news analysis of Carlile report into NHS child protection services in Wales

A review published last week urges that medical staff
and social workers should share vital information that could
prevent child abuse within the NHS. Alex Dobson
reports.

The Carlile review published last week makes 150 recommendations
aimed at safeguarding children treated by the NHS in Wales. It has
a wide-ranging agenda that urges that the ownership of child
protection policies should be seen as a national responsibility and
that child welfare should be at the centre of all health providers’
agendas.

Set up after allegations about a child and adolescent mental
health unit during the Sir Ronald Waterhouse North Wales child
abuse inquiry, the review has taken two years to complete. Lord
Carlile, who led the review, said the purpose was to bring the
protection of children from abuse to the forefront of NHS thinking.
It calls for a culture of vigilance and a complete revision of the
procedures for the protection of children from abuse within the NHS
in Wales.

The review comes at a time when UK child protection strategies
are under the spotlight as never before, as the inquiry into the
death of Victoria Climbie‚ enters its second phase. With the
outcome of the inquiry likely to involve a radical reappraisal of
the way children are protected by all agencies, many of the Carlile
recommendations will undoubtedly hold some relevance well beyond
the Welsh borders.

Evidence from previous high-profile child abuse inquiries has
repeatedly pointed to failures on the part of hospitals and social
services departments to share vital information that could have
been used to prevent child abuse.

Two of the review’s key recommendations tackle this issue head
on: medical staff should have access to child protection registers
and social workers should in turn have access to a child’s medical
history.

Former president of the Association of Directors of Social
Services Moira Gibb broadly welcomes the report’s recommendations
and what she describes as the “self-audit” from the NHS in
Wales.

“Information sharing can be more complex than it may appear on
the surface, but the whole intention behind the child protection
register is to advise those who come across people in different
circumstances that there is a reason to be concerned and watchful,
and to interpret evidence more sceptically in certain
circumstances. The history of the register is that it isn’t hugely
consulted and it is a major mistake not to give those staff who
come across children – for instance in an accident and emergency
unit – information that will help them not to miss a child at
risk,” she said.

Gibb does not think that issues of confidentiality are likely to
be of major concern, as there are a number of protections that are
built into the system and parents are already aware that their
children’s names are on the register.

She does acknowledge, however, that this practice of allowing
medical staff access to the register, as the report recommends, may
have human rights implications.

In terms of social workers accessing a child’s medical history,
Gibb is cautious about how useful that would prove to be for social
workers and suggests that practitioners are more likely to want
technical information interpreted for them before using it as a
tool in evaluating potential risk. Finding that a child has
regularly presented with injuries is of much more value to a
practitioner than working through a list of appointment times, she
says.

Overall, however, Gibb sees the attempts to stop children
slipping through safety nets as welcome and believes that some of
the review’s recommendations may prove valuable for the rest of the
UK. However, she admits that setting up systems in Wales may prove
easier to achieve than in England due to the differences in size
and structure.

Children’s charity the NSPCC also welcomes the report and Liz
Atkins, the charity’s head of policy, says it provides food for
thought for policy makers and practitioners in the rest of the UK,
not just Wales.

“Keeping children safe is everybody’s responsibility and health
professionals are a key piece in the child protection jigsaw. More
vetting, more training and greater vigilance are all needed to
ensure that the NHS is a safe setting for children and that health
professionals look out for children at risk of abuse and act on
their concerns. Inter-agency co-operation is vital. We must look at
how all parts of the child protection system can be pulled together
more effectively and share information more readily,” she said.

Others are more cautious about some of the recommendations. Dr
Harvey Marcovitch of the Royal College of Paediatricians and Child
Health says that, although paediatricians would always support
placing child protection above issues of confidentially, there are
serious issues surrounding the disclosure of information because of
the stance taken by the General Medical Council.

Harvey sees the extension of access to information, with many
more medical staff potentially using the child protection register,
as valuable. But he emphasises the importance of treating
confidential information with sensitivity because of the inherent
dilemma between the family’s rights to privacy and the child’s
rights to protection.

“Social workers having access to health records is much more
concerning,” Harvey says. “Not surprisingly, social services are
very cautious about what they allow access to, because it may
contain highly personal information that the doctor does not need
to see. In the same way, medical notes contain a lot of material
that social services do not need to access because it is not
relevant in terms of child protection.”

In Wales, the Carlile review has been greeted with widespread
approval. Children’s commissioner Peter Clarke is pleased with the
proposed network of independent children’s advocates that will
strengthen the NHS complaints procedure with regard to young
people.

A spokesperson for the commissioner said his office is now
considering all 150 recommendations. He added that issues
surrounding confidentiality will need to be handled
sensitively.

Hugh Gardner, chairperson of the Association of Directors of
Social Services in Wales, also welcomes the review, adding that
access to child protection registers by medical staff already takes
place in some parts of Wales.

“A number of A&E departments have access to registers, but
it is important that they have a secure and discreet information
area. There can be problems surrounding information-sharing but
there is a cultural shift towards trying to achieve it,” he
says.

The review will now be considered by the Welsh assembly, and it
is expected that a working group will be established. There will
also be widespread consultation.

Promising to deal with the proposals speedily, Welsh social
services and health minister Jane Hutt adds: “It is my intention
that, with colleagues in the NHS, we will commence work on the
execution of this task with enthusiasm with a view that, at the
end, Wales will have a safe and secure NHS for all our
children.”

Too Serious A Thing from www.wales.gov.uk

Key recommendations:

– Professionals working in child protection should be managed by
an all-Wales NHS child protection service.

– A network of independent police-checked advocates for all
children in the NHS.

– Two children’s charters to be produced and a director of
children’s services to be appointed to complement the children’s
commissioner’s role.

– A set of Welsh national child protection documents to be
produced within 12 months.

– New safeguards for whistleblowers within the NHS.

– Staff in A&E, outpatient and minor injury units to have
access to councils’ child protection registers, subject to secure
password safeguards.

– Social workers to have access to relevant parts of a child’s
medical history on “reasonable request”.

– All NHS trusts to have children’s complaints officers.

– Working Together guidance to apply to the NHS.

– Care Standards Inspectorate for Wales to be given
responsibility for regulating and inspecting all NHS in-patient
child and adolescent mental health services.

– Police checks on all NHS staff working with children.

– Urgent review of the inadequacy in Wales of therapeutic
services for survivors of abuse.