Referral to the lead statutory agencies

This section will support clinicians to take forward concerns that a child or young person may be at risk of, or suffering, maltreatment (abuse and neglect).

How do I know when to make a safeguarding referral to Children's Social Care?

One of the challenges in safeguarding children and young people, is to know whether the situation necessitates a safeguarding referral to Children's Social Care or a different response. With thresholds to Children’s Social Care seemingly getting higher and higher, practitioners understandably can be unsure whether to make a referral and equally be frustrated when a referral is rejected. In all situations, it is important to view each case individually. Below is a guide to considering abuse and neglect in a child/young person and guidance on what action to take.

Safeguarding Children Guidance - considering abuse neglect in a child or young person 

What can I do if I am still unsure what to do?

  • Check your local children safeguarding board website for guidance - many have guidance on specific topics and advice on what to do if you have a safeguarding concern such as a 'threshold'or 'vulnerability checklist' or 'criteria for action' document.
  • Refer to the NICE guideline Child maltreatment: When to suspect maltreatment in under 18s [CG89] 
  • Talk to your GP Practice Safeguarding Lead or Deputy Lead
  • Talk to other safeguarding professionals such as Named GP, Designated Professionals or similar depending on country/area
  • Talk to NSPCC or Children's Social Care

If at any time, you SUSPECT child maltreatment, you should refer the child or young person to children's social care, following Local Safeguarding Children Board Procedures 

NICE Guideline CG89

GPs and practice staff, who have a statutory duty to make referrals, should ensure that they have access to their current local multi-agency safeguarding children partnership policies and procedures which set out how national guidance (see Section 5 of the toolkit) is translated into local protocols and practice. Some localities may have a 'threshold' or 'criteria for action' document, allied to the procedures, that indicate the level of need that may require statutory intervention. The document will also normally indicate when the provision of early help, or a single agency response may be a more appropriate course of action. Contact and referral details will be given within the document. 

The General Medical Council states: 

"In sharing concerns about possible abuse or neglect, you are not making the final decision about how best to protect a child or young person. That is the role of the local authority children's services and, ultimately, the courts. Even if it turns out that the child or young person is not at risk of, or suffering, abuse or neglect, sharing information will be justified as long as your concerns are honestly held and reasonable, you share the information with the appropriate agency, and you only share relevant information".
(GMC: Protecting Children and Young People)

NICE Clinical Guidance (CG89) Child Maltreatment: when to suspect maltreatment in under 18's (published 2009, undated 2017)

NICE Clinical Guidance (CG89), which has been written for non-specialists in child maltreatment, helps practitioners to recognise and prioritise concerns about possible presentations:

  • Suspect means a serious level of concern about the possibility of child maltreatment, but not proof of it;
  • Consider means that maltreatment is one possible explanation for the alerting feature and so is included in the differential diagnosis;
  • Exclude maltreatment if a suitable explanation is found for the alerting feature, which might be after discussions with colleagues.

Practitioners can access NICE evidence and explanations to help them identify possible child abuse and neglect in clinical presentations. You can also access clinical and practice guidance that informs practice. (NICE, 2009; NICE, 2017).

Other resources to help practitioners

A short guide for practitioners (in England): What to do if you are worried a child is being abused sets out the actions that should be taken when child safeguarding concerns are raised. 

This guide includes an outline of the process of referral to the local authority Children's Social Care services and the steps that may follow a referral. It also provides details of what to do in an emergency, including the powers of Police Protection.  

Early Help

Early help (may be called different names in different areas) means providing support as soon as a problem emerges; and details of local early help services will be available for your locality. This type of support is normally informed by an early help assessment (EHA) and is undertaken with the agreement and consent of the child, young person and/or parent(s). The lead professional co-ordinates a team around the child and family in ensuring the provision of appropriate support and help to prevent escalation of the issues.

