Regulator says NHS must do more to protect children from neglect and abuse

16 July 2009

CQC publishes national review of NHS child safeguarding.

The Care Quality Commission (CQC) today (Thursday) urges 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.

CQC said that this review is part of a major programme of assessment, inspection and enforcement on safeguarding, designed to drive improvement.

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 per cent 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: “Immediately after the Baby P tragedy, everyone agreed that everything possible must be done to prevent a recurrence. This must not prove to be hollow rhetoric. The NHS has got to play its part by getting these safeguarding measures in place.

“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. If that were to change, it would be an appropriate legacy for Baby Peter. We will be using every tool at our disposal to make it happen.”

CQC says 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:

• All healthcare staff should have basic training in child protection (level one)
• All healthcare staff with regular contact with children and young people should have standard child protection training (level two at least).

Survey findings include:

• 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, one in three GPs eligible in each PCT are recorded as having up-to-date training (35%, level two). In 2007/8, around one in ten consultations in GP practices were with children aged 14 or under.
• 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). In 2007/8, around three million children under 16 attended A&E.

The regulator has a major follow-up programme to help drive improvement:

• CQC has asked all NHS trusts to make public declarations against the core standard on safeguarding (C2) as part of the annual performance ratings. In the declarations, published last month, 29 trusts said they did not meet the standard, an increase on previous years.
• CQC inspectors will now follow up with trusts that have declared non-compliance to check on action being taken. They are also carrying out follow-up work where there is a discrepancy between the declarations and the data collected in the safeguarding review.
• Over the summer, CQC will make available individual trusts results from the safeguarding review so that organisations can benchmark themselves against others and look for ways to improve.
• In partnership with Ofsted, CQC will carry out week-long inspections focusing on safeguarding and the health of looked-after children. The inspections will cover every part of the country over the next three years.
• CQC is urging the government to expand the existing yearly data collection exercise on children’s services to provide an annual update on performance against measures to safeguard children.
• The CQC will use its new registration system – being introduced from April 1 2010 – to drive improvement. From next January, NHS trusts can apply to be registered with CQC, against a number of legally enforceable standards, including standards on safeguarding children. To be successful, they must meet legally enforceable standards on safeguarding of children. The regulator has a range of powers to enforce compliance, including registering trusts with conditions and issuing fines and forcing closure.

In May, CQC published a review of the healthcare provided to Baby Peter by the four NHS trusts involved.

Ends

For further information please call Sarah Robertson in the CQC press office on 020 7448 9210 or out of hours on 07917 232 143.

Notes to editors

Appendix:

• Guide to the different levels of safeguarding training
• List of trusts that have declared themselves non-compliant with the child safeguarding requirements core standard, C2, as part of this year’s annual health check.

The NHS employs around 1.3 million people. Through this review, NHS trusts have told us that around 851,000 staff are eligible for training at level one, and that just short of 400,000 staff are up-to-date. This 'eligible' figure may exclude staff who are eligible for training at a level higher than level one. It will exclude those staff who do not work in healthcare settings who are usually staff working in areas such as finance, IT or other corporate services. It should also be noted that the review considered only NHS trusts, other staff employed by the NHS, for example in strategic health authorities, would therefore be excluded.