The Review of Safeguards for Children and Young People Treated and Cared for by the NHS in Wales
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The Review of Safeguards for Children and Young People Treated and Cared for by the NHS in Wales "Too Serious a Thing" "A child’s nature is too serious a thing to admit of its being regarded as a mere appendage of another being" (Charles Lamb) Further copies of this document are available from : Family Health Branch Primary and Community Health Division National Assembly for Wales Cathays Park Cardiff CF10 3NQ Tel : 029 2082 5840 The National Assembly for Wales Internet Site : www.wales.gov.uk Contents Foreword 1.SETTING THE SCENE 1 Recommendations 4 2.THE HISTORICAL CONTEXT AND RECENT DEVELOPMENTS 6 IN THE NHS STRUCTURE 2.2 Background to the Review 6 2.9 The Structure of the NHS in Wales 7 2.12 Independent Contractors 8 2.13 Current Structure of Child Protection 8 in the NHS and Published Guidance 2.16 Children’s Commissioner 10 2.17 Cabinet Sub-Committee on Children and Young People 10 2.19 Recent Proposals 10 2.25 The Effect of Change 11 Recommendations 12 3 VULNERABLE PARTS OF THE NHS 13 3.11 Human Resources Policies 14 3.14 Paediatrics 14 3.17 Registered Children’s Nurses 15 3.18 Children’s Community Nurses 16 3.22 Prison Health Services 16 3.24 Use of Agency, Bank and Locum Staff 16 3.36 Recruitment of Staff from Abroad 19 3.38 Accident and Emergency Departments 19 3.43 Services for Young People who Use or Misuse Substances 20 3.47 Deliberate Self Harm (DSH) 22 3.49 Postmortem Examinations 22 3.50 Speech and Language Therapists 23 3.53 Radiologists and Radiographers 23 3.55 Play Specialists 23 3.56 School Nurses 24 3.60 Health Visitors 24 3.67 General Practitioners 26 3.78 Independent Dental Practice 28 3.81 Optometry 29 3.83 NHS Direct 29 i 3.89 Students 30 3.92 Transport 31 3.94 General Measures 31 3.98 Welsh Risk Management Standards 32 Recommendations 33 4. THE GWYNFA REVIEW 37 4.11 The Remit, Terms of Reference and Work of the Gwynfa 38 Group 4.16 Gwynfa 39 4.25 Cedar Court 40 4.27 The Allegations – The Nature of the Allegations 41 4.34 The Allegations against AB42 4.45 The Other Allegations 43 4.50 Responses to the Allegations – The Police Investigation 44 4.55 The Disciplinary Process 45 4.62 The Response of the NHS Trust then Responsible for Gwynfa 46 4.66 The Role of the Welsh Office Health Department 47 4.85 The Corporate Group 49 4.91 Subsequent Local Reviews 50 5. THE LESSONS OF GWYNFA 51 5.1 Introduction 51 5.3 Lessons for Policy 51 5.6 The Principles of Good Practice 51 5.13 The Professional Context 52 5.17 The Service Context 53 5.25 Lessons for Strategy – The All Wales CAMHS Strategy 54 5.30 Implementing the All Wales CAMHS Strategy 55 5.32 Post Abuse Services 55 5.35 The Role and Client Group of Psychiatric Inpatient Units for 56 Adolescents 5.42 Application of the Strategy to Developing Child 57 and Adolescent Mental Health Services in North Wales 5.46 Training and the Workforce 57 5.50 Lessons for Service Leadership and Management – Board 58 Accountability for Children in the NHS 5.53 Leading and Managing Directorates 58 5.59 Clinical Governance 59 5.65 Lessons for Operational Leadership and Management - 61 Avoiding Isolation ii 5.76 Leadership and Management at the Service Delivery Level 62 5.81 Regulation 63 Recommendations 63 6.BUILDING REALITY FROM POLICY 67 6.3 Child Protection Policies and Procedures 67 6.8 Current Multi-Disciplinary Working 68 6.23 Information Sharing 72 Recommendations 74 7.OLD VIRTUES IN NEW STRUCTURES 76 7.2 Designated and Named Professionals in Child Protection 76 7.11 The Children’s Commissioner for Wales 78 Recommendations 79 8.CHILDREN IN NEED AND THOSE CARED FOR 80 AWAY FROM HOME 8.19 Secure Non-NHS Provision for Children 83 Recommendations 84 9.INFORMATICS: WARNINGS AND RECORDINGS 86 Recommendations 88 10.EMPLOYMENT: RECRUITMENT PROCEDURES: 89 TRAINING 10.4 Recruitment Procedures 89 10.13 Registration Bodies and Disciplinary Records 91 10.18 Agency, Bank Staff and Locums 91 10.20 Staff from Abroad 92 10.21 Induction Training 92 10.22 Board Members 92 10.25 Continuing Development of Staff 92 Recommendations 93 11.POLICE CHECKS 95 Recommendations 98 12.DISCRIMINATION, RIGHTS AND ADVOCACY 99 Recommendations 104 13. HOSPITAL BASED AND SPECIALISED 106 MEDICAL CARE FOR CHILDREN 13.1 Welsh Background 106 13.2 Learning from Bristol 106 13.3 Paediatric Services across Wales 107 iii 13.6 Tertiary Services 107 13.7 Admission of Children to Adult Wards 107 13.9 Adolescents 108 13.12 Physical Security of Hospital Based Services 108 13.13 Surgical Services for Children 109 13.14 Children with Profound and Multiple Disability 109 13.15 Services for Post Natal Mental