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Safeguarding Children PolicyDocument Control Sheet

Q Pulse Reference Number POL-CCPS-SG-3

Version Number 02

Document Author Named Professional for Safeguarding Children

Lead Executive Director Sponsor Director for Clinical Care and Patient Safety

Ratifying Committee Quality Committee

Date Ratified 24 March 2016

Date Policy Effective From 24 March 2016

Next Review Date 01 March 2019

Keywords Child, protection, safeguarding, FGM, Prevent, Abuse, neglect, Allegation, unexpected death, sexual assault, dangerous dogs, information sharing, referral, mental capacity, drug misuse, self-harm, record keeping, domestic violence

Unless this copy has been taken directly from the Trust Quality Management site (Q-Pulse) there is no assurance that this is the most up to date version.

This policy supersedes all previous issues.

Version No 02 Ratified of 42

Safeguarding Children Policy

Version Control - Table of Revisions

All changes to the document must be recorded within the ‘Table of Revisions’.

Version number

Document section/ page number

Description of change and reason (e.g. initial review by author/ requested at approval group

Author/ Reviewer

Date revised

02 5.16 Added to policy to ensure NEAS adhere to statutory duty

SafeguardingChildren Lead

March 2016

5.20 Allegations Against Staff overview added in line with the full Allegations Against Staff policy

SafeguardingChildren Lead

March 2016

5.25 Child Sexual Exploitation - SafeguardingChildren Lead

March 2016

5.26 Female Genital Mutilation SafeguardingChildren Lead

March 2016

5.27 Prevent SafeguardingChildren Lead

March 2016

This page should not be longer than one single page.

Version No. 02 Ratified of 42


Table of Contents1. Introduction 6

2. Purpose 6

3. Duties - Roles & Responsibilities 7

3.1 Trust Board 7

3.2 Chief Executive 7

3.3 Director of Clinical Care and Patient Safety 8

3.4 The Head of Clinical Care and Patient Safety 8

3.5 The Named Professional for the Safeguarding of Vulnerable Groups (children) 8

3.6 Safeguarding Administrator / Officer 10

3.7 All staff 10

3.8 All clinicians/frontline staff must also: 11

3.9 Other Specialist Advisers may include: 11

3.10 Sources of Expertise and Support 12

4. Glossary of Terms 12

5. Policy Content 13

5.1 Action when abuse of harm is suspected 13

5.1 Non Urgent Concerns 14

5.2 Urgent Concerns 14

5.3 Patient Assessment – Ambulance Crew 16

5.4 Action to be taken by Ambulance Crews, 16

5.5 Contact Centre Staff, 17

5.6 The PTS Contact Centre Staff, 17

5.7 Contact Centre Clinician, 111 and 999, 17

5.8 Police assistance, 17

5.9 Logistic Officer 18



5.10 Senior Management Responsibilities, 18

5.11 Consultation and Communication with Stakeholders 19

5.12 Public Involvement 19

5.13 Information Sharing 19

5.14 Record Keeping 19

5.15 Support for Staff 20

5.16 Unexpected death 20

5.17 Sexual Assault 22

5.18 Children of Drug-Misusing Parents 22

5.19 Domestic Abuse 22

5.20 Allegation Against Staff 23

5.21 Serious Case Reviews 23

5.22 Deliberate Self-Harm/Suicide/PARA-Suicide 24

5.23 Dangerous Dogs/Animals 25

5.24 The Mental Capacity Act 2005 25

5.25 Child Sexual Exploitation 25

5.26 Female Genital Mutilation 26

5.27 Prevent 26

6. Training Required for Compliance with this Policy 27

7. Equality and Diversity 29

8. Monitoring Compliance with and Effectiveness of this Policy 29

8.1 Compliance and Effectiveness Monitoring 29

8.2 Compliance and Effectiveness Monitoring Table for this policy 31

9. Consultation and Review of this Policy 32

10. Implementation of this Policy 32

11. References 32

12. Associated Documentation 34



13. Appendices 35

13.1 Appendix 1 Types of Abuse 35

13.2 Appendix 2(a) - Safeguarding Children Referral Pathway 38

13.3 Appendix 2(b)Safeguarding Children Referral Process (Operational Staff ECS/PTS) 39

13.4 Appendix 2(c) - Safeguarding Referral Process for Call Takers (999/111) 40

13.5 Appendix 3 Child Death Process 41

13.6 Appendix 4 PREVENT Referral 42



1. IntroductionAll children have the right to be protected from harm and their safety and welfare is paramount. The protection of children from harm is the responsibility of every individual in a position to help. It is essential that whenever an individual has concerns about whether a child is suffering or is at risk of suffering significant harm; they share their concerns using the procedures identified in this document.

Social Care and the Police have statutory authority and responsibility to investigate allegations or suspicions about child abuse. NEAS will refer all such concerns to Social Services. However, in circumstances which could be described as an emergency, cases should be referred immediately to the Police.

The National Service Framework (NSF) for Children, Young People and Maternity Services September 2004, sets standards for children’s health and social services, and the interface of those services with education. This NSF aims to ensure fair, high quality and integrated health and social care from pregnancy, right through to adulthood. Core Standard 5.5 states ‘In the course of their work, ambulance staff have access to family homes, often in a time of crisis and they may identify initial concerns regarding children’s welfare…and may be best placed to identify concerns’. It also states that each Ambulance Trust must designate a named professional for safeguarding children.

Section 11 of the Children Act 2004, section 175 of the Education Act 2002 and section 55 of the Borders, Citizen and Immigration Act 2009 place duties on organisations and individuals to ensure that their functions are discharged with the regard to the need to safeguard and promote the welfare of children.

NEAS has responsibilities under the Children Act (1989), which states:

"All those working in the field of health have a commitment to protect children, and their participation in inter-agency support to Social Service departments is essential if the interests of children are to be safeguarded."

Every investigation into a child death has included in its findings the importance of good communications and professional relationships between the organisations responsible for the care and protection of children. The organisation recognises its responsibility to promote best practice in this area and therefore actively supports liaison with other agencies through representation on Safeguarding Boards as requested by Clinical Commissioning Groups (CCG) and Local Authorities.

The organisation will work with partner organisations to protect children and participate in reviews established in ‘Working Together to Safeguard Children’ (2010).



2. PurposeThe aim of this policy is to ensure that, throughout the Trust, children are protected from abuse and exploitation.

To ensure all NEAS Staff and those sub contracted to deliver services are aware of, and can recognise, cases of suspected child abuse.

To ensure that all NEAS staff involved in a case of reported abuse are aware of the possible outcome of any subsequent actions.

To promote education and training in all aspects of safeguarding children.

To ensure the Trust complies with Working Together to Safeguard Children a guide to inter- agency working to safeguard and promote the welfare of children; Every Child Matters Green Paper (2003); the formal response to the Inquiry into the death of Victoria Climbié and the Children Act 1989 and 2004.

In conjunction with the Joint Royal Colleges Ambulance Liaison Committee guidance (JRCALC) 2013

This policy aims to ensure that all risks associated with the recognition of a vulnerable child and the referral processes are adequately controlled.

3. Duties - Roles & Responsibilities3.1 Trust Board

The Trust Board is responsible for ensuring that effective systems are in place to safeguard children. Good governance in safeguarding will follow where it is seen as integral part of patient care and all staff take responsibility. Risks of neglect harm and abuse will be reduced where there is strong leadership and a shared value base. The Board will provide that strong leadership and demonstrate leadership across the organisation, set strategic safeguarding objectives and connect aligned strategic areas. The Board will provide accountability for the governance of safeguarding – to the service, partners and regulators.

Non-executive directors and lay members of the Trust also have a vital role to play in embedding the safeguarding agenda. They have an opportunity to provide independent scrutiny and hold services to account. They can also help ensure that quality and safety are not pushed from the agenda by other operational and financial pressures.

