safeguarding children policy - bristol ccg · flow chart for serious case review process 33 . 4 1...

Safeguarding Children Policy

Policy Name

Policy ref no: CCG 011-15

Author (inc job title)

Julie Henderson, Deputy Designated Nurse for Safeguarding Children; Jacalyn Mathers, Designated Nurse for Safeguarding Children

Date Approved 26/05/2015

Approved by Bristol CCG Governing Body

Date of next review

April 2017

How is policy to be disseminated

Check list for Governing Body/approving committee

Has an Equality Impact Assessment been completed?

In process

Has legal advice been sought? No Have training issues been addressed? Are there financial issues and have they been addressed?

How will implementation be monitored How will the policy be shared with: • Staff? • Patients? • Public?

Are there linked policies and procedures? Yes

Version Control

Version Date Consultation Vo.1 Bristol CCG

March 2015 Jackie Mathers

Vo.2 Bristol CCG

April 2015 Alison Moon, Jackie Mathers, Helen Mutch, Maria Bredow, Bridget James, Inge Shepherd, Paulette Nuttall

Vo.3 Bristol CCG

18 May 2015 Kirsty Alexander, Judith Champion, Maria Bredow, Catherine Hiley, Richard Lyle, Kate Spreadbury, Jackie

Mathers, Alison Moon, Paulette Nuttall, Patsy Hudson, Bridget James, Inge Shepherd, Helen Mutch, Emma Savage (BCCG Safeguarding Board)

Vo.5 Signed off and completed by Governing Body

26 May 2015 Governing Body, BCCG

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Contents 1. Introduction

2. Purpose and Scope 4

2.1 CCG safeguarding arrangements 4 2.2 CCG staff 4 2.3 Safeguarding awareness 5 2.4 Commissioning 5 2.5 Corporate accountability 5 2.7 Safeguarding advice and guidance 5 2.7 Scope of policy 5 2.8 Independent contractors 5 2.9 Safeguarding Children Standards 5

3. Responsibilities and Accountability 5

3.1 CCG accountability 5 3.2 Monitoring 5 3.3 Governance 6 3.4 Stakeholders 6

4. National and Local Context 6

4.1 National context 6 4.2 Local context 7

5. Safe Recruitment and Employment 7

5.1 Current legislation 7 5.2 Recruitment policies and procedures 7 5.3 Commissioned services 7 5.4 Professional codes of conduct 7

6. Managing Allegations Against Staff 8

6.1 Statutory guidance 8 6.2 Historical abuse 8 6.3 Process 8 6.4 Whistleblowing 8

7. Designated Professionals 8

7.1 Statutory role 8 7.2 Professional role 8 7.3 Professional advice 8 7.4 Benchmarking 9 7.5 Serious Incidents and Serious Case Reviews 9 7.6 Training and Supervision 9

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8. Clinical Commissioning Group Leadership 9

8.1 Accountability 9 8.2 Transformation and Quality Directorate 9 8.3 Safeguarding Team 9 8.4 Governing Body Lead 9 8.5 Annual Report 9 8.6 Partnership working 9

9. GP Safeguarding Links 10

10. Child Protection Training 10

10.1 Mandatory training 10 10.2 Training matrix 10 10.3 Training and competence 10 10.4 Safeguarding advice 10 10.5 Availability of information 11 10.6 Safeguarding newsletter 11

11. Supervision and Support 11

11.1 Providers 11.2 Health Visitors and School Nurses 11 11.3 Designated Professionals 11 11.4 Named Professionals 12 11.5 Further advice and support 12

12. Mental Capacity Act 12

12.1 Context 12 12.2 Guidance for professionals 12

13. Looked After Children 13

13.1 Context 13 13.2 LAC services in Bristol 13 13.3 Lead professionals 13 13.4 Mental health and well-being 13 13.5 Health Leavers Passport 13

14. Female Genital Mutilation 13

14.1 Context 13 14.2 Legal aspects 13 14.3 Staff responsibilities 14 14.4 The Rose Clinic 14 14.5 Mandatory Reporting 14 14.6 Submission of data to DH 14 14.7 Mandatory Reporting to police 14

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14.8 Failure to comply 14 14.9 Working with communities 14

14.10 Further guidance 15 15. Child Sexual Exploitation 15

15.1 Context 15 15.2 Recognition of CSE 15 15.3 Role of health professionals 15

16. Extremism and Radicalisation 15

16.1 Context 15 16.2 PREVENT 16 16.3 Training 16 16.4 Joint working and compliance 16 16.5 Additional information 16

17. Serious Case Reviews and Serious Incidents 16

17.1 Lead roles 16 17.2 Dissemination of recommendations 16 17.3 Incident reporting 17 17.4 Child deaths 17

18. Information Sharing 17

18.1 Staff responsibilities 17 18.2 Collaborative working and further guidance 17

19. Appendices

1. Bristol CCG Governance Structure 18 2. Links to national legislation and policy documents 19-20 3. Child Protection training matrix for GPs 21-25 4. Child Protection training matrix for staff 26-29 5. Safeguarding Contacts List and referral information 30-32 6. Flow chart for Serious Case Review process 33

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1. Introduction

Section 11 of the Children Act 2004 places Clinical Commissioning Groups (CCGs) under a statutory duty to make arrangements to ensure that in discharging their functions they have regard to the need to safeguard and promote the welfare of children. Working Together to Safeguard Children, 2015 defines safeguarding and promoting the welfare of children as:

• protecting children from maltreatment; • preventing impairment of children's health or development; • ensuring that children grow up in circumstances consistent with the

provision of safe and effective care; and • taking action to enable all children to have the best outcomes.

This policy supports national legislation and guidance, together with local policies and procedures and should be read in conjunction with:

• South West Child Protection Procedures at www.swcpp.org.uk • Working Together to Safeguard Children 2010/2013/2015 DCSF

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419595/Working_Together_to_Safeguard_Children.pdf

Effective safeguarding arrangements in every local area should be underpinned by three key principles:

• Safeguarding is everyone’s responsibility: for services to be effective each

professional and organisation should play their full part. • A child-centred approach: for services to be effective they should be based

on a clear understanding of the needs and views of children. • Think Family agenda

Advice about what to do if you are worried a child is being abused can be found by following this link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419604/What_to_do_if_you_re_worried_a_child_is_being_abused.pdf

2. Purpose and Scope

2.1 This policy sets out Bristol CCG’s (BCCG) arrangements for safeguarding and promoting the welfare of children and young people at risk and to demonstrate how BCCG works effectively with its partner agencies.

