SAFEGUARDING CHILDREN AND YOUNG PEOPLE PRACTICE GUIDANCE/OPERATIONAL POLICY

Version 6

Name of responsible (ratifying) committee Safeguarding Committee

Date ratified 27 January 2017

Document Manager (job title) Named Nurse Safeguarding Children

Date issued 21 February 2017

Review date 20 February 2018

Electronic location Clinical Policies Working Together to Safeguard Children (2015) 4 Local Safeguarding Children Board Safeguarding Children Procedures (2015) Related Procedural Documents Safeguarding Children Supervision Policy (2016). Safeguarding Adults’ Policy (2016)

Safeguarding children, Child protection, Children Key Words (to aid with searching) Services; Police; Staff; Supervision. MAPPA; MARAC; Allegation; Care Act 2015.

Version Tracking Version Date Ratified Brief Summary of Changes Author/s 6 27/01/2017 New working hours, update of staff names. New flow chart. Diane Urquhart CP-IS. Looked after Children Guidance update from Intercollegiate document March 2015 5 25/11/2015 Annual review: References/telephone numbers updated, early Pam Aspinell assessment updated, Safeguarding and promoting the welfare of children updated to ‘life chances’ rather than ‘outcomes’ Working Together 2015, CDOP/CPIS updated, domestic abuse updated, resolving professional disagreements (escalation procedure), children and young people subject to violent extremism, supervision updated, Care Act 2015, new professional duty to report FGM cases in under-18s to police 4 03/10/2014 Annual review: Flow chart, FGM, Child Sexual Exploitation, Pam Aspinell Honour based violence, further definitions added Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 1 of 40 Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 2 of 40 Table of Contents QUICK REFERENCE GUIDE...... 3 WHAT TO DO IF YOU ARE WORRIED ABOUT A CHILD...... 4 1. INTRODUCTION...... 5 2. PURPOSE...... 6 3. SCOPE...... 6 4. DEFINITIONS...... 6 5. DUTIES AND RESPONSIBILITIES...... 10 6. PROCESS...... 13 7. CHILDREN/FAMILIES REQUIRING ADDITIONAL SUPPORT...... 19 8. TRAINING REQUIREMENTS...... 20 9. PORTSMOUTH AND HAMPSHIRE SAFEGUARDING CHILDREN BOARD...... 20 10. POLICY STATEMENT AND SAFEGUARDING CHILDREN DECLARATION...... 20 11. REFERENCES AND ASSOCIATED DOCUMENTATION...... 20 12. MONITORING COMPLIANCE WITH AND THE EFFECTIVENESS OF PROCEDURAL DOCUMENTS...... 22 13. MONITORING AND AUDITING (EFFECTIVENESS OF POLICY)...... 23 14. IMPLEMENTATION...... 24 Appendix 1: Related procedures/information...... 25 Early Assessment (EA) previously known as the Common Assessment Framework (CAF).....25 2. Safeguarding children policies and procedures...... 25 3. Preventing harm to children where parents have mental illness, misuse drugs/alcohol and parents with a learning disability...... 26 4. Information Sharing/Confidentiality...... 27 5. Freedom of Information (FOI) & media requests...... 28 6. Reporting in the Trust...... 29 7. Documentation...... 29 8. Fabricated or Induced Illness (FII) (previously known as Munchausen Syndrome by Proxy) 29 9. Management of a Child Death...... 30 10. Dealing with Allegations Against Staff...... 31 11. Multi-agency Public Protection Arrangements (MAPPA)...... 31 12. Multiagency Risk Assessment Conferences (MARAC)...... 31 13. Disclosure by a Child:...... 32 14. Child Missing from Hospital...... 32 15. Child not Registered with a General Practitioner (GP)...... 32 16. Were not Brought to an Appointment...... 32 17. Guidelines for Children Attending the Emergency Department...... 32 18. Non-Accidental Skeletal Survey Guidance...... 32 19. Emergency Department (Children and Adult)...... 32 20. Notification of an Child/Young Person’s Admission to Hospital...... 33 21. Privately Fostered Child...... 33 22. Safeguarding Children Supervision...... 33 23. Consent (Fraser Guidelines/Gillick)...... 34

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 3 of 40 24. Parental Responsibility (PR)...... 34 25. Restraint...... 34 26. Domestic Abuse...... 34 27. Children and Young People Subject to Violent Extremism...... 35 28. Resolving Professional Disagreements (Escalation Procedure)...... 35 Equality Impact Screening Tool...... 37

QUICK REFERENCE GUIDE

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 4 of 40 For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

1. Safeguarding children is widely acknowledged as ‘Everyone’s Responsibility’ and this Operational/Practice Policy applies to all Portsmouth Hospitals NHS Trust (PHT) staff, both clinical and non-clinical, whether they work with children or with adults.

2. The Children Act (1989, s.27 and s.47) and (2004 s.11), places a duty on all agencies to work together to safeguard and promote the welfare of children. The statutory guidance, Working Together to Safeguard Children (2015), outlines the legislative requirements and expectations on individual services to safeguard and promote the welfare of children; and provides clear framework for Local Safeguarding Children Boards (LSCBs) to monitor the effectiveness of local services. This policy outlines corporate and individual responsibilities in accordance with legislation, guidance and standards for Safeguarding Children.

3. The fundamental principle of the Children Act 1989 is that the welfare of the child is ‘paramount’ and is an important consideration in assessing parenting capacity and balancing the rights of parents with the child’s right to be protected from harm. The Care Act 2015 (under the Child and Families Act 2014) aims to make care and support more consistent across the country and introduces the wellbeing principle and safeguarding as themes running through all aspects of care and support and is applicable to children & young people (appendix 1).

4. Parenting can be challenging and seeking help should be seen as sign of responsibility and not of failure. Health professionals have a key role in early intervention to support parents experiencing difficulties. Compulsory intervention in family life should be seen to be exceptional.

5. The Trust has a duty to ensure that ALL staff understand the importance of safeguarding children and to ensure that all health professionals be alert to potential indications of abuse or neglect in children, know how to act upon their concerns and who to contact in their organisation to express concerns about a child’s welfare.

6. The Trust recognises the importance of multi-agency working in safeguarding children (child protection) and is committed to developing effective multi-agency practices.

7. Local authorities have overall authority for the investigation and management of safeguarding children cases. Police have overall authority for investigation and management of potential criminal offences. Trust staff are required to co-operate with the provision of timely, accurate responses to requests for information.

8. Further advice can be sought internally from the Safeguarding Children Team on ext. 4314/4315,

9. External agencies Multi Agency Safeguarding Hubs. (MASH). Trust website will always have current numbers if changes are made after production of the policy.

Hampshire Children Services MASH (All Hampshire residents) via the Professionals Line 01329 225379

Portsmouth City Council MASH on 023 92688793 or 02392 839111 (Portsmouth City residents)

Out of Hours (Social Care) on 0300 555 1373

10. This policy relates to the Trust’s Safeguarding Adult Policy.

WHAT TO DO IF YOU ARE WORRIED ABOUT A CHILD

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 5 of 40 What to do if you are worried about a child or young person including the unborn child.

Emergency Non-Emergency Perceived immediate threat to Perceived NO immediate threat to safety or wellbeing safety or wellbeing

Discuss with a Paediatrician, CONSIDER, SUSPECT, AND Manager and/or Safeguarding REFER. Children Team. Analysis of Risk – level of If you consider the child to be at concern prompts towards risk of immediate harm call the suspicion of child maltreatment Police 08450454545 or 999 Including the unborn

Early Help Contact Children’s Assessment Social Care and can meet the make formal referral. needs of child CONTACT or unborn. CORRECT AREA (SEE

Contact MASH by telephone to inform of referral.

Follow up ALL referrals with written referral from (IARF) within 24-48 hours. SEND VIA SECURE EMAIL ADDRESS.

Portsmouth MASH 02392 688793 Hampshire MASH 01329 225379

 Place Copy of Interagency referral form in medical notes.  Send copy of IARF to safeguarding children team electronically or hard copy taken to office to scan.  Emergency department to send copy referral to Departmental lead for safeguarding children.

Please contact the office team as per numbers below for all day to day case management (office ‘phone lines will be covered form 0830 hours until 1700 hours) Single point of contact for all office calls 4315 Specialist Midwife SCT: Sharon Ward 02392 286000 x 4581 Mob: 07834765963 Specialist Nurse SCT: Jenny Januszczak 02392 286000 x 4312 Mob: 07768 030341 Named Doctor: for Safeguarding Children/Lead Doctor for Child Death: Dr Simon Birch 02392 286000 via switchboard. Named Nurse: Safeguarding Children (SCT) Diane Urquhart 02392 286000 x 4313 Mobile: 07540668378 Named Midwife: Safeguarding Children (SCT) Dr Wendy Marsh 023 92286000 x 4533 Mobile: 07809103031 Senior management for Women's & Children CSC. Head of Nursing W&C: CSC Lesley Coles 02392 286000 ext 3602 Mob: 07515 190522 Head of Midwifery: Gill Walton 02392 286000 ext 4532

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 6 of 40 1. INTRODUCTION

1.1 Portsmouth Hospitals NHS Trust (PHT) aspires to the highest standards of behaviour and clinical competence, in order to ensure that all care provided to children and young people is fair and equitable. All children and young people have a right to be safe and protected from harm.

1.2 Protecting children from harm and promoting their welfare depends on a shared responsibility and effective joint working between different agencies (Working Together to Safeguard Children 2015, Care Act 2015). NHS Trusts are expected to co-operate with the Local Authority and share responsibility for the effective discharge of its function in safeguarding and promoting the welfare of children and young people. Working Together (2015) has been updated in line with statutory guidance and informs the Trust’s Safeguarding Children Practice Guidance/Operational Policy in conjunction with the Safeguarding Children Procedures set out by Hampshire, Isle of Wight, Portsmouth and Southampton Local Safeguarding Children Boards (2016).

1.3 PHT has regular contact with children and young people in a variety of settings and circumstances. This includes children and young people as service users, children and young people as relatives, close contacts or carers of adult service users. All children and young people will be afforded the same level of safeguarding regardless of their age and diversity.

1.4 PHT will ensure we optimise the opportunity for children and young people who we come into contact with to achieve their full potential. This is clearly the responsibility of the Board and its individual members, the Executive, each Clinical Service Centre and every individual working within the Trust.

1.5 This Policy sets out the ways in which the Trust supports this in practice, identifying responsibilities for all employees guiding them through the issues they need to consider and pathways they need to follow.

