
                            Refresher training will be delivered through an annual written update




                                                                                                                                             18
Group 1 & Group 2      Target Group
Basic                 All staff whose work brings them directly into contact with children, young people parents and carers.
Awareness             This includes Health care students, clinical laboratory staff, pharmacists, audiologists, radiologists, nurses
& Update              working in adult acute and community, adult physicians and all other adult orientated secondary care
Level two             professionals, Outpatient department staff including allied health professionals working in both Acute and
                      Community setting.
                      Method of Delivery

                      Training Content
                      What is child abuse and neglect? Signs and indicators of abuse and neglect. Sources of stress for children
                      and families. Information sharing, referral processes and documentation.
                      For participants to understand what constitutes child abuse, Know about the range of child abuse and the
                      signs and indicators of abuse and neglect. To know about local policies and procedures. Know who to share
                      their concerns with and the importance of information sharing. Maintaining a child focus. Their role in relation
                      to safeguarding children
                      Frequency
                      Annual written update
                      Classroom based refresher training at least every three years.


Group 3                Target Group
Basic Awareness and   All members of the workforce who work predominantly with children, young people and /or their parents/
Update                carers and who could potentially contribute to assessing, planning, intervening and reviewing the needs of a
Level three (Core)    child and parenting capacity where there are safeguarding concerns. This group includes Accident and
                      Emergency Nurses and Medical Staff, Nursing staff working in Day case and Day care settings, Paediatric
                      allied health professionals including Paediatric Speech Therapists Dieticians, Physiotherapist and
                      Occupational therapists, new born hearing, Surgeons including ENT Consultants, Orthopaedic Consultants
                      and Consultant Anaesthetist and theatre staff, Obstetricians, Paediatric radiologists. GP’s , Dentists,

                      Method of Delivery
                      Can be single agency health training or interagency.




                                                                                                                                       19
                           Training Content
                           Working together with other Agencies to identify, assess and meet the needs of children where there are
                           safeguarding concerns. .
                           Recognising the importance of family history and functioning and working with children and family members.
                           Frequency
                           Annual written update
                           Mandatory annual requirement to attend update session or attendance at interagency training. Over a three
                           year period training must equal at least two hours per annum.


Group 3                     Target Group
Basic Awareness, Update    All members of the workforce who work predominantly with children, young people and /or their parents/
and Interagency training   carers and who could potentially contribute to assessing, planning, intervening and reviewing the needs of a
Level 3 (Additional        child and parenting capacity where there are safeguarding concerns. This group includes midwifes,
Competences)               Paediatric Nursing and Paediatricians, Paediatric nurse specialists, Paediatric learning disability staff., GP’s
                           Dentists, Health Visitors, School Nurses

                           Method of Delivery
                           Single Agency health training update.
                           Interagency training delivered in a multi agency setting in conjunction with the LSCB.
                           Training Content
                           Working together with other Agencies to identify, assess and meet the needs of children where there are
                           safeguarding concerns. .
                           Recognising the importance of family history and functioning and working with children and family members.
                           Frequency
                           Annual written update
                           Mandatory annual requirement to attend update session
                           The key areas: Paediatrics and Midwifery, has an annual requirement to identify staff on a rolling programme
                           to attend inter agency training.
                           Training over a three year period should be a minimum of 12-16 hours with at least two hours per annum.




                                                                                                                                              20
Group 4 & 5                    Target Group
Contents of Groups 1, 2 & 3   Members of the workforce who have particular responsibilities in relation to Section 47 Enquiries and
Inter Agency Training and     professional advisers, named and designated lead professionals and Consultant Paediatricians and Expert
relevant National courses     Witnesses.
and Conferences               Method of Delivery
Level 4 and 5                 Interagency training in addition to professional development related to specific role. This should include non-
                              clinical knowledge acquisition such as management, appraisal, and supervision training
                              • Named professionals should participate regularly in support groups or peer support networks
                              for specialist professionals at a local and National level, according to professional guidelines
                              (attendance should be recorded)
                              • Named professionals should complete a management programme with a focus on leadership and
                              change management within three years of taking up their post
                              Expert witnesses should undertake specific training in the role of the expert witness in court.
                              Training Content
                              The above plus: Working together to identify, assess and meet the needs of children where there are
                              safeguarding concerns The impact of parenting issues, such as domestic abuse, substance misuse on
                              parenting capacity Recognising the importance of family history and functioning Working with children and
                              family members, including addressing lack of cooperation and superficial compliance within the context of
                              their role
                              Frequency
                              A minimum of 24 hours over a three year period. (Intercollegiate) 2 to 3 days per year continuing
                              professional development.( Working Together)



Group 6                       Target Group
Contents of Groups 1 & 2      Operational managers at all levels. Clinical managers including: practice supervisors and frontline managers
Update of new                 Method of Delivery
Safeguarding Issues           Single Agency training related to specific roles.
Level two                     Training Content
                              Managing performance to promote effective inter-agency practice.




                                                                                                                                                21
                                  Frequency
                                  Three yearly update.

Group 7                           Target Group
In house and LSCB                 Senior strategic managers and NHS Board members
Induction                         Method of Delivery
National and Local                In house and LSCB induction programme. National / Local Leadership Programmes
Leadership Programmes             Training Content
Level two                         Content as for Groups 1,2 and 3 to include Section 11 expectations and roles and responsibilities
                                  Frequency
                                  Refresher training at least three yearly

Group 8                           Target Group
LSCB Induction and                Members of the LSCB
LSCB Development Day              Method of Delivery
Level; two                        LSCB induction programme
                                  LSCB development days
                                  Training Content
                                  Content as for groups 1, 2 and 3 and roles, responsibilities and accountabilities.
                                  Frequency
                                  At least three yearly

Reference:
Safeguarding Children and Young People Roles and Competence for Health Care Staff – Intercollegiate Document September 2010

http://www.rcpch.ac.uk/Publications/Publications-list-by-title

Search for: PDF file S - Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff – Intercollegiate Document
September 2010




                                                                                                                                          22
11.    NON ATTENDANCE OF APPOINTMENTS AND NO ACCESS VISITS

The Commissioners for Healthcare Audit and Improvement recommend that Trusts
monitor the number and types of Did Not Attend and No Access visits and pay
particular attention to the reasons, if known. (CHI 2003, DoH 2005).

The Healthcare Commission audit on Safeguarding Children also highlighted that
good practice should include a policy on taking action when a child/family fail to
attend an appointment or the health professional fails to gain access to a family.

Serious Case Reviews both locally and nationally have frequently shown a history of
DNA appointments and No Access visits for Health care.
Clear guidelines, protocols and policies must be in place to ensure that all children
receive the care and assessments they require.

11.1 Risks of Non-Attendance / No Access to Unborn Child / Children / Young
Person

In the event that the young person has failed to attend, or the parent / carer has
failed to bring the child to an appointment, please refer to the Flowchart for DNA and
No Access Visits.
As a minimum the child should either be offered a further appointment or referred
back to the referrer if necessary.

It is often difficult to quantify the likely risk to the child / young person / pregnant
woman of non-attendance / no access. In view of this it is preferable to discuss this
with the referrer, parent /carer and possibly other professionals who have knowledge
of the family. In this way more information can be obtained, allowing for a more
holistic assessment of the possible impact on the unborn child / child / young person
from non-attendance / no-access.

Low / medium risk might be considered for children / young people / pregnant
women with a stable condition / situation or where there are no known concerns. This
may be considered for families who are known to engage with services generally.
Each case will require individual consideration.

High risk will be all children / young people / pregnant women whom it is thought
require assessment / intervention to prevent permanent or serious deterioration of
their condition, or for whom there is a risk of significant harm as a result of non-
attendance / no access (DOH 1999). It is essential to consider all children / young
people / pregnant women who are known to Social Care and / or subject to a
protection plan a high risk

The Common Assessment Framework Pre-Assessment Checklist should be used
when assessing risk. (Appendix 2)

11.2   Guidance for Healthcare Professionals

a) On the first Did Not Attend or No Access Visit
    Assess the reason for the non attendance or no access visit and assess
       where there are risk to the child’s health and well-being.
    Liaise with other professionals involved with the family.
    For No Access visits leave a written communication that you have called as
       arranged and record action to be taken in the child’s case notes.