Practitioners should, in particular, be alert to the potential need for early help for a child who:

  • Is disabled and has specific additional needs
  • Has special educational needs (whether or not they have a statutory Education, Health and Care Plan)
  • Is a young carer
  • Is showing signs of being drawn into anti-social or criminal behaviour, including gang involvement and association with organised crime groups
  • Is frequently missing/goes missing from care or from home
  • Is at risk of modern slavery, trafficking or exploitation
  • Is at risk of being radicalised or exploited
  • Is in a family circumstance presenting challenges for the child, such as drug and alcohol misuse, adult mental health issues and domestic abuse
  • Is misusing drugs or alcohol themselves
  • Has returned home to their family from care
  • Is a privately fostered child
(Working Together to Safeguard Children, 2018)

Information Sharing

Information sharing is essential for effective safeguarding and promoting the welfare of children and young people. It is a key factor identified in many serious case reviews (SCRs), where poor information sharing has resulted in missed opportunities to take action that keeps children and young people safe.

  • Information sharing. Advice for practitioners providing safeguarding services to children, young people, parents and carers. HM Government July 2018

All staff working in primary care should be familiar with guidance on information sharing. 

The Information sharing. Advice for practitioners providing safeguarding services to children, young people, parents and carers guidance (HM Government, July 2018) is an excellent guide to information sharing and has been updated in light of the GDPR (General Data Protection Regulation) and Data Protection Act 2018 (England).
 
It is important to note that GDPR and the Data Protection Act 2018 are not barriers to sharing information, the document states:
 
"Where there are concerns about the safety of a child, the sharing of information in a timely and effective manner between organisations can improve decision-making so that actions taken are in the best interests of the child. The GDPR and Data Protection Act 2018 place duties on organisations and individuals to process personal information fairly and lawfully; they are not a barrier to sharing information, where the failure to do so would cause the safety or well-being of a child to be compromised. Similarly, human rights concerns, such as respecting the right to a private and family life would not prevent sharing where there are real safeguarding concerns."
 
Other sources of guidance regarding information sharing:

If a GP has concerns about revealing sensitive information within medical records then advice may be sought from a child protection professional on an anonymised basis, but it must be remembered at all times that it is the child's safety which is paramount and central to the process (GMC, 2012).

What happens when a referral is received by Children's Social Care?

Children's Social Care should make a decision within one working day of receipt of a child protection referral and should provide feedback on the decisions taken both to the family, and to the referrer. If the referral is not accepted, they should indicate the reasons why, together with suggestions for other sources of help and support.   

It is worth noting that when Children's Social Care receive a referral, they have very tight timeframes set down in statutory guidance to carry out further investigations and decide on further actions. Often these tight timeframes do not match our working practices in primary care which can be a source of frustration. It is important that practitioners from different professions gain an understanding of each other's working practices and duties to foster good working relationships which ultimately will serve to protect children and young people. 

If a referral is not accepted

If a referral is not accepted or the practitioner feels there has been an inadequate response, the practitioner should take further action. Further actions may include:

  • Reviewing the referral and ensuring all the relevant information is included and that they have outlined their concerns very clearly. If more information or explanation can be given, re-refer with this additional information.
  • Review their local 'threshold' guidelines to see if there is a more appropriate 'early help' response.
  • Consider contacting other professionals who are involved with the child/family for further information and collateral history in order to help inform further actions.
  • Seek further guidance and discussion from the GP Practice Safeguarding Lead, Named GP, Designated Professionals or other similar colleagues. 
  • If despite this, the referral is still not accepted and the practitioner still feels the response has been inadequate, then the practitioner should follow their local safeguarding partnerships procedures for practitioners to escalate their concerns and manage professionals' disagreements. 

The process of safeguarding referrals into Children's Social Care can be fraught with difficulty and practitioners can end up feeling demoralised when their referrals are repeatedly rejected and concerns seemingly dismissed and not acted on. This can be a time-consuming and stressful process. 

