IPE Powerpoint 12A (foot notes)

Slide 2

A literature review was undertaken of recognised evidence in child protection, the

requirements for child safety and the recognition of care delivery optimised for the
vulnerable/at risk child. These appear to only expand as far as the child protection register
and government polices guiding practice.
We have identified within our individual professions the practices currently in place, and
through this knowledge have highlighted the lack of a stable pathway connecting us all. The
information was consolidated and demonstrated an optimised service that could be
implemented and accessed by a multi professional team.
Profession examples
'jointly developed children/young people networks provide a seamless high quality service'
(NHS Institute for innovation and improvement 2008)
'integrated information provides provision across a whole system facilitates patient care and
flow' (NHS Institute for innovation and improvement 2008)
'a central information point helps staff identify what they need, what needs recording and
allows analysis of data for all inputs' (NHS Institute for innovation and improvement 2008)
'an integrated safeguarding team that works across primary and secondary care and in all
departments where children and young people are treated ensuring a safe, effective and
timely response to any concerns about safeguarding'
(NHS Institute for innovation and improvement 2008)

Slide 4

-The principles of Clinical governance were established by members of the NHS clinical
governance support team in 1999
-The seven pillars are; (poster)
clinical effectiveness, risk management effectiveness, clinical audit, staff and staff
management, education and training, clinical information & patient and public involvement.
-The five foundation stones;
systems awareness, teamwork, communication, ownership and leadership
If any of the pillars or foundation stones crumble and are ineffective, the rest of the structure
also crumbles, and the effectiveness of the components which make up clinical governance.
-clinical governance 'requires changes in culture, team working, ways of thinking and
behaviour'.
-aims to integrate all activities
-involves improving quality of information, promoting collaboration team working and
partnerships, reducing variation in practice, and implementing evidence based practice.

Slide 6

NSPCC research (2009) shows that a significant minority of children suffer serious abuse or
neglect. Our 2000 study of the childhood experiences of 2,869 18-24 year olds found that:
• 6% experienced frequent and severe emotional maltreatment during childhood.
• 6% experienced serious absence of care at home during childhood.
• 31% experienced bullying by their peers during childhood, a further 7% were
discriminated against and 14% were made to feel different or 'like an outsider'. 43%
experienced at least one of these things during childhood.
• 72% of sexually abused children did not tell anyone about the abuse at the time. 27%
told someone later. Around 31% still had not told anyone about their experience(s) by
early adulthood.
 • 25% of children experienced one or more forms of physical violence during
childhood. This includes being hit with an implement, being hit with a fist or kicked,
shaken, thrown or knocked down, beaten up, choked, burned or scalded on purpose,
or threatened with a knife or gun. Of this 25% experienced 'some degree of physical
abuse' by parents or carers.
• Almost two thirds of children killed at the hands of another person in England and
Wales are aged under five.
Other Sources Show:
• UK child abuse deaths could be double official figures
• Number of children killed in the UK through abuse or neglect is more than twice as
high as official records suggest, according to the United Nations Children's Fund
(Unicef, 2003).
• Two children under the age of 15 die from maltreatment in the UK each week
• Death rate, increased from 0.4 deaths per 100,000 children to 0.9 deaths per
100,000 children.
• Up to 80% of child abusers are the biological parents, with the risk of death from
maltreatment approximately three times greater for the under-ones than for those
aged one to four, who in turn face double the risk of those aged five to 14.

Slide 7

--There are a great number of examples of recent evidence that highlight a need for a
service such as ours, recent coverage of vulnerable and abused children has spurred a need
for increased care of young people. It also has to be taken into consideration the relevant
government polices, professional body requirements and trust requirements for the
protection of children, founded by various guidelines, protocols and procedures. The
following highlights very briefly some of these.
--Social services- on report of abuse/allegation of abuse social services have 24hrs to
decide what to do next. Decide to either -
• Conduct an 'initial assessment' of child’s needs; decide if there is need to look at the
allegation in more detail
• Make a referral to another agency
• Provide advice/information to family
• Take no further action
--Baby P and Victoria Climbie – care quality commission (2009) 'keeping children safe;
checking how the NHS keeps children safe' report on how children in the NHS are kept safe
from abuse/neglect. A review of the original document 'safeguarding children'. Encouraged
by the Baby P case, aimed at all NHS trusts. 6 levels of training of how to keep children safe.
Enquiry- Highlighted lack of money, staff not trained beyond levels 1/2, lack of
encouragement for staff to speak of concerns. Highlighted the need to have a central system
that can be regularly checked and assessed by the relevant people i.e. the local
safeguarding children board.