                                                                                     23
           Arrange another appointment if appropriate – it may be necessary to refer to
            Social Care or to send a letter to parents.
           Document in case notes.

    b) Second Did Not Attend or No Access Visit
        Assess the reason for the non attendance or no access visits and assess the
          risk to the child’s health and well-being.
        Liaise with other professionals involved with the family.
        For No Access visits leave a written communication that you have called as
          arranged and record action to be taken in the child’s case notes.
        Arrange another appointment if appropriate – it may be necessary to refer to
          Social Care or to send a letter to parents.
        Liaise with the referrer/and other professionals who may have knowledge of
          the family to obtain further information to assess the risk to the child/young
          person.
        Document in case notes the action taken.

    c) Third Did Not Attend or No Access Visit
        Contact Social Care to establish if child/family known to their service. Refer
           to Social Care if there are significant risks to the child.
        Inform referrer of non attendance / No Access.
        Inform line manager.
        Document action in child’s health notes/child health records.


Please Note

Whilst the use of a letter is being cited as the standard form of communication with parents / carers
in these situations additional methods of communications may be used where parents /carers
circumstances would make this ineffective or inappropriate (for example, where there is a visual
impairment, learning disability, low level of literacy or other factors affecting a carer's ability to read
or understand the letters instructions).




                See Flowchart for Did Not Attend / No Access Visits – Appendix 3




                                                                                             24
                              12. Continuum of Need and
                       How we Work Together to keep Children Safe




                            Key: I = identification and action, T = Transition, N = Needs met


Specialist needs
Children and young people who require              Refer to appropriate specialist agency. Refer
specialist/acute services to meet their needs.     concern to Children’s Social Care. Children’s
This includes children who have suffered or are    Social Care shall make such enquiries as they
likely to suffer significant harm (Children Act    consider necessary to enable them to decide
1989, s.47) Significant harm may be the result     whether they should take any action to safeguard
of physical abuse, emotional abuse, sexual         or promote the child’s welfare (Children Act
abuse or neglect.                                  1989, s.47) The local authority and health bodies
                                                   have a duty to help with enquiries about
                                                   significant harm. (Children Act 1989, s.47)

Complex needs
Children and young people whose needs are          If a multi-agency response is required, the
not fully met due to the range, depth or           Common Assessment Framework (CAF) process
significance of these needs. This includes         should be used. This should involve the
children whose vulnerability is such that they     parent/carer and child/ young person. Children’s
are unlikely to reach or maintain a satisfactory   Social Care carry lead responsibility for
level of health or development, or their health    establishing whether a child is in need and for
and development will be significantly impaired,    ensuring services are provided to that child as
without the provision of services (CA 1989,        appropriate. This does not require Children’s
s.17) Child whose health or development is         Social Care itself necessarily to be the provider
being impaired, or there is a high risk of         or co-ordinator of such services. The local
impairment                                         authority and health bodies have a duty to help
                                                   with enquiries about children in need (Children
                                                   Act 1989, 17).Reference s10 Children Act 2004
                                                   duty to co-operate?



                                                                                          25
Targeted -additional needs
Children and young people who would benefit
from additional help from public agencies in       If a practitioner identifies a concern about a child
order to make the best of their life chances.      they should assess the needs and agree a plan
                                                   of support with the parent/carer and the child
                                                   using the Common Assessment Framework.
Universal -no identified additional needs
Children and young people whose needs are          For the local authority and health bodies and
being adequately met by their parents/carers,      youth justice organisations, there is a duty to
and who are accessing universal services.          safeguard and promote the welfare of child, and
                                                   a duty to cooperate (Children Act 2004).


      13.0 THE COMMON ASSESSMENT FRAMEWORK (CAF)

      The CAF is a tool to enable early and effective assessment of children and young
      people who need additional services or support from more than one agency. It is a
      holistic consent based needs assessment framework which records, in a single place
      and in a structured and consistent way, every aspect of a child’s life, family and
      environment. For guidance on when to complete a CAF see appendix.

      CAF documentation can be accessed via

      http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
      protection_information.aspx

      http://www.cheshirewestandchester.gov.uk/default.aspx?page=892

      13.0 DISSEMINATION AND IMPLEMENTATION

      This policy will be disseminated to senior managers in all departments and will be
      available on the intranet. The content of the policy and its significance is included in
      mandatory training and local induction programmes. Staff will be briefed through
      team brief and divisional and ward meetings. The policy should be reviewed
      annually and the responsibility for this review lies with the named professionals.

      14.0 AUDIT AND KEY PERFORMANCE INDICATORS

      Compliance with the requirements of this policy will be monitored by the business
      units. Non compliance with this policy should be reported through the clinical
      incident reporting system. This may result in a multi-disciplinary incident review and
      action planning meeting.

      Attendance at safeguarding children training will be recorded by learning and
      development and monitored by departmental managers. Knowledge and Skills
      relating to safeguarding children will form part of the KSF appraisal process and will
      be evidenced in personal performance plans where this is appropriate for the
      employee’s role.

      Compliance with the requirements of the Victoria Climbié Enquiry (Laming 2006) will
      be monitored by an annual audit of case notes of those children where a
      safeguarding issue has been identified by the Named Nurse and Doctor for
      Safeguarding.
      A further audit will be undertaken annually by the Named Midwife in relation to
      antenatal safeguarding.


                                                                                            26
The Safeguarding Team will contribute to all case audit requests made by the two
LSCBs

Measuring Performance
Key performance indicators identified relating to this policy are as follows:
    All staff will be provided with child protection information on commencement
      of employment
    All staff who have direct contact with children and families will attend basic
      awareness training (level 2) within 3 months of commencement
    All staff who to have direct contact with children and families will attend
      update training as defined within the policy i.e. either annually or every 3
      yearly as defined by post.
    Annual audits of Safeguarding children / antenatal safeguarding will be
      undertaken in relation to this policy. These will be presented as part of the
      business units audit program.

An annual report on Safeguarding Children will review the key performance
indicators for presentation to the Trust Board.

Audit Standard
The efficacy of this guideline will be audited annually.



These guidelines cannot anticipate all possible circumstances and exist only
to provide general guidance on clinical management to clinicians.



15.    REFERENCES and INTERNET LINKS

In developing this Policy account has been taken of the following statutory and non-
statutory guidance, best practice guidance and the policies and procedures of the
Local Safeguarding Children and Adults Board.

Every Child Matters
http://publications.everychildmatters.gov.uk

The Protection of Children in England – A Progress Report
http://publications.everychildmatters.gov.uk

The Children Act 2004
www.opsi.gov.uk/acts/acts2004/ukpga_20040031_en_1

Making Arrangements to Safeguard and Promote the Welfare of Children
http://publications.everychildmatters.gov.uk

Children Act 1989
www.opsi.gov.uk/acts/acts1989/ukpga_19890041_en_1

Information Sharing Guidance for practitioners and managers
www.dcsf.gov.uk/ecm/informationsharing




                                                                                   27
National Service Framework for Children Young People and Maternity
Services
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy
AndGuidance/DH_4089101

Statutory guidance on making arrangements to safeguard and promote the
welfare of children under section 11 of the children Act 2004
www.everychildmatters.gov.uk/resources-and-practice/IG00042/

What to do if you’re worried a child is being abused
www.dcsf.gov.uk/everychildmatters/_download/?id=760

When to suspect child maltreatment
www.nice.org.uk/nicemedia/pdf/CG89FullGuideline.pdf

Working Together to Safeguard Children March 2010
http://publications.dcsf.gov.uk/default.aspx?PageFunction=productdetails&
PageMode=publications&ProductId=DCSF-00305-2010

Safeguarding Children and Young People: Roles and Competencies for
Healthcare Staff
www.rcpch.ac.uk/doc.aspx?id=Resource=1535


15. GLOSSARY

CAF           Common Assessment Framework
LSCB          Local Safeguarding Children Board
LAC           Looked After Children




                                                                             28
                                                                   APPENDIX 1

           PRINCIPLES TO SAFEGUARD THE SERVICE AND STAFF


The general principles to safeguard the service and staff and to ensure professional
integrity whilst working to safeguard children are:

   1. Safe recruitment and selection practice in accordance with Safer
      Recruitment-A Guide for NHS Employers(NHS Employers 2005) and Safe
      from Harm(Home Office 1993) which ensures that appropriate Criminal
      Record Bureau (CRB) checks are undertaken for new staff and volunteers
      including registered translators who have contact with children and vulnerable
      adults.

