NHS Highland Board 28 March 2017 Item 4.11 CORPORATE PLANS FOR CHILD PROTECTION AND LOOKED ATER CHILDREN AND YOUNG PEOPLE Report by Dr Stephanie Govenden Lead Doctor Child Protection and Looked After Children and Sally Amor Child Health Commissioner on behalf of Hugo Van Woerden Director of Public Health and Executive Lead for Children and Young People Background and summary NHS Highland has corporate responsibilities with regard to keeping children and young people safe (Child Protection) and as a Corporate Parent for Looked after Children and Young People. These responsibilities are detailed in both Scottish Government Legislation and related policy and guidance. The NHS Board has a proven track record of commitment and engagement in Child Protections Committees in Argyll and Bute and Highland and to its role as a Corporate Parent. The Board has a pro active approach to looking at employment opportunities for young people leaving care and engages in the CHAMPS Board in the Highland partnership and the Corporate Parenting Board in Argyle and Bute. These activities are core to integrated working for children and young people in the Argyll and Bute and Highland partnerships. The Corporate Plans appended to this paper set out the responsibilities and related governance arrangements for the NHS Highland Board with regard to these two areas of responsibility. The scope of the Plans is for all NHS Highland Directors, employees and health staff including those in the commissioned service in the Care and Learning Service Highland Council. The Strategic Goals outlined in the reports will be implemented through the NHS Highland Child Protection and Looked after Children and Young People Governance Group. This is co-chaired by the Deputy Director of Nursing and the Lead Paediatrician for Child Protection and Looked after Children. This group reports to the NHS Highland Children and Young People Planning Forum and informs integrated service planning for children and young people and related improvement work in the Highland and Argyll and Bute Partnerships. The Corporate NHS Highland Plan forms the NHS health contribution for the Highland and Argyll and Bute Corporate Parenting Strategies. The NHS Highland Board is asked to: Note and agree the proposed Corporate Plan for Child Protection Note and agree the proposed Corporate Plan for Looked After Children and Young People Agree to updates on progress to be included in the Child Health Commissioner report to the NHS Board in autumn 2017
Report The Corporate Plans are appended to this report. 3 Contribution to Board Objectives The revised role and remit will address a range of Board objectives as follows: Objective 2: Improving Population Health and Reducing Inequalities Objective 3: Creating a Caring, Person-centred Experience Objective 4: Providing Safe and Effective Care Objective 5: Transforming Services Objective 7: Engaging our People Objective 9: Ensuring Value and Sustainability 4 Governance Implications Staff Governance Patient and Public Involvement Engagement and consultation with Care Experienced Young People through the Highland CHAMPS Board will inform the work Clinical Governance (including Information Governance, where relevant) None of note Financial Impact None of note 5. Risk Assessment None of note 4. Planning for Fairness An equality impact assessment is available from the author on request 5. Engagement and Communication None of note Stephanie Govenden Lead Consultant Paediatrician Child Protection Sally Amor Child Health Commissioner/Public Health Specialist 23 February 2017
NHS Highland Child Protection Corporate Plan 2016-2018 Summary The Child Protection Corporate Plan sets out the corporate responsibilities and related governance arrangements for the NHS Highland Board to keep children and young people safe. The Plan details a series of strategic goals and actions required to strengthen child protection processes across the organisation over the next two years. The Strategic Goals outlined in this report will be implemented through the Child Protection and Looked After Children and Young People Governance Group. This is chaired by the Deputy Director of Nursing and the Lead Consultant Paediatrician for Child Protection and Looked After Children. This group reports to the NHS Highland Children and Young People Planning Forum and informs integrated service planning for children and young people and related improvement work in the Highland and Argyll and Bute Partnerships. The scope of the paper is for all NHS Highland Directors, employees and health staff including those in the commissioned service in the Care and Learning Service Highland Council. Introduction All children and young people deserve to be safe, no matter who they are or what their circumstances. All Directors and employees in NHS Highland have a duty of care to protect children and young people. These responsibilities range from leadership roles for the Executive team and corporate services, and staff participation in formal processes to the everyday duties of all staff to respond appropriately at every level of the organisation to a concern about a child s welfare and safety. The Board has a responsibility to ensure the necessary knowledge and skills across the organisation to achieve this to best effect. The NHS Board has a proven track record of commitment and engagement in Child Protections Committees in Argyll and Bute and Highland. This plan focuses on the specifics of the NHS s