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Safeguarding children policy

Contents

  1. Policy summary
  2. Introduction
  3. Purpose
  4. Scope
  5. Procedure or implementation
  6. Training implications
  7. Equality impact assessment screening
  8. Links to any other associated documents
  9. References
  10. Appendices

1 Policy summary

Rotherham, Doncaster, and South Humber NHS Foundation Trust (RDaSH) has a statutory duty under section 11 of the Children Act 2004 to protect children from harm as part of a wider work of safeguarding and promoting the welfare of children. Safeguarding children is the action we take to promote the welfare of children and to protect them from harm, this is everyone’s responsibility. Everyone who comes into contact with children and families has a role to play. In order to fulfil this responsibility effectively, all practitioners should make sure their approach is child centred. This means that they should consider, at all times, what is in the best interest of the child.

No single practitioner can have a full picture of a child’s needs and circumstances. If children and families are to receive the right help at the right time, everyone who comes into contact with them has a role to play in identifying concerns, sharing information, and taking prompt action.

Safeguarding and promoting the welfare of children is defined for the purposes of this policy as:

  • protecting children from maltreatment
  • preventing the impairment of children’s mental and physical health or development
  • ensuring that children grow up in circumstances consistent with the provision of safe and effective care
  • taking action to enable all children to have the best outcomes

Children includes everyone under the age of 18.

2 Introduction

Child safeguarding can be complex and diverse and cover a wide range of activity from prevention, through to multi-agency responses to stop harm. The child or children should be central to the safeguarding process and their wellbeing must be promoted. All staff should follow the principles of the Children Act 1989 and 2004, which state that the child’s welfare is paramount and that they are best looked after within their families, with their parents playing a full part in their lives, unless compulsory intervention in family life is necessary.

Statutory Guidance Working Together to Safeguard Children (2018) (opens in new window) states that it is everyone’s responsibility to ensure that the principles and duties of safeguarding children are holistically, consistently and conscientiously applied.

RDaSH have a duty to follow the principles and meet the requirements of the:

Children are clear about what they want from an effective safeguarding system. These asks from children should guide the behaviour of all staff working with them.

Children have said they need:

  • vigilance, to have adults notice when things are troubling them
  • understanding and action: to understand what is happening; to be heard and understood; and to have that understanding acted upon
  • stability, to be able to develop an ongoing stable relationship of trust with those helping them
  • respect, to be treated with the expectation that they are competent rather than not
  • information and engagement, to be informed about and involved in procedures, decisions, concerns, and plans
  • explanation, to be informed of the outcome of assessments and decisions and reasons when their views have not met with a positive response
  • support, to be provided with support in their own right as well as a member of their family
  • advocacy, to be provided with advocacy to assist them in putting forward their views
  • protection, to be protected against all forms of abuse and discrimination and the right to special protection and help if a child refugee has been separated from their parents

3 Purpose

The purpose of the policy is:

  • to raise awareness of the recognition of abuse of children
  • to clarify how the trust will promote the safeguarding and welfare of children and adults at risk
  • to minimise the risk of abuse
  • to ensure that, should abuse come to the notice of trust staff, they know what to do
  • to clarify governance structures, processes, roles, lines of accountability and responsibility in relation to safeguarding patients, including those of the named nurses or professionals

4 Scope

This policy is applicable to all trust staff, agency staff and other staff not employed directly by the trust such as volunteers who in the course of their duties, may come into contact directly with, or who may become party to information about, safeguarding children’s issues.

5 Procedure or implementation

5.1 Quick guide

5.1.1 Concerned

  • You have a concern that a child or children are at risk of, or is experiencing, abuse or neglect.

5.1.2 Safety

  • Ensure the immediate safety and welfare of the child or children at risk and any others who may be affected (including adults).
  • Consider if the emergency services are required.

5.1.3 Advice

  • Seek advice from a safeguarding supervisor or the RDaSH Safeguarding team.
  • Advice is also available from the Local Authority Safeguarding team both inside, and outside, of working hours.

5.1.4 Report

  • Complete a referral to children’s social care.
  • Complete an IR1 incident report.

5.1.5 Record

  • Update the electronic patient record.
  • Include actions taken to mitigate the risk.

5.2 Child at risk

The legal definition of ‘child’ applies to all children from unborn up to 18 years of age whether the children are patients in their own right or children cared for by patients. It also applies to other children in the wider community that come to the attention of RDaSH staff in the course of their work.

The fact that a child has reached 16 years of age, is living independently, is in further education, is a member of the armed forces, is in hospital or in custody in the secure estate for children and young people, does not change his or her status or entitlement to services or protection under the Children Act (1989).

Child protection is part of the safeguarding process. Child safeguarding refers to policies, procedure and practice to ensure all children are safe from harm. Child protection refers to specifically protecting individual children identified as suffering or likely to suffer significant harm. This includes child protection procedures which detail how to respond to concerns about a child.

