Leading change

The Deputy Chief Nurse responsible for safeguarding and harm-free care at Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) identified an opportunity to use new digital technology to introduce electronic Child Protection-Information Sharing (CP–IS) to the Trust. The process is quicker and more efficient. Any child with particular safeguarding needs can be quickly identified by the Trust whenever they are registered as a patient.

Where to look

Setting up a CP-IS system in unscheduled care settings within a hospital was recommended following publication of the Children and Young People’s Health Outcomes Forum report. Across the country, there was unwarranted variation in the way alerts for children in unscheduled care had been picked up and managed. In BHRUT this was done manually on a daily basis, which proved to be labour intensive and could be subject to human error.

What to change

The Trust’s Safeguarding Administrator spends each working day processing child protection lists from three local authorities. This includes checking for updates, making amendments, adding children onto the hospital system and setting the alert in readiness for when the child may attend BHRUT.

The Deputy Chief Nurse recognised the benefit of using the national CP–IS system to support frontline professionals in providing holistic healthcare, reducing risk to children and enabling immediate access to safeguarding concerns, in turn reducing the risk of human error and missed safeguarding opportunities. The system is automated, current and available at the point of need. The CP-IS system provides an instant view of children who are subject to Child Protection Plans, have Looked After status and or are unborn with Child Protection Plans.

How to change

A consultation took place with the Safeguarding Team and senior staff, including the Chief Nurse to consider the implementation of the CP–IS system. A key element to the consultation was to identify which departments would be vital parts of the organisation to have immediate access to that level of information regarding children. It was agreed to implement CP-IS in the Accident and Emergency Department including Paediatric Emergency department, Maternity, Gynaecology, Urgent Care, Paediatric Wards and the within the Safeguarding team. As the system is designed to be utilised most effectively in unscheduled care settings, these areas where considered the priority departments within BHRUT and Queens Hospital.

The Deputy Chief Nurse led a task and finish group to oversee implementation, this group included representatives from the following teams: Information Technology, Safeguarding and Nursing and Midwifery. They decided to access CP-IS via the Summary Care Record application (SCRa), using smartcards, as this is the most secure system to enable frontline nursing staff to access the system. A CP-IS protocol was developed, training given and smartcards were issued. BRHUT participated in the local tri-borough CP-IS meetings and shared the new protocol with other Trusts planning to make a similar change.

It has required a change for staff at the point of registering patients for care. They use the smartcard to access CP-IS and check for relevant information on every child up to the age of 18 years. If the system identifies the child has a plan, they alert the safeguarding team.

Adding value

Better outcomes – Patient safety has been enhanced. Clinical assessment and decision-making is more informed, ensuring the best outcome for the child. Using smartcards for CP-IS enables the checking of patients’ demographic data. This ensures the most up-to-date information is put on hospital systems. As a result, more patient discharge summaries are being sent to the GPs with a more holistic review of the child’s needs, including safeguarding concerns, rather than just a clinical summary of medical needs. There has been better information sharing, providing hospital staff with direct access to a child’s social worker and child protection plan, enabling timely, on the spot information sharing between health and social care staff. This has helped to break down barriers of communication and time delays, especially when a child is admitted from another area of the country.

Better experience – Health and social care staff have a more holistic picture of a child’s needs and their interaction with services. This enables better care provision and early detection of risk or concerns.

Better use of resources – CP-IS has reduced cost and time in supporting children and young people’s administrative processes, by:

• Enabling health care staff in accessing live and up to date information regarding a child’s needs. This timely information enabled staff to respond quickly and efficiently to any risk or concern.
• As a national system, identifying all children, not just local ones – reducing the risk of missing any safeguarding concern for a child who may come into contact with BHRUT.
• Providing timely contact information relevant to the child’s needs, reducing the time needed to track down the relevant social worker.
• Using the NHS number as the unique identifier, adding certainty that both health and local authorities are dealing with the same child.

Challenges and lessons learnt for implementation

• The change has had a positive impact, leading to a new shared responsibility for raising safeguarding alerts within the Trust.
• The change has drawn health and social care working closely together providing a more holistic and effective response to a child’s needs.
• This was a big project, requiring robust planning, training and staff engagement. BHRUT was supported from the national CP-IS team and the local CCG’s CP-IS lead. This was invaluable.

Find out more

For more information contact:

• Gary Etheridge, Deputy Chief Nurse, Safeguarding and Harm Free Care gary.etheridge@bhrhospitals.nhs.uk