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Child Safeguarding provision from health in Haringey during the COVID19 Pandemic

Update 1: 02/04/2020

Ann Guindi, Designated Nurse Children’s Safeguarding, Haringey CCG

Bianca Lee, Designated Dr Children’s Safeguarding, Haringey CCG

The current COVID19 pandemic places additional stressors on health services. Health providers in the borough have been asked to clarify the mechanisms by which they will ensure that statutory safeguarding roles are met and the most vulnerable children and young people within our borough are safeguarded.

Key expectations of health services with regards to safeguarding include:

  1. Ensuring that newborns have safe discharge planning, maternity, GP and health visiting follow up.
  2. Contribution of health information and attendance at virtual core groups/ case conferences/ child in need meetings for children of all ages
  3. Health input into MASH
  4. Child Protection Medicals
  5.  Continuing healthcare services and safe discharge of vulnerable children on discharge from hospital
  6. Continuing health care services and contribution into the multiagency care of disabled children.
  7. Continuing Healthcare services for Children in Care including statutory health assessments.
  8. Provision of enhanced CAMHS service
  9. Identification and signposting/referral to social care where adults with caring responsibilities are admitted to hospital, no recourse to public funds, domestic abuse
  10. Supervision and support for staff
  11. Provision of accessible sexual health services for young people
  12. Continuation of the CDOP process

At this uncertain time it is clear that services may need to adjust/ develop and this document will be reviewed and updated 2 weekly by the designated professionals.  Please feedback comments or queries to Designated nurse or Dr and we will endeavour to answer these as quickly as possible.

1. Ensuring that newborns have safe discharge planning, maternity and health visiting follow up.

Whittington Health Maternity Services. 

Midwives will have face to face care with minimal reductions in visit schedules within the community. Safeguarding is a priority and all antenatal women will have a scripted phone conversation at 28/40 to ensure vulnerability, domestic abuse, safeguarding, mental health and homelessness are discussed.

Discharge planning meetings continue where baby CP/CIN/social concerns. Attendances at conferences continues in line with social care requirements

Postnatal home visiting continues especially where CP Plans exist.

All IDVAs working from home but co-ordinated through safeguarding midwife and Victoria Golden, ED Sister. Information posters and IDVA contact slips visible to and given to staff in all clinical areas, clinics and midwives.

North Middlesex University Hospital Maternity Services

Currently consultants are vetting all high risk cases. Low risk women are being booked over the phone. All are being seen for blood test/scan alone in hospital due to restriction on visitation – midwives are exploring safeguarding issues at this point as well (DV etc). Based on risk assessment 16 week appointments are being completed over the phone. All follow up are being conducted as per normal arrangement - unless client other symptomatic/self-isolating.

Post natal care -If low risk 1st visit over the phone unless other concerns arise and day 5 visit at home. Discharge visit can be over the phone- however this can be changed dependent on clinical needs for mother and baby. Child protection cases will maintain the required agreed visiting from the discharge planning and continue as normal for these cases, plans agreed in the discharge planning meeting.

Magnolia midwives caring for  women with mental health concerns  continue to provide care to these women. The perinatal mental health team whom they work closely with are continuing the care as normal at present.

Health visiting

An essential Health Visiting service will continue to be delivered from  2 main bases in Haringey, Hornsey Central and Tynemouth road.  Locality managers will continue to have oversight of the service delivery and will be supported by the safeguarding team , with supervision, case management and ad hoc advice and support

Service delivery will include:

New Birth Visits

New births will be allocated dependant on whether staff are working from home or undertaking face to face contact. New births are contacted by an administrator at day 5 to clarify details ,check if the midwife have seen the family ,  book an appointment and enquire how  things are, if there are any concerns e.g.  Infant feeding  these are referred  to the HV for contact sooner. New births are   carried out phone /video  between 10-14 days.  There will be a small number that will require a face to face NBV: Safeguarding cases for example pre-birth babies on CP plan, CIN plan and where safeguarding concerns have been raised and babies discharged from SCBU or with medical issues.

6-8 Week Review is booked after the new birth – as above

Management of UPP families

Updated spreadsheet of all CP/CIN/Highly vulnerable families will  be kept  updated by the team secretaries and saved password protected on the shared drive in the Covid-19 file.

  • On CP plan and CIN. Agreed a Covid-19 Safeguarding plan for each individual family with CP supervisor. This should be done via telephone conversations and plan clearly documented for each child. Think family as there maybe school age children
  • The plan should reflect the level of risk, if recently seen, are they in a setting, can the case be managed via the telephone or is face to face contact necessary
  • CIN and CP conferences will be done remotely. Please provide health reports for conference on time. Health information is highly significant at this time.      
  • Where possible it should be the named HV so that there is consistency but mindful that some staff will not be able to undertake face to face visiting due to pregnancy/underlying health issues
  • The need to liaise with the multiagency is key at this time to safeguard families

GPL’s

GPL’s are suspended in their current format. The service are reviewing how to keep contact with practices. It is important to keep lines of communication open with all GP practices. Any concerns about families should be highlighted to GP’s in a timely manner and visa verse. Teams have been provided with the GP’s bypass numbers. GP’s can continue to use the teams’ generic email address to highlight any concerns to the service

Duty health visitor

Each base (HCHC and TR) will have one duty Health Visitor who will take all duty calls on the day. The duty HV will be done via a rota and ideally by HV’s working from home. Admin staff will follow their present processes for informing the duty HV of a call. This should be documented on RiO.

