safeguarding children annual report · committee, which meets bi-monthly and reports to the...

Safeguarding Children Annual Report

April 2017 - March 2018

Clinical Lead: Dr Noel Baxter

Chief Officer: Andrew Bland

Director Lead: Kate Moriarty-Baker

Chair: Dr Jonty Heaversedge Chief Officer: Andrew Bland

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CONTENTS Page No.

1. Summary & Background Information 3

2. Executive Summary 3

3. Purpose of the Report – Safeguarding Assurance 4

4. Compliance 4

5. Southwark Child Safeguarding Reviews 7

6. National guidance and legislation 8

7. SEND Special Educational Needs and Disability 10

8. Learning Disabilities Mortality Review (LeDeR) 11

9. Training 12

10. Supporting Safeguarding within Primary care 13

11. Safeguarding Supervision 15

12. Audit 16

13. Key Achievements against 2017/18 Objectives and SSCB 20 Priorities:

Child Sexual Exploitation and Young People who go missing 20 Early Help and Neglect 21 Female Genital Mutilation 21 Prevent 21

14. Key Objectives for 2018/19 22

15. Conclusion 24

Appendix 1 – Southwark Child Safeguarding Activity 25


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1. Summary And Background Information

The Annual Report provides assurance on how NHS Southwark Clinical Commissioning Group (CCG) is meeting its statutory responsibilities with regard to safeguarding children. It demonstrates NHS Southwark Clinical Commissioning Group’s strong commitment to safeguard and promote the welfare of children at risk who are living within the local communities.

The Annual Report provides assurance that commissioned services within Southwark are working collaboratively to ensure that in Southwark children live free from abuse and neglect and that those people in vulnerable circumstances are not only safe but also receive the highest possible standard of care.

The requirements upon health are enshrined in statute within children’s services. The Children Act 1989 and 2004 provides the legislative framework for safeguarding children and is supported by statutory and supplementary guidance in Working Together (HM Government 2015). This guidance sets out the roles and responsibilities of all agencies including CCG’s in ensuring their functions are discharged with regard to the need to safeguard and promote the welfare of children.

2. Executive Summary

Clinical Commissioning Groups, as with all other NHS bodies, have a statutory duty to ensure that they make arrangements to safeguard and promote the welfare of children and young people and to protect them from abuse or the risk of abuse.

As a commissioning organisation, NHS Southwark CCG is required to ensure that all health providers from whom it commissions services (both public and independent sector) have comprehensive single and multi-agency policies and procedures in place to safeguard and promote the welfare of children and to protect vulnerable adults from abuse or the risk of abuse.

Leadership and responsibility for safeguarding at the Governing Body level is achieved through the CCG Accountable Officer. The CCG has a Governing Body Clinical Lead for Safeguarding within a wider quality improvement remit, an Executive Lead responsible for safeguarding children who is the Director of Quality and Chief Nurse. The Designated and Named Professionals together with commissioned Designated Professionals in respect of Looked after Children and Designated Paediatrician for Child Deaths work in partnership to provide clinical expertise.


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3. Purpose Of The Report – Safeguarding Assurance

Under Section 11 of the Children Act 2004 NHS Southwark CCG has a mandatory requirement to ensure that robust arrangements are in place to safeguard and promote the welfare of all children and young people.

The annual report to the Board covers the period April 2017 to March 2018 and provides assurance that, as commissioners:

NHS Southwark CCG has robust child protection / safeguarding arrangements in place.

Assures NHS Southwark CCG Governing Body and the Southwark Safeguarding Children Board (SSCB) that systems are in place to ensure organisational learning from serious case reviews and internal management reviews, and that these are supported by robust action plans that address both statutory responsibilities and respond to local need.

Confirms joint working with partner agencies, including working with the Southwark Safeguarding Children Board on the key themes, for 2017-18 including child sexual exploitation (CSE) and young people who go missing, adolescents at risk including knife crime, early help and neglect and supporting vulnerable parents.

Looked after Children (LAC) have been included throughout the work of the CCG safeguarding team and where appropriate have been referred to explicitly in this report. However, the annual report for Southwark Looked After Children will be provided independently.

4. Compliance

During the period April 2017 to March 2018 NHS Southwark CCG has worked together with partner agencies to prevent children suffering harm and to promote their welfare by providing services to address identified needs and safeguarding children who are vulnerable.

NHS Southwark CCG is fully compliant with the current statutory guidance ‘Working Together to Safeguard Children 2015’ and ‘Children Act 1989 & 2004’.

This compliance is demonstrated in a number of ways including those listed below.

Overall accountability for safeguarding at Governing Body level is through the CCG Chief Officer. NHS Southwark CCG has a Governing Body member who takes the lead for safeguarding both children and adults. The CCG’s Director of Quality and Chief Nurse has the director level lead for safeguarding adults and children and is the Executive Lead for Safeguarding Children. These posts receive assurance via the Designated professionals and the Named GPs who have clinical safeguarding expertise. NHS Southwark CCG is represented on the Southwark Safeguarding Children Board (SSCB).


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Safeguarding governance within NHS Southwark CCG is via the Safeguarding Executive Committee, which meets bi-monthly and reports to the Governing Body via the Integrated Governance and Performance Committee. Minutes from the Safeguarding Executive Committee are included with Integrated Governance and Performance (IG&P) papers and in addition regular safeguarding updates are provided to IG&P via the Director of Quality and Chief Nurse reports.

