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5c Quality assurance sub group

Purpose of the group

The Quality Assurance sub group conducts regular thematic multi-agency case file audits.

Functions

The members of the Quality Assurance sub group are responsible for:

  • Agreeing the themes of multi-agency audits, identifying the aims of each audit and selecting cases to be audited
  • Overseeing the auditing of their own individual organisations’ case files and providing the findings to the subsequent sub group meeting
  • Identifying individual practice recommendations and multi-agency strategic recommendations from each audit
  • Identifying actions for their organisation to achieve the agreed recommendations
  • Monitoring the compliance of recommendations within their organisation to ensure that learning from case file audits influences and becomes embedded in practice
  • Dissemination of learning from the audits within their organisation to enable professionals and organisations to reflect on the quality of their services and learn from their own and others’ practice

Membership

  • Strategic Safeguarding Service Manager, Dept. for Children Adults and Health, South Gloucestershire Council
  • Head of Education, Dept. for Children Adults and Health, South Gloucestershire Council
  • Safeguarding Manager, Avon and Somerset Constabulary
  • Named General Practitioner, South Gloucestershire CCG
  • Managing Director South Gloucestershire Mental Health Services, Avon & Wiltshire Mental Health Partnership
  • Named Nurse, North Bristol NHS Trust (HV, SHN, Comm Paed, Midwifery and NICU records for NBT and CAMHS records)
  • Lay Member, South Gloucestershire Safeguarding Children Board

Frequency

The sub groups meets quarterly. The sub group is chaired by the Deputy Nurse Director / Designated Nurse Safeguarding, South Gloucestershire Clinical Commissioning Group. Membership of the group has been reviewed twice during 2014 – 2015; representatives from Education, Early Years and a SGSCB Lay Member were invited to join the group. This additional input has been recognised as a positive development and enhanced the information available for the thematic audits and subsequent recommendations.

Performance and effectiveness of work undertaken

Children open to social care for an extended time audit

In September 2014 the sub group audited four cases open to social care for an extended period of time. An audit was undertaken on four cases open to Social Care for three years or more to ascertain whether the recommendations from the SGSCB Family L multi-agency case review had been embedded in practice.

The aim of the audit was to identify:

  • Whether there was evidence of good information sharing and communication
  • Whether the men in families were considered as part of assessments
  • Whether professionals were aware when strategy meetings were held and informed of the outcome
  • Whether decisions made at strategy meetings were appropriate
  • Whether the right professionals were invited to case conferences
  • Whether professionals provided reports to the conference chair as per the South West Child Protection Procedures
  • Whether decisions made at case conferences were appropriate
  • Whether there was a clear multi-agency plan which was known to all professionals working with the family
  • If there was domestic abuse within the family whether the child protection processes related appropriately to the MARAC process
  • Whether risks were adequately assessed prior to CYPS closing the cases

Members audited their records using their organisations’ audit tools prior to the meeting and brought the findings to the meeting.  The audit made several multi-agency strategic recommendations:

  1. Professionals should give greater consideration to the ongoing impact of parental alcohol use on parenting skills
  1. Professionals should give greater consideration to the daily experience of the child, social workers should consider conducting “A day in the life of” work with the child in long term complex cases
  1. Social workers should give greater consideration to the use, wording, meaning and enforcement of written agreements
  1. Consideration to be given to how mental health professionals can most effectively support other professionals when working with parents in long term complex cases
  1. Housing to consider how complex families can be supported, outside of the normal processes, to obtain permanent housing
  1. Social Workers to ensure all risks have been fully assessed before closing cases
  1. Professionals to consider the benefits of holding professional only meetings when managing very complex long term cases

Child in Need Plans audit

In December 2014 the group audited four families in which a child/children were subject to Child in Need  plans to ascertain whether the recommendations from the SGSCB Child C Serious Case Review had been implemented in practice. The aims of the audit were to identify:

