Southwark Safeguarding Children & Young People Key Contacts For Primary Care ​

Refer all cases of suspected child abuse (neglect, physical, emotional, sexual) via MASH except:

Acute injuries – liaise with on-call consultant paediatrician at local hospital

At immediate risk of harm – contact the police on 999​

Please use the London Safeguarding Children Thresholds guide to support referral.

Referrals

Advice and guidance

Key local agencies

NEW – Health Visitor-GP liaison protocol

GP practices are asked:

• To schedule meeting dates and times in advance with all communication going through team and nurse managers, according to locality.
• To share list of children and families to be discussed in advance of meeting to allow Health Visitors to gather updates from colleagues. Health Visitors will update practices on local service developments e.g. E-red book update and local children centre provision.
• To provide list of children under 5 years old newly registered, in response to examples of families identified via MASH/ MARAC referrals who have been in borough for extended periods but have not been known to the Health Visiting service.

New-Bright Beginnings Early Intervention Health Visiting – please see letter and referral form attached for this new service following Family Nurse Partnership decommissioning. Bright Beginnings is part of the Evelina Health Visiting Service that provides rapid assessment and enhanced support to families who have complex health and social care needs to improve health outcomes for children and families

Parents/carers/families can be referred to the service if they present one or more of the following risk criteria and have a child under the age of 2 years:

• Young parents aged 19 and under
• Significant mental health conditions (not issues of low mood alone)
• Domestic violence and abuse posing current risk or impact (including intimate partner violence, forced marriage, honour-based violence)
• Alcohol and substance misuse posing current risk or impact
• Parent with a learning disabilities or complex medical needs posing current risk or impact
• Parental history of safeguarding issues (Child Looked After, Child in Need or subject to a Child Protection Plan, gang affiliation, female genital mutilation, sexual exploitation, adverse childhood experiences) posing current risk or impact
• Concealed pregnancies posing current risk or impact

Useful documents

• Southwark Safeguarding Children Board Multi-Agency Threshold Guide
• MASH Inter-Agency Referral Form
• Multi-Agency Safeguarding Hub (MASH) Information for Professionals
• Early Help Inter-Agency Referral Form
• Family Early Help Flowchart for Primary Healthcare Workers
• Family Early Help Restructure – Briefing for GPs – December 2019
• Children’s Centres in Southwark
• CAMHS Emergency and Developing Crisis Protocol – August 2021
• Evelina London Health Visiting and GP Liaison Communication Protocol – April 2021
• Evelina London Health Visitor and Community Nursing Teams Southwark – April 2021
• Parental Mental Health Team Information
• Referral to School Nursing Sept 2020 
• School Nurses Lambeth and Southwark Allocation March 2020
• Solace Southwark (SASS) Referral Form
• Solace Southwark Poster
• Under 16 Attended Consultation With Protocol
• Printable version of Primary Care Key Contacts Safeguarding Children
• Diagrammatic record example template

Guidance on Information Sharing with link to summary from myth busting guide from Working Together 2018 and suggested wording for incomplete information requests is available below. All requests for information should contain context as to concern in order that we can review our records accordingly.

• Information Sharing and Safeguarding Children
• Child Protection Case Conferences – QUA GP Forum – December 2019
• Multi-Agency Child Protection Conference Report Template

Consent

*Good practice to discuss with a parent/carer who has parental responsibility unless this would put child/ren at risk or jeopardise an investigation 

Only share information deemed relevant to case. Remember that many professionals reading the reports will not be medical, so ensure that risks and significance of medical history are clear.

www.gov.uk/government/publications/working-together-to-safeguard-children–2

Information of factors with potential to impact parenting capacity should be considered –

General Medical Council (2018), Protecting Children and Young People: The responsibilities of all doctors Paragraphs 2, 32-38

Key Principles of information sharing

www.gov.uk/government/publications/safeguarding-practitioners-information-sharing-advice

• Necessary and proportionate
• Relevant
• Adequate
• Accurate
• Timely
• Secure
• Record

Record Keeping for Child Protection 

Child Protection Reports are as important as records of serious physical illness and should be recorded in the same way and with the same degree of permanence.

