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SESSION 2002/2003 Committee for Health, Social Inquiry into Child Protection Services in Ordered by the Committee for Health, Social Services and Public
Safety to be printed 9th October 2002
WRITTEN SUBMISSION BY: 31 August 2002 Thank you for your
letter inviting the Police Service of Northern Ireland to submit evidence to
the Committee for Health, Social Services and Public Safety of the Northern
Ireland Assembly. The Police Service
of Northern Ireland, in recognition of its statutory child protection responsibilities
under the Children (Northern Ireland) Order 1995 and the previous Children
and Young Persons Act 1968, has developed specialist investigative units known
as Child Abuse Rape Enquiry (CARE) Units. These units have been tasked with
the responsibility of representing the Police Service of Northern Ireland on
the various multi-agency fora whose priorities are child protection. These
include the 4 Area Children and Young People's Committees, the Area Child Protection
Committees and the various Trust Child Protection Panels. Police play an active
role in contributing to the Regional Children's Services Plan and participate
in individual case conferences and strategy discussions in relation to the
subject of child protection. The main function of the CARE Units is to enhance
child protection through a high standard of investigation into allegations
and suspicions concerning abuse of children. In that respect police work closely
with their colleagues in Social Services, NSPCC and the other statutory and
voluntary organisations under an agreed protocol for the investigation of abuse. The Police Service of Northern
Ireland is convinced that the present model of specialist investigative teams
working in partnership with the various other organisations and disciplines
is the most effective means of ensuring full police involvement in child protection.
Outside of the CARE Units all police officers have been trained to carry out
child protection duties in accordance with the Children (Northern Ireland)
Order 1995. Some 60 Detective officers have been selected and provided with
specialist training before being dedicated to the investigation of child abuse
and sexual offences. All crime reports,
including those involving children, are recorded in accordance with the Home
Office counting rules. Each case is dealt with and investigated individually
with responsibility for its investigation falling on one officer. The investigation
is then supervised by a Detective Inspector or Detective Sergeant. Each investigation
under the Child Protection Procedures is carried out jointly with Social Services.
All information received by the police in relation to a particular case is
made available to their counterparts in Social Services and vice versa. Communication
and liaison between Social Services and the police is of a very high standard.
The standard required is clearly defined in the Joint Protocol document which
has come to be expected of all participants in every
investigation. The involvement of other professionals, including nursing, health
visitors, General Practitioners, Paediatricians, etc, is carried out
again in accordance with the Joint Protocol. Police officers investigating
cases under the Child Protection Procedures ensure close liaison is established
with the children involved, with their parents or carers, and that developments
in investigation and new information coming to light is communicated to them
when appropriate, as soon as possible. When opportunities arise, police provide
presentations to local communities, schools, voluntary groups and other organisations
in order to enhance public awareness and knowledge of the issues surrounding
child protection. Police officers involved
directly with child protection duties have access to both uni- and multi-disciplinary
training. They are closely supervised in their work and have direct
access to nursing staff through the Police Occupational Health Unit. As with many of the
organisations in Northern Ireland, resources within the Police Service of Northern
Ireland are stretched. This has resulted in police officers' duties therefore
being prioritised, one of the results being the reduction in attendance at
case conferences and review case conferences. Lessons have been learned
from previous case experiences and steps have been taken, where possible, in
co-operation with Social Services and the other statutory and voluntary
agencies to ensure that child protection provisions are brought to and maintained
at the highest possible level. In addition to the
above I would make the following general comments:- (a) Police are concerned that the standard
of protection available to children with disabilities may not be fully adequate
and are keen to ensure that equity of service is provided to all children,
including those with specific vulnerabilities. (b) In recognition of the importance of the
multi-agency case conferences and the belief that such conferences are the
key to effective child protection measures, police are keen to see a system
developed in which attendance at case conferences can be enhanced and improved
in a way that is both cost effective and efficient. The current reduction in
police resources has made it difficult for police to attend case conferences
as regularly as they would wish. (c) One of the major developments in the whole
area of child and public protection over the last number of years has been
the Multi-Agency Sex Offender Risk Assessment and Risk Management Procedures.
Although all the relevant agencies are fully involved and committed to protecting
children through assessing and managing the risk posed by sex offenders, little
has been made available by way of financing or resources to ensure that these
procedures are effective. The Police Service of Northern Ireland believes that
child protection must be seen as past of a community safety initiative and
that resources should be made available to ensure that all of the agencies
are able to play a full part in both assessing and managing the risk that is
posed to the community, particularly to children. (d) In recognition that the joint protocol
for the investigation of alleged and suspected cases of child abuse has greatly
enhanced child protection and the ability to investigate cases, police are
keen to develop similar policies and protocols in relation to other areas,
including such things as the investigation of unexplained deaths in children
and cases of child neglect. (e) The Police Service of Northern Ireland
recognises that the criminal justice system cannot adequately protect children
by itself. Nationally we know that only some 12% of child abuse cases are ever
referred to police or other statutory agencies. This leaves some 88% of children
who have been subjected to abuse receiving little or no protection or support.
Police recognise that abuse of children, particular sexual abuse, must not
be viewed only as a crime problem but should be seen in the wider context of
a public health problem. In that respect police are keen to support initiatives
such as "Stop It Now" and "Circles of Support". These initiatives, which are
aimed at reducing the incidence of abuse and therefore providing primary child
protection, ought to have a higher priority in the overall child protection
strategies. Provision of child
protection is a huge and daunting task. It seems that together we very often
are only dealing with
the "tip of the iceberg". The number of cases referred continues to cause great
concern. It seems that we collectively need to address the causes of
the problem within families and within communities as opposed to concentrating
all our resources on dealing with that small percentage of cases which eventually
come to our attention through the criminal justice system. The Police Service
of Northern Ireland recognises that child protection must be one of its highest
priorities and is therefore keen to work with the other statutory and voluntary
agencies within Northern Ireland to ensure that all that is possible is done
to enhance child protection. I hope these comments
are of some use to you.
J R SHORT D/C/Supt WRITTEN SUBMISSION BY:
1. The Probation Board for Northern Ireland
(PBNI) is a community-based Board with the status of a non-departmental public
body. It has a number of functions which are laid down in legislation eg, to
carry out assessments and provide reports to court which are designed to make
a contribution to the decisions which magistrates and judges make in relation
to sentencing; to supervise offenders in the community; and have staff who
work in prisons providing a range of services. We are permitted to fund organisations
that provide hostels for offenders, and run various projects in the community,
which address the offending behaviour of offenders who are under PBNI supervision.
2. In our current Corporate Plan (2002-05)
we have committed to 3 main themes ie, professionalism, public protection and
partnership. Under public protection PBNI fully accepts its responsibility
to protect the public, while at the same time integrating offenders into the
community. We seek to meet this responsibility by continuous improvement in
our performance and to this end welcome the inquiry into child protection services
in Northern Ireland. We are also committed to forming and sustaining partnerships
across a wide range of statutory, non-statutory and community bodies. Therefore
this response will aim to address the structural, legislative and service issues
regarding PBNI's involvement in child protection service. CASEWORK 3. PBNI believes that casework should reflect
professionalism; this professionalism should be demonstrated by staff having
knowledge, skills and understanding to perform their duties on the basis of
consistency. It is our belief that all child protection agencies should have
a research-led method of assessment which is applied consistently. To this
end PBNI has adopted a consistent and evaluated method of risk assessment ACE
(Assessment, Case Management and Evaluation). We suggest that all professionals
involved in child protection should follow a consistent method of assessment
and management of risk. Equally there should a standard referral system and
an agreed method of case recording across all 4 board areas and all agencies
involved in child protection. This information should be, as a matter of course,
shared with the subject unless it includes third party or confidential information.
COMMUNICATION 4. PBNI notify social services in all situations
where there is a suspicion that a child might be at risk. PBNI recommend that
there should be agreed thresholds for decision-making for the use of the Child
Protection Register, based on clear and consistent criteria. On behalf of the prison
service PBNI notify social services when offenders move on from prison
in accordance with DHSS Interdepartmental Circular 3/96 (see attached). 5. In terms of sex offenders PBNI is committed
to the Multi-Agency Procedures for the Assessment and Management of Risk posed
by Sex Offenders. These procedures were formally launched by the NI Sex Offenders
Strategic Management Committee in May 2002 (see attached) and, unlike England
and Wales, only cover adult male sex offenders. PBNI currently provides the
chairperson for each of the 6 Area Sex Offender Risk Management Committees
(ASORMCs) and probation staff contribute to the management of sex offenders
who are considered at these meetings. PBNI suggest that one possibility to
protect the public would be to extend the remit of these committees to include offenders
who have perpetrated non-sexual offences against children. The Sex Offenders Act 1997 requires
the key statutory agencies involved with sex offenders to co-operate
and collaborate more closely, building on the inter-agency relationships that
already exist. The NI Sex Offenders Strategic Management Committee have produced
2 useful documents (see attached: 1.
Protecting our Children - A Guide for Parents 2.
Assessment and Management of Risk (Information for Sex Offenders)).
6. PBNI believe it is essential to ensure
there is appropriate communication and liaison between agencies and involved
parties. PBNI believe it is crucial to create a system of communication which
encourages staff and agencies to pass on information in a supportive environment
rather than in a climate of fear. This issue is further addressed under workforce
issues. LINKAGES 7. The protection of children should be a
top priority for everyone in Northern Ireland. Any child, parent/carer or local
community who requires help or support in the protection of children should
know where to seek and receive this support. PBNI believe that prisoners' families
are a vulnerable group who are deserving of resources through preventative
services. At present these children get little or no service from social services
unless there is a clear child protection issue. 8. PBNI believe that it's best contribution
to public protection and community well being is to help offenders change
their behaviour and reduce their offending. It is important to remember that
no risk can be completely eliminated and no accommodation is completely
isolated from children or vulnerable people. For this reason we believe it
is preferable for offenders to live in settled accommodation rather than live
a nomadic lifestyle where children could be placed at a greater risk. We would
ask the community to understand and support the work of voluntary agencies
and statutory agencies providing accommodation for ex-offenders. PBNI support
the principle of constructive community involvement in the management of potentially
dangerous offenders. However, community access to a sex offender register in
itself would not protect children, may lead to potentially dangerous vigilante
action and harm through mistaken identity to innocent parties and also risks
to family members. 9. PBNI supports the harmonisation of child
protection procedures across the United Kingdom and Europe. PBNI is committed
to multi-disciplinary training in the area of child protection and believe
that this is the way forward for all statutory and voluntary agencies. However,
it is also important for agencies to take responsibility for internal training.