3.2 Chief Executive

The Chief Executive is ultimately responsible for the proper and effective management of risk within the Trust and is responsible for ensuring the safety of patients, visitors and staff within the organisation. Responsibilities also include:

Having robust systems in place to identify trends and themes around



safeguarding children incidents

Ensuring that measures are taken so that the safety of patients, staff and visitors are not compromised

Having robust system in place to learn lessons across the organisation

Ensuring this procedure is implemented within all areas of the Trust through responsible Directors and Managers.

3.3 Director of Clinical Care and Patient Safety

The Director of Clinical Care and Patient Safety will:

Act as the nominated Executive Director within the Trust for Safeguarding and ensures the Trust complies with the statutory duties for safeguarding Children.

Be accountable for reporting on the governance for Safeguarding Children to the Trust Board, its regulators, people who use the service, their carers, families and partner agencies.

Represent the Trust at Quality Review Group (QRG) locally and Quality Governance and Risk Directors (QGARD) nationally for Safeguarding issues.

They are also the nominated Caldicott Guardian and responsible for ensuring Caldicott principles are followed in relation to safeguarding and information sharing.

Chair of the Safeguarding Committee.

3.4 The Head of Clinical Care and Patient Safety

Is the Strategic Lead for Safeguarding development and ensures the Safeguarding Children Policy is developed and delivered in line with National and Local Legislative and Statutory requirements, manage the Safeguarding Team, its roles and functions which include Chairing the Safeguarding Group.

3.5 Named Professional for the Safeguarding of Vulnerable Groups (children)

Named professionals have a key role in promoting good professional practice within the Trust.

Joint responsibility with the Named Professional (Adults) for the management of the Safeguarding Team;

Responsible for implementing the review of the Trust’s Child Protection Policy and procedures in line with the Trust policy.

Responsible for liaising with external stakeholders and the sharing of information where appropriate in accordance with the Trust’s information sharing policy and associated procedures;



Communicate learning points identified during investigations to relevant internal and external stakeholders;

To be accessible to frontline staff for advice and guidance within the multi-agency guidance and trust policy;

To ensure patients reported via the Trust procedures for Safeguarding Children are recorded on the Trust record of safeguarding alerts (Ulysses);

Responsible for producing safeguarding reports for relevant sub-groups, committees and the Trust Board;

Responsible for the contribution to Serious Case Reviews (SCR) reports and co-ordination of requests for information for legal cases;

Represent the Trust at appropriate external safeguarding meetings (multi-disciplinary / strategy / Domestic Homicide Reviews (DHR) / Serious Case Reviews / patient review) across the North East, Child Death Reviews CDR;

Provide clinical leadership and expert practice, lead improvements, innovations and best practice;

Coordinate the production of the Trust’s annual Safeguarding report;

Maintain links with the wider safeguarding children network and ensure relevant information is disseminated as required to all staff within NEAS and external third party providers;

Provide assurance that the appropriate level of safeguarding training via the Essential Annual Training (EAT) programme, working in partnership with the training department;

Offer where necessary support, guidance and supervision to staff with concerns relating to safeguarding children;

Support relevant Local Safeguarding (LSCB) and their sub-groups as part of the multi-agency safeguarding agenda;

Maintain data base (Ulysses) following case review meetings;

Share the learning from Serious Case Reviews (SCR);

Undertake enquiries internally to establish facts as and when requested by the Local Authority where the service user resides and there has been a safeguarding alert raised by NEAS or external agency;

Authorise Safeguarding reports produced by the Safeguarding Officer;

Develop, monitor and review the Safeguarding Annual Work Plan following discussion at the Safeguarding Group;

The Named Professional for the Safeguarding of Vulnerable Groups



(Children’s) is responsible for the updating and monitoring of the Safeguarding Risk Register which details the significant risks identified and associated risk action plans;

The Trust is a member of the National Ambulance Safeguarding Network which promotes best practice in the ambulance sector for the Safeguarding agenda. The Named Professionals for the Safeguarding of Vulnerable Groups are the representatives of this group on behalf of NEAS.

3.6 Safeguarding Administrator / Officer

The role of the administration team is to;

To be the single point of access internally within the Trust for all Safeguarding Adult enquiries and to receive notifications from the Local Authority regarding Safeguarding Referral Alerts against the Trust ensuring all processes and policy guidance is adhered to.

Analyse data relating to the safeguarding and identify any trends or common themes. Produces and updates the Integrated Performance Report (IPR) on a monthly basis.

Produce reports following requests by the relevant Local Authority for the purpose of information sharing and child protection arrangements.

Research and complete Chronology templates on behalf of NEAS following requests by the relevant Local Authority for SCR and CDR.

Log Multi-Agency Public Protection Arrangements (MAPPA) and Multi-Agency Risk Assessment Conference (MARAC) notifications.

3.7 All staff

All staff within North East Ambulance Service NHS Foundation Trust are responsible for ensuring that the principles outlined within this policy are universally applied.

All operational staff have a responsibility to make themselves aware of this policy and act accordingly in safeguarding the welfare of all children.

All staff involved in working with children should attend training in safeguarding and promoting the welfare of children and should have regular updates as part of any post-registration educational program.

All staff working for the organisation must:

Must complete level 1 safeguarding training, then further training appropriate to their role.

Understand what constitutes child abuse

Be able to recognise signs of child abuse as related to their role (See Appendix 1 for definitions of abuse and neglect)



Know what to do when they are concerned that a child is being abused and be aware of their own (and other’s) professional boundaries

Be able to seek advice and report concerns ensuring they are listened to

Understand the importance of sharing information, how it can help and the dangers of not sharing information

Know how to share information in writing (and document appropriately) by telephone, electronically or in person, differentiating between fact and opinion.

3.8 All clinicians/frontline staff must also:

Know who to inform or seek advice from, when and how when further support is needed

Know who to share information with and when

Understand the difference between information sharing on individual, organisational and professional levels.

To attend Safeguarding children training as part of the Trust’s corporate induction programme, mandatory training programme in accordance with requirements in the Trust’s training needs analysis.

Attend safeguarding training appropriate to their role.

NEAS have in place relevant recruitment policies and practices, including Disclosure and Barring (DBS) checks for all staff – including third party providers, agency staff, students and volunteers-who work with children.

In the reporting of a suspected case of abuse, the emphasis must be on shared professional responsibility and immediate communication. Attempts must be made to work in partnership with the child and family, taking into consideration their race, culture, gender, language and experience of disability.

Although parents/carers should generally be kept informed of the actions required in the interest of child protection, this may not always be practicable for NEAS staff. It is particularly important that parents should not be informed of an ambulance crews concerns in circumstances when this may result in a refusal to attend hospital or in any situation where a child may be placed at risk.

3.9 Other Specialist Advisers may include:

Clinical Advisory Group (CAG)

Risk and Regulatory Services

Human Resources

Local Safeguarding Adults Board (LSAB)

Multi Agency Risk Assessment Committees (MARAC)



Local Police Constabularies

Trust Solicitors

Clinical Commissioning Groups (CCG)

3.10 Sources of Expertise and Support

The Trust has a dedicated Safeguarding Team compromising of a Safeguarding Lead for Adults, a Safeguarding Lead for Children and Administrative support.

The Trust is a member of the National Ambulance Safeguarding Network which promotes best practice in the ambulance sector.

4. Glossary of TermsThis policy uses the following terms:

Term Description

Child/children Anyone who has not yet reached their 18th birthday. ‘Children’ therefore means ‘children and young people’ throughout. 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 or custody in the secure estate for children and young people, does not change his or her status or entitlement to services or protection under the Children Act 1989.

Child Death Review CDR Each death of a child is a tragedy and enquiries should keep an appropriate balance between forensic and medical requirements. Professionals should be advised 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. The Local Safeguarding Children Board (LSCB) functions in relation to child deaths are set out in Regulation 6 of the Local Safeguarding Children Boards Regulations 2006, made under section 14(2) of the Children Act 2004.

Multi-Agency Public Protection Arrangements (MAPPA)

Public protection arrangements to manage the risks from potentially dangerous individuals. Regular meetings held between the local Police Force, National Probation Service, Prison services and other partners to manage violent and sexual offenders and protect the public.

