NHS public protection accountability and assurance framework

Exemplar evidence for Health Boards

The following section sets out exemplar evidence of high-quality, safe, and effective services that promote the protection of children and adults for territorial Health Boards. Some aspects of this evidence will also apply to Special Health Boards. We recognise that some examples provided do not apply equally to all employees and contractors due to varying contractual and management arrangements, in particular with regard to independent general practices.

Chief Executives should consider whether this evidence is reflective of the public protection arrangements in their Health Board, and where further focus is required as part of ongoing development and quality assurance processes.

1. An executive Health Board lead has overall responsibility for child protection, adult protection, and MAPPA and champions public protection across the Health Board and contracted services.

Evidence

• This lead is up to date with their public protection training, has public protection responsibilities reflected in their job description, and participates in relevant Chief Officer and Committee meetings.
• It can be shown that the executive lead promotes a positive culture of safeguarding children (including unborn babies) and adults at risk of harm.
• This lead ensures that local governance arrangements for the protection of children and adults at risk of harm in their area support Chief Officers of Health and Social Care Partnerships.

2. Lead clinicians are resourced and supported to provide advice, expertise, and professional leadership across the Health Board and contracted services.

Evidence

• There is a Chief/Lead Nurse or Nurse Consultant (or equivalent) for child protection. There is a Chief/Lead Nurse or Nurse Consultant (or equivalent) for adult support and protection. If this role is combined it must be shown that the nurse is able to undertake duties within their Health Board area. It can be shown that the Chief/Lead Nurse(s) or Nurse Consultant(s) take the professional lead on all aspects of the health contribution to safeguarding and are central to the Health Board's clinical and care governance processes for public protection.
• In Health Boards providing care to children, there is a Lead Paediatrician for child protection directly employed or contracted through a Service Level Agreement to provide expertise to the Board.
• The Lead Paediatrician and Chief/Lead Nurse or Nurse Consultant (or equivalent) have job descriptions which clearly define their roles, responsibilities, and expectations. They have sufficient protected time and support to carry out their duties and responsibilities.
• There is a designated Health Board Trauma Champion who supports the ongoing development of trauma-informed practice across all services. This role may be undertaken by the Chief/Lead Nurse or Nurse Consultant (or equivalent) in Special Health Boards and smaller territorial Health Boards.
• There is a process in place to monitor the workload of Health Board lead clinicians with a clear reporting mechanism to the executive Health Board lead.
• The Chief/Lead Nurse(s) or Nurse Consultant(s) and Lead Paediatrician have a high degree of visibility across Health Board and contracted services. They are responsible for preparing a child and adult protection annual report for the Health Board to provide assurance that the Board is meeting its obligations in respect of child and adult protection in line with national guidance which highlights areas for improvement.
• Lead clinicians have access to regular supervision appropriate to their role.
• The Chief/Lead Nurse or Nurse Consultant (or equivalent) for adult support and protection has access to relevant resources and support, including links with the NHS Adult Support and Protection Leads Network.

3. All NHS employees, GP practices, and independent contracted practitioners are supported and directed to the actions they need to take when a child or adult is at risk of harm.

Evidence

• The role of Health Board lead clinicians is communicated and understood throughout the Board and contracted services. All employees, GP practices, and independent contracted practitioners know where and when to seek advice, support, and supervision at an appropriate level for their role.
• Public protection protocols and guidance are up to date, aligned with national guidance, and accessible to all employees, GP practices, and independent contractors; information regarding where these protocols and guidance documents can be found is communicated to all.
• Health Board information sharing guidance and advice, including on sharing information during the pre-birth period, is accessible to all employees and contractors. Records are maintained in line with this advice. There are Caldicott Guardians who can advise on sharing information about children and adults at risk of harm.
• There is a mechanism to monitor awareness and understanding of public protection responsibilities and duties including the duty to refer.
• There are arrangements in place to monitor timescales for actions required as part of public protection processes, including the health contribution to Inter-agency Referral Discussions (IRDs), Child Protection Planning Meetings, Adult Protection Case Conferences, MAPPA case review meetings, and reports requested by the Scottish Children's Reporter Administration (SCRA), in line with national guidance. There is a clear reporting mechanism on performance to the executive Health Board lead.
  