PBNI ensure that all new staff undertake induction training which includes
child protection procedures and would suggest that this model, supplemented
by on-going refresher training in acknowledgment that this is a dynamic situation
where new research regularly informs practice, should be standard practice
for all relevant agencies. 10. In particular education has a crucial role
in the area of child protection. NI-wide organisations experience difficulty
in covering all their responsibilities at board and trust level in the field
of child protection, children's services planning, etc. In our response to
the paper "Developing Better Services: Modernising Hospitals and Reforming
Structures" we intend to support the proposal to create a single regional authority
with responsibility for strategic planning, workforce planning and commissioning
of regional services. WORKFORCE ISSUES 11. PBNI recognises the pressure on child protection
staff. We recommend that preventative services need to be adequately funded
and that organisations and management have a responsibility to create a supportive
environment. It has been recognised in several inquiries that vacancies in
child protection were left unfilled and staff did not receive sufficient training
and supervision. This is an unacceptable situation. We believe that staff working
at all levels of child protection should have the right level of knowledge,
skills, experience and competence. In addition to line management support there
should be access provided to an independent counselling service. PBNI has introduced
this service for our staff and this has been positively received. RESOURCES 12. Organisations should devote the necessary
resources to staff the complex areas of prevention, investigation and management
in the area of child protection. The issue of child abuse is both emotive and
of deep concern to the public. Therefore it is essential that all necessary
resources are provided to protect children. 13. PBNI are currently working on plans to
build on existing programmes for sexual and violent offenders by the adoption of a Home Office
accredited programme entitled 'Community Sex Offender Groupwork Programme
(CSOGP). This will require intensive resourcing particularly if we are to respond
to child protection referrals in the absence of statutory court orders. We
have also developed programmes for perpetrators of domestic violence throughout
NI and in two areas this is based on partnership with social services in recognition
of the close links to child protection. 14. PBNI recognise that services for victims
who disclose childhood abuse when they become adults are often under-resourced.
Resources for work with offenders should not be seen to be in competition with
resources for victims services because the aim of the work with offenders is
to reduce victimisation. Research tells us that some victims of child abuse
can themselves become perpetrators in the absence of appropriate intervention.
As noted earlier, PBNI support the proposal that the 4 HSS Boards should be
replaced by a Regional
Strategic Health and Social Services Agency and that the 18 HSS Trusts (excluding
the Ambulance Trust) should be replaced by 3 integrated Health and Social
Care systems for delivering services. LESSONS LEARNT 15. There have been several inquiries in England and Wales dealing
with the deaths of children through omission and co-mission by parents/carers.
In all these reports there is a common theme of lack of communication, particularly
in situations where workers have "trusted" inappropriately. Therefore any organisation
involved in child protection should not rely exclusively on the self
report of offenders or other people who may pose a risk to children. Furthermore,
organisations should seek to create a culture of support and positive encouragement
where staff have concerns around child protection. Staff themselves should
have the appropriate knowledge and, skills and up to date research on issues
relating to child protection. In turn it should be expected that the behaviour
of staff will reflect their knowledge and respond to what is evidenced. 16. PBNI would draw the Committee's attention
to a recent NSPCC publication on Child Protection Care Management of Infants with
Serious Injuries and Discrepant Parental Explanations (What Really Happened?,
NSPCC, 2002). GENERAL COMMENTS 17. It is the responsibility of everyone in
NI to help protect children. PBNI has addressed the structural, legislative
and services issues for this organisation and have no objection to the information
contained in this report being made available to the public. WRITTEN SUBMISSION BY: July 2002 Background 1. The Royal College of Nursing [RCN] in
Northern Ireland represents over 12,000 nurses, midwives, health visitors,
health care assistants and nursing students. We are an independent professional
body, which raises nursing issues with a broad political audience and works
in the public arena to promote what is best for patients and the nurses who
care for them. The RCN has three key functions. We
are:
n
the voice of nursing in Northern Ireland, campaigning on a wide range of nursing
and health issues in order to improve standards of care for patients
n
a professional association for nurses, providing continuing professional development
and lifelong learning to help nurses improve standards of patient care
n
a trades union for nurses,
addressing issues such as employment relations, pay and working conditions.
3 Across the United Kingdom, we have 360,000
registered nurse, nursing student and health care assistant members. This makes
us the world's largest professional association and trades union for nurses. Introduction 4. The RCN is grateful for the opportunity
to submit written evidence on this important issue to the Committee for Health,
Social Services and Public Safety. We wish the Committee every success with
its Inquiry and subsequent recommendations to the Minister. 5. The RCN in Northern Ireland represents
a wide variety of practitioners who are professionally responsible for the
health and social care of children. They include children's nurses practising
within both acute and primary care settings, health visitors, school nurses
and those specialising in working with children with mental health problems and learning disabilities.
Our membership therefore has a strong professional interest in
the scope of the Committee' Inquiry and considerable expertise upon which the
Committee may wish to draw. 6. The RCN's written evidence is structured according to
the key areas specified within the invitation to submit. Case work 7. The nurse's Code of professional conduct requires practitioners to act as an advocate
for those in their care. This requirement applies to those working with children
as much (if not more so) than to those working with any other client group.
According to the Code of professional
conduct, nurses must "promote the interests of patients", "respect patient's
autonomy" and "act quickly to protect patients from risk.. We believe that
these principles should guide the practice of all those working with children,
regardless of whether or not they are members of a statutorily-regulated profession. 8. Commitment
to Care, the RCN's Health Manifesto to be published in September 2002,
points out that some 30% of children and young people in Northern Ireland are
affected by mental health problems. Child abuse can take many diverse forms,
both physical and psychological. It is essential that all health and social
care professionals working with children are able to detect, recognise and
address different types of abuse. Communication and
linkages 9. Child protection is the exclusive domain
of no single profession or group. All practitioners must understand and demonstrate
respect for the child protection roles and responsibilities of other practitioners
within the health and social care team. This mutual understanding could be enhanced
by the establishment of child protection communications protocols encompassing
all professional groups and agencies involved in working with children. 10. Actively promoting and monitoring this
inter-professional collaboration should be a key responsibility of the office
of the new Children's Commissioner. 11. Publicity material published by the health
and personal social services for the information and guidance of children,
their carers and of practitioners must be simple, clear and easily understandable
for all parties. 12. Inter-professional and inter-agency collaboration
in the sphere of child protection must include effective liaison with the various
statutory regulatory bodies that govern the professional practice of practitioners
working with children. In the case of nursing, the relevant body is the Nursing
and Midwifery Council [NMC]. It is clearly unacceptable, for example, that
a nurse could be removed from the NMC register for reasons of professional
misconduct (particularly if this involved the abuse of children) only to find
subsequent employment working with children in a different capacity. Resources and lessons
learned 13. It is essential that the greatest possible
uniformity exists throughout Northern Ireland in the provision of child protection
services. Allowing services to develop in different ways, at different paces
and with different degrees of effectiveness in different areas is unacceptable. Workforce issues 14. In order to be able to enhance inter-professional working in
the interests of children, the content and structure of training programmes
for all health and social care professionals working with children must contain
a multi-disciplinary set of core competencies and outcomes, to be supplemented
as appropriate by specialised training for particular groups. Further information 15. For further information about the RCN's
position on child protection services in Northern Ireland, or about the wider
work of the RCN in support of nurses and patient services in Northern Ireland,
please contact Dr John Knape (Public Affairs Adviser) at john.knape.rcn.org.uk.
or by telephone on 028 90 668 236. written submission by: 13 September 2002 The Royal College
of Paediatrics and Child Health welcomes the opportunity to respond to the
above consultation document. The College's response was developed following
comments received from Dr Jean Price, Chair of the College's Standing Committee
on Child Protection and Dr John Jenkins, the College's Officer for
Ireland. The College's response is attached. We would point out
that there are a number of paediatricians in Northern Ireland with particular
expertise in this area, in particular, Dr Moira Stewart who not only has much
experience but is also the College's regional representative for Northern Ireland
on the Council. The Committee may wish to contact Dr Stewart to receive further
expert advice. Dr Stewart's contact details are attached. I hope this is helpful.
Please contact me if you require any further information.
DR PATRICIA HAMILTON Inquiry into Child Protection Services in Northern Ireland: Response of the Royal College of Paediatrics and Child Health General Comments: We would point out that there
is a general lack of resources for both further specialist Paediatric manpower,
facilities in which examinations can take place in a child friendly setting, and
equipment (such as that for specialised examinations in cases of suspected
child sexual abuse). There is always the
possibility of better communication between involved parties, and this often
links to shortage of manpower as people do not have the time which is necessary
to attend multidisciplinary meetings, or indeed to contact others who might
have a relevant interest. There is a particular
need for further development of the relationships with forensic medical services,
and for linkages to provide prompt access to information, not only to Paediatricians
but also to staff in Accident & Emergency Departments regarding current
and previous child protection decisions and concerns. Specific comments: 1. Casework Professional judgement and
analysis of information is referred to. There is a need to consider how this
will be measured and what it will be measured against. 2. Lessons Learnt Have recommendations from
previous enquiries actually been activated? There should be a monitoring system
in place to ensure that they work. 3. Clinicians Support facilities should be in place for clinicians?
For example, two doctor examination, photo-documentation for child sexual
abuse and peer review. 4. Consent There should be a standardised
consent form and consent should be sought for examination, photo-documentation
and its uses, and sharing of information. 5. Consumer Views These should be routinely
sought and be subject to a periodic review. 6. Provision of Information from Health This should be provided to
Strategy Discussions and/or Case Conferences? Paediatricians or doctors should
play a part in the decision making. 7. Training Designated health personnel,
particularly Designated and Named Doctors, should understand their roles and
feel they are adequately resourced to carry them out in an appropriate fashion.
