NHS public protection accountability and assurance framework

Annex A: National Guidance and Leadership

Child protection

Chief Officer guidance

The Protecting Children and Young People: Child Protection Committee and Chief Officer Responsibilities Guidance (2019) sets out Ministers' expectations that Chief Officers work collaboratively with regard to local arrangements for child protection, including to oversee local Child Protection Committees. It also sets out the role of the Chief Social Work Officer in providing professional leadership and supporting performance improvement and management of corporate risk. Additionally, the Chief Social Work Officer has a pivotal role to play in building strong collaborative relationships with Health Board named professional leads for child protection and other professional leads in Health and Social Care Partnerships.

National Guidance for Child Protection in Scotland 2021

The National Child Protection Guidance in Scotland 2021 was published on 2 September 2021, replacing the 2014 version and the 2012 National Guidance for Child Protection in Scotland: Guidance for Health Professionals in Scotland. Revision of the guidance has involved consultation and collaboration with a wide range of partners including a formal Scottish Government consultation. It incorporates understanding of best practice from various sources, including practitioner and stakeholder experience, inspections, research, and learning from Significant Case Reviews.

This guidance sets out the overarching responsibilities for all NHS staff and particular roles and responsibilities for staff within a range of services. The previously separate guidance for health professionals – the 'Pink Book' – has been integrated to underline the multi-agency nature of child protection and the guidance more clearly defines the role, function, and contribution of health professionals and designated services to child protection processes.

The guidance makes clear that NHS employees and contractors working with or treating adults who are parents/carers and/or significant adults must also be alert to the possibility that their patient may pose a risk to an unborn baby or child. Healthcare staff have a duty to act and must raise their concerns in line with local child protection procedures.

The guidance also notes that those experiencing trauma and adversity in childhood, in the absence of compensating protections, are at greater risk of a multiplicity of disadvantage. It states that trauma can leave those most in need of support and protection least able to develop the necessary trusting relationships to engage with health care and wider support and protection services. The need for trauma informed child protection practices is highlighted throughout, specifically in child protection assessment, planning, and interventions that avoid re-traumatising with links to the National Trauma Training Programme.

Further details of the intended outcomes of the new national guidance and key changes from the 2014 version is provided in Annex B.

Linked to the guidance, but published separately is the National Guidance for Child Protection Committees Undertaking Learning Reviews. This guidance supports Child Protection Committees to reflect, learn and improve child protection systems and practice when a child dies, is significantly harmed, or was at risk of death or significant harm, or where effective practice has prevented harm or risk of harm.

Implementation of the National Guidance for Child Protection in Scotland

Implementation of the national guidance will support greater consistency in what children and families can expect in terms of support and protection in all parts of Scotland. However, it is recognised that local structures and protocols must be attuned to local conditions and demands. This may necessitate some flexibility in local implementation, to take account of this context and need.

While a degree of local variability may be seen across the country, the Scottish Government has set out its expectation in the supporting narrative that there should be a clear alignment between local and national guidance, with an expectation that all public bodies in local areas will be able to describe the rationale for any divergent arrangements or practice within the context of their Children's Services and Corporate Parenting Plans. Public bodies will be expected to set out how their practices remain consistent with the national guidance to avoid unwarranted variation and ensure compatibility with their human rights obligations.

A National Child Protection Guidance Implementation Group has been established to provide strategic oversight and offer support to local areas. This group has strong health representation including a Health Board Chief Executive, Executive Nursing Director, clinical and nursing leads, Health Improvement Scotland, and Public Health Scotland. Resources that are currently or soon to be available to support implementation and likely areas of focus include:

• The Minimum Dataset for Child Protection Committees which supports Child Protection Committees to collect, present, and analyse data on key indicators to inform local planning and practice and discussions with Chief Officer Groups. Version 2 of the Minimum Dataset for Child Protection Committees in Scotland was published in June. This includes new key indicators, which align with the guidance and support local areas with implementation. Webinars and bespoke support for CPCs is planned.
• The Chief Officers Public Protection Induction Resource which supports effective leadership and highlights key policy, legislation, and Chief Officers' role within public protection. This resource, which has been developed in response to a request of Chief Officers for induction support, emphasises linkages in the public protection arena, supporting senior leaders to work together and offering opportunities to reflect on their local context and data.
• The development of an NHS Education for Scotland public protection national e-learning education resource to support health professionals in their child and adult protection roles. This "Once for Scotland" approach is intended to help alleviate some of the current pressures on the resources of individual Health Boards and improve consistency and access to high quality educational resources across Scotland. The aim is to enhance the patient safety culture which the NHS seeks to embed within safe, effective, and person-centred care. The specific focus on public protection is intended to build on each employee's knowledge, competence, and confidence in this area of practice and therefore support, enhance, and maximise their contribution within both a multi-disciplinary and multi-agency context.

