Working Together To Safeguard Children NHS Waltham Forest Clinical Commissioning Group Governing Body Training 14.01.2015

Key Roles and Responsibilities of NHS Waltham Forest CCG Governing Body (Section 11 of the Children Act 2004, NHS Accountability Framework 2013). Responsibility To ensure that there is a clear line of accountability for the commissioning and/or provision of services designed to safeguard and promote the welfare of children.

Accountability and Child Protection Chief Executives are responsible for ensuring the Health contribution to Child Protection is discharged effectively. Safeguarding is located in the Quality and Governance Nurse Directorate.

The Legislative Foundation Children Act 2004 In response to Victoria Climbie Public Inquiry Arrangements to ‘Safeguard and Protect Welfare’ – by ALL agencies Duty to protect LSCBs instead of ACPC (statutory membership held to account). Human Rights Act 1998 Article 2 and 3 - Right to life, Right not to be tortured or suffer degrading treatment Article 8 – Right to private and family life Domestic Violence Legislation Sits slightly Outside of Adult Protection as in ‘No Secrets’ Impacts on children – risk to children must be considered DVHR are statutory (Safeguarding SCR - DVHR) Sexual Offences Act 2003 Age of consent 16 for SI (hetero and homosexual relationships) Children of 12 (under 13) cannot consent to SI = statutory rape

TWO KEY DOCUMENTS PUBLISHED MARCH 2013 Safeguarding Vulnerable People in the Reformed NHS Working Together to Safeguard Children

Why does this matter? IMPACT Messages from Research 2 children per week are killed by deliberate harm in England Neglect is common and a threat to health and wellbeing Abuse in childhood is associated with poorer physical and or mental health, elevated delinquent behaviour and risk taking Severely maltreated children 11 – 17 are 6.4 times more likely to have suicide ideation and 4.6 times more likely to self-harm that non abused peers (18–24 years 3.9 times more likely) Poor parenting capacity (what is learned - attachment and empathetic development) can creates an inter-generational abuse cycle Safeguarding profile changes over time. Children are the future! IMPACT ON SOCIETY / SERVICES / ECONOMY IS ENORMOUS IMPACT ON NHS SERVICES AND FUNDING?

What does good look like?

What does good look like?

& How do you know its good? General Evidence Meetings / meeting schedules - attendance Formal reports / Annual Reports Audits /CQC Inspections/ Sec11 Work-plans, Action plans, Dashboards, Risk registers and data etc Cultural Evidence 360 degree staff surveys about how safeguarding is looking? Do they feel they can share and participate? Ask LSCB Chair how you are doing? Ask the population Ask the child The way it is and the way it is perceived to be? That is the Question?

Political Hot Spots Cross Government – DFE and HO work-streams Child Sexual Abuse & Sexual Exploitation (Rotherham) DA and DVHR Troubled Families Gun and Gang Crime Female Genital Mutilation Radicalisation (Prevent) Neglect Sector Integration and Innovation Engagement in MASH Call to action HV and School Nursing / Early help LSCB and SAB engagement and development Can hold NHS to account (can’t direct) SEC 11 audits / SCR

LEADERSHIP AND VISION

Leadership, Accountability and Assurance for NHS Organisations Internal assurance processes and Board accountability Local Safeguarding Children Boards (LSCBs) Safeguarding Adults Boards (SABs) The draft Care and Support Bill proposes putting SABs on a stronger, statutory footing. It is intended that CCGs will become statutory members of SABs. Health and Wellbeing Boards (HWBs) have overall strategic responsibility for assessing local health and wellbeing needs in the Joint Strategic Needs Assessment and agreeing Joint Health and Wellbeing Strategies for each local authority area. External regulation and inspection– CQC and Monitor Locally developed peer review and assurance processes Effective commissioning, procurement and contract monitoring.

Safeguarding Vulnerable People in the Reformed NHS England, through the leadership of the Chief Nursing Officer: Ensures that NHS Waltham Forest meets its specific safeguarding duties in relation to the services that it directly commissions (e.g. primary care, specialised services) Leads policy for NHS safeguarding, including defining improvement in safeguarding practice and outcomes Leads, in conjunction with Regional Directors of Nursing, assurance and peer review processes for both CCGs and directly commissioned services. Provides specialist safeguarding advice to the NHS Leads a system where there is a culture that supports staff in raising concerns regarding safeguarding issues. Leads a system where there is a culture that supports staff in raising concerns regarding safeguarding issues

Clinical Commissioning Groups CCGs need to assure themselves that the organisations from which they commission services have the following safeguarding arrangements in place: Safeguarding training for staff in order to recognise and report safeguarding issues A clear line of accountability for safeguarding, properly reflected in the CCG governance arrangements Arrangements to co-operate with local authorities in the operation of LSCBs, SABs and Health and Wellbeing Boards Effective arrangements for information-sharing The expertise of designated doctors and nurses for safeguarding children and for looked after children and a designated paediatrician for unexpected deaths in childhood A safeguarding adults lead and a lead for the Mental Capacity Act, supported by the relevant policies and training. Monitoring and quality assurance of all services commissioned occurs through CQRM, SI panels, QA visits, Dash boards (KPIs).

Directly commissioned services All providers of health services are required to be registered with the Care Quality Commission (CQC). In order to be registered, providers must ensure that those who use the services are safeguarded and that staff are suitably skilled and supported. This includes private healthcare providers Named professionals. Named GPs GP practices should have a lead for safeguarding, who should work closely with named GPs and designated professionals.

The 6Cs - Strengthening Safeguarding Practice Incorporating compassion in Safeguarding Practice, the national strategy for nurses, midwives and care staff Compassion Competence Communication Courage Commitment Working Together to Safeguard Children is our business

Co-commissioning in primary care CCG will look to take back some of primary care commissioning, including but not exclusively; Contract management of extended GP services Education and training Complaints management Development of new services Revising existing contracts which will include safeguarding of children

The Voice of the Child and Vulnerable Adult / Adult at Risk Securing the voice of the child young person and vulnerable adult to inform safeguarding arrangements within Waltham Forest CCG needs accelerated progress and must be managed as a priority area for the CCG. Further work is required to ensure that outcome measures and quality of experience are included within the safeguarding performance reporting The CCG are co – working with the Local Authority to progress this essential facet of CCG objectives.

The voice of the child, young person and vulnerable adult •Vision, strategy, leadership and capacity to improve •Governance, accountability and risk management •Quality improvement, learning and workforce development •Efficient/effective use of safeguarding resources to meet current requirements and future challenges operationally

Vision, strategy, leadership and capacity to improve d)Strengthen the connections between adult safeguarding and domestic abuse by identifying some of the organisational developments which can support best practice in this area. e)Ensure that the strategic approach for safeguarding commissioning reflects the recently revised definition of domestic abuse to include so called ‘honour based’ violence, female genital mutilation and forced marriage.

Governance National The Francis Public Inquiry The Review of Winterbourne View Child sex abuse scandal’s Rochdale and Oxford The Investigations following Saville The Death of Baby Peter and the Munro review Murder of Daniel Pelka Rotherham inquiry Local Child KK CTG FT MK Child F