We note that under
the Terms of Reference, the Inquiry will consider the quality and allocation
of resources to Child
Protection services in Northern Ireland, with reference to the provision of
similar services in Great Britain and other selected countries. In our view, whilst there could
be some value in this, it might be helpful to other countries for Northern
Ireland to consider what they think adequate resources are for such a high
profile and risky service. written submission by: Contents 1.0 Setting 1.1 Structures, arrangements and responsibilities
of the Child Protection Committee 2.0 Delivery of Child Protection Services 2.1 Child Protection Policies and Procedures 2.2 Multidisciplinary Training 2.3 Professional support for staff 2.4 Social Services Support 2.5 Child Protection Register 2.6 Investigation and management of possible
sexual abuse 2.7 Linkages 3.0 Conclusions 1.0 Setting The Royal Hospital Trust is the largest hospital
complex in Northern Ireland, comprising the Royal Hospital, the Royal
Maternity Hospital, the Royal Belfast Hospital for Sick Children and the School
of Dentistry. There are approximately 900 beds on site and a high proportion
of regional specialities are concentrated in the complex. These specialities
include, cardiac and thoracic surgery, paediatric surgery, neonatology, cardiology and intensive
care. The Faculty of Medicine of Queen's University of Belfast enrol approximately
180 medical students and 40 dental students each year and a large proportion
of their training is in this group of hospitals. The Trust employs approximately
6000 members of staff, many from the local area but others travelling from
throughout Northern Ireland. It sees well over 500,000 people per year, with
334,000 as outpatients, 50,000 inpatients and 24,000 day patients as well as
124,000 patients attending the Accident and Emergency department. Within the Royal Hospital
Trust the Paediatric Directorate is based within the Royal Belfast Hospital
for Sick Children. It is has its own dedicated Accident and Emergency department,
seeing 30,000 patients per annum, with a further 37,000 patients attending
as outpatients, 7,000 as inpatients and 4,000 as day cases. However, 15% of
the Royal Hospital Trust activity excluding the paediatric directorate involves
children and young people up to the age of 16. Social work support for the
Trust is through the Disability Team of North & West Belfast Health &
Social Services Trust. The Trust, recognising the importance of Child
Protection issues and indeed the issues concerning children's needs, in 1997 appointed
a Consultant in Ambulatory Paediatrics with responsibility for issues arising
from the Children's Order of Northern Ireland (1995). This consultant
acts as the named consultant for Child Protection issues within the Trust and
is a member of the North & West Belfast Health & Social Services Trust
Child Protection Committee. The Nurse Manager of the Paediatric Directorate
is the named nurse for Child Protection issues within the Trust. In 1998 a
Child Protection Committee for the Paediatric Directorate was established and
in the year 2000 this was extended to encompass the Trust as a whole. 1.1 Structures, arrangements and responsibilities
of the Child Protection Committee The Committee is multidisciplinary
in nature, and has representatives from the different Trust sites. Members
of the Committee include a Consultant Paediatrician with responsibility for
Child Protection, a named nurse, Senior Social Worker attached to the Royal
Belfast Hospital for Sick Children, the Assistant Principal Social Worker
for Hospital Social Work Services and a representative from Professionals Allied
to Medicine. The Committee meets regularly
in order to: a)
Develop, monitor and review the Trust's Child Protection Policy and
Procedures; b)
Assess child protection knowledge and arrange appropriate multidisciplinary
training; c)
Overview, evaluate and consider any significant child protection issues/incidents
arising in any of the Trust's premises; d)
Provide guidance and advice to Trust staff on the Child Protection Policy
and Procedures; and e)
Prepare an annual report to the Medical Director. 2. Child Protection Policies and Procedures 2.1 Delivery of Child Protection Services The Child Protection Committee
have developed, in conjunction with North & West Health and Social Services
Trust and the Eastern Health and Social Services Board Area Child Protection
Committee, Policies and Procedures for the detection and management
of child abuse within the Trust. These policies were launched in June 2002
and are at present being disseminated to all staff groups. 2.2 Multidisciplinary Training A multidisciplinary audit
was carried out in 1999 to identify training needs of all professionals within
the Trust. A Business Case was developed in conjunction with North & West
Belfast Health & Social Services Trust, taking on guidance from Co-operating
to Safeguard Children. It identified four levels of knowledge which were required
by staff members from simple awareness, which should be delivered to all members
of staff, not only to empower them within their role within the Trust but also
within their role within the community, through to case conference working,
court reports and court attendance's. For a staff of 6,000 it was identified
that a resource of £150,000 over a three year period was required to provide
sufficient training for the 6,000 person work force which is employed by the
Trust. This bid is with the Eastern Health & Social Services Board Area
Child Protection Committee but they have significant problems as they do not
have adequate resources for training. Without appropriate training we cannot
identify and manage cases appropriately and this is a significant weakness
in our present system. 2.3 Professional Support for Staff Lack of training for personnel
within the Trust gives us significant concerns that child protection issues
are not being properly addressed by Trust staff. The vast majority of children
will present to the A&E department of the Royal Belfast Hospital for Sick
Children, but they will also present to the Royal Maternity Hospital, the A&E
department of the Royal Hospital Trust and may be inpatients in any area of
the Trust as a whole. In order to identify children appropriately it is essential
that training and awareness is available for all staff which then can be applied
through the Trust's child protection policies and procedures for the management
of those children. It is also essential that the staff receive adequate support.
Although the Nurse Manager of the Royal Belfast Hospital for Sick Children
is the named nurse for Child Protection issues within the Trust, she is not
in the position to be able to offer support and counselling to members of staff
on Child Protection issues. The Trust bid for a nurse consultant for child
protection without success and are now biding for a nurse specialist for child
protection issues. This would reflect the structure in the community trust
and allow a professional to offer expert support to all members of staff for
child protection issues. This is most important for strategy discussions, case
conference working and for preparation for court. At this point in time Eastern
Health & Social Services Board lack resources to be able to support this
post. 2.4 Social Services Support At present social services
support is provided by the North & West Belfast Health & Social Services
Trust disability team. However, it is clearly identified that there is a major
shortfall in social services support for the Trust as a whole. The transfer
of services from other acute sector Trusts have not been complimented with
an appropriate increase in social services staff, the most significant of these
being the transfer of Jubilee Maternity Hospital. The Royal Trust in partnership
with the North & West Health and Social Services Trust are submitting requests
for resources to all recruitment of three additional social workers, one for
the paediatric A&E department, one for the adult A&E department and
one for the Royal Jubilee Maternity Unit. In addition a further business case
was submitted to the EH&SSB in February 2002 for a Senior Social worker
responsible for maternity services and child protection within the Trust. We
feel this is essential to allow at risk children and families to be clearly
identified to improve liaison with the Community Trusts and to try to ensure
that preventative measures are put in place for any at risk families before
an abusive situation has developed. 2.5 Child Protection Registrar Access to the Child Protection
registrar for the Eastern Health & Social Services Board is through the
social worker on-call for the 24 hour period. In practice out of hours contact
is required for children attending Accident and Emergency departments where
concerns have been raised regarding child protection issues and professionals
wish to establish if the family are known to social services or on the Child
Protection registrar. The Royal Hospital Trust is a regional service and therefore
it is essential that we can access not only Eastern Health & Social Services
Board information but also Child Protection registrars for the region. Within
areas of the United Kingdom there are electronic registrars established which
are updated on a regular basis and allow instant access to child protection
registrars. These data bases are password protected with a limited number of
individuals able to access them. The development of such a system within Northern
Ireland would not only facilitate medical professionals within the acute sector
but also social services professionals as a whole. 2.6 Investigation and management of possible
sexual abuse At present children suspected of being sexually
abused may be referred directly to the accident and emergency department
of the Royal Belfast for Sick Children, either as self referrals, through their
GP or social worker. Extensive work has been carried out over the last two
years in conjunction with the forensic medical officers to try to establish
a joint procedure for the medical examination of such cases. There have been significant problems
in trying to ensure cohesive working between the Forensic Medical Officers
and the paediatricians
but also in ensuring adequate services are available for the assessment and
management of the children. The children roughly fall into three groups: 1.
Those who are suspected of chronic abuse, who require disclosure work
as well as medical examination. 2.
Those who have been acutely abused who may have injuries which require
treatment and require the collection of forensic evidence. 3.
Those who may have developed a sexually transmitted disease, who again
require medical assessment with samples being taken for virology and bacteriology.
The working group has identified
that three sites within the Eastern Health & Social Services Board need
to be developed
to allow these children to be appropriately managed. One is already in existence
at Garernaville. It was felt a second site needs to be established at
the Child Care Centre based on the Lisburn road in South & East Belfast
Health & Social Services Trust and the third centre within the Royal Hospital
Trust. For these centres to work
effectively they need access to appropriate swabs and culture mediums as well
as a culposcope. The centre
in Garernaville has a culposcopy suite but does not have access to the necessary
swabs for detection of sexually transmitted disease. The Child Care
Centre has the ability to carry out the swabs but does not have a culposcope.
The Royal Hospital Trust do not have a culposcope in an area that is suitable
for young children. In addition children referred with possible genital urinary
infection are being seen by the adult genito urinary medicine physician at
the Royal Hospital site rather than the child friendly RBHSC site. In order
to address this two additional culposcopes need to be provided, one within
the Child Care Centre and one within the Paediatric Directorate of the Royal
Hospital Trust. Resources need to be identified to allow the establishment
of a genito urinary medicine clinic within the paediatric directorate run jointly
by a paediatrician and consultant in GUM (Genito Urinary Medicine). At present
only two community paediatricians in the greater Belfast area have specific
training in the medical examination of children with suspected sexual abuse.
There needs to be an increase in provision of training for paediatricians in this
examination as advised by a recent publication of the Royal College of paediatrics
and child health.
An on-call rota for child protection issues needs to be developed within the
Eastern Health and Social Services Board. This will require an increase in the number
of staff grades or consultants in post. 2.7 Linkage The Royal Hospital Trust has strong linkages with
North and West Health & Social Services Trust through their disability
team. In addition the named consultant for child protection also has sessions
within the community
trust, is a member of the North & West Belfast Health & Social Services
Trust child protection panel and chairs the Eastern Health & Social
Services Board community paediatricians group. However, such linkages are not
in place for South & East Health & Social Services Trust or Down &
Lisburn Trust. The Royal Hospital Trust seeks to establish stronger linkages
with these groups part of which will be helped by the establishment of a greater
Belfast Community Health & Social Services Trust. However, should this
happen it will leave the Royal Hospital Trust as the only acute hospital that
is not part of a combined Trust. We therefore would still have considerable
problems in ensuring continuity of care across Trust boundaries. 3.0 Conclusion In conclusion therefore the
Royal Hospital Trust clearly identify their responsibilities on issues pertaining
to Child Protection and are actively seeking ways to improve the services they
provide. Many of these issues are to do with linkages but there are significant
resource implications, not only for training but for professional staff to
improve liaison with community services and to ensure professional support
for staff managing cases of suspected child abuse. The Royal Hospital Trust
welcome the committee for health social service and public safety for Northern
Ireland Assemblies enquiry into Child Protection Services in Northern Ireland
and will provide any further information or evidence which the enquiry requests. written submission by: 6 September 2000 The Senior Nurse
Forum for Child Protection N.I. welcomes this Inquiry and the opportunity to
participate in the consultation
process. Forum members appreciate the extension to the consultation period
to facilitate this contribution. Regulation and Guidance
to support the Children Order (N.I.) recommends that all Health and Social
Services Trusts appoint a named Senior Nurse with responsibility for child
protection in relation to nursing issues. The Senior Nurse Forum for Child
Protection was established in 1996 to provide a support network for senior
nurses and to facilitate the sharing of best practice throughout the region.