1.6 Management and mitigation of risks are an integral part of good management practice and clinical Governance, with risk assessment being a fundamental element of this process. Clinical Service Centres (CSCs) and specialties working with children and young people need to undertake risk assessments for foreseeable risks within their areas and provide evidence that identified risks to children and young people are being managed, controls are in place and that actions have been taken to mitigate any harm occurring. These risk assessments are to be documented, circulated widely for consultation and submitted for inclusion on local, CSC risk registers depended upon risk ranking. If risk is assessed by the CSC as high ranking and unable to be managed locally the risk will need to be submitted to the Trust Risk Assurance Committee for consideration for inclusion on the Trust Risk register.

1.7 Every Child Matters (2005) sets out five outcomes that the Government expects all children to achieve. These are:

 Be Healthy  Stay safe  Enjoy and achieve  Make a positive contribution and  Achieve economic wellbeing

1.8 The Trust (PHT) is required to demonstrate that they are achieving the standards set by the Care Quality Commission (DH 2015). This follows the (KLOE) Key Lines of enquiry for organisations, which include evidence to highlight the following - Safe, effective, responsive, well- led. The organisation will be part of regular inspections to ensure compliance.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 7 of 40 2. PURPOSE

2.1 The Trust has a statutory responsibility set out in the Children Act 2004 to safeguard the welfare of children and young people. The purpose of this policy is to guide practice to ensure that the Trust fulfils its responsibilities. This Operational Policy should be used as a reference point to inform professional decisions in specific situations. This Policy should be read in conjunction with the Safeguarding Children Procedures set out by Hampshire, Isle of Wight, Portsmouth and Southampton Local Safeguarding Children Boards www.4lscb.org. The objective is to ensure that child welfare concerns are identified and appropriately acted upon resulting in the safeguarding of all children who access the Trust.

3. SCOPE

3.1 This policy applies to all Trust staff directly employed or contracted to work for PHT. Any individual working within the Trust irrespective of their role or employment status has a duty to safeguard children. This includes agency staff, volunteers and staff contracted to work on any Trust site.

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain on-going patient and staff safety’.

4. DEFINITIONS

4.1 This is not an exhaustive list but should help the reader with some of the common terms and words used in relation to Safeguarding Children and Young People (SC&YP). 4.2 Children for the purpose of safeguarding refer to anyone who has not reached their 18th Birthday. The fact that a child has reached 16 years of age, is living independently or is in further education, is a member of the armed forces, is in hospital, prison or in custody in the secure estate, does not change his/her status or entitlements to services or protection. 4.3 Safeguarding and Promoting the Welfare of Children is defined in Working Together 2015 as:  protecting children from maltreatment;

 preventing impairment of children’s health and development;

 ensuring that children are growing up in circumstances consistent with the provision of safe and effective care, and;

 taking action to enable all children to have best life chances.

4.4 Child Protection - part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering, or are likely to suffer, significant harm.

4.5 Abuse - a form 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 in an institutional or community setting by those known to them or, more rarely, by others (e.g. via the internet). They may be abused by an adult or adults, or another child or children.

4.6 Significant Harm - there is no absolute definition of the criteria for significant harm. Most often it is a compilation of significant events both acute and long standing which interrupt, change or damage the child’s physical and psychological development.

4.7 Children in Need are those whose vulnerability is such that they require services above universal services to maintain a “reasonable level of health and development”; this includes the disabled child. Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 8 of 40 4.8 Physical Abuse A form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child.

4.9 Emotional Abuse 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 a child 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 a 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.

4.10 Sexual Abuse Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or 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 (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.

4.11 Neglect 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. Once a child is born, neglect may involve a parent or carer failing to:

 Provide adequate food, clothing and shelter (including exclusion from home or abandonment);

 Protect a child from physical and emotional harm or danger;

 Ensure adequate supervision (including the use of inadequate care-givers); or

 Ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.

4.12 Young Carers are children and young people who assume important caring responsibilities for parents or siblings, who are disabled, have physical or mental ill health problems, or misuse drugs or alcohol.

4.13 Female Genital Mutilation (FGM)

 Female genital mutilation (FGM) is a collective term for procedures, which include the removal of part or all of the external female genitalia for cultural or other non-therapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on new-born infants or on young women before marriage or pregnancy.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 9 of 40  FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and makes it an offence for the first time for UK nationals or permanent UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

 Radicalisation/PREVENT is defined as the process by which people come to support terrorism and violent extremism and, in some cases, to then participate in terrorist groups. The Associate Director of Quality and Governance is the lead. Please see Appendix 2 of the Adult Safeguarding Policy.

NHS Actions

From April 2014 NHS hospitals will be required to record:

 If a patient has had Female Genital Mutilation;  If there is a family history of Female Genital Mutilation;  If a Female Genital Mutilation-related procedure has been carried out on a patient.  From September 2014 all acute hospitals must report this data centrally to the Department of Health on a monthly basis. This is the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.  PHT staff identifying any women and or child confirmed of having any type of FGM must record this using the NHS number.  Access to the site is via the Trust’s intranet – the data is used in the national prevalence records. The Safeguarding team report case numbers in Commissioners reports from 2017.

From October 31st 2015, it became a professional duty to report cases of FGM in girls under 18 to the police.

 ‘ Phone the police non-emergency crime number, 101, in cases when a girl is under 18 you treat tells you she has had FGM (female genital mutilation) and has signs on examination which appear to show she has had FGM.  Report as soon as possible; normally by close of the next working day. Longer timeframes are allowed under exceptional circumstances but always discuss with the Safeguarding Children Team.  If a girl appears to have been recently cut or you believe she is at imminent risk, act immediately – this may include ‘phoning 999.  The professional who identifies FGM/receives the disclosure must report the case. It is their personal duty; if you do not comply, your professional regulator may consider the circumstances under the existing ‘Fitness to Practise’ proceedings.  NSPCC FGM helpline: 0800 028 3550 [email protected]  All documents and Home Office guidance are located on the Safeguarding intranet site and are updated as and when changes to policies are received.

REMEMBER: Mandatory reporting is only one part of safeguarding against FGM and other abuse.

For further information contact the Safeguarding Children Team or Head of Midwifery.

4.14 Child Sexual Exploitation/Missing and Trafficked.

 The sexual exploitation of children under 18 involves exploitative situations, contexts and relationships where children (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of performing, and/or others performing on them, sexual activities. Child sexual exploitation can occur through use of technology without the child’s immediate recognition, for example the persuasion to post

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 10 of 40 sexual images on the internet/mobile phones with no immediate payment or gain. In all cases those exploiting the child have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources.  Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person's limited availability of choice resulting from their social/economic and/or emotional vulnerability.‛ this definition was created by the National Working Group for Sexually Exploited Children & Young People (NWG) and is used in statutory guidance in England.  There are two local risk assessment tools available (Portsmouth & Hampshire). Both areas have devised a shortened assessment tool that can be used in certain areas considered to have time limited contact - for instance in ED or paramedics. All tools can be located on the intranet site or directly from the LSCB sites. Please speak to your Safeguarding Children Team.  Missing/trafficked - Where a child has been trafficked, the Assessment should be carried out immediately as the opportunity to intervene is very narrow. Many trafficked children go missing from care, often within the first 48 hours. Provision may need to be made for the child to be in a safe place before any Assessment takes place and for the possibility that they may not be able to disclose full information about their circumstances immediately. Urgent referral to Children’s Social Care and an allocated lead social worker needs to lead on the case. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/330787/Care_of_unacco mpanied_and_trafficked_children.pdf

4.15 Honour Based Violence

 Honour based violence is a collection of practices, which are used to control behaviour within families or other social groups to protect perceived cultural and religious beliefs and/or honour. Such violence can occur when perpetrators perceive that a relative has shamed the family and / or community by breaking their honour code. The individual is being punished for actually, or allegedly, undermining what the family or community believes to be the correct code of behaviour. So-called 'honour based violence' is a fundamental abuse of Human Rights. There is no honour in the commission of murder, kidnap and the many other acts, behaviour and conduct which make up violence in the name of honour.  The ‘One Chance Rule' All practitioners working with victims of honour based violence need to be aware of the ‘one chance’ rule. That is, they may only have one chance to speak to a potential victim and thus they may only have one chance to save a life. This means that all practitioners working within statutory agencies need to be aware of their responsibilities and obligations when they come across these cases. If the victim is allowed to walk out of the door without support being offered, that one chance might be wasted.

4.16 Forced Marriage

 There is a clear difference between a forced marriage and an arranged marriage. In arranged marriages, the families of both spouses take a leading role in arranging the marriage but the choice of whether or not to accept the arrangement remains with the young people.  In a forced marriage, one or both spouses do not consent to the arrangement of the marriage and some elements of duress are involved. Duress can include physical, psychological, financial, sexual and emotional pressure. Forced Marriage is an abuse of human rights and, where a child is involved, an abuse of the rights of the child.  Forced marriage involving anyone under the age of 18 constitutes a form of child abuse. A child who is forced into marriage is likely to suffer Significant Harm through physical, sexual or emotional abuse. Forced marriage can have a negative impact on a child’s health and development, and can also result in sexual violence including rape. If a child is forced to marry, he or she may be taken abroad for an extended period of time which could amount to child abduction. In addition, a child in such a situation would be absent from school resulting in the loss of educational opportunities, and possibly also future employment opportunities. Even if the child is not taken abroad, they are likely to be taken out of school so as to ensure that they do not talk about their situation with their peers.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 11 of 40 For information on when to suspect child maltreatment you can access NICE Guidelines www.nice.org.uk/CG89 “Listen and observe, seek an explanation, record, consider, suspect or exclude maltreatment”.

If you have concerns about the welfare and safety of a child or young person regarding FGM, Child Sexual Exploitation, honour based violence or forced marriage, please speak to the Safeguarding Children Team. A referral to Children’s Social Care may follow and should be made in accordance with the Referrals Procedure. Children’s Social Care will undertake an assessment and, jointly with the Police, undertake a Section 47 Enquiry if they have reason to believe that a child is likely to suffer or has suffered harm. A strategy discussion/meeting should include the relevant Health professionals and, if the child is of school age, the relevant school representative.

Good practice in caring for children and young people means taking a ‘child-centred’ approach, seeking their views and listening to what they have to say. Some of the worst failures in safeguarding have occurred when professionals have lost sight of the child and concentrated instead on their relationship with the adult. This includes good risk assessments, care planning, inter agency working and sharing of relevant information. Practitioners therefore need to understand risk factors warning signs and how to share information effectively.

5. DUTIES AND RESPONSIBILITIES

5.1 Whilst Children’s Social Care has a lead role in working with children and families where children are at risk of, or have experienced significant harm from abuse and neglect, working to protect children is not their sole responsibly. It is shared by all those who work with children or parents/carers. S.11 of the Children Act 2004 places a duty on a range of organisations to make arrangements for ensuring that the functions and services provided on their behalf are discharged with regard to safeguarding and promote their welfare. 5.2 As part of the Trust’s safeguarding arrangements, explicit clarification on the following roles reflects:

 Senior management commitment to the importance of safeguarding and promoting child welfare.