contribution to keeping children and young people safe from significant harm. Background The corporate responsibilities of the NHS Board are detailed in child protection legislation, as a number of Acts, including: Children (Scotland)Act 1995; Adoption and Children (Scotland) Act 2007; Protection of Vulnerable Groups (Scotland) Act 2007; Children s Hearings (Scotland) Act 2011; Children and Young People (Scotland)Act 2014. Importantly, the Scottish government is committed to its duties under the United Nations Convention on the Rights of the Child (UNCRC). The Convention includes four general principles that are not only rights in themselves but underpin every other right within it, these are: For rights to be applied without discrimination (Article 2) For the best interests of the child to be a primary consideration (Article 3) The right to life, survival and development (Article 6) The right to express a view and have that view taken into account (Article 12)
National Guidance for Child Protection in Scotland and Child Protection Guidance for Health Professionals was published in 2014 and 2013, respectively. Intercollegiate training guidelines published in 2014 also inform the Board s responsibilities. In addition to legislation the Scottish Government published revised guidance to Child Protection Committees in 2014. Child Protection Health Services There is a Lead Paediatrician for Child Protection for the Board who provides expert advice and consultation to the Board. Clinical teams in the Highland Health and Social Care Partnership include the paediatric medical team at Raigmore with the Child Protection Advisors in the commissioned service Care and Learning. They also work with Forensic Medical Examiners where medical examinations are required. In Argyll and Bute Health and Social Care Partnership, the Child Protection Advisors work with the Lead Paediatrician (Greater Glasgow and Clyde SLA) with Greater Glasgow and Clyde Forensic Medical Examiners. Child Protection clinical practice is supported by Regional Managed Clinical Networks in both the North (HHSCP/Care and Learning Highland Council) and the West of Scotland (A+ HSCP). They have responsibility for setting clinical standards and core data sets with related scrutiny and oversight activity. Child Protection Committees (CPC) Children and young people are kept safer by good partnership working. Highland and Argyll and Bute each have a Child Protection Committee (CPC) whose principal role is to ensure that positive child protection outcomes are achieved through continuous improvement, strategic planning, public information and communication. NHS Highland is a key statutory partner in the CPC, with representation by the Director of Public Health, the Child Health Commissioner and the Lead Doctor for Child Protection and Looked After Children. Key to protecting children is that relevant professionals appropriately share information according to current government and local policy. The primary role of the CPCs is to ensure that the across the Safer Highland Partnership in Highland and through the Public Protection Chief Officers Group in Argyll and Bute, there are adequate measures in place to protect and safeguard the welfare of children. The governance structure below details the governance and lines of accountability for child protection: Overview of Governance Structure
Safer Highland Partnership NHS Highland Board HHSCP Children and Young People's Planning Forum A&B Public Protection Chief Officers Group Highland CPC A&B HSCP Child Protection & Looked After Children Clinical Governance Group Argyll & Bute CPC Child Protection Vision, Values and Strategic Goals The NHS Highland Vision for keeping children and young people safe is informed by legislation, national policy and professional best practice. Our vision is that all staff feel both confident and competent when making decisions in the context of child protection. We aim for staff to be supported by a positive internal response to incidents and concerns. NHS Highland values listening, treating people with respect and dignity and recognises that children and young people are equally entitled to receiving excellent and compassionate care from our organisation. The strategic goals that inform how will deliver the vision are detailed below: Strategic Goals 1. Embed child protection processes into mainstream working across the organisation. 2. Develop a culture of learning that is reflective and adaptive, to include incorporating learning from any significant case reviews into NHS Highland s policies and working practices. 3. Deliver high quality multi-agency training to meet professional and national standards for child protection training to allow staff to fulfil their roles. 4. Measure and monitor the quality of our work through an effective audit process. 5. Provide up to date, appropriate advice and support that will enable staff to make the right decision at the right time for children. 6. Work in partnership with all agencies within the Child Protection Committee to demonstrate continuous learning and improvement and to raise awareness of child protection matters within the community. 7. Provide guidelines and policies for staff to fulfil their child protection responsibilities. Achieving the Strategic Goals 1. Goal 1: Embed child protection processes into mainstream working across the organisation. With the introduction of child protection training across the organisation we will ensure that staff and managers have all necessary processes in place to consider child protection matters within their clinical teams, including those staff whose work is exclusively with adult