Multi-Agency Risk Assessment Conference (MARAC)

Meeting where information is shared on the highest risk domestic abuse cases between representatives of the local police, health, child protection, housing practitioners, Independent Domestic Violence Advisors (IDVAs) and other specialists from statutory and voluntary sectors.

Whistle blowing Whistle blowing policies and procedures are in place to enable staff to raise serious concerns that cannot or have not been



Term Description

addressed through normal line management routes.

Ulysses Risk Management tool

Safeguarding and promoting welfare and child protection

Protecting children from maltreatment;• Preventing impairment of children’s health or development;• Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care;Child protection is a part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering or likely to suffer, significant harm.

Significant Harm The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and gives local authorities a duty to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering or likely to suffer, significant harm.

Section 11of the Children Act 2004

Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children.

Coroner Coroners are independent judicial officers who are responsible for investigating violent, unnatural deaths, sudden deaths of unknown cause, deaths whilst a person is subject to a Deprivation of Liberty and deaths in custody.

Joint Royal Colleges Ambulance Liaison Committee

Clinical Practice Guidelines – provides robust clinical specialty advice to ambulance services within the UK, these guidelines are reviewed and updated when necessary.

5. Policy Content5.1 Action when abuse of harm is suspected

There are a number of ways in which ambulance crews may receive information or make observations which suggest that a child has been abused or is at risk of harm. For example, the nature of an injury to a child might suggest that the child has been abused (e.g. the story given for an injury may be inconsistent with what is observed) Observations about the condition of other children or adults in the household might suggest risk (e.g. a child living in an environment where domestic violence has taken place). Staff may observe hazards in the home, or find that children have been locked in a room. Signs of distress shown by other children in the home should be recorded.

An ambulance crew will often be the first professional on scene and their actions and recording of information may be crucial to subsequent enquiries.



Control Contact Centre and 111 Urgent Care staff may overhear or suspect a possibility of abuse or risk of harm and will then complete an electronic Child Protection/Safeguarding Concern Referral Form by contacting the Logistic Desk (Appendix 2c) as well as advising the crew of their concerns raised on the call.

The Logistic Officer will complete the electronic referral form on Ulysses Risk Management System and email to the appropriate social care area. The logistic officer MUST discuss the incident with the Emergency Duty Team (EDT) during out of hours (17.00 till 08.00 hrs, weekends and Bank Holidays.

5.1 Non Urgent Concerns

If the threshold for harm has been assessed as being one of a lower level of concern i.e. a ‘child in need’ rather than a ‘child in need of protection’ the clinician should ensure the GP, Health Visitor or local Safeguarding Children’s Team is informed of the concern the next working day. This should be done by documenting in the call record in the first instance and secondly by completion of the Child Protection/Safeguarding Concern Referral Form and direct liaison with the Logistics Desk on 0300 011 0132.

This form will then be sent to the NEAS Child Safeguarding Team and to NDUC for retention with the patient’s records the next working day.

An example of a non-urgent concern may be a child who is not in any immediate danger but perhaps is seen to be living in poor conditions; wearing dirty clothes or appears to have dental problems, such as black teeth or prolonged tooth ache which has not been relieved with appropriate pain relief. These types of concerns may indicate social care issues rather than physical neglect or abuse. However, if a child has suffered a facial injury resulting in dental problems e.g. broken teeth which may be a suspected non accidental injury, this must always be treated as an urgent concern.

5.2 Urgent Concerns

If you have any doubt as to the level of concern, you must seek the advice of the on Call Paramedic or Emergency Care Clinical Manager or Team Leader. The On Call Paramedic will be happy to discuss any clinical or operational problem with you. If you feel in any doubt and need support or advice coming to a decision or even just reassurance that your chosen decision is appropriate.

If you have knowledge of, or suspicion that, a child is suffering or likely to suffer from significant harm:

Discuss your concerns immediately with the Emergency Duty Team (EDT) social worker for the specific CCG Area by contacting logistic desk requesting to arrange contact prior to a formal referral to Children’s Services.

An agreed strategy will be implemented together with the EDT Social Worker, the strategy will determine how the case will be managed and monitored and at what point your and thereby the organisation’s responsibility will be discharged.



You should where appropriate inform the parent/carer of your concerns and request their permission to refer the child/family to Children’s Services. If the parent/carer refuses to give their permission, you will need to explain to the parents that they are required under the organisational policy to make the referral, even without their consent. However, if informing the parents/carers at that particular time is deemed to put the member of staff at risk, and a clinician has concerns about their own safety they should contact the Emergency Duty Team social worker to discuss and agree other options that would allow them to inform the parents in a way that would ensure the child’s and their own safety.

The EDT social worker must be informed of whether or not the parents/ carers are aware of the referral (or the reasons why they have not been informed).

Document in the child’s electronic patient records the following information:

The date and time the referral was made, or when the case was discussed with the Social Worker.

The name of the Social Worker with whom the discussion took place, or the name of the person taking the referral.

Details of the information given to the Social Worker (reference can be made to the written referral form).

What strategy has been agreed i.e. who will be taking future action and what action is to be taken. You should be aware of the legal framework relating to the disclosure of information. However this is a complex area and if you are at all unsure about your right to disclose information, or your duty to share information, you must seek the advice of the On Call Paramedic.

When there is suspicion that a child has been physically or sexually abused or neglected, a referral should be made to a pediatrician ‘on call’ for child protection as a forensic examination, medical opinion and written report may be required. This information will be passed on at the hospital handover.

If the child is referred for a physical examination, you must contact the place of referral to ensure the child attends.

If you have concerns that a medical opinion is not being sought when you believe it should be, contact the Social Worker to inform them of your concerns and to discuss any further action which may be required. If the issue remains unresolved, contact the On Call Paramedic to discuss further. Clarify the point at which your responsibility will end.

Once a verbal referral has been made to the EDT, you must complete the Child Protection/ Safeguarding Concern Referral Form for reporting concerns regarding child abuse or neglect, and contact the Logistics officer on 0300 0110132.

The Logistic Officer will forward the concern to the relevant Safeguarding Children Team via secure e-mail and, in addition, send a notification to the NEAS



safeguarding children team who will be able to access the copy on Ulysses.

A copy of the referral will be available to NDUC and a note to be filed with the patient’s records.

5.3 Patient Assessment – Ambulance Crew

NEAS crews should follow the normal history-taking routine, taking particular note of any inconsistency in history and any delay in calling for assistance. They should limit any questions to those of routine history-taking, asking questions only in relation to the injury or for clarification of what is being said. It is important to stop questioning when their suspicions are clarified. They should not question the child, but should listen and react appropriately to instill confidence. They should avoid unnecessary questioning or probing, as this may affect the credibility of subsequent evidence. They should write down exactly what they have been told.

Crews should accept the explanations given, and not make any suggestions to the child as to how an injury or incident may have happened. Similarly, if they are told of abuse, they should not question the child, but should accept what they are being told and act appropriately.

Remember, NEAS is not there to investigate suspicions. The task for ambulance crews is to be aware of the issues of child abuse including sexual exploitation, but not to be experts in this area. They should ensure that any suspicion is passed to the appropriate agency, i.e. staff in the ED, receiving department, social services or the police.

5.4 Action to be taken by Ambulance Crews,

If an ambulance crew attend a child and are concerned that the child may have been either physically, sexually, emotionally abused, or neglected, they should take the following actions:

If the child is the patient, and the parents/carers agree that he/she is to be conveyed to hospital, they should not let the parents/carers know they are suspicious if this may result in refusal to go to hospital. They should speak to the most senior member of nursing staff on duty and inform them that they are going to make a referral to safeguarding via the logistic desk.

