NHS public protection accountability and assurance framework

Background

Roles and responsibilities of NHS Boards, employees, and GP contractors in protecting children and adults at risk of harm

Health Boards have structural and organisational responsibilities in respect of child and adult protection. These include use of appropriate policies to keep children and vulnerable adults safe, safe recruitment practices, staff induction and provision of adequate training, procedures for whistleblowing and complaints, robust information sharing agreements, and the promotion of a workplace culture that listens to children, young people, and adults and considers their views and wishes.

Health boards, NHS employees, and contractors have an important role in upholding the wide range of rights which underpin public protection, reinforcing and protecting many of the guarantees set out in the UNCRC (such as Articles 3, 12 and 24) and in the ECHR.

All NHS employees, GP and dental practices, and other independent contractors have a role in protecting the public and allregulated staff in Health Boards and services have professional duties to protect children (including unborn babies) and adults. Staff in supporting roles (including administrative, catering, cleaning, and other support roles) across primary, secondary, specialist, and community health services also have public protection responsibilities. These contacts provide opportunities for early and effective interventions and, in many cases, avoiding escalating need.

This role includes:

• Being aware of their responsibilities to identify and promptly share concerns, including making referrals where appropriate, about actual or potential risk of harm from abuse or neglect.
• Undertaking training and learning to ensure they attain and maintain their competencies, skills, and knowledge appropriate to their role.
• Knowing where and when to seek specialist advice and supervision.
• Being aware of their own regulated responsibilities and duties as well as understanding relevant legal frameworks within which they operate and their duty to refer.
• Being aware of the early signs of neglect; recognising the signs of self-harm and self-neglect and the need for co-ordinated assessment.
• In working with or treating adults who are parents/carers, being alert to the possibility that their patient may pose a risk to an unborn baby or child and have a duty to act.
• Working collaboratively with social work and police on multi-agency child and adult protection activity.
• Contributing to GIRFEC and, in relation to Health Visitors holding the named person function for pre-school children, coordinating the assessment and planning for children for whom a GIRFEC response is appropriate.
• Contributing to Looked After Children and other multi-agency child and adult protection processes, including pre-birth assessment and planning, child protection Inter-agency Referral Discussions, Children's Hearings, child protection investigations, Child Protection Planning Meetings, and interim safety planning.
• Working collaboratively with the lead professional when there is a multi-agency child's plan.
• Working collaboratively with the Council Officer undertaking adult protection procedures and contributing to Case Conferences as well as the development and implementation of Protection Plans.
• Maintaining factual, accurate, concise, and up to date records.
• Contributing to ensuring that there are planned and co-ordinated transitions between age and services, particularly where there are multiple and/or complex health needs.
• Having a Protecting Vulnerable Groups (PVG) Scheme in place via Disclosure Scotland.
• Contributing to multi-agency analyses of child and adult protection data (for example the Minimum Dataset for Child Protection Committees) to identify and understand key trends in numbers of vulnerable children and adults, types of concerns, and service responses.
• Using the available qualitative and quantitative data for robust analyses of the protection landscape.

NHS staff must also comply with their regulatory body's codes of practice:

Nursing and Midwifery Council The Code: Professional standards of practice and behaviour for nurses, midwives, and nursing associates

General Medical Council Protecting children and young people – The responsibilities of all doctors

Health and Care Professions Council Standards of conduct, performance and ethics

General Dental Council Standards for the Dental Team

NHS Education for Scotland Core Competency Framework for the Protection of Children

General Pharmaceutical Council Standards for pharmacy professionals

General Optical Council Standards of practice for optometrists and dispensing opticians

The Royal College of Nursing Intercollegiate Framework Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff provides further details of required skills and competencies and applies to all healthcare staff.

Role of Health Boards in Multi-Agency Public Protection Arrangements (MAPPA)

As MAPPA Responsible Authorities, Health Boards are the lead agencies for restricted patients within the meaning of Section 10 of the Management of Offenders etc. (Scotland) Act 2005. They are responsible for both the clinical care and risk management of these patients.

