north of scotland planning group managed clincial network for child sexual abuse welcome to the...

North of ScotlandPlanning Group

MANAGED CLINCIAL NETWORK FOR

CHILD SEXUAL ABUSE

Welcome to the SPRING EVENT

23 March 2011

South East & Tayside Planning Group


INTRODUCTION

SPRING EVENT

23 March 2011Dr Ross Cameron, MCN Chair



Aims of the day (1):

To provide an update on progress so far To learn from the ‘Manchester’ experience To use the collected expertise in the room to

explore some of the most challenging issues

Box for your questions for plenary discussion (on registration table at coffee and lunch time)


Aims of the day (2)

Plenary discussion at the end of the day: Very pleased Dr McKay, National Clinical Lead

for Children and Young People’s Health, and Dr Herbison, WoS MCN Clinical Lead, will join Dr White and Dr Hammond

Highlighted feedback from each workshop /Questions from ‘box’ & floor

All input will be collated and fed back


Programme10.00 Aims of the Day Dr Ross Cameron, Chair of the MCN

10.10 Introduction of the MCN and Dr Helen Hammond, MCN Lead Clinician,the Story so Far Anne-Marie Pitt, Regional Manager of the MCN

10.30 “The Manchester Experience” Dr Catherine White, Clinical Director, SARC, St Mary’s

11.15 Questions & Answers

11.30 Coffee Break

11.45 Introduction to Workshops Ian Peterson, OD Facilitator

12.45 Lunch

1.30-3.30 Workshops

3.45 Plenary Session Panel Members

4.30 Close


Practicalities

Toilets are off the main hall Fire evacuation procedures


Managed Clinical Network for Child Sexual Abuse

the story so far…

Dr Helen Hammond

Anne - Marie Pitt



Background to the establishment of SEAT MCN for Child Sexual Abuse

Winter event December 2007! looking for a solution to mounting concerns

re sustainability and quality….


Paediatric forensic examination ‘solution’

fulfil requirements of immediate clinical care and evidence gathering- skills and facilities

must fit well into context of multi-agency process- investigation and protection

must be child centred and provide appropriate follow through care

fulfil requirements of any subsequent legal processes- reports court skills


Current situation 2007

what are the strengths and difficulties with the current services?

what does the paediatrician bring to the process?

why did we think a clinical network was the solution?

key issues in moving forward?


Paediatric forensic service:weaknesses/threats

small specialist workforce (ageing!) unpredictable workload- clinical, court difficulties with recruiting/retaining paediatricians combining acute and child protection

responsibilities/job plans sustainability of 24/7 ? best value


Out of hours examination??

already working to clear and agreed criteria:clinical need (bleeding, in pain, injured)forensic need (evidence from locus or child)need to comply with police procedures (suspect in custody…)child care need extreme anxiety/distress (child or family)

subject to ongoing audit…. very tiny numbers overnight particularly <13yrs


Why is a network the answer?

offer wider access to limited highly specialist resources ensure consistency/equity from referral ongoing care ensure high quality child friendly facilities offer a range of options and settings:

clinics in paediatric settings

clinical facilities in co-located units

Multi-disciplinary/agency ‘one stop shop’

(e.g. SARC Sexual Assault Referral Centre)


Wider role of network

setting and implementing standards RCPCH/AFP (now FFLM)

training: clinical, multi-agency, court skills peer review essential (local, national -

paediatric, forensic- clinical cases, topics) service development/innovation eg use of

telemedicine, single examiner if both sets of skills

audit and research


Key issues in moving forward

agreeing appropriate balance local/ networked

travelling…children, doctors, social workers, police

standardised equipment contracting/indemnity acceptability to other agencies


Background to the establishment of SEATMCN for CSA

application for funding to SEAT regional panning group

child sexual abuse- seen as greatest priority

successful in securing funding from NDP for first 2 years of 3 year plan

Clinical lead appointed April 2009…


MCN structure

SEAT Steering Group

MCN Steering Group

SEATChildren & Young People’s

Health Planning Group

Clinical Sub GroupEducation & Training

Sub Group

Objectives: Clinical protocols, pathways &

referrals Identification of performance

standards and measurement of performance

Agree clinical skills and competencies

Workforce Development including Paediatric Forensic Nurse Role

Objectives: Baseline training and support

available Training needs analysis Development, education and

training programme

Members: Chair/Co-Chair, Lead Clinician Specialist Paediatricians (all

Health Boards) FME – Fife Senior Managers (all Health

Boards) Police Crown Office Social Work Regional Planning


10 objectives agreed – in pack

Objective 2 - Service Development & Improvement: establish and implement a clinically safe and sustainable model of service delivery supported by agreed clinical standards across the south and east of Scotland.