NHS Southwark CCG Safeguarding Executive is well attended by commissioned organisations and considers key documents from the Southwark Safeguarding Children Board (SSCB). Minutes from the CCG Safeguarding Executive Committee are included in SSCB papers.

The Designated Doctor and Designated Nurse roles are in place. These roles support the acute and community healthcare providers by providing advice and supervision to the Named Safeguarding Leads. The Designated professionals attend the safeguarding children assurance meetings within local acute Trusts. For Southwark the Trusts supported are Kings College Hospital NHS Foundation Trust, Guy’s & St Thomas’ NHS Foundation Trust and the South London & Maudsley NHS Foundation Trust.

Designated professionals, the Named GP and CCG Governing Body Lead for Safeguarding attend the SSCB.

Local Safeguarding Children Boards are the key mechanism for agreeing how the relevant organisations in each local area will co-operate to safeguard and promote the welfare of children and adults in that locality, and for ensuring the effectiveness of what they do. NHS Southwark CCG supports the SSCB through attendance at Board meetings and actively supporting the sub groups. The CCG Designated Nurse co-chairs the Audit and Learning Sub-committee and is a member of the Practice Development and Training Sub Group and the HR and Safeguarding Sub-group of the SSCB. This high profile involvement of Southwark CCG with SSCB enables a robust dialogue between Health and the multiagency within Southwark.

The Designated Nurse for Safeguarding Children provides supervision to the Named Nurses and Named Midwife at South London and Maudsley Foundation Trust (SLaM), King’s College Hospital (KCH) and Guy’s and St Thomas’ Trust (GSTT) and provides advice and mentoring for these roles. Supervision is included in the CCG Safeguarding Children Commissioning Strategy and Policy 2015-18. This enables robust supervision across the borough and supports the complexities of the safeguarding children agenda.

The Designated Professionals assist in providing the SSCB multiagency safeguarding training including disseminating key messages from National and Internal Serious Case and Management Reviews. The CCG Safeguarding Executive Committee has ensured that learning from SCRs and national enquiries have been presented at Governing Body Seminars and via the CCG’s Integrated Governance and Performance Committee.


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The Designated Nurse for Safeguarding Children is a member of Lambeth and Southwark’s Child Death Overview Panel (CDOP) and provides professional opinions on safeguarding issues in particular to support recommendations to the Child Death Review, partners and other organisations, where actions have been identified which may prevent future child deaths or promote the health, safety and wellbeing of children.

The Designated Nurse and Adult Safeguarding Lead Nurse are members of the Multi Agency Risk Assessment Conference (MARAC) steering group. To improve communication with GP Practices in Southwark a MARAC template has been developed to be sent to GP Practices whose patients are discussed at the MARAC. This template will provide information about MARAC, IRIS (Identification and Referral to Improve Safety) training and the contact number for Solace Women’s Aid and the Community Safety Unit desk, the pathway to embed this communication is currently under review.

Systems are in place through the Designated Nurse and Safeguarding Adult Lead nurse to ensure linkage with the Multi Agency Public Protection Agency (MAPPA) in the event that actions for Health are required from Southwark CCG or its providers. MAPPA is the name given to arrangements in England and Wales for the "responsible authorities" tasked with the management of registered sex offenders, violent and other types of sexual offenders, and offenders who pose a serious risk of harm to the public.

The Governing Body lead for Safeguarding Children provides clinical leadership for NHS Southwark CCG and liaises closely with other Governing Body members, clinical leads, key directors, stakeholders and the designated professionals to enhance understanding of safeguarding issues and ensure synergy in respect of policy, practice and safeguarding training. Joint work continues with the Local Authority and all health providers (Acute Hospitals, Independent Contractors and Mental Health Trusts) and partner agencies to promote and safeguard children’s welfare by ensuring robust governance and organisational systems are in place to support quality safeguarding practices.

The Safeguarding team work closely with commissioning and contracting colleagues in order to ensure that safeguarding is embedded in the commissioning cycle.

NHS Southwark CCG is committed to a policy of continuously improving the health and quality of healthcare for its population. In order to commission high quality care, the CCG will ensure that all risks arising from its activities or events, threatening the well-being of patients, staff and other stakeholders, are effectively and efficiently identified, minimised or mitigated against. Through its work with provider services, the CCG safeguarding team may identify areas of practice which give cause for concern. When these concerns are of significance and/or on-going they will be formalised and raised using the process set out in the CCG Risk Management Framework 2017. The CCG safeguarding team will escalate any significant concerns with imminent risk to the Director of Quality and Chief Nurse immediately following identification.

http://en.wikipedia.org/wiki/England

http://en.wikipedia.org/wiki/Wales


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The National Serious Incident Framework (NHSE 2013) set out the principles for serious incident management for all organisations in the healthcare system. Where serious incidents originate or involve the actions of commissioning organisations, the CCG is accountable for its response to and management of the incident in line with the framework document. In incidents where Safeguarding Children and/or Safeguarding Adults is indicated the Safeguarding Team support the Quality Lead and the Local Authority (when appropriate) in ensuring that safeguarding concerns are highlighted and addressed as part of the root cause analysis and subsequent action plans.

To ensure that those multi-agency guidance documents and policies that are in place to support the work of the Board remain current on the CCG Members Zone and on the Safeguarding Children’s Board website and therefore accessible to all services and agencies.

