Integration of health guidance
Q7: Integration of health guidance – We have integrated previously separate guidance for health practitioners into the revised guidance and more clearly defined the key role of health in protecting children at risk of harm from abuse or neglect.
Do you have any comments on specific aspects for health practitioners?
Stakeholder Event Themes
The main themes raised at the stakeholder events were:
The integration of the health guidance into the revised child protection guidance was welcomed as it makes the role of health more obvious and supports multi-agency working.
The role of primary care could be given greater emphasis.
Clarification is needed on the 'named person', in particular the role of the Family Nurse.
The issue of consent requires more thought, including when it should be sought and whether or not it should be in writing.
Competencies, roles and responsibilities may be more useful than the list of job descriptions.
A total of 70 respondents commented at Question 7, with many confirming that the inclusion of the 'National Guidance for Child Protection in Scotland: Guidance for Health Professionals' (the 'Pink Book') was helpful. Associated points included that the new approach acknowledges the key role of health professionals, widens the audience for the guidance and supports multi-agency working. The recognition of health professionals as full partners in the IRD process was also welcomed.
However, some respondents questioned whether incorporating the health guidance into the wider child protection guidance may make is harder for health professionals to access the information they require, and which is most relevant to them. Others observed that the sections on health seemed to be an addition to the main document, disrupting the overall flow of the guidance.
Roles and Responsibilities
Other comments addressed the roles and responsibilities of the various health professionals, as set out in the draft guidance. They included a number of areas in which respondents thought the coverage could be strengthened. These were in relation to the role of:
- Adult Health Services, to reflect the importance of partnership working between Children's Services and Adult Services staff.
- General Practitioners (GPs), to reflect the leadership role they play in relation to child protection, in some areas.
- Allied health professionals (including physiotherapists and occupational therapists), due to the level of contact they have with children and young people.
- The Scottish Ambulance Service, in recognising and responding where children may be at risk.
It was also suggested that the Family Nurse Partnerships section should be updated following recent developments to the service.
It was noted that details of qualifications for health professionals are included in the guidance. There was a question about why this level of detail is necessary, especially since it is not included for non-health professionals.
In terms of how different health professionals may be involved in child protection processes, comments included that:
- The guidance could be clearer about who can undertake comprehensive medical examinations, for example if there is no specialist resource available nearby (rural and islands services were given as an example).
- A paediatrician would not normally be involved in the examination of a 16-17 year old where sexual assault was alleged, or where sexual abuse was disclosed.
- There should be guidance for GPs on information sharing where there are child protection concerns, including how this relates to patient confidentiality issues. This should also cover emergency situations involving young people aged 16 and 17, where GDPR issues may be raised at a later date.
Terminology and definitions
There were comments about inconsistencies in the use of terminology and definitions within the draft guidance. They included that:
- The designations used in the guidance are not used consistently across all health boards and the guidance should use generic terms, where possible. For example, different health boards may use the title Lead Nurse, Nurse Consultant or Chief Nurse for Child Protection.
- The term 'health professionals' rather than 'medical professionals' should be used throughout, as the former includes dentists, allied health professionals and pharmacists.
- The use of 'health assessment' and ''medical examination' should be consistent in the guidance. Currently they seem to be used interchangeably but are two separate processes requiring their own guidance.
- The difference between 'comprehensive medical assessments' and 'forensic medical assessments' needs to be explained.
As noted above, there was some confusion about the inclusion of midwives as a named-person; it was noted that a recent directive makes it clear that health visitors should have this role from newborn onwards.
It was also noted that the health visitor and family nurse practitioners' sections of the guidance do not reference their named-person responsibilities.
A number of respondents favoured joint agency training to support implementation of the guidance. Specific suggestions for topics to be covered were:
- Awareness training on young carers for health professionals working with this group.
- Domestic abuse and coercive control.
- Training for health staff within a framework or support and development, including child protection training for all new clinicians.
A number of further suggestions were made regarding other aspects of policy or practice that should be covered in the guidance. These included:
- National policy on "Children Missing from Known Address'.
- The process for raising a Missing Family Alert should be set out.
- Guidance on the discharge planning process.
- More advice on young carers, to increase awareness of their role and responsibilities.
- Clearer messaging about child protection being 'everyone's job', with the importance of professional curiosity emphasised to encourage health professionals to ask relevant questions.
- Details of the responsibilities for each agency.