Sponsoring Director: Chief Nurse

SAFEGUARDING CHILDREN POLICY

(POLICY ID: GEN 6.17)

Implemented September 2010

Sponsoring Director: Chief Nurse Last Reviewed Jan 15

1 Document Control

Author / Contact Safeguarding Department

Document Ref POLICY ID: GEN 6.17

Document Impact Yes Date Jan 15 Assessment

Version V2

Status For approval

Publication date Jan 15

Review date Jan 17

Approved By Trust Board Date:

( Executive)

Ratified By Safeguarding Steering Group Date 4.3.15

Patient Safety and Quality Group Date 13.5.15

Quality & Governance Committee Date 27.5.15

Distribution Barnsley Hospital NHS Trust-intranet

Please note that the Intranet version of this document is the only version that is maintained.

Any printed copies must therefore be viewed as “uncontrolled” and as such, may not necessarily contain the latest updates and amendments

2 Table of Contents

1.0 Introduction Page 1

2.0 Statement and Principles Page 1

3.0 Objectives Page 1

4.0 Roles & Responsibility Page 3

4.1 Trust Board Page 3

4.2 Chief Executive Page 3

4.3 Chief Nurse Page 3

4.4 Safeguarding Steering Group Page 4

4.5 Safeguarding Department Page 4

4.6 Named Dr for Safeguarding Page 5

4.7 Director of Human Resources Page 5

4.8 Training Department Page 5

4.9 Managers Page 6

4.10 Staff Page 6

4.11 Emergency Department Staff Page 7

4.12 Paediatric Services Page 7

4.13 Maternity Services Page 8

5.0 Definitions and Recognition of Abuse Page 8-10

6.0 Patients who are Carers of Children Page 10

7.0 Domestic Abuse Page 10

8.0 Young People or Parents who Misuse Substances Page 10 3 9.0 Young People or Parents with Mental Health or Self Page 11 Harm issues

10.0 Children and Forced marriage and Honour Crimes Page 11

11.0 Female Genital Mutilation Page 11

12.0 Children who Miss Outpatient appointments Page 12

13.0 Suspected fabricated or Induced Illness Page 12

14.0 Looked After Children (LAC) Page 12

15.0 Child Sexual Exploitation Page 13

16.0 Children not Registered with a GP Page 13

17.0 Discharge Process Page 14

18.0 Sharing Information Page 14

19.0 Making a Referral to Social Care Page 14

20.0 Following up Referrals to Social Care Page 15

21.0 Resolving Professional Differences Page 15

22.0 Child Death process Page 15

23.0 Serious Case Reviews Page 15

24.0 Managing Allegations Against Staff Page 16

25.0 Safer Recruitment Page 16

26.0 Staff Support Page 16

27.0 Multi Agency Public Protection Arrangements Page 17

28.0 The Prevent Strategy Page 17

29.0 Training Page 17

30.0 Monitoring and Audit Page 17

31.0 Equality and Diversity- Page 18

32.0 Conclusion Page 18

33.0 References and Abbreviations Page 19

34.0 Recording and Monitoring of Equality and Diversity Page 20

4 Introduction

1.1 “Safeguarding children and the action we take to promote the welfare of children and protect them from harm is everyone’s responsibility. Everyone who comes into contact with children and their families has a role to play.” (Department of Health, DOH 2013).

1.2 Since the amendments to the Children Act 1989, brought about within the Children Act 2004, all those working within the field have a STATUTORY DUTY to safeguard and promote the welfare of children (Chapter 31, Section 11- Children Act 2004). Their participation in inter-agency procedures is essential if the interests of children are to be safeguarded. The effective safeguarding of children can only be achieved by putting children at the centre of the system, and by each organisation playing their full part in working together to meet the needs of our most vulnerable children and families. (DOH 2015).

1.3 The primary objective of this policy is to provide staff working for Barnsley Hospital NHS Foundation Trust (BHNFT) with the necessary framework to ensure that cases of child abuse do not go undetected and multi-agency procedures are followed in such cases. The Trust follows the Barnsley Safeguarding Children Board Procedures for the protection of children.

Statement and Principles

2.1 BHNFT is fully committed to the principles set out in the government guidance “Working Together to Safeguard Children 2015 ” , section 11 of the Children Act 2004 and to joint working with Barnsley Safeguarding Children Board. As outlined within the safeguarding children training strategy for BHNFT, the Trust undertakes to support and contribute to training health staff who come into contact with children and their family to ensure they attain competencies appropriate to their role. The Trust will also support appropriate staff to attend the multi-agency training provided by the local safeguarding boards.

2.2 The Trust will ensure that systems are in place to co-ordinate activities in a way that protects the best interests of all children who come into contact with our services, which will include guidance for staff in all areas.

Objectives

3.1 The intention of this policy is to ensure that BHNFT has robust systems in place to comply with Section 11 of the Children Act 2004, to safeguard and promote the welfare of children, and to ensure that the staff who undertake this demanding and stressful work are adequately supported and trained.