5. Summary of the Southwark Child reviews in 2017/18 which have been completed or are in the process of being completed.

Serious Case Reviews are undertaken to learn lessons and improve the way in which local professionals and organisations work together to safeguard and promote the welfare of children. Local safeguarding Children Boards (LSCBs) must always undertake a Serious Case Review (SCR) when criteria are met under Regulation 5 of the 2006 LSCB

Regulations.1

NHS Southwark CCG undertakes Serious Case Reviews (SCR), single agency management reviews and multi-agency reviews of cases as required. Whatever the type of review, the principles are still the same with the aim being to share information, identify good practice and establish the key lessons that will help to improve safeguarding arrangements. The CCG takes a leadership role for health agencies across the borough, having oversight of provider health reports and where required completing the integrated health overview report. It provides assurance to the governing body that identified learning and recommendations for health is disseminated and implemented across health organisations.

The Director of Quality & Chief Nurse, Designated Nurse and Designated Doctor are all members of the Serious Case Review (SCR) subgroup of the SSCB and participate in SCR panels. The subgroup decides whether referred cases meet the threshold for SCR or Concise Review or other formal reviews and oversees the implementation of recommendations from such reviews across the multi-agency partnership. It also receives regular briefings on Child Deaths.

1 Working Together to Safeguard Children HM Government 2015.


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A briefing on all reviews that were undertaken or contributed to by the Southwark Safeguarding Children’s Board during 2017 was presented by the Director of Quality & Chief Nurse to the CCG Integrated Governance & Performance Committee in March 2018. For each review the briefing provided:

A summary of the case

Learning from case and recommendations for Health

Progress to date against recommendations for Health There were 3 multi-agency reviews undertaken in 2017/18, 2 have been completed and the 3rd is in final draft. In February 2018 an initial SCR panel meeting took place to agree the methodology and scope for a Joint SCR with London Borough of Wandsworth. This followed the injury to a 5 year old child by a 17 year old child at their shared foster care placement. In February 2018 contribution was made to a Croydon SCR as the child who is the subject of the review was resident in Southwark until the age of 15 years. This child died following collision with a police vehicle in Wimbledon. This is in the initial stages and the report will be published when completed. Learning themes from completed reviews in 2017/18 include:-

Improved inter-agency information sharing and record keeping in the context of

safeguarding

Equal access to services when there are barriers i.e. language barriers, disability

6. National Guidance And Legislation

Alan Wood’s review of the role and functions of Local Safeguarding Children Boards, published in May 2016 found widespread agreement that the current system of local multi-agency child safeguarding arrangements needed to change. A new model needed to be introduced that would ensure collective accountability across local authorities, the police and health. The review also recommended a new system of local and national reviews, to replace serious case reviews; and the transfer of responsibility for child death reviews to the Department of Health. The review’s key recommendations are now included in the Children and Social Work Act 2017 which was passed in April 2017. The Government has worked to revise the statutory guidance Working Together to Safeguard Children, and draft the regulations required to commence the legislation. The public consultation on these draft documents ran from 25 October 2017 to 31 December 2017. The Governments response was released in February 2018 in the report entitled ‘Changes to Statutory Guidance: Working Together to Safeguard Children; and new regulations’.


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A briefing on the new system of multi-agency safeguarding arrangements established by the Children and Social Work Act 2017 was presented to the Southwark Safeguarding Children Board (SSCB) in March 2018 by the interim board chair. The Board was asked to consider and discuss:

The SSCB response to the new local safeguarding arrangements led by three safeguarding partners, Police, CCG and Local Authority which places a duty on those partners to make arrangements to work together and with any relevant agencies for the purpose of safeguarding and promoting the welfare of children in their area.

Changes to provision pertaining to Serious Child Safeguarding Cases. Local reviews for the review of serious child safeguarding cases which they think raise issues of importance in relation to their area. In addition to this, there will be establishment of a national Child Safeguarding Practice Review Panel for cases which are complex or of national importance.

The Southwark Safeguarding Children’s Board, (SSCB) currently meets bi-monthly. There are 11 sub-groups accountable to the Board and chaired by various agencies. The SSCB and the Southwark Safeguarding Adults Board, (SSAB) have benefited from having the same Independent Chair to ensure synergy and appropriate level of challenge and quality assurance. Joint Board meetings are held twice a year on issues which require closer collaboration, such as knife crime and vulnerable parents. The Independent Chair position is currently vacant with appointment due to take place in spring 2018. It is recognised that the SSCB has to date demonstrated strong leadership and effectiveness around local safeguarding arrangements. This was demonstrated through a recent OFSTED inspection of Good. Specific reference was made to how locally, Children’s and Adults’ safeguarding arrangements had been aligned to ensure greater synergy and a focus on the family. This has resulted in reducing duplication, improving efficiency and promoting a shared understanding of issues such as gangs and female genital mutilation.

The SSCB concluded that the current local arrangements are strong and that arrangements continue to include input from the wider partnership to ensure Southwark continues to make safeguarding children everybody’s responsibility.

Changes to Child Death Overview Panels were presented by Public Health colleagues. These changes are to give clinical commissioning groups and local authorities joint responsibility for child death reviews, and enable a wider geographical footprint for these partnerships in order for them to gain a better understanding of the causes of child deaths.

For Looked after Children it introduces corporate parenting principles to which local authorities must have regard. Local authorities in England must publish a Local offer for care leavers and extend local authority support to Care Leavers to age 25.