patients. It is envisaged that child protection is a regular topic for discussion within a multidisciplinary setting where this is relevant to clinical practice. 2. Goal 2: Develop a culture of learning that is reflective and adaptive, to include incorporating learning from any significant case reviews into NHS Highland s policies and working practices. NHS Highland supports and contributes to initial and significant case reviews conducted by the CPCs. Learning from local and national significant case reviews, with direction and guidance from the Child Protection Committees, will be disseminated to staff through training events and updates. Staff will be invited to consider the implications of these for current practice and to model best practice throughout the board and across teams. The SCR process is separate to internal NHS procedures such as serious adverse event reviews. 3. Goal 3: Deliver high quality multi-agency training to meet professional and national standards for child protection training to allow staff to fulfil their roles. NHS Highland staff will participate in, support and contribute to child protection training that is delivered to health staff and to multi-disciplinary and multi-agency groups. We will develop and publish our child protection health staff training strategy with the support of the child protection learning and development coordinator. 4. Goal 4: Measure and monitor the quality of our work through an effective audit process. The Child Protection Clinical Governance Group oversees the monitoring and audit of NHS Highland s child protection processes. Staff will be invited to audit relevant topics of their own choosing as well as key indicators of progress. Audit is one method of providing required assurances to the board and thus the Child Protection Committee that NHS Highland meeting the required standards. 5. Goal 5: Provide up to date, appropriate advice and support that will enable staff to make the right decision at the right time for children. NHS Highland has a number of resources for staff who have child protection queries. Resources include web based information, accessible both on the intranet and internet, and a range of fully qualified staff that are available for advice, support and guidance. NHS Highland is committed to updating the web resources including those to support training and to ensuring that staff know who to contact for advice when they have a concern. 6. Goal 6: Work in partnership with all agencies within the Child Protection Committee to demonstrate continuous learning and improvement and to raise awareness of child protection matters within the community. It is a government requirement that the Child Protection Committee provides evidence of continuous learning at a local level. NHS Highland is a key agency that contributes to the work of the CPC and is closely involved in its work to demonstrate the multitude of ways in which lessons have been learned and practice has changed as a result of direct experience of challenging child protection events. NHS Highland is actively supportive of all health staff who work across agencies and in the third sector to support vulnerable children who have experienced abuse or are at risk of abuse. We are committed to working with partners to
protect children and young people in Highland, in the knowledge that child protection is everyone s business. 7. Goal 7: Provide guidelines and policies for staff to fulfil their child protection responsibilities. Staff at every level of our organisation require appropriate guidance to support their clinical practice and to use as a basis for making difficult decisions and informing risk in cases where they are considering child protection matters. This guidance may be multi-agency or specifically directed at health staff working a child protection context. NHS Highland will contribute to the writing and production of relevant guidance for staff working with children, young people and their families where there is a child protection concern. The guidance will be subject to all due scrutiny through local clinical governance processes and the review of the Child Protection Committees to ensure it is fit for purpose. Next steps The Strategic Goals outlined in this report will be implemented through the Child Protection and Looked After Children and Young People Governance Group. This is chaired by the Deputy Director of Nursing and the Lead Paediatrician for Child Protection and Looked After Children. This group reports to the NHS Highland Children and Young People Planning Forum and informs integrated service planning for children and young people and related improvement work in the Highland and Argyll and Bute Partnerships. It is proposed that the NHS Board be advised and updated annually on progress being made alongside consideration of Child Protection Committee Annual Reports from the Highland and Argyll and Bute Partnerships. NHS Highland Relevant Contact Information: Pat Tyrrell, Deputy Director of Nursing Dr Stephanie Govenden, Lead Paediatrician for Looked After Children and Child Protection Sally Amor, Child Health Commissioner
