Policy for recording and processing the non-attendance [was not brought] of children and young people [0-18 birthday] for pre-arranged referral/appointments Department / Service: Originator: Anne Crohill Lead Nurse Safeguarding Children Accountable Director: C Approved by: Paediatric Clinical Governance Committee Date of approval: 28 th March 2014 Extension approved: 22 nd July 2015 First Revision Due: 28 th March 2017 Target Organisation(s) Worcestershire Acute Hospitals NHS Trust Target Departments All areas where patients aged 0-18yrs access services Target staff categories Medical, Nursing / Midwifery and Clerical Administrative Staff Policy Overview: This policy sets out the procedure to be followed when a child / young person [0-18 yrs of age] is not brought / fails to attend a pre-arranged outpatient appointment, investigation, clinic or ward admission. This guidance predominantly applies to children under 16 years of age but the same principles apply to young adults 16-18 years who are still defined as children under the Children s Act 2004. This Policy should be read in conjunction with the documents cited below where applicable: WAHT-OBS-073 Follow-up of women who fail to attend their appointment for antenatal care. Failure to attend guideline for children and young people with diabetes Key amendments to this Document: Date Amendment By: February This Policy is new 2014 May 2016 Document extended for 12 months as per TMC paper approved on 22 nd July 2015 TMC This Policy is held electronically on WAHT Intranet. Any printed copy of this policy may be out of date due to regular updating of the content. WAHT-NUR-088 Page 1 of 12 Version 1.1
Contents page: 1. Introduction 2. Scope of this document 3. Definitions 4. Responsibility and Duties 5. Policy detail 6. Implementation of key document 6.1 Plan for implementation 6.2 Dissemination 6.3 Training and awareness 7. Monitoring and compliance 8. Policy review 9. References 10. Background 10.1 Equality requirements 10.2 Financial Risk Assessment 10.3 Consultation Process 10.4 Approval Process Appendices Supporting Documents Supporting Document 1 Supporting Document 2 Equality Impact Assessment Financial Risk Assessment WAHT-NUR-088 Page 2 of 12 Version 1.1
1. Introduction Every child has the right to health and healthcare United Nations Convention on the Rights of the Child, Article 24, 1989. 1.1 Failed attendance of a child or young person may be due to several factors, for example incorrect contact details, inappropriate referral/problem resolved, fear & anxiety or multiple appointments at diverse locations on consecutive days or they have just forgotten about the appointment. Many parents/ carers will telephone the hospital to rearrange or cancel appointments but a significant number just fail to turn up. 1.2 However, professionals need to also consider the issue that failure to attend can be an indicator of a family s vulnerability, potentially placing the child s welfare in jeopardy. Younger children in particular are reliant on their parent/carer accompanying them to appointments. 1.3 There may be a perfectly acceptable reason for the child s failure to attend, however, it is also possible that the parent/carer does not share our concerns, may be hiding injuries or signs of neglect or is just unable to put their child s needs first. 1.4 Where there could be child protection concerns, sharing information regarding failure to attend can be vital in protecting the child and the opportunity to safeguard children and young adults should not be missed. Sharing information on missed appointments may contribute to timely interventions in children whose needs are not being met or who are experiencing abuse. 1.5 Evidence from studies looking into Serious Case Reviews and child deaths have identified that missed health appointments is a significant risk factor in some cases where children have been killed or seriously injured by their parents or carers. However, there was a failure to be proactive in following up these missed appointments or seeing it in the context of what was happening for the child within the family. 1.6 Where neglect is not a factor, the failure to attend appointments wastes professional time, increases waiting lists and is an ineffective use of resources, both human and financial. 1.7 The purpose of this policy is to ensure a Trust wide approach in proactively following-up non-attendees and sharing this information with other known professionals who are involved with the child and family, on a multi agency basis. 2. Scope of this document This policy sets out the procedures and information sharing pathway to be followed by all staff involved with the planning and delivery of care for a child/young person who fails to attend a pre-arranged appointment or admission for any department within WAHT. 3. Aim & Purpose Safeguarding and promoting the welfare of children is everybody s business within WAHT. 3.1 The aim of this policy is to provide a process which is followed for all children / young people who fail to attend appointments. This is in line with National and Local Safeguarding Children guidance to ensure that children are protected in WAHT-NUR-088 Page 3 of 12 Version 1.1
