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Childrens safeguarding

CCG Safeguarding Team

Herts Valleys Clinical Commissioning Group (CCG) is fully committed to our responsibility for protecting and safeguarding children and young people. We have a number of Designated Safeguarding Professionals who play a role in decision making. We also work in partnership with Hertfordshire Safeguarding Children Partnership (HSCP) which oversees policy development.

All staff are required to adhere to Safeguarding Children policies and guidance. Hertfordshire Safeguarding Children Partnership procedures can be found at http://hertsscb.proceduresonline.com/index.htm

Our principal philosophy is that safeguarding is everybody’s business and all staff will respond and act to raise safeguarding awareness and address any emerging issues. This includes all commissioning intentions, services commissioned and contractual arrangements. The organisation will hold to account all provider organisations contracting with the CCG regarding their safeguarding responsibilities and processes. We ensure that commissioned organisations have safe systems that safeguard children in line with section 11 of the Children Act (2014), including; clear accessible policy and procedure, safer recruitment, training and governance systems.

Herts Valleys CCG has approved a number of strategic documents to support safeguarding within the NHS, including:

The Safeguarding Children, Looked after Children and Care Leavers Annual Report for 2016/17 is now available

Safeguarding Children and Young People

Herts Valley Clinical Commissioning Group (CCG) is fully committed to our responsibility for protecting and safeguarding children and young people. We have a number of Designated Safeguarding Professionals who play a role in decision making. We also work in partnership with Hertfordshire Safeguarding Children Partnership (HSCP) which oversees policy development.

All staff are required to adhere to Safeguarding Children policies and guidance. Hertfordshire Safeguarding Children Partnership procedures can be found at http://hertsscb.proceduresonline.com/index.htm

Hertfordshire Safeguarding Children Partnership

Our principal philosophy is that safeguarding is everybody’s business and all staff will respond and act to raise safeguarding awareness and address any emerging issues. This includes all commissioning intentions, services commissioned and contractual arrangements. The organisation will hold to account all provider organisations contracting with the CCG regarding their safeguarding responsibilities and processes. We ensure that commissioned organisations have safe systems that safeguard children in line with section 11 of the Children Act (2014), including; clear accessible policy and procedure, safer recruitment, training and governance systems.

CCG Safeguarding Children Team

Herts Valley CCG has Designated Professionals that have specific roles and responsibilities for safeguarding children and promoting the health of looked after children. They take a professional and strategic lead on all aspects of the health service contribution to safeguarding children. For support with any safeguarding children concerns contact the designated professionals:

  • Designated Nurse Safeguarding Children - via 01707 685349

  • Deputy Designated Nurse Safeguarding Children - via 01707 685349

  • Primary Care Nurse Specialist Safeguarding Children - via 01707 685349

  • Deputy Designated Nurse Looked After Children and Care Leavers - via 01707 685349

  • Designated Doctor, HV CCG on 01923 470 606

  • Designated Doctor Child Death on 01438 781455  

     

What to do if you are concerned about a child?

The guidance below is for anyone whose work brings them into contact with children and families, including those who work in early years, social care, health, education (including schools), the police and adult services. It is relevant to those working in the statutory, voluntary or the independent sector, and applies in relation to all children and young people irrespective of whether they are living at home with their families and carers or away from home.

You should make sure that you are alert to the signs of abuse and neglect, that you question the behaviour of children and parents/carers and don’t necessarily take what you are told at face value. You should make sure you know where to turn to if you need to ask for help, and that you refer to children’s social care or to the police, if you suspect that a child is at risk of harm or is immediate danger.

Whether you are a parent, concerned resident or a professional, you can find out more on the Hertfordshire Safeguarding Children Partnership (HSCP) website

Click here to report concerns about a child or request support.

More information:

If you have any reason to suspect that a child is not being treated appropriately or their welfare is at risk contact:

 Call 999 if they are in immediate danger or if a crime is being committed.

Children’s Services - 0300 123 4043 – call any time if you're a child or young person being abused.

NSPCC Child Protection Helpline 0808 800 5000

Childline on 0800 1111

 

Child Sexual Exploitation

Child Sexual Exploitation (CSE) is a form of sexual abuse that involves the manipulation and/or coercion of young people under the age of 18 into sexual activity. 

