1. Child Safeguarding Protocol
In EMIS Web
Jez McCole, GP, Gleadless Medical Centre, Sheffield
@jezmccole

2. The Problem Lack of awareness of Safeguarding issues
Common to most busy surgeries
What is already in the busy record?
What was the point of coding it?
Coding is more than just about QOF
Bringing the electronic medical record to life
Highlighted during our Three Minute Surgery

3. Theme 2 - Everything is ok
This theme demonstrated how professionals didn’t recognise the safeguarding issues or vulnerabilities that existed. There were 2 main reasons for this:
1. Normal for Community. In 3 cases professionals felt that the children were one of a ‘number of children like this’ in the community:
‘There are lots of other families like this in their practice area so this family would not have stood out. This is of concern… because of the clear level of risk that there was in this family.’ (2011)
2. Misplaced Optimism. There was evidence (in 8 cases) of professionals working with an overoptimistic view of the situation. The most common reason was that they didn’t question, recognise, know or collate the family history or vulnerabilities that exist.
‘Assessments failed to consider the historical information regarding this couple. Agencies failed to consider the multiple risk factors’ (2011)
Normal for community
Professionals viewing the child(ren) as one of ‘a number of children like this’ can lead to lower expectations of parenting and increasing the ‘threshold’ for referral for additional services.

4. Theme 3 - Assessment, Assessment, Assessment
This highlights the importance of assessment and the difficulties that arise when this isn’t thoroughly completed.
An Assessment Mindset is seeing every encounter with a family as an opportunity to re-evaluate the situation. The lack of this was an issue in 6 cases.
Silo Thinking. In 6 cases professionals viewed situations in isolation, were task focused and ‘episodic’. This also highlighted where professionals didn’t consider the possible impact of the parents mental health on their parenting.
Downgrading of risk (4 recent cases). In these professionals closed cases when there was no evidence of any new information to inform this decision.
Recognition of risk by universal services. 3 cases highlighted that although universal services had contact with a family, they didn’t recognise the circumstances the children were living in.
Communication and information sharing was an issue in 10 reviews.
1. Assessment Mindset
Working without an ‘assessment mindset’ can be due to a number of reasons including:
working with the ‘start again approach’ - a failure to take account of past history and starting again. This has been recognised nationally (Brandon, Belderson & Warren (2008))
Assessments getting stuck – reaching a conclusion regarding an aspect of the case and not changing from this opinion even when new information contradicted this. This was highlighted as an issue by Munro (1999, quoted in Burton, 2009) ‘Professionals need to constantly guard against the tendency to cling to their original beliefs and overlook, devalue or re-frame any new information that challenges those beliefs’.
Assessments lacked rigour – new information was available but services didn’t use this. This was an issue across agencies but particularly for Children’s Social Care. ‘It is what is done with information, rather than its simple accumulation, that leads to more analytic assessments and safer practice.’ (Brandon et al, 2008)
Assessment Tools – in 7 reviews assessment tools were not used when these could have added to the information available. These mainly referred to the CAF. In addition, recent reviews demonstrated this is being viewed as a referral, not an assessment tool.
2. Silo Thinking
Ofsted (2010) analysis of SCR completed in 2009 – 10 reported that ‘Agencies tended to respond reactively to each situation rather than seeing the whole context’. An example of this in one of the local reviews:
‘Analysis of concerns may also have been downgraded by the treatment of incidents in isolation rather than as part of a pattern indicating long term difficulties and growing stress and tensions within the family’ (2011)
3. Downgrading of risk
This was a particular issue for Children’s Social Care and one decision made by the Children’s Hospital
4. Recognition of risk by universal services
Two of the 3 cases were very recent ones.
The importance of the role of universal services has been highlighted nationally. In an analysis of SCR published between 2007 – 09 approximately half of all cases ‘are in relation to babies under one year of age, underlining the importance of effective universal services provision for young children e.g. health visitors’ (Brandon, Bailey & Belderson, 2010)
5. Communication and information sharing
The local results were in line with national findings, ‘as in all other studies of serious case reviews, communication problems among agencies and professionals were common’ (Brandon et al, 2008).
Locally, there were particular issues for various health agencies and children’s social care.

5. Three Minute Surgery GP
HCA Room1
HCA Room2
Distraction
N = 40+

6. Our Aims When any record is loaded
To present the Child Protection Status of the patient
To inform the user about Safeguarding procedures

7. Protocol Overview – The finished product

8. Protocol Ingredients A coded record Concepts Connectors
Protocol Alerts (‘Zap box’)

9. A (well) Coded Record Agree your codes Used on the record of the child
[13Iv] Child is the subject of a Child Protection Plan
[13Iw] Child has been removed from a plan [13IO]
[13IS] Child is a Child in Need
[13IT] Child is no longer a Child in Need
Used on the record of a parent/guardian
[13Iy] Family member subject of a Child Protection Plan
[13Iz] Family member removed from a Child Protection Plan

10. THE CONCEPTS The engines of the protocol Interrogate the record
Change the direction of flow based on what they find
Written in the Concept Manager

11. Creating a Concept 1

12. Creating a Concept 2

15. Create a Protocol

16. Starts as a blank canvas
Build the Protocol
Starts as a blank canvas

17. Add a pre-prepared Concept

18. Protocol Flow – Child currently on a plan

19. Protocol Alerts - ‘Zap’

20. Protocol Alerts

21. Safeguarding Template

22. Safeguarding Template

23. Protocol Overview – Child currently on a plan

24. Protocol Overview – Child no longer on a Plan

25. Concept & Alert
Alert
No Longer on a Plan
Concept

26. Protocol Overview – The finished product

27. …and finally!

28. Program the trigger
Update Record
Thank you

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