3.2 This policy and supporting procedures will help to:

Maintain effective organisational processes to ensure a Trust-wide consistent approach to safeguarding children, which compliments multi agency arrangements. 1 Ensure compliance with relevant NHS Litigation Authority (NHSLA), Risk Management Standards, Clinical Governance Standards and Care Quality Commission Standards, and promote best practice across the organisation.

Ensure the Board of Directors and the Chief Executive have assurance that appropriate systems are in place.

3.3 This policy reflects the guiding principles on child protection issued by the DOH (2013) ‘Working Together to Safeguard Children’ and the most recent version of this 2015, and should be used in conjunction with the Barnsley Safeguarding Children Board Child Protection Procedures - available via http://www.proceduresonline.com/barnsley/scb/ and other internal policies, procedures, protocols and guidance found on the safeguarding intranet page http://bdghnet/Departments/protection/

3.4 This policy has been produced to assist staff to take appropriate action with regard to: Safeguarding children (which should be an absolute priority). Carrying out their professional responsibilities.

This policy applies to all staff employed by Barnsley Hospital NHS Foundation Trust (BHNFT), including volunteers, agency workers and students in training and staff employed by BHNFT.

3.5 The aims of the policy are to ensure that:

Processes are robust and fit for their intended purpose. Processes are clear and properly understood by staff. To raise awareness for all staff in recognising potential / actual safeguarding concerns and instances of child abuse and neglect To raise awareness for all staff of the importance of prompt and effective action in response for safeguarding children concerns. To provide staff with the necessary guidelines and training to ensure that potential safeguarding issues and instances of child abuse / neglect do not go undetected. To ensure that multi-agency procedures are followed in dealing with any safeguarding issues and suspected / actual cases of child abuse and neglect. To ensure children receive timely therapeutic and preventative interventions. To promote and practice good inter-agency co-operation at all levels. BHNFT will work with partners to develop integrated working practices and shared local documentation where this enhances practice.

3.6 The aims will be achieved through meeting the following core objectives.

Ensuring Board level commitment to and leadership of safeguarding Children processes / procedures. Ensuring robust procedures are in place to guide and support staff. Ensuring appropriate staff training is provided. Ensuring appropriate staff access Safeguarding Children Supervision. 2 Development of clinical effectiveness and governance frameworks to demonstrate application of agreed processes Providing resources to support the implementation of this policy. Involvement with subgroups of the Barnsley Safeguarding Children Board (BSCB) to ensure that processes are fully proactive, and effective. Providing a mechanism for all near misses and incidents involving Safeguarding Children to be reported in a timely manner, risk assessed, categorised by their potential consequences and investigated to determine any system failures.

Supporting this policy are the BSCB procedures and internal protocols and guidance, all of which can be accessed on the safeguarding intranet page or by following this link http://bdghnet/Departments/protection/

4. Roles and Responsibilities

4.1 Responsibility of Trust Board

The Trust will act in partnership with other key agencies to safeguard children and take appropriate action when abuse is identified. The Trust Board has overall responsibility for ensuring that systems are in place and adequate resources are provided for safeguarding children and for monitoring the impact of the policies of the Trust and its management. All staff are responsible for working within the Trusts framework for maintaining the safety of children at all times.

4.2 Responsibility of the Chief Executive

Overall responsibility for the management of risk lies with the Chief Executive as Accountable Officer.

All Trust directors are responsible, collectively, for the Trust’s systems of internal control and management. The Board of Directors is responsible for signing the Annual Health Check statement and needs to be satisfied that appropriate policies and procedures are in place and that systems are functioning effectively. The Board of Directors has delegated its accountability arrangements to the Chief Nurse.

4.3 The responsibility of the Chief Nurse

The Chief Nurse will be the Executive Lead responsible for Safeguarding Children / Child Protection and will be responsible for governance systems and organisational focus on safeguarding children and will work closely with the Named professionals, and ensure: That Safeguarding Children Procedures are agreed through relevant staff groups That Safeguarding procedures are updated regularly in line with national guidance and audit reports

3 The Chief Executive and the Board of Directors are up to date with progress (in terms of safeguarding) and highlight any areas of concern. That the Trust works in partnership with the BSCB and co operates in the effective discharge of its functions. Representing the Trust on the Safeguarding Children Board.

4.4 Safeguarding Steering Group

The Trust Safeguarding Children Committee is responsible for co-ordinating activity and lessons learnt from issues relating to safeguarding children in the Trust, ensuring appropriate governance arrangements are in place and staff receive the necessary support to undertake safeguarding duties. The Designated Doctor and Nurse safeguarding Children are both members of this group.

