On 15 April 2013, the new Working Together To Safeguard Children (2013) came into force. This document should be complied with unless exceptional circumstances arise and it replaces:

  1. Working Together to Safeguard Children (2010)
  2. The Framework for the Assessment of Children in Need and their Families (2000)
  3. Statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004 (2007).

Background

This new statutory guidance comes as a result of recommendations made by Professor Munro in her review of child protection, which followed the death of Baby P. She found that excessive red tape was hindering social workers’ ability to focus on children’s needs. She recommended that the statutory guidance be streamlined. The new guidance condenses around 700 pages of guidance into 97 pages.

It is divided into five easy to read chapters on:

  1. Assessing need and providing help
  2. Organisation responsibilities
  3. Local Safeguarding Children Boards
  4. Learning and improvement framework
  5. Child death reviews

There is also a helpful table at Appendix B setting out which bodies are covered by key duties.

Changes include:

  1. Removing the requirement to have a separate initial and core assessment of children in need. The 10-day target to complete initial assessments is also removed.
  2. Introducing a new national panel of independent experts to advise Local Safeguarding Children Boards (LSCBs) about the initiation and publication of SCRs.

The statutory guidance should be read by senior managers within organisations who commission and provide services for children and families, including professionals from health services. We have set out below some of the key points in the guidance for healthcare professionals to be aware of.

Early help

Providing early help is identified as being more effective in promoting the welfare of children than reacting later. Health professionals have a key role to play in identifying children who might benefit from early help. They may also be called upon to act as the lead professional in undertaking an early help assessment and to provide the support needed to the child and family, act as an advocate on their behalf and co-ordinate the delivery of support services.

Information sharing

Healthcare professionals have a key role to play in the effective sharing of information between professionals and local agencies to keep children safe. The guidance states:1

"no professional should assume that someone else will pass on information which they think may be critical to keeping a child safe. If a professional has concerns about a child's welfare and believes they are suffering or likely to suffer harm, then they should share the information with local authority children's social care".

Fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children. The guidance emphasises that no single professional can have a full picture.

Anyone who has concerns about a child’s welfare should make a referral to local authority children’s social care.

What should happen after a referral has been made?

If a referral becomes necessary then, within one working day of a referral being received, a local authority social worker should make a decision about the type of response that is required and acknowledge receipt to the referrer2.

For children in need of immediate protection, for example removal from the family home, action must be taken as soon as possible after the referral has been received.

Following acceptance of a referral in non-emergency cases, a social worker should lead a multi-agency assessment under section 17 of the Children Act 1989. Where the local authority decides to provide services a multi-agency child in need plan should be developed. This sets out which agencies will provide which services to the child and family.

Under section 17 of the Children Act 1989, the Local Authority is required to provide services for children in need for the purposes of safeguarding and promoting their welfare.

Under section 27 of the Children Act 1989, other authorities, including health bodies, have a duty to co-operate with a local authority in the exercise of that authority’s duties to provide support for children and families. The request should be complied with if it is compatible with the body’s own statutory or other duties and obligations and does not unduly prejudice the discharge of any of their functions.

Where information gathered during the multi-agency assessment results in the social worker suspecting that the child is suffering or likely to suffer significant harm, the local authority should hold a strategy discussion (in person or by telephone) to include health professionals from services the child or family are receiving. This is to decide whether to initiate enquiries under section 47 of the Children Act 1989.

The maximum timeframe for an assessment to conclude should be no longer than 45 working days from the point of referral3.

Working Together 2013 gives guidance on undertaking a good assessment4. As recommended by Professor Munro, the new guidance has removed some of the layers of prescription which was found to constrain professional judgment and children’s needs have been put back at the heart of the assessment by removing the requirement to have a separate "initial" and "core" assessment of children in need and the related 10 working day timescale for completion of the initial assessment. This will make the assessment a continuous process, rather than a stop/start one, and allow professionals the flexibility they need to carry out an assessment designed around individual children.

Section 47 enquiries will include health professionals undertaking appropriate medical tests, examinations or observation. This is to determine how the child’s health or development may be being impaired. Health professionals will provide any range of specialist assessments. They will ensure appropriate treatment and follow up health concerns.