 It also specifies the agreed clear lines of accountability within the organisation for work on safeguarding and promoting the welfare of children. 5.3 Trust Board has:

 Responsibility and overall accountability for ensuring that Health contribution to safeguarding and promoting the welfare of children is discharged effectively. The Board sets the strategic context and is alerted to relevant issues arising that may affect the organisation and the welfare of children and young people.

5.4 The Chief Executive (Children’s Champion) is responsible for:

 Ensuring that the health needs of all children and young people are at the forefront of local planning and that high quality health services meet identified quality standards.

 The Chief Executive will ensure that monitoring takes place of safeguarding activity to fulfil the requirements of Section 11 (Children Act 2004) Care Act 2015, Working Together to Safeguard Children (2015), Quality contracts and recommendations from Serious Case Reviews. The Chief Executive has overall responsibility for ensuring that there are safe and robust operational arrangements in place for safeguarding in all the services which are provided.

 In order for this responsibility to be effectively discharged, Executive Directors and senior colleagues will have specific delegated responsibility to support the Chief Executive in this process. Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 12 of 40 5.5 Director of Nursing (Safeguarding Children Executive) is responsible for:

 Provision of Board level leadership for Safeguarding Children.

 Representing the Trust at Portsmouth Local Safeguarding Children Board and on the Health Forum of Hampshire Safeguarding Children Boards as required.

 Ensuring Safeguarding key performance indicators are progressed and achieved.

 Supporting the development of robust audit systems for safeguarding children.

 Supporting the implementation of efficient and effective safeguarding children procedures.

 Supporting the implementation of robust Safeguarding Children Training and development.

5.6 The Named Doctor

The Named Doctor is a Paediatrician at Consultant level. The duties are as follows:

 To promote good practice and effective communication within and between Trusts and all agencies on matters related to safeguarding and protection of children.

 To be a source of advice and expertise on Safeguarding Children and Child Protection matters to all staff at the point of need.

 To co-ordinate and monitor medical input into cases of abuse and/or neglect.

 To co-ordinate child protection training for medical staff and provide supervision.

 To participate and contribute to internal management and serious case reviews.

 To ensure there are effective systems of child protection audit to monitor the application of agreed child protection standards.

5.7 The Named Nurse and Midwife

These are senior experienced Nursing/Midwifery staff with specific duties (not exhaustive)

 To promote good practice and effective communication within and between Trusts and partner agencies on matters related to the protection of children.

 To develop, monitor and review health service specifications and standards for child protection practice.

 To be a source of advice and expertise on child protection matters to all staff at the point of need.

 To provide child protection advice and supervision.

 To identify and co-ordinate child protection training within the Trust.

 To undertake Internal Management Reviews (IMR), contribute to Multi-agency Serious Case Reviews and Independent Reviews.

 To work with managers to identify the resources needed by staff to enable them to carry out their roles in relation to child protection and safeguarding children.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 13 of 40 5.8 Clinical Service Centres leads are responsible for ensuring through their governance systems that:

 Staff are familiar with this policy.

 Staff know what to do if they are worried about a child and or young person.

 Staff know what to do if they are worried about an adult’s behaviour which may be impacting on a child and or young person.

 Staff are aware of their responsibilities in relation to safeguarding children and young people.

 Staff know where to go for help and information.

 The service meets its performance targets in relation to the percentage of staff trained in Safeguarding Children and Young People (all levels) (ref. Trust Training Strategy 2015).

 Incidents are reported appropriately and discussed in appropriate forums to ensure that any learning/further action is always considered (SCRs/Adverse incidents).

5.9 All Trust Staff

Each individual employee has a responsibility in safeguarding children and promotes their welfare. These responsibilities are set out in Working together to safeguard children document 2015 https://www.gov.uk/government

 Specifically all Trust staff must: Attend Safeguarding Children Training at appropriate level to enable to safeguarding and promotion of welfare for children and young people.  Be alert to potential indicators of abuse or neglect of children.  Know how to act upon their concerns in line with the safeguarding and child protection procedures, including referral systems.  Act and respond appropriately to third party concerns; advice can be sought from Named Professionals (as above) or Paediatrician on call.  When it is known that a patient or visitor to the Trust is a risk to children, in whatever context, each case must be risk assessed and managed on an individual basis. Advice and support may be sought from the Named Nurse for Safeguarding Children, the Safeguarding Adult Lead and the Risk Management Team. There is a Standard Operating Procedure for celebrity, high- profile, media or organisational visits to Portsmouth Hospitals NHS Trust and can be located on the intranet http://pht/HospitalCommunications/Corporate%20Identity/VIP%20Protocol.docx the welfare of children in our care must be paramount at all times.  Whilst it is important to acknowledge the Human Rights and confidentiality of individuals, the welfare of children and young people in our care must be paramount at all times. Trust employees who work predominantly or completely with adults who have parental responsibilities share a commitment to safeguard and promote the welfare of the child.

5.10 Safeguarding Committee

 This committee forms an integral part of the Governance system and reports to Trust Board. It is chaired by the executive lead for Safeguarding. Its purpose is to obtain safeguarding assurance, monitor and ensure effective safeguarding children arrangements throughout the Trust.

5.11 Paediatric Standards and Quality Committee

 This Committee forms an integral part of the Governance umbrella for Children and Young People across the organisation. The purpose of the committee is to ensure the Trust provides a safe service and to oversee the clinical governance provision provided to Children and Young People. The Committee provides a focus on the quality agenda for Paediatric and Neonatal Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 14 of 40 Services. It will take into account local and national best practice policies, including the Care Quality Commission Standards, all relevant National Service Frameworks and associated improvement strategies and NICE / NPSA guidance. The committee will also consider the implications arising from national reports and enquiries, including the National Confidential Enquiries, and will consider any outcomes of the national audit programme co-ordinated by the Healthcare Quality Improvement Partnership (HQIP) and the Local Safeguarding Children Board.

5.12 Safeguarding Children Operational Group

 Is chaired by the Named Doctor Safeguarding Children and has representation from all Clinical Service Centres. Its purpose is to ensure communication across the workforce and monitor safeguarding children compliance and reports to 5.12.

5.13 Risk Assurance Committee (RAC)

 The purpose of the Risk Assurance Committee is to promote effective risk management and to establish and maintain an assurance framework and a risk register through which the Board can monitor the arrangements in place to achieve a satisfactory level of internal control, safety and quality. 5.14 The Policy Author is responsible for:

 Updating the policy in the light of any relevant legislation or change in policy and or procedure.

5.15 Trust Policies Officer is responsible for:

 Administering the control of policy management.

6. PROCESS

6.1 Everyone who works with children and young people, or with carers of children and young people, should be able to recognise, and know how to act upon, indicators that a child’s welfare or safety may be at risk. Professionals should always be mindful of the welfare and safety of children, young people and the unborn child in their work.

6.2 Trust’s service users are predominantly, but not exclusively, adults. Adult services have a responsibility to safeguard children when they become aware of or identify a child at risk of harm. Staff should routinely record details (name and date of birth) of children within households of service users and the service users’ responsibilities in relation to those children. Other assessments and care plans should also involve the needs of children who are the children of parents with a mental health illness, substance misuse and/or chronic disease. Details of any professionals involved with children should also be recorded.

6.3 All health professionals who work with children, young people and families should be able to:

 Understand risk factors and recognise children and young people in need of support and/or safeguarding;  Recognise the needs of parents who may need extra help in bringing up their children, and know where to refer for help and use the single Assessment Framework to access support as appropriate for them;  Recognise the risks of abuse or neglect to an unborn child;  Communicate effectively with children and young people and stay focused on the child’s safety and welfare;  Liaise closely with other agencies, including other health professionals, and share information as appropriate.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 15 of 40  Assess the needs of children and the capacity of parents/carers to meet their children’s needs, including the needs of children who display sexually harmful behaviours;  Plan and respond to the needs of children and their families, particularly those who are vulnerable;  Contribute to planning meetings, child protection conferences, family group conferences and strategy discussions;  Contribute to planning support for children who are suffering, or likely to suffer, significant harm, for example, children living in households with domestic violence, parental substance misuse and/or parents may have a severe learning and/or physical disability;  Where appropriate, play an active part, through the child protection plan, in keeping the child safe; as part of generally safeguarding children and young people, provide on-going promotional and preventative support, through proactive work with children, families and expectant parents; and contribute to the Child Death Process, Serious Case Reviews, Independent Reviews and implementation of the lessons learned.

6.4 All staff members within PHT are responsible for ensuring:

 They know what to do if they are worried about the safety of a child (0-18) including the unborn baby.  Understand their responsibilities in relation to safeguarding children, with particular attention to the children or contacts of service users and the process of information sharing.  Identify development and training needs through individual performance reviews.  Report and document all concerns and subsequent actions in accordance with Trust procedures.

6.5 Referring to Children’s Social Care

 Children and young people who may have been abused will present with different symptomatology to a wide number of different departments within the Trust.  It needs to be recognised that some children and young people may present to departments with signs and symptoms of possible abuse which are discovered by chance and do not relate to the initial reason for referral or attendance e.g. a baby is noted to have facial bruising in a routine outpatient appointment, or seen by a midwife on a community visit, a child who is in the waiting room and observed to be reprimanded and or physically hit by their carer.  Staff within all CSCs need to know what to do where there is concern about a child’s safety and know how to refer concerns to statutory agencies in line with the Trust’s and 4LSCB procedures (see enclosed Hyperlink for HSCB).  www.hampshiresafeguardingchildrenboard.org.uk

6.6 Careful consideration should be given to children and young people in the following categories (not exhaustive):

 Pregnant mothers may be at risk from domestic violence (including forced marriage or honour based violence), drug and alcohol abuse or may be victims of sexual abuse.  Pregnant mothers who have a learning disability and or mental health concern.  Overdose/self-harm - those children who fall into this category are vulnerable and must be referred to Child and Adolescent Mental Health Service/Adult Mental Health (CAMHs/AMH) for assessment.  Young people engaged in sexual activity - must be considered for risk of exploitation, trafficking and abuse.  Looked after Children (LAC) Local authorities and health care planners and commissioners have statutory duties to safeguard and promote the welfare of children in their care.  Healthcare professionals have an important role to play in enabling looked after children to overcome disadvantages and to reach their full potential. (Looked after children: Knowledge, skills and competencies of health care staff. Intercollegiate role framework 2015.)  Children with disabilities – children in this category will need careful assessment (consider Care Act 2015 – assessment of families by Local Authority). Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 16 of 40  Mothers/female carers and children who have clinical signs of having Female Genital Mutilation (FGM) or disclose they have been cut.  Children who witness domestic abuse, children becoming fearful or distressed, or suffering physical, psychological or emotional developmental problems. Children who experience domestic abuse often display more behavioural and emotional problems, both internal (such as depression and anxiety) and external (such as aggression or anti-social behaviour) than other children (Humphreys, 2006).