Regular updates on the development of implementation supports will be provided to the Chief Executives Group, Scottish Executive Nursing Directors, Scottish Nursing Leadership for Child Protection, Scottish Association of Medical Directors, and Child Protection Managed Clinical Networks.

The National Child Protection Guidance Implementation Group reports to the National Child Protection Leadership Group. Membership of the National Child Protection Leadership Group, which is chaired by the Minister for Children and Young People, includes the Chief Medical Officer and Chief Nursing Officer. It also has Health Board Chief Executive and Executive Nurse Director representation.

Adult support and protection

The Adult Support and Protection (Scotland) Act 2007 provides measures to identify, support and protect certain adults who may be at risk of any type of harm, including neglect; self-harm or self-neglect; physical, psychological, sexual, financial, or institutional harm. Health Boards have duties under the Act to refer adults they know or believe to be at risk of harm and to co-operate with other agencies to aid inquiries and investigations. Additionally, the Adult Support and Protection Code of Practice sets out the roles and responsibilities of named public bodies, including health, and others in relation to supporting and protecting adults at risk of harm.

The Code of Practice has been refreshed to ensure it takes account of policy and practice developments since the Act came into operation in 2008, and brings the guidance up to date with current legislation and relevant changes in policy. The revised Code was published in July 2022.

The substantive amendments are:

• More detail about the three-point criteria in section 3 of the Act, which determines if a person is an "adult at risk" for the purposes of the Act
• Clarification on capacity and consent
• Emphasis on the duty to refer and co-operate in inquiries
• Clarification regarding information sharing expectations
• Clarification of relationship between inquiries and investigations
• New sections on referrals and related matters
• Further detail and clarification on visits and interviews
• New chapter on assessing and managing risk, including case reviews and large scale investigations
• New section on chronologies

In tandem with the refresh of the ASP Code of Practice, revisions have also been made to the Guidance for General Practice. The updated guidance provides greater clarity so that GP practices can be confident that their actions will meet safeguarding expectations and improve outcomes, whilst adhering to their professional guidelines and ethos.

Revisions to note include:

• expanded sections on information sharing
• emphasis on collaboration and co-operation
• trauma and its impacts
• types of harm, locations, and undue pressure
• the role of general practice in ASP
• the referral process – why and when

Both the revised ASP Code of Practice and updated ASP GP Practice Guidance place considerable emphasis on the need for trauma informed approaches to Adult Support and Protection practices.

The Adult Support and Protection (Scotland) Act 2007 recognises that a person may be capable of some decisions and actions and not capable of others. A person lacks capacity to take a particular decision or action when there is evidence that he/she is unable to do so. Adult support and protection applies to those with and without mental capacity. ASP legislation is relevant to those who are "unable to safeguard their own well-being, property, rights or other interests."

Health professionals may be the first professionals to see signs of potential harm,and thus a collaborative approach is vital. Participation of health staff and managers is invaluable when developing or refining local adult protection policy, procedure, and strategy. This includes contributions from GP practices.

Like Child Protection Learning Reviews, the purpose of Adult Protection Significant Case Reviews (SCR) is to learn lessons from circumstances where an adult at risk has died or been significantly harmed.

Scottish Government has revised the ASP Significant Case Review (SCR) Guidance and published National Guidance for Adult Protection Committees Undertaking Learning Reviews, aligning this with the recently published Child Protection Learning Review Guidance. The purpose of the learning review guidance is to promote consistency and to make it easier for learning to be shared. It provides a common set of objectives and criteria for establishing if a learning review is required. The guidance is designed to complement local processes. The Adult Protection Committee is responsible for deciding whether a learning review is warranted using the criteria in this framework, and for agreeing the way in which the review is conducted on behalf of the Chief Officers Group or equivalent. Some Adult Protection Committees may have an established group whose role is to oversee, on behalf of the Adult Protection Committee, matters relating to learning reviews.

Scottish Government is also working with the Care Inspectorate to identify and share learning arising from learning reviews, as well as from Initial Case Reviews and SCRs undertaken since November 2019.

MAPPA

Updated MAPPA National Guidance, which was published on 31 March 2022, provides guidance to support the Responsible Authorities in carrying out their statutory obligations under Section 10 of the Management of Offenders etc. (Scotland) Act 2005.