Following section 47 enquiries, an initial child protection conference is convened. This involves professionals most involved with the child and family. If the local authority decide not to proceed with a child protection conference, then other professionals can request one if they are concerned that a child’s welfare may not be adequately safeguarded. At the initial child protection conference, a child protection plan should be agreed and a core group should meet within 10 working days of the conference. A review conference should be held within three months and thereafter every six months.

Health services’ responsibilities

Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions5, and any services that they contract out to others, are discharged, having regard to the need to safeguard and promote the welfare of children. This includes NHS organisations, including NHS England (formerly the NHS Commissioning Board), clinical commissioning groups (CCGs), NHS trusts and NHS foundation trusts. These organisations should have in place arrangements that reflect the importance of safeguarding and promoting the welfare of children.

Working Together 2013 sets out the responsibilities for health services6:

  • NHS England will be responsible for ensuring that the health commissioning system as a whole is working effectively to safeguard and promote the welfare of children. It will also be accountable for the services it directly commissions. NHS England will also lead and define improvement in safeguarding practice and outcomes and should also ensure that there are effective mechanisms for LSCBs and health and wellbeing boards to raise concerns about the engagement and leadership of the local NHS.
  • CCGs will be the major commissioners of local health services and will be responsible for safeguarding quality assurance through contractual arrangements with all provider organisations. CCGs should employ, or have in place, a contractual agreement to secure the expertise of designated professionals ie, designated doctors and nurses for safeguarding children and for looked after children (and designated paediatricians for unexpected deaths in childhood). Designated professionals, as clinical experts and strategic leaders, are a vital source of advice.
  • All providers of NHS funded health services including NHS trusts, NHS foundation trusts and public, voluntary sector, independent sector and social enterprises should identify a named doctor and a named nurse (and a named midwife if the organization provides maternity services) for safeguarding. In the case of NHS Direct, ambulance trusts and independent providers, this should be a named professional. GP practices should have a lead and deputy lead for safeguarding, who should work closely with named GPs. Named professionals have a key role in promoting good professional practice within their organisation, providing advice and expertise for fellow professionals and ensuring safeguarding training is in place.

NHS England has also published its accountability and assurance framework for safeguarding in the NHS Safeguarding Vulnerable People in the Reformed NHS. Thee framework complements the revised Working Together 2013 and will support NHS organisations in fulfilling their safeguarding responsibilities.

Learning and improvement

Working Together 2013 sets out guidance7 in relation to LSCBs who must include:

  • NHS England and CCGs.
  • NHS trusts and NHS foundation trusts all or most of whose hospitals, establishments and facilities are situated in the local authority area.

There is an emphasis8 on learning and improvement and the different types of review are:

  1. Serious Case Reviews (SCRs), for every case where abuse or neglect is known or suspected and either:
    • child dies; or
    • a child is seriously harmed and there are concerns about how organizations or professionals worked together to safeguard the child.
  2. Child death review: a review of all child deaths up to the age of 18.
  3. Review of a child protection incident which falls below the threshold for an SCR.
  4. Review or audit of practice in one or more agencies.

In order to ensure that lessons are learned from SCRs, a new national panel of independent experts has been established. The panel will provide advice to LSCBs about the initiation and publication of SCRs. The Working Together guidance makes clear that LSCBs should have regard to the panel’s advice when making decision about SCRs. The panel will also report to the Government their views of how the SCR system is working.

Child death

The guidance reminds us9 that where a child dies unexpectedly, all registered providers of healthcare services must notify the Care Quality Commission (CQC) (but NHS providers may discharge this duty by notifying NHS England).

Conclusion

The revised Working Together 2013 clarifies the responsibilities of professionals towards safeguarding children, and strengthens the focus away from processes and onto the needs of the child. It clarifies the core legal requirements on individuals and organisations to keep children safe. It sets out, in one place, the legal requirements that other agencies, including health services, that work with children, must follow. It emphasises that safeguarding is the responsibility of all professionals who work with children.