   2. A recruitment procedure that includes the use of standard application forms,
      references, interview procedure and applicant declaration

   3. Development of a culture of listening and engaging in dialogue with children,
      seeking children’s views in ways that are appropriate to their age and
      understanding.

   4. Encouraging staff to use the whistle blowing policy and procedure East
      Cheshire Trust `Guidance for Staff Raising Concerns at Work’ policy.


   5. Ensuring the staff and managers follow procedures for managing allegations
      and concerns regarding the suitability of adults who work with children and
      young people in accordance with L.S.C.B. procedures for Cheshire and the
      guidance in Working Together to Safeguard Children 2006. Including having
      a nominated service manager who is the identified person to whose reports or
      concerns regarding allegations of abuse against children are reported to in
      connection with his/her employment or voluntary activities.

   6. Providing and monitoring access to training to safeguard children in
      accordance to the statutory guidance in Working Together to Safeguard
      Children 2010, chapter 4, (HM Government 2010). (Safeguarding Children
      Policy, Mandatory Training Policy).

   7. Ensure that all those involved in safeguarding work should have access to
      clinical supervision and peer review/support. Advice should also be available
      from Named and Designated professionals. Supervision should scrutinize and
      evaluate work and case records to include key decisions reached during
      supervision. (See East Cheshire Trust Safeguarding Children Supervision
      Policy.)

   7. Medical examination of a child should be done in the presence of a
      chaperone to safeguard the child and the doctor, to assist the doctor and to
      make the child feel more at ease. The chaperone should be an experienced
      member of staff who is familiar with procedures and the special aspects of
      these examinations. The parents or the social worker should not be used as
      chaperones. (Child Protection Companion, Royal College of Paediatrics and
      Child health 2006)




                                                                                 29
8. If there are language difficulties or communication difficulties it is essential
   that a formal interpreter service is used. Other family members are not
   suitable interpreters. It is good practice for formal interpreters to have child
   protection training (Child Protection Companion, Royal College of Paediatrics
   and Child health 2006, Working Together to Safeguard Children, Chapter 10,
   H.M. Government 2006 )

10. Staff must not:

          Engage in rough physical games with children and young people in
           their care, this includes horseplay.

          Touch a child in an intrusive or sexual manner or make sexually
           suggestive comments even as a joke.

          Do things of a personal nature that the child or young person can do
           for themselves (Gain consent from the child, young person or parent
           before carrying out care, refer to the Consent Policy No. C4).
           (Child–safe code for Staff and Volunteers Avon and Somerset Police
           1991) adopted by the Local Safeguarding Children Board of Cheshire
           County Council.




                                                                                30
                                          Appendix 2

                              EAST CHESHIRE TRUST
               THE PROCESS FOR UNDERTAKING A COMMON ASSESSMENT



The Practitioner identifies child/young                   If unclear whether a common
    person has an additional need                          assessment is required complete
                                                           the pre-assessment checklist
                                                           with the child/young person
                                                           and/or their parent as
   Discuss identified need with the                        appropriate
 children/young person and/or their
        family as appropriate                             Check if there is an existing or
                                                           previous common assessment
 During the discussion gain consent to                    Check if a Lead Professional is
complete the common assessment and                         already working with the family
        to sharing information                            If there is a CAF or Lead
                                                           Professional identified contact
                                                           the relevant practitioner
Contact CAF co-ordinator to see if CAF
already in place 01625 528986                             As part of the assessment
                                                           contact    other    practitioners
                                                           working with the family to
 Complete common assessment with                           discuss needs and share relevant
 the child/young person and/or their                       information – based on consent
  family as appropriate Use CAF form                       given
                                                          Inform the family of these
                                                           discussions
 Agree next steps with the family and                     Agree with the child/young
 record these on the action plan of the                    person and/or their the content
      common assessment form                                f h
                                                       A – Assessment indicates no
                                                       additional support is required.
  C – Assessment indicates additional                  Current support with universal
 support is required and multi-agency                  services can meet the needs of the
          support is required                          child/young person. Agree no
                                                       further action is required
                                                       B - Assessment indicates additional
   Child in Need meeting convened                      is required from another agency,
                                                       single agency or service. Liaise
                                                       with agency regarding provision of
                                                              t
     Services and actions initiated
                                                          Lead Professional is identified
                                                          Action plan is written and
                                                           agreed
 Regular review and update of action                      Review date is set
                plan                                      CAF is faxed to the CAF co-
                                                           ordinator 01606 288958
                                                          Copy of CAF sent to Named
                                                           Nurse
                                                          Copy of CAF filed in child’s
                                                                                   1
                                                                                  31
                                                           records
                                                                  Appendix 3
   Flowchart for DNA and No Access Visits
   NB: Record actions at
   each stage                     1st DNA/NO ACCESS VISIT


                                           ASSESS
                                           REASON
          RISK                                                           MINIMAL RISK
                                           ASSESS
                                        POSSIBLE RISK
   Assess level of risk
(Consider the use of CAF
 Assessment Framework
   and or the CAF Pre-
assessment – Appendices
       11 and 12)                                                            No further appointment or
                                         2nd DNA/NO                           2nd appointment/contact
                                        ACCESS VISIT                          depending on individual
  HIGH            LOW                                                          service specification.
  RISK            RISK
Inform Line   Send letter to
 Manager.     Parents/liaise
  Refer to    with referrer
Social Care

                                      ASSESS POSSIBLE
                                           RISK
          RISK                                                                 MINIMAL RISK

   Assess level of risk                  3rd DNA/NO                          No further appointment or
                                                                             3nd appointment/contact
                                        ACCESS VISIT                         depending on individual
  HIGH            LOW
                                                                             service specification.
  RISK            RISK                                                       Liaise with referrer.
Inform Line      Send 2nd
 Manager.         letter to
  Refer to       Parents –
Social Care


                                Liaise with other agencies and referrer.
                                Liaise/refer to Social Care if necessary.
                                Inform manager of outcome.
                                A meeting may be required.
                                Keep GP informed.
                                Letter to parent/carer and/or continue to
                                 try to access opportunistically.




                                                                                    32
                                                                     Appendix 4

PRINCIPLES OF CARE FOR WHEN A CHILD IS ADMITTED TO HOSPITAL AND
                      ABUSE IS SUSPECTED


  1. Medical conditions must be treated as a priority. The child, parents and carers
     must be afforded the same degree of sensitivity and respect as any other.

  1. If English is not the family’s first language or the child requires additional
     support to be able to communicate and understand effectively then an
     appropriate interpreter or form of communication must be used. A source of
     interpreter should be identified by the trust.

  2. Where a child has been treated at another hospital, those records should be
     obtained as soon as possible.

  3. Details of the child including general practitioner and current school should be
     recorded in the child/young person’s medical/nursing notes.

  4. Where child abuse is suspected, the admitting Consultant should be notified
     as soon as possible. If the admitting Consultant is not a Paediatrician then a
     referral should be made by the admitting Doctor to the on call Paediatrician
     and the child should be admitted jointly under the care of the Speciality
     Consultant and the Paediatrician. The Consultant Paediatricians role will be to
     ensure that appropriate guidance and management of the safeguarding
     Concern. This applies to all children under the age of 18yrs.

  5. A full history and physical examination should be taken and recorded in an
     agreed form as soon as possible and within 24 hours unless there is a reason
     to delay, which has been recorded in the child/young person’s
     medical/nursing notes.

  6. The examining doctor should consider taking a history directly from the child,
     if appropriate, even if parental permission is not forthcoming.          The
     Responsible Consultant should make this decision.

  7. If there are differences of opinion regarding the cause of harm to a child (for
     instance between doctors or nursing staff) this should be recorded in the
     medical/nursing record. The matter must be referred to the Named
     Professionals. If differences persist, the Designated Professionals should
     also be consulted. Any health professional with continuing concern should be
     able to raise concern with the Named/Designated Professionals.