• There is evidence that transitions between age and services, including the Scottish Ambulance Service and NHS 24, particularly where there are multiple and/or complex health needs, are planned and co-ordinated.

4. The Health Board promotes a children's rights-based approach and a culture of listening to children and young people and taking account of their wishes and feelings, both in individual decisions and in the development of services.

• The Health Board can evidence how it meets its statutory duties (including safeguarding and promoting the welfare of children) under the Children (Scotland) Act 1995, which provides a major part of the legal framework for child welfare and protection in Scotland. The Health Board can also evidence how it satisfies its duties under Part 1 of the Children and Young People (Scotland) Act 2014, which embeds duties on public authorities, and can demonstrate how they have secured the better or further effect within its areas of responsibility of the UNCRC requirements.
• Service planning and delivery is developed with an understanding of the evolving capacities of children and young people in relation to decisions which affect them.
• Feedback from children and young people is sought on matters affecting them and used to inform service planning and delivery (Service User feedback), in line with Article 12 of the UNCRC (children and young people have a right to express their views on matters affecting them and for those views to be given due weight).
• The outcomes of individual decisions are evaluated from the perspective of Article 3 of the UNCRC which states that the best interests of the child shall be a primary consideration.
• Complaint procedures are child friendly and adapted according to age, level of maturity, and understanding.
• Support and advocacy are available for children and young people who do not feel their full range of rights, under the UNCRC and otherwise, are being fulfilled.

5. Robust governance, accountability, assurance, and reporting arrangements for public protection are in place across Health Board services.

Evidence

• The Health Board has clear written governance, accountability, and assurance frameworks for public protection that apply to all services, both provided and commissioned. These frameworks link to Scottish Ambulance Service and NHS 24 public protection arrangements. Public protection governance processes and systems apply to IJBs and are embedded in wider Health Board governance arrangements.
• Reporting arrangements enable organisational assurance that all NHS employees and contractors are supported in accessing relevant learning and education appropriate for their role and scope of professional practice.
• There are arrangements to monitor compliance with safer recruitment procedures and selection procedures in relation to children and adults, including Protecting Vulnerable Groups (PVG) scheme membership.
• Guidance and support are in place for employees, GP practices, and independent contractors raising child and adult protection concerns. Audit shows that policy and procedures are adhered to.
• There are clear governance arrangements and processes in place to determine the appropriate review process when the Board is notified about the death of a child or adult who was subject to Adult Support and Protection measures.

6. Education, learning, and development arrangements support all NHS employees, GP practices, and independent contracted practitioners in their public protection roles and responsibilities.

Evidence

• There is an organisational training plan or strategy that ensures all employees and contractors are competent to carry out their public protection responsibilities in line with national guidance.
• All employees and contractors have undertaken training at an appropriate level for their role and area of practice, including the NES eLearning modules to support health professionals in their child and adult protection roles (available on Turas Learn). There is a mechanism in place to ensure that training is up to date.
• An education and learning framework supports all employees and contractors to build confidence and competence in discharging their duty to safeguard and protect children and adults. This framework also supports all employees and contractors to build confidence and competence in taking a children's rights-based approach.
• Safeguarding training is available on a single and multi-agency basis, accessible to all noted above.
• Senior managers monitor attendance and non-attendance at training.
• Public protection is a mandatory aspect of induction for all employees, GP practices, and contractors, with access to child and adult protection supervision at an appropriate level for their role to support continuous professional development.
• All NHS employees and contractors are trained to the appropriate level, dependant on their role, in line with the Transforming Psychological Trauma Knowledge and Skills Framework, using guidance in the Scottish Psychological Trauma Training Plan.
• NHS employees and contractors are aware of, and suitably skilled, to fulfil their duties in relation to the rights of children and adults.
• All NHS employees and contractors working with children or parents have a clear understanding that young children can be especially vulnerable as they are (often) not able or in a position to verbalise or explain concerns or distress personally.
• All NHS employees and contractors are clear about the interaction of the National Hub for Reviewing and Learning from the Deaths of Children and Young People with other review processes.

