1 Final

Designated Safeguarding Children Team

Annual Report

2015-2016

July 2016

The Designated Safeguarding Children Team (DSCT) Annual Report provides information and assurance to stakeholders and

partners about the role and functions of DSCT for Norfolk and Waveney. However, the team are unable to report on all aspects of

business and activity due to the sensitive nature of some areas of work/functions of the service.

Designated Safeguarding Children Team Norfolk & Waveney CCGs

2 Final

1. Purpose of Report

1.1. The purpose of this report is to:

set the context for safeguarding children in Norfolk and Waveney;

provide an overview of the arrangements in place to safeguard and protect children across health services in Norfolk

and Waveney;

outline quality assurance arrangements;

set out objectives for 2016-2017.

1.2. The report will cover the period from 1st April 2015 to 31st March 2016.

2. Safeguarding Context

2.1. National Context

2.1.1. The following documents provide the statutory framework which sets out safeguarding responsibilities and ensures

effective arrangements are in place to safeguard children:

Working Together to Safeguard Children (March 2015);

Safeguarding Vulnerable People in the NHS - Accountability and Assurance Framework (July 2015);

Section 11 of the Children Act (2004) places duties on a range of organisations and individuals to ensure their

functions, and any services that they contract out to others, are discharged having regard to the need to safeguard

and promote the welfare of children;

The Care Quality Commission (CQC) Essential Standards for Quality and Safety (2010) includes outcome 7 which

focuses on ensuring the safeguarding of people who use services from abuse. Joint inspections are now being

implemented which look at the effectiveness of front-line safeguarding and how well the different agencies work

together.

2.2. Local Context

2.2.1. Norfolk Safeguarding Children Board (NSCB) policies and procedures.

2.2.2. NSCB priorities – Neglect, Child Sexual Exploitation (CSE) and Child Sexual Abuse (CSA).

2.2.3. Norfolk Ofsted Improvement Plan.

2.2.4. Norfolk County Council Looked After Children Strategy.

3 Final

2.3. Children subject to a Child Protection Plan (CPP)

2.3.1. The following graphs show a monthly breakdown of children subject to a CPP in Norfolk and Waveney for 2014-15 and

2015-16 (graph 1-2) and the types of abuse (graphs 3-4). Data is supplied by the Local Authority.

Graph 1

0

100

200

300

400

500

600

700

800

900

2014/15

2015/16

Number of children on Child Protection Plan - Norfolk

4 Final

There has been a decrease in the number of children on Child Protection Plans for 2015-2016 from the same period in the

previous year. The reason for this is not clear but it may be due to the impact of the roll out of Early Help, the implementation

of Signs of Safety and the Norfolk Ofsted Improvement Plan.

Below is a graph demonstrating the number of children with a Child Protection Plan in Waveney for 2014-2015 and 2015-

2016. It is difficult to make direct comparisons between Norfolk and Waveney data as Waveney’s population is far smaller.

Graph 2

0

50

100

150

200

250

Number of Children with a Child Protection Plan - Waveney

2014/2015:

2015/2016:

5 Final

Graph 3 Graph 4

Neglect remains the highest category of abuse in both Norfolk and Waveney. This suggests that greater emphasis is

required on identification and early intervention. The NSCB Neglect Strategy has continued to be implemented in 2015/16.

The ‘Multiple Abuse’ category represents more than one type of abuse.

0

10

20

30

40

50

60

70

80

Emotional Neglect Physical Sexual Multiple

Categories of Abuse - Waveney

2014/2015

2015/2016

0

50

100

150

200

250

300

350

400

450

Emotional Neglect Physical Sexual Multiple

Categories of Abuse - Norfolk

2014/15

2015/16

6 Final

2.4. Children In Care

Graph 5

The numbers of children in care in Norfolk are generally unchanged apart from a small drop in the third quarter of the year. This is

despite the Early Help Strategy which aims to identify families in need of early support in order that the appropriate assistance can

be provided with the aim of preventing family breakdown and children being placed in care. Norfolk remains a Local Authority with

higher numbers of children in care than their statistical neighbours. No information is available for Waveney at this time, however

DSCT are planning to present this information in quarterly reports going forward.