6.7 For all children with suspected or actual abuse and/or neglect, no subsequent appraisal of those concerns should be considered complete until each concern has been fully addressed, accounted for and documented.

6.8 The investigation and management of a case of deliberate harm to a child must be approached in the same systematic and rigorous manner as would be appropriate to the investigation of any other potentially fatal disease.

6.9 When the deliberate harm of a child has been raised as an alternate diagnosis to a purely medical one, the diagnosis of deliberate harm must not be rejected without full discussion and, if necessary, obtaining a further opinion.

6.10 Professionals must see the child/young person as the main focus of their work and communicate with the child/young person in way that is appropriate to their age, understanding and preference. This is especially important for disabled children and for children for whom English is not their first language. Where concerns arise as a result of information given by a child it is important to not to promise confidentiality.

6.11 When abuse is suspected an enquiry should be made to check if the child is subject to Child Protection Plan or known to Children’s Social Care; this can be done by:

6.12 Making a Telephone call to Children’s Social Care within the local area for the child’s permanent address.

6.13 Staff can request a professional advice call – THIS IS NOT a referral, indeed no details will be collected. Staff can describe current concerns and discuss the outline of the case with guidance to help the clinician to decide upon best line of action. The CSC still require the staff member to make overall decision on the case they have.

 Areas within the PHT for non–scheduled care can access the CP-IS (Child Protection information sharing system). This is part of normal booking systems in allocated areas within PHT. They include Emergency Department (ED), Child Assessment Unit (CAU) and some areas of maternity. This system will replace the previous JCPR (Joint Child Protection Register) and the new system will be fully implemented during 2016-17. PHT ED are live on the system as from November 2016.

 The CP-IS is an information service that is being implemented nationally and its aim is to deliver a higher level of protection to children who visit the NHS unscheduled care settings. It is only used when booking children into departments and is part of the overall Safeguarding process of all children. It does not replace the need to make a full assessment of case based on presentation and we will still need to ensure that any admissions are shared with the with the named social worker if one has been identified, being mindful of the level of medical information shared, based on Caldicott principles.

 Following assessment, where concerns are identified, contact should be made with Children’s Social Care (appendix 1).

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 17 of 40 It may be helpful to gather information from the following sources.

 The GP, midwife, health visitor and or school nurse may be helpful to be consulted.

 Emergency Department records are checked for index child (and or siblings). Maternity records obtained (if the child is less than 6 months) and the child’s hospital records requested.

 The issue of abuse should not be raised with the parent or carers without discussion with a senior Registrar and/or Consultant. There are very few urgent situations where confrontation is required. The important issue is to ensure the child’s safety and treatment of the presenting problem. However, if the parents/carers try to remove the child then advice should be sought from Children’s Social Care and/or the Police.

 When the situation is uncertain or there is a difference of opinion advice should be sought from the Named Doctor or Safeguarding Children Team.

 Following assessment, where concerns are identified, contact should be made with Children’s Social Care (appendix 1).

 Refer appropriately after having fully informed the parent/carer, unless personal safety or the safety of the child is likely to be compromised by doing so.

 All referrals must be followed up in writing within 24-48 hours using the guidance and documentation found on the Trust Intranet Safeguarding Children Homepage (Portsmouth & Hampshire). (Best practice is 24 hours and remember that action may not be taken until the IARF has been received by CSC.)

 Referral forms need to be e-mailed via a secure e-mail address. It is the responsibility of the professional to check that it has been received and followed up.

 Referrals that are sent for all inpatients and maternity cases for unborn that are receiving scheduled care are also sent to the Safeguarding children team.

 It is the responsibility of the professional involved to make the referral to Children’s Social Care and/or the Police and to follow up on the referral outcome.

 Police and security should be contacted immediately if a child or staff member is perceived to be in immediate danger from an abusive parent/carer.

 If there are child protection/safeguarding concerns relating to vulnerable young people (16-18 years) who have been admitted to the adult unit referral processes to Children’s Social Care and notification to the Safeguarding Children Team must be followed as above. In addition consideration should be given to the child’s sibling/s who remain in the family home.

 Consideration should also be given to assess the family for any adult safeguarding concerns/risks as outlined in the Trust’s Adult Safeguarding Policy.

 Investigations – will vary dependent on case as guided by medical team but are likely to include (not exhaustive):

 Blood tests, FBC, LFTs, Calcium, Vit D-specialist blood tests…  Coagulation should be checked where there are concerns about bruising, contact Duty Haematologist in individual cases if there are concerns about the possibility of a clotting disorder.  Urine for toxicology  Consider Intra-abdominal injury

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 18 of 40  Medical photography  X-rays-NAI skeletal protocol (CT/MRI)  Ophthalmology  Follow up chest x-ray and non-axial skeleton (updated 2016 based on evidence review) and or any view that may have been concern (11-14 days)  Historical child sexual abuse (CSA) case refers to Community Paediatricians (repeated examinations should be avoided where possible and should only be undertaken if presenting symptoms demand this for immediate clinical care).

 Acute CSA (Child Sexual Abuse) as per the Emergency Department Pathway.

 When a referral has been made to Children’s Social Care about suspected abuse, the child must not be discharged without full multi-agency discussion (strategy and/or pre-discharge meeting) which will include information from the GP midwife, health visitor, school nurse and Police (list not exhaustive). All discussions must be recorded on the pink pro forma and placed in the child’s notes and documentation of who is responsible for carrying out any actions agreed and it what timescale.

 PHT serves patients from Portsmouth and Hampshire Clinical Care Groups (CCGs). The processes for referrals are the same for both areas, but the contact details are different. Please note a patient’s address prior to referral.

 Any practitioner, who feels that their personal safety might be compromised when visiting a family, must undertake a risk assessment. They must contact their line manager/supervisor or the Named Nurse/Midwife Safeguarding Children at the earliest opportunity to discuss safe contact arrangements for the family.

 Maintain appropriate records and reports to Trust standards. Staff must record details of advice received chronologically within the child’s and/or adult’s records.

Practical Support to staff involved in safeguarding children processes

 Staff may be involved in Safeguarding/Child Protection processes including, initial referrals, planning, strategy meetings, case conferences and core groups. This could be a meeting about a service user, the child or contact of a service user or about a child of a member of staff. Staff involved with a child should attend meetings wherever possible or nominate a deputy to attend.

 Single Assessment- a holistic assessment used to identify additional needs which may require a multi-agency response. Early Help Assessment-if the child/family does not meet the need/criteria for Social Care.  Interagency Referral Form (IARF) – summary of concern/analysis of risk, what it means for the child, what you require Children’s Social care to do.  Strategy Meeting (multi-agency) – will be held (without parents/carer) led by Children’s Social care (Statutory lead) and minutes taken. This meeting is to ensure the safety of the child in hospital and of any siblings. Social care will feedback to parents as and when appropriate plans have been made.  Report writing (Police and Children’s Social care) - It is the responsibility of the Consultant to ensure there is a written medical report for any child there are concerns about the possibility of non-accidental injury or where there are concerns over neglect. Other staff involved may also be requested to provide a report, parenting, observation etc.  Planning meeting/pre-discharge meeting- (multi-agency) including parents will be held if a plan for discharge is required to ensure continuing safety.  Pre-birth planning –refer to 4LSCB maternity services and Children’s Social Care Joint Working Protocol to Safeguard Unborn Babies (2011).(review of policy currently underway to be completed end of 2016) 4lscb.org.uk/documents  Child Protection Conference- a written report should be submitted 48 hours prior to the conference and seen by the parent/carer prior to the conference wherever possible. This report

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 19 of 40 should give an account of involvement, your assessment of the unborn/child’s needs and any risks to the unborn baby/child, your professional judgement of the parent/carers ability to safeguard and promote the welfare of their child/ren. They must be factual and distinguish between fact, observation, allegation and opinion.  Core Group meeting- meeting held post conference to put a plan together to ensure the unborn/child is safeguarded.  Court report/attendance- if a report is required or you receive notification to attend court, inform your line manager, legal team and/or the Safeguarding Children Team immediately for advice and support. It is recommended that staff required to provide written statements or attend court proceedings should utilise this support.

 The Safeguarding Children professionals’ team and administrators are available for advice, support and discussion about safeguarding vulnerable families/child protection

Telephone lines will be operating from Monday-Friday 08.30-17.00

Please contact the Safeguarding Children Office ext. 4314/4315.

We will be operating the office as a single point of contact. The team will be available to offer advice and signpost staff to the correct pathways. The team will take details and then escalate to the appropriate Professionals for Safeguarding Children Please note it may not be always possible for the Named Professionals to speak to you immediately but all calls will be triaged and a call back will be arranged.

The Named professionals are available for strategic planning and advice – please call the admin team to discuss. Appointment bookings with Named Professionals can also be arranged

 Weekends and Bank Holidays please contact the Duty Paediatrician via switch to discuss concerns about a child and or young person, but if the child is in immediate danger contact the Police and Out of Hours Social Services.

 If a child does not require emergency treatment and is not on hospital site

Monday – Friday (does not apply to a Bank Holiday), the child is to be referred to the Community Paediatric Team Tel 0300 300 2013.

 Safeguarding Children (child protection) work can be difficult and complex, raising ethical and legal concerns. It is recognised as engendering high emotions and it is recommended that staff seek support. This could be Safeguarding Children Supervision, team debriefs and peer review of cases. These are offered and are available upon request from the Safeguarding Children Team; Aquilis may also provide support and individual assistance if it is considered applicable. Please book via telephone or email system with the admin team.

Human Resources and Recruiting Line Managers

 It is the responsibility of the organisation to ensure that we recruit and employ individuals who pose no risk to children and young people and will actively promote their safety and welfare; this includes temporary, locum and agency staff as well as permanent staff.

All job descriptions and contracts of employment promote the organisation as actively committed to safeguarding and promoting the welfare of children, young people and vulnerable adults.

 The Trust has policies, procedures and good practice in place to ensure that the appropriate checks are made when recruiting new staff (Data Barring Scheme). There are a number of specific processes in place and it is the responsibility of recruiting line managers to understand and implement these processes.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 20 of 40  The Trust’s Human Resources department is a source of further guidance if required. Further advice involving the requirements of staff engaged in regulated and controlled activity is included within PHT’s Pre-Employment and Employment checks policy which is reviewed and updated on a bi-annual basis in line with the Safeguarding Vulnerable Groups Act 2006. Further information and explanations are available at http://www.isa-gov.org.uk/

Security

 If any staff member identifies a person accessing the Trust who is deemed to be a risk to child/children from any perspective, this must be dealt with on an individual basis, always advising the line manager, Safeguarding Children Team and/or Duty Manager and or Security.