Membership of the Forum includes senior nurses based in community and acute
Trusts, and has members from all four Board areas. This response will use the
structure proposed by the Committee. It will focus on the issues of casework,
communication, linkages, workforce issues, resources, lessons learnt
and general comments, however, it must be acknowledged that the issues are
interlinked and some overlap will be inevitable. CASEWORK Detailed and accurate recording
is an integral part of child protection practice. It is essential that those
interpreting records can obtain an accurate description of previous
client contact and professional opinion. Effective recording is critical in
the current climate of an unstable workforce including shortages of nurses
and health visitors. There may be frequent changes of health visitors visiting
a family where there are child protection concerns. Recording is an increasing
resource issue in terms of both time to record and training in the legal aspects
of record keeping. Recording methods and formats in relation to child protection
practice should be agreed at regional level. Forum members believe
that contracting arrangements do not reflect the contribution of nurses and
health visitors in the child protection process. This is significant in relation
to the allocation of resources. It is inevitable that a poorly resourced service
will have difficulties in providing high standards of practice and in securing
effective and co-temporaneous records. Senior nurses in acute hospitals are
particularly concerned that hospital based nurses are ill equipped to
recognise and deal with child protection concerns and do not record their child
protection concerns.
The fact that nursing records may be kept at the patient bedside and are accessible
to parents and visitors may contribute to this problem. Health visitors spend a disproportionate
amount of their time with families where there are child protection concerns.
Whilst they consider their priority to be prevention and early detection
of health related problems, much of their time is spent with families who are
experiencing child protection problems or with children in need. This demand
limits the public health role and preventative role of health visitors. Individuals, professional
groups and multi-disciplinary/multi-agency teams make professional judgements for example nurses
make judgements about a client or family situation and the need for referral
to another agency. They contribute to judgements made during multi-disciplinary
case plans and the child protection process. It is essential that nurses have
adequate training and support in relation to judgements in relation to child
protection. It is critical that nurses have a process to challenge others when
their judgements or concerns are not accepted and that they have the confidence
to do so. Senior nurses for child protection
are available to support nurses with decisions in relation to their child protection
practice. The role of the child protection nurse specialist/senior nurse for
child protection has been evaluated in the SHSSB during a Board wide Health
Visitor audit process. Health Visitors were asked for their opinion on the
usefulness of the senior nurse role. Feedback was positive and demonstrated
that health visitors found the post to be effective. Forum members would welcome
a regional evaluation of the senor nurse role with recommendations in relation
to its development. Multidisciplinary
decision making: Nurses, midwives
and health visitors accept that social services are the lead agency in child
protection and believe that this should continue. However, it is crucial that
the opinions of nurses and other professional groups are respected and valued.
The contribution of nurses in decision-making during the child protection process
varies between Trusts from inclusive to not at all. Their involvement can also
vary within Trusts depending on the values and approaches taken by senior social
workers. Newry and Mourne HSST have developed a multi disciplinary approach
to decision making in relation to child protection referrals. All referrals
are considered by a multi-professional team who make recommendations regarding
the management of individual cases. The child protection nurse specialist is
a member of this team. Forum members consider this to be a truly multi-disciplinary
approach and would suggest that consideration should be given to the development
of this approach and its introduction in other Trusts. Such a team approach
makes it easier for the referral agent to appeal decisions made as they would
not be challenging an individual. Forum members believe that decisions made
in isolation can be dangerous decisions and believe that such a team approach
to threshold decisions would be in interests of all stakeholders including
children and professionals. The introduction
of the Greg Kelly risk analysis model at all case conferences in the SHSSB
area is considered by Forum members to be a useful development. However, its
application needs to be evaluated. The model has the potential to improve multi-disciplinary
discussion between core members of case conference both prior to and during
case conference. The model also offers families a visual record of concerns,
progress, potential growth and services and offers an alternative to lengthy
narrative professional reports. The use of such a model should be considered
in case planning as decisions regarding risk can be equally if not more complex
in case planning situations. This will have resource implications. COMMUNICATION Poor communication
is a repeated theme of all inquiries since the 1970s yet is cited as a problem
in child death inquiries in 2002. Efforts have been made in many Trusts to
improve communication for example the introduction of triplicate update/liaison forms used by nurses
in the Craigavon & Banbridge CHSST. These are forwarded to social
work and G.P. colleagues
or others as appropriate. Time for effective communication is a resource issue,
the extent of which is an unknown entity. Good communication is dependent
on good inter-professional relationships. In the highly pressured work environment
experienced by professionals involved in child protection, there is
little opportunity to develop such relationships. Whilst Northern Ireland has
a Health and Social Services structure whereby health professional and social
workers share the same building they have separate management structures.
It is crucial that effective links are established and maintained throughout
the organisation. There needs to be
more effective methods of transferring information between Trusts and professionals. I.T. systems need
to be developed in all Trusts that reflect the multi-disciplinary nature of
child protection work. General Practitioners
have an opportunity to play a pivotal role in child protection. Their contribution
to the child protection process varies considerably and needs to be examined
as a matter of urgency. Forum members consider
the Framework for Assessment Model as potentially useful. A multi-disciplinary
model if implemented appropriately could have a positive impact on communication
and practice. Forum members are aware that this is a resource issue and decisions
regarding the implementation of this model have been delayed. Decisions regarding
the implementation should be made on a regional basis and appropriate funding
allocated. Forum members welcome
the clinical governance framework. There is a need to increase the numbers
of multidisciplinary audits, policies and procedures in relation to child protection
issues. There is a need for
a robust liaison nursing posts to ensure effective communication between nursing
staff in the hospital and community settings. Such posts should involve discussion
of identified issues and agreed action plans. Forum members recommend an increase
in community nursing liaison posts and that consideration should be given to
such posts being based in the community in order that the liaison nurse will
have an awareness of the professionals, services and resources available. LINKAGES Links with local
communities needs to improve and should be a priority in any action plan. Whilst
efforts have been made to involve parents and children where appropriate in
the child protection process since the introduction of the Children Order (1995)
community development initiatives in relation to child protection have not
been a priority.
This is unfortunate considering that people who live and work in the community
are best placed to protect children. There needs to be a public awareness
and education programme to help the public take to take positive action in
order to prevent, recognise and respond to child abuse. Links with the voluntary
sector need to improve. Nurses would welcome a community development approach
to child protection. Family Group Conferences
are used in some Trusts and the principles of such an approach are in keeping
with good community links. The introduction
of parent held child health records is a positive contribution to the provision
of an open and transparent service to families. WORKFORCE ISSUES There are insufficient
training opportunities for nurses in relation to child protection practice.
Postgraduate courses are unavailable in Northern Ireland for senior nurses
in child protection. All Senior nurses in Scotland have had post graduate training
at Dundee University. Forum members would welcome a similar programme in Northern
Ireland. The training and
education programme for health visitors has been significantly reduced in length
over the last ten years. This means that many student health visitors qualify and have not
had experience in child protection practice. Health visitors are dependent
on good supervision and mentorship arrangements being in place post-qualification.
Such supervision and mentorship is difficult when there are staff shortages
and other pressures. The level of supervision and mentorship varies throughout
the region and training opportunities for mentors are scarce. Child protection
training is provided by ACPC Training Units. Nurses are not included in the
training teams. Limited numbers of places are allocated by the Training Units
to nurses. They are insufficient to meet the needs of health visitors who are
considered to be the key health professional in child protection never mind
other groups of nurses for example hospital nurses, midwives, practice nurses
and mental health nurses. Whilst others provide training this is dependent
on commissioners of such training recognising child protection as a priority.
Nurses, for example community mental health nurses have invaluable opportunities
when working with families to address childcare concerns. They can only do
this if properly trained and resourced. There is a risk that if pertinent questions
are not asked, children in need are left unrecognised. RESOURCES Nursing services
have not recovered from the disinvestment in the nursing profession and 'efficiency
savings' of the '90s. Community nursing and health visiting were forced to
reduce their workforce whilst coping with increasing demands, not least in
relation to their child protection practice. Health visitors are expected to
attend core group meetings, contribute to the comprehensive assessment of families
subject to case conference, write reports and appear in Court.
In addition there has been the introduction of nurse prescribing, the clinical
governance agenda and other such initiatives. The significant recruitment
and retention of nurses in the hospital setting poses a serious threat to the
development of child protection practice in hospitals. Forum members wish
to highlight the lack of resources available to health visitors when dealing
with families in need. Family support/health workers linked to the Health Visiting
teams offer a non-stigmatised service to vulnerable families at the earliest
opportunity for a limited period of time. This reduces the number of referrals
to social services and the duplication of assessment that occurs when social
workers visits the family to reassess the family circumstances following a
referral from a health visitor or community nurse. The employment of such family
support workers needs to be given serious consideration. The introduction
of adequate levels of clerical support for nurses and health visitors would
represent a significant contribution to the health visiting service. At present
teams of up to twelve health visitors are sharing one whole time equivalent
clerical worker. This requires health visitors to spend unreasonable time on
clerical duties and is a waste of valuable time that could be spent with clients
or on professional recording. LESSONS LEARNT A child death inquiry or
'near miss' investigation is a stressful situation for all those involved.
The process becomes a waste of effort if lessons are not learned and
shared with other colleagues and Trusts. Whilst consideration should be given
for the feelings of those directly involved it is essential that information
that could prevent further deaths or serious injury be shared. Forum members
believe that whilst it is not always necessary for detailed information to
be distributed, that recommendations should be published within a short timescale
agreed at regional level. OTHER ISSUES The role of the child
protection nurse specialist/named senior nurse Forum members describe
their role as challenging but rewarding. They are responsible for the supervision
of nurses during individual casework, development of nursing policies and procedures,
facilitating training and training needs analysis and contributing to children's
services planning groups and committees. Many find this to be an impossible
task and would support a review of the senior nurse role. Nursing contribution
at strategic level Forum members believe
that the nursing contribution to child protection at Department level and Board
level should be reviewed as a matter of urgency. Members acknowledge the contributions
made by individual nurses at these levels but believe that there is insufficient
of them to make a significant contribution to the child protection agenda.
It is crucial that nurses are an integral part of teams at regional and board
level that are developing policy and guidance for child protection issues,
children's services planning, looked after children and adoption. Good multi-disciplinary
and multi-agency relationships should be evident at every level. Forum members
believe that there should be a nursing officer at the Department who is responsible
for child protection issues. Child Protection Register The child protection
register in itself does not protect children. The low numbers of inquiries
regarding its information would suggest that it does not significantly improve
the outcomes for individual children in need of protection. It does however
give statistical information and indicators in relation to threshold decisions
and aspects of registration. Low levels of children registered under sexual
abuse indicate that the recognition and response to sexual abuse is poor in
some areas. Disabled Children Disabled children
are more likely to be abused, a fact that is not represented in child protection
statistics. This anomaly needs to be investigated and addressed. Looked After Children Children who are
looked after have poorer health and social outcomes that those who are not.