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The proposed timeline for final implementation for these legislative changes is September 2019.

7. Send Reforms 0-25 Years

The Children and Families Act 2014 introduced new duties for health services to children and young people who have a Special Educational Need and/or Disability (SEND) between the ages of 0 and 25. The main areas of health focus in the reforms are:

New joint commissioning arrangements for local authority and health commissioners

Health services role in the identification and assessment of children and young people with SEN and Disability

Education, Health and Care plans with the CCG being responsible for agreeing the health provision set out in an Education, Health and Care plan

Mediation, complaints and redress when children, young people and their families are unhappy about the content of their EHC plan they can challenge, up until now it has only been the education element of a plan that has been possible to appeal against via tribunal. From April the Health and Care elements can also be challenged

Across this group there are a diverse range of health needs, which include long term health conditions, autism, sensory impairments, mental health issues (including behaviour that challenges) and children and young people with multiple and complex needs who may meet the threshold for Children and Young Peoples Continuing Care National Framework and or be dependent on technology. Children and young people have been disadvantaged by a system that has not integrated services to look at the needs of a child across the life course and in the variety of settings that they will attend. From the act we now have a duty to jointly commission services to this group to meet their education, health and care needs to provide the right support in the right place at the right time.

The CCG has worked in partnership with Southwark Local Authority to establish robust local governance arrangements to ensure shared responsibility and accountability in delivering the SEND Reforms. There are joint commissioning arrangements in place and following a Joint Strategic Needs Assessment (JSNA) for Southwark SEND population, there is a better understanding of what education, health and care provision is needed by local children and what will need to be commissioned to meet those needs and who will deliver it.

To support the SEND agenda the CCG has identified a Designated Medical Officer (DMO) working to a Service Level Agreement (SLA) and a Designated Clinical Officer (DCO) employed directly by the CCG to coordinate the health involvement and to ensure that NHS Southwark CCG are delivering its statutory functions effectively.

The Senior Responsible Officer for SEND at Southwark CCG is the Director of Quality & Chief Nurse who is a member of the Governing Body. This Director is a member and joint chair of the strategic SEND Board meetings which report to the Health and Wellbeing Board. The DMO and or DCO represent the CCG at all of the operational and sub groups of the SEND Board. The


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Director of Quality & Chief Nurse and the DCO are members of the Children and young Peoples Commissioning Development Group.

The CCG is compliant with the NHS England Assurance Framework (in relation to SEND) processes via reporting against the assurance framework as required. SEND action plans are formulated from completion of quarterly SEND audits and informs us of our progress and priorities. Areas that we have focused our work on in the last year have included: The completion of a JSNA SEND deep dive, the development of a SEND e-training programme for all staff working with 0-25 age range which is currently at a pilot stage. Mediation must be offered to any child or young person (or their family), dissatisfied with the health element of the Education Health and Care Plan (EHCP). The CCG has agreed a process for this.

The SEND team worked with GPs in 2017 during a protected practice learning event to ensure they were aware of their responsibilities in supporting young adults not under the care of paediatricians and in particular with relation to medical assessments. GPs needing support were reminded of their access to support from experts with the CCG and other local and linked providers.

The DCO works closely with the CCG Safeguarding Team on joint and overlapping areas of work such as the Learning Disabilities Mortality Review (LeDeR) and ensuring opportunities are in place to learn from the outcomes of these reviews. In addition to this the DCO and DMO work closely with our LAC Designated professionals and transforming care agenda to ensure alignment of these processes. This is important so that we have a more holistic understanding of our most vulnerable groups of children and young people who often represent and overlap in various vulnerable client groups such as LAC and care leavers, YOS, transforming care and continuing care.

8. Learning Disabilities Mortality Review (LeDeR)

The LeDeR programme is a review process for the deaths of people with learning disabilities aged 4 years and over in England. The new guidance for the review of child deaths following the creation of the Children and Social Work Act 2017 provides strategic level guidance about the interface between the child death review process and the deaths of children with learning disabilities.

In April 2017, a steering group was set up to oversee the implementation of learning disability mortality reviews in Southwark. The group reports to the Safeguarding Children Board via the Quality and Performance group. A series of discussions were held with the Child Death Overview Panel (CDOP) Chair and panel members in Southwark to agree a way of integrating the outcome of CDOP into LeDeR framework for reviews of deaths of children with learning disabilities. Following consultation with colleagues nationally through the NHS England and LeDeR team in Bristol a CDOP/LeDeR interphase template has been developed.


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9. Training All NHS staff are required to have the appropriate levels of knowledge and competence as defined within the following documents: Safeguarding Children and Young People: Roles and competencies of health care staff (intercollegiate document, 2014) and Looked After Children: Knowledge, skills and competencies of healthcare staff (Intercollegiate Role Framework, 2015) Safeguarding training is therefore critical to protecting children and young people from harm and staff must know how to identify abuse and neglect and how to act on their concerns.

Level 1 Safeguarding and Prevent training is mandatory for all staff within NHS Southwark CCG.

The following table represents the status of CCG staff members as of end of March 2018. The CQC recommended compliancy is for 90%. Action has been taken to ensure the target of >90% is met by the next financial quarter.

Prevent Level 1

Number of Staff – 85 out of a total of 104 completed training

Safeguarding Adults – Level 1

Number of Staff – 93 out of a total of 104 completed training

Safeguarding Children – Level 1

Number of Staff – 91out of a total of 104 completed training

80.2% 87.7% 85.8%

Governing Body members received Safeguarding Children training in 2017 via Governing Body bespoke sessions and protected learning time events.