4.5 The responsibility of the Named Nurses / Midwife Safeguarding Children

The Named Nurses / Midwife for Safeguarding Children are responsible for providing expert advice and support to all BHNFT staff on any issue relating to child protection and children in need. Ensuring that all staff working for BHNFT are aware of their responsibilities relating to Safeguarding children. The Named Nurses / Midwife will provide child protection supervision to a defined group of staff on a regular basis, and ad hoc to other staff as requested. The Named Nurses / Midwife will plan and deliver training on all areas of child protection, on both a single and multi agency basis. The Named Nurses/ Midwife will represent the Trust on appropriate safeguarding children groups and at appropriate meetings. The Named Nurses/ Midwife will undertake internal reviews relating to child protection in accordance with ‘Working Together to Safeguard Children’ (2015). The Named Nurses will undertake Serious Incident Reports as appropriate. The Named Nurses / Midwife will provide progress reports to the Chief Nurse The Named Nurses / Midwife will ensure that regular audit of agreed processes and procedures and performance monitoring takes place to monitor the effectiveness of practice and that remedial action is implemented where required. The Named Nurses/ Midwife will collate evidence to support the Trust’s compliance with the Care Quality Commissions Regulatory standards. That the Trust works with the BSCB and co operates in the effective discharge of its functions. The Named Nurse/ Midwife will provide professional advice to all staff, managers and executive teams on matters regarding safeguarding and the PREVENT strategy. The named Nurse will play a key part in the child death process as per local guidance.

4 4.6 The responsibility of the Named and Designated Doctor for Child Protection

The Named Doctor and Designated Dr are responsible for providing leadership, training, advice and support to Medical Staff in relation to Safeguarding Children and Child Protection. The Named and Designated Doctor will collate evidence to support the Trust’s compliance with the Care Quality Commissions Regulatory standards. The Named and Designated Doctor will provide skilled professional involvement in child safeguarding processes in line with Barnsley Safeguarding Children Board procedures. The Named Doctor will undertake, with the Named Nurse / Midwife safeguarding children, individual reviews in accordance with ‘Working Together to Safeguard Children’ (2015). The Named Doctor and Designated Dr will represent the Trust at appropriate BSCB sub groups and at other appropriate safeguarding meetings. The Named and Designated Doctor will review and evaluate practice and learning from all involved health professionals as part of the serious case review process. The Designated Dr will provide a medical strategic lead for safeguarding children.

4.7 The responsibility of the Director of Human Resources

It is the responsibility of the Director of Human Resources to ensure that Employment Policies incorporate the requirements of ‘Safer Recruitment’, including Criminal Records Bureau checks and the Independent Safeguarding Authority requirements. The Trust induction programme includes safeguarding children training for all new employees and volunteers Appropriate whistle blowing procedures are in place and a culture about safeguarding and promoting the welfare of children are encouraged. Supporting the safeguarding team in managing allegations against staff in line with the Safeguarding Allegations Against Staff Policy and Procedure

4.8 The responsibility of the Training Department

The role of the Training and Development Department in liaison with Departmental Managers is to coordinate corporate induction for all staff, identify training needs via staff appraisal procedures, including KSF outlines and ensure relevant safeguarding children training programmes are accessed.

Staff will have access to the following relevant training as part of corporate induction:

Info sharing / governance Safeguarding Children Basic Awareness Training

5 Further training will be provided relevant to the role of individual staff as identified through position documents, KSF outlines and appraisal processes, in line with Safeguarding Children Training Strategy and the Trust Corporate Curriculum.

Staff who have significant access to children should build on their knowledge and access multi agency training.

4.9 The responsibility of the Manager

Managers are responsible for ensuring their staff have received safeguarding children mandatory training in accordance with the Barnsley Hospital NHS Foundation Trust Training Strategy and Corporate Curriculum. Managers are responsible for ensuring staff receive protected time to undertake safeguarding children supervision.

4.10 The responsibility of all Staff

All staff have a legal and professional obligation under the Children Act 2004 and professional codes of conduct to take actions as necessary to safeguard and protect children in their care.

It is the responsibility of all staff working in the Trust to ensure that they are familiar with their responsibilities under this policy, and the Barnsley Safeguarding Children Board Procedures. Staff treating adult patients must ensure they ask about any dependants or persons they have caring responsibilities for. Staff must consider the welfare and needs of children (who may not be their patient) when treating adults with childcare responsibilities. Staff should make enquiries regarding children who have an alert on their file. If these children are subject to a child protection plan or have safeguarding concerns identified, then concerns should be shared with other professionals as appropriate and they should ensure no child is discharged whilst concerns for their safety and wellbeing remain. Staff will make referrals to Social Care in accordance with the BSCB procedures when they believe a child is in need of protection. Staff should not discharge children from their care where there are concerns about the child’s safety and welfare. All concerns should be fully explored. Staff will share information with other agencies in accordance with the Children Act 2004, Barnsley Child Protection Procedures and the ‘One Barnsley’ Information Sharing Protocol. Where there is a difference of opinion in relation to the diagnosis, safety or welfare of a child, the matter should be brought to the attention of the Designated/ Named Doctor and/or Named Nurses or Midwife for Safeguarding Children as soon as possible. Staff will access appropriate training and will build on their knowledge as appropriate in accordance with the BHNFT Training Strategy and the BHNFT Corporate Curriculum. Staff will report any untoward incidents or near misses. 6 Staff will assist where appropriate with audit processes. Staff will access safeguarding children supervision (as appropriate) in accordance with safeguarding children protection supervision guidance (2012). Staff will report any concerns in line with the PREVENT strategy. This policy should be read in conjunction with the Prevent Policy

4.11 Emergency Department (ED) Staff

The primary role of all staff working in the A&E department with regard to safeguarding children is to express concern rather than make a diagnosis of child abuse. They may be the first professionals to identify a child in need or at risk of significant harm. Therefore staff should be able to recognise abuse and be familiar with local procedures for making enquiries to find out whether a child is subject to a safeguarding children plan.