Guest Visitors, Celebrities and Volunteers

 Please refer to Trust guidance: Standard Operating Procedure for celebrity, high-profile, media or organisational visits to Portsmouth Hospitals NHS Trust http://pht/HospitalCommunications/Corporate%20Identity/VIP%20Protocol.docx

 Guest visitors and celebrities must be made aware not to approach babies, children or young people randomly. Such visits need to be prearranged and a small number of patients selected and consent obtained prior to any introduction to a child or young person (and siblings).

 Volunteers with contact with children and young people must have DBS (enhanced clearance).

7. CHILDREN/FAMILIES REQUIRING ADDITIONAL SUPPORT

7.1 When concerned that a child/family has a number of unmet needs or the parents are struggling to provide the child with appropriate care, they will discuss their concerns with the parent/carer (and/or child if appropriate) and request permission to undertake Early Help Assessment / Single Assessment. This may be completed internally in the organisation, alternatively close liaison with community teams may be helpful in following up with an assessment at home.

In these cases an IARF needs to be completed and sent to CSC to inform them of the level of support and plans in place around the family.

7.2 If the staff member has not undertaken Early Help training and or completed an Early Help Assessment / Single Assessment then contact the Safeguarding Children Team for discussion who will advise and assist in the process. Completed assessments can be emailed to the local social care teams to inform the early help teams of the current plan in place around the family.

7.3 If the parent declines an Assessment other support services the staff member has to consider that without these services would the child be left at risk of significant harm if so an inter-agency referral form should be completed. When an assessment is declined it must be considered if it is now appropriate to log with Children’s Social Care.

7.4 Any assessment or any other referrals that are undertaken on a Child-in-Need basis cannot be undertaken without the parent/carers or child’s consent.

7.5 Once an assessment has been completed and signed this should be logged and stored on a local authority computer system, and a copy placed in the maternity records and child’s record.

7.6 An early/single assessment is not a referral to Children Social Care.

8. TRAINING REQUIREMENTS

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 21 of 40 8.1 The Safeguarding Children Learning and Development Strategy is available on the Trust’s Learning and Development Webpage. This Strategy will be reviewed on an annual basis in consultation with Learning and Development leads. The strategy recognises that safeguarding children training/learning is an essential/mandatory requirement for staff and that staff groups will have different training needs, depending on their degree of contact with children, young people and their families, as well as their level of responsibility. The strategy also recognises that a range of learning opportunities will be available, including multi-agency approaches.

8.2 Managers have a responsibility to enable new starters and existing staff to have access to appropriate learning and development opportunities and to ensure that these are monitored. The development of safeguarding children knowledge and skills should be recorded in individual PDPs, discussed as part of the APDR process and used for revalidation. Documented learning will be recorded centrally, monitored by Workforce Planning and Intelligence Team and Clinical Service Centres. Training data will be used to inform compliance i.e. Commissioners’ contract, annual submission to the Care Quality Commission and S.11.

8.3 Safeguarding children learning and development opportunities will reflect a ‘child-centred’ approach, promote equality, and respect diversity in relation to race, gender, age, sexual orientation, class, cultural and religious beliefs and disability. The difficult and emotive nature of the topic will be acknowledged and support mechanisms identified.

8.4 The uptake of training is recorded on the training data base ESR, and monitored through the CSC structure, with any training undertaken externally to the organisation being captured as a training competency via line managers using ESR and manager self-service.

8.5 If a person is registered to attend a course and does not attend the employee’s line manager will be informed of the non-attendance. It is the responsibility of the line manager to ensure staff attends appropriate statutory, mandatory and essential training.

9. PORTSMOUTH AND HAMPSHIRE SAFEGUARDING CHILDREN BOARD

9.1 The Trust is a statutory partner of Portsmouth Safeguarding Children Board and of a subcommittee of Hampshire’s Safeguarding Children Board which includes a Health Forum. The Trust is committed to fulfilling its roles in relation to safeguarding children practices. The Trust also works with its community partners in ensuring safeguarding assurance, monitoring and effective safeguarding children arrangements.

10. POLICY STATEMENT AND SAFEGUARDING CHILDREN DECLARATION

10.1 The Trust is committed to promoting the welfare of children and to protecting them from risks of harm. The Trust also recognises its responsibility to ensure safe working systems are in place for all staff regardless of role or area of practice. The Trust is committed to working together to enhance the welfare of children and young people.

10.2 The Trust has declared its Safeguarding Children Status; this can be found on the Trust’s website.

11. REFERENCES AND ASSOCIATED DOCUMENTATION

Care Act 2015 available at http://www.legislation.gov.uk/ukdsi/2015/9780111128626 (Accessed 24.11.16)

4 LSCB Procedures on line available at: http://4lscb.proceduresonline.com (Accessed 24.11.16)

Bichard, S. (2006).The Bichard Inquiry Report. London: TSO

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 22 of 40 Care Quality Commission (2010) Guidance about Compliances: Essential Standards of Quality and Safety. Available at www.cqc.org.uk/ (accessed 24.11.16)

Children Act 1989 London: HMSO

Children Act 2004 London: HMSO

CM 5860 (2003) The Victoria Climbié Inquiry: Report of an Inquiry by Lord Laming. London: TSO

Department for Education (2003) Every Child Matters www.education.gov.uk (Accessed 24.11.16)

Department for Education (2015) Working Together to Safeguard Children: a guide to inter- agency working to safeguard and promote the welfare of children. London: TSO

Department for Education and Skills, Department of Health (2004) National Service Framework for Children, Young People and Maternity Services London: DH

Department of Health (1998) Data Protection Act. London: TSO Available at: www.dh.gov.uk (Accessed 24.11.16)

Department of Health, Education and Employment (2000) Framework for Assessment of Children in Need and their families. London: TSO.

Department of Health (2001) Health and Social Care Act. London: TSO: Available at: www.dh.gov.uk

Department of Health (2003) NHS Confidentiality Code of Practice. London: Department of Health Available at: www.dh.gov.uk

Department of Health (2004) The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process London: TSO

Department of Health (2006) The Caldicott Guardian Manual. London: Department of Health Available at: www.dh.gov.uk/publications

Department of Health (1998) The Human Rights Act. London: TSO Available at: www.dh.gov.uk

HM Government (2006) What to do if You’re Worried a Child is Being Abused. London: Department for Education and Skills. Available at: https://www.gov.uk/government/publications/what-to-do-if-youre-worried-a-child-is-being- abused--2 (Accessed 24.11.16)

HM Government (2008) Safeguarding children in whom illness is fabricated or induced: Supplementary guidance to Working Together to Safeguard Children. Department for Children, Schools and Families (DCSF). Available at: www.dcsf.gov.uk (accessed 24.11.16)

HM Government (2011) Female Genital Mutilation: Multi-Agency Practice Guidelines. London: TSO Available at: www.dcsf.gov.uk (Accessed 24.11.16)

NICE clinical guideline 89: NHS National Collaborating Centre for Women’s and Children’s Health Clinical Guideline When to suspect maltreatment (2009) London: Royal College of Obstetricians and Gynaecologists (RCOG) Available at: www.nice.org.uk/nicemedia/pdf/CG89FullGuideline.pdf

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 23 of 40 NICE clinical guidance: Domestic violence and abuse: QS116. Feb 2016. https://www.nice.org.uk/guidance/qs116 (Accessed 24.11.16)

NSPCC. (National Society for the Prevention of Cruelty to Children). (2013).Child Sexual Exploitation. London: NSPCC

Nursing and Midwifery Council. (NMC), (2003), Position Statement on Clinical Supervision. London: NMC.

Internal (At time of issuing the hyperlinks are valid, due to the longevity of the policy these may change- please access the Trust intranet page for the most recent version)

Essential Skills Training Policy

Pre-employment and employment checks Policy

Supervision policy

Learning and development strategy

Wellbeing and Stress Policy

Whistle blowing Policy

Domestic Abuse Policy

Managing Allegations

Infant/Child Abduction Policy (Including Incident Response Procedure)

Were not brought to appointments

Guidance on the management of risk posed by sex offenders.

12. MONITORING COMPLIANCE WITH AND THE EFFECTIVENESS OF PROCEDURAL DOCUMENTS

12.1 Monitoring of compliance with this guidance will be undertaken at two levels: one at a corporate level related to corporate function and response and at a Clinical Service Centre level related to Key Performance Indicators (under the Clinical Governance Framework).

12.2 The Trust regularly audits safeguarding children compliance with national standards for submission to external bodies, such as Commissioners, Care Quality Commission and the Local Safeguarding Children Board including Joint inspections.

12.3 Managers are responsible for initiating an on-going performance monitoring process within their areas of responsibility.

12.4 From an organisation perspective the Trust Safeguarding Children Committee will be responsible for monitoring that this policy and associated procedures are being adhered to, and that appropriate actions are being taken in regards to Safeguarding Children (child protection).

12.5 Portsmouth and Hampshire Safeguarding Children Boards monitor Serious Case Reviews and Child Deaths externally.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 24 of 40 13. MONITORING AND AUDITING (EFFECTIVENESS OF POLICY)

13.1 Monitoring and auditing may be undertaken at a variety of levels. The ‘Annual Health Check’ requires annual self-assessment of compliance with Standard 7 (Care Quality Commission). In addition, the Local Safeguarding Children Board has responsibility for monitoring ‘Section 11’ compliance (Children Act 2004) and this is undertaken on an annual basis. Any non-compliance will be reported to the Accountable Director. The LSCB may also commission cross-agency audits of safeguarding practice.

Indicator Measure Frequency Responsible Officer 85% of all clinical Report from Learning staff will have Named Nurse/Midwife and Development Quarterly completed essential Safeguarding Children Department skills training. 85% of clinical staff sampled will be aware of where to Audit ( sample of 10 Matrons/Practice seek advice external Annually staff per specialty) Educator to the Trust with regard safeguarding children issues. 85% of clinical staff sampled will be aware of where to Audit ( sample of 10 Matrons/Practice seek advice Annually staff per specialty) Educator internally within the Trust with regard safeguarding issues The Trust will provide representation at 85% of all strategy Audit of records held by Named Nurse/Midwife (planning) meetings PHT Safeguarding Annually Safeguarding Children at the request of Children relevant local authorities. A minimum of ten Medical Notes Audit cases will be selected will be undertaken on on an annual basis Named Nurse/Midwife where it has been Safeguarding an annual basis to Annually ensure compliance of identified the child has Children/Safeguarding policy met the threshold for Children Team Multi-agency intervention

13.2 THE NAMED DOCTOR/NURSE/MIDWIFE FOR SAFEGUARDING CHILDREN WILL ENSURE THAT:

 Information, including outcomes of audits, serious case reviews and associated action plans are provided to the Safeguarding Committee to support development of the Annual Safeguarding Children report.