7. Strategic and operational arrangements between the Health Board and its multi-agency partners support effective joint working and communication.

Evidence

• There is appropriate and consistent Health Board representation on Chief Officer Groups and Child Protection/Adult Protection/Public Protection Committees with specified reporting mechanisms to the Health Board.
• There is appropriate health representation in Inter-agency Referral Discussions (IRDs), Child Protection Planning Meetings, Adult Protection Case Conferences, Learning Review meetings, and MAPPA Strategic Oversight Group and case review meetings, in line with national guidance. There are systems in place to allow clinicians including, for example, midwives, paediatricians, health visitors, family nurses, and GPs to attend when appropriate. Support and guidance are provided to Board representatives attending these meetings.
• Protocols and guidance are in place to support effective multi-agency working, including Special Health Boards where relevant. This includes that the Health Board can demonstrate its contribution to training and multi-agency audit.
• There are clear arrangements and processes in place to determine the appropriate review process when the Health Board is notified about the death of a child or adult who was subject to Child Protection or Adult Support and Protection measures. There is a process in place for staff to contribute to work across organisations and agencies to undertake one single review wherever this is possible. There is a process in place to notify relevant agencies or bodies if a Health Board-led review is undertaken that may have relevance for wider needs and risk assessment, as well as learning.
• There is a process in place for learning from child and adult protection reviews, including Significant Case Reviews, Learning Reviews, Significant Clinical Incident Reviews, and Significant Adverse Event Reviews, and from inspection findings. Learning is shared across the Health Board and contracted services.
• Health engagement in all risk assessment processes is monitored and reviewed with a clear reporting mechanism to the executive Health Board lead.
• There are clear whistleblowing procedures and a policy for dealing with complaints against employees and contractors.
• The Health Board has clear information sharing guidance which sets out the process and principles for sharing information, relevant to safeguarding and promoting the wellbeing of children and vulnerable adults. This includes guidance on handling and storage of information and records, including responding to requests made under Section 10 of the Adult Support and Protection Act 2007 (Councils may, in certain circumstances, request health records relating to an individual's physical or mental health). Information sharing guidance is accessible to practitioners.
• The Health Board ICT systems allow sharing of information about children and adults for whom there are concerns, and ICT systems allow flagging where there is a concern. Audit work demonstrates public protection learning is disseminated and acted upon.
• 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.
• When the Board is notified about the death of a child or adult who was subject to Adult Support and Protection measures, there is a process in place to notify relevant agencies or bodies, including those leading on Adult Support and Protection activity, if a Board-led review is undertaken which may have relevance for wider needs and risk assessment, as well as learning.

8. The Health Board provides an effective medical response for children and adults in need of assessment and care.

Evidence

• Arrangements are in place to provide assessment for child abuse and neglect, including joint paediatric/forensic medical assessment examinations (JPFE) when required.
• Medical assessments are conducted in line with sections 9 and/or 11 of the Adult Support and Protection (Scotland) Act 2007 where a Council Officer knows or believes a person is an adult at risk of harm. The assessment may be conducted under an assessment order, if the court has granted an order for a health professional nominated by the council to conduct a private medical examination of the specified person.
• Assessment and care arrangements draw on best practice contained in the Child Protection Scottish National Clinical Guidelines.
• There are clear assessment pathways for accessing assessments of capacity to contribute to protection decisions, including decisions relating to the use of Adult Support and Protection, Adults with Incapacity, and/or Mental Health (Care and Treatment) (Scotland) Act 2003 legislation.
• There is access to appropriately trained medical staff during out of hours periods when there is a requirement for paediatric examination, medical assessment, or a JPFE.
• Processes are in place within Emergency Departments and acute receiving units to respond to suspected abuse and neglect of children and vulnerable adults, with appropriate information sharing mechanisms to support clinical staff and named persons to work in line with Getting it right for every child/everyone.
• Medical assessment and care responses are monitored and reviewed with a clear reporting mechanism to the executive Health Board lead.