Significant harm is the threshold which justifies compulsory intervention in family life in the best interest of children. Section 47 of the Children’s Act places a duty on local authorities to make enquiries, or cause enquiries to be made, where it has reasonable cause to suspect that a child is suffering, or likely to suffer significant harm. Under section 31(9) of the Children Act (1989) (opens in a new window), as amended by the Adoption and Children Act (2002)(opens in a new window):

  • ‘harm’ means ill-treatment or the impairment of health or development, including for example impairment suffered from seeing or hearing the ill treatment of another.
  • ‘development’ means physical, intellectual, emotional, social or behavioural development.
  • ‘health’ applies to both physical and mental health.
  • ‘ill-treatment’ includes sexual abuse and forms of ill-treatment that are not physical.

There are no absolute criteria on which to rely when judging what constitutes significant harm. Consideration of the severity of ill treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, the degree of threat, coercion, sadism, and bizarre or unusual elements in child sexual abuse.

Some children live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of long term emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm. In each case, it is necessary to consider any ill-treatment alongside the family’s strengths and support networks.

To understand and establish significant harm, it is necessary to consider:

  • the family context, including protective factors
  • the child’s development within the context of his or her family and wider social circle as well as cultural environment
  • any special needs, such as a medical condition, communication difficulty or disability that may affect the child’s development and care within the family
  • the nature of harm, in terms of ill treatment or failure to provide adequate care
  • the impact on the child’s health and development
  • the adequacy of parental care

5.3 Categories of abuse

Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. A parent or carer fabricating the symptoms of illness in a child or deliberately inducing illness in a child may cause physical harm.

Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction. It may involve seeing or hearing the ill treatment of another. It may involve serious bullying, causing children to frequently feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Sexual abuse involves forcing or enticing a child to take part in sexual activities, whether the child is aware of what is happening.

Contact sexual abuse involves touching activities where an abuser makes physical contact with a child, including penetration. It can include:

  • sexual touching of any part of the body whether the child’s wearing clothes or not
  • rape or penetration by putting an object or body part inside a child’s mouth, vagina or anus
  • forcing or encouraging a child to take part in sexual activity
  • making a child take their clothes off, touch someone else’s genitals or masturbate

Non-contact sexual abuse involves non-touching activities, such as grooming, exploitation, persuading children to perform sexual acts over the internet and flashing. It can include:

  • encouraging a child to watch or hear sexual acts
  • not taking proper measures to prevent a child being exposed to sexual
  • activities by others
  • meeting a child following sexual grooming with the intent of abusing them
  • online abuse including making, viewing or distributing child abuse images
  • allowing someone else to make, view or distribute child abuse images
  • showing pornography to a child
  • sexually exploiting a child for money, power or status (child exploitation)
  • children or young people may be tricked into believing they’re in a loving, consensual relationship. They might be invited to parties and given drugs and alcohol. They may also be groomed and exploited online

Neglect is the persistent failure to meet a child’s basic physical and or psychological needs and is the most common form of child abuse. Failing to meet a child’s physical and, or psychological needs by not:

  • providing adequate food, clothing and shelter (including abandoning them)
  • protecting a child from physical or emotional harm and danger
  • ensuring adequate supervision (including the use of inadequate caregivers)
  • ensuring access to appropriate medical treatment
  • meeting the child’s basic emotional needs

A child who is neglected will often suffer from other abuse as well. Neglect often occurs over a period of time and can cause serious, long-term damage or even death.

5.4 Other safeguarding vulnerabilities

5.4.1 Child criminal exploitation and county lines

Child criminal exploitation is described in the serious violence strategy (2018) as being where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into criminal activity. This can be in exchange for something the victim needs or wants and for the financial or other advantage of the perpetrator through violence or threats of violence. The victim may have been criminally exploited even if the activity appears consensual.

County lines is a term used to describe gangs and organised criminal networks involved in exporting illegal drugs into one or more importing areas within the UK using a dedicated mobile phone line or other form of deal line. They are likely to exploit children and vulnerable adults to move and store the drugs and money and they will often use coercion, intimidation, violence (including sexual violence) and weapons. See below for local policies or procedures:

5.4.2 Child sexual exploitation (CSE)

CSE is a form of sexual abuse that occurs when an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity. This can be in the form of gifts, drugs, money, status or affection. Children and young people are often tricked into believing they are in a loving and consensual relationship and may trust their abuser and not understand that they are being abused.

Child sexual exploitation does not always involve physical contact, it can also occur using technology and via social media platforms. See below for local policies or procedures:

5.4.3 Contextual safeguarding and risks outside the family home

This is an approach to understanding, and responding to, young people’s experiences of significant harm beyond their families and can be outside the family home. It recognises that the different relationships that young people form in their communities, schools and online can feature violence and abuse.

This becomes of increasing importance for adolescents who naturally begin to spend more time out of their home and under the influence of their peers.

In the community, young people can be negatively affected by a range of risks as they spend more and more time in retail areas, open spaces, and on public transport.

A safe and supportive peer group will engender positive relationships, whilst negative experiences may lead to violent, coercive, and harmful behaviours.

Parents and carers have little influence over these contexts, and young people’s experiences of extra-familial abuse can undermine parent-child relationships.