  8. No child/young person about whom there is concern should be discharged
     from hospital without the permission of the Consultant Paediatrician or
     Named Professional. This Policy should be read in conjunction with
     East Cheshire Trust Hospital Discharge Policy

  9. A check to ascertain whether there is a child protection plan in place must be
     made before the child leaves hospital. This information is available through
     the social service access team or the duty social worker out of hours. See
     See Guidance 7




                                                                                  33
   10. Any concerns about a child at risk or a child’s welfare must be referred to
       Social Services according to the LSCB procedures and a documented plan of
       care agreed. For guidance see What to do if you have concerns about the
       Welfare of a Child Flowchart Appendix 9



    11. If referral to social care is deemed necessary, a telephone referral to the
        Access team must be followed up with a completed referral form within 48
        hours. Social Care should then be contacted in 72 hours to ensure that the
        referral has been received and to discuss social cares response. Referral
        forms must be photocopied and filed in the child’s records. (Follow link for
        referral form)
http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx


Future care plans must be agreed taking into account any information received from
other Agencies or Health Personnel and evaluated by the responsible Consultant.

   12. All cases of an infant/child death up to 18 years of age must be referred to the
       named professionals in line with Cheshire LSCB procedures.

When a child is referred to the Hospital for possible Child Abuse

Cases of possible child abuse referred by the Police, Social Services and/or other
health professionals should be referred directly to the Consultant Paediatrician on
call. Arrangements will be made as appropriate for the child to be seen in Paediatric
Outpatients or the Children’s ward, it is usual practice for the child to be
accompanied by a Social Worker. The Trust Safeguarding Documentation should be
used.


Process for Children Attending Hospital Who Are Not Registered With a GP

If a child is not registered with a GP the parents/guardians should be advised to
register the child immediately. Information regarding GPs accepting patients can be
found on www.nhs.uk

Further assistance with the allocation of a GP can be provided by the FHSA
Registration Department 01244 650 400

If there are safeguarding concerns the child must not be discharged from
Hospital until a GP has been allocated to the child.

Discharge of a Child against Medical Advice
For Guidance regarding parents/guardians wishing to take their child’s discharge
against medical advice where there are Safeguarding issues, see the East Cheshire
Trust Hospital Discharge Policy

http://trustnet/PoliciesNew08/ECT001339/ECT001339.PS.20091001.DischargePolicy
.pdf




                                                                                    34
The Process for the Transfer of a Child from Hospital to Hospital when there is
a Safeguarding Concern.

Transfer documentation must be completed that ensures that Nursing and Medical
staff at the receiving Hospital is aware of the Safeguarding concerns and any
ongoing support that the child/family are receiving. This may include information
about CAF, Lead Professional, any Child Protection Plan and Named Social Worker.

This information should also be transferred via a telephone conversation with the
receiving Medical and Nursing Staff.

If the child is an inpatient then the Senior Nurse must be informed.

The Nurse for Safeguarding Children at the receiving Trust must be informed

The Paediatric Liaison Health Visitor must also be informed so that she can inform
the local area Health Visitor and the liaison Health visitor in the receiving area.

The child’s Named Social Worker must also be informed.
If there is no current social care involvement and there is a Child Protection concern
then a referral to social care must be made in line with ECT and LSCB Procedures

All phone conversations must be documented in the patient notes and copies
of referrals and transfer documentation filed in the patient’s records.


Process for when a child is to be removed from the Hospital by Social Care
into Foster Care.

Regular contact should be maintained between the Named Nurse for Safeguarding
Children and the Named Social Worker to ensure a safe and orderly handover of
care.
 In the case of a newborn Social care will be informed of the delivery of the baby by
the midwife as soon as possible in order to initiate plans for the transfer of care.

Contact between Mother/Father will be allowed at all times if this is not considered to
expose the baby /child to further Risk. In such cases contact will have to be
supervised and agreed by Social Care.

If the child is a newborn then duplicate mementoes, cot cards, foot prints and
identification bracelets should be made for use in the future if required.

Arrangements will be made for the Social Worker to attend the ward to discuss
discharge planning with the mother and the medical and Nursing Staff.

When visiting the ward the Social Worker should introduce themselves on each
occasion and show identification to the Nursing Staff prior to visiting Mother/Father
and Child

The Social Worker will provide details of the baby’s discharge address to the
Nursing/Medical staff including foster carers names and, if possible, General
Practitioner details.




                                                                                    35
It will be viewed as positive if the foster carers are able to visit the Child prior to
discharge. This contact can be arranged through the named Social Worker.

On discharge the name of the Social Worker collecting the baby should always be
known in advance and the Social Worker must present appropriate identification.

If foster carers are collecting the baby they should normally be accompanied by the
Social Worker. Where this is not possible, prior notification will be provided to the
Nursing/Medical Staff with details of the foster carer. Identification must be produced
on arrival.

A convenient date and time for the discharge of the baby should be agreed between
the Nursing/Medical Staff and Social Worker.

Following discharge the Named Nurse for Safeguarding must be told of discharge
details so that the Named Nurse for the area to which the baby has been transferred
to can be made aware, and The Looked after Children’s Nurse can be informed.

The Paediatric Liaison Health Visitor must also be informed so that the local Health
Visitor can be informed.

If the child is being discharged from the Maternity Unit then the discharging Midwife
must inform the Midwife in the area the baby is being transferred to of the baby’s
Address and the foster Cares details.

Midwifery care for the baby will continue in the home of the foster parents until hand
over of care to the health visitor.


Process for Children who spend more than 3 months in hospital

Children who spend more than 3 months in hospital should be referred to Social
Care, to trigger an assessment under the framework for the assessment of children
in need and their families and to follow up their welfare needs. For referral form see
Trust Intranet




                                                                                    36
                                                                       Appendix 5

PRINCIPLES OF CARE FOR WHEN A CHILD IS SEEN ACCIDENT AND
EMERGENCY DEPARTMENT FOR WHO THERE ARE SAFEGUARDING
CONCERNS

(For AED Pathway see Appendix 6)

Children attending without referral or liaison with child protection concerns

In a medical emergency the needs of the child are paramount, and medical
intervention must take priority over any other action.

The triage nurse who assesses a child initially will inform the nurse in charge and the
A/E doctor if there is a suspicion that the child has been or is at risk of abuse or
neglect.

The investigation and management of a child about whom there are concerns must
be approached in the same systematic and rigorous manner as would be appropriate
to any other potentially fatal disease.

The nurse or allied health professional will continue to manage the care of the child
and family (including any siblings who may be present), under the supervision and
co-ordination of the nurse in charge of Accident and Emergency Department.

The nurse in charge will take the appropriate action following this policy to
inform/liaise with the relevant professionals and agencies.

 If a nurse, allied health professional or doctor suspects, receives an allegation or
disclosure, or has evidence of child abuse or neglect, the concern must be discussed
with the senior A&E doctor with a view to refer to the on call Consultant Paediatrician.

If a child has a genital injury which is thought to be accidental, a senior A&E doctor
should initially examine the child. If there are Safeguarding concerns then the child
must be referred to the on call Paediatrician

In all cases of suspected or actual sexual abuse, refer to the consultant paediatrician
on call. Examinations in these cases should only be undertaken by an experienced
Paediatrician, usually as a joint examination with the forensic medical examiner
(police surgeon).

In a case of suspected deliberate harm the examining doctor should consider taking
a history directly from the child. In the cases where English is not the child’s first
language, the use of an interpreter should be considered. However, this must only be
done if it is in the best interests of the child.

Any concerns about a child at risk or a child’s welfare must be referred to
Social Services according to the LSCB procedures and a documented plan of
care agreed

If referral to social care is deemed necessary, a telephone referral to the Access
team must be followed up with a completed referral form within 48 hours. Social Care
should then be contacted in 72 hours to ensure that the referral has been received


                                                                                     37
and to discuss their response. Referral forms must be photocopied and filed in the
child’s records. (Follow link for referral form)

http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx


While professionals should seek in general, to discuss any concerns with the
family and, where possible, seek their agreement to making referrals to Social
Services, this should only be done where such a discussion will not place a child at
increased risk of significant harm.

Special Register in Accident and Emergency Department.

Children who have a child protection plan in place in the Cheshire area, or who are
frequent attenders at MDGH AED, or who have been discussed at the Multi Agency
Risk Assessment Conference (MARAC) in relation to Domestic Abuse will be
highlighted on the Special Register in Accident and Emergency.

