New guidance sets out procedures for safeguarding the wellbeing of children, and healthcare professionals have an important role, as Dr Gerard Panting explains
The Government's recently updated guidance 'Working together to safeguard children', which describes how individuals and organizations should work together to safeguard children's welfare, runs to 270 pages,1 and refers to a number of other documents offering further advice.
It is aimed at everyone who has responsibilities for child welfare, which obviously includes GPs. The good news is that it is not necessary for all GPs to read the whole document, but there are sections that are particularly relevant for doctors, and others detailing responsibilities that PCTs must fulfil.
A lot has changed since the previous guidance was published in 1999.2 The report into the tragic events surrounding Victoria Climbié's death, published in 2003,3 and the joint Chief Inspectors' report on safeguarding children (2002),4 both highlighted weaknesses in the child welfare system.These reports resulted in the Green Paper Every Child Matters,5 which in turn led to new provisions in the Children Act 2004.6 Of these changes, the guidance identifies the following as the most important recommendations: the creation of children's trusts; the establishment of Local Safeguarding Children Boards (LSCBs); and the duty of all agencies to safeguard and promote the welfare of children.1
Roles and responsibilities
The range of individuals and organizations with responsibilities is, to say the least, extensive. Local authorities, the police, LSCBs, probation services, governors and directors of all prison establishments and juvenile young offender institutions, schools, childminders, the Family Court Advisory and Support Service, the armed forces, the voluntary sector, and faith communities all get a mention, as, of course, do healthcare professionals and healthcare organizations.
Healthcare professionals are seen as having a key role, and the guidance sets out the general principles to be applied:
- aim to ensure all affected children receive appropriate and timely therapeutic and preventive interventions
- those professionals who work directly with children should ensure that safeguarding and promoting their welfare forms an integral part of all stages of care that they offer
- those professionals who come into contact with children, parents and carers in the course of their work also need to be aware of their safeguarding responsibilities
- all healthcare professionals should be able to recognize risk factors and contribute to reviews, enquiries and child protection plans, as well as plan support for children, and provide on-going promotional and preventive support through proactive work.
Local Safeguarding Children Boards (LSCBs)
Local Safeguarding Children Boards are statutory bodies, operating at county or unitary authority level. They are charged with agreeing how the organizations in each local area will work together to promote childrens' welfare and safety, and ensure they are effective in what they do. GPs are not always included on LSCBs.
The guidance sets out the scope of the LSCB's work as follows:
- engaging in activities that safeguard all children, and aim to identify and prevent maltreatment, or impairment of health or development, and ensure that children are growing up in circumstances consistent with safe and effective care
- to lead and coordinate proactive work that targets particular groups
- to lead and coordinate arrangements for responsive work to protect children who are suffering, or at risk of suffering, maltreatment.
The core functions of LSCBs are also set out in the new guidance (see Box 1).
|Box 1: Core functions of Local Safeguarding Children Boards|
Inter-agency training and development
Working across service boundaries always carries the risk of communication failures, and in the case of child welfare, it creates the potential for children to come to harm. In this guidance, the expectation is that training will create an ethos of collaborative working, respecting diversity, promoting equality, being child-centred, and promoting the participation of children and families.
All this should happen under the watchful eye of the LSCB, and involve general practitioners who:
- are in regular contact with children and young people
- work regularly with children and young people, and with adults who are parents or carers
- may be asked to contribute to assessments of children in need
- have a particular responsibility for safeguarding children.
Managing individual cases
The guidance sets out what should happen if someone, including GPs and other healthcare professionals, has concerns about a child's welfare. The processes in place to manage an individual case should include:
- responding to concerns about the welfare of a child, and making a referral to a statutory organization (children's social care, the police, the NSPCC) that can take action to safeguard and promote the welfare of children
- undertaking an initial assessment of the child's situation and deciding what to do next
- taking urgent action to protect the child from harm, if necessary
- holding a strategy discussion where there are concerns that a child may be suffering harm and, where appropriate, convening a child protection conference
- deciding whether a child is at continuing risk of significant harm and, therefore, should be the subject of a child protection plan; implementing the plan and reviewing it at regular intervals.
Child death review process
Chapter 7 of the guidance deals with the response to a child's death, and how the Child Death Overview Panel should manage the procedure.
The two interrelated processes for reviewing child deaths are:
- a rapid response by a group of key professionals who come together for the purpose of enquiring into and evaluating each unexpected death of a child
- an overview of all child deaths in the area, undertaken by a panel.
The GP's role in the child death review process is to ensure that all relevant information they have access to is disclosed to the review team.This often creates conflicts over confidentiality as the information may pertain to other individuals.
While it is best practice for a GP to seek consent to disclose the information, the overriding responsibility is to ensure that the review is not hampered by a failure to provide the required information.
Serious case reviews
Following a child's death attributable to known or suspected abuse or neglect, or in other circumstances where a child has been harmed, the LSCB should conduct a serious case review.
The purpose of the review is to examine what happened and to establish whether there are lessons to be learnt about inter-agency working, which in turn should lead to a plan. The guidance states 'at least as much effort should be spent on acting upon recommendations as conducting the review.'1
Protecting children's welfare is obviously important. Responsibilities inevitably stretch across agency and professional boundaries, which can be problematic. Working together to safeguard children sets out to address these issues comprehensively, but to some extent that also makes it less accessible, heightening the need for LSCBs to ensure that inter-agency training is genuinely inclusive.
- Department of Health, Home Office, Department for Education and Employment. Working Together to Safeguard Children. A guide to inter-agency working to safeguard and promote the welfare of children. London: Her Majesty's Stationery Office, 2006.
- Department of Health, Home Office, Department for Education and Employment. Working Together to Safeguard Children. London: Her Majesty's Stationery Office, 1999.
- Presented to Parliament by the Secretary of State for Health and the Secretary of State for the Home Department. The Victoria Climbié Inquiry. Report of an Inquiry by Lord Laming, Norwich. Her Majesty's Stationery Office: London, 2003.
- Social Services Inspectorate, Commission for Health Improvement, Her Majesty's Inspectorate of Constabulary, Her Majesty's Crown Prosecution Service Inspectorate, Her Majesty's Magistrates' Courts Inspectorate, Ofsted, Her Majesty's Inspectorate of Prisons, Her Majesty's Inspectorate of Probation. Safeguarding Children – a joint Chief Inspectors' report on arrangements to safeguard children. London: Department of Health, 2002.
- Department for Education and Skills. Green Paper – Every Child Matters. London: Her Majesty's Stationary Office, 2003.
- Her Majesty's Stationery Office. Children Act 2004. London: Her Majesty's Stationery Office, 2004.