Ensure that the Patient Report Form/Electronic Patient Report Form (PRF/ePRF) is completed and your concerns clearly documented in the free text area. This should be done away from a public area and in private if possible. Full details of their concerns or suspicions should be relayed to the receiving nurse, with a recommendation that the Child Protection Register should be consulted. Although individual ED Departments have access to the Child Protection Register for their area, they may need to ask for police assistance if the central register needs to be consulted. PTS crews should complete a copy of the electronic Child Protection/Safeguarding Concern Referral Form by contacting the Logistic desk as detailed in appendix 2b and notify the ward staff of your concerns.

The crew (A&E, Urgent Care or PTS) should inform Logistic Desk about their concerns so that they can complete the electronic referral document as soon as



reasonably possible.

If the child is the patient and the parents/carers refuse to allow them to be conveyed to hospital, the crew should inform Logistic Desk who will complete an electronic Child Protection/Safeguarding Concern Referral Form. The Logistic Officer will contact the police and Social Care on the 24-hour emergency number. They will also arrange for peer support if necessary via the Duty Manager via their ECCM.

If the child is not the patient but the circumstances are suspicious, the crew should consider the implications of leaving the child. If the child is accompanying another person (e.g. a parent) who is being conveyed, the crew should inform hospital ED staff of their concerns. If no-one is conveyed to hospital, and the crew leaves the scene, they should contact Logistic Desk who will complete the electronic Child Protection/Safeguarding Concern Referral Form with details of the incident.

In all cases where abuse of a child is suspected an electronic Child Protection/Safeguarding Concern Referral Form must be completed and, where the child is conveyed to hospital, to the ED or other relevant hospital department the staff must be notified of your concerns and informed that you have contacted social care.

5.5 Contact Centre Staff,

In all cases where abuse is suspected an electronic Child Protection Safeguarding Concern Referral Form must be completed by contacting the Logistics Desk as detailed in (appendix 2c).The Logistic Officer will forward the concern to the relevant safeguarding team via secure e-mail, in addition, send a notification to the NEAS safeguarding team.

5.6 The PTS Contact Centre Staff,

In all cases where abuse of a child is suspected an electronic Child Protection Safeguarding Concern Referral must be completed by the member of staff taking the call by contacting the Logistic Desk (appendix 2b)

5.7 Contact Centre Clinician, 111 and 999,

If you are a clinical member of staff then you must first seek to identify the potential threshold or risk of significant harm to the child. Any concern must be carefully documented in the case records by making a factual, non-opinion based statement.

5.8 Police assistance,

The police have a number of legal powers to protect children. These include the power to gain entry into a building in some circumstances and the power to remove a child into police protection for up to 72 hours. Any police constable may affect this if he/she considers that a child is at risk of ‘significant harm’. The child should have a clinical assessment before being taken into police custody.

In urgent circumstances where an ambulance crew think that a child is at immediate risk of significant harm, they should inform the contact center who will



request the police attendance.

There may be circumstances where there are concerns for an unborn child, e.g. when a pregnant woman has been physically assaulted or is alcohol/substance dependent. In a situation of this type, NEAS staff should make an immediate referral to Children’s Social Care.

5.9 Logistic Officer

On receiving details about a potential case of abuse or concern from any source within NEAS and NDUC the Logistic Officer should contact the relevant Social Care or Emergency Duty Team (Out of Hours) by telephone for that area to start the referral process. During weekends, Bank Holidays and evenings the Logistic Officer should briefly advise the Social Worker of the concerns raised by the staff so that a decision can be made whether the referral can wait until the next working day or requires immediate action by the Emergency Duty Team. A note of the contact and name of the person contacted should be recorded on the electronic safeguarding referral form. The Logistic Officer should complete the logistic desk data spread sheet and forward to the safeguarding team on a monthly basis.

The Logistic Officer will send an email to the safeguarding mailbox alerting them to the referral and the actions taken. As part of this policy and procedure the Trust has identified all Social Care Departments within our boundaries, established contact and gained contact numbers and secure email addresses for the referral of vulnerable children, this list will be maintained and regularly updated in the contact center by the safeguarding team.

The Social Care staff may ask for details of the incident and what the crew considers to be the level of risk. This will include whether the child is at risk of ‘significant harm’.

5.10 Senior Management Responsibilities,

Senior Managers will ensure that any request from a statutory agency for a statement or other information will be communicated through the crew's line manager. They will also ensure that any member of NEAS staff instructed to attend court to give evidence will receive appropriate support and advice from the Trust. This will include ensuring the documentation is available in good time, allowing time for brief / debrief before and after a court appearance or case conference, and that the member of staff will be accompanied by their line manager, ECCM or NEAS Safeguarding Lead.

Child protection concerns notified by the NEAS will be subject to enquiries by Social Care departments and will be investigated by Social Care and/or the Police. Ambulance crews may be required to assist by giving a statement to clarify their observations in more detail. NEAS staff may be requested to attend a case conference, will be accompanied by their line manager, ECCM or NEAS safeguarding lead and supported by other Designated Professionals for Child Protection.



5.11 Consultation and Communication with Stakeholders

All health professionals may seek advice from a Designated Nurse or Doctor for Child Protection in their area during normal working hours. NEAS crews may obtain contact information from the Control Duty Manager in Ambulance Contact Centre or the Safeguarding Lead.

In the reporting of a suspected case of abuse, the emphasis must be on shared professional responsibility and immediate communication. Attempts must be made to work in partnership with the child and family, taking into consideration their race, culture, gender, language and experience of disability.

Although parents/carers should generally be kept informed of the actions required in the interest of child protection, this may not always be practicable for NEAS staff. It is particularly important that parents should not be informed of an ambulance crew's concerns in circumstances when this may result in a refusal to attend hospital or in any situation where a child may be placed at further risk.

5.12 Public Involvement

The Trust is committed to ensuring that the general public are kept fully informed of its performance relating to issues regarding the Safeguarding Childrens agenda. The Safeguarding Annual Report is available for public scrutiny. Details of the Trust’s Safeguarding initiatives including policies and procedures are available to the public via the Trust’s web-site.

Under the Care Quality Commission members of the local authority health overview & scrutiny committee and service users and their representatives on Health Watch are invited to comment on the Trust’s Safeguarding Childrens policy.

5.13 Information Sharing

All requests for information regarding Safeguarding Children issues should be referred to the Named Professional for Safeguarding Children. The Corporate Governance team should be contacted prior to any information being shared with external agencies. Information will be shared on a need to know basis in compliance with Caldicott Guidance, Data Protection Act (1998) and ‘Information Sharing’ A Practitioners Guide (Dfes, 2006).

On occasions, the Trust will receive alerts regarding Safeguarding Children issues i.e. absconded pregnant patients with care orders/Police Protection Orders. In this instance, the information will be dealt with in accordance with the Trust’s data flagging. If there is evidence to suggest the threat of harm or violence to NEAS staff, the information will also be shared with the Director of Clinical Care and Patient Safety and the Head of Risk and Regulatory Services for NEAS.

5.14 Record Keeping

All staff will recognise that records should be factual, accurate, concise and clearly written in black ink, with a legible date, time and signature.

Referrals should include as much information as possible and as a minimum, the child/children’s full name(s), date(s) of birth and address. Where possible details of



parents or carers, GP, siblings and school attended should be included.

5.15 Support for Staff

All staff will have the opportunity to access clinical or personal support in relation to Safeguarding Children issues, if they feel they need or would benefit from this, either immediately following an incident or at any time in the future. Should staff require personal support, then their line manager should be contacted and a self-referral to the Occupational Health Provider should be initiated.

Support may be offered by persons suitably experienced/qualified in Safeguarding Children Clinical Supervision. Staff requesting Clinical Supervision should contact their line manager in the first instance. The line manager should contact the Named Professional for Safeguarding Children to discuss the issue and arrange the process.

Any staff who are required to attend Coroner’s or Crown Court regarding children and young people may contact the Named Professional for Safeguarding Children, for safeguarding advice and support prior to the event if required.

5.16 Unexpected death

Unexpected death in children and young people is defined as:

“The death of a child that was not anticipated as a significant possibility 24 hours before the death, or where there was a similarly unexpected collapse leading to or precipitating the events that led to the death.” Working together to Safeguard Children (Dfes 2006).