• All reports should be scanned onto the relevant child’s records.
• Appropriate coding and templates should be used in Active and Past Problem Lists and priority lists
• Child’s records should be linked in some way to parents even if not living at the same address, siblings and others in household by use of appropriate templates and codes.
• Snomed codes expressing that a child is on a Child Protection Plan should be entered into notes of all individuals living at same address.

It is vital that when a child who is or has been on a Child Protection Plan moves to another area that the full clinical record including Case Conference Reports be sent to the next GP. Therefore they must NOT be kept separate or isolated from the child’s written or computer records.

• www.rcgp.org.uk/clinical-and-research/toolkits/the-rcgp-nspcc-safeguarding-children-toolkit-for-general-practice.aspx
• Record Keeping for Child Protection Information and Case Conference Reports

Online Services for patients under 16 years and cases with safeguarding concerns.

Particular concerns surround:

• Risk of coercion in domestic abuse relationships, thereby sharing access to notes against a person’s will
• Active child protection and safeguarding cases
• Third party access by an authorised third person, consider for family members with language barriers
• Child proxy access and the point at which it is unsuitable for parents to access their child’s notes.

EMIS tools have now been developed to facilitate ‘child proxy access’ for parents with age maturity notifications.

Automated emails are sent 3 months before and on patient’s 11th notify that proxy access will be switched off.
Recommendation stands that access should not be given between ages of 11 and 16 years.

Online service guides are available at the site emisnow.com

Where safeguarding concerns exist and we feel it is not in the best interest for the patient or family at that time, access should be declined with reason documented in the notes

All primary care staff should familiarise themselves with the online visibility functions available within EMIS.

Online learning toolkits are available through RCGP and NHS England which hosts a useful FAQ document and training slides for practice use in the webinar section.

Further guidance from November 2019 available from NHS England and regularly updated from NHS Digital National Network of Named GPs Accelerating Citizen Access Dec 2023

Online access to GP health records – NHS Digital

GMC Protection Children and Young People

A ‘person with parental responsibility’ means someone with the rights and responsibilities that parents have in law for their child, including the right to consent to medical treatment for them, up to the age of 18 years in England, Wales and Northern Ireland, and up to 16 years in Scotland.

Mothers and married fathers have parental responsibility, and so do unmarried fathers of children registered since 15 April 2002 in Northern Ireland, since 1 December 2003 in England and Wales and since 4 May 2006 in Scotland, as long as the father is named on the child’s birth certificate.

An unmarried father whose child’s birth was registered before these dates, or afterwards if they are not named on the child’s birth certificate does not automatically have parental responsibility. He can gain parental responsibility by reregistering a birth, by entering into a parental responsibility agreement with the child’s mother or by getting a parental responsibility order from the courts. Married step-parents and registered civil partners can gain parental responsibility in the same ways.

Parents do not lose parental responsibility if they divorce. If a child is taken into local authority care under a care order, their parents share parental responsibility with the local authority. If the child is in voluntary care, the local authority has no parental responsibility. Parents lose parental responsibility if a child is adopted. Parental responsibility can be restricted by a court order.

Guide on Parental responsibility and consent from BMA.

Southwark Safeguarding Children’s Partnership (SSCP) holds responsibility for co-ordinating all safeguarding and child protection activity in the borough

• Policy and guidance
• Child Safeguarding Practice reviews
• Child Death Overview Panel
• Learning and improvement
• Raise local awareness

For more information please see the Southwark Safeguarding Boards website.

Child Safeguarding Practice review- formerly Serious Case reviews/Local Learning Reviews are commissioned when a child suffers serious injury of death as a results of child abuse of neglect.

Understanding not only what happened but also why things happened as they did can help to improve our response in the future. Understanding the impact that the actions of different organisations and agencies had on the child’s life, and on the lives of his or her family, and whether or not different approaches or actions may have resulted in a different outcome, is essential to improve our collective knowledge. It is in this way that we can make good judgments about what might need to change at a local or national level.