2.2 This policy is designed to support all staff employed by, volunteering at or contracted to work for BCCG in their safeguarding and child protection duties and to ensure managers take responsibility for the actions of their entire staff. Managers within Bristol CCG are responsible for ensuring that practice reflects the standards laid out within this policy and that staff are given adequate resources and support to comply with them.

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2.3 All BCCG employees must be mindful of their responsibility to safeguard children. They should be able to recognise indicators of abuse and know how to act upon concerns. Staff should seek advice from their line manager or another senior manager when they have a safeguarding concern. They can also seek advice and support from the safeguarding team.

2.4 Staff involved in the commissioning of services must consider this policy when they develop and commission services and must include the safeguarding children standards in all contracts for services which have contact with adults or children.

2.5 To demonstrate how BCCG will discharge its corporate accountability for

safeguarding children through the governance structure. Please see APPENDIX 1.

2.6 To empower all members of BCCG by providing advice and guidance to

enable them to fulfil their safeguarding children and young people responsibilities.

2.7 The scope of this policy includes all staff employed by BCCG who work with families and children either directly or indirectly or commission services for children or parents/carers of children and young people. The policy is also applicable to contractors and volunteers working within the organisation including celebrity or fundraising volunteers.

2.8 It is expected that all providers of health services should have their own

safeguarding children policy. Working Together to Safeguard Children, 2010 particularly highlights independent contractors, namely GPs, dental services, orthoptists, community pharmacists and therapists as groups needing a safeguarding children policy. The need for a Safeguarding Policy is also reinforced by Section 11 of the Children’s Act, 2004.

2.9 BCCG will develop safeguarding children’s standards which will be included in

providers’ contracts. Providers must comply with the annual and/or quarterly returns of performance indicators as appropriate to their contract.

3. Responsibilities and Accountability

3.1 BCCG has a clear line of accountability within the organisation for work on

promoting the welfare of children and safeguarding children and young people. Quarterly reports are submitted to the BCCG Safeguarding Group and the Quality and Governance Committee.

3.2 BCCG is monitored in fulfilling its functions by NHS England, the Care Quality

Commission (CQ C), the NHS Litigation Authority and Bristol Safeguarding Children’s Board (BSCB).

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3.3 BCCG is responsible for ensuring that safeguarding is integral to service development, quality improvement, clinical governance and risk management arrangements.

3.4 BCCG will work with stakeholders including Foundation Trusts, NHS Trusts,

Independent contractors, Third Sector and Social Enterprises to ensure they have comprehensive safeguarding policies and procedures which are in line with statutory requirements and are informed by BSCB and SWCPP guidelines.

4. National and Local Context

4.1 National Context

Safeguarding continues to have a high national priority which has been escalated following recent events with even greater scrutiny of the way in which organisations execute their safeguarding responsibilities.

This Safeguarding Children Policy supports the legislation and guidance in:

• Human Rights Act 1998

• The Adoption and Children’s Act 2002

• The Victoria Climbie Inquiry (DH 2003)

• Female Genital Mutilation Act 2003

• The Sexual Offences Act 2003

• The Children Act 1989 and 2004

• Bichard Inquiry Report (HMSO 2004)

• Mental Capacity Act (2005)

• Safeguarding Vulnerable Groups Act 2006

• Public Law Outline (2008)

• Vetting and Barring Scheme (2009)

• The Protection of Children in England: A Progress Report (2009)

• The protection of children in England: action plan

• The Government’s response to Lord Laming (2009)

• Health and Social Care Act 2012

• Protecting children and young people: the responsibility of all doctors – GMC (2012)

• Safeguarding Children and Young People: Roles and Competences for Healthcare staff. Intercollegiate Document, Third Edition (2014)

• Serious Crime Act 2015

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This is not an exhaustive list of all safeguarding legislation, policies and procedures but directs staff to the key publications they may wish to reference in their work. Links for these documents can be found at APPENDIX 2.

4.2 Local Context

Bristol is the largest city in the south west and the seventh largest city in England outside of London. There is projected to be a large increase in the number of children living in Bristol over the 25 year period 2012 - 2037 - an increase of 22.1% which is one of the highest projected growth rates in the country. The majority of this increase is projected to be in the under 10s (+20,100). It is estimated that there are 81,800 children in Bristol; making up 29% of the population and 1 in every 5 people in Bristol is aged under 16 years (The Population of Bristol 2014).

Between 2003 and 2013 the number of children aged 0 – 15 living in Bristol is estimated to have increased by 14.2%. Amongst 0 – 9 year olds the increase is 25% and in particular amongst 0 – 5 year olds the increase is 36%, one of the highest in the country. The number of children subject to a Child Protection Plan in Bristol in June 2014 was 422, a decrease from a peak in 2012 following the public Inquiry into the death of Peter Connelly. The number of Looked After Children in Bristol in June 2014 was 712.

5. Safe Recruitment and Employment

5.1 BCCG undertakes its recruitment procedures and practices in accordance with current employment legislation and guidance which includes the Safeguarding Vulnerable Groups Act (2006) and Safer Recruitment (2006) (http://www.opsi.gov.uk/acts/acts2006/pdf/ukpga_20060047_en.pdf) (http://www.nhsemployers.org/Aboutus/Publications/Documents/safer_recruitment _alert_scheme_2006.pdf All job descriptions should reflect requirements for staff to have due regard for safeguarding. BCCG will ensure that managers have access to training in safer recruitment practices as appropriate.

5.2 BCCG’s recruitment policies and procedures adhere to the principles of safer

recruitment including enhanced Disclosure and Barring Service checks (DBS), inclusive of agency staff, students and volunteers working with children;

5.3 The requirement for an enhanced DBS will be considered when any new

member of staff is appointed. BCCG will require assurance that all commissioned services have safe recruitment processes in place as required by the safeguarding children standards attached to all contracts.

5.4 All staff employed by BCCG or delivering services commissioned by BCCG

should conduct themselves in a professional manner, adhering to their professional codes of conduct and BCCG policies at all times. This includes consideration in the personal use of social media and information technology.

