NHS and Children Safeguarding: How we can Make a Difference

26th Mar 2016

This the second part of Briony Ladbury’s blog on children safeguarding and the NHS.

Safeguarding professionals are routinely coming into conflict with senior managers and commissioners who can’t always see the value of putting money behind developments unless there is a proven evidence base.

Whilst an evidence base is important, it has always been a tall order and tricky to measure the negative – of how much serious harm has been prevented.

These days the responsibility for safeguarding in NHS England rests in the hands of the Chief Nurse. She has the central responsibility, assisted by a deputy and a safeguarding lead for children and adults who are accountable to her. The NHS works to a national model, there are no regional variations as such, creating a poor fit with the Governments push towards localism.

There are safeguarding leads for adults and children in the four NHSE geographical areas. They too, adhere to centralised national policy, working at a high level on big strategy, sometimes sharing safeguarding responsibilities with other work streams in their portfolios. Contrast this with the system pre-2013. In those days there was a large team of health professionals and civil servants at the Department of Health concentrating only on children. They worked through regional Strategic Health Authority executive boards that were responsible for the services in their regions. Safeguarding leads for children were employed in each strategic health authority to work closely with senior teams and senior practitioners in their regions on strategic and practice matters, representing their regions with the team at the Department of Health.

Holding the safeguarding children agenda in mind in this new centralised national model is a mighty big ask, it is no wonder that responses are slow and enabling any change is difficult. It’s certainly not the fault of those in the national leadership team. They preside over huge portfolios, managing national strategic developments and priorities, as well as having to respond to emergencies that have caused public concern.

The ‘big ask’ requires that the NHS gets it right at the front line, adopting a seamless approach that adheres to national direction, but it has to be translated into a local context. This is best done through well-informed, experienced professionals who understand children and families and who have the ability and leadership qualities to influence across a complex health system, and work constructively with multi-agency colleagues.

Safeguarding professionals in the children’s sector have had to move with the changing face of child protection over the years. It is not so long ago that physical abuse occupied the child protection space; child sexual abuse and sexual exploitation were relatively unknown and certainly not talked about….until Cleveland, which brought sexual abuse into the public arena and a paediatrician’s practice into question.

The realisation of the many and complex ways that children suffer, physically, emotionally and sexually; the impact of huge technological and societal changes, and a much broader understanding of the damage abuse inflicts on individuals and on society in general, has made the safeguarding profession, to my mind, one of the fastest moving, interesting and rewarding jobs you can do.

Being a safeguarding children professional in the NHS is a dynamic job, done by dedicated people. To recruit and retain these committed and special practitioners in the system will require a great deal of support and a leap of faith by those with the power, to give them back the authority that goes with the job – which is essential for their credibility let alone their ability to influence change. We’re not there yet.

Designated and Named Safeguarding professionals should be expected to advise NHSE, CCGs and CEOs of Trusts. They should be enabled to bridge the so-called commissioner-provider split to inform the system as a whole. Sadly , the NHS feels more fragmented and silo’d than ever. Our safeguarding professionals are trying to work within the new system and processes, but it’s an uphill battle because morale is so low in places.

So it’s now a case of just letting our safeguarding health professionals do their jobs. Some will need to reassert themselves into the spheres of influence they have been denied, however exhausting that may be and others in the safeguarding children business should help and support them in any way that they can.
There is light at the end of the tunnel though – key, experienced safeguarding professionals are still in the statutory framework – and that’s really good news. Yes its early days for our safeguarding professionals, but you’re worth it!