10.2 Child Protection Discharge Procedure

To ensure that all key agencies are party to the decision to discharge and that there is a record kept of this.

To ensure a plan of care is in place for the ongoing protection of the child.

To comply with Laming recommendations 56 & 70.

Prior to discharge any gaps in the following need to be passed on to the relevant authority:

• Name
• Age
• Child's Primary Carer
• G.P.
• Child's school (if of school age)

To ensure relevant authority is aware of any gaps.

To comply with Laming recommendation 12.

12.

Front line staff in each of the agencies which regularly come into contact with children must ensure that in each new contact, basic information about the child is recorded.  This must include the child’s name, address, age, the name of the child’s primary carer, the child’s GP, and the name of the child’s school if the child is of school age.  Gaps in this information should be passed on to the relevant authority in accordance with local arrangements.

Was the following information collected for each new case:

• Child's name
• Address
• Age
• Name of the child’s primary carer 
• Child's GP 
• Name of Child's School if the child is of school age N/A

If yes, were gaps in information passed on to the relevant authorities  YES   NO

21.

When a professional makes a referral to Children's Social Care Services concerning the well being of a child, the fact of that referral must be confirmed in writing by the referrer within 48 hrs.

Was the fact of the referral confirmed in writing by the referrer within 48 hours

 YES   NO 

64.

When a child is admitted to hospital and deliberate harm is suspected, the nursing care plan must take full account of this diagnosis.

Did the Nursing Care plan take full account of this diagnosis

YES   NO 

65.

When deliberate harm of a child is suspected as a possibility, the examining doctor should consider whether taking a history directly from the child is in the child’s best interest. When that is so, the history should be taken even when the consent of the carer has not been obtained, with the reason for dispensing with consent recorded by the examining doctor.  Working Together guidance should be amended accordingly.  In those cases in which English is not the first language of the child concerned, the use of an interpreter should be considered

Was the history taken directly from the child?

YES   NO 

Was the child’s first language English?

YES   NO    N/A

If no, was an interpreter used?

YES   NO    N/A

66.

When a child has been examined by a doctor, and concerns about deliberate harm have been raised, no subsequent appraisal of these concerns should be considered complete until each of the concerns has been fully addressed, accounted for and documented.

Was a list of concerns documented in bullet point format by a paediatrician?

YES   NO 

Were they all addressed, accounted for and documented?

YES   NO 

67.

When differences of medical opinion occur in relation to the diagnosis of possible deliberate harm, a recorded discussion must take place between the persons holding the different views. When the deliberate harm of a child has been raised as an alternative diagnosis to a purely medical one, the diagnosis of deliberate harm must not be rejected without full discussion  and if necessary obtaining a further opinion.

Did a difference in medical opinion occur?

YES    NO 

If, yes, did a recorded discussion of the two views take place?

YES    NO 

Was it felt necessary to obtain a further opinion?

YES    NO 

If Yes, Was a further opinion sought?

YES    NO 

68.

When concerns about the deliberate harm of a child have been raised, doctors must ensure that comprehensive and contemporaneous notes are made of these concerns.  If doctors are unable to make their own notes, they must be clear about what it is they wish to have recorded on their behalf.

Were Comprehensive notes made about concerns

YES    NO 

Did the doctor make his own notes?

YES    NO 

69.

When concerns about the deliberate harm of a child have been raised, a record must be kept in the case notes of all discussions about the child, including telephone conversations.  When doctors and nurses are working in circumstances in which case notes are not available to them, a record of all discussions must be entered in the case notes at the earliest opportunity so that this becomes part of the child’s permanent health record.

Is there evidence that a record was made in the case notes following all discussions made about the child

YES    NO 

When notes were not available was a record made in the notes at the earliest opportunity

YES    NO 

70.

Hospital trust chief executives must introduce systems to ensure that no child about whom there are child protection concerns is discharged from hospital without the permission of either the consultant in charge or a paediatrician above the grade of SHO. Hospital chief executives must introduce systems to monitor compliance with this recommendation.

