nigel thompson - inside government · in middlesborough, children, young people and families who...
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#IGCSI17
Nigel Thompson
Head of Inspections Children’s Health and
Justice
CQC
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Not Seen, Not HeardA review of the arrangements for child
safeguarding and health care for looked after
children in England
Nigel Thompson
Head of Inspections – Children’s
Health and Justice
23 January 2017
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Overview
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• CLAS reviews
• Headline findings from the report
• Recommendations
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CLAS Reviews
1. Experiences and views of children and their families
2. Quality and effectiveness of safeguarding in health:
1. Assessing need and providing early help
2. Identifying and supporting children in need
3. Quality and impact of child protection arrangements.
3. Quality of health services and outcomes for looked
after children and care leavers
4. Health leadership and assurance of local
safeguarding and LAC arrangements, incl. leadership and
management, governance, training and supervision
Headline recommendations
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1. Children and young people must have a voice
2. The focus must be on outcomes
3. Most must be done to identify children at risk
of harm
4. Children and young people must have access
to the emotional and mental health support
they need
1. The child’s voice
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• The majority of children we spoke to said they did not
feel involved in their care
• This led to care plans that were impersonal and
contained only basic information
• Children said it meant they didn’t seen the point in
accessing the care and support they need
• What about children without a voice?
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Services in Salford were taking strides to improve how they listened
to and engaged children at multiple levels.
• Holistic assessments of children and young people, capturing
their version of events and wishes, and including a
comprehensive picture of what life was like at home.
• Good quality health reports to CP case conferences:
demonstrated clear analysis of risk and protective factors and
priority given to reflecting the voice and experience of the child.
• The trust had set up a group to seek feedback from young
people and their families attending hospital. Action was also
being taken to employ new methods for engaging young people.
• Services developed an extensive range of useful resources on
capturing the child’s voice e.g. in the CAF.
2. The “so what” factor
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• Worrying loss of focus on identifying and addressing
early need
• Improving outcomes – from ‘SMART’ health plans to
service evaluation to commissioning
• Strength and difficulties questionnaires (SDQs) for
looked after children
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In Middlesborough, children, young people and families who were
not making sufficient progress in early intervention programmes
were discussed at regular multi-agency forums.
These were made up of senior staff from agencies across the
partnership (incl. Children’s Social Care, CAMHS, Sue Start
Children’s Centres, Integrated Youth Support Service, Parenting
Services and Neighbourhood safety teams) and provided specialist
targeted support, advice and consultation to practitioners. They
were identifying trends and emerging issues with more challenging
families to achieve positive outcomes through joint initiatives.
Outcomes had been identified for children and young people as
part of their Early Help Strategy, and were being used to measure
progress.
3. Quality of information sharing
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• How health professionals are assessing risk
• How that identified risk is shared across agencies
• Trust, relationships… face to face?
• Standardisation e.g. CAF
• GP engagement
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4. The five ‘P’s in multi-agency working
• Physical systems (IT or paper-based) – support accurate
and timely documentation and information sharing.
• People – facilitate joined-up working and strengthen
partnerships. It is often individuals who work hard to ensure
that any gaps in existing systems are anticipated and
avoided.
• Policies, Protocols and Pathways – help staff to be clear
on what should be done when, where and by whom, and
reduce variation in practice.
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Several effective flagging systems across the trust in Kent
reflected good practice. For example:
• Electronic flagging systems in A&E identified those who were
subject to a child protection plan.
• Young people with ten or more attendances were automatically
reviewed by the consultant paediatrician responsible for
safeguarding.
Flagging systems were also helping to identify vulnerable,
safeguarded or looked after children in GP records, maternity units
and CASH services across the trust.
Missing children and those identified as being at risk of domestic
violence at MARAC meetings were also flagged.
4. The five ‘P’s in multi-agency working
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5. Finding the hidden child
• Think Family especially in adult mental health services
• Female genital mutilation
• Child sexual exploitation
• Trafficking?
• Radicalisation?
• Unaccompanied asylum seekers?
6. Transitions and access
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• Young people in transition from paediatric
care to adult services
• Looked after children:
• Access to services when moved area
• Health information on leaving care
• Support on leaving care
• Access to CAMHS for these children, but
also more generally across health
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Older looked after children and care leavers were well supported by
weekly drop-in sessions at a local cafe in Stockport. They
attended regularly and told us they valued the opportunity to come
to a safe environment where they could immediately access health
and daily living advice from volunteer mentors in a non-
judgemental setting.
Care leavers who were young mums told us they appreciated
meeting the designated looked after child nurse every week at the
café to get parenting advice and reassurance.
We heard about one care leaver with frequent attendances at A&E
for serious self-harm who, since accessing the mentoring service,
had not attended ED and had not required intervention from the
crisis mental health team.
7. Leadership
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• Leadership and purpose
• Governance
• Workforce and capacity
• Training and supervision
CQC’s commitments
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• CQC continues to seek and report on the experiences and
views of children who use health services as part of our
single- and joint-agency inspections
• Joint-Targeted Area Inspection programme (JTAI)
• Special Educational Needs and Disability programme
(SEND)
• CAMHS Review 2016-17
• CQC ensures that Think Family is embedded in our
inspection approach across all adult health services,
including mental health services