0

200

400

600

800

1000

1200

Apr-Jun Jul-Sept Oct-Dec Jan-Mar

2014/15

2015/16

Number of Children in Care - Norfolk

7 Final

2.5. Children in Need (CIN)

A Child in Need is defined under the Children Act (1989) as a child who is unlikely to reach or maintain a satisfactory level of health or development, or their health or development will be significantly impaired without the provision of services, or the child is disabled. The data for Waveney was not available at the time of this report. It is planned to be included in future reports.

Graph 6

Overall there has been a small decrease in numbers of Children in Need.

0

50

100

150

200

250

300

350

Apr-Jun Jul-Sept Oct-Dec Jan-Mar

2014

2015

Rate of Children in Need per 10,000 under-18 population - Norfolk

8 Final

2.6. LADOs

2.6.1. Twenty seven LADOs relating to health care professionals were reported in Norfolk for the period of this report.

2.6.2. More robust links have been developed between the DSCT and the LADO team and this has led to improvements in joint

working.

2.7. Serious Incidents (SI)

2.7.1. Two health serious incidents were reported to NSCB for the period of this report.

2.7.2. This represents a small increase in the numbers reported which is due to the DSCT raising with health providers the

importance of appropriate reporting of any safeguarding children SI’s to the NSCB.

9 Final

2.8. Commissioner/ Provider Framework

Great Yarmouth and

Waveney CCG

GPs

(Jointly

with

NHSE)

NNUH

IC24 JPUH

ECCH

NSFT

South Norfolk CCG

NSFT

NCEDS

Norwich CCG

NCH&C

Marie

Stopes Int

IC24

North Norfolk CCG

Spire NNUH

West Norfolk CCG

999

Service

NSFT

NCH&C

Marie

Stopes

Int

QEH

10 Final

Ellingham

Huntercombe

Public Health

Cambridge Community

Services: Children & Young

People’s Services in Norfolk

NHS England

School age

Immunisations

Opticians

CAMS Tier 4 SARC

EEAST

GP’s Dentists Pharmacists

Smoking

cessation

FNP as

part of

HCP

Specialist Commissioning

Neonatal

L4 CAMHS

T4

Renal

Dialysis

Bariatric

surgery

Airey Close

NSFT

ICASH

11 Final

3. Designated Safeguarding Children Team (DSCT)

3.1. In 2015 funding was agreed with the CCGs and Public Health, to increase the establishment within the team due to the

significant increase in workload. The team was fully recruited to by March 2016.

ROLE WTE

Designated Doctor for Safeguarding Children/Looked after children 0.6wte (0.4wte/0.2wte)

Designated Nurse for Safeguarding Children 1wte

Designated Nurse for Looked after Children 0.6wte

Deputy Designated Nurse for Safeguarding Children 0.7wte

Named GPs 0.8wte (0.6wte/0.2wte)

Quality Assurance Manager 0.46wte

Senior Administrator 1wte

Administrator 1wte

3.2. The DSCT provides support to named and lead professionals as tabled below:

DESIGNATED SAFEGUARDING CHILDREN TEAM PROVIDER SUPPORT

PROVIDER DESIGNATED LINK

Norfolk and Norwich University Hospital Designated Safeguarding Children Nurse/ Deputy Safeguarding Children Nurse

James Paget University Hospital Designated Safeguarding Children Nurse/Deputy Safeguarding Children Nurse

Norfolk and Suffolk Foundation Trust Designated Safeguarding Children Nurse/Deputy Safeguarding Children Nurse

Queen Elizabeth Hospital Designated Safeguarding Children Nurse/Deputy Safeguarding Children Nurse

East Coast Community Health Designated Safeguarding Nurse (Suffolk)

Norfolk Community Health and Care Deputy Safeguarding Children Nurse/Named GPs

Named Paediatricians Designated Doctor

12 Final

General practitioners Named GPs

999 service Designated Doctor/ Named GPs

IC24 Designated Doctor/Named GPs

Integrated Contraception and Sexual Health (ICASH)

Designated Safeguarding Children Nurse/Deputy Safeguarding Children Nurse

Cambridge Community Services Designated Safeguarding Children Nurse/Deputy Safeguarding Children Nurse

Ellingham Designated Doctor/Designated Safeguarding Children Nurse/Designated Nurse for LAC

Huntercombe Designated Doctor/Designated Safeguarding Children Nurse/Designated Nurse for LAC

SARC Designated Doctor/ Named GPs

East Anglian Ambulance Service Designated Doctor/Designated Safeguarding Children Nurse

NCH&C and ECCH LAC Services Designated LAC Nurse

3.3. DSCT has implemented safeguarding children group supervision facilitated by an external facilitator for named

professionals working within Norfolk and Waveney provider organisations which takes place on a 6 weekly basis.