Staff in ED should also be aware of the need to safeguard the welfare of children when treating the parents/ carers of children. They should also be alert to parents/ carers who seek medical advice from a variety of sources in order to conceal the repeated nature of a child’s injuries. If a child presents from the same household presents repeatedly, even with slight injuries in a way that is concerning staff should act on their concerns in accordance with local policy.

Specific guidelines are available for ED staff and can be accessed on the safeguarding intranet page or by following the link below http://bdghnet/Departments/Protection/6371.html

4.12 Paediatric services

Paediatric staff have an enhanced role in safeguarding children and should be fully conversant with relevant safeguarding policies, procedures, protocols and guidance.

Guidelines are available and can be accessed on the safeguarding intranet page or by following the link below http://bdghnet/Departments/Protection/6371.html

4.13 Maternity services

Maternity services have an enhanced role in safeguarding in both helping to promote the welfare of pregnant woman and her unborn child or new-born. All midwives should be fully conversant with relevant safeguarding policies, procedures, protocols and guidance.

Guidelines are available and can be accessed on the safeguarding intranet page or by following the link below 7 http://bdghnet/Departments/Protection/6371.html

5. Definitions and Recognition of Abuse

Child – Anyone who has not yet reached their 18th birthday or 19th birthday for a child with a disability. (Children Act 1989).

5.1 Recognition

Child abuse affects children regardless of race, gender or age and impacts across all religious groups and sexual orientations. Children with a known disability can be particularly vulnerable to abuse because of their higher level of dependence.

Child abuse can take place in all strata of society, in families, in institutions, between children and in some situations on an organised basis. It manifests itself in various ways from the more obvious physical forms e.g. burns, bites, bruises, fractures etc. to sexual harassment and sexual exploitation, through neglect and the withdrawal of emotional support and scapegoating. Sometimes it will only become obvious from what children are saying.

It is the responsibility of all staff in all settings throughout the Trust and members of the general public to report all concerns about children where there is suspicion that they are or may be at risk of suffering significant harm.

The child is said to be at risk of suffering significant harm if the child has suffered or is likely to suffer ill treatment or impairment of health or development as a result of physical, emotional or sexual abuse or neglect, when health or development is compared with that, which could be reasonably expected of a similar child. (Children Act 1989). The amendment made in section 120 of the Adoption and Children Act 2002 to the Children Act 1989 clarifies the meaning of “harm” in the Children Act, to make explicit that “harm” will include, for example, impairment suffered from seeing or hearing then ill treatment of another (Domestic Abuse).

Someone may neglect or abuse a child by inflicting harm or by failing to act to prevent harm in the following ways;

5.2 Neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse.

Neglect may involve a parent or carer: failing to provide adequate food and clothing failing to provide shelter, including exclusion from home or abandonment failing to protect a child from physical and emotional harm or danger failing to ensure adequate supervision including the use of inadequate care- givers 8 failing to ensure access to appropriate physical care, medical care and treatment (including treatment for dental caries) failing to respond to basic emotional needs

5.3 Physical Abuse

Physical abuse may involve hitting, shaking, pinching, throwing, poisoning, burning or scalding, drowning, suffocating or any other means of causing physical harm. Physical harm may also be caused when a parent or carer deliberately causes ill health or fabricates or induces the symptoms of illness.

5.4 Sexual Abuse

Sexual abuse of children involves forcing or enticing a child to take part in any sexual or indecent act whether or not the child is aware of what is happening. These activities may involve actual physical contact with the child, including assault by penetration and non penetrative acts including masturbation, kissing, rubbing and touching the outside of clothing. It may also involve non-contact activities such as involving children in the production of, sexual images, watching sexual activities encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse. Sexual abuse is not solely perpetrated by adult males. Women can commit acts of sexual abuse, as can other children.

5.5 Emotional Abuse

Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Please remember the child’s voice must be heard – where age appropriate please ensure all efforts are made to gain the child’s view and listen to the child.

6. Patients who are carers of children

9 6.1 Adult and adolescent patients should routinely be asked if they have dependents or caring commitments as part of their assessment. This information about dependents is integral to the welfare of children and should be recorded at the first contact. This is particularly important during acute illnesses, some mental health conditions, parents with a learning disability and substance misuse issues (including alcohol). Any member of staff who is concerned about a patient’s ability to care for their dependants and feels a child may be at risk of neglect or abuse should contact the safeguarding children team on 2092. The impact of any illness or disease must be considered in relation to a patient’s ability to fulfil their caring responsibilities.