 Any identified risks associated with Safeguarding Children are to be presented to the Women and Children’s Clinical Service Centre where they are reviewed and monitored, but if necessary escalated to the Risk Assurance Committee for consideration of entry onto the Trust Risk Register. The Women and Children’s Clinical Service Centre, and the Risk Assurance Committee will then monitor the progress of actions against the stated risks.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 25 of 40 13.3 THE SAFEGUARDING COMMITTEE THROUGH THE CHAIR WILL ENSURE THAT:

 Serious Case and Independent Reviews, Reflective Practice, audit findings and/or National Action plans are disseminated to Clinical Service Centre Leads for review of their service, implementation and monitoring; and provide and action plan to Committee for monitoring.

 Safeguarding Children Operational Group will consider and action annual practices audits and participate in any Multi Agency Audits commissioned by Portsmouth and or Hampshire’s Safeguarding Children Board.

 The Chair of the Risk Assurance Committee will ensure that should it appear that the timescales for implementation of the actions to mitigate the identified risks are not going to be achieved, that a Named Professional from the Safeguarding Children Team is invited to the next Committee meeting to provide an update.

 An Annual Safeguarding Children Report is provided to Trust Board.

 The Trust Board will be informed of Safeguarding Children activity through the Safeguarding Committee (Governance reporting structure).

14. IMPLEMENTATION

This policy will be available to Trust staff on the Trust’s Intranet. It is the responsibility of all managers to ensure all staff in their area (clinical and non-clinical) are aware of this policy and it is adhered to. It is the responsibility of the Lead Consultants to ensure all medical staff in their service are aware of it, and adhere to the policy. The intranet version is the most up to date version.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 26 of 40 Appendix 1: Related procedures/information

Early Assessment (EA) previously known as the Common Assessment Framework (CAF)

1.1 A child within a family whom staff are working with may have additional needs that do not constitute a child in need or a child in need of protection. Under those circumstances an EA should be considered as a means to meet those needs. Details of how to complete a EA can be accessed by using the following links:

 DCSF www.dcsf.gov.uk/everychildmatters/resources.../TP00004/  Portsmouth www.portsmouth.gov.uk/learning/18622.html  Hampshire www3.hants.gov.uk/childrens.../caf.../caf-support-and-resources.htm

1.2 The Care Act 2014 and Children and Families Act 2014 (Consequential Amendments) Order 2015

 The Care Act came into force in April 2015 and will help to make care and support more consistent across the country. Designed to put the family/carer (young carer) in control of the help received and decisions about care and support will consider wellbeing, what is important to the carer/family, in order to remain healthy and remain independent for longer.  Young carers are children under 18 with caring responsibilities, and their rights to be assessed come mostly from the Children Act 1989 and the Children and Families Act 2014.  If there is an adult being looked after, then the local council has a duty to consider whether there are any children involved in providing care, and if so, what the impact is on that child.  The local council have a duty to assess ‘on the appearance of need’ (ie without a ‘request’ having to be made). They also have a more general duty to ‘take reasonable steps’ to identify young carers in their area.  The local council must involve the child with caring responsibilities, their parents and any other person the young carer requests in the assessment process. The assessment itself must look at whether or not the young carer wishes to continue caring, and whether it is appropriate for them to continue caring. When doing this they have to take into account any education, training, work or recreational activities the young carer is in or wishes to participate in.  Parent carers of disabled children: a parent carer is someone over 18 who provide care to a disabled child for whom they have parental responsibility.  The Children and Families Act 2014 amends the Children Act 1989 requiring local councils to assess parent carers on the appearance of need or where an assessment is requested by the parent. This is called a parent carers needs assessment. This assessment can be combined with one for the disabled child, and could be carried out by the same person at the same time.  The local council must also be satisfied that the child and their family come within the scope of the Children's Act, ie that the child is a child in need (see below). Assessments for disabled children will be carried out under the Children Act 1989. Local councils have a duty to assess a 'child in need' under the age of 18 for any services that they or their family may need. Note: The Children Act considers a child disabled if the child is blind, deaf, non-verbal, suffering from a mental disorder of any kind, substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed.  The assessment considers the help the disabled child needs, the needs of any other children in the family and the help required to care for the disabled child.

2. Safeguarding children policies and procedures

2.1 The Trust follows the Safeguarding Children Interagency Child Protection Procedures set out by Hampshire, Isle of Wight, Portsmouth and Southampton Local Safeguarding Children Boards Safeguarding Children Procedures (2015), which are based on the Department for Education (DfE) Working Together to Safeguard Children (2015) and relate to the Children’s NSF, (Standard 5) (2003) and Safeguarding Children in whom illness is fabricated or induced. These can be accessed via the Trust Intranet Safeguarding Children homepage.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 27 of 40  Hampshire, Isle of Wight, Portsmouth and Southampton Local Safeguarding Children Boards Safeguarding Children Procedures (2015) available at www.4lscb.org

 Working Together to Safeguard Children (2015) available at www.education.gov.uk

 National Service Framework for Children, Young People and Maternity Services available at www.dh.gov.uk › Home › Publications  Safeguarding Children in whom illness is fabricated or induced (2008) available at www.dh.gov.uk › Home › Publications 2.2 There are some policies and procedures that are specific to the Trust and can be found on the Trust Intranet Policies and Procedures Page.

 Drug and Alcohol Use, Pregnancy and Care of the Newborn – Guidelines for Professionals

 Guidance for Management of risk posed by sex offenders/sex related crime whilst on PHT site

 Baby/ Infant Sleeping and Prevention of SIDS Guideline

 Safeguarding Adults Practice and Procedure Guidance (DOLs/MCA)

 Domestic Abuse Staff Policy can be found on the Trust Intranet Human Resources Policies and Procedures

 Safeguarding Children Supervision Guidelines

 Infant/Child Abduction Guidance

 Missing Person’s Policy

 Children who were not brought to appointments

 Pregnant women who do not attend appointments

 Non-Accidental Injury- Imaging Referral Pathway and Protocol

 Well infants accompanying mothers

2.3 The following Guidance may be particularly relevant to Trust staff, they form part of the policies and protocols of Portsmouth (and Hampshire) Safeguarding Children Board (LSCB). They can be accessed directly via the 4LSCB website or via the link on the Trust Intranet Safeguarding Children home page.

 Child Death Overview Panel: DCSF forms for rapid Response procedures and Hampshire Child Health Investigation Booklet available at www.4lscb.org

 Bruising Protocol: Bruising in Children who are Not Independently Mobile. A 4LSCB Protocol for Assessment, available at www.4lscb.org

 Maternity Protocol: 4LSCB Protocol for Assessment, available at www.4lscb.org

 Female Genital Mutilation 5.21, Available at: http://4lscb.proceduresonline.com/chapters/p_fem_gen_mut.html 3. Preventing harm to children where parents have mental illness, misuse drugs/alcohol and parents with a learning disability

3.1 Our knowledge and understanding of children’s welfare, and how to respond in the best interests of an unborn baby/child to concerns about maltreatment (abuse and neglect) develops over time, informed by research, experience and the critical scrutiny of practice. Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 28 of 40 3.2 Staff in the Trust assessing a patient and/or family or social networks, MUST consider the needs of the unborn baby, children and young person and any potential for neglect and/or abuse and harm and make referrals following the flow chart on page 6.

4. Information Sharing/Confidentiality

4.1 Sharing information amongst professionals working with children/young people and their families is essential for the purposes of safeguarding and promoting the welfare of children. It is often only when information from a range of sources is put together that a child can be seen to be in need or at risk of serious harm. Professionals must use their judgement but should also be aware that failure to pass on information that might prevent a tragedy could expose them to criticism in the same way as an unjustified disclosure.

4.2 Professionals often face moral and practice dilemmas in relation to information sharing especially if that information involves adults they are caring for. In deciding whether there is a need to share information you need to consider your legal obligations including:

 whether the information is confidential; and  if it is confidential, whether there is a public interest sufficient to justify sharing the information.

4.3 Even where sharing of confidential information is not authorised, it may lawfully be shared if this can be justified in the public interest. Seeking consent should be the first option, if appropriate. Where consent cannot be obtained to the sharing of the information or is refused, or where seeking it is likely to undermine the prevention, detection or prosecution of a crime, the question of whether there is a sufficient public interest must be judged by the practitioner on the facts of each case. Therefore, where a practitioner has a concern about a child, he or she should not regard refusal of consent as necessarily precluding the sharing of confidential information.

4.4 A public interest can arise in a wide range of circumstances, for example, to protect children or other people from harm, to promote the welfare of children or to prevent crime and disorder. There are also public interests, which in some circumstances may weigh against sharing, including the public interest in maintaining public confidence in the confidentiality of certain services. The key factor in deciding whether or not to share confidential information is proportionality, i.e. whether the proposed sharing is a response in proportion to the need to protect the public interest in question. In making the decision, the practitioner must weigh up what might happen if the information is shared against what might happen if it is not, and make a decision based on a reasonable judgment.

4.5 It is not possible to give guidance to cover every circumstance in which sharing of confidential information without consent will be justified. It is possible however to identify some circumstances in which sharing confidential information without consent will normally be justified in the public interest. These are:

 when there is evidence that the child is suffering or is at risk of suffering Significant Harm; or  where there is reasonable cause to believe that a child may be suffering or at risk of significant harm; or  to prevent significant harm arising to children or serious harm to adults, including through the prevention, detection and prosecution of serious crime, i.e. any crime which causes or is likely to cause significant harm to a child or serious harm to an adult.

4.6 The key factor in deciding whether or not to disclose information is proportionality – is the disclosure a proportionate response to the need to protect the welfare of the child? The ‘need to know’ rule will apply to such information to ensure that the number of people to whom it is disclosed is no more than strictly necessary. Information should not be shared with parents in cases of Fabricated or Induced Illness (FII) or if the sharing of information would be likely to contaminate evidence in further investigations of the case.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 29 of 40 4.7 Good practice demands that effective information sharing starts when the practitioner establishes a relationship with the service user ensuring that the service user understands when information they impart, or the practitioner observes, must be shared.

4.8 All decisions related to the sharing (or not) of information should be recorded in the child/adults records. A decision not to share information may be challenged. It is unlikely that a similar challenge will be received for the appropriate sharing of information provided that the guidance has been followed.