3.4. The Designated Doctor and Designated Nurse have supported the development of a regional training event (Level 4) which

took place in May 2016 covering a range of ‘Hot Topics’ relating to safeguarding children.

3.5. An ‘Away Day’ was held in November 2015 led by the DSCT for named professionals covering topics such as Prevent,

Female Genital Mutilation (FGM) and CSE. This will become an annual event with one planned for November 2016.

4. Norfolk Safeguarding Children Board (NSCB). 4.1. DSCT and health providers provide representation at the NSCB and NSCB sub-groups.

4.2. The NSCB priorities continue to be Neglect, CSE and CSA which provide the strategic direction for the DSCT and health

providers regarding the safeguarding children agenda.

13 Final

5. Child Death Overview Panel (CDOP).

5.1. The CDOP process was deemed to be inadequate by Ofsted due to the large backlog of cases. The backlog of cases was

addressed in October 2015. Terms of reference have been reviewed along with the membership and the national process

has been adopted including using National Forms A, B and C to streamline the review of child deaths. Form A is for

notification of a child death and will be completed by the notifier. Form B will be sent to relevant agencies asking the case

responsible individual to complete as much as is known about the circumstances of death and relevant history and return

within 3 weeks. If an Agency has no relevant information or involvement regarding the death, then CDOP is asking that an

email be sent to inform CDOP of this. Once Form B has been completed and returned, this will then become Form C. Form

C will be the information presented to the CDOP for discussion.

5.2. CDOP meetings are now held bi-monthly.

5.3. CDOP meetings are attended by the Designated Doctor or Designated Nurse for Safeguarding Children.

5.4. The Designated Doctor will be working with CDOP to undertake a preliminary review of circumstances around child deaths

in preparation for CDOP meetings to underpin more effective and timely information gathering and inform decision making

at Panel.

5.5. The DSCT are part of a multi-agency task and finish group reviewing the NSCB ‘Management of Child Death Policy’ and

‘When a Child Dies’ booklet which will then be ratified by the NSCB in due course.

5.6. The DSCT is awaiting proposed changes to CDOP arrangements in line with the Wood Report recommendations (May

2016).

5.7. The DSCT has highlighted gaps in the provision of the Rapid Response Team in the Waveney area. The Great Yarmouth

and Waveney Children’s Commissioner is now working with NNUH to address the gap.

6. Norfolk Safeguarding Children Health Advisory Group (NSCHAG).

6.1. The function of the NSCHAG is to define the strategic direction in relation to the planning, commissioning and delivery of

services to vulnerable children. The group provides assurance to the NSCB that commissioners and providers of health

services in Norfolk and Waveney work closely with each other. The group monitors and reviews the effectiveness of

safeguarding arrangements across the health economy, across organisational locality boundaries and across borders. The

group has representation from the Norfolk and Waveney CCGs, Public Health, NSCB and NHS provider organisations

across the county and the group reports to the NSCB.

14 Final

6.2. Poor attendance has led to the Terms of Reference and format of the group being revised. There are now two parts to the

group. Part A includes Commissioners and the DSCT meeting to address quality assurance and commissioning issues.

Part B includes Provider Executive Safeguarding Children Leads joining the meeting to agree priorities and actions to

address safeguarding issues. Attendance logs are now being monitored (Appendix 2).

6.3. The Norfolk and Waveney CCG Risk Register (Appendix 1) is monitored through this group. It has recently been

reformatted to meet governance processes within Great Yarmouth and Waveney CCG; it is submitted monthly and

reviewed at Great Yarmouth and Waveney Executive Team meetings (HEX) along with all Directorate Risk Registers. HEX

will approve/challenge the risks and when appropriate oversee migration of the risks onto the CCG Strategic Risk Register;

this mirrors the process in West and Norwich CCGs. Any risk to safeguarding will be shared with CCGs to migrate onto

their Risk Registers.