5.4.4 Disclosures of non-recent sexual abuse

This can also be referred to as historical abuse and is when an adult was abused as a child or young person under the age of 18. This type of abuse will often perpetrate as exploitation of a trusted relationship through a process commonly termed as ‘grooming’. For example, it is common for offenders to seek a position of trust either in their personal lives or through employment which allows them to gain access to children and young people.

Staff should remain sensitive to any disclosure, wishes and support needs of the patient while remaining alert to any current risks to children the perpetrator may pose. Dependent on information shared a safeguarding response may be required, see RDaSH flowchart (staff access only) (opens in new window) for further guidance.

5.4.5 Domestic abuse

Includes an incident or a pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse, by someone who is, or has been, an intimate partner or family member regardless of gender or sexual orientation. This includes psychological or emotional, physical, sexual, financial abuse; so called ‘honour’ based violence, forced marriage or female genital mutilation (FGM).

Domestic abuse always has an impact on children. Being exposed to domestic abuse in childhood is child abuse. Children may experience domestic abuse directly, but they can also experience it indirectly by:

  • hearing the abuse from another room
  • seeing someone they care about being injured or distressed
  • finding damage to their home environment like broken furniture
  • being hurt from being caught up in or trying to stop the abuse
  • not getting the care and support they need from their parents or carers as a result of the abuse (Holt, Buckley and Whelan, 2008)

Adolescent to parent violence and abuse (APVA) or child to parent violence and abuse (CPVA), ]adolescent to parent violence and abuse falls under the same pathway as domestic abuse (see above), there is current no legal definition and can involve children under the age of 16.

Children and adolescents being abusive and violent towards parents, family members or caregivers is a serious issue and evidence suggests it is increasing. The abuse or violence can be carried out by sons and daughters against mothers, fathers, grandparents and carers. It is easy for parents to feel guilty and ashamed when children are abusive and violent. Rather than focusing on how parents are part of the problem, it is much more productive for them to think about how they can become part of the solution, and how you as a professional can support this. That said, it is the parent that often must take the first step to stop the abuse.

CPVA or APVA is a safeguarding matter and requires a multi-agency safeguarding response. Domestic abuse services may have specialist support available. Link to domestic abuse policy.

5.4.5.1 Female genital mutilation (FGM)

FGM is a procedure where the female genitals are deliberately cut, injured or changed, but where there’s no medical reason for this to be done. It’s also known as “female circumcision” or “cutting”, and by other terms such as sunna, gudniin, halalays, tahur, megrez and khitan, among others. FGM is usually carried out on young girls between infancy and the age of 15, most commonly before puberty starts. It is very painful and can seriously harm the health of women and girls. It can also cause long-term problems with sex, childbirth and mental health. FGM is considered child abuse in the UK and is illegal, as is taking a child abroad to undergo FGM, as legislated in the FGM Act (2003).

The legislation requires health professionals to report to the police where, in the course of their professional duties, they either:

  • are informed by a girl under 18 that an act of FGM has been carried out on her
  • observe physical signs which appear to show that an act of FGM has been carried out on a girl under 18 and they have no reason to believe that the act was necessary for the girl’s physical or mental health or for purposes connected with labour or birth
5.4.5.2 Breast flattening or breast ironing

This is where young pubescent girls’ breasts are ironed, massaged, flattened and, or pounded down over a period of time (sometimes years) in order for the breasts to disappear or delay the development of the breasts. Breast flattening usually starts with the first signs of puberty, which can be as young as nine years old and is usually carried out by female relatives. It should also be acknowledged that some adolescent girls and boys may choose to bind their breast using constrictive material due to gender transformation or identity, and this may also cause health problems.

If you have concerns regarding FGM or breast flattening, contact the RDaSH safeguarding team for advice and refer to local authority guidance.

5.4.6 Honour based abuse

This is a crime or incident committed to protect or defend the ‘honour’ of a family or community. This can include violence, threats of violence, intimidation coercion or abuse (including psychological, physical, sexual, financial or emotional abuse) to a child to protect or defend the honour of an individual, family or community for alleged or perceived breaches code of behaviour. See below for local policies or procedures:

5.4.7 Mental health

5.4.7.1 Children placed in tier 4 establishments

Where a child or young person has been placed in a tier 4 unit for more than 3 months the local children services need to be made aware to undertake section 85 duties. Such children are potentially vulnerable by virtue of their being accommodated outside the family. It is the responsibilities of the child’s care coordinator to ensure that the relevant local authority is aware of the admission. Upon notification that a child from their area is living in such arrangements, children social care can assess whether a child’s welfare is being adequately safeguarded and promoted and whether any additional services or interventions should be offered to the child and, or their family. For further information see link to Children and young people’s mental health service for children and young people that are placed in tier 4 establishments standard operating procedure.

5.4.7.2 Children admitted to adult mental health inpatient areas

Whilst it is accepted that the admission of a child or young person to an adult acute mental health ward should not occur, there may be exceptional circumstances in which this may happen, urgent necessity and the absence of satisfactory immediate alternatives.