7. Domestic abuse

7.1 Children may suffer directly or indirectly if they live in households where there is domestic abuse most domestic abuse takes place with a child in the room or in an adjoining room (NCH, 2002). Moreover health staff are in a prime position to identify victims of domestic abuse and offer the appropriate help and support.

7.2 If a member of staff is concerned that an adult or child may be suffering from domestic abuse or its impact, irrespective of whether there are children, advice on how to respond can be found in the BHNFT Domestic Abuse Policy, BSCB Child protection Procedures or the Department of Health handbook on Responding to Domestic Abuse all available via the safeguarding intranet page. http://bdghnet/Departments/protection/. Please note social care must be informed of all incidents of violence where there are children in the home. Additionally staff can contact the safeguarding team on 2092.

8. Young People and Parents who misuse substances or alcohol

8.1 Where a young person presents under the influence of substances including alcohol, staff should follow the Pathway for Management of Alcohol and Substance Misuse in under 18s, in order that we make the most of this opportunity to offer the young person specialist help and advice. The pathway is available via the safeguarding intranet page http://bdghnet/Departments/protection/.

8.2 Equally it is essential that when caring for adults, staff should consider the caring responsibilities of substance misusing parents as they may not be known to any other services or be in treatment. Remember that this may be the first time the child or children have been identified as living with a parent who has a substance misuse problem. For further information see the BSCB Child Protection Procedures available on the safeguarding intranet page http://bdghnet/Departments/protection/ and contact the safeguarding children team for further advice and support (2092).

9. Young People and Parents / Carers with Mental Health of Self Harm Issues 10 9.1 Self-harm is when somebody intentionally damages or injures their body. It can be a way of coping with or expressing overwhelming emotional distress. Sometimes when people self-harm they intend to die but often the intention is more to punish themselves, express their distress or relieve unbearable tension. Self-harm can also be a cry for help.

9.2 If a young person presents having self harmed the Pathway for Management of Young People Presenting at the Emergency Department with Mental Health and or Self Harm Issues (including overdose) should be followed. The pathway is available via the safeguarding intranet page http://bdghnet/Departments/protection/.

9.3 When an adult who has caring responsibilities presents with mental health issues, again staff should consider if this may be having an impact on any children they have care of and should discuss their concerns with the safeguarding department on 2092.

10 .Children and Forced Marriage or Honour Crimes

10.1 A forced marriage is one that takes place under duress where one or both partners do not consent. An honour crime is abduction or assault related to shame or ‘Izzat’ and can be associated with attempting to escape from a forced marriage. Honour crimes usually affect women. Further information about forced marriages and honour crimes can be found on the Foreign and Commonwealth website at http://www.fco.gov.uk/resources/en/pdf/3849543/forced-marriage- guidelines09.pdf If a member of staff has a concern that a child may be involved in a forced marriage or honour crime, the assessment teams in social care should be informed (772423 or 438831). Further advice can be accessed from the Hate and Hidden crime team on (01226 774991/774966).

11. Female Genital Mutilation

11.1 Female genital mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The practice is illegal in the UK. There is a duty on staff to report any cases of FGM they become aware of or any intention to undertake FGM whether in this country or aboard. Staff should report / discuss all cases of FGM to the Safeguarding Department on 2092 and refer all cases where there are children in the family (including unborn) to social care. Please see guidance on FGM available on the safeguarding intranet page http://bdghnet/Departments/protection/

12. Children who miss out patient appointments

12.1 The National Service Framework for Children (core standards 2004) states that: “Children and young people failing to attend clinic appointments following referral from their general practitioner or other professional may trigger concern, given that they are reliant on their parent or carer to take them to the 11 appointment. Failure to attend can be an indicator of family’s vulnerability, potentially placing the child’s welfare in jeopardy.”

12.2 The DNA Policy and Procedure for Children and Young People describes the process that should be followed to identify if there is any cause for concern when children fail to engage with or access health services; and how to act on any concerns raised. This document can be accessed on the Safeguarding Children website on the Intranet http://bdghnet/Departments/protection/. Additionally the Safeguarding Children Team can be contacted for advice and support (2092).

13. Suspected Fabricated or Induced illness

13.1 Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.

13.2 The Safeguarding Children Team can advise about symptoms that might indicate a fabricated or induced illness. The process for referring suspected cases of fabricated or induced illness are defined in the Barnsley Child Protection Procedures and on the intranet- http://bdghnet/Departments/protection/. Further information can be obtained from the ‘When to suspect fabricated or induced illness’ (DCSF 2008) document.

13.3 Children with suspected fabricated illness might present to a range of specialists. In addition their carer’s may be in receipt of mental health services, and the professionals involved may have concerns about the welfare of the child/ children.

14. Looked after children (LAC)

14.1 The term LAC is used to describe any child who is in the care of the local authority or who is provided with accommodation by the local authority Social Services Department for a continuous period of more than 24 hours. These children may live in a foster placement or in children’s home and are considered to be extremely vulnerable due to their past and current circumstances. This status may be applicable until that young persons 19th birthday.

