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7 Outcome of external inspections

Avon and Somerset Constabulary

Her Majesty’s Inspectorate of Constabulary (HMIC) inspections from this year (Apr 2014 through to Mar 2015) that involved children were:

  • Child Protection Inspection during March 2015
  • Vulnerability in Case Files at the end of March 2015

A comprehensive data and documentation submission was also made to HMIC in early March as part of the Honour Based Violence, Female Genital Mutilation, Forced Marriage Inspection; we are waiting to hear if we will be one of the forces visited during the summer 2015.  HMIC is also planning an inspection around Missing and Absent Children later in 2015, which is likely to include CSE and Domestic Abuse.

The Vulnerability in Case Files (ViCF) is an ongoing inspection on which HMIC will be reporting later in 2015, so there is nothing to feedback at this stage.  An inspection of the identification of vulnerability in police prosecution case files (ViCF) was included in the Criminal Justice Joint Inspection Business Plan 2014-16. It is the latest in a series of joint inspections, the last two of which have focused on case file quality.

Child Protection is also an ongoing inspection programme – we are waiting to receive the inspection findings from HMIC in respect of their visit during March 2015 (these findings will not be published as we were the pilot force).  Follow up activity by HMIC is part of the National Child Protection Inspection programme (NCPI). It allows inspectors to assess the progress each force is making in its work to improve services for the safety and protection of children.

Details of these inspection programmes are on HMIC web site. Once the reports are published they will also be available on the website – apart from Child Protection for Avon and Somerset Constabulary as we were a pilot force (other force reports are published on the website).

Vinney Green Secure Unit

A full inspection of Vinney Green Secure Unit was undertaken by Ofsted in September 2014. The focus was on the progress the unit had made in implementing the requirements and recommendations from the previous inspection and demonstrating continuous improvement. The unit also had a licence inspection in March 2015 which included the Education provision. The outcomes were:

  • Education: Good
  • Outcomes: Outstanding
  • Quality of care: Outstanding
  • Safeguarding: Good
  • Management and Leadership: Good
  • Overall Grading: Good

There was just one statutory requirement: “Ensure that all parts of the Children’s Home used by children are of sound construction and kept in good structural repair externally and internally”.  This referred to an external gate, outside of the secure area, that was not closing efficiently. The gate has since been mended and a warning light attached to highlight if it has not closed properly in the future. There are also three recommendations that are being considered and worked on in Vinney Green Secure Unit development meetings.

CQC REPORT UHBRISTOL 

There was one area of improvement that the CQC identified from their review, this was the Trust compliance with safeguarding training with regard to adults and children. The Safeguarding Steering Group is aware of the current challenges in meeting the compliance standards for all safeguarding training. This is on the risk register with a clear action plan to improve compliance, monitored by the Safeguarding Steering Group.

The CQC review of UHBristol identified many areas of good practice relating to safeguarding.

They found that:

  • the children’s hospital had outstanding safeguarding procedures in place. The safeguarding team had links in every department where children were seen. The Trust considered child safeguarding issues in relation to adult patients in the Bristol Royal Infirmary: for example, A&E consultants checked all overnight admissions for safeguarding concerns
  • Weekly multi disciplinary meetings were held and there were clear links to the Trust’s safeguarding board
  • arrangements for safeguarding were excellent and staff told them about the open culture that encouraged them to report issues as they arose
  • staff were aware of their responsibilities to protect vulnerable adults and children. They understood safeguarding procedures and how to report concerns
  • In the BRI, staff had received training in how to identify people at risk of domestic or sexual abuse and specialist advisers were available to support identified patients
  • There were posters displayed in the BRI reminding staff to discuss child welfare with patients attending the department who may have childcare responsibilities
  • In the BRHC, consultants reviewed all patients’ records, including the records of all attendees during the night, to check for any safeguarding concerns
  • Staff they spoke with were aware of the safeguarding processes within the organisation and were knowledgeable about the Trust’s safeguarding process and aspects of the associated Mental Capacity Act 2005
  • There were systems in place to identify people in vulnerable circumstances from the local community and the wider community served by the maternity services
  • There were clear pathways for the escalation of concerns to senior staff and the chief nurse if required
  • Noticeboards throughout the hospital displayed information about safeguarding and how to raise safeguarding concerns
  • A safeguarding policy was in place across the Trust. The staff they spoke with all knew how to access the policy and were able to explain the different types of abuse and how they would refer a child should they have any safeguarding concerns
  • Staff recognised that being involved in a safeguarding referral could be distressing to both the child and their parents. An information leaflet was available for parents involved in any safeguarding concerns. The leaflet described what happens when a referral is made and from whom the parents can seek further help and advice
  • A safeguarding checklist was completed for each child on admission. The notes that they looked at had completed checklists in place. For young people, additional adolescent checklists were in place and had been completed appropriately
  • The electronic patient administration system had the facility for alerts to be displayed for any child where safeguarding concerns were already known. This made staff aware of additional things that might need to be put in place or considered for that individual child, for instance family visiting arrangements
  • Where children or young people failed to attend two clinic appointments, a referral would be made to the safeguarding team and contact would be made with the child’s GP and health visitor or school nurse to ascertain whether there were any concerns
  • The arrangements for young people to transition from children’s to adult services, for example within oncology, were very good. The trust had a transition group that involved young people. This group highlighted and promoted good practice in order to replicate it in all areas.
  • Nursing staff and Allied health professionals (AHPs) were aware of what to do if they had a safeguarding concern

NORTH BRISTOL NHS TRUST

North Bristol NHS Trust (NBT) was inspected by the Care Quality Commission (CQC) from 4 – 7 November and 17 November 2014 as part of the CQC’s in-depth inspection programme.

