1. Dr Sheila Shribman National Clinical Director, Children, Young People and Maternity Safeguarding Londons Children Update on Safeguarding and ways forward for the NHS Queen Elizabeth II Conference Centre 8 th December 2010

2. Past Policy background High profile cases and Lord Lamings Review What would really make a difference in the NHS is? - Keeping focused on safeguarding – opening framework 2011/2012 -A culture that supports staff in complex, risky practice -Improved information sharing -A culture of continuous improvement -Clear leadership and accountability

3. Current context for Policy Development The Munro Review of child protection –Early intervention –Trusting frontline social workers –Transparency and accountability Increased referrals Financial position

4. Current context for Policy Development NHS White Papers Consultations: White Paper: Equality and Excellence, Liberating the NHS Liberating the NHS: Commissioning for patients Liberating the NHS: Increasing democratic legitimacy in health Liberating the NHS: Transparency in outcomes: a framework for the NHS Liberating the NHS: Regulating healthcare providers Liberating the NHS: Greater choice and control Liberating the NHS: An information revolution Public Health White Paper, title Healthy Lives, Healthy People.

5. Health Bill The Health Bill will place a clear responsibility for every NHS Commissioning body to make arrangements to Safeguard children and promote their welfare. Membership of LSCBs. Government response to the White Paper consultation is coming shortly and will set out more details. Detailed work with stakeholders on how it will work for safeguarding. Health Bill – the New Year. Coalition commitment to 4200 extra health visitors. Increase in FNP programme (x2).

6. Proposed future NHS architecture

7. Prevention, Early Identification and Support Evidence based programmes, eg FNP, Parenting Evidence based policies, eg HCP Focus on Maternity and Early Years

8. Safeguarding training Challenge Wide range of NHS training programmes but inconsistency, and lack of clarity about what should be received, by whom, and how frequently Barriers: resources (including staff capacity to deliver/attend); prioritisation (by individuals/organisation) and competing training requirements Gaps: multi-agency, specialist, SCR and supervision training; training for named and designated, GPs and independent contractors

9. Safeguarding training Need a way for Safeguarding Training to be taken forward Build on the updated Intercollegiate document DH developing a training matrix to help local organisations – providing appropriate training. Maintain pressure on organisations to do this

10. Clinical networks for child protection Challenge: Inequitable care for C&YP and support for clinicians Specialist advice on complex presentations For complex presentations, such as FII, advice may be required from a range of medical specialists not available locally Current arrangements are often informal, ad hoc, dependent on personal contacts Inequitable and unsustainable - lack of: succession planning, clarity about roles, allocation in job plans, remuneration for trusts, robust governance arrangements

11. Clinical networks for child protection Access to doctors with paediatric and forensic competencies to assess C&YP who may have experienced sexual violence or abuse Lack of skilled/willing doctors – difficulties accessing training; low volume of cases Reliance on good will of non-rostered doctors - including from neighbouring areas, without formal trust-to-trust arrangements Services lacking photo-documentation and forensically approved environments Delays in examinations and risks of DNA contamination - reducing likelihood of obtaining positive evidence

12. Clinical networks for child protection Proposals Formal arrangements between trusts for specialist advice Reflected in commissioning, job plans, pathways Not hub and spoke but web of networking arrangements – the range of specialists may be located in a number of units Local treating clinicians retain responsibility for clinical management of C&YP (advice normally by phone/electronically without need for travel)

13. Clinical networks for child protection CSA Networks Sexual Assault Referral Services (SARS) – local services pool skilled clinicians, equipment & facilities to deliver dedicated paediatric forensic medical services, specialist CAMHS and psychological support Managed Clinical Networks Added functions: population-based commissioner support & strategy development; governance and improvement; joint delivery/coordination of training & development Added features: multi-professional/agency network board with recognised authority; leadership and management capacity Will build on existing informal networks; models will vary; not mandated

14. Imaging Networks – The Way Forward http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndG uidance/DH_114980

15. Background There are wide variations in the provision of specialist paediatric imaging with comprehensive services concentrated in childrens hospitals and major teaching centres. The majority of routine, emergency and trauma imaging takes place in district hospitals. This is provided with variable levels of local expertise and variable support from specialist units to smaller hospital imaging departments. Most imaging of children is centred on traditional plain radiography and ultrasound and should continue to be so. Some areas of imaging such as contrast fluoroscopy are in decline and others such as CT, MRI, Nuclear Medicine and interventional radiology are increasingly necessary in support of routine paediatric care pathways. One commonly expressed view of childrens imaging services is that there is little of concern. Children rarely breach the targets and there are few complaints about paediatric imaging services.

16. Challenges Imaging children provides distinct challenges to radiology departments. The presentation of disease and pathology is unique to children and varies with the age of the child. Effective examination is dependent upon gaining the co-operation of the child, is age dependant and sedation or anaesthesia may be required. The needs of parents or carers should also be understood and addressed when considering any childrens service. Equipment and facilities suitable for children ranging from premature infants to adult sized teenagers is required and these are often different to those used for adults.

17. Challenges Imaging needs to be child focussed and specific to the age of the child. Radiation protection and Safeguarding are paramount concerns for this age group. Children must be considered in their own right, and imaging techniques should not be compromised by using techniques akin to imaging small adults. Recruitment of Radiologists Recruitment of Radiographers

18. A Tiered Model of Paediatric Imaging Services Level 3Dedicated facilities and equipment – minimum plain radiography and ultrasound. Level 2 CT as well as a minimum – DGH setting – GPs, A&E, OPD, IP, Neonatal Services Level 1 – Specialist Paediatric Imaging – the centre of a network a childrens hospital or mayor teach centre.

19. Tier Model – Level 3 Paediatric Imaging Service Child and Adolescent friendly No specialised examinations Dedicated facilities and equipment Link to a Level 2 or 1 for advice PACS and RIS links with 2 or 1 units SLA with 2 or 1 units. ie not in isolation

20. Tier Model – Level 2 Paediatric Imaging Service Level 1 plus a minimum of CT but May have MRI, Nuclear Medicine, Fluoroscopy Distinct General Hospital environment supporting a paediatric clinical service Imaging for GPs, A&E, OP and IP and may include Neonatal Clear protocols

21. Tier Model – Level 1 Paediatric Imaging Service Specialist Centre for an imaging network Children and/or major teaching centre Anaesthesia for under 10kgs Include skills for eg intussusception reduction upper and lower GI micturating cystourethrogram Also Interventional radiography Vascular Non-vascular eg biopsy and drainage Cancer imaging with PET arrangements Neuro radiology Complex Nuclear Medicine

22. What does the Imaging Strategy mean for Trusts 1.Safe Services – Governance Issues 2.Consider this report in the local context. 3.Use for planning purposes and discussion with commissioners – alongside specialist services review. 4.Staff Recruitment, Retention, CPD etc 5.Environment and Equipment issues 6.Networks

23. Summary Policy Context New NHS Architecture Focus on early intervention Training Clinical Networks for Child Protection and for Imaging On-going challenges Review Findings Keeping Focussed.