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6. Managing allegations of abuse against staff

6.1 Statutory guidance placed on the Bristol Safeguarding Children Board exists to

manage allegations of abuse made against staff. Each member organisation of the Bristol Safeguarding Children Board must follow these guidelines if an allegation is received or concern expressed that a professional has behaved in a way that has harmed a child or behaved in a way which may indicate that he or she is unsuitable to work with children.

6.2 Additionally, these procedures may also be used if there are concerns about

the professional’s behaviour towards their own children or children unrelated to their employment or voluntary work, or when an allegation is made about abuse that took place some time ago and the accused person may still be working or having contact with children.

6.3 Concerns should first be discussed with a line manager, senior manager or

the Designated Officer for dealing with such allegations. The Head of Human Resources provides this function for BCCG supported by the Designated Nurse for Safeguarding Children. It is the role of the Designated Officer to inform the Local Authority Designated Officer (LADO) within one working day of the allegation being made. Details of the LADO process can be found via this link: http://www.online-procedures.co.uk/swcpp/procedures/allegations-against-staff/consideration-lado-manager/

6.4 If the allegation is about the Designated Nurse or Doctor for Safeguarding

Children then it should be directed to the Director of Transformation and Quality who is the Governing Body Lead for safeguarding. If the allegation is against a GP it should be directed to NHS England who may seek the support of the named GP. BCCG is committed to promoting a culture where employees are able to raise concerns about safeguarding issues and will be supported in doing so. BCCG Raising Concerns Policy is available via this link: https://www.bristolccg.nhs.uk/media/medialibrary/2014/05/govbody_12a_04june2013.pdf

7. Designated Professionals

7.1 The Designated Doctor and Designated Nurses take a strategic and professional lead on safeguarding children across the health economy. The Designated professionals for children work closely with the provider Trusts’ Named professionals to develop and improve safeguarding practice within and between organisations.

7.2 The Designated professionals will provide safeguarding advice on policy and

procedure as well as on day to day safeguarding management of children and families’ concerns.

7.3 They are a source of professional advice on safeguarding children matters to

health professionals to ensure the range of services commissioned and

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contracted by BCCG take account of the need to safeguard and promote the welfare of children and young people.

7.4 The designated professionals will attend relevant regional and national forums

in order to benchmark safeguarding work in Bristol. 7.5 Designated professionals will collaborate with the Governing Body Lead,

BSCB and Health Trust Governing Body Lead in each Trust in reviewing the involvement of health services where serious Incidents are related to safeguarding and which may meet the criteria for a Serious Case Review.

7.6 The designated professionals will access training and supervision

commensurate with their roles and maintain competencies as laid out in the Intercollegiate Document, Third Edition, March 2014.

8. Clinical Commissioning Group Leadership

8.1 BCCG is accountable for the organisation’s overarching safeguarding responsibilities; this includes assuring the Board that the organisation is fulfilling its duties. The Board will get its assurance from the Quality and Governance Collaboration that partnership working is the key factor in securing successful outcomes for safeguarding children and promoting their welfare.

8.2 The safeguarding function of BCCG sits within the safeguarding team which is

part of the Transformation and Quality Directorate. The executive lead for safeguarding within BCCG is the Director of Transformation and Quality whose responsibilities include championing safeguarding issues at the Governing Body and the BSCB main Board.

8.3 BCCG Safeguarding Team consists of the Director of Transformation and

Quality, the Designated Nurse for Safeguarding Children, the Deputy Designated Nurse for Safeguarding Children, the Designated Nurse for Safeguarding Adults, the Designated Doctor for Safeguarding Children, the Named GP for Safeguarding Children, the Lead Commissioner for Looked After Children and the Administrator for Safeguarding Children.

8.4 The Governing Body Lead is managerially accountable for the designated and

named professionals ensuring that safeguarding children is an integral part of BCCG’s governance arrangements. They should also ensure that safeguarding children is considered when planning or commissioning new services.

8.5 The designated professionals are responsible for submitting an annual report

outlining safeguarding activity to the BCCG Board. 8.6 The Governing Body Lead is responsible for ensuring that BCCG works

effectively with other relevant organisations to identify, assess and manage children in need/those in need of protection and Looked After Children.

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9. GP Safeguarding Links

BCCG has established a network of Link GPs for safeguarding children, one in every practice. This network is supported by BCCG Safeguarding Team who hold twice yearly meetings for all Link GPs to discuss changes in local policies. The team also offers advice, regular newsletters, resources and training at Level 3 to the Link GPs. Their role is to:

• Co-ordinate safeguarding policy and practice within their primary care teams.

• Act as a first point of contact for colleagues with safeguarding concerns • To act as local champion for children and safeguarding best practice • To Alert BCCG Safeguarding Team of local barriers to effective working

together • To disseminate relevant information to the practice, provided by BCCG

Safeguarding Team and the BSCB.

10. Child Protection Training

10.1 Child protection/safeguarding training is mandatory for all BCCG employees. Independent contractors who are now commissioned by BCCG, such as GPs, should also receive child protection training as recommended by the Intercollegiate Document, Third Edition, 2014. BCCG has produced a training matrix for General Practice to support GPs which can be found at Appendix 3

10.2 All commissioned services must ensure that staff have completed the

appropriate level of child protection training as recommended by the Inter-Collegiate Document, Third Edition, March 2014. Adherence to this requirement is actively monitored and reviewed. In addition, all commissioned services must have a training matrix in their safeguarding policy.

10.3 Through training all staff must:

• Be aware of the risk factors for child abuse – this includes situations where adults may pose a risk to children

• Know how to recognise the different forms of abuse • Know what to do if a child’s welfare or safety may be at risk • Be aware of local procedures in child protection • Know the names and contact details of named and designated

professionals • Ensure they have access to adequate training relevant to fulfil the

responsibilities of their role

10.4 There are several routes through which staff can access child protection training or demonstrate their knowledge and competencies around safeguarding children. For example:

• Safeguarding children training is included in the mandatory induction programme for BCCG as well as for all contracted and commissioned services

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• e-learning packages and child protection updates for single or multi-professional groups which can be accessed via the BCCG in-house training link: https://www.mymle.org.uk/.

• Independent contractors can access training via this link: www.e-lfh.org.uk/

• Multi-agency training through the Bristol Safeguarding Children Board which is free for BCCG staff. This training should be booked through the safeguarding children administrator on 0117 900 2384. The full BSCB programme can be accessed using the attached link: www.bristol.gov.uk/page/bscb-training-courses

• If staff undertake bespoke training the named or designated professionals can ratify the quality of the training and the appropriate level related to the Intercollegiate Document, Third Edition, 2014.

