To receive a presentation from Janette Harrison, Designated Nurse, Children and Adult Safeguarding LLR CCG Safeguarding Team, Chris West, Director of Nursing and Quality Leicester City CCG, Neil King, Head of Safeguarding Leicestershire Partnership Trust and Michael Clayton, Head of Safeguarding  University Hospitals Leicester on the issues raised in the Care Quality Commission (CQC) Review of Safeguarding and Looked After Children’s Health Services Rutland: 2019 and the action plans arising from them.

A presentation (appended to the minutes) was received from Janette Harrison - Designated Nurse for Children and Adult Safeguarding LLR CCG, Chris West - Deputy Director of Nursing, Quality and Performance LLR CCGs, Neil King – Head of Safeguarding LPT and Michael Clayton – Head of Safeguarding UHL. The presentation was in response to the questions raised by the committees on receipt of the action plans that stemmed from concerns outlined in the CQC Review of Safeguarding and Looked After Children’s Health Services Rutland 2019.

During the discussion the following points were made:

·       Councillor Razzell acknowledged the response to question 1 that health service providers commissioned by the CCG were monitored by submitting a Safeguarding Assurance Template (SAT) on a quarterly basis, but was interested to know how these checks were physically carried out and whether records of them were in the public domain. He also queried how these checks had been affected by the significant increase in use of locum and agency staff at GP surgeries and at sites such as the minor injuries unit at Rutland Memorial Hospital (RMH) which Oakham Medical Practice (OMH) operated from. The urgent care center also operated from RMH, run by Derbyshire Health United (DHU), and so there were two organisations using the same site and facilities but with different electronic systems, and Councillor Razzell wanted to know how the safeguarding audits were carried out under these conditions.

·       Because of their work at RMH, the CQC, as part of their review, had asked a direct question of Oakham Medical Practice on the use of the Child Protection Sharing Information System (CPIS). Unfortunately, there was not a national child protection sharing system in place yet so flags were not automatically put on GP records when children went on child protection plans or were children looked after. Currently however, there was an NHS England/NHS digital project, in conjunction with Local Authorities, to address this and there were now automatic flags in the majority of unscheduled healthcare appointment settings and emergency departments. Oakham Medical Practice, along with other GP surgeries, would get flags put on their records as part of the second roll out of this system although the time line of this roll out was not known yet.

·       The CCG had maintained this flag issue on their register as they recognised it was still a risk and had been in touch with the regional lead for CPIS and NHS Digital to request, as a matter of urgency, that sites such as RMH be put on CPIS sooner rather than later. Jan Harrington confirmed that she was happy to share these emails with the Committee.

·       Derby Health United (DHU), who operated the urgent care unit at RMH during the out of hours period, were originally commissioned by the CCG as an extended hours service, not an urgent care one and therefore had not been picked up in the first wave of the project to place automatic safeguarding flags on their system. Emails had been sent to NHS digital requesting that this too be rectified as soon as possible.

·       Regardless of the CPIS system delays, Jan Harrington reassured Councillors that in terms of recognition of abuse, when any child visited any health establishment the CCG ensured that all staff were trained to recognise and respond to signs and that the contact number for local care services was always available. Whether the CPIS flag was on the system or not, staff always had to be mindful that there may be safeguarding issues and underwent extensive training to be aware of any signs of this.

·       Mr King, Head of Safeguarding at LPT, added that there was an additional safeguarding safety net in that when a child or young person accessed an out of hours service, regardless of whether CPIS was there or not, a notification was sent through to the school nurse or health visitor alerting them that a child had presented at an urgent care/out of hours setting.

·       The CCG invested heavily in making sure that staff were highly skilled and qualified in being able to spot any safeguarding concerns about children who presented at RMH but who normally accessed healthcare and went to school outside of the County and therefore did not have the ‘safety net’ as described by Mr King.

·       The CCG worked very closely with RCC colleagues as part of a multi-agency team to continually review their safeguarding performance. In order to be compliant with CQC standards, over 90% of staff had to have had the requisite safeguarding training and the CCG met with colleagues every quarter to monitor this level. DHU Staff working at RMH, were a commissioned service by the CCG and therefore met these CQC standards.

·       Section 32 of the standard NHS contract qualified the safeguarding standards that had to be in place by any service commissioned by the CCG. The safeguarding Assurance Template went through eighteen questions to ask providers and checked that safeguarding was a priority, with specific lead officers in place for child care sexual exploitation and prevent. There were audits to drill down on the assurance of those standards.