Unexpected death may be caused by one of the following (this list is not exhaustive):

Trauma - i.e. Thermal Injuries/Road Traffic Collision, Assault, Fall etc.

Medical - i.e. Respiratory Disease/Sepsis/Convulsions/OD/SUDI etc.

LSCB regulations mean that child death review functions became compulsory from 1st April, 2008. Therefore as co-opted partners with each LSCB in NEAS regional area, NEAS has a responsibility to share information in relation to any unexpected death of children from birth to 18 years of age. (Not including stillbirth). Regardless of whether there are child abuse/neglect issues present or not.

All children and young people who suffer an unexpected death must be conveyed to the nearest Emergency Department following resuscitation attempts. However, there will be occasions when this is not possible due to extreme trauma, decapitation for example, or preservation of a crime scene. Staff must ensure police have been notified of such an event at the earliest opportunity and liaise with the attending officers. Crew must remain on scene

The main objectives of management are:

To collect the evidence needed to determine the cause of death. To provide support for the bereaved family.



To ensure that the law is complied with, and that forensic requirements are met.

It is acknowledged that a difficult balance needs to be achieved between supporting parents and families and enabling the police to thoroughly investigate the death.

Staff/ECCM/EOC Team Leader should inform NEAS Named Professional for Safeguarding Children as soon as possible of any unexpected death involving children and young people less than 18 years of age. This can be conducted via the telephone or e-mail, with the following information:

Incident Number

Location of Incident

Date of Incident

Nature of Incident

Patient Details (to include if known –Age/Sex/Name/DOB/Address/GP/Health Visitor etc.)

Treatment by personnel attending incident

Destination conveyed to or ROLE policy applied at scene

The Named Professional for Safeguarding Children will contact the contact center that handled the call to ascertain any further information that may be required. This information will be shared with the administrator for each CDOP in the locality where the child normally resides utilising national Confidential Enquiries into Maternal and Child Health (CEMACH) data collection tools. The information will also be shared with the Designated Nurse for the locality where the child/young person normally resides where possible.

NEAS staff attending the incident will offer treatment in accordance with current JRCALC clinical guidelines and refer to NEAS Recognition of Life Extinct (ROLE) policy when confirming that death has occurred. Liaison with Police and Emergency Department staff is crucial in securing evidence and ensuring continuity is provided.

Personnel must complete a Patient Report Form and a ROLE form as per NEAS procedure in the usual manner, to display all assessments/treatments and decisions regarding the incident.

On completion of the incident a safeguarding referral should be completed by contacting logistic desk on 03000110132, the logistic officer will complete the child death/safeguarding referral form and email a copy to the local social care department of the child’s home address locality (if known). Details of the incident should be documented in the free text, the concern should again state what the circumstances are and any further details available regarding the incident. (Appendix 3 PCU 5050)



5.17 Sexual Assault

Sexual assault of children and young people necessitates ambulance personnel to liaise with the Police at the earliest opportunity. On receiving such a call, the contact center must inform the Police operations room as soon as possible.

Personnel must follow guidelines for dealing with sexual assault in accordance with current JRCALC guidelines.

If in the opinion of the ambulance practitioner the patient is clinically stable following baseline observations recording, i.e. respiratory rate, pulse, BP, temperature, GCS etc., and there are no apparent injuries, it may be necessary, under guidance from the police, to transport the patient to a Sexual Assault Referral Centre (SARC) where a Forensic Medical Examiner (FME) is present. This judgment must be based solely on clinical decisions made by the staff attending the incident. This may dictate that the patient is not taken to the nearest ED department. Ensuring the patient is clinically stable takes precedence over any suggested forensic gathering exercise. Therefore, if patients require medical/supportive treatment following the incident, transportation to the nearest ED department is the first priority. Liaison with the Police and FME must be sought on making any such judgments. Clarification must also be sought by the contact center handling the incident, and contact made with the receiving ED to ascertain suitability to handle such a case.

5.18 Children of Drug-Misusing Parents

After receiving a call regarding the usage of illegal drugs, the contact center must contact the Police Operations room and share information regarding the incident.

NEAS staff attending such incidents must establish if any children/young people are at risk from the event, (i.e. needle stick injuries, cross-infection, ingestion etc.)

If children/young people are present at such incidents, then staff should inform the contact center as soon as possible. The staff must also consider making a referral to social care as soon as is practicable.

5.19 Domestic Abuse

Children and young people may suffer directly and in-directly if living in situations where domestic abuse is occurring.

“Everyone working with women and children should be alert to the frequent inter-relationship between domestic violence and the abuse and neglect of children”. National Service Framework for Children, Young People and Maternity Services (2004).

NEAS staff must consider the physiological and psycho-social impact of children and young people witnessing (or being subjected to) domestic abuse. When attending such an incident, staff must request liaison with the Police, especially if the patient is not conveyed to hospital. Staff must also consider whether the magnitude of the incident is sufficient to warrant a referral to social care. If NEAS staff become aware of domestic abuse occurring within a household, concerns must be raised with via a safeguarding referral and concerns documented on Patient Report Forms within



case notes. Attending police officers can provide access to, and support from, the local Multi Agency Risk Assessment Committees (MARAC) in the locality. This would enable the victim and perpetrator to receive the appropriate level of support and monitoring.

Further support and guidance for health professionals can be found in the document: “Responding to Domestic Abuse: A Handbook for Health Professionals” (DH 2006).

5.20 Allegations Against Staff

Please refer to the Allegation against Staff Policy

When NEAS receives an allegation or complaint against any member of staff that may have Safeguarding Children issues, the Named Professional must be consulted at the earliest opportunity. This also relates to incidents raised via the NEAS whistle blowing policy. If staff have concerns regarding an employee’s behaviour towards or around children and young people, then these concerns may be raised via this process.

The Named Professional will seek guidance on the issue, which may include discussing the case with the Local Authority Designated Officer (LADO) and/or the police. Following this the Named Professional will discuss the case with a Human Resource Manager if the NEAS Allegations Against Staff policy should be activated.

Working Together to Safeguard Children (Dfes 2006) suggests:

“The scope of inter-agency procedures is not limited to allegations involving significant harm, or risk of significant harm, to a child.

Guidance should be followed in respect of any allegation that a person who works with children has:

behaved in a way that has harmed or may have harmed, a child; or

possibly committed a criminal offence against, or related to, a child; or

behaved towards a child or children in a way that indicates s/he is unsuitable to work with children

In the absence of the Named Professional, the Director for Clinical Care and Patient Safety must be contacted with details of the incident.

Staff have a duty to report at the earliest opportunity if they have been stopped or cautioned by police in such incidents as described in this policy.

5.21 Serious Case Reviews

A serious case review (SCR) may be initiated in the following circumstances: Regulation 5, 1989 Children’s Act requires LSCB’s to undertake serious case review and should be undertaken in accordance with national procedures. LSCB’s decide whether or not a case should be the subject of a serious case when:

A child dies, and abuse and neglect is known or suspected to be a factor in



the death; or

A child sustains a potentially life threatening injury or serious and permanent impairment of health and development through abuse or neglect; or

A child has been subjected to serious sexual abuse; or

A parent has been murdered and a homicide review is being initiated; or

A child has been killed by a parent with a mental illness; or

The case gives rise to concerns about interagency working to protect children from harm

Working Together to Safeguard Children (2006)

The Named Professional for Safeguarding Children will be responsible for the SCR process and ensuring compliance with the scope of the review and terms of reference for the case.

Bi-Monthly reports will be delivered to the safeguarding group and quarterly reports to the Strategic Safeguarding Committee, regarding the status of the SCR and any associated recommendations/action plans relating to the case

5.22 Deliberate Self-Harm/Suicide/PARA-Suicide

When attending incidents involving the above, NEAS staff must consider the impact on children and young people involved in such cases, either as patients or witnesses to these events involving their parents and carers. NEAS practitioners must seek guidance and support from other professional agencies, and not deal with these issues in isolation. This may include the Police, Mental Health Crisis Teams or Child and Adolescent Mental Health Services (CAMHS) for example.