The process of referral, re-referral and escalation of concerns can also cause considerable strain on the doctor-patient relationship. Practitioners may have already had difficult conversations with the family prior to making the initial referral, particularly if the family are not in agreement with the referral. Practitioners should not hesitate to seek support from their safeguarding colleagues in these situations. 

It is paramount throughout this process that the needs and welfare of the child remain the central focus.

Referrals to Children's Social Care

The mechanism of referrals to Children's Social Care may vary depending on locality. In some areas, referrals can be made by telephone in the first instance but should be followed up in writing within 24 hours. In other areas, referrals may be made by email or via the Local Authority website. In some areas, Children’s Social Care, police, health and other services are working together to provide a 'front door' for referrals that may be known as a multi-agency safeguarding hub or MASH or MAST (multi-agency safeguarding hub/team). Local authorities may have a proforma for inter-agency referrals, this can act as an aide memoire and help to ensure that the referral is comprehensive and complete. 

Practice protocols and procedures (see Section 3 of the toolkit) should set out understandable guidance for all staff on how to handle concerns about possible maltreatment or disclosure of abuse by a child, parent or carer. 

Consent to the referral should normally be sought, unless to do so would place the child at risk of further harm, but it can be over-ridden if abuse and neglect are suspected. 

Child Protection System in the UK

Each of the four nations in the UK have their own child protection system and laws to protect children from abuse and neglect. The NSPCC provide up to date information on each nation's laws, guidance, frameworks and practice.

 

10 Top Tips for Making a Child Safeguarding Referral

Each area will have their own multi-agency referral form which should be used. These tips are designed to help you make a clear and effective Child Safeguarding Referral once you have made the decision to do so. These tips can also be applied to writing a safeguarding conference report. 

  1. Make clear who you are, what your role and relationship is to the child you are making the referral about. Include where the child is now and what actions have been taken to ensure the safety of that child. If a child is in immediate danger, an emergency response should be initiated contacting the Police on 999.
  2. State the source of your concern and be clear what is fact and what is opinion. Reports should distinguish clearly between facts, such as investigation and examination findings, observations, such as those relating to demeanour or personal hygiene, and opinion such as those about relationships. 
  3. If possible, try to include the child's thoughts and feelings about what is happening to them and what they would like to change. Use as much of the child's language as possible. 
  4. Explain medical terminology and what this means for the child as the reader of the referral may not have any medical background.
  5. Describe and explain your concerns in as much detail as possible. Give a clear outline of why you are concerned, for example what is happening, or not happening, that is causing concern or impacting on the health and/or safety of the child or young person; this may include a short chronology of significant events. Be clear about what type of abuse you think may be happening. Include what is going well for the child/family and who is currently supporting them.
  6. State how the referral meets the local threshold for referral; include contextual issues. For example concerns about parental mental illness, substance abuse, domestic abuse, a chaotic lifestyle or missed appointments. State whether or not an EHA (Early Health Assessment) has been undertaken (although this is not a prerequisite for a child protection referral).
  7. State who lives in the household and the relationship of these individuals to the child and to each other (a genogram* can be useful). Consider whether there is anyone else at risk for example, other children or vulnerable adults, and state this and who they are. Consider whether you need to make an Adult Safeguarding Referral also.
  8. State whether the situation/referral has been discussed with the child and/or parents (which is expected practice, unless it is thought that to do so would place the child at additional risk). State whether consent has been obtained.
  9. State what actions have been taken by the referrer, including discussions with other relevant health professionals, practice leads or named professionals. 
  10. Document clearly in the notes what action has been taken and code appropriately (see section on Processing and Storing of Safeguarding Information in Primary Care).

*A genogram is a picture of a person's family relationships and history. It goes beyond a traditional family tree allowing the creators to visualize patterns and psychological factors that affect relationships. For more information visit the North Cumbria CCG website.  

The Common Assessment Framework triangle (below) can be a useful reference for practitioners to use when completing referral forms for a child safeguarding referral. 

What comes after a Child Protection referral?

