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Safeguarding in health settings

Everyone who comes into contact with children and their families has a role to play in safeguarding children.   All staff, whether they work in a hospital, a care home, in general practice, or in providing community care, and whether they are employed by a public sector, private, or not-for-profit organisation, have a responsibility to safeguard children.

On this page you will find information particularly relevant to those working in health settings, but we strongly recommend that you explore this website and look at the other subject specific information that is of equal relevance to your work.

What happens if a health care professional is worried about your child being safe? The LSCPs in Hampshire, Isle of Wight, Portsmouth and Southampton have put together this leaflet that can support you in explaining your safeguarding responsibilities to families.

All children are entitled to receive services to promote their health, wellbeing and development. Whilst under the age of being able to provide informed consent, it is the responsibility of those with parental responsibility to act on the behalf of their children, to ensure they are recipients of these services.

Non-attendance at, or repeated cancellations of, appointments and lack of access to the child on visits are indicators that should increase concern about the child’s welfare. In circumstances where children are denied access to these services by their parents/carers, health professionals (including GPs) must consider that it is their professional responsibility and duty to act on the child’s behalf.

All NHS providers should have policies for the management of children not brought to health care appointments. The HIPS LSCPs have produced guidance for both primary and secondary health care settings, to support this.

The HIPS LSCPs have also developed a leaflet for parents and carers to explain what will happen if their child in not brought to an appointment. You can download copies of it here

The aim of this protocol is to enable practitioners to work together with families to safeguard unborn/new born babies where risk is identified. The protocol sets out how to respond to concerns for unborn babies, with an emphasis on clear and regular communication between professionals working with the pregnant person and their family. This protocol outlines the agreed process between health agencies, social care and other partner agencies who are working with the pregnant person and their family on the planning, assessment and actions required to safeguard the unborn/newborn baby.

The roles and responsibilities of those professionals involved with the family are clearly laid out in the protocol. There is an interactive Risk Assessment Flowchart to help you in ensuring that families receive the right support at the right time.

A concealed pregnancy is when a person knows they are pregnant but does not tell anyone; or a person advises someone about the pregnancy but conceals the fact they are not accessing antenatal care or where a person appears genuinely unaware they are pregnant.

A denied pregnancy is when a person is unaware of or unable to accept the existence of their pregnancy.

This can become apparent at any stage of the pregnancy. Concealment of pregnancy may be revealed late in pregnancy; in labour; or following delivery. The birth may be unassisted and may carry additional risks to the baby and person’s welfare.

The reason for any concealment will be a key factor in determining the risk to the unborn/child, the person who has given birth and any other children in the household; in all cases, a holistic risk assessment should be undertaken to ascertain the reason for the concealment.

An unborn baby has no legal standing in the UK. Law cannot force an expectant person to have any medical intervention at birth unless they lack capacity, which has been assessed in line with the Mental Capacity Act, and if there is an unassisted delivery; the lack of professional involvement may lead to undiagnosed complications which could have serious outcomes for mother and/or baby where medical intervention is judged to be necessary and in the person’s best interest. It is only possible to make appropriate contingency plans and to ensure that the individual is fully aware of the consequences of their actions. In all cases, legal advice should be sought.

Where a person is in the third trimester (more than 27 weeks pregnant) and there are concerns about late presentation or lack of engagement, a referral to MASH needs to be considered.

In the situations where a person presents during labour then a referral to MASH must be made.

If a person presents following unassisted delivery at the end of a concealed pregnancy then a referral to MASH must be made.

For further information please refer to the HIPS Concealed Pregnancy Guidance

Sudden Infant Death Syndrome (SIDS), or cot death, is the sudden and unexplained death of a baby where no cause is found. While SIDS is rare, it can still happen day or night and there are steps parents and carers can take to help reduce the chance of this tragedy occurring.

We would encourage you to discuss sleeping arrangements with all parents of babies you come into contact with, and ask parents to also have those discussions with extended family members who may also be supporting care.

All parents/carers must be told that co-sleeping with a baby when under the influence of alcohol or drugs (this also includes prescribed medications that may make them drowsy) is particularly dangerous and could result in inadvertent overlay and death of the baby. Parents/carers should be asked about patterns of drinking as well as weekly intake. They could consider having a nominated non-drinking/drug-taking adult to look after the baby at times when they plan to drink or take drugs.

The ICON campaign aims to help parents and carers to cope with a crying baby. The call for the campaign comes from a number of infant deaths and serious case reviews where a baby has died or been seriously injured as a result of abusive head trauma.

Abusive Head Trauma (AHT) – also known as ‘shaken baby syndrome’ – causes catastrophic brain injuries, which can lead to death, or significant long term health and learning disabilities. AHT is not restricted to specific socio-economic groups – it can occur in any environment, when a parent or carer is on the edge due to infant crying.