6.4. The Suffolk Health Executive Group for Safeguarding Children is attended by the Chief Nurse from Great Yarmouth and

Waveney CCG.

7. Safeguarding Monitoring of Providers

7.1. Providers – Queen Elizabeth Hospital Kings Lynn (QEHKL) and Norfolk and Norwich University Hospital (NNUH) have new

safeguarding children team models in place.

7.2. DSCT Quality Dashboard - The Dashboard continues to develop with the inclusion from SARC and Ellingham Hospital

since quarter 3. Cambridge Community Services have also been invited to provide data. Going forward IC24, Huntercombe

and Quidenham will also be invited.

7.3. Provider audits have been carried out. Members of staff within a provider organisation are randomly selected to ascertain

their knowledge of safeguarding children and to determine the effectiveness of safeguarding children training. A report is

produced for the provider to demonstrate the effectiveness of their safeguarding children training or to inform the

organisation’s work plan.

7.4. Goddard Inquiry – An independent inquiry into CSA led by Justice Lowell Goddard is underway and will provide annual

reports, concluding in 2020. Chief Executives have been written to and a checklist provided to enable organisations to be

proactive in preparing to meet the expectations of the inquiry. This will be monitored through NSCHAG.

7.5. CQC Action plan - A Review of Health Services for Children Looked After and Safeguarding Children in Norfolk, was

carried out from 20th-24th October 2014 by the CQC. The report and recommendations were published online on 4th June

15 Final

2015. In response an action plan was developed by the DSCT on behalf of the CCGs and has been monitored through

NSCHAG. Good progress has been made and complete sign off on this action plan is anticipated in September 2016.

8. Serious Case Reviews (SCR)

8.1. The DSCT are leading on the health contribution to the SCR process, working with providers to identify health specific

themes and areas for learning.

8.2. Two SCRs have been commissioned for the period covering this report.

8.3. The DSCT have worked with providers to develop action plans for cases M, N, O and P which are being monitored through

the NSCHAG.

9. Child Protection Information System (CPIS).

9.1. The DSCT continue to work with the Local Authority on the implementation of CPIS.

9.2. Concerns around delays in implementation have been escalated by the DSCT to the Assistant Director for Performance

and Challenge within the Local Authority. An update is awaited from the Local Authority IT department.

10. Looked After Children (LAC)

10.1. Following an inadequate Norfolk Ofsted Inspection in September 2015, health organisations have been working with the

Local Authority to improve timeliness and quality of health assessments for children to meet compliance with statutory

guidance.

10.2. A Business Process Re-engineering (BPR) event was held on 3rd February 2016 which included all stakeholders and

mapped the complex process between Norfolk County Council and the health providers. This has enabled some

adjustments and a refocussing to deliver more timely compliance. Since the event, there have been parallel work streams

in progress with collaboration between partner agencies to achieve positive improvement in several areas.

10.3. Initial health assessments – there has been significant improvement in compliance since the 4% compliance reported in

February 2016 by the Local Authority.

10.4. Following on from work undertaken at a workshop in September 2015 to scope a way forward, an inaugural meeting of a

steering group to agree a Project Initiation Document (PID) was held on 19 February 2016, with representation by

stakeholders from Health and Social Care sectors. The project will implement a new model of care agreed at the

16 Final

September workshop. A project lead was commissioned by the central CCGs, and a business case has been developed,

and this was presented at a workshop held on 25th May 2016. Following wide agreement from stakeholders, the business

case was ratified by the Joint Commissioning Committee in June 2016. The aim is to implement the new model

immediately and negotiation of a contract variation.

10.5. The ‘Re-imagining Norfolk’ team at the Local Authority has worked with Public Health and the LAC designated health

professionals to undertake an audit of the clinical quality of health assessments. A re-audit will be carried out in July 2016

and the results of this will be available in September 2016`. A joint-agency event will be held on 7th June 2016 to write an

action plan from the results. This example of joint working should provide a catalyst for ongoing collaboration which will

reduce duplication and enable best practice across services and disciplines.