The inspection team inspected the following eight core services at the Southmead site: Accident and Emergency, Medical Care (including older people’s care), Surgery, Critical Care, Maternity Services, Children’s Care, End of life care, Outpatients. At Cossham Hospital Maternity Services and Outpatients were inspected. At Frenchay Outpatients was inspected. At Riverside the child and adolescent mental health wards were inspected. The CQC also inspected the Children’s Community Service and Community Mental Health Services (CAMHS) for children and young people.

Summary of issues relating to Safeguarding:  this summary is taken from the CQC Inspection Reports for each of the above services, http://www.cqc.org.uk/provider/RVJ.

There were policies in place for safeguarding both children and vulnerable adults. The director of nursing was the Trust’s safeguarding lead.

Safeguarding procedures were in place with clear lines of reporting. Staff were aware of these procedures and their own responsibilities for the safeguarding of children and young people. All staff throughout the hospital were able to describe what constituted a safeguarding concern and were aware of their role and responsibilities to safeguard vulnerable adults and children from abuse.

The Trust required at least 85% of staff to be up to date with training at all times. This made an allowance for staff on long term leave. Overall the trust was exceeding this target. All the staff we spoke with told us they had completed safeguarding training, which was part of the required mandatory training for the Trust.

NICU: the NICU had robust safeguarding processes in place and a clear process of referral for staff when concerns were identified.

Emergency Department: there was a designated child protection nurse in the ED. The ED had evaluated child safeguarding referral rates, which demonstrated they required improvement. This resulted in staff undertaking research and training to improve staff competence in referral processes. There had subsequently been a significant increase in the number of vulnerable children being identified and referred to the local authority safeguarding team. The project had been externally peer reviewed by the Royal College of Paediatrics and Child Health. There was a team that provided support to people who had been victims of domestic violence or sexual abuse. A nurse in the ED had championed this area of work and had provided staff training to raise awareness of the issues. Clinical staff were alerted to frequently attending children because this information was printed on patients’ booking-in sheets.

Women and Children’s: the Trust employs a teenage pregnancy specialist midwife, a drug and alcohol specialist and safeguarding midwives. They undertook daily ward rounds, identifying women with concerns and providing advice and support to midwives.  Midwives attended case conferences and a Multi-Agency Risk Assessment Conference (MARAC) as part of a coordinated community response to domestic abuse and safeguarding concerns. All cases of female genital mutilation had safeguarding referrals to the local authority made during pregnancy. There were trust-wide guidelines for the care of women with female genital mutilation, mental health problems, teenagers, substance misuse and alcohol dependency, complex social factors, and prisoners from HMP Eastwood Park (which was located near to the unit).

Children’s Community Health Services:  the culture of the CCHP was totally child, young person and family centred. Through strong participation, it had the voice of children and young people at the heart of what staff did. Staff told us how proud they were to be able to listen to the voice of children and young people. The ethos of family-centred care was visible across all the teams within the Community Children’s Health Partnership (CCHP). Children and young people were full partners in their own care, and the collaboration with Barnardo’s meant innovative ways were explored to increase participation and improve care. Excellent multidisciplinary and multi-agency working through programmes such as the Be Safe Programme  and the Barnardo’s Child Sexual Exploitation (BASE) project.

The inspection team highlighted the following in relation to safeguarding children in CCHP:

  • A named nurse and doctor were available for Bristol and for South Gloucestershire. Robust safeguarding systems were in place for children and young people
  • When children were seen in the ED at Southmead Hospital, the health visitors or school nurses were informed. Health visitors and school nurses were then responsible for forwarding this information to the child’s GP and to other professionals such as social workers when necessary. We saw evidence that this took place. This process is audited annually. Excellent links were established with the ED department. The Named Nurses delivered bespoke safeguarding children training to the department
  • A safeguarding children audit plan, led by the Safeguarding Children operational group was in place. The audit programme was agreed and shared with the commissioners. This programme was comprehensive and ranged from multi-agency communication in safeguarding through to the quality of transfer arrangements from midwives to health visitors. Reports from the audits were completed, together with action plans which were reported back to the commissioners
  • In safeguarding assessments the views of the child were clearly assessed and recorded
  • Child protection supervision was found to be comprehensive across all professional groups. This supervision ranged from one-to-one supervision (four monthly) to group supervision. For the medical staff, supervision also included locality peer review and reflective practice
  • The safeguarding leads confirmed that all staff are required to have had safeguarding training at level three. Training records showed that 93% of staff had completed the training
  • There was a community paediatrician on call 24 hours a day for any safeguarding issues such as medicals, so that they happened in a timely way. They explained that the safeguarding team worked closely with Bristol Children’s Hospital and had access to their dedicated suite of rooms for safeguarding medicals
  • Child death rapid response reviews took place for all children and young people under 18 years who had unexplained deaths. Where learning was identified, it was cascaded to staff through operational and governance meetings
  • The CCHP had clear lines of reporting through the safeguarding leads through to the safeguarding group for children and ultimately to the Trust-wide safeguarding committee chaired by the director of nursing