Safeguarding Children
Extending the learning across the NHS
Written by: Sue Eardley, Senior Policy Lead, Children and Safeguarding Care Quality Commission. Published: 3rd June 2010
Summary
The extensive media coverage of eventsaround the tragic death of “Baby Peter” havelargely focussed on apparent inadequaciesin social services, care, focussing far lesson the many missed opportunities withinhealthcare which resulted in Peter’s deathat the hands of members of his householdin August 2007. This short article, linked toa presentation at the Safeguarding 2009conference explains how a regulatory focusis supporting transformation of the priorityof safeguarding in the NHS.
Introduction
The Care Quality Commission is the newregulator for health and adult social care.Formed by merger in April 2009 of threeprevious regulators (the Commission forSocial Care Inspection, the Mental Health ActCommission and the Healthcare Commission),CQC’s principal task is to make a positivecontribution to improving outcomes forpeople and one of the ways in which this isdone is through robust monitoring and reviewsystems with a range of powers inherited fromthe predecessor organisations.
When news of events surrounding BabyPeter’s death came through, the thenHealthcare Commission was asked by theSecretary of State to join Ofsted in a JointArea Review of safeguarding arrangementsin Haringey. In parallel with this, the natureof the events had also triggered a specificintervention by the Healthcare Commissioninto the four NHS organisations that hadhad contact with Peter and his family in themonths before his death. These two piecesof work were complementary, and theirfindings showed worrying gaps in systemsand processes within and between theorganisations involved, and a failure to learneffectively from Peter’s death.
Although child protection cases like Peter’sare relatively rare in proportion to thenumber of children using the health service,we wanted to understand the system wheredespite Peter having 60 contacts withhealth professionals in his life, for number ofreasons none of them managed to triggerappropriate protection to prevent his death.
The Healthcare Commission/CQC’sintervention was relatively short andfocussed but followed a robust process.We found a number of inadequacies hadoccurred in the systems in terms of
- Communications between healthprofessionals and agencies
- Awareness of staff around childprotection procedures and adherenceto them
- Recruitment practices and training
- Shortages of staff
- Failings in governance in three of theTrusts involved
Compliance with Standards
Particularly worrying was that the Boards ofthe three organisations causing concern hadall self-declared compliance in 2006-7 and2007-8 with relevant standards in the AnnualHealth Check of the NHS conducted by theHealthcare Commission/CQC.
These standards include specific topicssuch as child protection (C2), employmentchecks (C10a) and training and professionaldevelopment (C11a,b,c).
We found that 97% of all organisations, likethose in Haringey, declared specifically thatthey had met standard C2, so we wantedto explore whether the concerns we foundin Haringey were unique or were replicatedto a greater or lesser extent in other healthcommunities in England.
The review
We launched, in December 2008, a fulland swift review of systems for childprotection across all 392 organisations inthe NHS. We wanted to assess, through aquestionnaire and accompanying notes,how far organisations were compliant withthe statutory guidance “Working Together toSafeguard Children”, and whether there wereany steps that needed to be put in place on anational or local basis to ensure that systemswere working effectively.
Following a literature review we consultedwidely, albeit over an extremely tighttimetable, to get the right questions inthe survey, building a picture of what wasimportant whilst minimising the burdenof completion and submission. Namedand designated nurses and doctors, inparticular, told us their experiences andareas to explore to ascertain if boards wereknowledgeable and supportive of the risksand responsibilities carried by frontlinestaff in child protection work. Peopletold us the importance of effective teamworking, good leadership and sensitiveperformance management, recognisingthat success was in fact the absence of afailing. We recognised that measuring thequality of interventions that keep a childsafe is much harder but more effective thanmeasuring things that have gone wrong.We worked with Government Departments,Strategic Health Authorities and Ofstedto minimise overlap with other surveysand questionnaires, keeping in mind theimportance of developing clear questionsthat were useful for staff and that wouldprove beneficial as Nationally collectedbenchmark indicators.
We wanted to examine how well Boardswere assured that they had sound systemsin place, and how well those systems wereworking. We focussed on staffing, training,governance, working with LSCBs andprocesses around Serious Case Reviews.There were many more questions that wewould have liked to ask or which staff told uswould be useful, but we were constrained bythe questionnaire length and the need to stickto examining only statutory requirements.
The resulting questionnaire wasaccompanied by a detailed set of noteswhich explained the rationale for eachquestion and the relevant section ofstatutory guidance. All Chief Executiveswere contacted to nominate a memberof staff to lead on completion of thequestionnaire and all 392 Trusts completedthe 114-question survey by the deadlinedate in late March. Soon after this, at theend of April, Boards were again asked tomake declarations against Annual HealthCheck Standards. This time self-declaredcompliance had dropped around 3% to 94%which we interpreted not as a worsening ofsystems but a better understanding by someBoards of what compliance required. Wehave followed up those Trusts that declarednon compliance and cross-checked thequestionnaire submissions against those Truststhat declared that they met the standard.
Analysis of the findings showed worryingconcerns in several areas across England,including staffing and training levels, proceduresin A&E departments, Board reporting systemsand the time taken to conduct Serious CaseReviews. These and wider policy developmentssuch as the implication of Lord Laming’s reportand new processes for Serious Case Reviewreporting will be discussed in the presentationon 21st October.
Next steps
By April 2010, all NHS organisations will havehad to register the services they providewith the Care Quality Commission. Unlesscertain services (such as maternity, careand treatment, surgery, etc) are registered,it will be illegal to practise. Registrationrequires compliance with statutoryconditions of registration, which were setout in a consultation by CQC during thesummer (www.cqc.org.uk). One of thoseregistration requirements is based on havingrobust safeguarding arrangements in placeand the findings of this survey provide animportant wake-up call to provider unitsabout what they need to do to ensure theyare compliant with the new procedures.This will be expanded upon further, alongwith other findings of the review at the CQCpresentation on 21st October 2009 at the‘Safeguarding Children – Getting it rightacross the NHS’ conference to be held inFriends House, London.