Children living in other local authority social services areas will not have this facility.

      • Therefore it is important not to assume that if they are not highlighted on the
          special register that the child is not at risk.

      • There are more children at risk whose names are not on the register than on
          the register.

      • If a child is recorded as having a Child Protection Plan in place this should be
            reported to the doctor dealing with the case, as a significant family factor.

      • Should there be any child protection concerns on attending the A&E
         department then the guidance within this policy must be followed

      • If there are no child protection concerns relating to the A&E attendance other
            than the fact that the child has a child protection plan in place, the Social
            worker must still be informed of the incident.

      • The nurse in charge must ensure that the Named Nurse for Safeguarding
          Children and the Liaison Health Visitor are informed of all children on the
          Special Register attending the A&E department, regardless of whether
          there have been child protection concerns.


- When an adult attends A&E with physical injuries, which are suspected to be
  inflicted personally or by another person,
Staff must ask if any children live with them. If they do, then a referral must be made
to the Liaison Health Visitor and consideration must be given to a referral to
Children’s Social Care if there are concerns for the welfare of the child.




                                                                                          38
                                                                                      Appendix 6
                Emergency Department Guidance for Child Protection
        Child Protection Concern Triggered: e.g.                    If you have a serious concern about a child,
            ffjrojfojeojfojwwwNB
            Physical Injury                                         and the carers threaten to take him away
            Neglect                                                from the department before an assessment
            Sexual Abuse/assault                                   can be completed immediately discuss with
            Emotional Abuse(eg.domestic violence)                     the most senior Doctor available in the
            Carer incapacitated                                                     department


      Clinician to assess child and ensure they are receiving appropriate medical treatment.
      Must discuss with senior ED Doctor (Middle Grade or Consultant) and refer to paediatric
      Middle Grade or Consultant as appropriate.


                    NB Carefully document all communications.
                    Sign and print name clearly.



 Check whether the child is subject to a Child Protection Plan by telephoning Social Care.
 An SR alert on the ED card may mean the child has CPP. However, the absence of an SR alert does not mean
    the child does not have a CPP. If the child has a CPP then social care MUST BE INFORMED OF ANY ED
     ATTENDANCE. For children with no CPP, and an SR alert means that there are safeguarding concerns
          registered on the PAS system. A receptionist will be able to access this information for you

                                                             NB it is good practice to inform parents of
                                                             referrals unless it is thought to put the child at a
                                                             further risk – discuss with senior doctor.



SOCIAL CARE REFERRALS – DISCUSS WITH SENIOR ED NURSE OR DOCTOR
   Telephone Duty Social Worker or Child’s Social Worker if known
   Complete a SOCIAL CARE REFERRAL FORM and ask reception to fax immediately
   Send a SAFEGUARDING NOTIFICATION FORM to Mel Barker(Named Nurse for Child
     Protection) and include a copy of the clinical notes and a copy of the Social Care referral
   Ensure all information including siblings is documented



                LIAISON HEALTH VISITOR BOOK MUST BE COMPLETED



             NB Ensure good communication with Primary Care by completing discharge letter
                                                     immediately.
        Telephone contact with GP may also be required.
        Advice or feedback of cases is available from Mel Barker 01625 661770 0r bleep 3342. For further
        contact details for advice please see Trust “What To Do If You’re Worried A Child is Being Abused”.
        Referral Pathway



                                                                                                 39
                                                                   Appendix 7

ANTENATAL PRE BIRTH SAFEGUARDING PRINCIPLES

  1. The relationship that midwives foster with women provides an opportunity to
     observe attitudes towards the developing baby and identify potential
     problems during the pregnancy, birth and the child’s early care. (HM Gov
     2006, 2.84)

  2. A holistic assessment of the mother should be undertaken, taking in to
     account family and environmental factors, lifestyle choices, parenting
     capacity, the possible impact on the health and developmental needs of the
     unborn child or of any previous children. (Framework of Assessment – DOH
     2000)

  3. It is estimated that a third of domestic abuse starts or escalates in pregnancy;
     therefore every woman should be given the opportunity to have a private
     consultation with a midwife so that issue of abuse can be raised in a
     supportive and enabling environment.

  4. To facilitate the assessment process and to enable disclosure of sensitive
     information where the woman’s first language is not English an interpreter as
     identified by the Trust must be used.

  5. When the midwife identifies special circumstances/ concerns she must
     commence a special circumstances form in the medical records and notify the
     Named Nurse for Safeguarding Children. The Special Circumstances Form is
     to facilitate effective communication about any circumstances that may affect
     the women’s capacity to provide a safe/adequate environment for her baby
     and to detail any plans made throughout pregnancy and following delivery for
     ongoing care to minimize risks. The Lead midwife taking the key responsibility
     would usually be the Team leader.

  6. A Significant Events Sheet should also be commenced and kept in the
     Mothers records. This must be transferred into the baby’s records following
     the birth. The purpose of the Significant Events Sheet is to aid information
     sharing.

  7. On identifying concerns, liaison should take place with Health visitor, GP,
     Social Care and any other agencies as appropriate.

  8. Supervision should be arranged with the Named Nurse for Safeguarding
     Children so that safeguarding issues can be discussed and a plan put in
     place.

  8.    The outcome may not always necessitate a referral to social care. It may be
       that the additional support can be met by the universal services. If additional
       support is      being provided or required from specialist agencies then an
       antenatal planning meeting will be called to co-ordinate an agreed plan with
       the woman and family. It may be decided with the client that a CAF will be
       undertaken.

  9. If referral to social care is deemed necessary, a telephone referral must be
     followed up with a completed referral form within 48 hours. Social Care



                                                                                   40
http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx


   10. It is the responsibility of the Lead midwife to record in the baby’s records that
       there has been a Special Circumstances Form during the pregnancy and give
       a brief summary of the concerns and any agencies involved and transfer the
       Significant Events Sheet. If there has been any case conference reports,
       recommendations, Child Protection Plan, planning meeting reports or a CAF
       completed then these must also be kept in the child’s records. This will alert
       staff on further admissions to the hospital that there have been concerns
       identified and of any agencies involved

   11. Following the discharge of a mother and baby at 28 days where there have
       been Safeguarding concerns’ raised, a discharge planning meeting held or a
       CAF completed a summary of the postnatal period should be sent to the
       Health Visitor, GP and any other agencies involved in providing support to the
       family. For Summary Letter see appendix 8

Following the Concealment of a Pregnancy.

See Guidance 8




                                                                                     41
                               Appendix 8
Summary Discharge Letter For Where There Have Been Safeguarding Concerns
Raised in the Antenatal Period

Clients Name                                  DOB



Address                                       Date and type of Delivery




Baby’s Name                                   Gravida/Parity

Midwifery Team                                GP and Address



Health Visitor and Address                    Social Worker and Address



Other Relevant Professionals                  CAF Open/ Closed
                                              Name of Lead Professional and Address



Reasons for requiring extra support




Summary of Postnatal period




In line with statutory regulations the above woman will be/was discharged from

midwifery care on the ------------------------------------at -----------------------days

post partum

Copied to:    GP     HV    Social Worker       Family Support      Mental Health Team

Drug and Alcohol Team.          CAF Team       School Health        Safeguarding Nurse

Other.