The purpose of reviews of serious child safeguarding cases, at both local and national level, is to identify improvements to be made to safeguard and promote the welfare of children. Learning is relevant locally, but it has a wider importance for all practitioners working with children and families and for the government and policy-makers. Understanding whether there are systemic issues, and whether and how policy and practice need to change, is critical to the system being dynamic and self-improving.

The process is set out in statutory guidance, Chapter 4 Working Together to Safeguard Children.

Any practice with a case will be supported by the safeguarding CCG team, throughout from initially case review to learning and recommendations.

Summary and key learning from recent reviews

Child T – a multi-agency review,15 year old girl, case of CSE,

Key learning on consistent documentation of adult accompanying children, giving children opportunity to consult alone, opportunity to identify vulnerable patients at registration and identity over use of OOH services.

Child T – Brief Summary

Child U- Serious Case Review, 16 year old boy killed following knife attack Sept 2015

Key learning on recognising impact of background of childhood trauma.

• Child U – Brief Summary
• Child U – Serious Case Review – Key Messages and Recommendations

Child V-Multi-agency review as possible ‘near miss’ for baby on Child in Need plan as parents disabled, with non-accidental injuries

Key learning on ensuing medical records for children contain details on known parental vulnerabilities.

Child V – Brief Summary

Child W – A multi-agency review following serious incident, 6 year old who told staff in his primary school he wanted to die, rapid escalation in behavioural issues.

Presented to the GP on a friday afternoon directed by the school following a significant episode, deemed a suicidal attempt. Child W’s mother is a care leaver who became pregnant at age 16 in foster care with additional vulnerabilities. We discussed events prior to his admission, the admission itself and his discharge to a full care order in a specialist residential unit.

Key learning on the emerging and developing crisis CAMHS protocol, recognition of parental vulnerability and record keeping.

Child A and B were the subject of a multi-agency thematic review and presented at a GP forum January 2021, presentation attached, with backgrounds detailing significant childhood trauma.

Key Learning- recognition of impact of childhood trauma and early neglect, all identified concerns regarding serious youth violence, gang involvement meets threshold for MASH referral.

Child A and B – Thematic Learning Review – GP Forum – January 2021

Child C – local learning review following death of Child C, 25 w old baby. Family new to Southwark during mother’s pregnancy, family previously known to social care services in other  London area

Key learning – threshold for urgent MASH referral met had previous children social care involvement been known, importance of coding child protection information in parents’ notes, risks around transient, sometimes deliberately evasive, families and importance of routine enquiry as to mood and domestic abuse during post-natal review.

Child C – Safeguarding Forum – May 2020

See section in Adult Safeguarding for details of our commissioned service Refuge, Iris Programme and MARAC (Multi-agency Risk Assessment Conferences) for high-risk cases of Domestic Abuse. Further resources available through Safelives with DASH risk assessment tool.

All identified case of domestic abuse and violence within a family environment, whether child present or not, meets threshold for a MASH referral. Remember you can call MASH for a Duty Social Worker Consultation to discuss individual cases. See Multi-Agency Threshold Guide for further details.

Domestic Violence and Abuse NICE guidance available here

Routine Enquiry: in antenatal, postnatal, reproductive care, sexual health, alcohol or drug misuse, mental health, children’s and vulnerable adults’ consultations, trained staff should ask service users whether they have experienced domestic violence and abuse. This should be a routine part of good clinical practice, even where there are no indicators of such violence and abuse.

Yuva is a new service, working with young people (age 11– 25) who have used violent or controlling behaviours towards their parents /carers or towards their girl/boyfriends. They aim to help young people to look at their abusive behaviour and find safe, non-abusive alternatives.

Read more about Yuva on the Domestic Violence Intervention Project website and in the Yuva Young People’s Service leaflet.

