Chapter 6 Health Boards Structure for Delivering Child Protection Services
- Outlines the strategic and corporate responsibilities of Health Boards in child protection.
- Sets out specific responsibilities of key personnel for delivering child protection health services.
- Identifies the responsibilities of operational managers in health services.
This guidance applies to all staff who have strategic responsibilities whether as part of their specific role or delegated to them from other strategic leaders.
Collective Responsibilities for Child Protection
The National Guidance for Child Protection sets out the responsibility of all agencies, professional bodies and services that deliver adult and/or child and young person services and work with children and young people and families to recognise and actively consider potential risks to a child or young person, irrespective of whether the child or young person is the main focus of their involvement. They are expected to identify and consider the child or young person's needs, share information and concerns with other agencies and work collaboratively with other services (as well as the child or young person and their family) to improve outcomes for the child or young person. Further information is contained in Part 2 of the National Guidance - "Roles and Responsibilities for Child Protection".
Strategic Leadership for Child Protection
Chief Officers are responsible for ensuring that their agencies, individually and collectively work to protect children and young people as effectively as possible. They also have responsibility for maximising the involvement of those agencies not under their direct control, including the Scottish Children's Reporter Administration, the Crown Office and Procurator Fiscal Service and the third sector.
The following flowchart sets out the Health Board accountability structure which describes the people with strategic and senior management responsibilities at Board level.
Specification for a Child Protection Service
Each Health Board in Scotland must ensure they provide the following services, processes and policies to ensure a high quality, safe and effective child protection service.
Each Health Board should have:
- Services which include preventative strategies using the GIRFEC approach which supports prevention and early intervention to reduce the number of children and young people within the child protection system.
- A governance, accountability and reporting framework that promotes good practice in child protection and a learning culture to ensure gaps in child protection services and systems which may have an adverse impact on the outcomes for children and young people are identified and addressed.
- Robust information sharing systems that support the identification of vulnerable children and young people.
- A child protection education and development strategy and delivery programme for all healthcare staff within their Health Board area including independent contractors (GPs) and their staff.
- Robusr systems in place to ensure that NHS staff contribute to the child protection interagency training programmes such as the local authority, police and voluntary services to ensure that all healthcare staff are trained to the level appropriate to their role and responsibility within the organisation.
- Child protection information, guidance, protocols and procedures which are evidence based and are in line with local, interagency and national policy and are accessible to all staff.
- A quality assurance framework which improves outcomes for children and young people. This should include regular self evaluation and audits in relation to child protection and vulnerable families.
- Safe and robust recruitment processes within current legislation and policies.
- Commissioned services for the provision of therapy, counselling and support for children and young people and families where abuse has occurred or where continuing support is required.
- Sufficient prioritisation of resources allocated to ensure the Board meets its responsibilities in the protection of children and young people.
- Services are in place so the health needs of all Looked After Children are assessed and their needs met.
The Chief Executive
The Scottish Government requires Chief Executives of Health Boards to have responsibility for the delivery of high quality services to support child protection. This includes the overall strategic direction for child protection and strategic management of all child protection health services delivered by the Health Board. The Chief Executive may delegate some of these responsibilities to an Executive Director/Lead for Child Protection. This Executive Director will report directly to the Chief Executive and will be responsible for the leadership, co-ordination and management of the child protection services in that Board.
The Chief Executive will:
- Ensure that the role and responsibilities of the NHS Board in relation to child protection are met as set out above and provide performance monitoring reports to the NHS Board on progress and reports on areas that require the Board's support.
- Work in partnership with the Local Authority and Police Chief Officers collectively to identify and commission inter-agency services to protect children and young people.
- Ensure meeting the needs of and protecting vulnerable children and young people is prioritised within Board and Integrated Children's Services Plans.
- Ensure the "Vision, Value and Aims" of child protection is disseminated and known by all staff and incorporated within all policies and guidelines.
- Ensure operational services are resourced to support/respond to the demands of child protection effectively.
- Ensure that services are delivered in ways that provide equity of service and take account of diversity.
- Ensure an effective child protection service and training and supervision strategies are adequately resourced and delivered.
- Ensure children and young people's views are sought within the development of services.
- Undertake the duties in respect of the roles and responsibilities of Chief Officer for the NHS Board.
- Ensure the NHS Board adheres to relevant current national guidance and standards for child protection.
Executive Director Lead Child Protection
The Scottish Government requires NHS Boards to have a Director at Board level with responsibility for child protection. The Executive Director Lead for child protection will report directly to the Chief Executive on the performance of delegated responsibilities and is responsible for providing leadership, co-ordinating the management and leading the long term strategic planning processes for all health services for children and young people across the Board.
The Executive Director Lead Child Protection will:
- Report directly to the Chief Executive on delegated child protection matters.
- Ensure the child protection service is aligned with the Community Health Plans and Children's Service Plans and to the Risk Management Strategy and Health Care Governance Framework.
- Ensure that the appropriate expert medical and nursing advice on child protection cases is made available to staff within the Health Board.
- Ensure that all specialist child protection staff have training on all aspects of child protection, achieved competencies and where appropriate, have a relevant qualification in child protection in line with current intercollegiate guidance.
- Ensure appropriate managerial and clinical representation on all Child Protection Committees.
- Take strategic lead for health and inter-agency child protection matters including co-operating with other agencies in planning, commissioning and monitoring services and undertaking timeous review of inter-agency procedures.