accordance with Every Child Matters Change for Children, the Children s National Service Framework ; When to suspect maltreatment : The Children Act 2004 and Working Together to Safeguard Children 2013. 3.2 If at any time safeguarding concerns are raised about a child / young person, then The Trust child protection procedures must be followed as set out in WAHT- CG- 455 Safeguarding Children and Young People Policy. Contact the Lead Nurse / Named Doctor for safeguarding children or the Consultant Paediatrician on call. 4. Responsibility and Duties This Policy is to be followed by all Trust staff who are involved in delivering / the planning of the care for all children / young people. All Administrative and Clerical staff are to be made aware of this policy via senior managers/ administrators. 5. Policy detail Whenever contact is made with a child the following information should be checked and recorded:- Full name of child Current Address Telephone Number Date of birth Name of primary carer does this person have parental responsibility Full name and relationship of person accompanying the child. GP and GP address School / Nursery if appropriate Health Visitor / School Nurse (if known) Other professionals involved with the child, e.g. Social Worker, speech therapist Previous attendances at hospital Details of ethnicity / language or method of communication Are there any other children within the family home If so, record their names and dates of birth in full Think Family is the parent / carer receiving support from a social worker, mental health worker, substance abuse worker, housing officer etc If the above is incomplete: complete the information If the child is not registered with a GP, contact the Lead Nurse for Safeguarding Children Ext: 39149 5.1 Failure to attend initial clinic appointment a) It is the responsibility of the clinician (Doctor, Nurse, Physiotherapist, Audiologist, Ophthalmologists etc.) to inform the referrer that the child / young person has failed to attend the appointment. This should be documented in the hospital record. WAHT-NUR-088 Page 4 of 12 Version 1.1
b) It is the consultant or clinician with overall responsibility for the child/young person s care who will make a professional decision as to whether the child/young person is discharged back to the care of the initial referrer, or whether a further appointment will be offered. c) The decision made should be clearly recorded in the notes. A letter should be sent to the parent/carer of the child [also to the young person where appropriate] detailing the relevant information, and copied to the GP, health visitor / school nurse, social worker and any other professional involved with the child / young person and family as appropriate. d) The letter for the health visitor / school nurse should be emailed to PaediatricLiaison.Nurses@hacw.nhs.uk e) If the child is a Looked After Child [LAC], for example living in foster care or a children s home, notify the Specialist Nurse for Looked After Children. 5.2 Failure to attend initial ward admission a) It is the responsibility of the clinician who accepts the emergency referral from the GP to inform the nurse in charge of the ward about the expected admission of the child. b) The details of the child/young person will be entered onto the ADT White Board including the time the referral was taken. c) If the child/young person has not arrived on the ward 2 hrs post the referral being taken, the duty consultant should be notified. The referring GP should be contacted to inform them of the failure to attend and also establish whether the failure to attend raises any safeguarding concern. A plan of action should be made and documented. If the child/family are known to Children s Social Care the social worker / support worker should be informed. d) If the failure to attend the ward causes safeguarding concern the Trust child protection procedures must be followed as set out in WAHT- CG- 455 Safeguarding Children and Young People Policy. Contact the Lead Nurse / Named Doctor for safeguarding children or the Consultant Paediatrician on call. If deemed an emergency situation contact Police. Involve Access Centre /EDT as appropriate. 5.3. Failure to Attend a Follow-on Appointment a) It is the responsibility of the clinician to check that the details for the child are correct and if necessary make changes and document in the hospital record. b) It is at the discretion of the consultant or clinician with overall responsibility for the child/young person s care who will make a professional decision as to whether the child/young person is discharged back to the care of the initial referrer, or whether a second or third appointment will be offered to the parent/carer/young person. WAHT-NUR-088 Page 5 of 12 Version 1.1