Illness 110 13.16 Shared Care Model 110 13.17 Adaptation of ‘Learning from Bristol’ to Wales 110 Recommendations 111 14.CHILD AND ADOLESCENT MENTAL HEALTH 113 SERVICES (CAMHS) 14.5 Progress Made by the National Assembly for Wales 113 14.20 Improving Care and Accountability – Implementing the All 116 Wales Strategy 14.23 Commissioning the Service Developments 116 14.27 The Four Tier Strategic Framework 117 14.30 Developing the Contribution of Primary Care to Tier One 118 14.40 Admission of Young People to Wards for Adult Patients 119 14.44 Provision of Secure Services 120 14.47 Very Challenging Behaviour 120 14.52 Integrating Specialist CAMHS with Other Healthcare Services 121 14.61 Risks of Abuse in CAMHS 123 14.64 Appraisal and Mentoring 123 14.66 Workforce Development – Recruitment, Retention and Training 124 14.70 Nurses in CAMHS 124 14.72 Child Clinical Psychologists 125 14.73 Child and Adolescents Psychiatrists 125 14.74 Transfer of Staff 125 14.75 Therapy Mix 125 14.77 Positioning CAMHS in the NHS – The Issues 126 14.83 Managed Clinical Networks 127 14.86 The Mental Health Act 1983 127 14.88 Customer Research 128 Recommendations 128 15.AN ABUSE PROOF SERVICE? 130 15.6 Whistleblowing 130 iv 15.7 Assembly Responsibilities 131 15.10 Public Understanding 131 15.11 Priorities – "Nothing less than" 131 Recommendations 132 CARLILE REVIEW RECOMMENDATIONS 133 Putting Children at the Centre 133 Leading From the Front – Strategic Leadership and Management 134 Effective Structures in the NHS – Operational Leadership and 137 Management People Principles – Recruitment and Selection 140 People Principles – Education and Training 141 Achieving and Maintaining Standards – Clinical Practice and 143 Delivery Making the Difference – Quality Counts for the Safety of the 145 Child – Continuous Quality Improvement Sharing Information to Achieve Outcome 146 ANNEXES 147 Panel Membership 147 Terms of Reference 149 Guidance Issued to the NHS in Wales in Respect of 150 Child Protection Children’s Commissioner for Wales Initial Functions under the 154 Care Standards Act 2000 National Assembly Child Protection Committee (NACPC) 155 Terms of Reference Gwynfa Sub Group – Terms of Reference 156 Sub Group’s Working Methods Managerial Responsibility for Gwynfa 1974 – 2001 158 Caldicott in Context 159 Child and Adolescent Mental Health Services 170 and the Four Tier Strategic Concepts Written Submissions 173 Oral Witnesses 177 Review Site Visits 2001 179 School Visits and Public Meetings 2001 180 Bibliography 181 v FOREWORD BY JANE HUTT AM, ASSEMBLY MINISTER FOR HEALTH & SOCIAL SERVICES I was shocked when I first heard about the allegations of abuse at Gwynfa, the former NHS inpatient clinic for children and young people with mental health problems. Young patients have the right to expect to be safe while in the care of the NHS. I was therefore anxious to ensure that consideration was given to the circumstances that had permitted the abuse to take place. I asked the Review Panel to consider the appropriate lessons from Gwynfa and the North Wales Child Abuse Inquiry generally and to make recommendations so that proper safeguards could be in place whenever and wherever a child had contact with the NHS. The Review Panel was asked to undertake a huge task as every child in Wales has contact with the NHS. I am grateful for the manner in which the Panel rose to the challenge and the co-operation offered by the NHS, local authorities and voluntary bodies. This demonstrates the importance that we all attach to the safety of our children. The result has been a thorough and complete consideration of the issues connected with the safety of our children when they are most vulnerable. What emerges from the report is a clear message that child protection is a matter for us all. It is important that proper safeguards are in place, of course, but the best safeguard is the constant vigilance of every member of staff, parent and adult. Those who perpetrate abuse are constantly looking for opportunities and we must be equally vigilant. The NHS has, however, an important role to play in both the prevention and detection of child abuse. This report outlines the ways in which it can best perform these roles. Some of the recommendations contained in the report will be reasonably simple to implement, and others that will require more planning. It is my intention that with colleagues in the NHS we will commence work on the execution of this task with enthusiasm with a view that at the end Wales will have a safe and secure NHS for all our children. Jane Hutt AM vi 1.SETTING THE SCENE 1.1 This Review was announced in September 2000 by the Minister of Health and Social Services in the National Assembly for Wales.