Prevent WRAP 3 training sessions have been provided to CCG commissioning staff who are identified as having direct contact with the public.

The Named GPs for children and adult safeguarding are both compliant with Level 4 training.

NHS Southwark CCG Designated Professionals are all compliant with Level 5 training.


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10. Supporting Safeguarding within Primary Care The Named GP for Children Safeguarding and the Named GP for Adult Safeguarding have continued an established and well-attended quarterly GP Forum for Safeguarding Leads. This forum covers both adult and children safeguarding issues. Attendance has continued to remain strong over the year with representation from 21 different practices at the March forum. Topics for discussion have included: Recommendations and learning from SCR/SARs

Definitions in adult safeguarding

Prevent

Children Home Educated

SSCB Multi-agency audits

Substance Misuse and safeguarding issues

The child protection plan process and information sharing Key safeguarding documents and information is sent to GP Practices via the CCG Communications Department to ensure GP’s have access to up-to-date safeguarding information available to support them in their role. NHS Southwark CCG also has a GP Safeguarding Webpage to promote access to safeguarding information and related resources. Safeguarding Children Protected Learning Event (PLT) The annual safeguarding children PLT was held in July 2017. The agenda included talks on Child U with focus on youth violence, multi-agency safeguarding hub, the pause project, with workshops on neglect, safeguarding children with disabilities and child death. The session was well attended with representation from all GP practices in Southwark which included GPs, Primary Care Nurses and Clinical Pharmacists. An escalation process has been developed to enable social care to flag any difficulties in communication with GPs; this was shared with GPs and has been developed partly from learning in response to Quality Alerts Raised about General Practice (QRAG) by providers and local authority partners. CQC Inspection of GP Practices in Primary care The CCG Safeguarding Team has been supporting practices to address issues of safeguarding practices that have been identified through the CQC inspections. This support has included both practices visits and the sharing of tools to support safeguarding systems and processes. Specific themes have been addressed through the quarterly Safeguarding Forum for GP Leads


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Primary Care Safeguarding Review In December 2017 the CCG undertook an Adult and Children Safeguarding Review within Primary Care. This review focused on four key areas of:

Training

Frontline Safeguarding, incorporating policy and procedure

Looked after Children

Recommendations from SCR/SARs

The review was completed by 36 out of 39 practices (92%).

Key findings and areas for improvement for 2018/19:

All Southwark practices have a Safeguarding Lead for both adults and children.

All practices have a Safeguarding Policy in place for both adults and children. In the majority of practices these have been updated within the last 12 months, 84% of practices had checked child safeguarding policy against the policy checklist produced last year.

72% of practices report to have signed up for the FGM enhanced dataset. There are concerns from practices about the ethical issues associated with this, and the use of provided information in future prosecutions.

Practices gave a range of examples as to how they support vulnerable patients (homeless, asylum seeking children) to register for care

44% of practices have undertaken a safeguarding related audit in the last year.

Target training levels for Child and Adult Safeguarding are 85%. Current training levels are met for clinicians for children, but below target for Adults and for the rest of the non-clinical team. All bar one practice reported to knowing how to access training,

Prevent training levels have improved, but remain below target; a session has taken place on a recent GP forum.

All practices were aware of changes to MASH and Early Help referrals.

In terms of recommendations from SCRs upon registration 69% (- increased from 44% 2016/17) of practices ask about current social worker for child or family, 58% ask about name of school.

Identification and Referral to Improve Safety (IRIS) To continue to raise awareness of domestic abuse, by ensuring the roll out of Identification and Referral to Improve Safety (IRIS) training in Primary Care. NHS Southwark CCG works closely with Southwark Council to ensure that health services play an active role in preventing and addressing domestic violence. Trauma and abuse can have a huge impact on a patient’s mental as well as physical health and GPs are therefore in a unique position to identify survivors. The CCG financially contributes to the existing contract the council has in place for the Southwark Advocacy and Support Service. This financial contribution has


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made it possible for the service to deliver a specialist GP based domestic abuse intervention known as IRIS which has been endorsed by NICE and which is being rolled out to all GP surgeries in the borough. A total of 22 GP Practices have engaged with this training, 17 are now fully trained and 1 is part trained. A total of 141 clinical staff and 119 reception staff have now received training. The project has received a total of 131 referrals from GP Practices following the roll out of this training. 124 of the referrals have been victim/survivors of abuse. 3 were referred as a perpetrator, 3 were referred as victims but transpired to be perpetrators. The IRIS training consists of 3 sessions, 2 for clinical staff and 1 for admin and receptions. After 2 years, clinical staff will receive refresher training.

11. Safeguarding Supervision

Working in the field of child protection entails making difficult and risky professional judgements. The work is increasingly demanding and can be distressing and stressful, not least because of the public interest created by national headline stories. All those staff involved in safeguarding situations have access to immediate advice and support from NHS Southwark CCG’s safeguarding team.

All health practitioners involved in day to day work with children and families require effective safeguarding supervision. Supervision and support standards are included in the Safeguarding Children Policy for provider organisations. Designated Professionals provide continuing support and supervision to Named Professionals within the local NHS economy. The Designated Professionals also provide supervision, support and advice when required and on an individual case basis.

