Child Protection service delivery standards

Good practice service delivery standards for the management of children referred for child protection medical assessments.

When concerns are raised about possible child abuse and neglect it is important for that child and family that there is an appropriate response from all agencies. Part of that response includes the availability of health services which are appropriately resourced and managed to deliver an agreed high standard of care. Through discussion between named and designated doctors for safeguarding children it has become clear that there is significant diversity between geographical areas in the way in which children, families and professionals experience the process of a medical assessment when there are child protection concerns related to physical abuse and neglect.

Diversity can often be a good thing, leading to innovation and better ways of working, but not when it describes inequitable services, either through inadequate resources, different interpretations of or lack of awareness of existing guidelines. Examples include the level of written and photographic documentation, availability of written policies and the nature of peer review.

The Royal College of Paediatrics and Child Health (RCPCH) and the Child Protection Special Interest Group (CPSIG) have therefore published this set of standards about the service delivery aspects of child protection medical assessments with the aim of reducing unwanted variation in care across all four nations of the United Kingdom. The standards bring together the range of processes and procedures that make up the often complex situation of a medical assessment in the context of child protection concerns. They are about the front line aspects of child protection work, hence will be of use to named doctors and their equivalents in Scotland who are tasked to ensure that their health provider organisation delivers a high level of care when their clinicians are called upon to carry out these assessments. In order to achieve some of the standards, named doctors will need to be supported by designated doctors for safeguarding and their equivalents in Scotland and by clinical directors and senior managers who are able to influence the working arrangements of those on the front line of this difficult but important work.

It is anticipated that this document will set a benchmark and therefore can be used to inform conversations between providers of health services, service planners and commissioners to enable child protection medical assessment services to be delivered appropriately. It is acknowledged that across the four nations of the United Kingdom commissioning and service planning arrangements differ, plus services will vary in terms of the amount or type of additional commissioning or investment that might be needed in order to achieve these standards.

In England the 2017 Children and Social Work Act led to the establishment of local safeguarding partnerships in which health is an equal partner with the local authority and police when safeguarding children. RCPCH and CPSIG therefore suggest that these standards should inform the benchmark expected in health provider organisations when addressing child protection concerns where a medical assessment is indicated.

These standards can also be seen through the lens of the United Nations Convention on the Rights of the Child They are supported by a number of Articles, in particular Article 3 covering the best interests of the child, Article 12 highlighting the importance of respecting the views of children and Article 19. Article 19 states that “Governments should do all they can to ensure that children are protected from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them.” Part of fulfilling this duty is surely to have a health system which is able to respond with the very highest level of care on every occasion that a child protection medical assessment is needed.