It is essential that when NEAS staff attend incidents regarding suicide and Para suicide (attempted suicide, where the intention is not to kill oneself) that the utmost consideration is given to children and young people. This must also include discussion with the parents and carers, if children and young people are in the address at the time of the incident or living at the address.

Medical needs of the patient should be addressed in accordance with current JRCALC Clinical Guidelines. These guidelines also stipulate that any child/young person, who takes an overdose either accidentally or intentionally, should be taken to the nearest Emergency Department. If this does not happen, for whatever reason, then current JRCALC guidelines stipulate that the child’s General Practitioner and Health Visitor must be informed. If NEAS practitioners encounter problems with contacting these professionals, then contact should be made with the Named Professional for Safeguarding Children. Appropriate information should be shared with the Designated Safeguarding Lead area where the patient normally resides by the NEAS Named Professional.



5.23 Dangerous Dogs/Animals

When attending incidents involving dangerous dogs and animals, NEAS staff must be vigilant regarding personal safety and the threat posed to children and young people present at the incident.

NEAS staff must request the attendance of the police at such incidents, and consider the threat posed to children and young people by animal attacks.

Further help and advice is available regarding the Dangerous Dogs Act 1991 and other issues from the Department for Environment, Food and Rural Affairs website at http://www.defra .gov.uk/animals/welfare/domestic/dogs

5.24 The Mental Capacity Act 2005

(Including the Deprivation of Liberty Safeguards, and MCA Codes of Practice which supplement the Act)

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over living in England and Wales who are unable to make all or some decisions for themselves.

The MCA also supports those who have capacity and choose to plan for their future; this applies to everyone in the general population who is over the age of 16. Through Lasting Powers of Attorney (LPA), Deputyship and Advanced Decisions to Refuse Treatment (ADRT) are 18 plus, MCA applies from 16 thus wishes and feelings apply.

Professionals and other staff need to understand and always work in line with the MCA. They should use their professional judgment and balance competing views. All professionals have a duty to comply with the Code of Practice. It also provides support and guidance for less formal carers.

Refer to Adult policy for guidance on MCA and always consider this when dealing with parents or carers of children.

5.25 Child Sexual Exploitation

Sexual exploitation of children (CSE) and young people has been difficult to identify, it is increasingly recognisable as practitioners gain more understanding of grooming and other methods of sexual exploitation, and begin to take a proactive and coordinated approach to this type of abuse. It is not known how prevalent this is, but sexual exploitation has been identified throughout the UK, in both rural and urban areas, and in all parts of the world.

The sexual exploitation of children and young people is a form of child sexual abuse. Working Together to Safeguard Children (2006) describes sexual abuse as follows:

‘Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape, buggery or oral sex) or non-penetrative acts. They may include non-contact



activities, such as involving children in looking at, or in the production of, sexual online images, watching sexual activities or encouraging children to behave in sexually inappropriate ways.’

5.26 Female Genital Mutilation

There are new legislative measures being brought through the Serious Crime Act 2015 which will strengthen the legislative framework around tackling FGM. However, healthcare professionals are not expected to investigate or make decisions upon whether a case of FGM was a crime or not, under the legislation. All cases should be dealt with under existing safeguarding frameworks, which for children under 18 who have undergone FGM would mean a referral to Children’s Social Care and/or the police as appropriate.

5.27 Prevent

Exploitation by radicalisers who promote violence - Individuals may be susceptible to exploitation into violent extremism by radicalisers.

Violent extremists often use a persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits and embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause.

There are a number of factors that may make the individual susceptible to exploitation by violent extremists. None of these factors should be considered in isolation but in conjunction with the particular circumstances of the individual: identity or personal crisis, particular personal circumstances, unemployment or underemployment and criminality.

All of these may contribute to alienation from UK values and a decision to cause harm to symbols of the community or the state. The Home Office leads on the United Kingdom’s Strategy for Countering Terrorism - CONTEST.

The aim of CONTEST is to reduce the risk to the UK and its interests overseas from terrorism, so that people can go about their lives freely and with confidence.

Counter-terrorism continues to be organised around 4 work streams, each comprising a number of key objectives:

Protect: to strengthen our protection against a terrorist attack;

Prepare: to mitigate the impact of a terrorist attack;

Pursue: to disrupt or stop terrorist attacks;

Prevent: to stop people becoming terrorists or supporting terrorism.

Prevent is part one of the 4 elements of the CONTEST strategy, aiming to stop people becoming terrorists or supporting violent extremism. The Prevent strategy:

Responds to the ideological challenge we face from terrorism and aspects of extremism, and the threat we face from those who promote these views;



Provides practical help to prevent people from being drawn into terrorism and ensure they are given appropriate advice and support;

Works with a wide range of sectors (including education, criminal justice, faith, charities, online and health) where there are risks of radicalisation that we need to deal with.

The strategy covers all forms of terrorism, including far right extremism and some aspects of non-violent extremism. The Home Office works with local authorities, a wide range of government departments, and community organisations to deliver the Prevent strategy. The police also play a significant role in Prevent, in much the same way as they do when taking a preventative approach to other crimes.

Local safeguarding structures have a role to play for those eligible for adult protection. If staff identify any potential PREVENT issues in a vulnerable patient/ carer they should completed a Safeguarding referral and clarify prevent. (Appendix 4)

Channel uses existing collaboration between local authorities, statutory partners (such as the education and health sectors, social services, children’s and youth services and offender management services), the police and the local community to:

Identify individuals at risk of being drawn into terrorism; Assess the nature and extent of that risk; Develop the most appropriate support plan for the individuals concerned

Channel is about safeguarding children and adults from being drawn into committing terrorist-related activity. It is about early intervention to protect and divert people away from the risk they face before illegality occurs.

6. Training Required for Compliance with this PolicyAll staff will receive training at the appropriate level for their role in accordance with the NEAS training needs analysis/structured training plan. Safeguarding Children is statutory on all induction courses. This includes Student Paramedics, Ambulance Care Assistants, and Emergency Care Assistants.

The learning objectives can be found in Intercollegiate Document incorporates aims and outcomes for Level 1 and 2 in accordance with guidance provided by the Royal College of Paediatrics and Child Health (RCPCH). Safeguarding children and young people: roles and competences for health care staff Intercollegiate Document 2014 advised paramedics to be trained to level 3 whilst the Named Professional for Children is required to complete Level 4 training; this will be updated every 3 years. Evidence of this will be included within the staff training registers and held by the training department.

Training should be facilitated by tutors with appropriate qualifications and experience in safeguarding children matters. The Named Professional for Safeguarding Children



will monitor and evaluate provision via tutor peer reviews and evaluation/feedback given by participants. The training provided will also acknowledge and incorporate the skills and knowledge outcomes suggested by frame working documents such as;

Safeguarding Children and Young People: Roles and Competencies for Health Care Staff – Intercollegiate Document Royal College of Paediatric and Child Health (2015).

Joint Royal Colleges Ambulance Liaison Committee Clinical Guidelines (2013)

Skills for Health

Knowledge and Skills Framework

The Named Professional for Safeguarding Children will also promote training and educational events provided by the LSCB in each locality of the Trust. The Non-Clinical Learning Facilitator will provide access to distance/e-learning packages as part of the Education and Development function. Data from this function will be incorporated within the Safeguarding Children annual training report, demonstrating participant/completion rates, and evaluation. Staff completing training events with LSCB’s, must inform the Named Professional and Non-Clinical Learning Facilitator of attendance and completion of events. This information will also be incorporated within the annual training report.

The Named Professional for Safeguarding Children will provide a training summary as part of the annual report for the Board. Standing items within the training section of the report will include the following:

Numbers of staff attending single-agency training in each staff group

Numbers of staff completing distance learning courses in relation to safeguarding children

Any changes that have occurred following changes in legislation/national drivers

Any changes that have occurred following recommendations from serious case review panels or child death overview panels

Results of evaluative documents and how these inform future training

Results of peer reviews of teaching delivery completed during the previous12 months.