Designated professionals for safeguarding children obtain supervision through the Designated Professionals Network and through external 1:1 arrangements.

Safeguarding supervision and support for primary care is provided at the quarterly GP Safeguarding Leads Forum and via the Named GP for Safeguarding Children and the Named GP for Safeguarding Adults. The Named GPs, Designated Nurse for Safeguarding Children and Adult Lead Nurse provide individual support to general practices regarding safeguarding issues.

Peer support supervision is given within the CCG Safeguarding Adult and Children team, which includes all designates, as required. This team also meets on a monthly basis with the Director of Quality and Chief Nurse to review and progress the joint safeguarding agenda.


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12. Audit

Section 11 audit It is a requirement of the Children Act 2004 that partner agencies of the Safeguarding Children Boards complete an annual Section 11 audit. The Section 11 audit for 2017/18 will be disseminated and the Section 11 Panels will be held in September 2018. NHS Southwark CCG monitors commissioned services on their Section 11 compliance and progress with the implementation of associated action plans via the Safeguarding Executive Committee. Multi-Agency Audits The Southwark Safeguarding Children’s Board (SSCB) Multi-Agency Audit and Learning Subgroup co-chaired by NHS Southwark CCG Designated Nurse and the Assistant Director for Quality and Performance Southwark Children’s Services undertook 3 in the year 2017 -2018

Multi Agency Risk Assessment Conference (MARAC) – process and effectiveness (July 2017)

Knife Crime (Nov 2017)

Quality of Strategy Meetings (March 2018) Multi-agency audit actions are identified and tracked through the Audit and Learning Sub Group.

MARAC (Multi-Agency Risk Assessment Conference) Audit The Domestic Abuse MARAC is a forum where information relating to high-risk domestic abuse victims (those at risk of murder or serious harm) is shared between local agencies to minimise risk. By bringing relevant agencies together at the MARAC, a risk-focused, co-ordinated safety plan can be drawn up to support the victim and any children. In Southwark the MARAC meets monthly, is chaired by the local Detective Inspector of the local Community Safety Unit. The Audit and Learning subgroup undertook a multi-agency audit on the 5 July 2017. The purpose of the audit was to examine the process and effectiveness of the MARAC and to provide an overview of activity and performance against the delivery of Southwark’s Domestic Abuse Strategy 2015-2020 The audit focused on the information sharing process, identifying areas of achievement and areas for development. Participants were asked to consider how the MARAC supports a victim’s journey to safety and what is needed to influence this journey; outcomes achieved and the effectiveness of the MARAC, including identifying any potential gaps and recommendations to improve processes. Partner agencies were asked to comment on the following:

Did the MARAC processes work effectively?

What difference did the MARAC make to the victim and their family?

How effective was the MARAC in reducing risk for children and young people? The audit identified 12 families that were referred into MARAC. Of the 12 families identified 2 cases were deferred due to adult services being under-represented. There was no single theme from the audit and the key themes identified were:


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Need to focus on the needs of the child in families where Domestic Abuse is a feature.

Consider more interventions with perpetrators of abuse to reduce recurrence.

Review effectiveness of the MARAC by engagement with service users. It was identified that it was difficult to identify outcomes of the work being undertaken through the MARAC process.

Need to improve information sharing between agencies to avoid silo working.

Improve understanding of complex cases including those with no recourse to public funding and clients with disabilities.

Southwark has seen a continuous increase in referrals to MARAC over the last three years and also an increase in repeat referrals. In terms of this increase this is a trend which is being seen both nationally and regionally. SafeLives also have a repeat referral recommended range between 28- 40%. Current figures for Southwark illustrate the MARAC is operating in this range. Knife Crime Audit This multi-agency audit was undertaken by the Audit and Learning Subgroup in December 2017 on behalf of the Southwark Safeguarding Children’s Board (SSCB). A broad representation of partner agencies contributed to the audit, including Early Help/Education, Youth Offending Service, Children Social Care, Adult Social Care, Specialist Family Focus Team (SFFT), Police, Housing and CAMHS. The purpose of this audit was to evaluate the partnership response to knife crime in Southwark, including reviewing how we collectively impact on the person that is a victim and/or perpetrator of knife crime

Methodology 12 names were randomly selected from a list of Southwark residents arrested in Southwark for a knife related crime between June and August 2017. Six were under 18 years and six were aged 18-24 years. Partner agencies were asked to complete a tool to consider what involvement they had had with the young person identified in relation to a number of factors.

Initial Findings/Themes The audit found the following risk factors were present for the vast majority of people involved in knife crime and knife carrying -

• Historic Domestic Abuse • Previous involvement / known to agencies • Parental vulnerabilities e.g. mental health, learning needs, physical health which

impacts on their parenting ability • Young carers • Capacity to change/ sustainability • Cannabis (substance misuse) • Lack of father figure / single mothers • Elder brothers and all male siblings


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• Loss, bereavement, absence, abandonment, attachment, grief • School exclusions /low attendance / poor achievement/ SEN/ additional needs • Sporadic/ inconsistent engagement- need for purposeful engagement? • Lack of support/ wider family networks

Overall, and as expected, an increase in protective factors meant better outcomes for the person.

Areas for Improvement / Next Steps It was evident that a huge amount of interventions have been received by the person and their family. However, what was apparent is that agencies are still working in silos and it would be more effective to work better together as a multi-agency.

• Currently the approach is to consider the person and not the event – proposal to ‘follow the knife’ as opposed to the person. The knife is the trigger.