An adult acute mental health ward will only be used if:

  • no specialist child and adolescent bed can be secured
  • it is an emergency situation with admission to an adult acute mental health ward being the only safe option

For further information see link to care and treatment of children under the age of 18 on adult acute mental health inpatient areas policy.

5.4.7.3 Non-accidental injuries in babies and children

These injuries are often identified when a parent or guardian are unable to explain how the injury occurred, or their explanation may be inadequate. Cuts and bruises can appear in many places on a child’s body. Common areas include the knees, elbows, shins and forehead. These locations tend to break a child’s fall when they are involved in a collision or trip, indicating that the trauma was unintentional. However, these marks can also appear in other locations. Softer regions such as the abdomen, thighs, buttocks and neck can all experience bruising and lacerations. While injuries to these parts can occur naturally, they are far more likely to be caused by intentional force.

Another common indication of physical abuse is the shape and size of these marks. Many take on the form of the object the abuser used. For example, a handprint may be noticeable on the child’s skin or the linear bruising of a stick or cane might spark initial concern. If these marks don’t appear to be healing over time, then it could be a sign of sustained abuse.

Things to consider if you identify an injury to a child is:

  • a parents or caregiver’s description of when and how an injury occurred
  • any delay in seeking treatment
  • inconsistent stories between parents and caregiver or a parent, caregiver’s and a child’s explanations differ
  • parent or caregivers who have an inappropriate response to the injury, for example, are not concerned with the injury and harm to the child
  • a pattern of injury that does not match what caregivers say happened
  • a child with a history of injuries
5.4.7.4 Injury to a non-mobile baby or child

Any injury in a non-independently mobile baby or child are unusual in this age and development group and always alert concerns, unless accompanied by a full consistent explanation. Even small injuries may be significant, and they may be a sign that another hidden injury is already present. If a staff member identifies an injury that causes concern, and the explanation is not satisfactory in your professional judgement then a referral should be made immediately to children’s social care and police (if appropriate). A strategy meeting should be held to determine if a child protection medical is required. See below for local policies or procedures:

5.4.7.5 Parenting capacity and mental illness

Parental mental illness does not necessarily have an adverse effect on a child, however, parents with mental ill health may neglect their own and their children’s physical, emotional and social needs. Their children may have caring responsibilities, which are inappropriate to their age and may have an adverse effect on their development.

Some forms of mental ill health may impair parents’ emotions and feelings or cause them to be ‘unavailable’ or not responsive to the child; or to behave in unusual, distressed or aggressive way towards their children or environment.

Some parents with severe mental illness are at risk of harming their children especially if their illness incorporates delusional beliefs about the child or the potential for the parent to harm the child as part of a suicide plan. See below for local policies or procedures:

5.4.7.6 Parental substance misuse

There is evidence to suggest that drug and alcohol misuse has an impact on parenting capacity and can cause significant harm to children of all stages of development. Maternal substance misuse in pregnancy can have serious effects on the health and development of the baby before and after birth. The level of risk to children will be dependent upon the parents’ ability to function having used substances. The assessment of risk should look at the impact on the child and wider implications such as safety, financial and health.

A thorough assessment is required to determine the extent of need and level of risk in every case. See below for local policies or procedures:

  • Doncaster parental substance misuse
  • Rotherham parental substance misuse
  • North Lincolnshire, non-available
5.4.7.7 Peer-on-peer abuse

Children can abuse other children at any age and can also be referred to as child-on-child abuse. This abuse can take place within the home, both inside and outside the education setting as well as online. Peer-on-peer abuse is most likely to include, but may not be limited to:

  • bullying (including cyberbullying, prejudice-based and discriminatory bullying)
  • abuse in intimate personal relationships between children (sometimes known as ‘teenage relationship abuse’)
  • physical abuse which can include hitting, kicking, shaking, biting, hair pulling, or otherwise causing physical harm
  • sexual violence, such as rape, assault by penetration and sexual assault
  • sexual harassment, such as sexual comments, remarks, jokes and online sexual harassment

This is a safeguarding matter and may require a multi-agency safeguarding response. However, please consult with the safeguarding team for further advice. Peer-on-peer abuse that involves sexual assault and violence must always result in a multi-agency response.

As well as supporting and protecting the victim, staff need to consider whether the perpetrator could be a victim of abuse too. It is known that children who develop harmful sexual behaviour have often experienced abuse and neglect themselves. See below for local policies or procedures:

  • Doncaster peer-on-peer abuse
  • Rotherham peer-on-peer abuse
  • North Lincolnshire, non-available

5.4.8 Perplexing presentations (PP) and fabricated or induced illness (FII)

5.4.8.1 Perplexing presentation

Children and young people with perplexing presentations often have a degree of underlying illness, and exaggeration of symptoms is difficult to prove and can be hard for health professionals to manage and treat appropriately. In the absence of clear evidence about risk of immediate serious harm to the child’s health or life, the early recognition of possible FII (not amounting to likely or actual significant harm) is termed perplexing presentations. PP requires an active approach by staff and an early collaborative approach with children and families. This differs from the previous advice not to inform families about FII suspicions while investigating. Though in some cases it may still be judged not safe to share concerns with the family at an early stage because of concerns that it may lead to increased risk for the child.