It relates to situations where a young person is manipulated or forced into taking part in some form of sexual activity in return for something the young person needs or desires, for example; attention, a sense of belonging, affection, money, drugs, alcohol or accommodation.

Sexual exploitation is child abuse and, although they may not realise it, it puts the young victim at huge risk of damage to their physical, emotional and psychological health. 

The impact of Child Sexual Exploitation can have a devastating effect on the lives of victims. It is known that children and young people who have experienced sexual exploitation have poor health outcomes. The health impact is varied, with victims experiencing many forms of physical, psychological and emotional health difficulties.

There are a number of different forms in which CSE can present itself; these can range from:

  • Internet sexual exploitation

  • Sexual exploitation at house parties and the movement of young people for the purpose of sexual exploitation.

  • Offenders grooming youngsters and using their power to sexually abuse them. 

  • It can take many forms, whether it occurs through a seemingly ‘consensual’ relationship with an older boyfriend, or a young person having sex in return for attention, gifts, alcohol or cigarettes.

    Many young people who are being abused do not realise they are at risk and will not call for help. They may see themselves as willing participants when in fact their behaviour is anything but consenting.

    The CCG has been working with local health providers to ensure they have processes in place to safeguard children at risk of CSE. Health professionals who provide support for young people have been receiving training to raise awareness and to spot the signs of CSE.

    We are increasingly improving our services to help identify children who are at risk of being sexually exploited and we are working together with partner agencies to safeguard and protect these children. 

    If you are concerned about CSE for yourself or somebody else please contact the police on the telephone 101 or Children’s Services on 0300 1234043.

    For more general information on CSE go to the following links:

On line Safety

Children and young people spend a lot of time online – it can be a great way for them to socialise, explore and have fun. But children do also face risks like cyber bullying or seeing content that's inappropriate.

The information within the link below can help parents and carers understand what children do online and the risks they face and will help keep children safe online.  

https://directory.hertfordshire.gov.uk/kb5/hertfordshire/directory/service.page?id=VcNCOAoCcBw

 

Radicalisation and Extremism

Hertfordshire’s Prevent strategy aims to reduce the threat to the United Kingdom from terrorism by stopping people becoming terrorists or supporting terrorism. The most significant threats are currently those associated with organisations such as Islamic State in Syria and Iraq, and Al Qaida associated groups. However, extremism associated with the far right also poses a continued threat.

Channel is part of the local Prevent strategy and is a multi-agency approach to identify and provide support to individuals who are at risk of being drawn into terrorism.

Channel is a programme which focuses on providing support at an early stage to young people and adults who are identified as being vulnerable to being drawn into terrorism. The programme uses a multi-agency approach to protect vulnerable people by:

1.       Identifying individuals at risk;

2.       Assessing the nature and extent of that risk; and

3.       Developing the most appropriate support plan for the individuals concerned.

Channel may be appropriate for anyone who is vulnerable to being drawn into any form of terrorism. Channel is about ensuring that vulnerable children and adults of any faith, ethnicity or background receive support before their vulnerabilities are exploited by those that would want them to embrace terrorism, and before they become involved in criminal terrorist related activity.

Success of the programme is very much dependent on the co-operation and co-ordinated activity of partners. It works best when the individuals and their families fully engage with the programme and are supported in a consistent manner.

Hertfordshire’s Prevent strategy aims to reduce the threat from terrorism by stopping people becoming terrorists or supporting terrorism.

Channel is part of the local Prevent strategy and is a multi-agency approach to identify and provide support to individuals who are at risk of being drawn into terrorism.

 Let’s talk about it is an initiative designed to provide practical help and guidance to the public in order to stop people becoming terrorists or supporting terrorism

https://www.ltai.info/

 

Female Genital Mutilation

The CCG Safeguarding Children Team and Primary Care Team have worked with a senior Social Worker from Barnardos to design and create a Multi-Agency Care Pathway for Female Genital Mutilation (FGM) in Hertfordshire. The Pathway contains information in relation to health implications, prevalence, the legal framework, care pathways for adult and child and a multi-agency screening tool. Launch events organised by Hertfordshire Clinical Commissioning Groups (CCGs) and the Hertfordshire Safeguarding Children Partnership (HSCP) took place in September 2017.