As there will be some differences between devolved government policy, and across regions, this section provides a generic account of what might be expected following a referral to statutory agencies. It is important that GPs and practice staff familiarise themselves with local criteria and processes and check their local safeguarding partnership (or equivalent) website regularly to keep abreast of any changes.

Children's Social Care is expected to acknowledge and act upon a child protection referral within 24 hours of receiving it. They may seek more information by discussion with the referrer; for example, ascertaining the existence of any previous records or referrals for the child and for any other members of their household, checking whether the child has been/is already subject to a child protection plan, checking whether there is a history of a past or current Early Help Assessment, contacting other agencies as appropriate (e.g. the police if an offence has been or is suspected to have been committed, or probation services if the child may be at risk of harm from an offender). GPs may be invited to take part in a strategy discussion, together with Children's Social Care and the police (which can take place over the telephone in an emergency). The purpose of an assessment is to gather information, analyse the needs of the child and/or the nature and level of any risk and harm and determine a course of action; which may lead to statutory intervention to safeguard and protect their welfare.

Why do GPs play such an important role in child protection?

GPs are perceived as having specific and relevant knowledge relating to the children and families in their care. Good record keeping remains an essential component of effective general practice and an important aid to early recognition of parental or carer problems and risks to children. See Section 3 of the toolkit for resources on coding and recording of safeguarding information in medical records.

Report Writing (See also Top 10 Tips for Making a Child Safeguarding Referral)

GPs may be asked to provide reports for children in need of extra services, safeguarding or protection. Reports of statutory child protection investigations (for example those delivered under Section 47 of the Children Act 1989) or Child Protection Care Conferences may be written without consent, if to obtain such consent could increase risk of 'significant harm' to the child. It is however good practice, wherever possible, to involve the child and family and to ensure they have full access to the report before it is sent. This may be difficult within the short timescale required for a statutory report.

At Case Conferences, families are usually shown all reports prior to the start of the meeting. GPs will be aware that many parents in this situation are themselves vulnerable and may have learning disabilities, mental or physical health problems, be substance misusers or may themselves be legally children (i.e. under the age of 18 years). GPs may worry about destroying a relationship perceived as therapeutic, but a concern to avoid potential distress or disruption of the doctor-patient bond must never be allowed to prevent disclosure of information to relevant agencies in a child's best interest. Such disclosure must be relevant, proportionate, objective and factual.

Reports for 'early help' and 'child in need' services (for example those delivered under Section 17 of the Children Act 1989) usually require full parent/carer/child consent and collaboration, with detailed descriptions of care required for any physical or learning disability, medication and/or aids.*Refusal to give consent for this information to be shared may require a child protection referral.

*In Wales, Section 17 has been superseded by the Social Services Wellbeing Act.

Absence of contact with a child or family may be pertinent to an investigation and should be communicated in the report. Relevant information should be provided on parents, carers and all adults resident within the household, significant adults resident elsewhere, also siblings, half and step siblings and other children within or connected to a family.

Information that the GP has no concerns about a family is as important to the conference as a long list of concerns about a family.

Child Protection Case Conferences

There are a large number of people who may be invited to attend a child protection case conference:

  • Independent Reviewing Officer (IRO) - the IRO chairs the meeting
  • Parents, carers and their representatives
  • The child or children – depending on age and situation
  • Social worker
  • Family support workers
  • Legal representatives for family and or social care
  • Health representatives, for example, GP, health visitor, midwife, school nurse, paediatrics, mental health
  • Education
  • Police or Probation
  • Substance misuse workers and youth justice workers
  • Young carers suppport workers

Every person in attendance has an important active role to play. The conference provides a forum for professionals from all agencies involved with the family to meet and discuss concerns about the care of an unborn baby, infant, child or children based on information gathered in the course of the child protection investigation.  

The child protection case conference (CPCC) will focus on the child's circumstances, what they mean for the child's lived experience, what parental/carer behaviours are causing harm or likely to lead to harm, whether the parents understand this and what needs to change. 