This should be clearly documented in the records and a further appointment sent if appropriate. c) No concern following failure to attend A letter should be sent to the parent/carer of the child [also to the young person where appropriate] detailing any decisions made re a future appointment, or that no further appointment will be sent. A letter documenting the failure to attend along with any other decisions made and any concerns identified should be sent to the referrer. Copy to the health visitor / school nurse via PaediatricLiaison.Nurses@hacw.nhs.uk. Also copy to Social Worker or other professional involved with the family eg adult mental health worker, substance misuse worker. Notify the Specialist Nurse for Looked After Children if the child is a Looked After Child [LAC], for example living in foster care or in a children s home. d) Concern that the child s medical needs are being neglected Check if the child has a child protection plan contact Lead Nurse Safeguarding Children / Paediatric Ward. If yes - Discuss with social worker. Contact Worcestershire Early Help Hub 01905 822666 to establish if the child is known to Children s Social Care. Notify the Specialist Nurse for Looked After Children, if the child is a Looked After Child [LAC] for example living in foster care or in a children s home Discuss your concerns with the child s GP, Health Visitor / School Nurse Discuss with the Lead Nurse for Safeguarding Children (ext: 39149) or the Named Doctor for Safeguarding Children. Consider a referral to Children s Social Care and informing the family of your concerns. e) When a parent/carer cancels an appointment If a parent or carer cancels two consecutive appointments, staff should follow the guidance as per Failure to Attend a Follow-on Appointment. Remember that a copy of all letters must be filed in the child s records. WAHT-NUR-088 Page 6 of 12 Version 1.1
f. Flow Chart of pathway to be followed in the event of non-attendance [was not brought] children and. NEW REFERRAL RECEIVED WARD Patient does not arrive within 2 hrs of initial referral received CLINIC Non attendance at Initial appointment Consultant / Clinician with overall responsibility for care of child to make the decision re:- No further appointment offered. Notify Duty Consultant. Inform GP of nonattendance. Establish plan of action. Discharged back to care of initial referrer. Notify parent/carer/young person and all professionals involved with child / family. Document in hospital record. Establish any safeguarding concern. Discuss with Duty Consultant. Discuss with Lead Nurse /Doctor safeguarding children if in doubt. Notify social worker / contact Children s Social Care if appropriate. In an emergency contact Police. Offer 1 st follow-on appointment. Ensure that all contact details for child / young person are correct. Send appointment. Notify parent/carer/young person and all professionals involved with child / family. Document in hospital record Non attendance at 1st follow-on appointment. Non attendance at 2nd follow-on appointment. Consultant decision to offer 2 nd follow-on appointment Non attendance at follow-on appointment Concern that the child s medical needs are being neglected. Establish if a Child Protection Plan / Social worker involved. Discuss your concerns with the child s GP, Health Visitor / School Nurse / Lead Nurse /Named Doctor Safeguarding Children. Consider a referral to Children s Social Care and informing the family of your concerns. [Copy referral to Lead Nurse Safeguarding Children] Notify all professionals involved with family. Document in Hospital notes WAHT-NUR-088 Page 7 of 12 Version 1.1
6. Implementation 6.1 Plan for implementation This Policy is to be implemented on a Trust wide basis to all areas where children and young people access services. This policy is available via the Trust Intranet. 6.2 Dissemination Information disseminated to all appropriate staff via management / directorate meetings. Use of communication briefs etc. 6.3 Training and awareness Information within policy to be given to all administrative staff who deal with non attendance letters from clinics, Emergency Departments and ward areas. 