10.6. Health Passports - The Norfolk health passport has been developed and signed-off by a working group including the In-

Care Council, and was launched at an event on 5th July 2016. It is intended that the health passport will be issued to all

school age new entrants to care at their initial health assessment appointment. For children and young people who do not

have a health passport these will be issued one at their next review health assessment.

10.7. 196 children are placed out of Norfolk, of these children 150 have had an up to date health assessment as at June 2016.

For those who have not had an up to date assessment there are various reasons for this which require further investigation.

The co-location of the LAC coordinator in the hub has improved working practice and areas for further improvement can

now be addressed.

10.8. The LAC Quality Dashboard is under development. Work is planned with the Local Authority to produce a joint dashboard.

11. GPs 11.1. The focus of the work in 2015-2016 has been to help equip practitioners and support them in their role to be engaged in all

aspects of safeguarding children work. 11.2. The named GPs have provided safeguarding children training sessions in all 5 CCG areas. These sessions addressed

Level 3 competences (Safeguarding Children and Young People: Roles and Competences for Health Care Staff - Intercollegiate Document 2014). In response to feedback from GPs and incidents the named GPs have developed some subject specific shorter sessions. The first of these was delivered on bruises in young children the west in December 2015.

11.3. A network aims to clarify the role of GP safeguarding children leads and provides a six monthly forum for them to share learning and experience. Topics discussed to date include ,role of GP safeguarding lead, training requirements for staff in general practice, practice processes (Section 11 Children Act 2004), Special Educational Need and Disability (SEND), thresholds and referral, Signs of Safety assessment tool, learning from serious case reviews and inspections.

17 Final

11.4. Sample safeguarding children policies and procedures and the resource pack for general practice have been revised and updated and audit tools have been developed for processes such as recording who attends consultations with a child and for following up of missed appointments for children.

11.5. The named GPs have worked with IT support from NELCSU to provide in-practice sessions on the use of the SystmOne

East of England safeguarding children template.

11.6. Work has been progressed with health visiting provider organisations to develop standards and a sample contract for

regular planned contact between Health Visitors (HV) and GPs.

11.7. A monthly newsletter ’Spotlight on Safeguarding’ is produced to publicise new policies, processes, publications, training

opportunities and learning from SCRs.

11.8. The named GPs have worked with the safeguarding children Quality Assurance Manager to produce an audit tool for

general practice to monitor compliance with Section 11 of the Children Act (2004).

12. Designated Safeguarding Children Team Priorities for 2016-2017

12.1. Reviewing medical aspects of NSCB policies and leading on the implementation for health:

Female Genital Mutilation

Managing Child Deaths

Medical Examinations

Joint Working Protocol

12.2. Multi Agency Safeguarding Hub (MASH)

The DSCT has led on a multi-agency task and finish group which has produced recommendations for an integrated MASH

model.

A business case is under development for additional health resource within MASH. DSCT provide representation on the Missing Children sub group of NSCB. The DSCT are working with Cambridgeshire Community Services around MASH health practitioner involvement in the review of the Missing Children in accordance with the NHS England policy ‘Safeguarding Alerts Policy and Procedures’.

18 Final

12.3. Links with Local Authority

The DSCT continues to build stronger links with the Local Authority to establish more effective joint working at a strategic

level and to support the Local Authority Ofsted Improvement Plan and Looked After Children Strategy.

12.4. NSCB Procedure for undertaking joint visits and assessments by Social Workers, Health Visitors and Midwives,

for Children under 5 (3.11)

DCST has led on the ongoing work to embed joint working between Health and Social Care professionals relating to

vulnerable children (0-5yr old).

The protocol has been ratified by the NSCB and published on the NSCB website.

12.5. Development of CCG training

The DSCT have developed mandatory safeguarding children board training which will be piloted in Great Yarmouth and

Waveney CCG. This will then be rolled out to other CCGs.

DSCT is supporting CCGs in undertaking a safeguarding children training need analysis for all CCG employees.