Contact Yuva on 020 8222 8281 or at yuva@dvip.org

All newly identified recent and historic cases of FGM for a child aged under 18 years must be referred to Children Social Care via MASH and the Police calling 101 as part of the FGM Mandatory Reporting Duty 2015

FGM comprises all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons. It has no health benefits and harms girls and women in many ways. It involves removing and damaging health and normal female genital tissue, and hence interferes with the natural function of girls’ and women’s bodies. The practice causes severe pain and has several immediate and long-term health consequences, including difficulties in child birth also causing dangers to the child.

Under the Female Genital Mutilation Act 2003 it is an offence for any person (regardless of their nationality or residence status) to:

• Perform FGM in England, Wales and Northern Ireland
• Assist the carrying out of FGM in England, Wales and Northern Ireland
• Assist a girl to carry out FGM on herself in England, Wales and Northern Ireland; and
• Assist (from England, Wales and Northern Ireland) a non- UK person to carry out FGM outside the UK on a UK national or permanent UK resident.
• Perform FGM abroad
• Assist FGM carried out abroad by a UK national or permanent UK resident
• Assist a girl to perform FGM on herself outside the UKAssist (from outside the UK) FGM carried out abroad by a non-UK person on a girl or woman who is a UK national or permanent UK resident.

Online FGM training and resources

• e-Learning for Healthcare Raising Awareness of FGM training
• Female Genital Mutilation Risk and Safeguarding – Guidance for professionals published by the Department of Health in March 2015.
• Patient Information Leaflet in English, available to order from DH Orderline in other languages and English.  Please note, all language versions are available to download on this page at NHS Choices.
• ‘A Statement Opposing Female Genital Mutilation‘ also known as the FGM Health passport, available to download from NHS Choices.
• NSPCC guide to Female Gential Mutilation
• GP practices are required to submit information under the Enhanced Dataset when treating patients who have FGM

Key documents

• Female Genital Mutilation Risk Indication System (FGM RIS) EMIS
• Asking Difficult Questions – Practical Advice for All Professionals
• Female Genital Mutilation Medical Protection Society Guidance

Sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where the young person (or third person/s) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities.

CSE can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post images on the internet / mobile phones without immediate payment or gain.
Violence, coercion and intimidation are common. Involvement in exploitative relationships is characterised by the child’s or young person’s limited availability of choice as a result of their social, economic or emotional vulnerability.
A common feature of CSE is that the child or young person does not recognise the coercive nature of the relationship and does not see themselves as a victim of exploitation.

Because of the universal nature of most health provision, health professionals may often be the first to be aware that a child may be involved, or be at risk of becoming involved, in sexual exploitation. Children involved in sexual exploitation are likely to need a range of services, including advice and counselling for harm minimisation, health promotion, advice on sexually transmitted diseases and HIV.

All identified and suspected cases of Child Sexual Exploitation meets threshold for a MASH referral. Remember you can call MASH for a Duty Social Worker Consultation to discuss individual cases. See Multi-Agency Threshold Guide for further details.

Further information is available from the London Child Protection Procedures

NHS England Pocket Guide available for Health Care Staff.

Stop it Now! UK and Ireland is a useful website for anyone with concerns about child sexual abuse.

CEOP helps keep children and young people safe from sexual abuse and grooming online. They offer help and advice to parents and carers

See ‘Child Safeguarding Practice review- formerly Serious Case reviews section’- Child T

Key documents

• Introduction to Child Health Exploitation – Southwark Health Forum 2021
• Spotting the Signs of Child Health Exploitation
• Look closer to spot and report signs of exploitation- Children Society
• Safeguarding Learning Together Week Flyer

The term Community Harm and Exploitation  encompasses Youth Violence, Child Sexual Exploitation, Criminal Exploitation and County lines

Youth violence and knife crime is a key part of the Southwark Safeguarding Children Board’s agenda for 2021/22 under the Community Harm and Exploitation work.

All identified case of concern regarding gang affiliation, criminal exploitation and violent crime in a child <18 years meets threshold for a MASH referral. Remember you can call MASH for a Duty Social Worker Consultation to discuss individual cases. See Multi-Agency Threshold Guide for further details.

Southwark’s Information, Advice and Guidance Pilot team available to contact directly, providing support pilot for parents and young people currently experiencing harm or exploitation.