• A lack of the child’s voice and consideration of the impact on siblings. • A commitment from all agencies to convene a Team around the Family meeting

(TAF) at an earlier stage. • Need to be clear about what the local authority offer is when a person is involved

with knives. • The acceptance that some families will always require intervention and support

from agencies. • Getting agencies to “think family” – this approach needs widening.

Quality of Strategy Meetings audit This audit was undertaken in March 2018 in response to the Southwark Single Inspection Framework by Ofsted who made recommendation that Southwark sought to improve the quality of strategy meetings. It recommended that we “ensure that strategy discussions and strategy meetings involve all relevant agencies so that multi-agency information informs assessment of risks”. This audit sought to identify current strengths and areas for development and recommendations for partners to achieve this outcome. The final report and action plan is in progress.

Health providers Safeguarding Assurance Visits

During June and July 2017 the CCG’s Safeguarding Team undertook safeguarding quality

assurance visits to services within the borough of Southwark.

Services included were:

• LAC Health Team • School Nursing and Health Visiting • Kings College Hospital • Midwifery Team • King’s College Hospital Emergency Department • Child and Adolescent Mental Health Services (CAMHS) • Adult Mental Health Services • Specialist Substance Misuse - Insight (young people) • Care, Grow, Live (adults)


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• Multi Agency Safeguarding Hub (MASH) and Sexual Health Services The purpose of the visits was to:

• gain assurance of compliance • highlight and disseminate good practice • demonstrate a learning culture • offer opportunities to discuss service development

There was excellent engagement from services to these assurance visits and recommendations and actions associated with the visits have been shared with the services and incorporated into the Safeguarding Team’s work plan. Themes from the assurance visits related to the following areas and identified areas good practice and areas for development. The visits confirmed that Child safeguarding is well embedded within Southwark provider services. There is strong multi-agency relationships are progressing the agenda for children and their families and visible commitment to developing this further. The CCG Safeguarding team aim to revisits services in 2018/19.


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13. Key Achievements Against 2017/18 Objectives and Themes of CCG and the SSCB

NHS Southwark CCG fulfils its statutory responsibilities for safeguarding children and young people and supports the Southwark Safeguarding Children Board in participating, alongside the key boards of Health and Well Being, Safeguarding Adults, Safer Southwark Partnerships in a strategic approach to Safeguarding in Southwark.

The 2017/18 objectives of the CCG reflected the SSCB priorities of:

Child Sexual Exploitation (CSE) and Young People who go missing Adolescents at Risk including Knife Crime – see audit section 12 Early Help and Neglect Supporting Vulnerable Parents FGM Prevent Child Sexual Exploitation (CSE) and Young People Who Go Missing The SSCB CSE Sub Group takes a strategic overview across the partnership and is attended by the CCG Director of Quality & Chief Nurse and the Designated Dr for Safeguarding Children. There is active feedback to this group from the MASE. The MASE is a multi-agency forum (previously named the CSE operational group) that meets monthly bringing together operational leaders to oversee cases, share local intelligence and data, discuss risk management and interventions, disruption, hotspots and training needs. It is attended by the CCG Designated Nurse for LAC and Specialist Nurse for Safeguarding Children at GSTT. There is feedback from MASE to practitioners and on-going audit of CSE cases. CSE is included in safeguarding training and updates across the health economy. Learning from audits continues to be disseminated to Local Authority and Health staff. There is SSCB training on CSE and related topics. The recent Ofsted report (June 2017) reported that CSE multi-agency arrangements were effective in reducing risk for children and young people. It was also highlighted that partnership work was creative and responsive to adolescents at risk of CSE.

GSTT Community Health Nurses and Paediatricians have established a pathway for health input into CSE cases: an audit is in progress.

LAC are over represented in CSE cases presented at MASE. The LAC Health Services continue to monitor a risk stratification of the LAC caseload for both missing and CSE. This work has been shared with children’s social care to promote a joined up approach to working with high risk children and young people. Also the LAC Health team share information on those at risk placed out of borough with provider the services.

Local Authority and CCG employees have participated in community awareness events in the borough.


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Early Help and Neglect Southwark Strategy for Childhood Neglect is agreed with Public Health (PH) as a priority to progress through CCG Safeguarding Team workplan 2018/2019 building on earlier PH needs' assessment. Healthy Weight updated strategy 2018 makes explicit the need for providers to consider that families may need early help or safeguarding services. The Healthy Weight & Obesity providers' working group is making this operational.

SSCB multiagency working group on Early Help 2017 included input from CCG Safeguarding leads.

Neglect is embedded in provider guidelines e.g. GSTT community directorate has updated & is auditing DNA policy to improve early identification of neglect, GSTT CSE pathway requires a health plan to address neglected health needs of these vulnerable children, and Neglect is considered in MASH and MARAC cases. Neglect is proactively addressed in supervision and in escalation of clinical cases.

Neglect is included in all safeguarding training, for example it was highlighted in GP PLT July 2017 (120 participants), update to CCG Governing Body September 2017, GSTT Consultants' mandatory level 2 training Nov 2017 (110 participants).

A Serious Case Review in 2015 identified the need for an audit of multi-agency practice when cases are "stepped down" from Child in Need to Early Help services and this has direct implications for cases of neglect.

Audits - neglect was identified as significant background factor in multiagency audits on Children Missing in Education/Home Education audit, the CSE audit, Neglect audit and the Adolescents at Risk of Harm audit.