• Team supervision sessions, or case management reflections. • Compliance with safeguarding children training at BCCG will be

monitored by the Human Resources and Organisational Development and Training team alongside the designated nurses and reported quarterly to the BCCG Governing body.

10.5 The safeguarding team will be happy to advise any member of staff on the

best training option to meet their needs. All staff must have a child protection/ safeguarding children update every three years (minimum). The intercollegiate document 2014 recommends an annual update. Those working directly with children or parents will have annual training as indicated in the matrix, which can be found at Appendix 4.

10.6 The safeguarding team produces an annual newsletter that will update all

NHS employees and independent contractors relating to any past or future changes in safeguarding children arrangements.

11. Supervision and support

11.1 BCCG is responsible for ensuring that all provider services make provision for their staff to receive safeguarding supervision and access to advice and support from qualified safeguarding professionals within the organisation.

11.2 Certain staff groups will be expected to have dedicated safeguarding supervision and reflective practice, including health visitors and school nurses, community paediatricians, specialist practitioners working with children and pregnant women, emergency department and intensive care staff. All clinical staff should discuss safeguarding concerns during supervision and know how to access further advice.

11.3 BCCG will commit to the external safeguarding supervision or peer support for

the designated professionals.

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11.4 The designated professionals are responsible for the provision of

safeguarding children supervision and support both on a formal basis and on an ad hoc basic to the named safeguarding professionals within Bristol Health.

11.5 Staff can access advice and support from a range of sources which include:

• Designated Nurses or Doctor for Safeguarding Children • Named GP • On-call Consultant Community Paediatrician (24 hours/7 days per

week) via the UHB switchboard on 0117 923 0000 • First Response on 0117 903 6444 • Police Safeguarding Coordination Unit on 0117 952 9456 or email #SafeguardingCoordinationUnitBristol@avonandsomerset.pnn.police.uk

Safeguarding children contact details and information about how to make a referral to Social Care for Bristol, North Somerset and South Gloucestershire can be found at Appendix 5

12 Mental Capacity Act

12.1 The Mental Capacity Act (2005) is intended to assist and support people who may lack capacity; it aims to balance an individual’s right to make decisions for themselves with their right to be protected from harm if they lack capacity to make decisions to protect themselves.

The Act is built on five principles that guide and inform decision making for people who may lack capacity for decision making in some aspects of their life including their health care. The Act applies to 16 to 17 year olds with the exception of the following provisions: • they cannot make a Lasting Power of Attorney (LPA) • they cannot make an advance decision to refuse medical treatment • The Court of Protection cannot make a statutory will.

12.2 There may be occasions when a 16-17 year old, who would usually be

presumed to be competent to make decisions, may lack capacity or may become incapacitated. In these circumstances professionals are advised to look at more detailed guidance on mental capacity and may need to seek expert advice. Government guidance can be found be following this link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/224660/Mental_Capacity_Act_code_of_practice.pdf

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13 Looked After Children

13.1 As of June 2014, 712 children were in Local Authority Care in Bristol. The majority of these vulnerable children enter the care system because of abuse and/or neglect. Evidence suggests that care leavers have poorer outcomes than the general population, particularly in relation to educational attainment, homelessness and mental health.

13.1 BCCG has a statutory role in ensuring that arrangements are in place to meet

the health needs of Looked After Children which is carried out by the Bristol Looked After Children Health Service. This service is responsible for monitoring the quality of health assessments, medical, nursing and psychological services available to children in care.

13.3 BCCG has arrangements in place for a Designated Doctor and Nurse for

Looked After Children who take a strategic lead in the health aspects of children in care including advising commissioners regarding the needs of this population.

13.4 NICE Guidance reports that around 60% of children in care suffer from mental

health problems (Department for Children, Schools and Families 2009a). Bristol Thinking Allowed (TA) is a specialist branch of Child and Adolescent Mental Health Services (CAMHS) which provides clinical services for Bristol’s Looked after Children and those children who have been adopted and are referred by Bristol Post Adoption Support Service (BASS). Thinking Allowed acts as a single point of entry for CAMHS referrals of children in the care of Bristol City Council. This includes those placed for adoption up to three years post adoption order, and those who have been adopted and are living in Bristol if they are referred by BASS.

13.5 From January 2015 care leavers will be issued with a Care Leavers Health

Passport to guide the young person with their on-going health needs as well as providing a written document for a diverse group of health professionals to reference. Initially the health passport will undergo a period of being piloted.

14. Female Genital Mutilation (FGM)

14.1 FGM is an illegal practice which affects a girl’s genital area which can impact on their emotional or physical wellbeing. Bristol has a diverse population and there are a significant number of girls who come from communities where Female Genital Mutilation (FGM) has been traditionally practiced.

14.2 FGM has been a specific criminal offence since 1985, under the Prohibition

Female Circumcision Act (1985), which was replaced by the Female Genital Mutilation Act (2003) in England, Wales and Northern Ireland). This Act carries a maximum penalty of 14 years imprisonment. The Department of Health issued an ebulletin in March 2014 regarding mandatory collection of data on FGM, Department of Health, 2014).

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14.3 If staff are aware of any parent who has had FGM or any female children are at risk of FGM they must discuss this with their manager or the Designated Nurse. A referral to Social Care should always be made if the child is at risk. Staff should follow the BSCB guidance for FGM which can be found via this link: http://www.bristol.gov.uk/page/children-and-young-people/bscb-practice-guidance

14.4 A new specialist FGM referral service at the Bristol Community Rose Clinic to

specifically address cases of Type III FGM was commissioned by Bristol Clinical Commissioning Group in 2013. This service is available to women who self-refer or who have been referred by a health professional. The contract with this service includes quarterly governance including reviewing any safeguarding concerns. http://www.lawrencehillhealthcentre.co.uk/downloads/jan14/BCRclinic_V1.pdf

14.5 Mandatory recording - the FGM Prevalence Dataset Information Standard

instructs all clinicians to record into clinical notes when a patient with FGM is identified, and what type it is. An enhanced dataset is now available in draft form by following this link: http://www.hscic.gov.uk/article/2021/Website-Search?productid=17885&q=fgm&sort=Relevance&size=10&page=1&area=both#top

14.6 From September 2014, it became mandatory for acute trusts to collate and

submit basic anonymised details about the number of patients treated who have had FGM to the Department of Health every month. This will be rolled out to GP practices and Mental Health Trusts by Autumn 2015.

