The Care Quality Commission (CQC) has urged NHS Trusts to respond to the tragic death of Baby P by delivering major improvements in compliance with measures to safeguard children.
It is publishing a review of child safeguarding in the NHS, commissioned by the Secretary of State for Health as part of the response to the case of Baby P, now known as Peter. Based on a detailed survey of 392 NHS Trusts, the findings indicate that a majority of organisations had the right people and systems to help protect children. But they highlight worrying shortfalls in the numbers of staff up to date with mandatory training, designed to help them identify and respond to concerns. This was true for staff across the NHS, as well as those dealing with children routinely, such as GPs and those in A&E, paediatric and sexual health services. Other issues include:
• Lack of clarity over the roles of doctors and nurses with specific responsibility for safeguarding – some 30% of these doctors had no contract or service-level agreement for safeguarding work.
• Some Trusts lacked policies in key areas of child protection – for example, a third of acute Trusts had no follow up process for children who miss outpatient appointments.
• Boards need to give more attention to safeguarding, with almost a third having no presentation from child safeguarding professionals during 2008.
• Twenty-nine out of 152 primary care Trusts (PCT) reported case loads of more than 500 children per health visitor, well above Lord Laming’s recommendation of 400.
Cynthia Bower, CQC chief executive, said: “It is clear that safeguarding has not been as high on the agenda of Trust boards as it should have been – and that has meant, in some cases, that NHS staff have not been given the support they need in terms of training and clear procedures for handling concerns.” CQC said that Trusts should monitor the training of staff and ensure their people are up to date. Guidance issued by the Royal College of Paediatrics and Child Health, approved by other Royal Colleges, says that all healthcare staff should have basic training in child protection (level one) and all healthcare staff with regular contact with children should have standard child protection training (level two at least). The survey found that, on average, only about half of healthcare staff eligible in each NHS Trust are recorded as having up-to-date basic training (54%, level one). On average, over half of eligible clinical staff in emergency or urgent care (hospitals) are recorded as having up-to-date training (58%, level two). The regulator will be implementing a follow-up programme to help drive improvement, which includes asking all NHS Trusts to make public declarations against the core standard on safeguarding as part of the annual performance ratings. Inspectors will check on action being taken by Trusts that have declared non-compliance. Results will be made available, so organisations can benchmark themselves against others.