Hertfordshire Multi Agency FGM Pathway

Resources:

National FGM Centre

Modern Slavery

The Modern Slavery Act 2015 has introduced changes in UK law focused on increasing the transparency in supply chains and ensuring our supply chains are free from modern slavery (that is slavery, servitude, forced and compulsory labour and human trafficking). As both a local leader in commissioning health care services for the population of west Hertfordshire and as an employer, Herts Valleys CCG provides the following statement in respect to its commitment to, and efforts in, preventing slavery and human trafficking practices in the supply chain and employment practices.

Our organisation

As an authorised statutory body, the CCG is the lead commissioner for health care services (including acute, community, mental health) in the West Hertfordshire area (including Watford, Dacorum, St. Albans & Harpenden and Hertsmere) covering a population of 639,566.

Our commitment to prevent slavery and human trafficking

The CCG Board, Senior Management Team and all employees support the Government’s objectives to eradicate modern slavery and human trafficking and recognise the significant role the NHS has to play in both combatting it and supporting victims. We are committed to ensuring our supply chains and business activities are free from ethical and labour standard abuses and in so far as is possible to holding our suppliers to account to do likewise.

Our approach

Our overall approach will be governed by compliance with legislative and regulatory requirements and the maintenance and development of good practice in the fields of contracting and employment.

Our policies and arrangements

Our recruitment processes are highly mature; requiring practices that adhere to safe recruitment principles. This includes strict requirements in respect of identity checks, work permits and criminal records. We pay all our employees above the minimum wage.

Our policies such as Bullying and Harassment at Work policy, Safeguarding Adults at Risk policy, Individual Grievance policy, Equality and Diversity policy and Whistleblowing policy provide an additional platform for our employees to raise concerns about poor working practices.

Our procurement approach follows the Crown Commercial Service standard.

In 2017/18 our anti-slavery programme will also work to:

•            Support our staff to understand and respond to modern slavery and human trafficking; the impact that each and every individual working in the NHS can have in keeping present and potential future victims of modern slavery and human trafficking safe.

•            Ensure that all NHS commissioned services staff have access to formal training on modern slavery and human trafficking which will provide the latest information and skills to deal with it.

 Modern Slavery: Further information and resources

Modern slavery is a growing problem globally and the scale of modern slavery in the UK is significant. It can take many forms, including the trafficking of people, forced labour and servitude.

Here in Hertfordshire, 119 potential victims have been identified as victims since 2009.

Operation Tropic was launched by Hertfordshire Constabulary as a dedicated police unit to coordinate the response to modern slavery in Hertfordshire.

Information about the Hertfordshire Modern Slavery Partnership and Operation Tropic:

Hertfordshire Police and Crime Commissioner: http://www.hertscommissioner.org/modern-slavery

Operation Tropic: http://www.shivafoundation.org.uk/operation-tropic-coordinated-response-modern-slavery-hertfordshire/

 Human Trafficking Organisations:

Home Office (www.modernslavery.co.uk)

Human Trafficking Foundation (www.humantraffickingfoundation.org/what-human-trafficking)

Unseen (www.unseenuk.org)

Salvation Army (www.salvationary.org.uk/human-trafficking)

British Red Cross (www.redcross.org.uk/who-we-are/modern-slavery/)

National Crime Agency (www.nationalcrimeagency.gov.uk/crime-threats/human-trafficking)

Shiva Foundation (www.shivafoundation.org.uk)

RCN MODERN SLAVERY POCKET GUIDE (https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/publications/2017/may/pub-005984.pdf)

 Additional Resources – Educational Videos:

Anti-Slavery Commissioner: www.antislaverycommissioner.co.uk/resources

Home Office: www.youtube.com/watch?v=yOe2-j3QzKl

National Crime Agency: https://www.youtube.com/watch?v=Cej6avHPIbg or https://www.youtube.com/watch?v=ew4TA0_daB0

Crimestoppers: www.youtube.com/watch?v=3C9VwiCP2bQ 

Gangmasters & Labour Abuse Authority: www.gla.gov.uk/publications/resources/glaa-videos

