#IGCSI17

Nigel Thompson

Head of Inspections Children’s Health and

Justice

CQC

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Not Seen, Not HeardA review of the arrangements for child

safeguarding and health care for looked after

children in England

Nigel Thompson

Head of Inspections – Children’s

Health and Justice

23 January 2017

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Overview

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• CLAS reviews

• Headline findings from the report

• Recommendations

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CLAS Reviews

1. Experiences and views of children and their families

2. Quality and effectiveness of safeguarding in health:

1. Assessing need and providing early help

2. Identifying and supporting children in need

3. Quality and impact of child protection arrangements.

3. Quality of health services and outcomes for looked

after children and care leavers

4. Health leadership and assurance of local

safeguarding and LAC arrangements, incl. leadership and

management, governance, training and supervision

Headline recommendations

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1. Children and young people must have a voice

2. The focus must be on outcomes

3. Most must be done to identify children at risk

of harm

4. Children and young people must have access

to the emotional and mental health support

they need

1. The child’s voice

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• The majority of children we spoke to said they did not

feel involved in their care

• This led to care plans that were impersonal and

contained only basic information

• Children said it meant they didn’t seen the point in

accessing the care and support they need

• What about children without a voice?

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Services in Salford were taking strides to improve how they listened

to and engaged children at multiple levels.

• Holistic assessments of children and young people, capturing

their version of events and wishes, and including a

comprehensive picture of what life was like at home.

• Good quality health reports to CP case conferences:

demonstrated clear analysis of risk and protective factors and

priority given to reflecting the voice and experience of the child.

• The trust had set up a group to seek feedback from young

people and their families attending hospital. Action was also

being taken to employ new methods for engaging young people.

• Services developed an extensive range of useful resources on

capturing the child’s voice e.g. in the CAF.

2. The “so what” factor

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• Worrying loss of focus on identifying and addressing

early need

• Improving outcomes – from ‘SMART’ health plans to

service evaluation to commissioning

• Strength and difficulties questionnaires (SDQs) for

looked after children

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In Middlesborough, children, young people and families who were

not making sufficient progress in early intervention programmes

were discussed at regular multi-agency forums.

These were made up of senior staff from agencies across the

partnership (incl. Children’s Social Care, CAMHS, Sue Start

Children’s Centres, Integrated Youth Support Service, Parenting

Services and Neighbourhood safety teams) and provided specialist

targeted support, advice and consultation to practitioners. They

were identifying trends and emerging issues with more challenging

families to achieve positive outcomes through joint initiatives.

Outcomes had been identified for children and young people as

part of their Early Help Strategy, and were being used to measure

progress.

3. Quality of information sharing

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• How health professionals are assessing risk

• How that identified risk is shared across agencies

• Trust, relationships… face to face?

• Standardisation e.g. CAF

• GP engagement

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4. The five ‘P’s in multi-agency working

• Physical systems (IT or paper-based) – support accurate

and timely documentation and information sharing.

• People – facilitate joined-up working and strengthen

partnerships. It is often individuals who work hard to ensure

that any gaps in existing systems are anticipated and

avoided.

• Policies, Protocols and Pathways – help staff to be clear

on what should be done when, where and by whom, and

reduce variation in practice.

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Several effective flagging systems across the trust in Kent

reflected good practice. For example:

• Electronic flagging systems in A&E identified those who were

subject to a child protection plan.

• Young people with ten or more attendances were automatically

reviewed by the consultant paediatrician responsible for

safeguarding.

Flagging systems were also helping to identify vulnerable,

safeguarded or looked after children in GP records, maternity units

and CASH services across the trust.

Missing children and those identified as being at risk of domestic

violence at MARAC meetings were also flagged.

4. The five ‘P’s in multi-agency working

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5. Finding the hidden child

• Think Family especially in adult mental health services

• Female genital mutilation

• Child sexual exploitation

• Trafficking?

• Radicalisation?

• Unaccompanied asylum seekers?

6. Transitions and access

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• Young people in transition from paediatric

care to adult services

• Looked after children:

• Access to services when moved area

• Health information on leaving care

• Support on leaving care

• Access to CAMHS for these children, but

also more generally across health

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Older looked after children and care leavers were well supported by

weekly drop-in sessions at a local cafe in Stockport. They

attended regularly and told us they valued the opportunity to come

to a safe environment where they could immediately access health

and daily living advice from volunteer mentors in a non-

judgemental setting.

Care leavers who were young mums told us they appreciated

meeting the designated looked after child nurse every week at the

café to get parenting advice and reassurance.

We heard about one care leaver with frequent attendances at A&E

for serious self-harm who, since accessing the mentoring service,

had not attended ED and had not required intervention from the

crisis mental health team.

7. Leadership

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• Leadership and purpose

• Governance

• Workforce and capacity

• Training and supervision

CQC’s commitments

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• CQC continues to seek and report on the experiences and

views of children who use health services as part of our

single- and joint-agency inspections

• Joint-Targeted Area Inspection programme (JTAI)

• Special Educational Needs and Disability programme

(SEND)

• CAMHS Review 2016-17

• CQC ensures that Think Family is embedded in our

inspection approach across all adult health services,

including mental health services