NHS Highland Corporate Parenting Plan 2016-2018 Summary This Corporate Plan sets out the responsibilities and related governance arrangements for the NHS Highland Board as a Corporate Parent for Looked after Children and Young People. The Plan, informed by legislation and Scottish Government policy, details a series of strategic goals and actions required to strengthen our approach as a Corporate Parent across the organisation over the next two years. The Strategic Goals outlined in this report will be implemented through the NHS Highland Child Protection and Looked after Children and Young People Governance Group. This is chaired by the Deputy Director of Nursing and the Lead Paediatrician for Child Protection and Looked after Children. This group reports to the NHS Highland Children and Young People Planning Forum and informs integrated service planning for children and young people and related improvement work in the Highland and Argyll and Bute Partnerships. The Corporate NHS Highland Plan forms the NHS health contribution for the Highland and Argyll and Bute Corporate Parenting Strategies. The scope of the paper is for all NHS Highland Directors, employees and health staff including those in the commissioned service in the Care and Learning Service Highland Council. Introduction It is well recognised that looked after children and young people remain one of the most vulnerable groups within our society. The term looked after refers to all children and young people who are looked after by the local authority and all care leavers up to age 26 years. Looked after children and young people are less likely to live a healthy and peaceful life where they have achieved their full potential compared to their counterparts who are not looked after (Education Outcomes for Looked After Children 2014/15 Scottish Government). They have often been faced with adversity and trauma at an early age, and the effects of those experiences can be lasting and potentially very damaging. In order to grow and thrive they need systems that support and nurture them proactively, and that can take into account the typical challenges they might face. These challenges include frequent changes of address and uncertainty over their carers or parents, placements and education (2010, Looked after Children and Young People. NICE guidance, PH28). NHS Highland strives to be a responsible corporate parent working with the partnerships in Argyll and Bute and Highland Council to provide joined up services for looked after children and young people. This supports the sharing of expertise and experience to promote the best possible outcomes for these children and young people. Background The Scottish government introduced the concept of corporate parenting through the Children (Scotland) 1995 Act, which was targeted at local authorities. Most recently through the Children and Young People (Scotland) Act 2014 the government has specified who corporate parents are, and what is expected of them. There is a clear message from senior politicians that looked after children and young people are a priority for all organisations in Scotland. The legislation and guidance makes explicit the fact that all partners have a duty to
safeguard the welfare and wellbeing of looked after children and young people, and to ultimately secure nurturing, positive childhoods, from which these vulnerable young people can develop into successful learners, confident individuals, responsible citizens and effective contributors. (Children and Young People (Scotland) Act 2014: Statutory Guidance on Part 9: Corporate Parenting: Scottish Government.) The legislation requires that these are embedded within organisations and that all organisations are jointly responsible for securing the rights and well being of looked after children and care leavers who are ordinarily resident within the health board area. A Needs Assessment undertaken in 2013 by NHS Highland showed that proportionally, Highland had more looked after children and young people in residential care (16% in Highland, 13% in Argyll and Bute, versus 9% nationally) and a greater percentage of children with additional support needs compared to Scottish averages (24%, compared to 11% nationally). Available from: http://intranet.nhsh.scot.nhs.uk/org/corpserv/publichealth/epidemiology- HealthSciences/Documents/Publications%20+%20Resources/LACYP%20Review%20Final %20Report%20June%202013.pdf [accessed September 2016]. Local audit work (Highland Partnership Looked After Children and Young People Data Commentary 1 January 2015-31 December 2015), shows that in terms of health needs there were developmental concerns in around a quarter of boys aged under 16 and in a third of girls aged 5-9 years. With regard to maintaining a healthy weight, Highland data revealed a concerning pattern of a rising proportion of LAACYP who are overweight as they get older (between 4 and 15 years) resulting in 40% of girls aged 10-15 years, who have a body mass index above the normal range, compared to a Scottish national average of 28% at risk of overweight or obese, amongst 2-15 year olds. Most recent Scottish government figures show that 93% of all children and young people in residential care have additional support needs, and a majority of these are social, emotional and behavioural in nature (Children's Social Work Statistics Scotland 2014/15, Scottish Government). Health Services for Looked After Children and Young People It is the duty of each corporate parent to assess the needs of the children and young people in its care and to provide each and every child with the opportunity to access the services they need and to promote the interests of looked after children. Within the Argyll and Bute Partnership health assessments for Looked After Children and Young People are undertaken by community paediatrics with ongoing health needs met by nursing colleagues. Within the Highland Partnership the health needs are assessed by the commissioned service in the Care and Learning Service. A review of data collected within the service, recently taken to the HHSCP Committee is informing a review and refresh of the health assessment and access to services and colleagues from Argyll and Bute are invited to be part of the discussion. The healthcare needs can be considered under the headings illustrated below in Fig.1:
