First multi-agency child protection inspection criticises health services

Neil Puffett
Tuesday, April 5, 2016

Health services have come in for criticism for failing to properly assess risks to children following the first joint inspection of child protection across health, social care and criminal justice services.

Following a joint targeted area inspection (JTAI) by Ofsted, the Care Quality Commission (CQC), Her Majesty’s Inspectorate of Constabulary (HMIC) and Her Majesty’s Inspectorate of Probation (HMIP), the way health services in South Tyneside deal with abuse and neglect was highlighted as an area of concern.

A judgment letter published today reveals that inspectors found a "lack of robust management oversight of the quality of safeguarding practice" at South Tyneside Foundation Trust.

"There is a lack of effective management oversight within health services to ensure that all health professionals routinely and effectively assess risks to children," the letter states.

It added that health authority and clinical commissioning group commissioners, and senior managers in South Tyneside Foundation Trust "do not have a sufficiently robust understanding of what is happening to assess and manage risk in frontline services inspected".

The inspection, which included a "deep dive" focus on responses to child sexual exploitation (CSE), and those missing from home, care or education, also raised concerns about the lack of standardised risk assessments across sexual health, school nursing and the accident and emergency department.

"This means that vulnerabilities, for example to child sexual exploitation, are not always fully considered," the letter states.

In two cases, sexual health services were found not to have shared relevant information with children's social care despite being involved with both young people. The issues with health services have been made subject to an immediate action plan.

Meanwhile, health services, police and schools were all criticised for the quality of initial "front door" contact with young people that resulted in risk and need not being adequately identified.

"This means that too much social work time is spent in gathering key information to inform judgments about the appropriate level of service response," the letter adds.

Northumbria Police was also criticised for not distinguishing between children who were "missing" and those who were "absent", including those who were late back home, until January this year. This meant that agencies had not previously had a coherent list of children most at risk in order to analyse the needs of children who go missing.

Inspectors also identified a number of strengths across the agencies - such as work to raise awareness in the community about the risks of CSE.

"This is leading to increasing identification of those at risk and effective responses to children when risks are first identified," the letter states.

"The partnership is aware of many of the areas that need further development, both in respect of the effectiveness of multi-agency practice at the front door and in the quality of practice in supporting children at risk of child sexual exploitation."

The youth justice service was praised for having a good understanding of the importance of identifying specific risks to young people at an early stage, including the risk of CSE.

"This enables practitioners to understand and respond to a range of risks that young people face and contribute effectively to multi-agency responses to children and their families," the letter states.

"For example, the involvement of the youth justice service is leading to some insightful and sensitive decisions about sequencing of interventions to protect children and reduce offending."

Inspectors also said there was a clear commitment from leaders across services to improve outcomes for vulnerable children and a clear determination and ambition to prevent CSE. As a result of agencies focusing on preventative work and awareness raising there has been an increase in notifications to the police from the community.

Meanwhile, bespoke materials have been developed to highlight the risk of CSE and all schools include CSE as part of the personal, social, health and economic curriculum.

Efforts to raise awareness, alongside mandatory training on CSE for all frontline staff, have led to increasing numbers of children being identified as being at risk of CSE - rising from 12 in 2014/15 to 38 in 2015/16.

Sir Paul Ennals, chair of the South Tyneside Safeguarding Children’s Board, described the results of the inspection as “broadly positive”.

“The inspectors praised us in many areas – for our work in increasing awareness of child sexual exploitation (CSE), for the commitment of leaders in all agencies to tackle the problems, and for the quality of much of the front-line practice,” he said.

“They also identified areas for improvement – many of which we had already identified and begun to address. It is important for ourselves and for the children we serve that we rapidly address the areas of improvement that they have identified.

“We have already begun work to develop an improvement plan to address all the issues that are raised. Our approach throughout this exercise has been as a partnership – so all organisations will work together to address the issues highlighted.

“We were much praised for the collective approach that we have been taking to tackling CSE, and I know that all partners are determined that this will continue.”

A total of six JTAI inspections are due to take place by September, with agencies being given a notice period of nine working days.

There has already been criticism of the inspection process. Responding last August to a consultation on the plans, the Association of Directors of Children's Services (ADCS), the Local Government Association (LGA) and council chief executives group Solace, said the new inspection process, which is over and above the existing single inspection framework, could be burdensome for services.

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