Presentation on Southwark Joint Strategic needs assessment 2019 and Southwark’s Extended learning review available in documents

See ‘Child Safeguarding Practice review- formerly Serious Case reviews section’- Child U, A and B

Key documents

• Information, Advice and Guidance for Parents and Young People – Harm and Exploitation
• Community Harm and Exploitation Information for GPs
• Public Health Youth Violence Prevention – Southwark JSNA 2019
• Southwark Extended Learning Review 2019
• NHS England Violence Reduction Training – October 2020
• Child A&B – Thematic Learning Review – GP Forum – January 2021

Avenues of support

• Southwark Anti Violence Unit – 020 7525 0316
• Growing Against Violence
• PACE – Parents Against Child Exploitation
• No Knives, Better Lives
• Childline – Gangs
• Family Lives – Gangs
• Metropolitan Police – Done Something You’re Worried About?
• Young Minds
• Barnardo’s – U-Turn (Child Exploitation)
• Time to Change

A recent report called “keeping kids safe” by the Children’s Commissioner estimates that there are 27,000 children across the country who identify as a gang member; far more then previously thought. One of the most important things that GPs can do is to chat to parents if they think that a child is at risk of exploitation. Parents Against Child Exploitation (PACE) has produced a guide which gives GPs ideas about how to initiate such a conversation. The Home Office explain here exactly what the options are once a risk of child exploitation has been identified. In Southwark we have the expert support of Barnardos and the Children’s Society

Fearless is the youth branch of independent charity, Crimestoppers, where young people can access non-judgemental information and advice about crime and criminality.

They provide a safe place to give information about crime 100% anonymously. When giving information through their online form, no personal details are taken and their anonymity promise has never been broken. Professionals’ page available here.

Be Fearless Against Crime in London information sheet

The National Child Safeguarding Practice review panel recent publication ‘It was hard to escape- safeguarding children at risk from criminal exploitation available here.

Safer London’s Webinar Dec 2020 series available here.

Private fostering is where a child, under the age of 16 (under 18 if disabled) who is cared for, or proposed to be cared for, and provided with accommodation by someone other than; a parent, a person who is not a parent but who has parental responsibility, a close relative i.e. an aunt, uncle, sibling, grandparent, step parent, which excludes a cousin, a great uncle/aunt and great grandparents or a friend/neighbour for a period of more than 28 days.

A relative is defined in the Children Act 1989 as a grandparent, uncle or aunt (whether by full-blood, half-blood or by marriage or civil partnership), sibling or step-parent.

Key points of identification are patient registration, immunisations and routine GP appointments where we have the opportunity to ask key questions. Private foster carers do not hold Parental Responsibility.

All possible cases of private fostering need to be referred to the Local Authority

Private Fostering Team available 020 7525 1921 – privatefosteringadvice@southwark.gov.uk

A video guide to private fostering

CoramBaaf’s guide to private fostering

Statutory guidance on national minimum standard for private fostering

Private Fostering in Southwark information

Private Fostering in Southwark leaflet

It has been a statutory requirement since April 2008 that each Local Safeguarding Children Partnership (SCP), formerly Local Safeguarding Children Board (LSCB) must review deaths of children (under 18 years) ordinarily resident in the SCP area. These processes are outlined in the Children Act 2004 and Chapter 5 of the statutory guidance Working Together to Safeguard Children

As part of this process GPs will be required to complete reporting Form B on the eCDOP database. This process, as used by all agencies contributes to analysis of potential factors contributing to the death.

