Inspectors says there are still worrying shortfalls in the quality of NHS training to ensure doctors and nurses identify and act on concerns about child abuse.
In its review of child safety in the NHS, commissioned by ministers in the aftermath of the Baby P scandal, the Care Quality Commission (CQC) surveyed 392 NHS trusts and found:
- On average, one in three GPs eligible in each PCT are recorded as having up-to-date training (35%, level two). In 2007/8, around one in ten consultations in GP practices were with children aged 14 or under.
- On average, only about half of healthcare staff eligible in each NHS trust are recorded as having up-to-date basic training (54%, level one)
- On average, over half of eligible clinical staff in emergency or urgent care (hospitals) are recorded as having up-to-date training (58%, level two). In 2007/8, around three million children under 16 attended A&E.
Baby P - now named as Peter - had been seen by health services 35 times by the time he died in 2007 aged 17 months after suffering more than 50 separate injuries.
The CQC said the findings indicate that a majority of organisations had the right people and systems to help protect children.
But they highlight worrying shortfalls in the numbers of staff up to date with mandatory training, designed to help them identify and respond to concerns.
This was true for staff across the NHS, as well as those dealing with children routinely, such as GPs and those in A&E, paediatric and sexual health services.
The CQC was also concerned to find a lack of clarity over the roles of doctors and nurses with specific responsibility for safeguarding – some 30 per cent of these doctors had no contract or service-level agreement for safeguarding work.
Some trusts lacked policies in key areas of child protection – for example, a third of acute trusts had no follow up process for children who miss outpatient appointments. It said NHS boards need to give more attention to safeguarding, with almost a third having no presentation from child safeguarding professionals during 2008.
Some 29 out of 152 primary care trusts surveyed reported case loads of more than 500 children per health visitor, well above Lord Laming’s recommendation of 400 which he made following the his damning 2003 report into the death of eight year old Victoria Climbie.
Cynthia Bower, CQC chief executive, said: ‘Immediately after the Baby P tragedy, everyone agreed that everything possible must be done to prevent a recurrence. This must not prove to be hollow rhetoric. The NHS has got to play its part by getting these safeguarding measures in place.’
CQC says that trusts should monitor the training of staff and ensure their people are up to date. Guidance issued by the Royal College of Paediatrics and Child Health, approved by other royal colleges, says that all healthcare staff should have basic training in child protection and all healthcare staff in regular contact with children and young people should have standard child protection training to at least level two.
The regulator has a major follow-up programme to help drive improvement. It has asked all NHS trusts to make public declarations against the core standard on safeguarding (C2) as part of the annual performance ratings. In the declarations, published last month, 29 trusts said they did not meet the standard, an increase on previous years.