4.9 The practitioner should use the six Caldicott principles for effective information sharing:

 Justify the purpose for using confidential information

 Use when absolutely necessary

 Use the minimum that is required

 Access should be on a need to know basis

 Everyone must understand their responsibilities

 Understand and comply with the law

4.10 There are policies and procedures to support and guide practitioners through ways in which to share information effectively and appropriately. Individuals should ensure that they are familiar with these and know where to access them in an emergency. Key documents include:

 What to Do If You Are Worried About a Child (DOH 2003)

 Information sharing Advice for practitioners providing safeguarding services to children, young people, parents and carers (2015)

 Standard for Sharing Personal Data (January 2007)

 The Caldicott Guardian Manual 2006

 The Data Protection Act 1998

 The Human Rights Act 1998

 The Freedom of Information Act 2000

 Health and Social Care Act 2001

 The Care Act 2014 and Children and Families Act 2014 (Consequential Amendments) Order 2015

4.11 Links between information sharing and legislation, e.g. Data Protection Act. Data Protection enables legal information sharing when there is a statutory requirement to do so – therefore the Children Act satisfies the Data Protection Act Schedules 2 and 3.

4.12 Staff must always seek advice from the Safeguarding Children Team, if they are in doubt whether information needs to be shared and or Information Governance.

5. Freedom of Information (FOI) & media requests

5.1 Where serious situations arise which may result in significant media interest (such as the death of a child, Serious Case Reviews and or an Allegation) the Trust as a partner agency of Portsmouth/Hampshire Safeguarding Children Boards are expected to liaise and agree an

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 30 of 40 appropriate communications strategy. Any request for specific information should be referred to Trust’s Communications Lead.

5.2 FOI requests shall be responded to following consultation by the Trust’s FOI Officer

5.3 The Trust’s Communication Team should be contacted if any media requests are made.

6. Reporting in the Trust

6.1 It is essential that all incidents, and near misses, relating to the abuse or neglect of children and young people have an appropriate response and the first tasks, as with any incident, are to:

 Make safe the situation

 Report the incident using the Trust incident reporting policy and procedures (DATIX)

 Incidents that are defined as Serious Incident Requiring Investigation (SIRIs).

6.2 A serious incident requiring investigation is defined as an incident that occurred in relation to NHS-funded services and care, for example:

 adverse media coverage or public concern about the organisation or the wider NHS;

 if the Safeguarding Children Incident meets that criteria then the SIRI Policy and procedure should be followed

7. Documentation

7.1 All records made by health and social care professionals need to be ‘defensible documents’ meaning that they must be concise and should differentiate between opinion, judgement and hypothesis. They must be dated, name printed and signed by the person completing them in black ink. Decisions, the basis for them and those involved in the decision making process should be clearly recorded. The reader should be able to track the assessments, treatments and outcomes in a chronological order within the notes. These notes should, as far as possible be collated and retained in a single Multi-disciplinary healthcare record. The records must be held securely and be retrievable promptly. The quality of healthcare records and communication is a direct measure of the service we are providing.

7.2 Any child or young person cared for in the Trust for whom there are concern regarding possible abuse must have a ‘Pink Pro forma’ (Paediatric Unit, Maternity and NICU) completed and all details regarding the child’s discharge completed before discharge can occur. Pink Pro forma can be accessed via the Trust intranet Safeguarding Children homepage.

7.3 Minutes of meetings, strategy meetings and planning meetings may be placed in the child’s notes. Case Conference documentation, Court and Police reports should be held by the professional in accordance with Trust procedures.

8. Fabricated or Induced Illness (FII) (previously known as Munchausen Syndrome by Proxy)

8.1 This is a rare but potentially very serious problem. Differentiating FII from extreme levels of parental anxiety or a child who has an unusual medical diagnosis can be extremely difficult, and is a judgement which should only be made after very careful consideration of the child’s entire medical history by an experienced paediatrician, safeguarding professionals and with help from the GP, Health Visitor and others involved with the family, and with Children Services.

8.2 If you have any concerns at all about FII, relay these concerns to the child’s own Consultant or one of the named or designated professionals. It is important that you record carefully what the parents have said about the child and your interpretation of the child’s clinical status. However, this is the one situation in which health care staff are not obliged to inform parents of their concerns or Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 31 of 40 referral to Children’s Social Care until the professionals have had a chance to discuss this further. It is important that you continue to treat the child and parents in exactly the same way as you would for any other illness – listening to their concerns, examining the child, discussing appropriate management etc. whilst further discussions are taking place.

9. Management of a Child Death

Definition of an unexpected death of a child, in this guidance an unexpected death is defined as the death of an infant or child which was not anticipated as a significant possibility for example, 24 hours before the death; or where there was an unexpected collapse or incident leading to or precipitating the events which lead to the death.

There are two interrelated processes for reviewing child deaths (either of which can trigger a Serious Case Review)

(i) Rapid Response by a group of key professionals who come together for the purpose of enquiring into and evaluating unexpected death of a child (ii) Overview of all child deaths up to the age of 18 years (excluding babies born stillborn and planned legal terminations)

9.1 When a Child Dies Unexpectedly

 When a child dies suddenly and unexpectedly, the consultant clinician (in a hospital setting) or the professional confirming the fact of death (if the child is not taken immediately to an Accident and Emergency Department) should inform the local designated paediatrician with responsibility for unexpected child deaths at the same time as informing the coroner and the police.  The police will begin an investigation into the sudden or unexpected death on behalf of the coroner. The paediatrician should initiate an immediate information sharing and planning discussion between the lead agencies (i.e. health, police and local authority children’s social care) to decide what should happen next and who will do it. The joint responsibilities of the professionals involved with the child include responding quickly to the child’s death in accordance with the locally agreed procedures.  Form A & B notification forms can be found at: https://www.gov.uk/government/publications/child-death-reviews-forms-for-reporting-child- deaths  Local procedures can be found in managing a child death can be found in the Emergency Department, Critical Care, Paediatric and Neonatal Unit.

9.2 Child Death Overview Panel (CDOP)

 From November 2015, Hampshire, Isle of Wight, Portsmouth and Southampton LSCB form their own CDOP, reviewing child deaths in their area, co-opting specialists to the panel as required. Chairs of the panels will meet bi-annually to discuss themes and share learning.  Each death of a child is a tragedy and enquiries should keep an appropriate balance between forensic and medical requirements and supporting the family at a difficult time. Professionals supporting parents and family members should assure them that the objective of the child death review process is not to allocate blame, but to learn lessons. The purpose of the child death review is to help prevent further such child deaths, and families may find it helpful to read the child death review leaflet available at www.lullabytrust.org.uk/file/-internal- documents/Lullaby  The responsibility for determining the cause of death rests with the coroner or the doctor who signs the medical certificate of the cause of death (and therefore is not the responsibility of the Child Death Overview Panel (CDOP)).

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 32 of 40 10. Dealing with Allegations Against Staff

10.1 Allegations may be related to staff as professional carers of children and/or their families or in the context of their personal lives. The Trust has to consider a member of staff’s suitability to work with children during any investigation into allegations, professional or personal. 10.2 The policy ‘Procedure for Dealing with Allegations’ provides staff with a process to ensure a consistent and effective response to any circumstances giving ground for concern. This procedure aims to draw together the duties and responsibilities of individuals without compromise and should be read in conjunction with Working Together to Safeguard Children (2015). 10.3 Any allegations relating to child protection will involve the Executive Lead for Safeguarding Children and Young People, the Human Resources Department, the Safeguarding Children Team working closely with the staff members’ line manager. All such cases will be notified to Portsmouth’s Local Authority Designated Officer (LADO) and a Strategy Meeting will be held and may include Children’s Services and/or the Police. 10.4 Following an initial investigation/evidence gathering/strategy meeting, and there is sufficient evidence to indicate that the employee has engaged in an activity that causes concern for the safeguarding of children or vulnerable adults, and or received a caution or conviction for a relevant offence an employee must be referred to the Independent Safeguarding Authority (ISA) (www.isa-gov.org.uk/) 10.5 Where the employee is a member of a registered body (i.e. GMC, NMC etc.) the relevant registered body must be informed with immediate effect.

11. Multi-agency Public Protection Arrangements (MAPPA)

11.1 MAPPA is a national framework for the assessment and management of risk posed by serious and violent offenders, including individuals who are considered to pose a risk, or potential risk, of harm to children.

The purpose of MAPPA is to:

 Establish the nature and level of risk of serious harm posed by persons meeting the notification criteria through the sharing of relevant information and assessments;  Share and co-ordinate risk management plans;  Identify gaps in either the risk assessment or risk management process;  Monitor and review multi agency risk management;  Encourage and support the involvement of all agencies and individuals (statutory and voluntary) involved in management plans;  Provide information and protection for past and potential victims;  Decide what information should be shared, to whom and by whom 11.2 Please refer to the Trust’s Guidance for Management of Risk Posed by Sex Offenders/Sex related crime whilst on Portsmouth Hospitals NHS Trust Site, available on the Trust’s intranet. The risk assessment involving children, unborn babies will be incorporated in the multi-agency child protection process.

12. Multiagency Risk Assessment Conferences (MARAC)

12.1 A MARAC is a meeting where information is shared on the highest risk domestic abuse cases between representatives of local police, health, child protection, housing practitioners, Independent Domestic Violence Advisors (IDVAs) and other specialists from the statutory and voluntary sectors. After sharing all relevant information they have about a victim, the representatives discuss options for increasing the safety of the victim and turn these into a co- ordinated action plan. The primary focus of the MARAC is to safeguard the adult victim. Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 33 of 40 12.2 At the heart of a MARAC is the working assumption that no single agency or individual can see the complete picture of the life of a victim, but all may have insights that are crucial to their safety. The victim does not attend the meeting, but is represented by an IDVA who speaks on their behalf.

 24-hour National Domestic Violence Freephone Helpline 0808 2000 247 13. Disclosure by a Child:

A child may make a disclosure suggesting abuse in any area across the Trust. It is suggested the following approach should be made:

 Allow the child to complete the statement  Be non-committal but accepting  Do not promise confidentiality  Document what was said in the child’s words  Tell the child what you are going to do i.e. inform the senior nurse/doctor and inform Children’s Social Care.