·       Councillors were frustrated that despite the assurances given, evidence had not been shared with the scrutiny committee. Ms Harrington replied that this evidence was extensive and had gone through comprehensive scrutiny from the different agencies own safeguarding committees before being sent to the CQC who were sufficiently satisfied that it demonstrated compliance and did not need further monitoring.

·       In response to questions raised about audit and assurance Ms Harrington stated that there was full engagement with multi agency audits by the providers and they had been able to extrapolate the learning from those audits. Mr King from LPT also confirmed that a full suite of internal and external audits were carried out. Any learning that had come about following an incident was followed up on at regular intervals to check whether it had been embedded and sustained.

·       Dawn Godfrey, Director of Childrens Services, wanted to offer the committees assurance that from a social care point of view, she had no concerns regarding the interaction between RCC and health colleagues, and communication took place on a very regular basis. Mrs Godfrey felt that health colleagues were very proactive in identifying potential signs of abuse and referring into social care in the right way. A multi-agency strategy meeting between social care, health and the police took place following every child safeguarding referral and all parties were fully involved in drawing up plans for any child protection investigation.

·       Ms West, from the CCG, commented that it was the responsibility of the regulator, the CQC, to wade through the huge amount of evidence that had been supplied in response to the original review in 2019. The CQC had gone through it with a fine tooth comb and had been satisfied; this then allowed for the green rag ratings shown on the action plans. The evidence supplied at the time was extensive but was now out of date

·       Mr King confirmed that Signs of Safety had been rolled out across LLR and practitioners were encouraged to attend the multi-agency training sessions that took place, although some training had been limited because of the impact of Covid.

·       Level 3 safeguarding training and other specialist training was still ongoing, despite Covid, and quarterly reports during Covid had not raised any concerns that the 90% training compliance had not been reached. 

·       At the time of the CQC inspection, nurses across LLR in GP practices were not able to access the same face to face level 3 safeguarding training that had been offered to doctors. The Intercollegiate Guidance specified an April 2021 deadline for extending this training to nurses but due to the Covid pandemic this had been amended so that on line training was now being offered. NHS England had advised that the online training was satisfactory and achieved the required level 3 compliance.

·       The CCG did not want the action plans published and in the public domain as they felt that they required an extensive amount of explanation and knowledge in order to be meaningful. They were happy to facilitate the provision of the evidence that backed up the action plans to Councillors providing it was not shared more widely and that partners had given their agreement. Ms West did however caution that in her opinion the evidence was now out of date and would therefore raise even more questions. Instead, Ms West suggested that instead of the original evidence, updated action plans with the most recent supporting evidence be supplied to Councillors. This evidence would demonstrate the improvements that had been made.

·       Councillors still wanted to see the original evidence in order for them to understand the context and the rag ratings of the action plans that had been supplied to them.

·       Records for children and adults used to be on two different record keeping systems that did not speak to each other, however for all of LPT services there was now just one seamless set of records (single electronic patient record) with no need for transition. There was still work to be done however on standardising the information.

·       Ms West would attempt to produce a diagram for Councillors that showed each organization’s responsibilities.

·       Councillor Walters, Portfolio Holder for Health, queried whether providing the original data supplied to the CQC, which was now out of date, was a good use of health colleagues’ time as they were currently operating under so much pressure due to Covid. In his view the updated action plans with supporting evidence would give Councillors a better understanding of the issues.

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At 9.30pm Councillors unanimously voted to extend the meeting time by 15 minutes.

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·       Councillor Razzell and Councillor Waller argued that in order to get a full understanding of the ‘journey’ to the current situation, Members needed to see the original documentation sent to the CQC and asked that the Committee vote on the matter.

A recorded vote was taken and there voted in favour:

Councillors Razzell, Waller, Cross, Webb, Begy, Harvey, Fox, Burrows and Bool

There voted against the recommendation:

Councillor Ainsley

The vote was therefore passed.

·       The Chair thanked Health Colleagues and officers for their attendance.

ACTIONS AGREED:

1.             That further information on the supply of GP safeguarding training be shared with the Committee.

2.             That Jan Harrison, as coordinator for the different bodies involved, would provide for the Committees by the end of the municipal year, the original paperwork that was submitted to the CQC in response to their report and which supported and evidenced the action plans.

3.             That updated actions plans with the most recent supporting evidence would be supplied to Councillors.

4.             That email evidence of the pursuit of a CPIS update for Derbyshire Health United, which operated from Rutland Memorial Hospital, be supplied.

5.             That all information supplied would remain in the strictest confidence and would not be shared publicly.