Staff unable to attend training, must inform the provider and Named Professional for Safeguarding Children as soon as possible. Training events provided and facilitated by NEAS, generate a participant register for every safeguarding children event. These registers will include actions taken by the facilitator of the event, when participants do not attend and any untoward incidents during the event. Data from this process will be included in the annual training report.



7. Equality and DiversityThis policy has been assessed for its equality and diversity impact. Please refer to the Equality Assessment.

8. Monitoring Compliance with and Effectiveness of this Policy

8.1 Compliance and Effectiveness Monitoring

Arrangements for the monitoring of compliance with this policy and of the effectiveness of the policy are detailed below.



8.2 Compliance and Effectiveness Monitoring Table for this policy

Process in the policy

Monitoring and auditKey Performance Indicators (KPI)/

Criteria

Method Who By Committee Frequency Learning/ Action Plan

Section 11 audit

Adherence with the referral pathway and referral process within the Contact Centre and Operational staff (all sectors)

LSCB statutory process

Select an agreed number of referral reports from Ulysses Safeguarding Module

Audit

Select an agreed number of referral reports from Ulysses Safeguarding Module

Named Professional for the Safeguarding of Vulnerable Groups, Safeguarding Administration Team and

Line Managers

Safeguarding Steering Group, Patient Safety Group

Monthly basis On 1-1 basis when individual is identified, through the training unit at Essential Annual Training and via Personal Development Plan reviews with Line Managers. Organisational learning will take place following the action plans, training and education and patient care updates.

Remedial action will be taken immediately by reporting to service leads

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9. Consultation and Review of this PolicyThis policy has been reviewed in consultation with Safeguarding Group and Patient Safety Group

10. Implementation of this PolicyThis policy will be available to staff via Q Pulse.

11. ReferencesThis document refers to the following guidance, including national and international standards:

References and internet links

Children Act 2004Internet link: www.opsi.gov.uk/acts/acts/2004ukpga_20040031_en_1

Education Act 2002Internet link: www.opsi.gov.uk/acts/acts2002/ukpga_20020032_en_1

Every Child Matters Green Paper.Internet link: http://publications.everychildmatters.gov.uk/eorderingDownload/CM5860.pdfwww.dcsf.gov.uk/everychildmatters/resourse-and-practice/IG00175

Fisher, J. et al (2006) ed. Uk Ambulance Service Clinical Practice Guidelines. London: JRCALC Great Britain dcsf (2010) Working Together to Safeguard Children, A guide to inter-agency

Great Britain Department of Health (2009) Review Safeguarding Children A review of arrangements in the NHS for safeguarding children. CQC [online] available at www.cqc.org.uk/Publications

National Service Framework for Children Young People and Maternity Services.Internet link: www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications Policy And Guidance/DH_4089101

Safeguarding Children and Young People: Roles and competencies for Health Care Staff.Internet link: www.rcpch.ac.uk/doc.aspx?id_Resource=1535

Working to Safeguard Children [dcsf online] http://publications.dcsf.gov.uk.

Department of Health (2000) No Secrets. London

Department of Health (2005) Mental Capacity Act, London



Parliamentary Act of Human Rights (1998)

Domestic Violence, Forced Marriages and ‘Honour’- Based Violence (2008)

Department of Health (2005)Responding to Domestic Abuse Handbook for Health Professionals. London

Department of Health (2001) National Service Framework for Older People. London

Safeguarding Vulnerable Groups Act (2006) HMSO. London Police Act (1997) HMSO. London

Care Quality Commission (CQC) 2014 Consultation on our guidance on the Fundermental Standards and on CQC’s enforcement powers. CQC, London.

Quality Care Commission (CQC) 2014 New regulations for NHS bodies: the fit and proper persons requirement for Directors and the Duty of Candour. CQC, London.

Department of Health (DH) 2014 Care Act. http://www.legislation.gov.uk/2014/23/pdfs/ukpfa2_20140023_en.pdf

Department of Health (DH) 2014 Care and Support Statutory Guidance issued under the Care Act 2014: Section 14: Safeguarding. DH, London.

Department of Health (2005) Mental Capacity Act 2005. http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_2005009_en.pdf

Department of Health (DH) 2007 Mental Health Act 2007 http://www.legislation.gov.uk/ukpga/2007/12/pdfs/ukpga_20070012_en.pdf

Department of Health (DH): Code of Practice Mental Health Act 1983. http://webarchive.nationalarchives.gov.uk.2013107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_087073.pdf

Department of Health (DH) 2010 Clinical Governance and Adult Safeguarding and Integrated Process. DH, London.

Department of Health (DH) 2011 Safeguarding Adults: The role of Health service practitioners. DH, London.

Department of Health (DH) 2015 Adult safeguarding: sharing information. Social Care Institute for Excellence (SCIE), London.

Counter-Terrorism Strategy (CONTEST) 2011 (accessed 08/03/2015)www.gov.uk/government/publication/counter-terrorism-strategy-contest.

Prevent 2012 (accessed 08/03/2015)www.gov.uk/government/policies/protecting-the-uk-against-terrorism/supporting-pages/prevent.

Channel 2012 (accessed 08/03/2015)



www.gov.uk/government/publications/channel-guidance

Female Genital Mutilation (FGM) accessed 20/02/2015http://www.nhs.uk/conditions/female-genital-mutilation/pages/introduction/aspx

Local Government Association 2013 Making Safeguarding Personal Local Government House, London

Ministry of Justice: Mental Capacity Act 2005 Deprivation of liberty safeguards: Code of Practice to supplement the main Mental Capacity Act 2005 Code of Practice. http://webarchive.nationalarchives.gov.uk.2013107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_087309.pdf

National Institute for Health and Care Excellence (2014): Public Health Guideline 50 Domestic violence and abuse: multi-agency working. NICE, London.https://www.nice.org/guidance/ph50/resources/domestic-violence-and-abuse-multiagency-working-1996411687621

North East Safeguarding Adults Network – Safeguarding Adults at Risk Threshold. Accessed 12/03/2015 www.safeguardingadultsne.co.uk

NHS Commissioning Board 2013 Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework. NHS Commissioning Board.

Social Care Institute for Excellence (SCIE) accessed 13th July 2015http://www.scie.org.uk/publications/guides/guide53/frontline-housing/people-at-risk/

12. Associated DocumentationThis policy relates to and impacts upon Policies

Management of Allegations against Staff Policy Disciplinary Policy Recruitment Policy Disclosure and Barring HR Policy Capacity to Consent to Examination or Treatment Clinical Supervision Security Policy Complaints Policy Investigation Policy Being Open Policy Incident Reporting Policy

12.1 Procedures

Safeguarding Referral / Alert Procedure – all staff Control Centre Referral Process (999/111/Dispatch/Logistics) Management of Allegations against Staff Recognition of Life Extinct (ROLE)



Assessment of Capacity Form –

13. AppendicesAppendix 1 - Types of child abuse

Appendix 2 a,b,c- Referral pathways

Appendix 3 - Child death process.

Appendix 4 – Prevent

13.1 Appendix 1 Types of Abuse

Types of Abuse – For the purpose of safeguarding children the categorises of abuse Physical Emotional Sexual Neglect/Acts of Omission

It should be noted that more than one type of abuse can happen at the same time and that the lists is not exhaustive. All forms of abuse have a negative emotional impact; the abused person may suffer feelings of insecurity, fear, rejection hopelessness and loss of self-respect and self-worth. Such damaging emotions inevitably affect the individual’s physical and mental health. Abuse may consist of a single act or repeated acts, abuse may happen intentionally or unintentionally, can take place in any relationship or setting.

Physical Abuse- includes hitting, slapping, pushing, kicking, and the misuse of medication, restraint, or inappropriate sanctions.

