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

2. 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.

3. 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.

4. 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 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

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

6. 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?

7. What does good look like?

8. What does good look like?

9. & 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?

10. 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

11. LEADERSHIP AND VISION

12. 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.

13. 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

14. 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).

15. 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.

16. 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

17. 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

18. 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.

19. 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

20. 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.

28. 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