5.4.8.2 Fabricated or induced illness

In children is a situation whereby a child is, or is very likely to be, harmed due to parental behaviour and action, carried out in order to convince doctors that the child’s state of physical or mental health or neurodevelopment is impaired or more impaired than is actually the case. This can involve actions to falsify investigations, or induction of actual illness in a child and can include inadvertent harm caused by medical professionals such as unnecessary invasive investigations or procedures.

FII involving deliberate deception of clinical services by the carer in the child is rare but is a serious safeguarding concern and requires immediate attention and action.

If any health professional has concerns that a child may be at risk of fabricated or induced illness the parents or carers must not be informed as this could jeopardise the child’s safety. Concerns must be recorded, and advice sought from their manager or RDaSH safeguarding team. The RDaSH PP and FII in Children Procedure can be found here.

5.4.9 Prevent

Prevent is part of the Government counter-terrorism strategy. One of the national objectives for Prevent is to avert people from being drawn into terrorism and ensure that they are given appropriate advice and support. Children can be used to commit acts of terrorism, and this is child abuse.

If you suspect someone, whether patient, staff or visitor is at risk of radicalisation you must report it. See prevent strategy for the process to follow.

5.4.10 Private fostering

A private fostering arrangement is essentially an arrangement between families, without the involvement of the local authority, for the care of a child under the age of 16 (under 18 if disabled) by someone other than a parent or close relative (close relatives are parents, step-parents, siblings, siblings of a parent and grandparents) for 28 days or more.

Private fostering can place a child in a vulnerable position because checks as to the safety of the placement will not have been carried out if the local authority is not advised in advance of a proposed placement. The carer may not provide the child with the protection than an ordinary parent might provide. Where there is reasonable cause to believe that a child who is being privately fostered has suffered or is likely to suffer significant harm, a referral must be made to children’s social care. In addition, staff must confirm with carers and children’s social care that it is known a private fostering arrangement is in place. See below for local policies or procedures:

5.4.11 Spiritual, cultural and religious beliefs

This is where parents and families believe that an evil force has entered a child and is controlling them, the child is likely to suffer significant harm. The belief includes the child being able to use an evil force to harm others. This evil is also known as black magic, kindoki, ndoki, the evil eye, djinns, voodoo and obeah and the children can be referred to as witches and sorcerers. Parents can be initiated into or supported in the belief that their child is possessed by an evil spirit by a local community faith leader, indigenous healer or spiritualist.

A child may suffer emotional abuse if they are labelled and treated as being possessed with an evil spirit. In addition, significant harm to a child may occur when an attempt is made to ‘exorcise’ the evil spirit from the child. Staff need to remember that while recognising that child rearing practices are highly diverse and that all differences are to be valued and understood, it is also important that any judgements about the care and protection of children are based on objective assessment of facts. Sensitivity to parental behaviour, culture, religion or ideology must not mean that children from any background receive a lower level of care or protection.

5.4.12 Young carers

Young carers are defined by the Children and Families Act 2014 (opens in a new window) as a young person under the age of eighteen who has a caring responsibility for ‘another person’ on a regular basis. The concept of care includes personal, practical or emotional support and includes someone with mental health or substance misuse problems. ‘Another person’ means anyone within the same family, either adult or child who have an illness or disability and includes both older and younger siblings with physical and, or emotional health needs. On rare occasions, this caring responsibility may be for a friend.

The key principle of the care and support statutory guidance (The Care Act, DH 2014 (opens in a new window)) is that children should not undertake inappropriate or excessive caring roles that may have an impact on their development. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing and their prospects in education and life. If a local authority considers that a young carer may have support needs they must carry out an assessment. The local authority must also carry out such an assessment if a young carer, or the parent of a young carer, requests one.

Young carers’ assessments can be combined with assessments of adults in the household, with the agreement of the young carer and adults concerned.

5.5 Attending child protection conferences and core groups

Staff who are invited to attend a child protection conference or professional meetings due to their professional involvement with the child or adult who is a parent or carer must ensure they attend or send their apologies and a suitable deputy on their behalf. A written report containing risk and protective factors and identifying any outstanding health needs must be prepared for conference. The report should be routinely shared with parents or carers prior to the conference. If this has not been possible then the reasons for this must be clearly stated on the report prior to submission. Where a practitioner has been identified as a core group member for a child made subject to a child protection plan, they must prioritise attendance at core group meetings. See below for local policy or procedure:

5.6 Death of a child or young person framework

There may be a time when a child on your caseload sadly dies, this may be expected due to an illness or happen suddenly with no known immediate cause.

Following the death of a child there is a responsibility to contribute to the child death review process. You may be asked to provide information about your involvement with the child and family and may be required to attend meetings as part of the child death review process (opens in a new window). This is to establish, where possible, the cause or causes of the child’s death, identify any potential contributory or modifiable factors, provide ongoing support to the family, ensure that all statutory obligations are met and learn lessons in order to reduce the risks of future deaths.