If it is decided that harm has occurred, or there is a risk of harm, the conference will determine whether the parents or carers have capacity to prevent future harm and to meet the child’s emotional, physical and developmental needs. If a decision is made to make the child subject to a child protection plan (or equivalent in Northern Ireland, Scotland or Wales), then this will state the category of maltreatment and decisions on what needs to happen, to secure agreed outcomes for the child and family.  

In summary the plan should reflect:

  • Factors that need to change to achieve the outcomes;                                      
  • Assessed needs/risks and priorities of the plan;                                      
  • Key people involved, agreed tasks and responsibilities;
  • Timescales for action;
  • Support and resources required to take the plan forward and a process for monitoring of the plan.

The aim of a child protection plan is to improve the child's daily life and address the impact of adverse parent/carer behaviours (or other risks) on the child's development and needs as well to ensure their long-term well-being.  

If a child becomes subject to a child protection plan, a core group is established, and this will meet regularly to monitor the plan. Review child protection conferences will be arranged (initially after three months, and then a further six months) until a decision can be made that the child can be removed from a plan, normally with a 'step-down' to continued support through a Child in Need plan. If serious risk remains, the local authority may instigate family court proceedings, and the child becomes 'looked after' (see section on Looked After Children). 

GPs will receive case conference meeting notes with details of decisions made. A child protection plan may require GPs and practice staff to undertake specific actions (e.g. to ensure immunisations as per schedule). Concerns about compliance with any health care plans should be communicated to the child's social worker at the earliest opportunity, as this may be an important sign of increasing risk to the child.

RCGP advice on the processing and storing of safeguarding information, such as meeting notes and reports from case conferences, can be found in Section 3. This guidance includes advice on coding.

GP Attendance at Case Conferences

GPs should attend the conference if at all possible. However, like all statutory agencies, primary care has increasing demands on it and less and less resources to meet those demands. The ability for practices to attend case conferences depends on many factors such as staffing, clinical demands, locality and proximity to where the case conferences are held, and how much advance warning practices are given about the case conference. 

The GMC (General Medical Council) in their guidance 'Protecting Children and Young People' states:

  • If you are asked to take part in child protection procedures, you must cooperate fully. This should include going to child protection conferences, strategy meetings and case reviews to provide information and give your opinion. You may be able to make a contribution, even if you have no specific concerns (for example, general practitioners are sometimes able to share unique insights into a child's or young person's family).
  • If meetings are called at short notice or at inconvenient times, you should still try to go. If this is not possible, you must try to provide relevant information about the child or young person and their family to the meeting, either through a telephone or video conference, in a written report of by discussing the information with another professional (for example, the health visitor), so they can give an oral report at the meeting . 

Practice child safeguarding policies and procedures (refer to Section 3 of the toolkit) should set out processes for ensuring that requests for case conference reports and attendance are handled in a timely and effective way.

Here are a few suggestions to help practices manage case conference attendances and timely report writing:

  • The date for the next child protection conference should always be in the case conference minutes that practices should receive – practices can put that date into the practice diary as soon as they receive the minutes, set up a reminder for when the report is due and if possible rota the most appropriate GP to attend.
  • Having a dedicated safeguarding administrator who can manage the case conference minutes, make the diary entries and set up reminders for when the report is due. 
  • Offer to hold the conference in surgery premises so you can attend, even if it isn't for the whole conference.
  • Liaising with social services to enable the practice to be invited to all strategy discussions which should result in the GP receiving the minutes from the strategy meeting and the date of any subsequent initial child protection conference. This will allow for more time for the GP to complete the report for the conference. 

Looked after Children

Looked after children are a particularly vulnerable group of children so it is essential that practitioners are aware of their particular needs and vulnerabilities. Children in care are removed from a situation that made them vulnerable. That doesn't mean they aren't vulnerable in care, but the whole reason for taking them into care is to make them safer. 