Forum members wish to highlight their concern at the lack of health professional
contribution to meeting the health needs of children who are or have been looked
after and for those subject to the adoption process. Many of these children
have been the subjects of the child protection process. Forum members recommend
that a Health Visitor for children who are looked after and leaving care should
be appointed in every Community Trust as a matter of urgency Domestic Violence Domestic violence has been
defined in ACPC procedures as a child protection issue and nurses support this
decision. The
proactive search for families who are victims of domestic violence is a resource
and skills based training issue for nurses and in particular for nurses working
in accident and emergency departments, midwives and health visitors. Sure Start Sure Start initiatives
are welcomed as an effective way of addressing the needs of vulnerable groups
and nurses and health visitors have made a significant contribution to this approach.
However, only a percentage of vulnerable families live in Sure Start
areas. Forum members are concerned that disadvantaged children who live outside
the Sure Start areas are further disadvantaged because they do not live in
a Sure Start area. It is essential that such children's needs remain a priority
when services are being commissioned and a balanced and flexible approach is
taken. Forum members support the development of Sure Start initiatives from
a child protection perspective. Addressing the needs of adults will have a
positive impact on the health outcomes of their children. School Nurses School nurses have
the potential to play a significant role in child protection. Their contribution
varies and needs to be evaluated. Recommendations should be made regarding
the development of the school health service in relation to child protection. Listening to children's
voices Forum members support
the introduction of a Commissioner for Children and believe that advocates
for children should be actively sought at all levels in service provision. CONCLUSION The Senior Nurse
Forum welcomes and supports the inquiry into child protection services in Northern
Ireland. Professionals from different disciplines work hard to provide effective
child protection services in a climate of poor staffing levels and inadequate
resources. Nurses, midwives and health visitors make a significant contribution
to child protection practice and health visitors in particular. Many of them
feel undervalued and under resourced. Many nurses believe that their preventative
role for example their contribution to parenting programmes, behaviour management
clinics and community development approaches, is eroded by their increasing
involvement in the child protection process. At the same time they recognise
that it is the non-stigmatising aspect of their service and knowledge of health
from its broadest perspective that makes them a valuable contributor to the
child protection process. WRITTEN SUBMISSION BY: 9 September 2002 In response to your
letter dated 20 June 2002 we are aware that you will already have received
submissions of evidence from each of the Health and Social Services Boards.
We would however wish to submit some further evidence from a nursing perspective
which we feel is relevant to the inquiry. We are writing as
the Senior Nurses/Directors of Nursing from the Health and Social Services
Boards and our submission relates to all branches of Nursing, Midwifery and
Health Visiting. While we are aware
that the focus of the inquiry is child protection services, we believe that
the issues of prevention and early detection are part of the continuum in striving
to safeguard all children. Thank you for extending
the period for receiving responses to your letter. We appreciate the opportunity
given and hope the evidence is of value to the inquiry. Our response is short
but highlights the areas where pressures within Nursing, Midwifery and Health
Visiting Services impact on the topic under review.
E M McNAIR (Miss) M WADDELL (Mrs) M BRADLEY (Mr) A McVEIGH (Mrs) CASEWORK
n
With the introduction of the Children (NI) Order 1995, concerns were raised
by health visitors province wide regarding the experience of a significant
increase in workload associated with child protection issues. An audit undertaken
in one Board area in 1999 demonstrated that child protection occupied up to
one full day of a Health Visitor's workload per week. No additional funding
was allocated to address this increase in workload as a consequence of the
implementation of the Order.
n
The health visiting service is the only universal service having contact with
every child from birth within their own home. Health visitors have a significant
role in prevention and early detection of child abuse and are often the first
professional to identify a child in need, at risk, or suspected to be suffering
abuse. It is important that the unique function of health visitors in supporting
families, across all socio economic groups is maintained and strengthened.
n
Additional resources should be provided in terms of clerical support, protected
time for clinical supervision and extra manpower to ensure this important area
of work receives the focus it requires. COMMUNICATION It is essential that
effective communication remains a key issue high on the agenda of the Review
Team. In particular it is imperative that:
n
Systems are in place to audit on an ongoing basis the effectiveness of inter
professional and interagency communication with benchmarked standards. This
should be integral to Clinical Governance arrangements.
n
Lessons learnt from case reviews are disseminated openly and transparently,
with regard for the confidentiality of those involved so that
all the region can learn from what went wrong and the implications for future
practice.
n
We learn lessons from previous inquiries. It has been clearly demonstrated
that even when good systems and procedures are in place, fatigue and stress
due to reduced staffing levels may lead to failure in communication or poor
professional judgement. In some areas due to low staffing levels health visitors
are having to cover two or even three caseloads as there are no permanent relief
staff. LINKAGES
n
Even though we work in an integrated health and social service system, there
has been a tendency over the years to produce reports in this area which are
social services orientated and do not adequately address the multi-professional,
in particular, the health component of delivering these services. There needs
to be a focus on the health related funding needed in child protection work
across the entire spectrum from prevention to protection.
n
We would strongly recommend that in the inspection of children's homes and
boarding schools that adequate attention is given to the health needs of children
in care and education settings.
n
We note that, within the DHSSPS, the responsibility of child care and child
health seems to span a wide range of directorates. We believe the appointment
of the nursing officer who, as part of her remit has child protection, is ideally
placed to bring these disparate strands together.
n
Nurses, midwives and health visitors are involved with children at all
stages of their development from midwives working with prospective parents,
health visitors through the early years and school nurses through the school
years. This is across all settings - primary care, secondary care, school health
and in many community and voluntary sector services e.g. Surestart projects,
minority ethnic groups and disadvantaged communities.
n
Often nurses are an important point of contact and support to children
and families at a stage prior to involvement in the formal child protection
system. WORKFORCE ISSUES
n
Child Protection Nurse Specialists are key in providing all nursing groups
with the appropriate support in regard to Child Protection. In particular they
assist in preparation for court, report writing and clinical/case supervision.
This level of nurse specialism is not employed in all Trusts in Northern Ireland.
There is a need to review the workload of many of these specialists as some
carry excessive workloads. There is also an issue about the interface between
the CPNS and mental health services because of mental ill health and post natal
depression. The Child Protection Nurse Specialist service should be reviewed
on a regional level.
n
The shortage of nurses in Northern Ireland is well documented and recognised
at all levels. While action is being taken to increase the number of pre registration
students it will be a number of years before the number estimated as required
can be trained. Workforce planning would need to ensure that an appropriate
uplift in the number of health visitors and school nurses is built in. Nurse
staffing levels for paediatric nurses in Accident and Emergency departments
should seek to meet the recommendation of the Clothier report.
n
In recognition of the increased role for Community Paediatric Nurses in caring
for disabled children and children with life limiting conditions we would recommend
that these teams are strengthened. RESOURCES
n
The threshold of "Children in Need" as defined in the Children Order is high
and because of the statutory function, the responsibility for this remains
in the domain of Social Services. The whole area of prevention work needs to
be revisited and reviewed as it would appear that protection still takes priority
over prevention or is resourced to the cost of prevention. The significant
preventive role by health visitors is barely recognised and they have no direct
access to funding to provide home support schemes for families. This can at
best delay support and at worst it may not be available when families need
it most. There needs to be a health care component of funding ring
fenced for staff working with a preventative focus for families where there
are children in need.
n
Historically there has been limited and ad hoc responses to the need for administrative
support and reliable data collection systems to reflect inputs and outcomes
of nursing, midwifery and health visiting services. This presents a difficulty
in reviewing these services, carrying out audits and developing bids to attract
additional resources. LESSONS LEARNT
n
There should be adequately resourced supervision systems for nurses, midwives
and health visitors. Present levels are often unsafe e.g. in some areas, 30-40
health visitors report to one manager.
n
The importance of proper audit systems in community nursing. In particular,
staffing levels do not allow for protected time for audit to take place.
n
It would be important for our healthcare organisations to develop a learning
culture and not a blame culture.
n
The impact of policy decisions on professional practice e.g. with the introduction
of the Children (N.I.) Order 1995 the trend was away from child protection
interventions and towards case management and family support. This inevitably
leads to health visitors taking on a greater role in supporting families where
there are childcare concerns but where social services do not get formally
involved. This has led to an increase in workload for health visitors and heightened
levels of stress. These extra pressures lead to fatigue, increased sick leave,
staff turnover and may affect performance and breakdown in communications.
n
The absence of a formal communication protocol between health professionals
and social services needs to be addressed. GENERAL COMMENTS There is a lot of
good practice across all professional groups who are involved in child protection
services to safeguard children. If the issues identified in this short report
along with those already outlined in the evidence from the four Health and
Social Services Boards were addressed, then services to safeguard children
would be enhanced. written submission by: SUMMARY This submission is
presented under the following headings: 1. Introduction 2. Legislative Context 3. Case Work 4. Communication 5. Linkages 6. Workforce Issues 7. Resources 8. Lessons Learnt 9. Other Issues Impacting on Child Protection 10. General Comment Key Messages:
n
Further development and commitment to inter-agency, multi-disciplinary working
is essential, including inter-departmental co-operation and the consideration
of multi-disciplinary teams in Child Protection, similar to those already established
in areas where there are less risk and less vulnerability. (Section3)
n
The Professional Training, Recruitment and Retention of front-line staff, particularly
social workers, requires to be reviewed to include recognition of the highly
stressful nature of this work. (Section 6)
n
The need for well developed and effective family support services, which reflect
the strategy to target social need and address the long-term well being of
children and families, and which positively discriminates in favour of those
at greatest risk. (Section 7)
n
The need to develop effective treatment models for those abused and those abusing
and to integrate these with Health and Social Services with appropriate infrastructures
to ensure the recruitment and retention of highly skilled staff. (Section 7)
n
The recognition that Child Protection is everyone's business and through a
Community Development Strategy, raise awareness of, and appropriate training
within local communities in respect of Child Protection issues. (Section 5)
n
Child abuse inquiries over the years have consistently referred to communication
breakdowns as a major shortcoming in the protection of children. The Trust
drew attention to the need accommodation arrangements which facilitate easy
communication between professionals, sound systems of recording and the use
of I.T. as pre-requisites to minimise the potential of communication breakdown.