Was permission for the child to be discharged given by the Consultant Paediatrician identified in recommendation 76?

YES    NO 

71.

Hospital trust chief executives must introduce systems to ensure that no child about whom there are child protection concerns is discharged without a documented plan for the future of care of the child. The plan must include follow up arrangements. Hospital trust chief executives must introduce systems to monitor compliance with this recommendation.

Was the child discharged with a documented plan for future care?

YES    NO 

Was the discharge negotiated with Social Services?

YES    NO 

And where appropriate, the Police?

YES    NO    N/A

No child about whom there are concerns about deliberate harm should be discharged from hospital back into the community without an identified GP.  Responsibility for ensuring this happens rests with the hospital consultant under whose care the child has been admitted.

Did the child have a GP prior to discharge

YES    NO 

73.

When a child is admitted to hospital and deliberate harm is suspected, the doctor or nurse admitting the child must inquire about previous admissions to hospital.

In the event of a positive response, information concerning the previous admissions must be obtained from other hospitals. The consultant in charge of the case must review this information when making decisions about the child’s future care and management. Hospital chief executives must introduce systems to ensure compliance with this recommendation.

Were previous admission enquired about?

YES    NO 

If yes, did these include other hospitals?

YES    NO 

If yes, Was information obtained from other hospital?

YES   NO    N/A

74.

Any child admitted to hospital about whom there are concerns about deliberate harm must receive a full and fully documented physical examination within 24 hours of their admission, except when doing so would, in the opinion of the examining doctor, compromise the child’s care or the child’s physical and emotional well-being.

Did the child receive a fully documented physical examination within 24 hours of Arrival

YES    NO 

If not, Why :

75.

In case of possible deliberate harm to a child in hospital, when permission is required from the child’s carer for the investigation of such possible deliberate harm, or for the treatment of the child’s injuries, the permission must be sought by a doctor above the grade of senior house office.

Was permission sought by a Doctor above the grade of a senior House officer

YES    NO 

76.

When a child is admitted to hospital with concerns about deliberate harm, a clear decision must be taken as to which consultant is to be responsible for the child protection aspects of the child’s care.  The identity of that consultant must be clearly marked in the child’s notes so that all those involved in the child’s care are left in no doubt as to who is responsible for the case.

Was the consultant in charge of child protection issues clearly noted in the medical file

YES    NO 

77.

All doctors involved in the care of a child about whom there are concerns about possible deliberate harm must provide Children's Social Care Services with a written statement of the nature and extend of their concerns.  If misunderstandings of medical diagnosis occur, these must be corrected at the earliest opportunity in writing.  It is the responsibility of the doctor to ensure that his/her concerns are properly understood.

Was a written medical report given to Social services

YES    NO 

Was there any misunderstanding in diagnosis

YES    NO 

If YES, was a corrected statement sent to social services at the earliest opportunity

YES    NO    N/A

78.

Within a given location, health professionals should work from a single set of records for each child.

Were Cas Cards used in A&E

YES    NO 

Did all disciplines use medical notes when on the ward

YES    NO 

79.

During the course of a ward round, when assessing a child about whom there are concerns about deliberate harm, the doctor conducting the ward round should ensure that all available information is reviewed and taken account of before decisions on the future management of the child’s case are taken.

Were medical and Nursing notes available for all discussions

YES    NO 

80.

When a child for whom there are concerns about deliberate harm is admitted to hospital, a record must be made in the hospital notes of all face-to-face discussions including medical and nursing hand over and telephone conversations relating to the care of the child, and of all decisions made during such conversations.  In addition a record must be made of who is responsible for carrying out any actions agreed during such conversations.

Is there evidence that all face to face discussions including medical/nursing handovers and telephone conversations were documented in the notes

YES    NO   

If any actions were required, was the person responsible for carrying them out documented.

YES    NO