Working Together to Safeguard Children 2013: What the changes mean for you Why was the guidance rewritten in the first place? business, set out clear principles and shared understanding and to increase the discretion and trust of the judgement of frontline professionals. It increases local flexibility and sets out a system which should be more flexible to, and centred on, the needs and journey of the child. Is it better than the 2010 version? Now that only core principles are within the guidance, there should be less confusion, less bureaucracy and less prescription. Responsibilities are explicit and there is better signposting to a list of links of other guidance which contains. What are the main changes? Structure and content A number of chapters and non-statutory and supplementary guidance has been stripped out, but a list of further sources is included The training chapter has been incorporated into other chapters A new chapter on early help creating a new approach to the identification of the need for early help, and an early help assessment process (which can include the CAF approach but does not need to). There is a natural and progressing flow from early help to children in need through to those children in need of protection (at risk of significant harm) Early help and thresholds There is a much greater emphasis on the benefits of providing early help, and elucidation of how to achieve this within section 10 Children Act 2004. Multiagency early help assessments will now occur, led by an identified professional Local areas should publish a threshold document which includes the early process, offer and the criteria for when cases should be referred to social care for assessment both for children in need (s17) for section 47 enquires Information sharing There is greater prominence and a shift in tone about the need to overcome fears about sharing information or assume others will do so Assessment and timescales: Initial and core assessments will now not exist and assessment will be a continuous and dynamic process. The associated timescales have been dispensed with although there will remain an outer parameter timescale of 45 days, to prevent the risk of drift
Local areas must develop and publish a protocol for assessment which sets out how cases will be managed There will be a focus on outcomes and regular case review points A social worker will have to decide on the response to a referral within one working day of receipt Initial child protection conferences will still be required, as will strategy discussions to be held within 15 working days of the initial conference The role of health Specific sections for component professional groups have been removed, Instead, all the previous material has been themed to apply to all health professionals. New sections have been added on the role of the NHS Commissioning Board and CCGs, linking to the Accountability and Assurance Framework Local Safeguarding C Boards (LSCBs) There is a summarised description of the minimum standards for LSCBs in order for them to meet their statutory regulations The NHS Commissioning Board (NHS CB) and Clinical Commissioning Groups (CCGs) are statutory partners of the LSCB and must be included LSCBs can still cover more than one local authority but this is now stated as only in exceptional circumstances The need for an independent Chair is reinforced, and the Chief Executive of the Local Authority (LA) must now explicitly appoint or remove the Chair, but only after agreement with a panel including LSCB partners LSCB funding has been subtly changed to now explicitly say that all member organisations have an obligation to provide reliable resource to enable a strong LSCB, and that financial responsibility should be proportionate to the size of the organisation Clarifies the current law on LSCBs requesting information The concept of a learning improvement framework The chapter seeks to extend practice from simply conducting Serious Case Reviews (SCRs) and instead have regular reflection and review of services with the learning and sharing of lessons (not just those cases which meet SCR thresholds) both of what works well and when things go wrong; covering the full range of reviews and audits which aim to drive improvement Serious Case Reviews (SCRs) It is clarified that professionals should contribute their perspectives without fear of being blamed for actions they took in good faith A national panel of independent experts on SCRs will advise LSCBs about the initiation and publication of SCRs. This includes scrutiny for when LSCBs decide not to initiate a SCR LSCBs should maintain a shared local learning and improvement framework Reviews should be conducted regularly, not only on those cases which meet statutory requirements but also on other cases which can provide valuable lessons LSCBs have flexibility to use any learning model, including the systems methodology recommended by Munro There is no longer any requirement for organisations to undertake formal Individual Management Reviews (IMRs) Increased transparency: final reports of SCRs findings must be published and must be on the LSCB's website for a minimum of 12 months Child deaths CCGs are required to employ or secure the expertise of paediatricians whose designated responsibilities are to provide advice on commissioning paediatric services from paediatricians with expertise in undertaking enquiries into unexpected deaths in childhood (Designated Doctor for Sudden Unexpected Deaths in Childhood)
Designated paediatricians for unexpected deaths in childhood have a responsibility to ensure that relevant professionals are informed of all unexpected deaths, to coordinate a team of professionals and to convene multiagency discussions after the initial and final post mortem results are available Findings from all child deaths should inform strategic planning, including the local Joint Strategic Needs Assessment What is the same? Duties Section 11 Children Act 2004 duties continue to apply to NHS organisations, which now includes the NHS CB and CCGs and continues to include NHS Trusts and Foundation Trusts (FTs) All organisations continue to be required to have safeguarding arrangements, including clear lines of accountability, senior leadership, a culture of listening to children and taking their wishes and feelings into account, information sharing protocols, designated professionals, safe recruitment, appropriate training, supervision and support and policies in line with those produced by the LSCB Private providers of services should have the same safeguarding arrangements in place as their public service counterparts NHS Trusts and FTs continue to be section 13 relevant partners of the LSCB and must be included in its work Competence The critical role of paediatricians in safeguarding is explicitly stated, as is the duty for all healthcare staff, to be competent to their role as per the intercollegiate safeguarding and looked after children competency documents Named and designated professionals The wording is as robust as it was in 2010 there has been no dilution of these roles and indeed the guidance explicitly recognises the essential nature of the roles. Roles must be explicitly defined in job descriptions and have sufficient time, funding, supervision and support in place to fulfil the duties effectively What happens now? The guidance comes into force on 15 April 2013. Before then, ensure you have read and understood it. After that, use it as a lever to improve practice in your area. Quote it, ensure it is being read and instigated in your area, and rely on its wording if you are having difficult conversations such as on the issue of designated professionals. The guidance replaces previous versions so all professionals are expected to follow the new version. This publication is only one part of implementation of the recommendations from the Munro Review of Child Protection. Other work and publications, such as on inspection and performance information datasets, should also be read and followed. How RCPCH influenced the document on your behalf RCPCH have been regularly and consistently involved in both the Munro Review and the subsequent implementation of the recommendations. We sit on a DfE Professional Advisory Group, which has reviewed the new Working Together. In 2012 the RCPCH led a delegation of six Royal Colleges in meeting the Secretary of State (SoS) for Education to raise concerns about the guidance. The result of that meeting was the SoS asking the Colleges to submit an amended draft of the guidance, which the RCPCH led on and submitted. Following this, RCPCH have held several meetings with DfE officials and have succeeded in significantly inputting into, and securing changes in, the new guidance on behalf of both our members and other health professionals. The new guidance is a vast improvement on the draft released for consultation in 2012.