14. Child Missing from Hospital

The Trust has a duty of care to ensure the safety of patients in its care and take all possible steps to do so. On occasions when this has not been possible and patients have left an area and cannot be located, the Trust will ensure a prompt and systematic response to minimise the risk to the individual. A recent Independent Review (September 15) published by Portsmouth Safeguarding Children Board identified lessons learned from a review of interagency working with a child in acute care. It identified development and implementation of guidelines to formalise the agreed leave of absence from the paediatric wards. These specify arrangements for children to leave the ward area in the company of their parents or an approved adult. Their destination, time of return and contact details must be recorded and signed by the accompanying adult. Written guidelines will be available so that the accompanying adult is aware of their responsibilities and the likely response if the conditions of leave are not complied with. Report available on Portsmouth LSCB website

15. Child not Registered with a General Practitioner (GP)

All parents/carers will be encouraged to register their children with a GP. If not registered notify the Health Visitor in their postcode requesting follow up.

16. Were not Brought to an Appointment

This guidance enables staff to determine the correct course of action when the child does not attend a pre-arranged appointment (DNA-Did Not Attend). See Trust policy on intranet/Safeguarding Children Website.

17. Guidelines for Children Attending the Emergency Department

These guidelines are aimed at staff working with children and young people and can be found within the department.

18. Non-Accidental Skeletal Survey Guidance

Can be found on the Safeguarding Children Website; Trust policy being written and will be available in 2016.

19. Emergency Department (Children and Adult)

The Emergency Department (ED) and Gosport Minor Injury Unit have department specific guidance and these can be found be found on the Trust Intranet Safeguarding Children Homepage: Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 34 of 40 20. Notification of an Child/Young Person’s Admission to Hospital

Paediatric Unit

 The GP, Health Visitor and or School Nurse to be informed of admission and reason for admission.  The Child Health Book should be completed where possible < 5years.  Looked After Children (LAC): LAC nurse to be notified.

Emergency Department

 The GP is to be notified of admission (standard letter).  Cause for Concern form to be completed for Health Visitor /School Nurse where it does not meet the threshold for referral to Children’s Social Care.  Looked After Children (LAC): LAC nurse to be notified.  Community Midwife to be notified of a women who is pregnant and post natal <28 days.

Elsewhere within the Trust

 The GP is to be notified of admission (standard discharge letter) and or Outpatient Appointment (Midwife, HV and school nurse to be copied into letter as appropriate).  Looked After Children (LAC). LAC nurse to be notified.

21. Privately Fostered Child

The definition of a Privately Fostered Child. The Children Act 1989 and 2004 and the Private Fostering Arrangements, defines a child to be Privately Fostered when he/she is under the age of 16 (under 18 if disabled) and is cared for, for up to 28 consecutive days by someone other than:

 His/her parents Includes unmarried or putative father.

 A person who has parental responsibility for him/her, but is not his/her parent.

 Sibling.

 A close relative, for example aunt, uncle, stepparent or grandparent (can be by full blood or half blood or by an affinity or stepparent but not a cousin, great aunt/uncle or a family friend). 21.1 Private fostering arrangements are irrespective of financial rewards and should last no longer than 28 days. 21.2 If you become aware or suspect that a child is being Privately Fostered then you have a responsibility to inform the Local Authority who will check upon the suitability of the arrangements and monitor the care the child receives. You must inform the carer of your intentions. 22. Safeguarding Children Supervision

Supervision is a formal process of professional support and learning, which aims to ensure clinical practice, safeguards children and promotes their welfare. Critical Reflection/Supervision. This is achieved by facilitating reflective discussion, assessment, planning and review, thereby supporting the development of good quality, innovative practice provided by safe, knowledgeable and accountable practitioners. This process is different from, and in addition to, the discussion and seeking of advice regarding specific concerns or situations, which happens during the course of everyday practice. The specific objectives of safeguarding supervision are as follows:

 To enable and empower practitioners to develop knowledge and competence.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 35 of 40  To provide a safe and structured environment for practitioners to reflect on, plan, review and account for their safeguarding children work

 To ensure that local and national policies and procedures are adhered to.

 To provide support and recognition of the stress and uncertainties which safeguarding work may cause Safeguarding Children Policy can be found on the Trust’s website. 23. Consent (Fraser Guidelines/Gillick)

23.1 Medical treatment can be provided for a young person with their consent if they are competent, without the consent of the parent or the court. Emergency treatment can be provided without consent to save a life or prevent serious deterioration in the health of child or young person. Young people over the age of 16 can consent and young people under the age of 16 may be deemed capable of giving consent in certain circumstances.

 The young person must be able to understand the nature, purpose and possible consequences of any investigations or treatments proposed.

 The young person must be able to understand, retain and use the information and be able to communicate their decision.

 Therefore parents cannot override the competent consent of a young person to treatment that is considered to be in the young person’s best interests. However, in most non- emergency situations it is best to avoid relying on “Gillick” competence to override the wishes of one or both carers with parental responsibility. If agreement cannot be reached it is often better to defer a treatment and seek senior safeguarding advice. This is also an important principle when there is disagreement between parents about controversial issues such as vaccination and circumcision.

 Refusal of treatment – in such situations it would be important to seek further legal advice and consider applying for a court order (dependent on the individual situation).

24. Parental Responsibility (PR)

24.1 Clarification is needed to ascertain who can give consent on behalf of a child. Only someone with Parental Responsibility (PR) as defined by the Children Act 1989 can give consent e.g. the mother or married fathers. Unmarried fathers who are named on the birth certificate if the child was born after 1st December 2003 will have PR. Those fathers whose children were born before this date even if named on the Birth Certificate will not have automatic PR unless there is a specific court order.

24.2 The Local Authority (LA) will have PR if the child is subject to a care order. This point is highlighted for those children coming in for surgery and an anaesthetic is required. The LA in the absent of a parent will be required to sign the consent form.

24.3 Although efforts should always be made to clarify parental responsibility and obtain consent accordingly, it is not absolutely mandatory in all cases if the child’s best interest clearly dictate otherwise. For example, if a co-operative child is brought in with a relatively minor injury requiring a simple intervention by a teacher and parents cannot be contacted.

25. Restraint

Refer to the Trust’s Restrictive Holding and intervention Policy. 26. Domestic Abuse

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 36 of 40  The Government definition of domestic violence and abuse has been widened to include those aged 16-17 and the wording changed to reflect coercive control. (Note that this is not a legal definition.) The new definition is: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse:  Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.  Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.  The definition includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to any one gender or ethnic minority.  Domestic abuse, violence may manifest itself in a variety of ways including physical abuse, emotional or psychological abuse, sexual abuse and financial abuse and the imposition of social isolation or movement deprivation. Often it will involve a combination of these behaviours or acts used by one individual to dominate another.  Where there is domestic violence and abuse, the wellbeing of the children in the household must be promoted and all assessments must consider the need to safeguard the children, including unborn child/ren (see also Maternity and Children's Services - Unborn Babies Safeguarding Protocol).  No one agency can address all the needs of people affected by, or perpetrating, domestic violence and abuse. For intervention to be effective the agencies and partner organisations of the Safeguarding Children Board need to work together, and be prepared to take on the challenges that domestic violence and abuse creates.

27. Children and Young People Subject to Violent Extremism

 Radicalisation is defined as the process by which people come to support terrorism and violent extremism and, in some cases, to then participate in terrorist groups.

 The aim is to ensure an early identification of children’s vulnerabilities and promote a coordinated response, wherever possible within universal provision and or Early Help. The emphasis should be on supporting vulnerable children and young people, rather than informing on or “spotting” those with radical or extreme views.

 In exceptional cases, it may be considered that a child or young person is involved or potentially involved in supporting or pursuing extremist behaviour. This may be, for example, where the child is part of a family with known extremists (e.g. people who are currently subject to criminal proceedings or who have been convicted of terrorism related offences.) Where this is the case, a referral must be made to Children’s Social Care Services under the Referrals Procedure and the police must be informed. Further investigation by the police will be required, prior to other assessments and interventions.

 Any member of staff who identifies such concerns, for example as a result of observed behaviour or reports of conversations to suggest the child supports terrorism and/or violent extremism, must report these concerns to the named professional in their organisation or agency, who will consider what further action is required. Guidance on how to make a referral can be found in Appendix 4 of the Safeguarding Adult policy.

28. Resolving Professional Disagreements (Escalation Procedure)

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 37 of 40  At no time must professional dissent detract from ensuring that the child is safeguarded. The child’s welfare and safety must remain paramount throughout.  Disagreements over the handling of concerns reported to Children's Social Work Services typically occur when a referral is not considered to meet eligibility criteria for assessment by Children’s Social Care Services or conclude that further information should be sought by the referrer before the referral is progressed. Children’s Social Care Services and the Police place different interpretations on the need for single/joint agency response.  If the professionals are unable to resolve differences through discussion and/or meeting within a time scale which is acceptable to both of them, their disagreement must be addressed by more experienced or more senior staff. With respect to most day to day issues, this maybe internally, someone within the Safeguarding Children Team contacting the Children's Services Social Care team manager. If agreement cannot be reached following discussions between the above ‘first line’ managers (who should normally seek advice from her/his line manager or designated/named/lead officer) the issue must be referred without delay through the line management of the respective agency/agencies structure.  Alternatively, and more commonly in health services, input may be sought directly from the Designated or Named Professional in preference to the use of line management.  At this point a meeting should be called to discuss the situation involving all parties. Records of discussions must be maintained by all the agencies involved. The outcome of discussions and agreed actions should also be recorded.

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 38 of 40

Equality Impact Screening Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval for service and policy changes/amendments.

Stage 1 - Screening

Title of Procedural Document: Safeguarding Children and Young People Practice Guidance and Operational Policy

Date of assessment 25th November 2016 Responsible Safeguarding children team Department Name of person Diane Urquhart Job Title Named nurse SG children & completing young people. assessment Does the policy/function affect one group less or more favourably than another on the basis of : Yes/No Comments  Age No  Disability No Learning disability; physical disability; sensory impairment and/or mental health problems e.g. dementia  Ethnic Origin (including gypsies and travellers) No  Gender reassignment No  Pregnancy or Maternity No  Race No  Sex No  Religion and Belief No  Sexual Orientation No If the answer to all of the above questions is NO, the EIA is complete. If YES, a full impact assessment is required: go on to stage 2, page 2

More Information can be found be following the link below

www.legislation.gov.uk/ukpga/2010/15/contents

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 39 of 40 Stage 2 – Full Impact Assessment What is the impact Level of Mitigating Actions Responsible Impact (what needs to be done to minimise / Officer remove the impact)

Monitoring of Actions The monitoring of actions to mitigate any impact will be undertaken at the appropriate level

Specialty Procedural Document: Specialty Governance Committee Clinical Service Centre Procedural Document: Clinical Service Centre Governance Committee Corporate Procedural Document: Relevant Corporate Committee

All actions will be further monitored as part of reporting schedule to the Equality and Diversity Committee

Safeguarding Children and Young People Practice Guidance and Operational Policy Version: 6 Issue Date: 21 February 2017 Review Date: 20 February 2018 (unless requirements change) Page 40 of 40