Name and Signature of Discharging             Date
Midwife




                                                                                       42
                                                        Appendix 9


  Safeguarding Children                 What to do if you are worried a child is being abused                      For Advice Prior to Referral
  Flow Chart for Referral
                                             PRACTITIONER HAS CONCERNS ABOUT CHILD’S WELFARE                      East Cheshire NHS Trust
                                                                                                                  Named Nurses
                                                                                                                  Danuta Jones
   First Contact – Cheshire East
                                                                                                                  01270 275302
         Tel: 0300 123 5033                                                                                       Mel Barker
                                                                                                                  01625 661770
                                         Practitioner discusses with manager and/or other senior colleagues, as   East Cheshire Named
  Children’s Assessment Team                                     they think appropriate                           Midwife
East           0300 123 5033 / 5012                                                                               Heather Millward
Fax            01606 288950                                                                                       01625 661145
                                                                                                                  East Cheshire Named
   The Children’s Contact and                                                                                     Doctor
         Referral Team                                                                                            Dr David Wright
                                                                                                                  01625 661304
                                                                                 No longer have concerns
West           01606 275099                   Still has concerns                                                  PCT Designated Nurse
Fax            01606 275776                                                                                       Moira McGrath
                                                                                                                  07721 510920
                                                                                  No further Child Protection     PCT Designated Doctors
                                         Practitioner refers to Social           action, although may need to     Dr Katina Marinaki
                                          Services, following up in                                               01625 661759
                                                                                act to ensure services provided   Dr Baljinder Singh
                                          writing within 2 working                                                01270 275369
                                                     days                                                         PCT Named GP's
                                                                                                                  Dr Finch / Dr Maund
                                                                                  Feedback to referrer within 3   01625 428081
       Emergency Duty Team                Social worker and manager               working days on next course
            [out of hours]                  acknowledge receipt of                         of action              Mid Cheshire Hospital -
        East 0300 123 5022                referral and decide on next                                             Named Nurse
        01625 378217 (fax)                course of action within one                                             Jo-Ann Carnwell
                                                                                                                  01270 278057
              West                                working day
                                                                                   No further Social Services     Mid Cheshire Hospital -
          01244 977277
                                                                                   involvement at this stage,     Named Midwife
        01244 364411 (fax)                                                                                        Liz Thompson 01270 273148
                                                                                 although other action may be
                                                                                                                  Mid Cheshire Hospital -
                                                                                 necessary, eg onward referral    Named Doctor
                                          Initial assessment required
                                                                                                                  Dr A Thirumurugan
          Cheshire Police                                                                                         [BLEEP]
       Public Protection Unit                                                                                     After hours, contact Consultant
  All calls via central referral line                                                                             Paediatrician
                                          Concerns about the child’s                                              On-call [BLEEP]
                                              immediate safety                                                                   43
                                                                                                                  MDGH 01625 421000
           0845 4580000
                                                                                                                  MCHFT 01270 255141
Safeguarding Children Guidance’s




                                   44
                                                  Guidance 1
        Guidance for Transfer of Information between Health Professionals and Services for children:
               Who are Cared for by the Local Authority, Subject to a Child Protection Plan /
                             Child in Need / Common Assessment Framework



                            Action                                                     Rationale

   Communication pathways between Midwives, GP’s, Health            To enable ongoing monitoring of families for whom
    Visitors, School Nurses and Allied Health Professionals should            concerns have been identified.
    be in place in respect of all children about whom there are
    concerns (Working Together dfes 2006). These pathways are a
    joint responsibility and should be reviewed regularly.              To ensure effective communication between
                                                                               professionals and services.
   For children subject to a Cared for Children Plan, Child
    Protection Plan, Child in Need Plan, Common Assessment
    Framework or those requiring extra support that is of a
    safeguarding nature a transfer meeting between the outgoing
    and receiving health practitioners should be arranged to hand
    over the case with East Cheshire Trust.

   When records are transferred within the ECT the Named Nurse
    must be informed.




                                                                                                                    45
                                                           Guidance 2
                         Guidance for Transfer of Community Child Health Records out of ECT Area
 For children who are cared for by the Local Authority children or in pre-adoptive placements, or subject to a multi-agency
     child protection plan / child in need / Common Assessment Framework or families identified as vulnerable due to
                                                       safeguarding


                                                                                                             0
                                 Action                                                                Rationale

1)   All records, including Multi-Agency plans and minutes must be filed              To ensure collation of all relevant information
     in the appropriate section of the Child Health Record before the
     Transfer Form is completed.
                                                                                 To ensure that records can be traced when necessary
2)   Details to be amended on all records including the birth / profile book
     [HVs]
                                                                               To ensure that the Child Health Computer in notified of all
3)   Child health amendment form to be completed and sent to the Child                                 changes.
     Health Computer office

4)   The complete Child Health Record should be internally transferred to      To ensure that the Safeguarding office in the new District is
     the Safeguarding office who will be responsible for the onward                  given relevant information in a timely manner.
     transfer by Special Delivery to the receiving area.
                                                                               To ensure security of records during transfer of information




                                                                                                                                    46
                                                            Guidance 3

                  Guidance for Resolving Differences of Professional Opinion in respect of Safeguarding


                          Action                              Rationale

 A recorded discussion should take place between the         When differences of medical opinions occur in relation to
  persons holding different views                             the diagnosis of possible deliberate harm to a child

 When deliberate harm of a child has been raised as an
  alternative diagnosis to the medical one, the diagnosis
  of deliberate harm must not be rejected without a full
  discussion and if necessary the opinion of the
  designated professional should be sought.




                                                                                                                          47
                                                  Guidance 4

                    Guidance for Request for a Change of Health Professional


                         Action                               Rationale


   Following requests for a change of health professional    Occasions may arise where relationships between parents or
    by parents where there are welfare or child protection    other family members, are not productive in terms of working
    concerns the practitioner should discuss the case with    to safeguard and promote the welfare of their children. In
    the safeguarding team.                                    such instances health should respond sympathetically to a
                                                              request for a change of worker, provided that such a change
   The safeguarding manager will ascertain that such a       can be identified as being in the interests of the child who is
    request is in the best interests of the child and will    the focus of concern. Working Together to Safeguard
    make a written request to the Professional Service        Children 2010
    Lead for a change of worker if required.

   The Professional Service Lead in conjunction with the
    Team Leader should allocate a new worker and inform
    the parents in writing.

   The allocated worker should write to all other
    professionals involved with the family informing them
    that they are now managing the case.

   The professional service lead will address any learning
    and development needs that become apparent




                                                                                                                          48
                                                              Guidance 5

                           Notification of Children where Safeguarding Concerns have been identified


                             ACTION                                                           RATIONALE

   1. The Safeguarding Children Team should be notified of any         1. To ensure ongoing monitoring of families for whom concerns
      unborn / child / young person or family where safeguarding          have been identified.
      concerns have been identified

   2. The Safeguarding Children Team and the Education Welfare         2. To ensure a child’s right to access education is met
      Officer should be informed by the practitioner if a school age
      child is not registered in a school or does not have an
      individual education plan.

   3. The Safeguarding Children Team should be informed of             3. To ensure a child’s right to primary care is met
      children who are permanent residents in the area who are not
      registered with a GP




See Supervision Section for Child Protection / Activation Form




                                                                                                                                   49
                                                            Guidance 6


                                                   Guidance for Missing Families


                             ACTION                                                        RATIONALE

If a family goes missing the following action should be taken:      To enable effective communication between agencies working
                                                                                  together in safeguarding children.
1) Notify the designated and named nurses for safeguarding
   immediately and agree contacts to be made to trace the
   family.

2) If the family is known to Social Services contact the key
   worker as soon as possible.

3) Make a record of all actions taken and communications.

4) Feedback results to designated and named nurses for
   safeguarding who will activate wider circulations if required.




                                                                                                                            50
                                                       Guidance 7
                       Guidance for checking whether a child is subject to a child protection plan

                             ACTION                                                             RATIONALE
                                                                     This process is for the purpose of;
Where a nurse, allied health professional or doctor has
Safeguarding concerns about a child, a check to ascertain
whether there is a child protection plan in place must be made       Establishing if the child has a Child Protection Plan in place, and
before the child leaves hospital. This information is available      if so the reason why.
through the social service access team or the duty social worker
out of hours. On contacting Social Care A Formal Child               Establishing if a child has any concerns logged within the last 90
Protection Enquiry must be requested.                                days from other A&E departments or other health professionals.

When checking whether a child has a child protection plan in         To establish the name of a registered child’s key worker and
place consideration must be given to the area that the child lives   communicate information about the child protection concerns
in. For a list of local numbers see below



Checking whether there is a Child Protection Plan must not influence clinical judgment, nor does it constitute a referral. A referral to
Social Services must be made independent of any conversations/discussions whilst requesting information.
NB. Full information about this child may not be known at the time of the Child Protection Enquiry .




                                                                                                                                      51
                              CONTACT NUMBERS FOR MAKING ENQUIRIES ABOUT
                                              CHILD PROTECTION PLANS
     When checking that a child has a child protection plan in place consideration must be given as to the area the child comes from.