14.7 An amendment to the Serious Crime Bill will introduce a mandatory duty on

frontline professionals to report cases of FGM in under 18s and will require reports to be made to the police within one month of initial disclosure/identification. The police will then work with the relevant agencies to ensure an appropriate safeguarding response is put in place.

14.8 The new duty will apply to all regulated healthcare professionals and failure to

comply will be dealt with via existing disciplinary measures either by referral to the professional regulator or via the Disclosure and Barring Service as appropriate. More information about this new duty can be found here: https://www.gov.uk/government/news/crime-prevention-minister-announces-mandatory-reporting-of-fgm

14.9 Any member of staff working with FGM affected communities should have completed child protection training on FGM. An independent female interpreter should always be considered when talking to these families.

Links to Home Office training can be found by following this link: https://www.fgmelearning.co.uk/

Further e-learning for healthcare professionals is available at: http://www.e-lfh.org.uk/programmes/female-genital-mutilation/how-to-access/

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14.10 Full guidance on how to manage these complex cases can be found at the following links:

• https://www.gov.uk/government/uploads/system/uploads/attachment_d

ata/file/380125/MultiAgencyPracticeGuidelinesNov14.pdf • http://www.hscic.gov.uk/media/15350/Frequently-Asked-

Questions/pdf/FGM_Frequently_Asked_Questions.pdf • http://www.rcn.org.uk/__data/assets/pdf_file/0010/608914/RCNguidanc

e_FGM_WEB.pdf 15. Child Sexual Exploitation (CSE)

15.1 As a result of recent nationwide cases CSE has become a national priority for health professionals and organisations. Health services and staff have a significant contribution to make in identifying children and young people at risk of sexual exploitation and supporting the treatment and recovery of those harmed.

15.2 Children and young people affected by CSE can present with a range of

physical and or emotional problems to Sexual Health Services; Unplanned/Urgent Care Services; Mental Health Services and Drug and Alcohol Services. It is therefore essential that all health care professionals are aware of the range of presentations, which may include but not be limited to: poor self-care, sexually transmitted infections, contraception, pregnancy, termination, drug and alcohol problems and self-harming behaviours, and that they know how to respond appropriately.

15.3 Health professionals are in a key position to recognise and assist children and

young people and have several roles including identifying the warning signs of risk or indicators of exploitation, engaging with children and young people so they are encouraged to share information with partner agencies as appropriate. How healthcare staff and agencies work together to promote effective early intervention is also of critical importance in supporting children and young people who are sexually exploited.

Guidance for assessing risk factors for young people at risk of CSE can be found via these links: http://www.bristol.gov.uk/sites/default/files/documents/children_and_young_people/child_health_and_welfare/CSE%20guidance.v1_08.pdf http://www.brook.org.uk/attachments/Spotting-the-signs-CSE-_a_national_proforma_April_2014_online.pdf

16. Extremism and Radicalisation

16.1 The current threat from Terrorism and Extremism in the United Kingdom is real and severe and can involve the exploitation of vulnerable people, including children, to involve them in extremist activity. A number of young girls and boys have been persuaded to leave the country against the wishes of their families, or GP, in secret, putting themselves in extreme danger.

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16.2 The Department of Health is a key strategic partner in The PREVENT Strategy

as health care professionals may meet and treat people who are vulnerable to radicalisation CCGs are required to ensure that provider organisations adhere to the requirements of the national PREVENT strategy.

16.3 The aim of PREVENT is to stop people becoming terrorists or supporting

terrorism. This includes the training of all relevant front line staff in the responsibilities of PREVENT as well as introducing and embedding processes to identify and protect those who may be at risk of radicalisation as well as escalating concerns regarding potential terrorist events to the Police.

16.4 All staff involved in the care and / or commissioning of healthcare should

ensure they are aware of the PREVENT Strategy and the referral process.

CCGs should:

• Ensure that best practice around PREVENT is promoted, implemented and monitored both within the CCG and within commissioned provider services.

• Ensure that safeguarding and PREVENT leads work within the local health and social care economies to influence local thinking and practice by working with partner agencies to provide joint strategic leadership on the PREVENT agenda.

• Ensure that provider contracts specify compliance with the PREVENT Strategy and that commissioned services are supported and contract monitored for compliance.

16.5 The key challenge for the healthcare sector is to ensure that where there are

signs that someone has been or is being drawn into terrorism, the healthcare worker can interpret those signs correctly, is aware of the support which is available and is confident in referring the person for further support.

Additional information can be found by following this link: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97976/prevent-strategy-review.pdf

17. Serious Case Reviews and Serious Incidents

17.1 The designated professionals take a lead role in conducting the health component of Serious Case Reviews as well as other forms of significant case reviews which do not reach the threshold for a SCR (Working Together to Safeguard Children, 2013) and for ensuring that a culture of learning and improvement is embedded across organisations and that practice is evaluated as a result of any review.

17.2 The Governing Body Lead for Safeguarding Children will ensure all

recommendations are reported to NHS England to ensure those with commissioning implications are fed into the new commissioning cycle.

17

17.3 All Serious Incidents related to children where there are safeguarding concerns must be reported through the Serious Incident reporting process of provider organisations and the Designated Nurse informed. In BCCG the Head of Quality is responsible for approving and closing such incidents and the Commissioning Support Unit is responsible for tracking and monitoring them on BCCG’s behalf.

17.4 Child deaths should be reported to the Designated Nurse in line with the

clinical incident process and the child death review process. BCCG should ensure that there is a designated paediatrician within Bristol who is responsible for oversight of child deaths and for co-ordinating responses to unexpected child deaths.

Please see Appendix 6 for a flow chart for the Serious Case Review process.

18. Information Sharing

18.1 Staff should recognise that sharing of information is vital to ensure that children are protected from abuse and neglect. BCCG staff should adhere to the principle that safeguarding of children is paramount and can override any duty of confidentiality. In making disclosures professionals need to disclose information incrementally, starting with the minimal disclosure.