5.7 Safeguarding practice reviews

These reviews are conducted when a child dies or is seriously harmed, and abuse or neglect is known or suspected to be a factor in the death. The purpose of reviews of serious child safeguarding cases, at both local and national level, is to identify improvements to be made to safeguard and promote the welfare of children. Learning is relevant locally, but it has a wider importance for all practitioners working with children and families and for the government and policymakers. Understanding whether there are systemic issues, and whether and how policy and practice need to change, is critical to the system being dynamic and self-improving. National guidance can be found here (opens in a new window).

5.8 Managing allegations against adults who work with children

Where it is alleged that a person who works with children has:

  • behaved in a way that has harmed a child, or may have harmed a child
  • possibly committed a criminal offence against or related to a child
  • behaved towards a child or children in a way that indicates they may pose a risk of harm to children

This may indicate that they are unsuitable to continue to work with children in their present position and until further investigation or assessments have taken place.

A referral should be made to the local authority designated officer (LADO), each area has their own managing allegations against people who work with children guidance. See below:

5.9 Managing allegations against people in positions of trust (PiPoT)

This is when a person who is working with adults with care and support needs has:

  • behaved in a way that has harmed or may have harmed an adult with care and support needs
  • possibly committed a criminal offense against or related to an adult with care and support needs
  • behaved towards an adult with care and support needs in a way that indicates she or he is unsuitable to work with such adults
  • behaved in a way that has harmed children or may have harmed children which means their ability to provide a service to adults with care and support needs should be reviewed
  • been subject to abuse themselves and there is evidence that this impacts on their suitability to work with adults with care and support needs

All allegations of abuse, neglect, or maltreatment of adults with care and support needs by a person in a position of trust must be taken seriously and treated in accordance with the managing allegations against people in positions of trust (PiPoT) procedure.

5.10 Raising concerns at work (whistleblowing)

RDaSH staff come into contact with lots of different agencies who may have children or childcare responsibilities. During a shift a member of staff could potentially witness or hear a disclosure of a colleague or care provider relating to child safeguarding concerns. Because abuse is a sensitive and difficult area it can be tempting not to take action when abuse is occurring within our work environment, especially when the abuser is a member of staff. However, ignoring our concerns can risk:

  • reinforcing abusive behaviour and perhaps put others at risk
  • no action, including support and protection, for all those in the situation
  • further misery because distress is not acknowledged
  • vulnerable victims seen as not needing or entitled to care, treatment, support or justice
  • perpetuation of a criminal act by the perpetrator

RDaSH has a whistleblowing policy which sets out roles and responsibilities of staff and the processes involved. Freedom to speak up: raising concerns (whistleblowing) policy.

5.11 Responding to child safeguarding concerns

If you are worried a child is at risk of harm make an immediate evaluation of the risk and take steps to ensure that the child or children is in no immediate danger. Where appropriate, call 999 for emergency services if there is a medical emergency, other danger to life or risk of imminent injury, or if a crime is in progress.

If you are referring to children’s social care, give as much information as possible using the safeguarding children partnership referral form (you can find this on the appropriate safeguarding children partnership website and on the safeguarding page on RDaSH intranet). All child safeguarding concerns must be reported to the children’s social care on the same day that the concerns were identified. See below for contact details:

Remember to:

  • contact RDaSH Safeguarding team for advice if required
  • report the incident internally on the Ulysses (IR1) electronic reporting system
  • ensure all decision-making is recorded in the electronic patient records, using the safeguarding child template

It is the responsibility of children’s social care to provide a written response to a referral. When a staff member does not receive a response, they should seek a response in the first instance from children’s social care after 5 days. If you still do not receive a response, please inform RDaSH’s named nurse for safeguarding.

Please refer to the diagram in appendix A and follow the pathway of what to do if you are concerned a child is being abused.

5.12 Escalation and resolution

Should a referral be declined by children’s social care, or the referrer informed that no further action is to be taken, the referrer must consult with RDaSH’s named nurse at the earliest opportunity where they believe that this response is inadequate to meet the needs of the child.

All agencies work within different structures and from a variety of perspectives, yet all agencies have a duty to comply with working together to safeguard children 2018 and to work cooperatively to safeguard and promote the welfare of children. Transparency, openness, and a willingness to understand and respect individual and agency views are core aspects of safe and effective multi agency working.

Safeguarding arrangements apply across the early help and the statutory safeguarding pathway and all agencies should encourage others to meet their responsibilities. Where a professional or agency believes that another professional or agency is not meeting their responsibilities, or that a child is not being safeguarded, then they have a responsibility for communicating such concerns through these agreed procedures. At no time must professional disagreement detract from ensuring that a child is safeguarded, and the child’s welfare and safety must remain paramount throughout. See below for
local procedures:

5.13 Information sharing

Safeguarding enables the sharing of information without the persons consent if it is for the purpose of the detection and prevention of crime and also where safeguarding of children is required (HM Government, 2018).