MCN FOR CSA OBJECTIVES


Obj.2: Potential CSA Service models

From status quo to the SARC model centralised non networked tertiary (paediatric)

service to totally networked service with an out of hours

regional service 9 in all reduced to 5 for formal option appraisal Potential use of telemedicine

North of ScotlandPlanning GroupObjective 6 - Education and Training:

agree a model for training, support, supervision and peer review for clinicians.

Objective 7 – Clinical Protocols: agree common protocols, pathways, proformas across the region


PROGRESS SO FARPROGRESS SO FAR

MCN Steering Group, work plan, Clinical Sub-Group, annual report and MCN Quality Assurance framework have been developed.

A baseline assessment has been carried out across the region A baseline assessment has been carried out across the region to capture the current services provided, staffing levels and to capture the current services provided, staffing levels and equipment in place equipment in place


Baseline Assessment FindingsBaseline Assessment Findings

Facilities Equipment

upgrades

Borders Borders General Hospital

- non specialist area

£39.66k

Lothian Vega Building

- adult facility/acute assault

Royal Hospital for Sick Children

- non specialist area and cramped

St Johns’ Hospital - non specialist area £14.85k Fife Greenfield Clinic - small waiting area £10.81k

Total = £65.32k


Baseline Assessment FindingsBaseline Assessment Findings

In-hours Consultants Associate Spec Staff Grade

Borders 2 0 0

Lothian 8 (7.6 WTE) 3 (2.6 WTE) 0

Fife 1 2 1

Total 17 (16.2 WTE)

Out-of-hours Consultants Associate Spec Staff Grade

Borders 2 0 0

Lothian 8 (7.6 WTE) 0 0

Fife 0 0 0

Total 10 (9.6 WTE)

Specialist Paediatricians trained in CSA


PROGRESS continuedPROGRESS continued

A gap analysis on clinical equipment across the region and a successful business case to obtain regional funds to update colposcope and photo-documentation equipment in all examination sites.A gap analysis on clinical equipment across the region and a successful business case to obtain regional funds to update colposcope and photo-documentation equipment in all examination sites.

Links made with national telemedicine colleagues and pilots have begun to investigate the effectiveness of telemedicine to increase accessibility of specialist services in rural areas and increase specialist skills through sharing education and training.

The development of an MCN wide portfolio of protocols , pathways of care and signposting to national standards The development of an MCN wide portfolio of protocols , pathways of care and signposting to national standards

Development of an MCN website www.mcncsa.scot.nhs.uk Development of an MCN website www.mcncsa.scot.nhs.uk RR

egistregistration ation docudocuments ments in the in the pack pack to be to be complcompleted eted and and left at left at the the registrregistration ation tabletable


PROGRESS continuedPROGRESS continued

Feedback mechanisms from children, young people and their parents about the medical examination process are being explored i.e. questionnaire

A training needs analysis has been carried out beginning with an electronic education, training and clinical experience survey completed by doctors carrying out csa examinations

Data on activity across the region has begun to be collected on CSA examinations in a standard and comprehensive manner.


Child sexual abuse examinations

2010 Quarterly Regional Examinations

127

4 6

31

19

3929

4

8

5

3

0

10

20

30

40

50

60

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Quarters

Nu

mb

ers

pe

r R

eg

ion

Borders

Lothian

Fife


Types of examinations

Type of Examinations Across RegionsJan - Dec 2010

3 4 0 4 9

54

18

0

2125

9

20

0

00

0

10

20

30

40

50

60

70

Number ofAcute JPFs

Number ofPlanned JPFs

Number seenby FME only

Number SPEfor CSAReferral

Number seenbefore IRD

Examination Type

Nu

mb

er Fife

Lothian

Borders


Times of examination

Times of ExaminationsJan - Dec 2010

26

91

18

23

27

0

20

40

60

80

100

120

140

Fife Lothian Borders

Region

Nu

mb

er Out of Hours

Daytime


Key priorities

Complete options appraisal Implement an education and

training programme Progress information gathering

from children and families Collate information from today’s

event Agree an implementation plan


Changing context

Dr Mike Winter’s paper re future shape of paediatric forensic services nationally

ACPOS response Scottish Govt- Short life working group New Sexual Offences Legislation (came

into force 1st December 2010)


Changing context

Revision of national child protection guidance

Intercollegiate competencies, training, modular credentialing

Revision of RCPCH CSA guidance Postgraduate qualifications DFCASA, MFFLM

North of ScotlandPlanning Group“the Manchester Experience”

Key note speaker:

Dr Catherine White


MANAGED CLINCIAL NETWORK FOR CHILD SEXUAL ABUSE

Questions and Answers



Introduction to Workshops

– Ian Peterson



Workshops sessions



Plenary Session

north of scotland planning group managed clincial network for child sexual abuse welcome to the...

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