Possible indicators of physical abuse: History of unexplained falls or minor injuries Unexplained bruising – in well protected areas, on the soft parts of the body or clustered as

from repeated striking. Unexplained burns in an unusual location or of an unusual type. Unexplained fractures to any part of the body that may be at various stages in the healing

process. Unexplained lacerations or abrasions Slap, kick, pinch or finger marks Injuries/bruises found at different stages of healing for which it is difficult to suggest an

accidental cause. Injury shape similar to an object. Untreated medical problem.



Weight loss – due to malnutrition or dehydration: complaints of hunger.

Emotional Abuse- Including emotional abuse, threats of harm or abandonment, forced marriage, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse.

Possible Indicators of emotional sometimes called psychological Abuse: Fearfulness expressed in the eyes; avoids looking at the carer, flinching on approach Overtly affectionate behavior to alleged perpetrator Change in appetite Unusual weight gain/loss Tearfulness Low self-esteem Excessive fears

Sexual Abuse- Including rape and sexual assault or sexual acts which the child is forced or persuaded to take part in, sometimes the child will not understand that what is happening to them is abuse.

Possible Indicators of Sexual Abuse: A change in usual behavior for no apparent or obvious reason Sudden onset of confusion, wetting or soiling Withdrawal , choosing to spend the majority of time alone Overt sexual behavior/language by the vulnerable person Self-inflicted injury Difficulty in walking or sitting Torn, stained, bloody underclothes Love bites Pain or itching, bruising or bleeding in the genital area Sexually transmitted urinary tract/vaginal infections Bruising to the thighs and upper arms Frequent infections Severe upset or agitation when being bathed/dressed/undressed/medically examined Pregnancy in a child not able to consent.

Child sexual exploitation (CSE) is a type of sexual abuse in which children are sexually exploited for money, power or status. Children or young people may be tricked into believing they are in a loving relationship. They may be invited to parties and given drugs or alcohol.Children and young people are trafficked into or within the UK for the purpose of sexual exploitation.

Neglect/Acts of Omission- is the ongoing failure to meet a child’s basic needs including ignoring medical or physical care needs, failure to provide access to appropriate health, social



care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

Possible Indicators of Neglect: Poor condition of accommodation Inadequate heating and /or lighting Child’s clothing in poor condition, e.g. unclean, wet, etc. Failure to give prescribed medication or appropriate medical care Malnutrition Inconsistent or reluctant contact with health and social agencies

Consideration should be given to domestic abuse where children witness abuse and teenagers suffer domestic abuse.

Online abuse - either by mobile phone, online gaming or social media including cyberbullying.

Female genital mutilation (FGM) – is the partial or total removal of external female genitalia for non-medical reasons.



13.2 Appendix 2 (a)- Safeguarding Children Referral Pathway


Concern Identified

Is there a concern that a child/ren has been the victim of abuse which has been perpetrated by another person or persons?

Categories of harm / risk: Physical, Sexual, emotional/Psychological, Neglect and acts of omission.

or involved in a Domestic Abuse incident.

Yes

Referral

The concern is appropriate for Safeguarding Children procedures and should be raised as a referral. Contact Logistics Desk on 0300 011 0132 as soon as possible to report

No

Is there a concern about the welfare of a child/ren i.e. environment, or requires a care assessment. There are no concerns of abuse? Remember the whole family approach

No

Yes

Have you made sure you have the parent/carer consent for notification to social care? If not document why.

Yes

Contact Logistics on 0300 011 0132 and complete SG Referral for a Welfare Concern and identify category

No further action


13.3 Appendix 2 (b) Safeguarding Children Referral Process (Operational Staff ECS/PTS)


POSSSG Notification is received via Terrafix to alert you of a possible Safeguarding situation.

Following assessment, if the Patient is to REMAIN AT HOME

Complete an ePRF

If concerns ARE CONFIRMED, contact Logistics Desk to document your concerns, using the vehicle mobile phone BEFORE leaving scene.

If concerns ARE NOT CONFIRMED, contact Control and advise why you have no concerns.

Following assessment, if the Patient is to be TRANSPORTED TO HOSPITAL

Complete an ePRF

If concerns ARE CONFIRMED, advise the receiving hospital that you are making a referral.

BEFORE pressing clear, contact Logistics Desk to document your concerns, using the vehicle mobile phone.

If concerns ARE NOT CONFIRMED, contact Control and advise why you have no concerns.

Logistics Desk 0300 011 0132

The Logistics Officer will complete an electronic referral. You will be asked for the minimum amount of information to process the concern and details of your concern will be typed word for word, and read back to you to confirm.

The Logistics Officer will send your concern via an agreed secure email address to Social Care and a copy will also be sent to the Safeguarding Team.

Due to the amount of referrals the Safeguarding Team receive, unfortunately we are not able to acknowledge each referral. We will however, notify you of any responses we receive from Social Care.

The Safeguarding Team can be contacted on the following numbers:

Safeguarding Admin – 0191 430 2271

Safeguarding Officer - 0191 4302245


13.4 Appendix 2 (c)- Safeguarding Referral Process for Call Takers (999/111)

Appendix E Safeguarding Adults Referral Pathway


Call handler receives call (999 or 111)

Safeguarding (SG) concern identified

End disposition ambulance response?

YES NO

Referrer must: Enter POSS (possible) SG in

Crew Notes and Save and Notify as soon as possible

Tick POSS SG from Call Keywords (see attached)

Input concise summary in Call Notes explaining the nature of the concern (1 line max)

Call handler contacts the logistics desk to raise a safeguarding

referral

Update from crew to dispatch if no concerns identified dispatch will:

Tick NO SG in call keywords field if no concern apparent

If a case is subsequently cancelled or PSS have used another form of transport for the patient and POSS SG has been entered in the case notes then the Dispatch Staff will notify a CSO who will copy the summary information from the call handler’s notes and process the referral on Ulysses

WHERE POSSIBLE THE PARENT/CARER MUST BE INFORMED OF THE REFERRAL AND GIVE CONSENT FOR COMPLETION AND NOTIFYING SOCIAL CARE. IF NOT THEN YOU MUST DOCUMENT

Crew CONF (confirmed) SG:

contact Logistics following procedure to make a referral, Logistics will then update the case with CONF SG

When Crew see POSS SG they MUST contact Control for an

update on the detail


13.5 Appendix 3 Child Death Process

YES NO NO


A call is received for an unresponsive Child/baby less than 18 years and CPR advice is given. Activate R1 and contact Police advising them

CPR in progress for an UNEXPECTED DEATH.

Crew (s) arrive on scene for an UNEXPECTED DEATH

Resuscitation

Appropriate

Commence and continue

Resuscitation

No Obvious Cause of Death

Obvious Cause of Death/or Crew

Suspect a Crime Has Taken Place

Request Police Attendance and Wait on Scene for

Their Attendance Transport Child and Patent/Carer to Hospital.

Advise Control to Pre-Alert Emergency Department and Update Police if not on Scene.

NOTE: If baby is a Twin, arrangements must be made for the Twin to be brought to Hospital

Transport to Nearest ED That Has Paediatric Services Unless Instructed Otherwise by the Senior Police Officer and follow their Instruction. (i.e. Suspicious Death)

Taken from Patient Care Update 5050 26/03/2013 and updated March 2016

Complete a safeguarding referral documenting where the child was found and who was present.


13.6 Appendix 4 PREVENT Referral


Identify potential PREVENT issue in a vulnerable

patient/carer or colleague

Member of staff to discuss concerns with their Line

Manager

Line Manager completes safeguarding adults referral

identifying concern via the Logistics Desk - 0300 011 0132

Safeguarding PREVENT Lead will make further enquiries

Assessment and Risk Assessment Process carried out by Local Police

PREVENT Lead

Descision Outcome - Support for Patient

Advice can be obtained from

Named Professional for the Safeguarding of Vulnerable Groups - PREVENT Lead via the Safeguarding Administration - 0191 430 2271 NEAS Risk and Regulatory Service Manager orForce Inspector for PREVENT Northumbria Police 01661 868073

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