A child who has been in the care of their local authority for more than 24 hours is known as a looked after child. Looked after children are also often referred to as children in care, a term which many children and young people prefer.

Each UK nation has a slightly different definition of a looked after child and follows its own legislation, policy and guidance. But in general, looked after children are:

  • living with foster parents
  • living in a residential children's home or
  • living in residential settings like schools or secure units.

Scotland's definition also includes children under a supervision requirement order. This means that many of the looked after children in Scotland are still living at home, but with regular contact from social services.

There are a variety of reasons why children and young people enter care:

  • The child's parents might have agreed to this – for example, if they are too unwell to look after their child or if their child has a disability and needs respite care. 
  • The child could be an unaccompanied asylum seeker, with no responsible adult to care for them.
  • Children's services may have intervened because they felt the child was at significant risk of harm. If this is the case the child is usually the subject of a court-made legal order.

A child stops being looked after when they are adopted, return home or turn 18. However local authorities in all the nations of the UK are required to support children leaving care at age 18 until they are at least 21 years old. This may involve them continuing to live with their foster family.

Needs of Looked After Children

Although looked after children and young people have many of the same health risks and problems as peers, the extent is often exacerbated due to their experiences of abuse. They may have complex emotional and mental health needs. 

Experiences of children who are Looked After

Most children in care say that their experiences are good and that it was the right choice for them. However, there are particular experiences they may have to face whilst in care:

  • The experiences of abuse and neglect can leave Looked After Children with an increased vulnerability to further abuse.
  • More likely to go missing than their peers. 
  • May display behavioural problems and attachment difficulties. This can make it difficult to form positive relationships. 
  • When looked after children are compared with children in the general population, they tend to have poorer outcomes in a number of areas such as educational attainment and mental and physical health. However, research also demonstrates that maltreated children who remain in care have better long-term outcomes than those who are reunited with their families.

NSPCC research has identified five priorities for change to improve the emotional and mental health of looked after children.

  • Embed an emphasis on emotional wellbeing throughout the system.
  • Take a proactive and preventative approach.
  • Give children and young people voice and influence.
  • Support and sustain children's relationships.
  • Support care leavers' emotional needs.

Supporting Looked After Children in Primary Care

There are a number of actions primary care can take to support Looked after Children:

  • Ensuring that there is an appropriate and obvious flag on their medical records highlighting that a child is looked after.
  • Ensuring that ALL staff are aware of the vulnerability of Looked after Children and that they can identify the Looked after Child flag in order to prioritise their healthcare such as availability of appointments and continuity of care.
  • Provide proactive healthcare when a Looked after Child attends the surgery. Evidence highlights that where Looked after Children have access to specialist health practitioners their health outcomes improved.
  • Ensuring that foster carers have an appropriate code on their records also so that clinicians are aware that additional support may be needed. 

References: 

  1. NSPCC, Looked After Children
  2. Intercollegiate Role Framework Looked after children: Knowledge, skills and competences of health care staff (March 2015)

 

Private Fostering

Private fostering is when children and young people under the age of 16 years, or under 18 if they are disabled, are cared for on a full-time basis by a person who is not their parent, who does not have parental responsibility or who is not a "close relative" for 28 days or more. Close relatives are defined as:

  • grandparents
  • brothers and sisters
  • uncles and aunts, or
  • step-parents (if married to the partner or in civil partnership)

Under the Private Fostering Arrangements (2005), professionals who come into contact with children, for example teachers, religious leaders, health care staff are under a duty to inform the Children and Families Service about any private fostering arrangements they are made aware of.

Further information

North Yorkshire Safeguarding Children Board, Notification of Private Fostering Arrangements: One minute guide [PDF]

The item has been added to your basket.

Continue shopping

Go to basket

This item is out of stock.

Continue shopping

The item is out of stock.

Yes Continue shopping

An error occured adding your item to the basket:

Continue shopping