ICON is an evidence based programme consisting of a series of brief ‘touchpoint’ interventions that reinforce the simple message making up the ICON acronym.

* I – Infant crying is normal

* C –Comforting methods can help

* O – It’s OK to walk away

* N – Never, ever shake a baby

Research points to persistent crying in babies being a potential trigger for some parents/care givers to lose control and shake a baby.

Remind parents and carers that it’s always OK to ask for help. If they are worried about a crying baby they should speak to:

  • friends and family
  • Health Visitor
  • GP
  • Midwife

Research shows that it is very unusual for infants who are not independently mobile to sustain bruises accidentally. Therefore any actual or suspected bruising, or other injury, in an infant who is not independently mobile should be suspected as caused by physical abuse.

Injuries to children must never be interpreted in isolation and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination, and relevant investigations. Any explanation for actual or suspected bruising or other injury in an infant who is not independently mobile needs to be assessed by a health professional with appropriate competency, usually a consultant paediatrician.

If you encounter an incidence of bruising in an infant who is not yet independently mobile, you should refer to the HIPS Protocol for the management of actual or suspected bruising and act accordingly.

Trained staff in antenatal, postnatal, reproductive care, sexual health, alcohol or drug misuse, mental health, children’s and vulnerable adults’ services should ask service users whether they have experienced domestic violence and abuse as a routine part of good clinical practice, even where there are no indicators of such violence and abuse. This is the DVA Screening Tool and Pathway for Portsmouth. Please also refer to the Domestic Abuse page on this website.

Solent NHS Trust has produced a Healthy Infant Feeding Booklet that contains information to support parents and carers with their decisions about feeding their babies.  Parenting is tough with lots of outside influences, pressures and advice and it can be hard to have the confidence that what they are doing is best for their baby. Whether they choose to breast, bottle or mixed feed, becoming overweight is a baby’s biggest health risk although, importantly, breastfeeding can help prevent later weight problems and is definitely healthiest. All parents want their baby to grow up healthy and happy and this booklet provides tips and facts about feeding so that they can give their baby the best start in life.

Portsmouth Child Obesity Pathway – This pathway was produced in response to a Portsmouth Case Review Committee recommendation following referral of a child with severe obesity, where safeguarding issues had been raised. It is intended for use by all those working with children in Portsmouth. The aim of the pathway is to:

  • Raise awareness that the child obesity is everyone’s responsibility, and to clarify the support available in Portsmouth to prevent and manage obesity for children of different ages.
  • Outline clear clinical pathways and thresholds for intervention in child obesity, from universal to targeted services.
  • To indicate when child obesity might become a safeguarding issue

 

To protect children and young people from harm, and help improve their wellbeing, all healthcare staff must have the competencies to recognise child maltreatment, opportunities to improve childhood wellbeing, and to take effective action as appropriate to their role.

Safeguarding/child protection competencies are a combination of skills, knowledge, attitudes and values that are required for safe and effective practice. Working Together signposts healthcare organisations to the intercollegiate safeguarding framework and states that ‘All staff working in healthcare services – including those who predominantly treat adults – should receive training to ensure they attain the competencies appropriate to their role and follow the relevant professional guidance’.

Different staff groups require different levels of competence depending on their role, their level of contact with children, young people and families/or contact with any adult who has responsibilities for children through work and hobbies, the nature of their work, and their level of responsibility. All staff working in a healthcare setting must know what to do if there is a safeguarding/child protection concern involving a child or family, know the referral procedure, which includes knowing whom to contact within their organisation to communicate their concerns or seek safeguarding advice.

The Intercollegiate document provides a clear framework which identifies the competencies required for all healthcare staff. To find out more about the relevant training the PSCP offers then please visit the PSCP training opportunities for Health Professionals page on this website.

 

NHS England Safeguarding App has been developed to act as a comprehensive resource for healthcare professionals. It provides access to current legislation and guidance, as well as information on how to report a safeguarding concern and even has a directory of safeguarding contacts for every local authority in England, searchable by region. It can be accessed via your device’s appropriate app store and searching for ‘NHS Safeguarding’.

You must have read the following of your setting’s policies:

  • Safeguarding and Child Protection Policy.
  • Behaviour Policy
  • Staff Behaviour Policy (also known as the Code of conduct)
  • The setting’s response to children who go missing from education (likely to be part of your setting’s attendance policy)

Worried about a child – If you are concerned that a child or young person has suffered harm, neglect or abuse, please contact Portsmouth Multi Agency Safeguarding Hub (MASH)

If a child is at immediate risk of harm, call the Police on 999