12.6. NSCB Priorities (CSE/CSA/Neglect) The Designated Doctor is the CSE/CSA lead for the Team. CSE leads have also established within the main provider organisations. The DSCT will support the implementation of CSE lead responsibilities once these have been published by NHS England. The DSCT is continuing to build stronger links with SARC. The DSCT is supporting the roll out of daily MARACS across the county following a positive evaluation of the pilot in the east of the county. The DSCT have supported a health provider to attend a NSPCC presentation on the Graded Care Profile version 2 (GCPv.2 - shorter version). The implementation of the GCPv.2 across Norfolk will be considered by the Neglect Strategy Steering Group. Neglect Raising Awareness Sessions continue to be cascaded to health professionals.

DSCT have supported the roll out of training for neglect champions and will continue to provide support in strengthening the

role of neglect champions.

19 Final

12.7. Signs of Safety The Designated Nurse for Safeguarding Children provides representation on the Signs of Safety Steering Group. The DSCT supported the Signs of Safety Conference in February 2016 which was led by the Local Authority. The DSCT continues to support the embedding of the Signs of Safety philosophical framework in practice.

12.8. Threshold Document

The Threshold document has been revised and relaunched by the NSCB and provides a framework for decision making to

ensure children and young people receive the right service at the right time for the right duration.

The DSCT has contributed to the review of this document which is aligned with the Signs of Safety Framework.

12.9. Level 3 Multi-disciplinary Safeguarding Children Training

The DSCT is currently developing bespoke multidisciplinary safeguarding children training in partnership with health

providers.

12.10. Bereavement Support

The DSCT have escalated gaps around bereavement support for a small cohort of parents and the Local Authority is

looking at potential options for addressing the gap.

12.11. Evaluation of GP/HV Communication and Information Sharing

A GP/HV evaluation was undertaken earlier this year to determine the effectiveness of GP/HV communication and

information sharing in light of the findings from the CQC Inspection in 2014 and SCRs.

An executive summary report has been circulated and an action plan will be developed with both commissioners and

providers to implement the recommendations to improve joint working to safeguard children.

12.12. Channel Panel

The DSCT provides representation on the Channel Panel to support multi-agency decision making around young people at

risk of radicalisation.

20 Final

Appendices

Appendix 1: Risk Register

Source Top

BAF

Priorit

y /

Corpor

ate

Objecti

ve

Date No. Risk

Type

Risk BAF

/

CRR

/

DRR

Impact Like

liho

od

Initial

Risk

Score

Key Controls &

Assurances

Impact Like

liho

od

Current

Risk

Score

Impact Like

liho

od

Target

Risk

Score

Progress Update

(including confirmation on gaps in assurance &

control /

note to confirm archiving on final HEX update)

Actions

complete

d Y/N

Function Responsible

Senior

Manager

Committee/Pr

ogramme

Board/Project

Steering

Group

Audit Trail

on

reporting

Safeguard

ing

Children

Quality

Oct-

15

Reputa

tional /

Quality

The setting of targets for Health in

the Ofsted Improvement Plan

compiled by Norfolk County Council

(NCC) have not been agreed with

CCG lead (Director of C&Q

GYWCCG) for Safeguarding

Children. The failure to meet targets

is potentially damaging to the Norfolk

CCGs reputation.

DRR 3 3 9 1. Escalated by Designated

Safeguarding Children Nurse

to Director of C&Q

GY&WCCG. 2. DSCT to

promote effective

partnership working across

the economy and

collaboration with NCC. 3.

NSCB Leadership group and

NSCB oversee and monitor

the NCC Action Plan

3 3 9 2 2 4 01/03/16:- 1. Director of C&Q has written to Michael

Rosen. 2. Escalated to NSCB via section 11 self-

assessment process.

y Partnershi

p &

Delivery

Director of

Commissioning

and Quality

GY&W

Norfolk

Safeguarding

Children Health

Advisory

Group.

<15 retain

on

Partnership

and Delivery

Directorate

Risk

Register

Safeguard

ing

Children Quality

/

Improv

ed

experi

ence

Mar-

16

Quality

/

Financi

al

Compliance with Looked After

Children Standards will not improve

unless the LAC service is led and

resourced correctly.

DRR 5 2 10 Multi Agency group in

progress to co-ordinate

planning of improvements.