Care Prevention Promotion Acute care needs including managing children with complex physical and mental health needs in residential and secure placements. Prevention covers the timely identification of health needs from initial health assessments with appropriate onward referral, through to addressing the mental health needs of looked after children. Promotion: Access to universal health services by looked after children, including primary care, dental services and vaccinations. Fig. 1 Pyramid of care to support the needs of looked after children. Collaborative Working with Partners Getting It Right For Every Child is an approach that is firmly embedded in the Highland Partnership through the use of the Highland Practice Model and related GIREFC processes in Argyll and Bute. Integrated service models further promote joint working between NHS, social care, education with health staff working within family teams to provide wrap around care for all children and young people. This system provides us with many opportunities to share best practice and to work together to provide joined up care for the looked after children and young people entrusted to us. Overview of Governance Structure CHAMPS Board For Highland s Children Leadershi p Group NHS Highland Board HHSCP A&B HSCP Children and Young People's Planning Forum Child Protection and Looked After Children and Young People Governance Group Corporate Parenting Board A&B Getting it Right for Argyll and Bute s Children Looked after Children and Young People Vision and Values and Strategic Goals NHS Highland has set out its key actions for the promotion of the health and wellbeing of looked after children below. These have been discussed and developed with the Looked After Children s Health Improvement Group (Care and Learning) and the Looked After Children s & Child Protection Governance Group (NHS Highland) and taken through the Children s and Young People s Planning Forum within NHS Highland. Following the introduction of these actions, progress towards achieving them will be tracked through an audit process, overseen by the NHS Highland Child Protection and LAC
governance group. In October 2017 the audit findings will be reported and reviewed and a follow on plan made for further actions. All findings and data will be shared with the Highland council through the looked after children s (health) improvement group so that where necessary, joint decisions can be made to best promote the welfare of looked after children and young people. Strategic Goals 1. Demonstrate visible corporate leadership by the NHS Board for the health and well being and access to quality services for children and young people. 2. Listen to the voice of looked after children and young people and incorporate their views and opinions wherever possible to promote their health. 3. Record and report looked after children s health information accurately and consistently. 4. Prioritise the mental health needs of looked after children and young people. 5. Promote awareness and knowledge of the specific health issues that looked after children face and how these can be addressed to relevant staff. 6. Enable close collaboration between health partners to ensure timely assessment and referral for looked after children who have additional health needs. 7. Provide support through the transition to adulthood for looked after children using our services aged 16 to 18 years. 8. Contribute to the Child s Plan health information to promote looked after child s wellbeing. Table 1. Corporate Parenting Goals for NHS Highland to promote the wellbeing of looked after children. Achieving the Strategic Goals Goal 1: Visible leadership training and development for Board Members and senior leaders with Who Cares? Scotland. Training and awareness raising with the NHS Board members and Operational Directors will be provided every two years. Goal 2: Listen to the voice of looked after children and young people and incorporate their views and opinions wherever possible to promote their health. NHS Highland will continue to participate in the young people s Champions Board in both the Highland and Argyll and Bute Partnerships which listens to the views and concerns of young people who are looked after. NHS Highland will work to engage looked after children and young people in awareness of their health needs and what it means to them, to be well, and healthy. Through the Child Protection Committeee, NHS Highland supports the introduction and use of Viewpoint, a software tool to gather children s views and thoughts. This will be used to direct areas of work and action and reports can be used as indicator to help us know how well our aim is being met. Goal 3: Record and report looked after children s health information accurately and consistently.