18.2 BCCG will work collaboratively with other organisations and agencies to

safeguard and promote the welfare of children and to work within the information sharing guidance of the SWCPP which can be found at:

http://www.protectinginfo.nhs.uk/ http://www.online-procedures.co.uk/swcpp/?s=information+sharing UK Government guidelines on information sharing can be found by following this link:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/419628/Information_sharing_advice_safeguarding_practitioners.pdf

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APPENDIX 1

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APPENDIX 2 Reference list The Children Act 1989 and 2004

http://www.legislation.gov.uk/ukpga/1989/41/contents


Human Rights Act 1998


Every Child Matters (DCSF 2003)

https://www.education.gov.uk/consultations/downloadableDocs/EveryChildMatters.pdf

The Victoria Climbie Inquiry (DH 2003)

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/273183/5730.pdf

The Sexual Offences Act 2003

http://www.cps.gov.uk/legal/p_to_r/rape_and_sexual_offences/soa_2003_and_soa_1956/

Female Genital Mutilation Act 2003


The Adoption and Children’s Act 2002.


Bichard Inquiry Report (HMSO 2004)

http://media.education.gov.uk/assets/files/pdf/b/bichard%20inquiry%20report.pdf

Safeguarding Vulnerable Groups Act 2006


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Public Law Outline (2008)

https://www.justice.gov.uk/downloads/protecting-the-vulnerable/care-proceeding-reform/pd12a.pdf

The Protection of Children in England: A Progress Report (2009)

http://www.cfoa.org.uk/download/18006

The Protection of Children in England: Action Plan, The Government’s response to Lord Laming (2009)

https://www.gov.uk/government/publications/the-protection-of-children-in-england-government-response

Vetting and Barring Scheme (2009)

https://www.gov.uk/government/organisations/disclosure-and-barring-service/about

When to suspect child maltreatment: Quick reference guide, NICE clinical guideline 89 (July 2009)

https://www.nice.org.uk/guidance/cg89

Health and Social Care Act 2012

https://www.gov.uk/government/publications/health-and-social-care-act-2012-fact-sheets

Protecting Children and Young People: the responsibility of all doctors - GMC (2012)

http://www.gmc-uk.org/guidance/ethical_guidance/13260.asp

Working Together to Safeguard Children (2013)

http://www.workingtogetheronline.co.uk/documents/Working%20TogetherFINAL.pdf

Safeguarding Children and Young People: Roles and Competences for Healthcare staff. Intercollegiate Document, Third Edition (2014)

http://www.lscbchairs.org.uk/sitedata/files/Safeguarding_Children_Heal.pdf

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APPENDIX 3

Training Matrix for Primary Care 2014 Safeguarding children training matrix for Primary Care- summary guidance

This guidance summarises recommendations from ‘Safeguarding Children and Young people: roles and competencies for health care staff. Intercollegiate Document, 2014. This Intercollegiate Document (ratified by all the royal colleges) outlines the level of training, skills and competencies in safeguarding children recommended for health staff in different roles. The guidance is used by the Care Quality Commission (CQC) as part of their registration process for all healthcare providers. These recommendations are not mandatory and this summary is intended as a guide for practices to identify the training requirements for their staff.

Level of safeguarding children training

Recommended staff groups

Frequency of training Length of training

Training options

Level 1 All non-clinical staff working in health care settings:

� Receptionist, � Administrator � Secretaries � Practice

managers

Minimum every 3 years. (competencies reviewed annually as part of the appraisal)

2 hours Can include a combination of : � E-learning package (1 hour) � Review practice Safeguarding policy

(1 hour) � Training supplied by practice through

link GP (resource available from Bristol CCG)

� Being part of any practice review related to safeguarding

Level 2 All clinical staff who have any

� Nurse Practitioners/ Practice nurse/ treatment

Minimum of every 3 years (competencies reviewed annually as part of

3-4 hours Can include a combination of : � Training offered by LMC (2-3 hours) � Attending level 3 training for GPs

delivered by the CCG. (3 hours

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Training options

contact with children, young people and or parents/ carers

room � Health care

assistance � Pharmacy

staff

appraisal) including reflective practice) � Attend Bristol Safeguarding children’s

Board (BSCB) training (3-7 hours per course- these are fee paying courses)

� Other Safeguarding training resources including E-learning

� Practice based discussions to aid reflective learning related to safeguarding children. eg critical incidents, clinical audit, vulnerable family meetings

Level 3 a/Core All clinical staff working with children/ young people/ parents and carers who could contribute to the assessing , planning and evaluation of the needs of children and their carers parenting abilities to safeguard and protect children

� GPs � Counsellors /

mental health workers

� Staff working with substance misuse services

3 hrs annually or a whole day (8 hrs) training course every 3 years. Approximately 3 hours in each 3 years should be multidisciplinary (i.e. involving non health agencies) (level 3 learning) (This training should include personal reflection, scenarios based discussions/ case studies and lessons from research)

3 hours annually or A whole day (min 8 hours) every 3 years

� Training offered by the CCG safeguarding team recommended as a minimum once every 3 years. (3 hours including reflective practice) This training is multidisciplinary/level 3

� Arrange practice based session to reflect on cases as part of annual practice training programme. (Best practice to involve agencies outside of health eg BDP, Next link, social care , Police voluntary sector workers)

� Attend case conference/ core groups/ strategy discussions/ Multi-professionals meeting and use as a basis for reflective piece of work.

� E-learning training related to safeguarding children

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Training options

� Attend Bristol Safeguarding children’s Board (BSCB) training (3-7 hours per course- these are fee paying courses)

Level 3 b Additional specialist

� Link GP for safeguarding children

12-16 hours over 3 years Approximately 5 hours in each 3 years should be multidisciplinary (i.e. involving non health agencies) (level 3 learning)

5 hours annually Or 12-16 hours over 3 years

• Attend and contribute to the training offered by the CCG minimum. (2 hours with reflection 3 hours) as above

• Attend the GP safeguarding link meetings (2 hours with reflection and reading minutes 3 hours)

• Attend a minimum of 1 BSCB or equivalent multi-agency training event every 3 years (2-7 hours depending on course The CCG will fund one of these courses every 3 years for a Link GP )

• Access regional and national training events related to safeguarding children

• Facilitate and participate in practice based sessions to reflect on safeguarding issues.