As MAPPA Duty to Co-operate Agencies, Health Boards have a duty to share information which is relevant to risk for all individuals subject to MAPPA. Each Health Board should have a MAPPA health liaison officer who has responsibility for this. The MAPPA health liaison officer also represents the Board at MAPPA meetings about specific individuals and manages information which is relevant to their risk which is provided to them by other MAPPA partners. This information is used to ensure that risk is considered and, when appropriate, managed within a healthcare setting.

Health Boards also have a responsibility to contribute to MAPPA strategic planning. Each Health Board should have a nominated senior manager who attends meetings of the MAPPA Strategic Oversight Groups (the overarching governance forum in each of the 10 MAPPA regions). Senior managers also attend MAPPA meetings about specific individuals who are managed at MAPPA Level 3 (the highest level of MAPPA meeting convened involving the most multi-agency involvement).

The role of the NHS in MAPPA can be summarised as follows:

• Restricted Patients: Health Boards are the lead Responsible Authorities in terms of assessment and management of risk.
• All individuals subject to MAPPA: Health Boards share information with other agencies – receiving and giving information to help protect the public (including NHS employees, contractors, and patients) from serious harm.
• Representation and points of contact – involvement of senior staff who can cover both management and clinical issues.
• Involvement in the strategic management of MAPPA.
• Providing clinical knowledge and resources, where appropriate, to help other agencies in the assessment and management of risk of serious harm posed by sexual and violent offenders.

Health Boards have a critical role in MAPPA, and NHS employees, GP practices, and other independent contractors should be supported to be clear on their role in relation to these arrangements and be appropriately supported. For example, those who attend MAPPA meetings about specific individuals need to know what is expected of them to be able to contribute meaningfully to risk management considerations.

Local leadership, governance, and accountability

Chief Officers in the context of child and adult protection are the Chief Executives of Local Authorities, the Chief Executives of Health Boards, and Police Scotland Divisional Commanders. Chief Officers, both individually and collectively, are responsible for the leadership, direction and scrutiny of child and adult protection services and public protection more broadly. Clear ownership and accountability by Chief Officers is required to ensure that protecting children and adults at risk of harm remains a priority within and across agencies.

Chief Executives of Health Boards are responsible for ensuring that governance, accountability, and assurance reporting frameworks are in place to ensure all health staff, including those contracted, are competent in discharging their child and adult protection responsibilities.

Health Boards also have corporate responsibility for ensuring that NHS staff have access to expert professional leadership and advice from their Health Board designated public protection leads, and it is desirable for this to extend to GP practices and other independent contractors. Whilst Health Board Executive Nurse Directors often have delegated responsibility for child protection, a designated Chief/Lead Nurse or Nurse Consultant (or equivalent) should be in place in each Health Board with responsibility for child protection. This strategic role carries full-time responsibilities and should have protected time allocation. The lead doctor for child protection is usually a paediatrician who, together with the lead nurse, provides clinical leadership, advice, and strategic planning.

The Chief Officers of Health and Social Care Partnerships are accountable to the Chief Executives of the local authority and the Health Board that make up their partnership, for their role in relation to child and adult protection. These Chief Officers should be appropriately linked to local governance arrangements for the protection of children and adults at risk of harm in their area. This applies regardless of whether children's services are in the scheme of integration and whatever scheme of integration is applied. Health Board Chief Executives should be assured that clinical and care governance has a high profile, ensuring that the quality of care – including attention to child and adult protection - is given the highest priority at every level within integrated services.

Child Protection and Adult Protection Committees are the multi-agency partnerships responsible for monitoring and advising on procedures and practice, ensuring appropriate cooperation between agencies, and improving the skills and knowledge of those with a responsibility for the protection of children and adults at risk. It is crucial that health representation on Committees has sufficient seniority to represent the Health Board in discussions and decisions about policy, resources, and strategy. It is also important that the Health Board is a key contributor to local, multi-agency analyses of child and adult protection data (for example the Minimum Dataset for Child Protection Committees) to ensure that data and intelligence held by health is shared with multi-agency partners and helps build a shared understanding of local needs and service responses.

An overview of national guidance and leadership is provided at Annex A.