5.13.1 Seven golden rules for information sharing

  1. Remember that the general data protection regulation (GDPR) is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately.
  2. Be open and honest with the person (and, or their family where appropriate) from the outset about why, what, how and with whom information will, or could be, shared, and seek their agreement, unless it is unsafe or inappropriate to do so.
  3. Seek advice if you are in any doubt, without disclosing the identity of the person where possible.
  4. Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the public interest. You will need to base your judgement on the facts of the case.
  5. Consider safety and wellbeing: base your information-sharing decisions on considerations of the safety and wellbeing of the person and others who may be affected by their actions.
  6. Necessary, proportionate, relevant, accurate, timely and secure: ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those people who need to have it, is accurate and up to date, is shared in a timely fashion, and is shared securely.
  7. Keep a record of your decision and the reasons for it, whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.

5.14 Capacity and consent

5.14.1 Consent

The age of consent in United Kingdom law, a person’s 18th birthday, draws the line between childhood and adulthood (Children Act 1989 s105), meaning in health care matters, an 18-year-old has as much autonomy as any other adult. To a more limited extent, 16 and 17-year-olds can also take medical decisions independently of their parents. The right of younger children to provide independent consent is proportionate to their competence, a child’s age alone is clearly an unreliable predictor of his or her competence to make decisions. Consent policy

In cases where a referral to Children’s Social Care is required, it is best practice to obtain parental consent, unless you think a child is suffering or likely to suffer significant harm, in which case parental consent can be overridden. In cases where it is appropriate to obtain consent, the parent or person with parental responsibility should have sufficient information provided to them to be able to make an informed choice about the sharing of the child’s personal data for the purposes of making the referral. This should include an explanation of:

  • what information is being shared
  • why the information is being shared
  • the agencies the information is being shared with

5.14.2 Mental Capacity Act 2005

The Children Act 1989 covers the care and welfare of children in most situations. However, some of the provisions within the act apply to young people of 16 years of age or over who lack capacity to make their own decisions. Decisions relating to treatment of young people of 16 and 17 who lack capacity must be made in their best interests in accordance with the principles of the Act. The young person’s family and friends should be consulted where practicable and appropriate.

The Mental Capacity Act applies to children under 16 years in two ways:

  • the Court of Protection can make decisions about the property and affairs of a child where it is likely that the child will lack capacity to make those decisions when they reach 16 years old
  • the criminal offence of ill treatment or neglect applies to children who lack capacity

For further information see Mental Capacity Act policy.

5.14.3 Gillick competence

Unlike adults when a child is under 16 it is assumed they’re unable to consent unless they can demonstrate sufficient understanding and intelligence to fully understand what is involved in a proposed treatment, including its purpose, nature, likely effects and risks, chances of success and the availability of other options. This is called the Gillick test If a child passes the Gillick test, he or she is considered ‘Gillick competent’ to consent to that medical treatment or intervention. However, as with adults, this consent is only valid if given voluntarily and not under undue influence or pressure by anyone else. Additionally, a child may have the capacity to consent to some treatments but not others.

The understanding required for different interventions will vary, and capacity can also fluctuate such as in certain mental health conditions. Therefore, each individual decision requires assessment of Gillick competence. If a child does not pass the Gillick test, then the consent of a person with parental responsibility (or sometimes the courts) is needed in order to proceed with treatment.

5.14.4 Fraser guidelines

The ‘Fraser guidelines’ specifically relate only to contraception and sexual health consent. Sexual health advice can be given to under 16’s as long as:

  • they have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
  • they cannot be persuaded to tell their parents or to allow the doctor to tell them
  • they are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
  • their physical or mental health is likely to suffer unless they receive advice or treatment
  • the advice or treatment is in the young person’s best interests

Health professionals must encourage the young person to inform their parent(s) or get permission to do so on their behalf, but if this permission is not given, they can still give the child advice and treatment. If the conditions are not all met, however, or there is reason to believe that the child is under pressure to give consent or is being exploited, there would be grounds to break confidentiality. Fraser guidelines originally just related to contraceptive advice and treatment, but they now apply to decisions about treatment for sexually transmitted infections and termination of pregnancy.

Under 13 there is no lower age limit for Gillick competence or Fraser guidelines to be applied. That said, it would rarely be appropriate or safe for a child less than 13 years of age to consent to treatment without a parent’s involvement. When it comes to sexual health, those under 13 are not legally able to consent to any sexual activity, and therefore any information that such a person was sexually active would need to be discussed with the named nurse, regardless of the results of the Fraser guidelines.

5.15 Reporting safeguarding concerns without consent

In cases where there is an overriding public interest or if gaining consent would put the child at further risk then the concern must be reported. This includes situations where:

  • there is a serious risk of harm to the wellbeing and safety of the child or a risk of harm to others
  • other adults or children could be at risk from the person causing harm
  • it is necessary to prevent crime or if a crime may have been committed
  • the person lacks the capacity to consent or consent is refused by a parent or caregiver but safeguarding concerns are present

If a staff member is unsure whether to report the advice can be sought from the RDaSH Safeguarding team via rdash.doncastersafeguardingchildren@nhs.net.

6 Training implications

6.1 Safeguarding children level 1

  • Employee groups requiring training: Staff required to be competent with Level 1 safeguarding children training.
  • Frequency: Every 3 years.
  • Length of training: 2 hours.
  • Delivery method: E-learning.
  • Training delivered by: E-learning for healthcare.
  • Where are the records of attendance held: ESR.

