Rotherham health services should improve the way they work together to protect children, finds regulator

The Care Quality Commission (CQC) has reviewed how effectively health services in Rotherham are protecting children and young people from abuse and neglect.

The regulator’s dedicated child safeguarding team assessed acute and community healthcare services in February and has today (Tuesday 14 July) published its findings.

The review concludes that there is still a lack of understanding about roles and responsibilities in safeguarding, in particular in Child Sexual Exploitation (CSE), and that this is surprising following the publication of Alexis Jay’s inquiry last August and subsequent scrutiny on the area.

Services must work together more closely to protect children who are vulnerable, with communication between midwives and health visitors and the capacity of the school nursing service to respond as particular areas for improvement.

This is important as it is the ability of partners to work together that leads to the early identification and effective protection of vulnerable children and young people at risk.

The review also identifies some positive practice. For example, contraceptive and sexual health services (Cash) in the area have an outreach worker who makes home visits and who has an innovative approach to using social media to keep in contact with her clients. Rotherham NHS Foundation Trust is also developing a new emergency centre with careful consideration being given to the needs of children and young people.

CQC has made a number of recommendations to the two NHS trusts, the clinical commissioning group and the local authority, so that it can be confident that health services in the area can keep children safe and promote the health and wellbeing of looked-after children and care leavers.

CQC’s deputy chief inspector, Sue McMillan said: “We’re disappointed that despite the intense scrutiny on child protection in Rotherham and the help packages that have been made available, services with a key role in child safeguarding are unclear about their responsibilities. While progress has been made, it is too slow and more is required.

“This is unacceptable and we will check progress against our recommendations. These agencies need respond quickly to this report to ensure that no child is let down by the services designed to protect them.

“We know from decades of inquires that things go wrong for vulnerable children when services do not work together and this is crucial in keeping children safe.”

The review focused on the experiences of and outcomes for children and young people using a range of methods, including interviews, focus groups and visits, and by examining the performance of health providers including Rotherham, Doncaster and South Humber NHS Foundation Trust and the Rotherham NHS Foundation trust, as well as Rotherham Clinical Commissioning Group (RCCG) and NHS England’s local area teams.

Services included in this review are accident and emergency, maternity services, child and adolescent mental health services (CaMHs), health visiting services, school nurses, sexual health services and GPs.

Other findings include;

• Children who are brought into the care of Rotherham Social Services were not receiving timely initial health assessments (IHA) and when they did take place, they were not always effective and not always followed up. IHAs are important because they include an assessment of whether the child is or has been abused and also, it is well recognised that the health of children who are looked after is often worse than those who are not. This is unacceptable.
• Rotherham’s contraceptive and sexual health services (Cash) and Genito Urinary Services (Gum) do not understand their roles or responsibilities in relation to safeguarding and in particular, CSE.
• There have been cases with young people receiving inpatient mental health services who have been discharged back to Rotherham without local mental health services knowing. This is unacceptable and puts vulnerable children at serious risk of harm.
• Rotherham NHS Foundation Trust’s community based service, The Family Nurse Partnership was well established and successful in working with young mothers who are traditionally difficult to engage and have complex and chaotic lifestyles.
• Children and young people attending the emergency department (ED) of Rotherham Hospital have their safeguarding needs assessed with action taken to keep them safe where appropriate. The hospital is also rebuilding its Emergency Department adding a specialist paediatric unit.

CQC has recommended NHS England and Rotherham Clinical Commissioning Group (CCG) should work with GPs to ensure they understand local child protection processes and their responsibilities therein.

Both trusts, NHS Engalnd and the CCG should ensure that pharmacists, doctors and nurses in Rotherham Walk-in Centre are aware of their role in referring young people for screening for sexually transmitted infections or in raising safeguarding concerns.

The CCG and Rotherham NHS Foundation Trust should make sure children or young people who attend the emergency department should have their previous attendances considered as part of the safeguarding assessment. Other recommendations can be found in the report.

CQC’s safeguarding children and young people team carried out this inspection as part of a two-year programme to review health services in 50 local authority areas across the country.

In addition to this programme, CQC is now enhancing it Child Sexual Exploitation (CSE) work, building it into all inspections carried out under its new approach. Safeguarding special advisors will attend all planned hospital inspections in future.

The safeguarding team inspected Rotherham NHS Foundation Trust in conjunction with inspectors from CQC’s hospitals directorate.

Separately, CQC carried out a comprehensive inspection of Rotherham NHS Foundation Trust to assess whether it was providing patients with care that is safe, caring, effective, responsive to their needs, and well-led. CQC has rated the trust as Requires Improvement overall and the report is available on this website.

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