- Be accountable for commissioning of Significant Case Reviews.
The performance and delivery of all dedicated child protection services will be regularly monitored and reported to the Chief Executive or appropriate strategic board. Additional responsibilities of the Health Board include ensuring access to the appropriate child protection expert medical and nursing advice. This advice should be provided to the Board strategically and to all healthcare staff within the Board. This expert advice will be provided by a Lead Paediatrician for child protection and supported by a Nurse Consultant/Lead Nurse child protection/vulnerable children or designated other professional as decided by individual Health Boards.
Lead Paediatrician for Child Protection
The Lead Paediatrician for child protection should be a Consultant Paediatrician with child protection expertise, competencies and training. They should advise the Health Board on child protection matters and contribute to the development of child protection strategic planning arrangements, standards and guidelines with the Lead Nurse both on an intra- and interagency basis. They are a member of the Child Protection Committee and are involved in the work of the subgroups.
The Lead Paediatrician should also provide clinical leadership to all medical and non-medical clinical staff, and direct professional leadership to other paediatricians delivering child protection services. They may have operational management responsibilities which include:
- Ensuring accessible expert child protection advice is available to all medical staff both within the acute and community service, including GPs.
- Having a working knowledge of all policies and procedures and legislation which may go beyond that of a generalist paediatrician.
- Working jointly with the Nurse Consultant/Lead Nurse to develop and undertake the evaluation and quality assurance of the child protection services provided by the Health Board.
- Ensuring that there are suitable facilities for the examination of children and young people suspected of being abused including advice on the nature of the examination, method of recording, and access to suitably trained forensic police surgeons.
- Developing, leading and participating in regular peer review, advice and support both locally and nationally with peers in the management of complex and difficult cases.
- Developing the medical workforce and training other doctors as appropriate.
Nurse Consultant/Lead Nurse for Child Protection/Vulnerable Children
The Nurse Consultant for child protection/vulnerable children provides strategic and professional leadership in child protection to all healthcare staff and to services working with vulnerable children and young people within the Health Board area. They should have additional training, competencies, qualifications and masters in a relevant subject. The Lead Nurse should advise the appropriate Health Board Executive staff on child protection services, contribute to the development of strategic planning arrangements, standards and guidelines with the Lead Paediatrician for child protection. The Lead Nurse may represent the Board in local, regional or national strategic groups in child protection.
The Lead Nurse for child protection will:
- Provide expert clinical advice on child protection to all healthcare staff.
- Work jointly with the Lead Paediatrician in order to undertake self evaluation and ensure quality assurance and service development in child protection.
- Ensure the national training strategy for child protection for all healthcare staff is incorporated, implemented and evaluated.
- Provide supervision for those nurses with a role in child protection including any operational responsibility and line management of the dedicated posts within the health child protection service and services for Looked After Children.
- Ensure direct child protection supervision for designated staff is in place.
- Ensure specialist advice and support is accessible to all staff in relation to child protection.
- Provide clinical and professional leadership in child protection and work in collaboration with medical colleagues, Allied Health Professionals (AHPs), managers and front-line staff to deliver high quality child protection services.
Child Protection Nurse Adviser
In some larger Health Boards there will be a Child Protection Nurse Adviser. The Child Protection Nurse Adviser will:
- Support the Nurse Consultant/Lead Nurse in delivering the child protection service across the Board area both in an intra and interagency basis.
- Provide advice and support on child protection to all healthcare staff as well as staff from partner agencies.
- Be involved in the design, planning and implementation of child protection policies and protocols, which includes the work of the Child Protection Committee and relevant subgroups.
- Take a lead role in the planning and delivery of child protection training to all healthcare staff, both single and multi agency.
- Participate in interagency meetings where appropriate (e.g. child protection case conferences).
Other Key Personnel in Health Boards
Health Boards must ensure there is access to child protection advice and support to all healthcare staff, 24 hours a day. This may be provided by child protection Nurse Advisers, Lead Nurses for child protection or paediatricians with specific responsibilities for child protection. In larger Health Boards, child protection Nurse Advisers may have specific areas of child protection responsibility where they can provide local support to specific groups (e.g. PHN-HV, family nurse, AHP's, mental healthcare staff, emergency medicine staff). Child protection Nurse Advisers may also have operational roles including delivering training in child protection and attending child protection case conferences to support other clinical staff or to provide specific clinical care to vulnerable children and young people (e.g. Looked After Children health assessments or comprehensive health assessments for neglect).
An operational manager within a Health Board is anyone who directly line manages clinical and non-clinical staff in all services including child and adult services.
All operational managers in Health Board services have a responsibility to manage staff and services, ensure appropriate guidelines and policies are in place and comply with governance procedures. In particular, for child protection they have a responsibility to:
- Ensure that the staff they manage are aware of, and have access to, the national and local child protection procedures and that staff are aware of the contact details specialist advisory staff who offer advice and support.
- Ensure they are aware of their own responsibility and accountability as managers to protect children and young people within professional, local and national guidelines.
- Ensure that staff they manage have achieved the relevant competence to deliver services to manage their caseload.
- Identify the training and supervision needs of their staff in respect of these procedures and guidance.
- Establish a system of clinical supervision and support for all staff dealing with child protection cases and a system of peer review.
- Release their staff to attend child protection training as appropriate and ensuring that this is recorded for audit purposes.
Email: Fiona McKinlay