Providers' recognition of neglect - and knowledge of referral pathways - was covered in CCG team's CQC preparatory visits to local health services in Summer 2017.

Female Genital Mutilation SCCG has continued to work in partnership to support the FGM agenda including supporting the reporting of FGM in Primary Care. The FGM steering group has continued to take a multi-agency approach to developing and providing leadership within Southwark for FGM. This has included raising awareness of FGM within each agency setting, developing guidance to support this multi-agency approach, ensuring primary care and community engagement with the FGM agenda and developing the early help offer and supporting schools to take forward the FGM agenda.


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Prevent The CCG Prevent policy is in place and available via the CCG Staff and Members Zone. Prevent awareness training has been provided to all CCG staff via an eLearning tool and compliance is 80.2%. Training on Prevent has been provided to GP practices via both the Safeguarding PLT s and the quarterly GP safeguarding Forum.

The CCG provides representation to the Chanel Panel by both the adults and children safeguarding leads within the CCG.

Provider Prevent compliance is a standing agenda item at the CCG Safeguarding Executive Committee. It is recognised that there are challenges in rolling out the relevant Prevent training across both acute and mental health providers

14. Key Objectives for 2018/19

The objectives for 2018/19 are aligned to the SSCB objectives and will continue to support NHS Southwark CCG to fulfil their statutory responsibilities for safeguarding children and young people.

Partnership Working

To continue to work with partners via the SSCB to progress the safeguarding children objectives.

Work with Public Health colleagues to promote safeguarding throughout the health agenda for children and young people in the borough.

To work jointly with the SSCB to identify risk and support parents and children with regards to mental health, alcohol and substance misuse which includes use of tobacco and alcohol misuse.

To empower young people and communities to eradicate FGM, CSE and Knife Crimes and work together with partners to raise awareness within schools, communities and hotspot areas with the aim of identifying local ambassadors to support the agenda.

To continue to implement the recommendations made from the Neglect audit to ensure that safeguarding services for children experiencing neglect makes a difference in early identification and promote a Families Matter approach to early help and neglect.

To work with colleagues within the CCG Safeguarding team and partners in the Southwark Safeguarding Adult Board to ensure that the “Think Family” approach to safeguarding is maintained and that agencies across both boards work together to address areas and issues that overlap across both the children and adult agendas.


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Service Development

To positively contribute to early intervention/early help work through commissioning in order for children, young people and families to be able to access help and have their health needs met at the earliest possible stage

To ensure that health service planning and developments consider the views of children and young people

To ensure that health is represented with the on-going development work being undertaken with local communities via the Community and Engagement Subgroup and voluntary organisations.

To ensure the children’s neglect agenda remains a high priority within Primary Care and to facilitate a workshop to develop and implement a strategy through a health lens in relation to neglect.

To provide a quarterly assurance report to the Governing Body on progress in relation to the CCGs Safeguarding Children Strategy and workplan.

Training and Development

To ensure that learning from all reviews and audits is disseminated and embedded across the health economy.

To provide bespoke safeguarding children training for commissioners with the CCG and the Governing Body

The CCG Safeguarding team will work in collaboration with the SSCB to promote a culture of multi-agency safeguarding and child protection learning using a learning and improvement framework.

To provide assurance that learning is cascaded to front line practitioners across the health economy through single agency training and multi-agency via the SSCB ‘My Learning Source’.

To provide training to ensure that all front line staff and managers are trained in recognising presenting risk factors.

To support the development of a comprehensive multi agency FGM training offer through the SSCB/SSAB.

SEND

To promote the work of the SEND agenda. For 18/19 some of the areas of work planned include: primary care LD registers and increasing the number and quality of annual health checks, developing a SEND dashboard jointly with LA colleagues and supporting our LA colleagues in developing a more comprehensive short breaks offer.


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Child Death Review

To work with Public Health colleagues to implement the new Child Death Review Statutory guidance published in draft October 2017.

15. Conclusion

NHS Southwark CCG continues to work in partnership with the SSCB and partner agencies to ensure robust safeguarding arrangements are in place within the organisation and within commissioned services provided by health organisations in the CCG footprint.

The CCG takes its duty seriously to ensure functions are effectively discharged with regard to the need to safeguard and promote the welfare of children and vulnerable adults. This Annual Report demonstrates how we are fulfilling our duty to safeguard children and young people and identifies planned improvements for 2018/19. These planned improvements take account of the Government’s mandate to NHS England, published in November 2012, which sets a specific objective of continuing to improve safeguarding practice in the NHS and also reflects the commitment to prevent and reduce the risk of abuse and neglect to adults.


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Appendix 1

Southwark Children Subject To a Child Protection Plan

Year to: Number of Children Subject to a plan in Southwark (Snapshot figure end of qtr. 4)

Number of Looked after Children in Southwark (snapshot figure end of qtr. 4)

March 2014 327 550

March 2015 309 503

March 2016 287 474

March 2017 326 498

March 2018 349 487

Children subject to a Child Protection Plan by category of abuse

Category of abuse March 2017 No. of Children %

March 2018 No. of Children %

Emotional Abuse 126 39% 181 51%

Neglect 161 49% 141 40%

Physical Abuse 17 5% 22 6%

Sexual Abuse 11 3% 12 3%

Multiple 11 3% nil nil

safeguarding children annual report · committee, which meets bi-monthly and reports to the...

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