  • Whether there was evidence that regular and timely CiN reviews had taken place
  • Whether there was evidence that the right people were invited to and attended the CiN reviews
  • Whether there was evidence of good information sharing and communication
  • Whether the men in families were considered as part of assessments
  • Whether there was evidence of parents/carers and the child/young person being included in the CiN review
  • Whether the plan made at the CiN review was appropriate and known to all professionals working with the family
  • Whether the previous CiN plan was reviewed at the meeting and progress or lack of progress was tracked
  • Whether the CiN process was making a difference to the outcomes for the child and family

Members audited their records using their organisations’ audit tools prior to the meeting and brought the findings to the meeting.  The audit made several multi-agency strategic recommendations:

  1. Work should take place to ensure a contingency plan is consistently formed to accompany each plan
  2. Ethnicity needs to be considered by all agencies and documented within each assessment and analysis and the implications considered when formulating a plan
  3. GPs, health visitors and school nurses should be informed of Child in Need Plans with parent’s consent
  4. Analysis by professionals during assessment and within supervision needs to consider and guard against over optimism and ‘start again syndrome’

Child Sexual Exploitation (CSE) audit

The Jay report of the Children’s Commissioner details the failings in Rotherham to identify child sexual exploitation and the recently published Ofsted thematic report highlighted the need for a clear multi-agency strategy which includes how children at risk of CSE are identified, managed and supported at an operational level. In February 2015 the group audited four children who had been recognised as at risk of sexual exploitation to ascertain whether cases that had been referred to the Child Sexual Exploitation Multi Agency Risk Assessment Committee (CSE MARAC) had received subsequent appropriate support and management.

The aim of the audit was to identify:

  • Whether formal child protection procedures have been followed for children at risk of CSE
  • Whether there are robust plans of how the social care and its partners are going to support individual children/young people at risk or who have been sexually exploited. What is the quality of the Child in Need/Child Protection/Looked After Children plan? Is it known to all professionals working with the family?
  • Whether there is evidence of good information sharing and communication. Is there information on agency’s records that hasn’t been shared?
  • Whether the plans are kept under robust review. Are professionals kept informed of reviews? Are their contributions incorporated into the plan?
  • Whether there is evidence of parents/carers and the child/young person being included in the plan and review
  • Whether there is evidence of a contingency plan if the initial plan is not successful
  • Whether there is clear management oversight of the case to ensure it is being properly progressed and monitored in line with the plan
  • Have all professionals been involved at all stages of the process and been informed of outcomes?

Members audited their records using their organisations’ audit tools prior to the meeting and brought the findings to the meeting.  The audit made several multi-agency strategic recommendations:

  • Assessments of children referred with CSE concerns should be thorough and clearly evidence the risks to the child and the child voice should be clearly documented
  • Resolution of professional differences should be used when workers and their managers disagree with a decision by social care to take no further action
  • Core groups should be held regularly and the minutes circulated to all those involved including schools and GPs
  • An identified sexual exploitation screening tool should be used across organisations to identify and measure the risk of CSE early so that a range of appropriate services can be offered at an early stage
  • All organisations should review the training needs of their workforce in relation to CSE. Both single organisational and multi-agency training should include examining attitudes as well as knowledge and young people should be involved in its development
  • The CSE MARAC should develop a framework for monitoring and recording actions and progress towards outcomes for the children discussed
  • Organisations need to coordinate their work with children at risk of CSE so that where possible one trusted relationship is established and continued
  • In all cases when risks of CSE are identified appropriate referrals should be made which enable the child to access sexual health support and services

Areas for improvement and future development

There have been some difficulties and delays in including school records in the thematic audits. This has now been resolved and schools have been represented at the meetings.

There has been slower than expected progress in implementing recommendations from some of the audits, however the group is robust at holding organisations to account and all recommendations from audits during 2014 – 2015 have been completed or are in progress and on target for completion.

Future plans

The group plans to undertake audits on the following themes during 2015 – 2016: child protection review case conferences, children subject to a child protection plan for neglect.

Lisa Harvey, Designated Nurse for Safeguarding, Chair of the sub group