14.2 Looked after Children and young people share many of the same health risks and problems as their peers, but often to a greater degree. They often enter care with a worse level of health than their peers in part due to the impact of poverty, abuse and neglect. They are also at increased risk of child sexual exploitation – see below (Children and Young People missing from Care and Vulnerable to Sexual Exploitation 2014). All instances where a LAC presents in hospital should be notified to the child’s Social Worker. If you need advice regarding a looked after child contact the Safeguarding Children Team on 2092.

15. Child Sexual Exploitation (CSE)

12 15.1 ‘Sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities’ (DCSF 2009 p9).

15.2 As a health care provider, BHNFT and its staff are a key part of the multiagency partnership within Barnsley and the surrounding areas in identifying potential and actual victims of sexual exploitation and ensuring that they are protected from harm. Where staff suspect that a child might be at risk of sexual exploitation, they should seek support from the Safeguarding Department on 2092. Any child at risk of harm as a result of sexual exploitation should be referred to the Assessment and Joint Investigation Team on 8831. Additional guidance and information related to child sexual exploitation can be located on the Safeguarding Children intranet site.

15.3 Where it is suspected that a child might be a victim of sexual exploitation, staff should also consider the possibility of child trafficking, as it is widely known that many victims of sexual exploitation are trafficked both into and around the United Kingdom. Where trafficking is considered, staff should again seek advice from the Safeguarding Department on 2092 and refer to Social Care on 8831.

16. Children and young people not registered with GPs

16.1 As part of routine care it should be established which GP a patient is registered with. Being registered with a GP gives access to the advantages of universal health surveillance, immunisations and access to a GP during times of illness. If a child or young person is found not to be registered, then GP registrations at South Riding Support Agency (01302 566615) should be contacted to arrange registration or the registration form kept in ED reception should be completed and returned. This is the responsibility of the professional discovering that an individual is not registered. Where there are concerns for the welfare and safety of a child they should not be discharged from hospital care.

17. The discharge process

17.1 If concerns have been identified and communicated about the safety and welfare of a child, they should not be discharged until the consultant in charge of their care is satisfied that there is an agreed safeguarding plan in place (Laming, 2003).

18. Sharing information

18.1 All staff who have access to children or to sensitive information relating to children need training on sharing information. Further details can be found in the HM Government Information Sharing; Pocket Guide which can be accessed on the Safeguarding Children intranet page http://bdghnet/Departments/protection/. BHNFT is a partner in the Barnsley 13 Safeguarding Children Board and as such has agreed to share information in a necessary, proportionate, relevant, timely and secure manner consistent with the Trust’s Information Governance standards, policies and procedures. The ‘One Barnsley’ document provides full and further guidance on information sharing.

18.1 The overriding principle in safeguarding children is to protect the child and secure the best possible outcome for the child. The needs of children must always be regarded as paramount as their age and vulnerability renders them powerless to protect their own interests. Fears about sharing information should never stand in the way of the need to promote the welfare and protect the safety of children. Effective information sharing between professionals and local agencies is essential for effective identification, assessment and service provision (DOH 2013).

19. Making a referral to Children’s Social Care

19.1 Where there are concerns for the safety and welfare of a child a referral should be made to Children’s social care by ringing 8831 and confirming this in writing using a Request for Service form. The process is described in the Barnsley Child Protection procedures, which are available in all areas and on the intranet -http://bdghnet/Departments/protection/. Referrals are normally made through the Assessment and Joint Investigation Team on 8831.

19.2 Children’s Social Care offer the opportunity to discuss cases with a Social Worker. This service is available for professionals to discuss their concerns. If a referral to Social Care is deemed inappropriate, the Social Worker will provide advice on other routes for seeking support. Alternatively contact the Safeguarding Department on 2092.

19.3 If Trust staff have concerns that a child may have a Child Protection Plan, or are concerned about a child but require more information to inform their assessment and decision as to whether a referral is required to Social Care, then the Children’s Services in the relevant area must be contacted to conduct the search. In Barnsley this is achieved by ringing 772361 and providing details. Please remember to ask for your current concerns to be logged for future reference. For children outside the Trust area, the Children’s Service office in the geographic area concerned should be contacted.

20. Following up referrals to Children’s Social Care

20.1 Staff should never assume that a referral has been received by Social Care. A telephone referral should always be followed up by a written referral (sent by secure e mail) as per Barnsley Child Protection Procedures (using the Request for Service form). A copy of this should be placed in the patient’s notes. The professional making the referral should expect a response. Feedback should be received via secure e mail, if it is not received within 72hrs, staff should follow this up with Social Care. A copy of the feedback will also be sent to the Safeguarding Department t and will be filed in the child’s notes.

14 21. Resolving differences of opinion

21.1 It is the responsibility of all staff to bring to the attention of the Named Nurse / Midwife and/or Designated / Named Doctor for Safeguarding Children cases where there is a difference of opinion in relation to the diagnosis, safety or welfare of a child. They will then take responsibility for negotiating and liaising with relevant professionals to ensure the safety and welfare of the child is achieved. The Named Nurses / Midwife can be contacted on 2092 , the Named Dr on 4363 and the Designated Doctor on 3184 (Laming, 2003).