7. Monitoring and compliance See table below. The Trust will also collaborate on any related audit undertaken by the Paediatric Liaison Team, Health & Care Trust Worcestershire Page/ Section of Key Docume nt Key control: Checks to be carried out to confirm compliance with the policy: How often the check will be carried out: Responsible for carrying out the check: Results of check reported to: (Responsible for also ensuring actions are developed to address any areas of noncompliance) Frequency of reporting: WHAT? HOW? WHEN? WHO? WHERE? WHEN? To ensure Random sample of 6 months after Safeguarding Safeguarding Annually that DNA children & young adoption of children team children & young letters are people DNA s from policy and people Sub generated across the Trust to then annually group. and sent to ensure letter has Shared with Paediatric been generated WAHT Trust Liaison and sent Childrens Board Nurses. and Paediatric Clinical Governance Committee WAHT-NUR-088 Page 8 of 12 Version 1.1
8. Policy Review The policy will be reviewed every two years by the Lead Nurse Safeguarding Children on behalf of the Trust Safeguarding Children & Young People Sub Group. 9.References Code: 10. Background 10.1 Consultation Initial draft of policy was circulated to those in the consultation list below. Key individuals involved in developing the document NAME Anne Crohill Dr Douglas Castling Dr Clare Onyon Chris Mitchell DESIGNATION Lead Nurse for Safeguarding Children Named Consultant Paediatrician for Safeguarding Children (WRH) Named Consultant Paediatrician for Safeguarding Children (AH) Quality Improvement Facilitator : Worcester & Kidderminster Hospitals Circulation list final draft Key stakeholders and managers. NAME DESIGNATION Lindsey Webb Chief Nursing Officer Dr Douglas Castling Named Consultant Paediatrician for Safeguarding Children (WRH) Dr Clare Onyon Named Consultant Paediatrician for Safeguarding Children (AH) Chris Mitchell Quality Improvement Facilitator Andrew Short Divisional Medical Director Cathy Garlick Divisional Director of Operations Julian Berlet Divisional Medical Director Jane Schofield Divisional Director of Operations Graham James Divisional Medical Director Matthew Train Divisional Director of Operations Tony Scriven Divisional Medical Director Paul Bytheway Divisional Director of Operations Chris Catchpole Divisional Medical Director David Burrell Divisional Director of Operations Heather Warner Head of Access Dr Andrew Gallagher Clinical Director Paediatrics Dr John Scanlon Consultant Paediatrician Dr Taruna Bindal Consultant Paediatrician Dr Tom Dawson Consultant Paediatrician Dr Kamal Nathavitharana Consultant Paediatrician Dr Marie Hanlon Consultant Paediatrician Dr Viviana Weckemann Consultant Paediatrician Dr Naeem Ahmad Consultant Paediatrician Dr Munir Ahmed Consultant Paediatrician Dr Peter van der Velde Consultant Paediatrician Dr M Ayaz Locum Consultant Paediatrician Dr B Williams Consultant Emergency Department Worcester Dr C Hetherington Consultant Emergency Department Redditch WAHT-NUR-088 Page 9 of 12 Version 1.1
10.2 Approval process Approval required Trust Childrens Board, Children and Young People Safeguarding Sub Group and Paediatric Clinical Governance Committee. 10.3 Equality requirements This Policy does not affect one group less or more favourably than another. 10.4 Financial risk assessment None WAHT-NUR-088 Page 10 of 12 Version 1.1
Supporting Document 1 - Equality Impact Assessment Tool To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Yes/No Comments Age 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? N/A 5. If so can the impact be avoided? N/A 6. What alternatives are there to achieving the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? N/A If you have identified a potential discriminatory impact of this key document, please refer it to Assistant Manager of Human Resources, together with any suggestions as to the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact Assistant Manager of Human Resources. WAHT-NUR-088 Page 11 of 12 Version 1.1
Policy Supporting Document 2 Financial Impact Assessment To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Title of document: 1. Does the implementation of this document require any additional Capital resources 2. Does the implementation of this document require additional revenue Yes/No 3. Does the implementation of this document require additional manpower 4. Does the implementation of this document release any manpower costs through a change in practice 5. Are there additional staff training costs associated with implementing this document which cannot be delivered through current training programmes or allocated training times for staff Other comments: If the response to any of the above is yes, please complete a business case and which is signed by your Finance Manager and Directorate Manager for consideration by the Accountable Director before progressing to the relevant committee for approval WAHT-NUR-088 Page 12 of 12 Version 1.1