                               Access/Referral Team (In Hours)                           Emergency Duty Team (Out of Hours)
                               East -     03001235012                                    03001235022
CHESHIRE
                               West      -   01606 275099                                01606 76611

STAFFORDSHIRE                  0800 1313126                                              08456 042880

STOKE ON TRENT                 01782 235100                                              01782 234234

DERBYSHIRE                     08456 058058                                              08456 058058

DERBY CITY                     01332 641172                                              01332 6411250

STOCKPORT                      0161 2176028                                              0161 7182118

TRAFFORD                       0161 9125125                                              0161 9122020


     Where there are concerns about a child’s Welfare The WHAT TO DO if you are worried that a child is being abused
     flow chart must be followed




                                                                                                                                        52
                                                                  Guidance 8

                                                       Guidance for Concealed Pregnancy

                                  Action                                     Rationale

 If a child is born at home or hospital health practitioners must ensure    Occasions may arise when a woman conceals a pregnancy and
   that the Named Nurse for Safeguarding is notified.                        does not access ante-natal care. In such instances health
                                                                             practitioners should recognize the potential vulnerability of the child
 If the baby is born at home mother and bay should be transferred to        and family.
   the Maternity Unit
                                                                             To Facilitate both information sharing and joint working with the
 A discharge planning meeting should be convened at the earliest            family and community services.
  opportunity and prior to the baby being discharged home to establish if
  the family need additional support / require referral to Social Care.
                                                                             To ensure that the baby is discharged safely from hospital
   Consideration must be given to the reasons for the concealment of the
    pregnancy, any other safeguarding issues including any other siblings, To construct a joint support plan with consideration to involving other
    the mother’s mental health, the parents’ attitude to the birth and what agencies
    preparations have been made. Consideration should also be given as
    to whether there have been any attempts to conceal the birth or any
    previous concealed pregnancies.

 The case holder should identify the child and family as being
  potentially vulnerable and provide extra support.

 Safeguarding supervision should be sought.




                                                                                                                                            53
                              Guidance 9


Multi-Agency Referral Form for Children’s Social Care
                      Services



If a health worker believes that a child maybe suffering, or may be at risk of
suffering significant harm, they should always discuss concerns with a
manager or a member of the Safeguarding Team.

If following discussion concerns remain, a referral to Children’s Social Care
must be made.

If the child is considered to be at risk of significant harm and immediate
telephone call must be made to the Duty Service in the relevant area.

For Cheshire East 0300 123 5012

For Cheshire West 01606 275099

In an emergency contact the Police – 0845 4580000.

All urgent telephone referrals must be followed up in writing within 48
hours by completing the relevant multi-agency referral form.




Practitioners should refer to the flow chart:

What to do if you are worried A Child Is Being Abused
Appendix 9




                                                                           54
                                  Guidance for Referral to the Children’s Assessment Team


                                  Action                                 Rationale
   Professionals who make a referral to Children’s Assessment           To ensure that local policies and procedures in Child Protection are
    Team by telephone must confirm the referral in writing within 2      adhered to.
    working days. Two copies of the referral form should be made,
    one to be filed in the Child’s Health Record and one to be sent to   To ensure that the Named Nurse for Safeguarding is aware of all
    the Named Nurse for Safeguarding.                                    referrals made to Children’s Social Care.



   Children’s Social Care should acknowledge the written referral       To ensure that the Professional and the Designated Nurse for
    within one working day of receiving it. If the referrer has not      Safeguarding Children are clear about the proposed response to
    received a response within 3 working days they must contact          the referral.
    Children’s Social Care.

 If a joint visit is requested by Children Social Care following a       To ensure Health professionals focus on families and children’s
 referral the Health Professional should be clear about their role and health development as part of holistic assessment
 responsibility. Health Professionals do not undertake
 investigations, but during a joint visit are responsible for the Health
 Assessment element of the visit. All visits must be documented in
 Health Records.
To access Referral forms:
East http://www.cheshireeast.gov.uk/default.aspx?page=10725
West https://apps.cheshirewestandchester.gov.uk/ChildSocialCareReferralForm/Default.aspx




                                                                                                                                       55
                               Guidance 10

                  Child Protection Case Conference


The Children Act 1989 & 2004 places a statutory duty on Health, education
and other services to help the LA in carrying out its social service functions.

Full participation at Child Protection Initial/Review Case Conferences is vital if
the child (where appropriate), family members and professionals most
involved are to reach well informed decisions about future action required to
safeguard and promote the welfare of the child.

Those attending conferences should have a significant contribution to make
arising from professional knowledge of the child or family or both.

The conference should be provided with a written report (see below for
relevant documentation)


Attendance at child protection conferences takes priority over other
work.




                                                                               56
                                         Guidance for Child Protection Case Conferences

                                   Action                                                                   Rationale

   In respect of Initial Case Conferences practitioners should arrange              To ensure effective and appropriate sharing of information
    supervision with a member of the Safeguarding Team prior to Case                        where there are child protection concerns.
    Conference. Ideally this should be face to face but in some circumstances
    telephone supervision may be appropriate

   When a Case Conference is convened a written (typed when ever                        To facilitate working together according to DFES
    possible) report should be completed using the appropriate form and                                   guidelines 2006.
    submitted to the Named Nurse for Safeguarding, for approval 2 days prior
    to Initial Conference and 5 days prior to a Review Conference. The
    report should be shared with the Parent/Child. Copies of the report should
    be handed to the Independent Reviewing Officer before the conference             To ensure that the Named Nurse for Safeguarding is kept
    begins.                                                                            up to date with all necessary information about child
                                                                                                          protection cases.
   Members of the Safeguarding Team should attend all Initial Case
    Conferences to provide expert safeguarding advice to the conference and
    also to provide the representative with responsibility for the health service,
    as recommended by government policy. (Working Together to Safeguard
    Children 2006 Dfes). If a decision is taken that a child is at continuing risk
    of significant harm and hence a child protection plan is necessary the
    named nurse must be informed.

   Prior to attending a Core Group all health professionals must complete
    a core group report. Supervision or guidance for completion of this form
    can be sought from the Safeguarding Team if required. The health core
    group report will be used to formulate a multi-agency collective decision




                                                                                                                                          57
   Practitioners should be aware that attendance at child protection
    conferences / core groups takes priority over other work. The Named
    Nurse for Safeguarding should be informed if a practitioner is unable to
    attend safeguarding meetings.

   Practitioners should ensure that they request and receive minutes from all
    multi-agency meetings which must be checked for accuracy prior to filing
    in the child health record




                                                                                 58
                                Guidance 11
           Record Keeping and Legal Report Writing


Record keeping is an integral part of professional practice. Clear and accurate
records ensure that there is a documented account of an agency’s or professional’s
involvement with a child/family. Records help with continuity when individual workers
are unavailable or change, and they provide an essential tool for the supervisor to
monitor work.

Well-kept records provide an essential underpinning to safeguarding practice.
Safeguarding children requires information to be brought together from a number of
sources and careful professional judgements to be made on the basis of this
information. Records should be clear, accessible and comprehensive, with
judgements made, and actions and decisions taken being carefully recorded. Where
decisions have been taken jointly across agencies, or endorsed by a manager, this
should be made clear.
                                  “Working Together to Safeguard Children 2010”



Patient/Client records should:
     Be factual, consistent and accurate, written in a way that the meaning is clear
     Be recorded as soon as possible after an event has occurred, providing
        current information on the care and condition of the patient/client and
        environment.
     Be accurately dated, timed and signed with signature printed alongside the
        first entry where this is a written record, and attributed to a named person in
        an identifiable role for electronic records.
     Not include jargon or abbreviations, meaningless phrases or subject
        statements.
     Be readable when photocopied or scanned
                                                                    (NMC Guidance 2007)


Legal Matters and Complaints.

Patient/client records are sometimes called into evidence in order to investigate a
complaint at local level or for criminal proceedings. Care plans, diaries and any other
documentation that makes reference to the care of the patient/client may also be
required as evidence.

The approach to record keeping that courts of law adopt tends to that “if it is not
recorded, it has not been done”.