22. Serious Case Reviews

22.1 Whenever a case involves an incident leading to the death or serious injury of a child with whom abuse is suspected or confirmed, the Trust may be requested by the Local Safeguarding Children Board (LSCB) to carry out an internal management review or detailed chronology. This will form part of the Serious Case Review process or learning event to establish whether there are lessons to be learned from the case about the way in which professionals and agencies work together to safeguard children. When the LSCB notify BHNFT of a potential serious case review, the Named Nurse/Named Midwife for Safeguarding Children must withdraw the case notes from circulation and ensure that a photo-copy of the notes is available for professionals to work from. The original notes must be secured safely until the LSCB advise that the Serious Case Review process is complete and the original notes can be re-patriated. It is the responsibility of the Named Nurse/Named Midwife to ensure this happens.

22.2 The members of staff involved in the review process will include the Designated/Named Doctor, Named Nurse and Named Midwife for Safeguarding Children. The report must be submitted within the requested time scale. The Named Director is responsible for ensuring that internal reviews meet the criteria set by the LSCB. All completed Internal Management Reviews (IMR) or reports must be signed off prior to submission by the Named Director or Chief

Executive. The lessons from the Serious Case Review will be imbedded into practice through in-house training, safeguarding supervision, child protection forum and child protection updates, newsletters for staff.

23. Child Death process

23.1 An unexpected death is defined as the death of a child, in any setting, that was not anticipated as a significant possibility 24 hours before the death, or where there was a similarly unexpected collapse leading to or precipitating the events that led to the death. The child death process must be followed in the event of any death of a child or young person under the age of 18 years within the Trust. The child death flowchart located on the safeguarding intranet page should be followed. http://bdghnet/Departments/Protection/6740.html

15 24. Allegations of Abuse against staff

24.1 All staff are accountable to ensure that no child is harmed either by itself or another member of staff whilst the child is in hospital. Any allegations of harm by a member of staff to a child must be reported to the safeguarding department on 2092 ASAP. Staff should refer to the Procedure for Managing Allegations Against Staff for further guidance. The Local Authority Designated Officer (LADO) must be notified of any allegations of harm to a child by a member of staff as soon as possible. Staff should be aware of the Trust Policy “Managing Allegations Against Staff.

25. Safer Recruitment

24.1 The Disclosure and Barring Service (DBS) became operational in December 2012. The primary role of this service is to help employers in England and Wales make safer recruitment decisions. It is a legal requirement for employers to check whether a person is barred from working with children prior to employing them. BHNFT currently carries out DBS checks on any prospective employee who has applied to work with children accessing its services (BHNFT Recruitment and Selection Policy).

26. Staff Support

25.1 The Trust recognises that there is a need to ensure that support is readily available for staff involved in child protection cases. In the first instance, the line manager should provide this support. Safeguarding Supervision should be provided in line with BHNFT’s Safeguarding Supervision Guidelines (2014).

25.2 Where staff are contacted by the Police and/ or Local Authority in relation to providing statements and potential court appearances, it is the responsibility of the individual member of staff to contact the Safeguarding Team to discuss what support they will need during this process.

27. Multi-Agency Public Protection Arrangements (MAPPA)

28.1 The principal responsibility for protecting the public from sexual and violent offenders rests with the criminal justice agencies. However, the effectiveness of public protection often requires more that just a criminal justice response (2012). BHNFT has a duty to co-operate with MAPPA. In cases where a known sexual or violent offender accesses the Trust for services it is the responsibility of the Police to assess the overall risk to other service users, staff and visitors. The Police will contact the safeguarding team initially with a request for information. The Safeguarding team will then contact the person in charge of the ward/ department, or their nominated deputy for further information. A decision will be made between the Police and the Safeguarding Team regarding what information will be shared with the ward/ department manager, so that any immediate risks can be identified and managed. Information sharing will be strictly monitored and shared on a need to know basis in order that patient

16 confidentiality can be maintained. See Guidance Management of MAPPA offenders (persons who pose a potential risk).

28. The Prevent Strategy

29.1 Staff should be aware of the Department of Health’s contribution to the national Prevent counter-terrorism strategy (2011) which focuses on preventing people becoming terrorists or supporting terrorism and provides guidance on how to address situations which cause concern where health care workers encounter someone (client or colleague) who may in the process of being radicalised towards terrorism or may be vulnerable to becoming involved in this process, in order for appropriate support to be supplied to such individuals. Please refer to the BHNFT Prevent policy for further details – available via the policy warehouse. All staff are required to attend Prevent training.

29. Training

All staff working for BHNFT should access Safeguarding Children Training. The level of training available should be appropriate to the level of contact the staff member has with children and families within the organisation. This is identified in the Trust Safeguarding Training Strategy

30. Monitoring and compliance and effectiveness of this policy

30.1 Regular audit of compliance, with this policy and associated processes and procedures will take place and be reported to the Steering Group. Any incidents will be reported via the Datix incident reporting system and where appropriate to the Named Nurses / Midwife Safeguarding Children. Any untoward incidents will also be reported through the Patient Safety Board and the Trust. An annual report will also be submitted to the Trust Board.