(Section 4)
n
The Trust's own experience, concerns and achievements in the area of child
protection work. 1. Introduction: South and East Belfast Health
& Social Services Trust provides health and social care services to a population
of 205,000 in the south and east Belfast and Castlereagh areas. The Trust Headquarters is
located at Knockbracken Healthcare Park, Saintfield Road, Belfast. Children's,
adult's and mental health services are delivered from a range of locations
throughout the area. Many are delivered to people in their own homes. Children's Services include
the statutory provision of child protection; adoption; fostering; early years;
residential care; after care as well as school health; health visiting; services
for children with a disability and community dental services. The Trust's Children's Services
division is unique in Northern Ireland in that it encompasses children's medical,
nursing, dental and social work in one integrated structure. 1.1 Statistical Information The following statistical
information is taken from "Key Indicators of Personal Social Services for Northern
Ireland 2001" presented by the Chief Inspector, Social Services Inspectorate.
n
1991 Census:- South and East Belfast had a population of 42,090 under 18 years
(22.3% of the population of the Trust).
n
Rate of referrals within the Trust has doubled since 1997/98 to 909.7 per 10,000
children aged under 18 in 2000/2001.
n
45.7% of referrals to Family
and Child Care Services in South and East Belfast involved child protection
issues.
n
For the years 1999/00, 2000/01
and 2001/02, there were a total of 1,709 child protection case conferences
held in South and East Belfast. As a result 485 children were added to the
Register. This activity equates to
up to three child protection case conference held on every working day.
n
Per capita expenditure on Family and Child Care Programme:- N. Ireland: £158.6 England: £248.2
n
At 31 March 2002, number of children on Child Protection Register per 10,000
aged under 18:- N. Ireland: 32.2 England: 26.8 The Trust welcomes this inquiry
into child protection services in Northern Ireland. It represents the first
opportunity which Trusts have had to provide evidence directly to the responsible
legislative authority. In making this submission
the Trust would wish to comment on each key area identified in the Committee
Clerk's letter of 20 June
2002 - namely: case work; communication; linkages; workforce issues; resources;
lessons learnt and general comment. In its submission the Trust
will also refer to some of those areas referred to in the Committee's Terms
of Reference - namely: role of Commissioner for Children; role and use of the
Child Protection Register; and the legislative context in which child protection
services operate. 2. Legislative context in which child Protection Services operate: The major piece of primary
legislation under which the Trust has significant statutory powers and responsibilities
is the Children (NI) Order 1995, introduced in November 1996. The Order seeks to establish
a balance between a series of rights and duties:
n
The rights of children to express their views and participate in decisions
made about their lives;
n
The rights and duties of parents to exercise their responsibilities towards
their children;
n
The duty of the State to intervene if the child's welfare requires it, subject
to the overriding criterion that children should, whenever possible, be brought
up and cared for within their own families. Decisions made in courts
concerning children are now taken with reference to a clearly articulated set
of guiding principles which perceive the child as a "person" and not as an
"object of concern". The Order is based on a clear
and consistent set of principles designed with the common aim of promoting
the welfare of children:
n
The welfare of the child is the paramount consideration in court proceedings.
n
Wherever possible children should be brought up and cared for within their
own families.
n
Children should be safe and be protected by effective intervention if they
are in danger, but such intervention should be open to challenge.
n
When dealing with children, courts should ensure that delay is avoided, and
may only make an order if to do so is better than making no order at all.
n
Children should be kept informed about what happens to them, and should participate
when decisions are made about their future.
n
Parents continue to have parental responsibility even when their children are
no longer living with them. They should be kept informed about their children
and participate when decisions are made about their children's future.
n
Parents with children in need should be helped to bring up their children themselves
and such help should be provided in partnership with parents.
n
Services provided to children and their families should draw on effective partnership
between Health and Social Services Boards and trusts and other agencies. It is important to present
this detailed overview of the Children (NI) Order 1995 here, because in the
Trust's response to many of the key issues, mention will be made to the impact
of this legislation in terms of workload for staff and resource implications
for the Trust. It is prudent to advise the
Committee that on the introduction of the Children (NI) Order 1995, the Department
of Health & Social Services issued seven volumes of Regulations and Guidance
which set out both legislative and Departmental requirements on all those involved
in the implementation of the Order. Meeting these demands has challenged Health
& Social Services Boards and Trusts and in many instances has prompted
organisational change. It is also necessary to highlight
that there are other pieces of legislation which impact on child protection
work. These include the Human Rights and the Data Protection legislation which
are having major impact in relation to the Trust's dealings with parents and
children and also in terms of information sharing between professionals and
agencies. It is important to apprise
the Committee that the Private Law aspects of the Children (NI) Order 1995
impacts significantly upon Trusts where Matrimonial cases involving disputes
over the custody of children requires social work assessment and representation
at court. Such cases are not high priority in terms of child protection or
child care issues, but they have become increasingly complex, acrimonious and
prolonged. This represents a significant drain on social work staff who are
the same staff as provide front line services in child protection. In cases where it has become
necessary to instigate legal action in order to protect children, the time
needed by social workers for the court process has increased significantly
with added financial pressures for trusts in terms of legal costs and costs
for expert witnesses which are now increasingly required by the courts in their
efforts to bring independence and expertise to the decision making process
and to meet the human rights of the parties involved. These costs are not funded
by the DHSS&PS and inevitably impact on the Trusts' performance in other
service areas. The Trust welcomes the Minister's
commitment as stated in the HSS&PS "Priorities for Action" to developing
arrangements to place Pre-employment Consultancy Service (PECS) on a statutory
basis - but we are disappointed that no other aspects of child protection receive
mention in those priorities. 3. Case Work Case recording, professional
judgement, and the assessment and analysis of information. 3.1 Case Recording The Trust is aware of the
findings of the review of the Victoria Climbie case in England, and of many
other such cases previously, where significant failings were identified in
case recording. The issue is one for all
professionals and agencies concerned with children and demands significant
resources in terms of training, administrative support and IT skills. Recording accurately and
comprehensively includes knowing what to record; knowing the significance of
certain pieces of information and being sure of the meaning and significance
of words/phrases used by other colleagues/professionals/agencies. It also involves
the development of IT systems and skills; robust systems for audit and monitoring
of records; clear evidence as to the source and identity of those providing
the information and those writing reports or other case notes. The Trust would
highlight the case of Lancashire County Council v. AD and others in which the judgement
included the following statement: "every social work file should have
as the top document a running chronology of significant events, highlighting
key points, and this should be kept up to date as events unfold". The Trust would also wish
to acknowledge that one of the characteristics of many families in which there
are child protection issues is their frequent change of address - often across
Trust boundaries. It is at times of case transfer
that case recording becomes critical for those taking on responsibility for
these cases. Robust case transfer procedures with clearly agreed standards
and protocols are essential to ensure that all relevant information is clearly
documented and presented in a coherent way. It is very clear from what has been said regarding
case recording, that there are significant resource implications. Front
line staff are faced with increasing competing demands on their time and skills
in both dealing on an interpersonal level with children and their families
and meeting the significant standards, government targets and the attendant
bureaucracy. 3.2 Professional Judgement Sound professional judgement is dependent not only
on the individual expertise and competence of individual professionals,
but on those professionals having access to all relevant information, not only
on particular cases, but in relation to child protection generally. Training is a key factor
in ensuring that professionals fully understand predictors in child protection
and that all professionals are fully aware, not only of their own duty and
responsibility for protecting children, but also of the duty and responsibility
which each other profession carries. One of the realities within social work is the
fact that as child protection becomes more and more complex and more
stressful, front line staff are often the least experienced of all core group
members. Yet, procedurally, these staff represent the profession which takes
the lead role in child protection cases. (This issue will be referred to later
under "workforce issues".) The DHSS study "Child Protection
- Messages from Research" has led to increased emphasis on managing high risk
cases in the community. Research indicates that the majority of children whose
names are placed on child protection registers are maintained in their families
and communities. Children on child protection registers attract high levels
of co-ordinated services. However, increasingly Trusts are now having to commit
services to children and families with high levels of need, but who have not
crossed the threshold for entry onto child protection registers. ACPC's have
taken strategic decisions to try to raise the threshold for child protection
and to promote family support strategies. Professional judgements are complex
in this area of work, and all involved require reliable and robust information
on which to make such judgements. One could appropriately use
the analogy of a jigsaw. Professionals involved in child protection work have
the task of 'piecing together' all the available information on individual
children, often with 'pieces missing' and without having the final picture
available. It is within this context that professional judgements are having
to be made. 3.3 Assessment and Analysis of Information The assessment and analysis
of information takes place on a number of levels:- (1)
each individual child's case; (2) information
available within and across Trusts, Boards and Regions within the UK and further
afield; (3)
research information available in relation to child protection issues. Professionals and agencies
involved in child protection require to be well informed in respect of each
of these levels in order to
plan, not only for individual children, but on a strategic front for child
protection services. Paradoxically, these professionals
closest to the children and involved in the day to day protection issues tend
to be those with least opportunity and time to keep abreast of the information
available. This has obvious resource implications for all
agencies to enable key front line staff to become well informed which
in turn enables more sound professional judgements to be made. We are aware of different
models across Trusts in relation to child protection work. However, we are
not aware of any examples of multidisciplinary teams in this area of work.
Our experience in other areas of service provision, e.g. children with disabilities, where multidisciplinary
teams are operating suggests that this model is worthy of being applied
to child protection. We would ask the Committee to consider this approach. The circulation across regions
and across the UK in respect of Case Management Reviews could be given greater
priority to ensure that lessons are learned and that services are continually
reviewed and improved in the light of experiences elsewhere. 4. Communication and Liaison between involved Parties The Trust is acutely aware
of the fact that the issue of inter-professional and interagency communication
has been a common feature of case management reviews across the UK over the
last 30 years. Despite the integrated Health
and Social Services structure in Northern Ireland, the Trust would not be confident
in believing that similar difficulties do not pertain here. The Human Rights legislation,
the Data Protection Act and the fact that society is becoming increasingly
litigious, have all impacted upon the flow of information between professionals
and agencies. The recent review of Victoria Climbie in England
revealed disturbing ignorance among different professions over each
other's roles and responsibilities. Doctors, police officers and housing officials
clearly felt that child protection was the role of Social Services. Yet social
workers often deferred to the judgement of these other professions. The issue
of cross communication was highlighted in the submission of Kensington and
Chelsea's Director of Social Services. Whilst the Trust gives high
priority to ensuring that relevant professionals are offered appropriate training
in child protection, and acknowledges the role which ACPC's play in interagency
responsibilities, this is a key issue which requires continual monitoring and
which is very dependent on the individual communication skills of all those
involved. Training is a key factor
in tackling this issue and the resource implications (including funding) require
to be identified. Trust figures for the year
2001-2002 suggest that at child protection case conferences, of which there
were 690, health visitors were present at over 80% while GP attendance was
only 5%. This reflects the difficulties presented to GPs in having sufficient
time/resources to attend case conferences often called at short notice and
often held at venues which may not be conducive to such basics as car parking
arrangements. Also, unless a GP has sufficient information on which to make
an informed decision as to the likely relevance or importance of their contribution,
it is unlikely that they will attend. Often the GP's attendance can be influenced
by the availability of reimbursement for locum cover. This Trust has been directly involved in a recent
piece of work with general practitioners across the Eastern Board's
area in an effort to address this matter. The objective was to examine ways
of ensuring that GPs received sufficient notice and information in relation
to cases where there were child protection concerns, on which they could make
informed decisions as to whether the case warranted their personal attendance
at the case conference or whether sharing information, either through
health visitor or social worker would be sufficient. It is hoped that this
would enable GP attendance to be targeted on the most relevant cases. During the process of this piece of work, it was
stressed by GPs that their confidence in social services would be enhanced
if they were able to build up relationships between themselves and named experienced
social work personnel. Whilst technology has increased the efficiency with
which information can be relayed, it has not replaced, nor will it, the benefit
of the human element in the building of trust and confidence. There are different models of staff accommodation
within and across trusts. In some models, health visiting and social work staff share
accommodation. Whilst it is arguable that in such a scenario, good communication
is facilitated between
professions, we believe that experience may show that the situation is more
complex. For example, if different
professional groups do share accommodation, their opportunity for frequent
and often impromptu discussions may take place as they come and go. The danger
that staff may rely upon such "chance" meetings/discussions as the "official"
passing of information has inherent dangers - it may not be recorded; if it
is it may not be done so contemporaneously. Therefore there is a danger of
"forgetting" to record or recording inaccurately. The Trust's vision for further
integrating professionals in delivering health and social care is seen in our
plans for Community Care and Treat Centres which will be "one stop shops" for
those requiring a wide range of community based care and treatment. Such innovation will inevitably
impact upon working practices and will have the potential for much more
interdisciplinary working and enhanced communication. However, we would stress
that whilst multidisciplinary teams, Community Care and Treatment Centres,
advances in I.T. all combine to make communication easier and better between
professionals, no system alone nor any combination of systems will offer a
foolproof resolution to this problem. However, we do believe that adequate
planning and resources must be directed to these issues in order to minimise
breakdown in communication in the future. Information technology has
the potential for aiding transfer of information on a targeted and efficient
basis. However, again any value flowing from personal face to face communication
can be lost. Guidelines and resources
need to be linked to addressing all of the facets of communication between
professions and agencies in the field of child protection. 5. Linkages 5.1 With children, parents/carers Obviously the focus of child
protection work is the child. Current procedures encourage the participation
of children and
parents in the entire process, including the multi-agency child protection
case conferences. Indeed this principle is found in the Children (NI)
Order 1995 as mentioned earlier in this submission - i.e. the need to involve
children in decisions which affect their lives. In this Trust, for the year
2001-2002, 48% of case conferences were attended by mothers; 22% by fathers
and 6% by children themselves. It is important to point out that whilst the
principle of inclusivity in the case conference process is fully supported
by the Trust, this results in three significant outcomes -
n
The inclusion of children, parents/carers in a multi-professional multi-agency
meeting results in the meeting having to be chaired in a way which is sympathetic
to family members for whom such a forum is both foreign and threatening. It
has been estimated across trusts in Northern Ireland that this inclusivity
has resulted in the time spent at case conferences being doubled and is now
an average two hours per conference, which excludes the preparation time for
family participation and the time needed to enable the family to understand
the outcome of the conference.