NHS Highland staff are working with looked after children across both Partnerships while health staff in the Care and Learning Service Highland Council are also supported professionally through NHS Highland. We will collect and share relevant information on an ongoing basis and add to and expand upon our existing data on the health of local looked after children through the improvement group structure. Goal 4: Prioritise the mental health needs of looked after children and young people Within the Highland Health and Social Care Partnership and Argyll and Bute children s and adolescent mental health team there is existing expertise in managing the acute and chronic mental health needs of looked after children and young people. There is a current programme of work being rolled out to both understand the full extent and range of mental health need experienced in the region by looked after children and young people, and to understand the needs of staff and carers who support children and young people who are looked after. Goal 5: Promote awareness and knowledge of the specific health issues that looked after children face and how these can be addressed to relevant staff. Whilst we recognise that certain staff groups such as Community Paediatricians have an expertise in caring for looked after children and in adoption and fostering, training and awareness are key to the action plan. NHS Highland will highlight the importance of focusing on the needs of looked after children and young people and their particular vulnerabilities through its wider training programme and through specific training events for key staff groups. These will be carried out face to face or online and NHS Highland will make available online training resources for staff to learn more about the specific health needs of looked after children. Goals 6, 7 8: Enable close collaboration between health partners to ensure timely assessment and referral for looked after children who have additional health needs; provide support through the transition to adulthood for looked after children using our services aged 16 to 18 years; contribute to the Child s Plan health information to promote looked after child s wellbeing. NHS Highland and partners in Argyll and Bute and Highland Council are involved in joint working to improve the health of looked after children. A Looked After Children (Health) Improvement Group has been established with links back to each partnership as part of Integrated Children s Service Planning arrangements. The group has identified four key themes or areas of work to focus upon, as follows: Early identification of health issues and appropriate timely referral when a need is identified. Communication and documentation at all levels between carers and parents, children themselves and between professionals when communicating concerns affecting a looked after child. Delivery of expert care including: o Workforce development (including foster carers) o Health assessments o Quality of health information within the Child s Plan o Governance Universal service delivery.
Within each area identified, a programme of work will be delivered to address the specific and relevant concerns. Next steps The Strategic Goals outlined in this report will be implemented through the Child Protection and Looked After Children and Young People Governance Group. This is co-chaired by the Deputy Director of Nursing and the Lead Consultant Paediatrician for Child Protection and Looked After Children. This group reports to the NHS Highland Children and Young People Planning Forum and informs integrated service planning for children and young people and related improvement work in the Highland and Argyll and Bute Partnerships. It is proposed that the NHS Board be advised and updated annually on progress being made alongside consideration of Corporate Parenting Annual Reports from the Highland and Argyll and Bute Partnerships. NHS Highland Relevant Contact Information: Pat Tyrrell Deputy Director of Nursing (co Chair Looked After Children and Child Protection Governance Group) p.tyrrell@nhs.net Dr Stephanie Govenden, Lead Doctor for Looked After Children and Child Protection (co Chair Looked After Children and Child Protection Governance Group) stephanie.govenden1@nhs.net Sally Amor Child Health Commissioner sally.amor@nhs.net