31. Equality Impact Statement

The Trust understands the business case for equality and diversity and will make sure that this is translated into practice. Accordingly, all policies and procedures will be monitored to ensure their effectiveness.

Monitoring information will be collated, analysed and published on an annual basis as part Equality Delivery System. The monitoring will cover the nine protected characteristics and will meet statutory duties under the Equality Act 2010. Where adverse impact is identified through the monitoring process the Trust will investigate and take corrective action to mitigate and prevent any negative impact.

17 The information collected for monitoring and reporting purposes will be treated as confidential and it will not be used for any other purpose. 31.1 Barnsley NHS Foundation Trust aims to design and implement services, policies and measures that meet the diverse needs of our service population and workforce, ensuring that none are placed at a disadvantage over others. We therefore aim to ensure that in both employment and services no individual is discriminated against by reason of their gender, gender reassignment, race, disability, age, sexual orientation, religion or religious/philosophical belief or marital status or civil partnership. This policy has been assessed against the protected characteristics and does not have an impact against the same.

32. Conclusion

32.1 This policy and the associated procedures will ensure that Children receive appropriate and timely therapeutic and preventative interventions;

Staff working with children ensure Safeguarding Children forms an integral part of all stages of care offered;

Staff who come into contact with children, parents and carers in the course of their work are aware of their safeguarding responsibilities;

Staff can recognise risk factors and are aware of the processes involved in protecting a child.

33. References

HM Government (2015) Working Together to Safeguard Children, HMSO, London.

Department of Health (2006) Standards for Better Health, HMSO, London.

DCSF (2012) Safeguarding Children and Young People from Sexual Exploitation: Executive Summary. HMSO, London.

Laming, Lord (2003) The Victoria Climbie Inquiry. HMSO, London.

National Children’s Home Action for Children (2002) The Hidden Victims: Children and Domestic Abuse. London: NCH Action for Children.

NMC – The Code (May 2008) – Standards for conduct, performance and ethics for nurses and midwives. 18 Intercollegiate document 2014- Roles and Competencies for Healthcare staff.

NICE (2009) When to suspect child maltreatment. Nice Clinical Guidance 89. London. NICE

NICE (2010) Looked After Children and Yong People. Nice Guidance PH28. London.

Research in Practice (2014) Children and Young People missing from Care and Vulnerable to Sexual Exploitation. Darlington.

Abbreviations

Barnsley Safeguarding Children Board (BSCB)

Barnsley Hospital NHS Foundation Trust (BHNFT)

Emergency department (ED)

Child Sexual Exploitation (CSE)

Looked After Children (LAC)

Equality Impact Analysis Template

The purpose of Equality Analysis is to ensure that the Trust does not unwittingly discriminate against any groups recognised under the Equality Act 2010. These are: Age, Disability, Gender reassignment, Sexual Orientation, Race, Religion or Belief, Sex, Sexual orientation, Marriage & Civil partnership, Pregnancy and Maternity. An EqIA is a process which ensures the Trust eliminate unlawful discrimination, foster good relations between others and promote equality of opportunity in the take up of its services and employment practices.

Division/Department Safegaurding Department

19 Policy/Service Safeguarding Chidren Policy

Is this policy/service Existing New/Existing

Name of Assessor(s) Angela Fawcett

Date of EqIA April 15

The intention of this policy is to Aims/Objectives/ ensure that BHNFT has robust Purpose Of systems in place to comply Policy/Service with Section 11 of the Children Act 2004, to safeguard and promote the welfare of children, and to ensure that the staff who undertake this demanding and stressful work are adequately supported and trained. Associated Objectives Section 11 of the Children Act for this Service e.g. requirements

National frameworks, Equality Act. Patients Does this policy/service

Affect patients or the workforce? Staff recognise and take What outcomes do you appropriate action to safeguard want to achieve from this children. process? What factors could Contribute Detract contribute/detract from the effective delivery of Staff being aware of this policy Keys staff groups not accesing this policy/service? and accessing appropritae training and adhering to the policy training

Are there any concerns This policy is based on that this service or policy Race no national guidelines for could have a differential safeguading and the local impact on or due to the multi-agency safeguarding following: procedures and does not discriminate against any of the 20 areas below

Age no

Disability no However it should remembered that children with disabilities are a particularly vulnerable group Gender Reassignment no

Religion/Belief no

Sexual Orientation no

Pregnancy Maternity no

Marriage Civil Partnership no

Sex no

Human Rights no

If you have answered yes to any of the above, please describe or attach any evidence of action which will mitigate your EqIA and ensure your policy/service will be able to show:  Eliminate discrimination  Promore equal opportunities  Foster good relations between others

Should the EqIA proceed No Comments to a full EqIA for the areas identified for attention? Comments

21 Send to: B Powell Equality and Diversity Advisor for signature and authorisation

Send to: A Bielby Line Manager for signature and authorisation

Head of Department A Fawcett Responsible for policy or service

When is the next review (please note review should be immediate on any amendments to your policy etc)

1 Year

2 Year Yes

3 Year