6.2 Safeguarding children level 2

  • Employee groups requiring training: Staff required to be competent with Level 2 safeguarding children training.
  • Frequency: Every 3 years.
  • Length of training: 3 hours.
  • Delivery method: E-learning.
  • Training delivered by: E-Learning for healthcare.
  • Where are the records of attendance held: ESR.

6.3 Safeguarding children level 3

  • Employee groups requiring training: Staff required to be competent with Level 3 safeguarding children training.
  • Frequency: Annually.
  • Length of training: 3 hours.
  • Delivery method: Multiple.
  • Training delivered by: Blended learning.
  • Where are the records of attendance held: ESR.

7 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

7.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

Consequently, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity, and respect, (when appropriate this should also include how same sex accommodation is provided).

7.1.1 Indicate how this will be met

No issues have been identified in relation to this policy.

7.2 Mental capacity act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individual’s capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all colleagues working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason, all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005)to ensure that the rights of individual are protected, and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

7.2.1 Indicate how this will be achieved

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act 2005.

9 References

10 Appendices

10.1 Appendix A Reporting a child safeguarding concern

  1. You have a concern that a child is at risk of or is experiencing abuse or neglect.
  2. Ensure the immediate safety and welfare of the child at risk and others who may also be affected.
  3. Are the emergency services required?
  4. Contact the appropriate Children Social Care team and complete a referral:
  5. Complete an IR1 choose safeguarding children and the appropriate category of abuse.
  6. Update the electronic patient record using the safeguarding children template, giving a comprehensive overview of the safeguarding concern and actions taken to mitigate the risk.

10.2 Appendix B Responsibilities, accountabilities and duties

The trust, the chief executive and directors of the trust are responsible for ensuring that robust systems are in place to identify and manage the risks associated with safeguarding children at risk and to support the effective multiagency partnership working and responses which are required.

This includes the identification and training of suitable staff to fulfil the roles set out within the multiagency safeguarding children’s procedures. All staff are responsible for fulfilling their responsibilities to safeguard children.

The trust’s nominated executive director: The trust has a nominated executive director for safeguarding children, who takes a professional lead in promoting best practice in safeguarding children at board level. In this trust, the nominated executive director for safeguarding children is the director of nursing and allied health professional’s.

Deputy director of nursing (operational lead) has responsibility to provide expert advice, strategic and operational leadership for safeguarding and professional standards. To continually develop a proactive approach to safeguarding through collaboration with the local authority and other agencies. To ensure all mandatory and statutory requirements around safeguarding are met and develop support systems.

Nurse consultant safeguarding has responsibility to provide expert advice, strategic and operational leadership for safeguarding and professional standards. To continually develop a proactive approach to safeguarding through collaboration with the local authority and other agencies. To ensure all mandatory and statutory requirements around safeguarding are met and develop support systems.

Named nurses or named professionals (practice leads) have responsibility to provide an expert professional leadership role in relation to safeguarding. To work at a strategic level across the health and the social care community, fostering and facilitating multiagency working and training in respect of safeguarding. To act as an expert resource on safeguarding issues, providing accessible, accurate and relevant information to staff.

The practice leads are responsible for delivering support, advice and guidance to the safeguarding managers and enquirers.

They have a key role in promoting best practice and are available as a source of advice or guidance and support for managers and staff involved in safeguarding.

Service managers, modern matrons or area clinical managers are responsible for ensuring all staff have access to the relevant multiagency safeguarding children procedures in their workplace and maintaining compliance with the policy and multiagency safeguarding children procedures within their services. They have a key role in arranging staff attendance at training, updates in relation to safeguarding children and providing support for staff involved in safeguarding children.

Safeguarding supervisors Have a key role in promoting best practice in relation to safeguarding children and supporting others through key aspects of safeguarding supervision and advice and guidance.

Employees of RDaSH: ‘Safeguarding is everybody’s business’.

All employees (including volunteers) have a responsibility to safeguard and promote the wellbeing of children at risk of harm. Employees must be able to recognise and report safeguarding concerns to their line manager or the Safeguarding team to ensure actions can be taken to address the concerns.

10.3 Appendix C Monitoring arrangements

10.3.1 Adherence to policy and process

  • How and who by: Training and supervision monitoring process, safeguarding nurse consultant.
  • Reported to: Safeguarding assurance group.
  • Frequency: Annually.

10.3.2 Adherence to safeguarding procedures

  • How and Who by: Audit Safeguarding team.
  • Reported to: Safeguarding assurance group.
  • Frequency: Annually.

Document control

  • Version: 2.
  • Unique reference number: 545.
  • Approved by: Clinical policies review and approval group.
  • Date approved: 2 May 2023.
  • Name of originator or author: Nurse consultant for safeguarding.
  • Name of responsible individual: Executive director of nursing and allied health professionals.
  • Date issued: 19 May 2023.
  • Review date: 31 May 2026.
  • Target audience: All staff within the trust.

Page last reviewed: November 13, 2024
Next review due: November 13, 2025

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