From Serious Case Review 8 dated 14th March 2009 (8 pages long)
When a child is presented to the Accident and Emergency Department there is a great need to challenge the history of an injury and any inconsistencies relating to that history as part of sound clinical skills in analysing paediatric injuries. There is great importance in using discussions with seniors as a forum for challenging opinions of juniors. These discussions must be documented. There is a need for greater awareness of safeguarding procedures particularly around referral to Children’s Social Care. Second opinions should be sought in equivocal cases, where the need for referral to child protection services is uncertain. There is importance in setting out the list of possible diagnoses and documentation of non diagnosis at the end of medical assessments. The need to communicate and document concerns to medical staff, nursing managers and the safeguarding nurse lead. There is a great need to communicate concerns to the community health staff via the liaison form. There is a need for criteria on timescales for visits for community staff when a child has been presented to accident and emergency with an injury – query cause. Timescales should be dependent upon the nature of the injury and this would aid staff in prioritising visits.
From Serious Case Review 25. (182 pages long) Keanu Williams died on 9th January 2011. He was only 4 months old when the previous serious case review was published.
Key Learning Point 4:
The quality of child protection medical assessments and the process followed by staff before and after the child protection medicals was found to be seriously lacking particularly when sharing and analysing information. The lack of clarity between the professionals involved, including their line managers, in terms of their understanding of their respective roles and responsibilities affected the quality of the decision making and therefore the outcome.
The BSCB should ensure that the Interagency Protocol for Child Protection Medical assessments and the procedures in place to support this should be critically reviewed by representatives from Children’s Social Care, Health and the Police in consultation with front line staff in the relevant agencies to ensure that the medical assessments are carried out to a good standard as a part of the assessment process. The updated Protocol should be reviewed regularly by the BSCB on the same interagency basis.
Expected outcome 4:
The core agencies; Health, Children’s Social Care and the Police, should undertake child protection medical assessments in line with the relevant Protocol, which should be subject to regular BSCB audit. When there are differences of opinion and /or specialist medical knowledge is required there should be arrangements in place to ensure that staff can access second opinions or specialist practitioners.
Unless we can deal with both the bullying management culture and the guidelines that prevent experienced staff being employed and move away from the tick box culture things will not improve. Comments on Radio 5