• Arrange practice based session to reflect on cases as part of annual practice training programme. Best practice to involve agencies outside of health (eg BDP, Next link, social care ,

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Training options

Police voluntary sector workers) • Attend case conference/ core groups/

strategy discussions/ Multi-professionals meeting and use as a basis for reflective piece of work

• E-learning training related to safeguarding children

Level 4 Named GP Annually 24 hours every 3 years

8hours annually

• Attend, local, regional and national training events

• Designing and delivering training • Supporting the serious case reviews

process • Offering guided supervision to other

GPs • Receiving Supervision/ reflective

practice with Designated Professionals

Access to Training Resources

• Accredited E-learning course- http://www.e-lfh.org.uk/programmes/safeguarding-children/ • Avon Practice learning- http://www.avonpracticetraining.co.uk/ • Avon GP Education- http://www.avongpeducation.co.uk/ • Bristol Clinical Commissioning Group (CCG) training- Annual flyer sent to every Link GP and Practice manager offering

the dates for the whole year- booking and information available from the CCG safeguarding children team on tel: 0117 9002384

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• BSCB training- http://www.bristol.gov.uk/page/children-and-young-people/bscb-training-courses (The BSCB charge for these courses the fee is £35.00 for a half day and £70.00 for a whole day -2014 prices)

• BSCB training- http://www.bristol.gov.uk/page/children-and-young-people/bscb-training-courses (Link GP’s can access a free place via the CCG to book training contact Safeguarding Children's team tel : 0117 9002384)

• Bristol Against Violence and Abuse (BAVA) training- http://www.bava.org.uk/professionals/training/ • Free e-learning on Female Genital Mutilation (FGM) Home office web site- http://www.fgmelearning.co.uk/ • Intercollegiate document 2014: http://www.rcpch.ac.uk/child-health/standards-care/child-protection/updates/child-

protection-updates / http://www.rcn.org.uk/development/practice/safeguarding/children_and_young_people

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APPENDIX 4

Safeguarding Children’s Training Matrix

This training matrix is a guide for Bristol CCG staff to identify their mandatory requirements to undertake child protection training to ensure safeguarding is recognised as everybody’s business. The matrix takes into account the training recommendations laid out in:

• Children Act 1989 and 2004 • Working Together to Safeguard Children 2013 • Intercollegiate Document 2014

The safeguarding children training matrix is identified in six levels recommended in the Roles and Competencies for Healthcare Staff - Intercollegiate Document 2014. Other agencies, e.g. Bristol Safeguarding Children Board (BSCB), use different levels. (See grid below) Level 1 and 2 is provided NHS Bristol CCG, level 3 training will be provided by the UHB or BSCB multi-agency training. Levels 4-6 are for specialist staff such as named, designated professionals, and doctors providing expert witness. Staff who need level 4-6 training should speak to the Designated professionals for guidance on appropriate courses to achieve competency in these levels. The Intercollegiate Document 2014 indicates the specific amount of time and knowledge the training must include and the competencies the student must acquire. The matrix below indicates how staff can achieve and evidence their training. All staff must complete induction safeguarding children’s training once and after that they must complete the level of training which is appropriate to their work. All Bristol CCG posts must have a safeguarding training level recorded on their electronic staff records (ESR), and completion of their training will be recorded on their Managed Learning Environment (MLE). It is the manager’s responsibility to ensure each post has a safeguarding training level allocated to it. No new post should be advertised without the correct level of safeguarding children’s training allocated. Induction training All new staff clinical and non-clinical All new staff must attend Induction training, which includes a basic awareness of issues related to safeguarding children. This training is 45 minutes. You can also completed the safeguarding children e-learning training on the core-learning unit Level 1 All Staff employed by Bristol CCG 30 min safeguarding children training is included in annual mandatory training program. Or you can complete the safeguarding children training on the core learning unit. Staff need to complete a minimum of 2 hours training every 3 years

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Level 2 Clinical and non-clinical staff who have regular contact with parents, children and young people This is a training session, which is 3 hours long and must be repeated every 3 years. The designated nurse for safeguarding children delivers this training. The course includes: advocating for the young person, being clear about yours and others roles in safeguarding children, understanding the law and information sharing, your role in effective documentation and recognising how parent’s behaviours can impact of child safety –‘Think Family’. Some professional groups may have their distance learning or e-leaning safeguarding training. The designated professionals can offer advice to senior managers or contract leads on the quality of training and it’s adherence to the intercollegiate document. Staff need to evidence a minimum of 3 hours training every 3 years Level 3 Core All staff working predominately with children, young people and parents This is specialist training for senior managers who support staff and for staff who manage complex safeguarding cases. To achieve this level you must attend BSCB multi-agency training, or a multi-agency training event related to safeguarding children. You must evidence you have completed an annual update on your level 3 multi-agency training. All GPs in their practice should be trained to a minimum of level 3 Core safeguarding children training. Staff need to evidence a minimum of 8 hours training every 3 years this can include some e-learning training but must include multi-agency face to face training as well Level 3 specialist All staff who provide health advice and support to manage child protection cases This training is also multi-agency and staff who meet these criteria must complete multi-agency training at both core and specialist levels. In addition they should access some form of safeguarding supervision or reflection on practice and an annual update of their safeguarding children training. This training must be multi-agency. BSCB training is offered free to staff employed by Bristol CCG. Staff need to evidence a minimum of 16 hours training every 3 years which can include some e-learning training but must include multi-agency face to face training as well. It is the duty of all staff to inform their manager and training when they have registered for any safeguarding children training, and they must inform them when they have completed the training. If you have received a certificate for any safeguarding children training, this can be used as evidence of attendance together with the aims and objectives of the training. If staff have completed training delivered by providers outside of Bristol the Designated Safeguarding Children’s Professionals can quality assure the training and accredit the training if they receive the certificate of attendance , the name of the trainer/ service provider and the aims and objectives of the training attended. You must complete all your safeguarding training to ensure you meet the requirements of your KSF and mandatory training

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•

Staff Group

Level 1 Induction Session

Level 2

Level 3 core

Level 3 specialist

Levels 4-6

Within 3 months

Within 6 months

Within 6 months

Within 6 months

All Bristol CCG employed staff, independent contractors and volunteers Minimum of 3yearly update (intercollegiate document 2010 recommend annual update

√ (30 Min annual update)

Clinical and non-clinical staff who have contact with parents, children and young people, eg: (Level 2)

Health trainers, smoking cessation staff, Pharmacist, Opticians, Dentists, practice nurses, ambulance staff, staff working with complex families where parents have Mental health, Domestic violence, Substance issue, earning difficulties, children’s commissioners, public health consultants and trainees, sexual health services, specialist commissioning services working with parents or having infrequent contact with children,

√

√ training is 3

hours with a 3 yearly update

To book BSCB multi-agency training contact the Bristol CCG safeguarding children team on 0117 9002384. E-mail [email protected] BSCB training program can be accessed by following this link: http://www.bristol.gov.uk/page/children-and-young-people/bscb-training-courses

The on-line e-learning package for your safeguarding children update can be accessed by following this link: https://www.mymle.org.uk/.