 Identifying Modern Slavery Victims:

https://www.modernslaveryhelpline.org/learn-more/general/spot-the-signs

 

Safeguarding Children in Primary Care

General practitioners (GPs) and primary healthcare teams are best placed to spot the early signs of child abuse and neglect. They have an overview of issues affecting individual members of a family which, in combination, may impact on a child’s welfare. They are also in a position to co-ordinate the work of different agencies supporting children and families NSPCC (2015). Learning for Primary Care teams from Serious Case Reviews following poor outcomes for children, whilst highlighting areas of good practice, also identify areas where safeguarding practice may be improved. An NSPCC summary of key learning for Primary Care can be accessed here.

Useful resources:

Nigel's surgery: Clearing up some common myths about our Care Quality Commission inspections of GP and out-of-hours services and sharing agreed guidance to best practice can be accessed here.

Brook Sexual Behaviour Traffic Light Tool: This tool supports professionals working with children and young people by helping them to identify and respond appropriately to sexual behaviours.

The tool uses a traffic light system to categorise the sexual behaviours of young people and is designed to help professionals:

  • Make decisions about safeguarding children and young people

  • Assess and respond appropriately to sexual behaviour in children and young people

  • Understand healthy sexual development and distinguish it from harmful behaviour

     

Training

Safeguarding children training is provided by Hertfordshire Safeguarding Children Partnership (HSCP) for professionals and volunteers.

The HSCP provides a wide variety of learning programmes and workshops across Hertfordshire to build skills for safeguarding children and young people.

Inter-agency training supports staff in:

  • sharing practice

  • understanding each other’s roles and responsibilities

  • working effectively both within and across organisations.

    The current available training can be accessed here

Examples of 'you said, we did'  

You said

We did

You said (again)

What difference did it make?

Patients and residents wanted the refresh of the strategic outline case (SOC) for hospital redevelopment to be comprehensive and to re-evaluate options relating to a new build hospital on a new site (even though those options had been discounted by the SOC submitted in 2017).

 

To view the full engagement report here

 

We carried out a more detailed refresh than NHSE/I had asked us to.

 

The refresh full retested the original SOC by looking again at various options, including building a new main A&E hospital on a new site, which formed part of an initial longlist. We analysed these options based on factors such as affordability and deliverability.

 

We carried out an extensive programme of communications and engagement to inform the refresh. This explained the process we were following.

As part of the public engagement patients shared their views. This told us:

·       Easy access to hospital facilities (including parking provision at Watford) remains important for residents.

·       Any hospital development must be able to meet future demands arising from new homes being built in west Herts.

·       Enthusiasm in some areas of west Herts (especially in Dacorum and in St Albans to a lesser extent) for a new centrally located hospital.  In other areas there was broad support for development scheme proposed in 2017 SOC.

·       Agreement from all sides that current condition of Watford General Hospital site is unsatisfactory. 

·       Having looked at and costed all options we concluded that redeveloping Watford as the main A&E hospital remained the only viable option within financial parameters.  

·       The refreshed SOC put forward a proposal to prioritise investment at WGH as this would have greatest beneficial impact overall for patients. We are aiming to make Watford look and feel like a new hospital within available finances.

·       Improved visitor parking at WGH will be the first development to take place on the site.

·       HVCCG and West Herts Hospitals NHS Trust have committed to work with the local councils and local transport providers to explore whether improvements can be made to public and community transport access to our hospitals.

·       The plan for WGH leaves space to create new buildings in future years should population growth create additional demand. 

·       We secured funding from the government based on the redevelopment plans we put forward in the SOC.

 

Some patient focussed information and communication is not written for a public audience and is not easy to understand.

We developed our reader panel to review all patient focussed information to ensure it is fit for purpose:

 

 

 

All patient / public focussed information is reviewed by the reader panel to check for easy read, plain English and clear.  This has included consultation material, patient letters, changes to service provider and medication.