Safeguarding Vulnerable People in the Reformed NHS: Accountability and Assurance Framework How does it link to Working Together? The Framework not statutory guidance it supports the NHS in fulfilling their statutory duties and offers a greater level of detail than Working Together. It articulates the how rather than the what, which is especially important as the reforms within the Health and Social Care Act come into force and new organisations and individuals get to grips with designing services and meeting responsibilities. The Framework is produced by the NHS Commissioning Board (NHS CB), who has a responsibility to ensure the NHS is supporting and safeguarding vulnerable children. What has changed since the interim advice issued last year? Much of the advice remains the same. However, the advice is now final and the latest document addresses a number of issues which were previously left unanswered. Detail has been crystallised in the current document, particularly on whole systems assurance, the role of each part of the NHS safeguarding system, and the responsibilities of new functions such as Safeguarding Forums, NHS CB Area Teams and Quality Surveillance Groups. It provides more information on the role of the NHS CB, CCGs, providers and LSCBs than was previously included. The interim advice was designed to support CCG authorisation processes. The final advice will continue to support this implementation process but also guide longer-term local service developments. What are the key points? The document lays out the function of new bodies such as the NHS CB, CCGs and local authority public health functions. It outlines the safeguarding responsibilities for each body and provides specific and detailed guidance on what organisations need to do to discharge those duties. General All new organisations have the same as, and no less, responsibilities than their predecessors NHS CB and CCGs must be members of the LSCB NHS CB and CCGs must learn lessons from cases where children die or are seriously harmed and abuse or neglect is suspected NHS CB and CCGs need to ensure effective safeguarding arrangements across the whole local health community CCGs They need to assure themselves that organisations from which they commission services have effective safeguarding arrangements in place CCGs need clear training plans, accountability and governance structures, arrangements to cooperate with partners, effective information sharing arrangements, designated professionals in place for safeguarding, looked after children and unexpected deaths in childhood. Designated professionals need to have the authority to influence practice and their role should be explicitly defined and supported by sufficient time to enable them to fulfil their duties effectively Designated professionals are likely to be employed by a CCG, with a clear Service Level Agreement to their provider organisation employer where relevant Where there is more than one CCG, they designated professional team
Funding for safeguarding services forms part of core budgets and is within agreed baseline funding Capacity to fulfil duties should be decided by factors such as the size and geography of the area, deprivation levels, population statistics, evidence from recent inspections and reviews and the number and complexity of the provider landscape NHS CB The Chief Nursing Officer, via the Director of Nursing as Clinical Lead, is the accountable officer for safeguarding within the NHS CB The NHS CB should ensure it meets safeguarding responsibilities for its directly commissioned services (primary care and specialised services), is a policy lead for NHS safeguarding and improves practice and outcomes, leads CCG assurance processes and provides specialist advice to the NHS The NHS CB is responsible for co-coordinating and funding safeguarding training for GPs The NHS CB Area teams will establish local Safeguarding Forums, which will supervise and support designated and specialist professionals, advise CCGs and Area Teams, drive improvement, underpin system accountability, ensure succession planning for designated and specialist professional The role of the named GP has been clarified, strengthened and described as critical. A minimum of 2 sessions per 220,000 is recommended Providers Private providers hold the same duties as NHS providers r practice is identified and tackled Safeguarding arrangements include safe recruitment, supervision, partnership working and identifying named professionals Other considerations Safeguarding assurance is via internal processes, LSCBs, external regulation and inspection, local peer review and effective commissioning, procurement and contract monitoring Designated professionals should be included in the work of the LSCB The work of the LSCB and the Health and Wellbeing Board should be complementary NHS CB Area Teams are responsible for local support, leadership and assurance Virtual Quality Surveillance Groups (QSGs) will lead on quality and performance improvement and information sharing, working closely with the NHS Trust Development Authority Safeguarding Forums will link with Strategic Clinical Networks to provide specialist clinical advice What should I do next? All professionals should read the document in full. Clinicians should use the provisions within the document to ensure that local service development complies with the advice and should, where necessary, use the advice as a lever to press for further improvement. The advice can act as a catalyst for initiating local discussions, to ensure named and designated professionals are protected and strengthened and to ensure commissioners and others understand the range and depth of their responsibilities in the reformed NHS. March 2013 Please contact nick.libell@rcpch.ac.uk if you have any queries