2. Provider manager of

NCH&C actively pursuing

and implementing new

model of GP recruitment.

Locum paediatricians in

place.

4 2 8 2 2 4 11/04/16 LAC resource and leadership raised at the

System Leadership Group where CEOs for

commissioners and providers are present.

Agreement for new senior officer and project

manager to be appointed. July 16- Quality and

timeliness improvements continue to progress.

y Designated

Doctor LAC /

Designated

Nurse LAC.

Norfolk

Safeguarding

Children Health

Advisory

Group.

Safeguard

ing

Children Quality

/

Sustai

nable

Financ

ing/

Improv

ed

experi

ence

Apr-

13

Quality

/

Financi

al

The Statutory responsibilities for the

provision of Health Assessments for

Looked after Children are not met.

5 4 20 Work streams in progress

from initial project planning

meeting led by

commissioners. CCGs

responsible for negotiating

contract with their providers,

with sufficient resource to

enable quality health care.

4 3 12 2 3 6 01/03/16 1. DSCT leading agreed proposed changes

for delivery of IHA using GP model. 2. Work also in

progress to improve administrative efficiency using

new processes following multiagency BPR work. 3.

DSCT working to replace BAAF paperwork with that

developed by Herts and Cambs. 4. DSCT working

with provider (NCH&C) to maximise number of initial

assessments in short term. 14.6.16: Although GP

model not yet in place there has been a significant

improvement in IHA completed within time frame. In

June 2106 almost 88% were completed in time

frame and 83% of all health assessments for the

1039 looked after children were up to date. The GP

model is due to come into place to ensure that

y Designated Dr

LAC/

Designated

nurse LAC

Norfolk

Safeguarding

Children Health

Advisory

Group.

21 Final

improvements maintained.

Safeguard

ing

Children

Quality

/ Make

a

differe

nce for

local

people

/

Improv

ed

experi

ence

Feb-

14

Quality Health needs of care leavers will not

be met due to lack of services.

3 5 15 CCG to commission

adequate service for this

group of young people.

3 4 12 2 3 6 01/03/16. 1. Project plan to include discussions

regarding improvements to service to care leaders.

Designated

Doctor LAC/

Designated

nurse LAC

Norfolk

Safeguarding

Children Health

Advisory Group

Safeguard

ing

Children Quality

/ Make

a

differe

nce for

local

people

/

Improv

ed

Experi

enced

Jul-

13

Quality Lack of effective Pathways and Tier

4 services resulting in inappropriate

admissions to adult / acute facilities

impacting on safe discharge/ transfer

from Tier 4 services.

3 4 12 1. NSFT to open Tier 4 unit

in Carleton Court.

2. Meeting convened to

discuss tripartite

arrangements for high risk

cases requiring secure

accommodation.

3 2 6 2 2 4 01/03/16. 1. Development of protocol for exceptional

placements in progress (PEEP). 14/03/161. The

draft transformation Plan for NSFT CAMHS

incorporating work streams alongside the local

authority and partner agencies looks to address;

early help and support for schools to manage

emotional well-being; intensive and crisis support for

young people; improved access to Eating Disorder

Assessment and Treatment; support for LAC in

partnership with the local authority within specialist

educational services. 2. From the multi-agency tri

partite meeting a working group has been formed

headed by the Designated Doctor to look at a joint

approach to the assessment and placement of young

people in crisis this includes acute Trusts, NSFT,

Police and the local authority

NHS England /

NSFT

Norfolk

Safeguarding

Children Health

Advisory

Group.

22 Final

Safeguard

ing

Children Quality

/

Sustai

nable

financi

ng/Effe

ctivene

ss

Apr-

16

Quality

/

Financi

al

Due to limited health practitioner

resource in the Multi Agency

Safeguarding Hub (MASH), there is

a risk around gaps in information

sharing to inform decision making for

safeguarding children referrals, and

no provision of health resource for

the assessment of adult

safeguarding cases.

2 5 10 1. MASH Board have made

proposals for the redesign of

MASH to an integrated

model increasing health

resource. 2. Cambridge

Community Services are

developing a rotational

model whereby safeguarding

supervisors provide

additional sessions.

2 4 8 2 2 4 18/04/16. Pilot of daily MARACS in the east of the

county.