n
A significant time factor for social work staff and for the chairs of child
protection case conferences who have to spend a considerable time with children
and parents/carers prior to a case conference, sharing reports and supporting
them through, what is for them, a daunting experience. Time has to be spent following the case conference
to ensure that the child, parents/carers fully understand the decisions and recommendations
of the case conference and the roles to be played by each professional/ agency
in undertaking the agreed Child Protection Plan. The time spent on the preparation
before and information-giving after case conferences is required for all
case conferences and not only those attended by family members.
n
The presence of children or their parents/carers at case conferences often
impedes the open sharing of information from all other agencies/professionals
who may still feel uncomfortable. This is a training issue for all agencies/professionals
involved in the case conference process. 5.2 Children, parents/carers access to information Consistent with the principle
of openness, children, parents/carers are fully advised from the outset of
the child protection process. Following case conferences, they are provided
with written copies of the conclusions and these are explained fully to them. We believe ACPCs are committed
to ensuring that copies of the policy and procedures and attendant information
leaflets are available in languages other than English and in formats appropriate
to those with visual impairment. In linking with local communities,
raising awareness through training initiatives with local community groups
is one means of "educating" communities in respect of child protection. The
state cannot prevent child abuse any more than it can prevent petty crime/car theft. It must be recognised
that child protection is everyone's business. The principles of the
International Convention on the Rights of the Child and the Child Protection
Processes available to communities, must be provided as a means to reducing
levels of risk. Such community development
strategies are seen as effective and the Trust would welcome any support which
would result from the Committee's consideration of this matter. 6. Workforce Issues The Trust is very aware of
the interlocking and interdependent relationship of all services across the
child care spectrum. The balance of all of these services is sensitive to any
pressure experienced in any part of system, as well as to overarching issues such as legal
and procedural context and organisational structures. The impact of the Children
(NI) Order 1995 on the work force has already been alluded to in this paper,
and it is important to stress that it is precisely the same workforce which
is undertaking child protection work that is also meeting the demands of looked
after children, children in need and court work. The pressures upon these staff,
in all disciplines, is significant. The effects of these pressures is evidenced in
issues such as high turnover of staff; difficulties experienced in terms
of recruitment and retention of experienced staff; staff having to work over
and beyond their contracted hours in order to discharge the wide range of statutory
functions. The Trust has brought its
concerns in this area, which it believes are also present in local authorities
across the UK, to the attention of the Department's Chief Social Services Inspector. We are aware of the recent
research undertaken by CCETSW (Central Council for Education and Training in
Social Work) which showed an anticipated shortfall of 150 qualified social
workers over the next few years in Northern Ireland. We believe that Family
and Child Care Services and Child Protection in particular may have the greatest
shortfall. We believe that steps need
to be taken to review professional salaries, terms and conditions of social
workers and to ensure that social workers in Child Protection are remunerated
appropriately. The current Child Protection
Policy and Procedures puts emphasis upon the chairing of child protection case
conferences being at the level of Assistant Principal Social Worker. The DHSS&PS
Guidance in relation to Reviews of Looked After Children requires the same
Assistant Principal Social Worker to chair all reviews under the relevant Regulations. This presents an enormous challenge to the Trust
and a threat to the strategic development of child protection services
within the Trust. This is because the proportion of these managers' time which
is taken up in chairing both sets of reviews and their required involvement
in the planning and preparation for them and the dissemination of accurate information to children,
parents and carers following them, mitigates against their ability to
contribute to the strategic planning and management of child care services
generally and child protection in particular. The Committee is requested
to give due consideration to the concept of independent chairpersons for child
protection as one means of contributing to the alleviating of this problem. 6.1 Clerical Support The increase in bureaucracy
associated with the implementation of the Children (NI) Order 1995 places significant
pressures on all our systems, and in particular upon those providing administrative
and clerical support to child protection. Minutes of all child protection
case conferences must be accurately taken, typed, verified, circulated within
procedural timescales. It is essential to the protection of children that these
minutes accurately reflect the decisions and agreements of all parties and
that the Child Protection Plan to which all parties subscribe is clear and
unequivocal. Current levels of funding
for such support are threatening Trusts' capacity to meet these standards and
requirements. 6.2 Training It is of particular concern
that social work staff, who take the lead role in implementing Child Protection
Procedures, are often the least experienced of all professions within the core
group dealing with child protection issues. We believe there is merit
in reviewing the content and structure of professional social work courses
to prevent scenarios of newly qualified staff having to be appointed to child
care posts with a high exposure to child protection issues, who have had no
specific child care/child protection input during their training. This presents
a two-fold problem - (1)
because of pressure on work force, releasing these staff on post-qualifying
courses further exacerbates the problem; and (2)
because of their lack of knowledge, skill and expertise in child protection,
these staff present added pressure on their supervising managers, who themselves
are working under significant pressure. 6.3 Supervision Formal supervision is an
expectation in all family and child care teams. However, we are aware that
there are no provincial training courses to ensure equality of standards in
supervision. We believe that further consideration should be given to this
issue. 7. Resources - access to and use of Since the implementation of the Children (NI) Order
1995, there has been strategic planning through Children's Services
Planning Process to strengthen family support services to children in need.
The development of a wide range of easily accessible and well resourced support
services are given a firm legislative basis in the Order. These services are
pivotal not only to increasing the wellbeing of families in the community,
but to reducing the pressures on child protection, court work, looked after
children and juvenile justice. We believe that a strategy
to provide well developed and effective family support services must reflect
the strategy to target social need. Such a strategy must also take account
of the long term wellbeing of children and families and must be capable of
discriminating in favour of those at greatest risk. The Directors of Social Services
of the four Area Boards believe that the additional allocation by the Department
for the implementation of the Children Order fell short by £17m of the estimated
costs provided by the Boards. Whilst the injection of new
money over the last seven years has been welcomed it has not met the requirements
of child protection services. Funding through Executive Programme funds and
Health and Wellbeing Investment Plans exclude child protection services.
An added problem is that a significant amount of new funding is of a short-term
nature which makes long term planning of services more difficult. We further believe that the
Departmental bid to the Public Expenditure Survey, excluded costs, identified
by the four Boards, for child protection. This omission must be redressed. In the field of child protection,
and particularly child sexual abuse, it is critical to have expert medical,
psychiatric, psychological and forensic resources available. We believe that
a review of current resources in this area with a commitment to addressing
the findings would be required. It is also necessary to reinforce
the linkage between thresholds of risk being managed in the community with
lack of appropriate resources in foster care and residential care, particularly
for respite and emergency placements. The Trust welcomes the priority
which the Minister intends to give through the implementation of the Children
Matter Task Force. The national average in respect
of child protection under the Quality Protects initiative is that 11% of children
currently remain on the Child Protection Register for more than two years. Maintaining as low a proportion
of children as possible in this category helps ensure the avoidance of stigmatising
and disempowering parents and families any longer than necessary. However, this issue has to be viewed in the context
of available family support services, respite placements, child and
adolescent psychiatry provision, residential provision and court timescales. Child and Adolescent Psychiatry
and Psychology services are under severe pressure and the development of child
protection services must include these services. Access to such specialist
services, including appropriate treatment models for abused and abusers, must
be integrated within Health and social Services provision. Appropriate infrastructures
in order to ensure recruitment and retention of highly skilled professionals
is essential. The Committee may believe
that further evidence of this matter on a Province-wide basis to be advantageous
to a better understanding of current difficulties in addressing the full range
of service needs of children on the Child Protection Register. 8. Lessons Learnt A review of child protection
inquiries across the UK over the past 30 years will demonstrate that whilst
certain universal procedures have been put in place, there is still much to
be done to effectively address the core issues which are regular features of
all these inquiries. The procedural aspects referred
to are the Pre-employment and Consultative Service (PECS) and the police checks
in respect of criminal records for those applying for posts where this direct
contact with children. We have responded separately to the proposed Child Protection
and Vulnerable Adults Bill which will place issue on a statutory footing. Whilst it is too early to
draw conclusions from the recent case involving the Cambridgeshire school girls,
that case does highlight again how vulnerable children are with adults whom
they 'trust', and the balance of Human Rights legislation and society's responsibility
to protect children must always be high on the Government's agenda. Earlier in this submission
reference has been made to findings in the recent inquiry in England (Victoria
Climbie) in relation to record keeping, communication, training - themes which
have been repeated in most of the inquiries over the last 30 years. Focus and
resources on these key areas is essential. We would also encourage the
development of formal sharing across regions and jurisdictions, of findings
of all inquiries into child protection cases. Essentially such inquiries are about adult human
behaviour, vulnerability of children and the responsibilities of all
agencies, and professionals involved in child protection. Such issues transcend
geographical and political boundaries and there needs to be formal means and
processes for ensuring maximum learning at all levels and in all regions and
jurisdictions. 9. Examples of other issues impacting on Child Protection We believe that there is
a gap in the tracking of many child abusers. Systems have been developed to
track convicted sex offenders. However, others convicted of physical abuse
or even manslaughter, are not tracked with such vigilance. We would urge particular
attention to this issue. 10. General Comment 10.1 Priorities for Action - DHSS&PS Family and Child Care is
only afforded one and a half pages of a 43 page document. Whilst the Trust
welcomes the statement that "the development of family and child care services
remains a priority for the Minister" we note that any reference to child protection
is restricted to "developing arrangements to enhance the Pre-employment Consultancy
Service on a statutory basis in line with the provisions of the Protection
of Children and Vulnerable Adults Bill". We hope that the Committee will recognise
that the provisions of this proposed Bill may not address the movement of personnel
from countries outside the United Kingdom and Republic of Ireland. We believe that the protection
of children requires a much higher profile in Priorities for Action, not only
in terms of legislative provision, but in terms of a funding strategy on a
multi-agency basis to meet the demands of the service and the rights of children. An agreed vision statement
for children may help to frame any such strategy. We would refer to one suggestion
of a vision statement made at the workshop on 10.04.02 organised by the Children
and Young People's Unit of the Office of the first Minister and Deputy First
Minister - "Every
child has the right to grow up in a SAFE and peaceful society, which respects
and PROTECTS the individual, values diversity, and promotes social inclusion
and equality of opportunity for all." Any agreed vision statement
should have the full support of ALL government departments involved with children
and funding to promote the vision should be "ring fenced" and not subject to
crises in any other part of the H&SS. 10.2 Corporate Parenting The Trust fully recognises
its responsibility as a Corporate Parent and takes that role very seriously.