For surgeries not yet signed up to eCDOP the CDOP Administrator will first send you an e-mail explaining that a sign-up request will shortly be sent from Holistix/QES/eCDOP For further details see ‘Announcement for GPs to start using eCDOP for Reporting Forms’

Local contacts and Single Points of Access Lambeth/Southwark deaths:

Helen Turnage  (CDOP@Southwark.gov.uk, tel: 0207 525 3105)

Further information is available on the Southwark Safeguarding Board Website alongside Government guidance

• Support for parents and families.
• Child Death in Southwark – JSNA April 2019
• Child Death Pathway for GPs in Lambeth and Southwark
• Magnet Safety Alert Poster

Sudden Unexpected Death in Infancy- Sleeping on a sofa with your baby increases the risk of Sudden Infant Death Syndrome (SIDS) by up to 50 times (www.lullabytrust.org.uk)

Safer Sleep for Babies – A Guide for Parents

As a cohort these children are not receiving the health offer from the school programme or the safeguarding element to school life e.g. sex and relationship programmes, immunisations. These families are just as likely, if not more, to have vulnerabilities such a significant parental mental health, substance misuse and domestic violence and abuse. Without the safeguarding aspect of school more responsibility falls to Primary Care.

Practices are reminded to review registration forms to check if children registrations forms contain a question about school attended; this will help identify any children who are home educated

Suggested code: Home-schooled [Snomed 302139001]

Southwark Pupil Tracking and Licensing Team electivehomeeducation@southwark.gov.uk

Tel. 020 7525 0528/0428

Please find presentation from GP safeguarding Forum 2017 below covering the various aspects to elective home education, including definitions, legal aspects and the 2017 Southwark picture.

Elective Home Education in Southwark – GP Forum – December 2017

Young carers are those aged from 5 to 18 who have a significant caring responsibility for a member of their family

It is estimated that there are over 2000 young carers in Southwark, many of whom remain unknown to services.

The 2014 Children and Families Act made it a statutory duty of the LA to offer a Young Carers assessment to all those who have been identified as having caring duties.

There is far reaching impact of caring on children and young people:

• Young carers have statistically poorer educational outcomes than their peers
• They also have poorer mental health and high rates of anxiety
• They can become socially isolated, as they stay at home with the cared for parent

Imago runs the Southwark Young Carer Service, referral form available on the Imago website.

GP practices are well placed to identify young carers in their direct work with parents and carers.

• Young Carers GP Forum – July 2021
• Imago – Young Carers Referral Form

The LADO deals with allegations made against people working and volunteering with children in Southwark.  This can also include allegations in people’s private lives which can impact on a person’s suitability to work with children. The role was introduced following the Bichard Inquiry published in 2004.

Further details in statutory  and local guidance and procedure including Chapter 2 of Working Together to Safeguarding Children, Chapter 2 of the London Children Protection Procedures and Southwark local authority website.

Allegations can be made in relation to physical chastisement and restraint but can also relate to inappropriate relationships between members of staff and children or young people, for example

• Having a sexual relationship with a child under 18 if in a position of trust in respect of that child, even if consensual (see s16-19 Sexual Offences Act 2003);
• ‘Grooming’, i.e. meeting a child under 16 with intent to commit a relevant offence (see s15 Sexual Offences Act 2003);
• Other ‘grooming’ behaviour giving rise to concerns of a broader child protection nature e.g. inappropriate text / e-mail messages or images, gifts, socialising etc;
• Possession of indecent photographs.

In addition, when there is an allegation that any person who works with children has behaved in a way in their personal life that raises safeguarding concerns:

• These concerns do not have to directly relate to a child but could, for example, include arrest for possession of a weapon;
• As a parent or carer, has become subject to child protection procedures;
• Is closely associated with someone in their personal lives (e.g. partner, member of the family or other household member) who may present a risk of harm to child/ren for whom the member of staff is responsible in their employment/volunteering.

Types of disclosures GP may get:

• Historic allegations – an adult making a disclosure about childhood abuse eg. abuse suffered whilst in care
• Remember recent historic abuse from young adults could suggest the person the allegation is about is still working with children
• Parents/carers bringing a child to the GP because they are worried their child is being abused at nursery or school
• If you are working with a patient who works with children
• Worries about colleagues

Contact Southwark’s LADO to discuss any potential cases for referral.

Eva Simcock  0207 525 0689 / 07943 076608 Eva.Simcock@southwark.gov.uk

Allegations Against Adults Who Work or Volunteer with Children – The LADO role