Slide 9

Mock service
Our service aims to “Put the child at the heart of the service”.
Our service aims to provide a system for children to reduce child abuse. It’s based on the
service already in place called system one.
It includes all area of the multidisciplinary team who have a separate page, but all will be
included on one document.
The document can be accessed between counties as it has been shown that parents of
abused children take them to hospitals in different counties. This is due to hospitals not
communicating across county boundaries therefore there is no information already stored
regarding the individual child. (Flanagan et al, 2002).
Specific areas will be highlighted e.g. RED for allergies, BLUE for fear of at risk of abuse
etc. Anything of relevance or importance is flagged up.
Also the areas of the MDT flash to show who has seen the patient and who hasn’t and
whether they have to be referred to another specific area.
Each member of the MDT has to complete mandatory fields before being allowed to close
the document. The mandatory fields must be filled in before the patient can be passed on to
the next profession.
If certain boxes/areas have been ticked, the patient will automatically be referred to social
services and CSF (Child School and Family).
Process mapping was used to work out what needed to be included in our service and how
the service would be run.

Slide 10

-Radiography;
-Paediatric Nurse;
-Physiotherapy;
-Paramedic;
5 year old male
Trapped lower leg in bike frame, but no details given as to how etc
bruising/grazes, pain on weight bearing
X3 previous A&E admissions that week
Old injuries – grazes, scabs, bruising over body, black eye
Filled in form for him and brother, faxed within one hour
On further information received ?any follow up

Slide 11

-Optimum configuration and location of services should be determined locally, based on the
needs of the population, after consultation with service users
-Ensure high quality and safety, the optimum use of skills in the workforce, seamless care,
efficiency and value for money
-Expectation that the service/system will be widely adopted across the NHS – high quality
care is received by all young people irrespective of where they receive care
-Implementation of this proposed service will have and effort on other processes throughout
the NHS = further imbedding the need to protect those that are vulnerable = improving their
NHS experience overall
-Potential to result in a significant increase in the number of vulnerable children recognised
and reduce the potential/stop the current harm/abuse occurring, by flagging up
problems/history of problems and also greatly improving inter-professional communication,
improving work environments

Slide 12 (SEE ALICES NOTES)

Clinical Governance – about ability to produce effective change so that high quality care is
achieved.

Consists of seven pillars that need to be adhered to, to different extents, depending on the
circumstances. They individually highlight issues that need to be addressed, and particularly
adapted when applied to our service.
Clinical Effectiveness
main issue to address is that 'patients need to achieve health care benefits that meet their
individual needs, through health care decisions and a service based on what assessed
research evidence has shown provides effective clinical outcomes'
Applied to our service;
-promote evidence based practice
-provide staff training in research and critical appraisal skills to give maximal benefit to
application of our system
-ensure all staff members have access to the service/system at all times, or address issues
with limitations

Risk Management
main issue to address is that 'patient safety is enhanced by the use of health care
processes, working practices and systematic activities that prevent or reduce the risk of
harm to patients'
Applied to our service;
-make sure staff are working towards objectives of trusts risk management strategy
-increase understanding about how clinical risk can be managed in regards to best practice
using the service and their contribution

Clinical Audit
main issue to address is 'regular clinical audit and reviews of clinical services, the need to
prioritise, conduct, report and act on clinical audits and the need to review effectiveness of
clinical services through evaluation, audit or research'
Applied to our service;
-work to the objectives of the trusts clinical audit strategy
-ensure programme is in place with the new service which meets the audit requirements of
national initiatives (NICE/NSF's)
-ensure that regular audits of the service are effective and meaningful, and result in changes
of clinical practice and quality of patient care
-communication of audit activity, results and subsequent action plans to ensure effectiveness