We are aware of the Government's National Objectives under Quality Protects
initiative in England and Wales - an initiative which not only set National
Targets, but which funded from Central Government, Action Plans to achieve
these Targets. We would welcome in principle
the application of such a strategy in Northern Ireland, but would stress our
belief that to set any local objectives in this context in the absence of planned
funding will not achieve the desired outcomes. 10.3 Assessment Framework The Trust is looking forward to receiving final
details of the current cross Board collaboration on agreeing an Assessment
Framework based upon the DOH model in Great Britain. We anticipate that this will
have significant resource and funding implications and would recommend that
the Committee's attention be given to that completed document. The Local Government Association's
submission to the Victoria Climbie Inquiry in its reference to multi-agency working states
"The Local Government Agency would like to see the establishment of individual
personal authority enshrined in procedures as part of multi-agency team working".
The commentary upon this issue, in Community Care 27.06.02, suggests that "if
this concept of personal authority can be combined with that of personal accountability
we will be spared the experience of another inquiry in which each professional
witness tries to blame the next for the lack of communication that contributed
to a child's death". The Trust would acknowledge
that the requirement, whether legislative or procedural to establish good communication
systems in itself does not pose the major difficulty. The challenge is in maintaining
and monitoring those systems particularly when the pressure/spotlight is "off". 10.4 Commissioner for Children The Trust was represented
at a recent presentation organised by the Office of the first Minister and
Deputy First Minister which highlighted the range of government department
which had responsibilities directly affecting children's lives. We believe
there is widespread recognition of the need to ensure inter-departmental communication
to ensure that children are high on the priorities for all departments. We are also aware that the
National Children's Strategy "Our Children - Their Lives" from the Republic
of Ireland (2000) was shared with delegates to that event. We believe that
the current devolved administration is ideally positioned to develop a Northern
Ireland strategy which builds upon experiences of neighbouring jurisdiction. 10.5 Role and Use of Child Protection Register We are aware that each Trust
in Northern Ireland has its "own" Child Protection Register. This in reality
means that there are 11 distinct Registers, each with its own agreed access
arrangements. We believe that there is
merit in considering access on a Regional basis given the size of our population
and the ease of movement of families across Trust/Board boundaries. Such an
initiative would resolve the inability of current information systems to allow
Trusts and Boards to comply with the procedural requirement to maintain children,
who move across trust boundaries, on the Child Protection Register of both
trusts pending the transfer of professional responsibility. 10.6 Current Research in relation to Multi-agency
working and Child Protection The Trust would refer the
Committee to three pieces of research which have particular reference to this
inquiry. (i)
"Multi-agency Working: An Audit of Activity", Local Government Association
Research Report 17, Local Govt. Association 2001 - M. Atkinson, A. Wilkin,
A. Stott, P. Doherty and K. Kinder. (ii)
"More than the Sum of its Parts?" A Study of a Multi-agency Childcare
Network, Joseph Rowntree Foundation 2001. (iii)
"Pulling Apart?" The National Health Service and Child Protection Network,
Policy Press, 2001 - C. Lupton, N. North and P. Khan. Points for practice identified by those pieces of research include:- (A) For multi Agency Working
n
Commitment and willingness;
n
Good working relationships;
n
Leadership/drive;
n
Establishing common aims;
n
Time to make arrangements work;
n
Sufficient resources to allow arrangements to work;
n
Clarity of issues and definitions. (B) For Child Protection
n
Increased commitment of health professionals;
n
Designated or named professionals as champions;
n
Further opportunities for joint training in child protection;
n
Increased commitment of GPs through training. A summary of these
pieces of research is available in "A digest of Research in Social Services"
- a Community Care Publication. WRITTEN SUBMISSION BY: 9 August 2002 I enclose for the
Committee's attention a response prepared by Board Officers. Unfortunately,
because of the timescale specified, it has not been possible to submit this
response to our Board for approval. We would wish to reserve the right therefore
to submit any additional views as a result of discussions at the relevant Board
Committee which meets in early September. Irene M Knox 1. Introduction 1.1 The South Eastern Education and Library
Board welcomes the opportunity to submit evidence to the Committee for Health,
Social Services and Public Safety of the Northern Ireland Assembly regarding
Child Protection Services in Northern Ireland. The Board is aware that the
Department of Education will be submitting more detailed evidence giving the
over arching structures for Child Protection within the education sector in
Northern Ireland. Accordingly the Board has structured its comments under the
headings requested in the correspondence from the Committee Clerk. 1.2 A Designated Officers for Child Protection
in Education Group (DOCPEG) was established a number of years ago to ensure
consistency across the education sector in child protection matters. The South
Eastern Board's Designated Officer for Child Protection, Ms Kate Bridge,
is a member of DOCPEG. The strategic objectives of the Group are: -
n
to develop and maintain the most appropriate policy on child protection;
n
to promote best practice by staff who work with children;
n
to ensure relevant training is available for staff who work with children;
and
n
to develop and sustain links with other organisations which can contribute
to the promotion of child protection within the education sector. 2. Case Work 2.1 The Board is aware the draft Education
and Libraries Bill, introduced in the Assembly on 24 June 2002 contains
a number of clauses, aimed at strengthening the current child protection arrangements
within the education sector. The Board would wish to endorse these draft provisions.
3. Communication 3.1 The Board is of the opinion that there is a need to promote
a greater emphasis on the prevention
of significant harm to children and young people. A useful forum already
exists within a number of schools, whereby a multi-agency team meets regularly
to develop a co-ordinated approach to pastoral care issues. Members are drawn
from education, health and social services. In this way early identification
and prevention of significant harm is promoted. Furthermore the provision of
a named social worker for each school encourages the development of positive
working relationships and facilitates education staff to feel more confident
about discussing potential child abuse cases with colleagues in the statutory
sector. 3.2 On occasions school staff do not feel they
have been given adequate feedback on cases they have referred. As teachers
are probably the only professionals to see children on a daily basis, it is
essential that they have sufficient information to allow them to monitor vulnerable
young people. They must be made aware of children who have been placed on the
child protection register. This is not always the case. 3.3 General Practitioners have a key role to
play, therefore strategies need to be developed to ensure their participation
in inter-agency meetings and child protection case conferences. 4. Linkages 4.1 The Board welcomes the fact that some of
the Health and Social Services Trusts have adopted a pro-active approach in providing "user
friendly" information leaflets and videos for parents and young people, explaining
the child protection process. This partnership approach is to be welcomed and
should be developed. 4.2 Within education, schools are being encouraged
to provide information to parents on an annual basis regarding pastoral care
and child protection procedures. The proposals in the Education and Libraries
Bill will strengthen these arrangements. 4.3 It is essential that there are close linkages
between the local Health and Social Services Trust Panels and the Area Child
Protection Committee (ACPC). 5 Workforce Issues 5.1 The South Eastern Education and Library Board currently provides
training annually for Designated Teachers for Child Protection and other
employees in the Board for example, Educational Psychologists, Bus Drivers,
Youth Workers. There are also opportunities for education personnel to attend
multi-disciplinary training offered by the ACPC. 5.2 In order to support Designated Teachers
in training of staff in their own schools, a video has been produced and issued
to every school in Northern Ireland. 5.3 The Board is of the view that knowledge and skills of
staff would be enhanced if there was closer consultation and linkage
between the uni-disciplinary and the multi-disciplinary training. 6. Resources 6.1 It is widely recognised that current resources
across sectors are not adequate to address all of the issues associated with
ensuring children's safety and well being. There are concerns that social workers
are only dealing with the most critical child protection referrals. This leads
to frustration for school personnel, who are concerned about delays between
the time a referral is made and subsequent action by Social Services. 6.2 A recent inspection of the Education Welfare
Service by the Education and Training Inspectorate has highlighted the need
for the role of Designated Officer for Child Protection within the Board to
be reviewed, because of the volume of the work. The majority of Designated
Officers carry out this role in addition to other duties associated with being
the Head of Service eg. Chief Education Welfare Officer. 7. Lessons Learnt 7.1 In general terms it would appear that when
there is an inquiry into case management, concerns are raised around multi-disciplinary
working and lack of communication. As stated earlier schools have a major role
in reporting and monitoring potential child abuse cases. It is essential therefore
that arrangements are in place to allow them to feel confident about passing
on concerns to social services, that relevant information is shared in a timely
fashion and that practical steps are put in place to promote closer working
relationships. 8. General Comments 8.1 The Board would have concerns that there
is a growing number of children, who do not reach the threshold of significant
harm for intervention and who may, therefore, be falling through gaps in agencies'
provision. It is the Board's view that implementation of the common assessment
framework, currently being devised will address this concern.
9 October (vol 3a) / Menu / 9 October 2002 (vol 3c) |
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