Business Case in development to ensure appropriate

health representation within MASH.

Fast track process for high risk CPIS forms (39D)

Designated

Safeguarding

Children Nurse

Norfolk

Safeguarding

Children Health

Advisory group.

Safeguard

ing

Children

Quality

Due to lack of placements and

Health involvement in planning there

is a risk that CYP are moved to

inappropriate placements as they

transfer from children to adult

services

1. Central and West CCGs in

Norfolk have a monthly

complex case eligibility panel

- managed by CSU - that

includes the reviewing of

CYP with tripartite funding.

2. Robust system within

Suffolk. 3. Transitional Lead

in Norfolk has regular

meetings with children’s

continuing care team to

ensure all CYP with complex

needs are included and

tracked.

May 2016- Norfolk and Suffolk have a Transitional

Lead (LA) have an overview on transition into adult

services. West Norfolk has this identified as a risk on

their RR (CCG). Each child should have a lead

health professional identified. Awaiting information

as to how this is managed in Norwich, North Norfolk

and South Norfolk CCG. All CCGs have been

informed that each child is required to have an

identified Lead health professional. Commissioning

managers to ensure that redrafted reviewed joint

commissioning arrangements with NCC take into

account the need for clinical input and oversight at

key points of transition process/out of county

returning CYP/ tripartite case reviews.

Lead Nurse

SEND

coordinating on

behalf of CCGs

CCGs and

Norfolk

Safeguarding

Children Health

Advisory

Group.

23 Final

Appendix 2: Norfolk Safeguarding Children Health Advisory Group Membership/Attendance 2015-16

Name: Role Membership Organisation 05/03/15 28/05/15 28/09/15 26/11/15 10/03/16

Cath Byford

Director of Commissioning and Quality Chief Nurse/Deputy Chief Executive

Full – Chair Great Yarmouth and Waveney CCG

Y Y Y Y Y

Karen Watts (previously Sheila Glenn)

Acting Director of Quality Norwich CCG Y

N

Chris Turner

N Y Sheila Glen

(part)

Jackie Schneider Governing Body Registered Nurse North Norfolk CCG

N

Marie McDermot

t

N Y N

N

Marie McDermott

(part)

Alison Leather (previously Jo Yellon)

Head of Quality Assurance South Norfolk CCG Y

N

Karen Ward

N

N

Karen Ward

N

Maggie Carter Head of Clinical Quality and Patient Safety

West Norfolk CCG N

N

Sue Hayter

N N N

Sarah Barnes Commissioning Manager for Children and Young People

Public Health N

N

Carolyn Watts

Y Y Y

Mavis Spencer Deputy Director of Nursing NHS England - East N N N N N

Catherine Knox (previously Jane Black)

Designated Named Nurse DSCT N Y Y N Y

Anita Bagge (previously Mark Gower)

Designated Nurse for LAC DSCT Y Y Y N Y

Suzie Fiske/Jane McIntosh

Named GPs DSCT Y Y N Y Y

Bindy Price Quality Assurance Manager DSCT N Y Y Y Y

Sarah Steel Designated Doctor for Safeguarding and LAC

DSCT Not in post

Not in post

Y Y N

Abigail McGarry Board Manager NSCB Y N Y N Y

24 Final

Mandy Renton Chief Nurse CCS N/A N/A N

John Peberdy

Y

John Peberdy

N

John Peberdy & Sian

Larrington

Ali Jennings Named Nurse ECCH N N N Y N

Simon Chase Regional Safeguarding Lead EEAST N N Y N N

Julia Hunt (previously Liz Libiszewski)

Interim Director of Nursing, Quality and Patient Experience

JPUH N N N

Julia Hunt

N

Julia Hunt

N

Julia Hunt

Anna Morgan Director of Service Pathways NCH&C N N N

Richard Allen N N

Emma McKay Director of Nursing NNUH Y Y N

Kim Goodby N N

Jane Sayer Director of Nursing, Quality and Patient Safety

NSFT Y

N

Saranna Burgess

N

N

Saranna Burgess

N

Saranna Burgess

Catherine Morgan Director of Nursing QEH

N

Valerie Newton

N

N

Valerie Newton

Y Y