Clinical Information
main issues to address is 'the use of effective and integrated IT and information systems
which support and enhance the quality and safety of patient care, choice and service
planning'
Applied to our service; particularly relevant as ours is an IT based service, difficulty is
ensuring it meets specifics of clinical governance needs
-work towards objectives of the trusts information strategies
-provide access to information to evaluate own performance – statistics to increased number
of children helped?
-ensure daily access to the clinical systems to support them in everyday practice
-ensure high levels of record keeping, a high standard of implementation input onto system
-promote the sharing on information inter-professionally paying attention to confidentiality
-work on continually developing the electronic service using IT advances to enhance patient
safety /well being

Education, Training and Development

main issue to address is 'organisations working together to meet the changing health needs
of their populations, appropriately constituted workforce with appropriate skill mix, ensuring
continuous improvement of service through better ways of working'
Applied to our service;
-work towards objectives in the trusts training and development strategy
-training and support to help staff work effectively within the system, and integrated within
the diverse setting to which its applied
-develop staff training and development prioritised towards child safety/the vulnerable child
-initial and update training to maximise effective use of the service by all professional groups

Staff and Staff Management

main issues to address are 'enhancing patient care by adopting best practice in human
resource management and continuously improve staff satisfaction'
Applied to our service;
-support staff in achieving a healthy work life balance to ensure maximum output during work
hours
-ensure that diversity of the workforce reflects that of the communities using the service (inc
careful use of translations, and awareness of cultural practices etc)

Service user, carer and public involvement

main issues to address are 'providing healthcare in partnership with patients, their carers,
and relatives, respecting their diverse needs, preferences and choices and in partnership
with other organisations and patients receiving services as promptly as possible'
Applied to our service;
-work towards objectives of trusts strategies
-provide clear and up to date information to users and carers about the trust and other
services, including progress of new services
-enhance/promote mutually respectful and meaningful interaction between service
users/carers/staff to maximise involvement

Slide 13

Limitations
Too big to be stored on computers as it would take up a lot of memory
The computer may highlight that a child is at risk, however they may not be. Does not take
clinical judgments into consideration
The system may be expensive to set up and maintain
The computer availability for health professionals
Parents may change details of the child and health care professionals would be powerless to
do anything.

Slide 14

-If our service was implemented there would have to be procedures in place to allow
evaluation of its effectiveness:
-Publication of a document explaining to users how the system works, with a test/quiz to
demonstrate understanding
-Demo of the system for staff to work with and feedback their opinions
-Training of all staff, and update training, with randomised monitoring to ensure proper use of
application
child/young person/family/multi professional staff groups: involved in all aspects of planning
and delivering service, as well and providing feedback.
-ICE 9 model allows analysis of technology, considering different aspects to highlight how
well it is working
-'the key characteristics for delivering optimal care in the NHS have been tested with the
organisations and others to ensure that change in practice is understood, is relevant and
appropriate, and that measuring the improvement is possible within a short time frame'

Slide 16

-The individual - children/young people have unique healthcare needs in comparison to

adults, they should be cared for in environments specifically tailored to their needs, their
rights and our duties as professionals to them should be paramount. Our service is
specifically adapted to their needs, and aims to achieve a high standard of care, and
protection towards every patient, specifically those that are or are potentially at risk of harm.
-'information sharing is a vital element in improving outcomes for all, it is essential to enable
early intervention and preventative work, for safeguarding and promoting welfare and for
wider public protection'
-importance – increasing emphasis on integrated working across services with the aim of
delivering more effective intervention at earlier stages'
-A voice- children need a voice when they are unable to say what is happening to them or
how they feel, this service/system by noting all aspects of a child including the subtle signs
may become their voice. It covers every aspect from home to every degree of hospital
treatment. It may take a change in environment for things to be noticed, and someone has to
note these things down, with this system this can be done and gives the enhanced
opportunity to protect children.
-A system – 'safeguarding children in everybody's business, any emergency/urgent care
pathway should have a system for safeguarding children embedded within it'.