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This is not an exhaustive list and your manager will need to plan your training with you. This matrix demonstrates your minimum requirements for safeguarding children training you may want to undertake extra training for your own development.

Any staff members who wish to clarify their child protection training needs should discuss this with their line manager. If the line managers have any questions about safeguarding children training they should contact the named or designated professionals for safeguarding children

Staff working predominantly with children, young people and parents, eg:

Level 3 Core Domestic Violence leads, MARAC Nurse, GP’s, specialist commissioning services working with children ____________________________________________________ Level 3 Specialist Link GPs, Staff working in regional neuro-muscular service with children on their case load

√

------- √

√ annual Multi-

agency training

Minimum of 3-4 hours annually

√ annual Multi-

agency training

Minimum of 5-6 hours annually

Specialist roles eg (Level 4-6) named and designated professionals for safeguarding children will also need to attend additional specialist training, community paediatricians, designated doctor for children’s death’s,

√ √

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APPENDIX 5

Safeguarding contacts and referral information

If the child has a social worker, please contact the office directly; see below.

If you have a concern about a child in Bristol, contact First Response: 0117 9036444

---------------------------------------------------------------------------------------------------------

For East Bristol GPs, who will have some patients who live in South Gloucestershire, contact

First Point on 01454 866000 / [email protected]

FOR 24 HOUR URGENT ADVICE AND SUPPORT:

Community Paediatricians (ask to speak to on-call paediatrician for child protection), contactable via UHB switchboard on 0117 923 0000

Telephone numbers for routine advice and support:

Bristol Clinical Commissioning Group (BCCG)

Designated Doctor for all Bristol Trusts and NHS South Gloucestershire

Dr Maria Bredow Tel: 0117 9002670 Email: [email protected]

Designated Nurse for Safeguarding Children

Jackie Mathers 5th Floor, South Plaza, Bristol, Tel: 0117 9002670 Mobile: 0779 9348386 Email: [email protected]

Deputy Designated Nurse for Safeguarding Children

Julie Henderson 5th Floor, South Plaza, Bristol, Tel: 0117 984 1527 Mobile: 0755 7848387 Email: [email protected]

Named Doctor for Safeguarding Children

Dr Helen Mutch Tel: 0117 9640900 Mobile: 0776 8414789 The Lennard Surgery Email: [email protected]

Police Safeguarding Co-ordination Units (SCUs)

0117 9529456 CHILDREN AND YOUNG PEOPLE’S SERVICES (use office nearest to the child’s address) Out of hours emergency duty team (after 5pm and w/e)

Tel: 01454 615165 (out of hours)

Ring FIRST RESPONSE to check if child is subject to a Child Protection Plan

Tel: 0117 9036444 (daytime)

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CONTACT NUMBERS FOR NEIGHBOURING TRUSTS

North Bristol NHS Trust (NBT)

Named Nurse for Child Protection

Anne Fry North Bristol NHS Trust, Beaufort House, Southmead Hospital BS10 5NB Tel: 0117 4149050, Mobile: 0779 5101319 Email: [email protected]

Named Midwife for Child Protection

Lisa Marshall. Deputy Director of Midwifery: Tel: 0117 323 5319 Email: [email protected]

Named Doctor for Child Protection

Dr Lindsey Mackintosh. Kingswood Locality Hub Alma Road Kingswood BS15 4DA, Tel: 01454 865185 Email: [email protected] Dr Richard Williams Email: [email protected] Consultant Community Paediatrician Osprey Court Unit 2 Hawkfield Business Park Whitchurch lane BS14 0BB, Tel: 0117 3408080

University Hospitals Bristol NHS Foundation Trust (UHB)

Named Nurse for Child Protection

Carol Sawkins Child Protection Team Office, Level C, St Michael’s Hospital Tel: 0117 3425269 Email: [email protected]

Named Midwife for Child Protection

Sarah Windfeld St Michael’s Hospital Tel: 0117 3425263 Email: [email protected]

POLICE

POLICE SAFEGUARDING Co-CORDINATION UNIT (SCU)

Tel: 0117 9529456 Email:

#SafeguardingCoordinationUnitBristol@avonandsomerset.pnn.police.uk

POLICE ACUTE POLICE ASSISTANCE

101/999

ONLINE INFORMATION

South West Child Protection Procedures available at www.swcpp.org.uk

First Response

http://www.bristol.gov.uk/page/children-and-young-people/first-response-bristol-report-concerns-about-child-social-worker

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Dr Lisa Goldsworthy Bristol Children’s Hospital Tel: 0117 3428187 Email: [email protected]

Bristol Community Health (BCH)

Named Nurse for Safeguarding Children

Stephanie Stacey Tel: 0117 9002146, Mobile: 0773 3361897 Email: [email protected]


Dr David Capehorn Leap Valley Sugery Tel: 0117 9702033 Mobile: 07778766473 Email: [email protected]

NHS South Gloucestershire

Lead Manager for Safeguarding Children

Lisa Harvey, Tel: 0117 947 4437 Email: [email protected]

Named Doctor for Child Protection Dr Kate Mansfield Email: [email protected] Wellington Road Surgery, Tel: 01454 323366

NHS North Somerset

Head of Safeguarding

[email protected] North Somerset CCG, PO Box 247, Castlewood, Tickenham Road, Clevedon, BS21 6FW, Tel: 01275 885138

Safeguarding Lead/ Named Nurse for Child Protection

Jocelyn Grimwood North Somerset Community Partnership, Worle Health Centre, Worle, Weston super Mare, BS22 6HB Tel: 01934 529163, Mobile: 07717 151180 Email: [email protected]


Dr Mike Pimm Cedars Surgery, Weston-super-Mare Tel: 01934 515878 Email: [email protected]

Associate Designated Nurse for Safeguarding Adults & Children

Carole Oriolo North Somerset CCG, Castlewood, Clevedon, BS21 6FW Mobile: 0799 0562023, Email: [email protected]

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Appendix 6 Flow Chart for Serious Case Review Process