Example

Information on over the counter medicines, shortages and stockpiling medication was shared with the reader panel to review

·       Change wording of community pharmacy  which is not recognised by the public to local chemist

·       Change positioning of information to ensure key messages  to increase impact

·       Increase font size for easier read and correction of  typos and grammar

 

·       Information amended according to feedback

·       Helping to ensure that any patient / public facing information is clear, non-ambiguous and easy to read

Practices and their patient groups highlighted the need for additional funding to support their group activities

Working with patients, Healthwatch Hertfordshire, lead GP,  practice managers and our patient group network we have agreed an incentive scheme to encourage development of groups with a payment to support activities

·       Include patient group members in assessment process

·       Provide clarity on whether the funding has to be used for patient group activities

·       Provide guidance on how to develop patient groups

·       Incentive scheme amended in line with feedback

Patients who have been involved in service redesign, procurements and other CCG activities have suggested lessons could be learnt from their experience of involvement

We have set up a focus group in 2020 with patient representatives and staff to review how we recruit and support patient volunteers– to learn from your experience and make improvements where necessary.

 

D

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Our PPI committee and local patient groups raised concern about lack of engagement with younger people as future users of the NHS

We have worked with our primary care nursing team and West Herts College to develop a session for their health and social care students. This includes an introduction to the NHS, information on local services, getting the students to think about their experiences and what good communication looks like

Feedback from the students following the sessions are here

·       Raised awareness with young people  of local health services

·       Session structure revised in accordance with feedback

Concern that provider services were not aware of what is expected from them in terms of patient participation when changes are proposed

Working with colleagues, NHS England and our patient and public involvement committee information on to be added to new contracts for 2020 to provide guidance.

Information to be added to 2020 shared with PPI committee for comment

·       Ensure early patient involvement  and communication when any changes are being proposed

Clear information on two week wait cancer referrals is needed to raise awareness of the importance of attending the appointment, an early diagnosis and treatment

Working with the lead Macmillan nurse,  patient information on initial referral by a GP on urgent two week wait pathway was drafted.

 

A focus group of public, experts by experience, carers and health professionals reviewed the information

·       Ideally leaflet should be printed in colour but equally clear if printed in black and white

·       Consider A5 booklet

·       Too much repetition

·       Use ‘gentle’ words with more consistent approach (questions/answers)

·       Change ‘prioritise’ to ‘very important’

·       Title too long, too many capitals: delete ‘suspected cancer’

·       Clarity that ‘other support’ can be accessed and useful within 2 week wait

·       Confirmed that ‘can I bring someone with me’ section is useful but could be shortened

·       Consider using FAQ approach to the information

·       Use ‘successful’ rather than ‘effective

·       Consider using symptoms / questions reminder box

·       Some disagreement re the use of the diagram – get rid of it or make bigger and put on A5 back page

 

·       The leaflet was amended based on all the feedback and distributed to GP practices in West Herts to give to patients

Following a brief introduction to GP group consultations  patient group network members requested a more detailed session to include GPs, practice managers and patients

On 18 July a co-creation event was included  nearly 50 primary care clinicians, GP practice staff and patients from local patient participation groups  to learn about group consultations and set a shared ambition for the benefits that could be realised by their introduction  in 18 months’ time.

In response to the question,

“In 18 months’ time, when group consultations are up and running, what will be different for….”

 

Discussions at the meeting summarised a co-created ambition, incorporating the feedback themes and produced a narrative to underpin the change that needed to be put into place to support the introduction of GP group consultations.

 

More detailed notes of the discussions are here

 

 

Information on the group consultations was shared with GP practices and practice patient groups.

 

Dr Jon Landy, Consultant Gastroenterologist at West Herts Hospitals NHS Trust asked for comments on proposed research project into bowel cancer testing

Information was sent widely through our patient networks and comments were invited on:

1.      If patients supported the study, felt it was important and had potential to enhance patient experience

2.      If there were aspects they felt should be changed so that it was better from a patient viewpoint

3.      Suggestions to improve the patient information sheet (PIS) that would make information more accessible to patients

Patients fed back to Dr Landy, with a number of suggestions based on the questions posed

·       The feedback suggested that the study was reasonable regarding patient experience and no changes were necessary to study procedures that were set out to minimise any discomfort or risk to participants

·       the protocol would not be shared with patients as it was considered too technical but the patient information sheet was useful

·       Descriptions and explanations of polyps and colonoscopy  were added to the PIS

 To view more information  here

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