Appointment only Child Health Clinic

An appointment only clinic in the West at HCHC and in the East at TR will be set up dependent on demand (currently there are HVs on site daily who can see babies/families by appointment )

Clear criteria for clinic appointments

  • Safeguarding
  • Low birth weight
  • Faltering growth
  • Jaundice review
  • Feeding difficulties that cannot be resolved over the phone
  • Professional judgement

Breast feeding support

HVs provide routine infant feeding support; client can Email generic HV team for further support and duty line

Peer Support/ Breastfeeding Network Haringey: haringeysupport@breastfeedingnetwork.org.uk (can offer email & Zoom consultations)

Specialist support from Infant Feeding Lead:

  • Ongoing phone/ video consultations
  • (Consider occasional one-to-one appointments in some circumstances at HC or TR)

2. Contribution of health information and attendance at virtual core groups/ case conferences/ child in need meetings for children of all ages

Midwifery, health visiting, paediatricians and school nurses and General Practice will continue to contribute to statutory meetings providing reports and being available for virtual meetings and conversations.

3. Health input into MASH

The Haringey safeguarding team will provide health input into MASH as previously but this input will be remote rather than face to face.

4. Child protection medicals

Child protection medicals for physical abuse and neglect will continue to be held at St Ann’s Hospital. The referral process is unchanged. Decision for a medical should be made on a case by case basis after discussion between the social work manager and the Consultant Paediatrician on call. (WH) Referrals for medicals for non acute sexual abuse should be discussed with the lighthouse as previously to ascertain the best place for a child to be seen.

5. Continuing healthcare services and safe discharge of vulnerable children on discharge from hospital

Children’s A&E will continue at NMH and WH. Children requiring an inpatient admission will be transferred from NMH or WH to Great Ormond Street Hospital for inpatient care. Discharge planning of children admitted to inpatient ward (GOSH) to follow safeguarding procedures – currently being put into place by GOSH). The community nurse team are supporting families at home as normal – phone contact and home visits.

6. Continuing health care services and contribution into the multiagency care of disabled children

Community Paediatricians will respond to any health issues regarding the special school children received from the SP school nurses or directly to the office. Families have been given a letter with contact details. In addition a telephone clinic will be run to maintain scheduled reviews. The therapy leads and nurses are in direct contact with the schools regarding children at risk in terms of safeguarding. They have created a list of socially vulnerable children related to safeguarding needs so we can monitor these children. They will also be liaising with the DCT about any children we feel should be RAG rated differently. The schools are still the main contact for these families, with schools and parents accessing health by phone if necessary.

7. Continuing Healthcare services for Children in Care including statutory health assessments.

Initial Health assessments (IHAs) will be carried out face to face or by telephone following triage by Consultant Paediatrician when notifications are received. Clinics have moved to St Ann’s so the paediatricians who complete the CP medical can also do the IHA’s if needed to. Review Health Assessments (RHAs) will be carried out over the phone as much as capacity allows and will be signposted on if any acute needs arises.

8. Provision of enhanced CAMHS service

CAMHS mental health assessments will not be possible in A&E. Model of two crisis/triage bases  at the Northern health centre, Holloway Road and at the Holly Oak CAMHS base on the Edgware Community hospital site

These will be staffed until midnight and at weekends. OOH psychiatry available midnight to 9am which can be used for presentations during the time the units are not open.

9. Identification and signposting/referral to social care where adults with caring responsibilities are admitted to hospital, no recourse to public funds, domestic abuse

North Middlesex University Hospital

Staff are trained to ask about children so are aware to refer / contact the team. Discussions have taken place to ensure that staff are asking about who is looking after the children at home for adults. LAS will have same responsibilities and will refer / call police if called to the property. For DA as our IDVA’s have been advised to work from home the safeguarding  team are from today screening A&E attendances and passing to IDVA’s who are working remotely. Same for assaults for our youth workers as again working remotely.

Whittington

Adults will still refer to IDVAs if DV concerns. We can refer to Youth support workers(red threads and at Giles trust working together to cover UCLH and Whit patch and are working remotely) for children involved in crime or violence although not seeing this at the moment.

10. Supervision and support for staff

Confirmation by providers of ongoing supervision and support around safeguarding issues.

WH, CNWL, BEH.  Group supervision will be on hold at NMH but they will continue to provide daily support / advise as required.  

11. Provision of accessible sexual health services for young people

Currently there are no walk in services being offered for sexual health in Haringey but there is telephone contact and advice given. YP can be signposted to Sexual Health London.

Pharmacies’ will continue to offer over the counter services.  30 Healthy Living Pharmacies commissioned to offer sexual health service to young people and adults which covers; Chlamydia/Gonorrhoea testing, Chlamydia treatment, Emergency Hormonal Contraception (Levonelle), condoms and HIV/Syphilis testing (over 18year olds), all services are free.

There are walk in services still operating from both neighbouring boroughs Archway and Mortimer Market.

12. Continuation of the CDOP process

Rapid review meeting will take place in line with statutory guidance as will Joint Agency Reviews (JARs), face to face where possible if not remotely.

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