Practitioners are required to make professionals judgements to decide what is
relevant and what should be recorded

Records should be written and stored in accordance with East Cheshire Trust
Policy and professional body guidelines should be followed


                                                                                      59
                                              Guidance 12

                          Guidance for Completion of CAFCASS Report

                         ACTION                                                          RATIONALE

   All requests from CAFCASS for reports must be in
    writing. Practitioners must inform Information Governance   To ensure form is completed within the time frame
    of requests.
                                                                To ensure relevant information is shared with CAFCASS
   Health Visitor / School Nurse should complete trust
    CAFCASS report form and forward to Information
    Governance for approval before release




                                                                                                                   60
                                                           Guidance 13

        Guidance for Requests for Police / Guardian Ad Litem Interviews / Statement for Children and Young People


                            ACTION                                                      RATIONALE

1. All requests, including requests from private solicitors, to
   be directed to the Safeguarding Team.                               To Safeguard the confidentiality of information

2. All requests must be in writing.
                                                                  To ensure practitioners are supported and legal advice is
3. Interviews / statements should be conducted at a time                obtained, in the event of court appearance
   convenient to the Health Practitioner in the presence of a
   member of the Safeguarding Children Team or service
   manager. (A copy of the statement should be obtained).




                                                                                                                              61
                                                   Guidance 14

                            Guidance for Writing Safeguarding Court Statements

                            ACTION                                                       RATIONALE

 All requests for Court Statements should be requested in writing  To ensure that practitioners receives appropriate
  to the Named Nurse for Safeguarding Children                       support and legal advice

 Named Nurse for Safeguarding Children to inform ECT Clinical       To ensure Clinical Governance are aware that a legal
  Governance Lead that a request has been received                    statement has been requested

 Named Nurse for Safeguarding Children will arrange to meet
  with practitioner to complete the statement.


 Once completed statement will be typed and sent to the legal       To ensure legal accuracy of statement
  team for legal review


 Once signed by the Professional the completed statement will
  be forwarded to the requesting Court Liaison Officer and a copy
  retained in the Safeguarding Teams files.




                                                           62
                    EQUALITY ANALYSIS (Impact Assessment)


What is being assessed? Name of the policy


Safeguarding Children Policy


Details of person responsible for completing the assessment:


Melanie Barker – Named Nurse for Safeguarding Children


State main purpose or aim of the policy, procedure, proposal, strategy or
service:
(usually the first paragraph of what you are writing. Also include details of legislation,
guidance, regulations etc which have shaped or informed the document)

East Cheshire Trust as with all other NHS bodies has a statutory duty to ensure that
it makes arrangements to safeguard and promote the welfare of children and young
people that reflects the needs of the children they deal with.

In discharging these statutory duties/responsibilities account must be taken of
statutory guidance on making arrangements to safeguard and promote the welfare of
children under Section 11 of the Children Act 2004. (HM Government 2007);
Working Together to Safeguard Children (HM Government 2010); Statutory
Guidance on Promoting the Health and Wellbeing of Looked after Children (DH
2009); and the policies and procedures of the Local Safeguarding Children Boards
(LSCB’s).

This policy is mandatory and should be read in conjunction with the Cheshire
Local Safeguarding Children Boards web based Procedures

http://www.cheshireeast.gov.uk/social_care_and_health/children_and_families/child_
protection_information.aspx

http://www.cheshirewestandchester.gov.uk/default.aspx?page=892



2.     CONSIDERATION OF DATA AND RESEARCH
To carry out the equality analysis you will need to consider information about the
people who use the service and the staff that provide it.

2.1    Give details of RELEVANT information available that gives you an
       understanding of who will be affected by this document


In this policy, as in the Children Act 1989 and 2004, a child is anyone who has not
yet reached their 18th birthday. ‘Children’ therefore means children and young people
throughout.



                                            63
2.2    Evidence of complaints on grounds of discrimination: (Are there any
       complaints either from patients or staff (grievance) relating to the policy


No evidence


2.3 Does the information gathered from 2.1 – 2.3 indicate any negative impact as a
    result of this document?



No negative on any patients/staff as a result of this policy




3.     ASSESSMENT OF IMPACT

Now that you have looked at the purpose, etc. of the policy, procedure, proposal,
strategy or service (part 1) and looked at the data and research you have (part 2),
this section asks you to assess the impact of the policy, procedure, proposal,
strategy or service on each of the strands listed below.


RACE:
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect, racial groups differently?

                                 Yes      No          
Explain your response: this document has no negative impact on any groups as it
applies to all children and actively promotes the consideration of the impact of race
and culture in relation to safeguarding children The policy is quite clear that if the
child’s or parents first language is not English the Trust interpreting service must be
used




GENDER (INCLUDING TRANSGENDER):
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect, different gender groups differently?

                               Yes         No         
Explain your response: Staff have access to equality and diversity training and
would be sensitive to children with gender dysphoria




                                           64
DISABILITY

From the evidence available does the policy, procedure, proposal, strategy or service
affect, or have the potential to affect, disabled people differently?

                                Yes         No         
Explain your response: this document has no negative impact on any groups as it
applies to all children and actively promotes the potential impact of disability and
safeguarding children therefore this policy can be said to have a positive impact as it
is putting more protection in place for them
Staff are trained in LD awareness and all paediatric and paediatric allied staff receive
annual training on communicating with children, including children with learning
difficulties and disabilities. There is a range of materials and specially trained play
therapists to support this.



AGE:
From the evidence available does the policy, procedure, proposal, strategy or
service, affect, or have the potential to affect, age groups differently?

                                Yes      No             
Explain your response: This document applies to all children as identified in the
Children Act 1989 and 2004, a child is anyone who has not yet reached their 18th
birthday. All paediatric and paediatric allied staff receive annual training on
communicating with children, including children with learning difficulties and
disabilities. There is a range of materials and specially trained play therapists to
support this.



LESBIAN, GAY, BISEXUAL:
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect, lesbian, gay or bisexual groups
differently?

                               Yes     No           
Explain your response: Staff have access to equality and diversity training and
therefore would be sensitive to the needs of children or parents with different sexual
orientations




RELIGION/BELIEF:
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect, religious belief groups differently?

                                Yes         No         


                                            65
Explain your response: this document has no negative impact on any groups as it
applies to all children. All support meetings held by health are arranged in
conjunction with the family at times that are mutually convenient to them and the
professionals.




CARERS:
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect, carers differently?

                               Yes         No           
Explain your response: Children may themselves be carers this document has no
negative impact on any groups as it applies to all children. There are number of
agencies who health are able to liaise with to support children who are carers. Any
measures that are taken to safeguard a child who is a carer would be undertaken as
part of a holistic assessment.




OTHER: EG Pregnant women, people in civil partnerships, human rights issues.
From the evidence available does the policy, procedure, proposal, strategy or
service affect, or have the potential to affect any other groups differently?

                               Yes         No           
Explain your response: this document has no negative impact on any groups as it
applies to all children.




4. Safeguarding Assessment - children


a. Is there a direct or indirect impact upon children?   Yes             No



b. If yes please describe the nature and level of the impact (consideration to be given
to all children; children in a specific group or area, or individual children. As well as
consideration of impact now or in the future; competing / conflicting impact between
different groups of children and young people:

The aim of these policies/procedures/protocols is to set out a clear framework for East
Cheshire Trust staff to work effectively with Children who are in need or at risk. Therefo
is a positive impact for children.



                                           66
 c. If no please describe why there is considered to be no impact / significant impact
 on children




 5. Relevant consultation
 Having identified key groups, how have you consulted with them to find out their
 views and that the made sure that the policy, procedure, proposal, strategy or
 service will affect them in the way that you intend? Have you spoken to staff groups,
 charities, national organisations etc?


 There has been no need to complete a consultation as there has been no policy
 changes


 6. APPROVAL – At this point, you should forward the template to:
     The Trust’s Equality and Diversity Lead lynbailey@nhs.net
     The Named Nurse for Safeguarding Children melaniebarker@nhs.net

 Equality and Diversity response:

 Safeguarding Children response:
 Approved

 7. Any actions identified: Have you identified any work which you will need to do in
 the future to ensure that the document has no adverse impact?

 Action                       Lead                          To be Achieved By




 8.       Review Date:

          Date completed:




The Trust’s Equality and Diversity Lead


The Named Nurse for Safeguarding Children Melanie         Barker




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