Analysis

The data-sharing system that could save the lives of abused children

A system that triggers safeguarding alerts when at-risk children attend emergency departments is being adopted by the NHS and local authorities

A system that triggers safeguarding alerts when at-risk children attend emergency departments is being adopted by the NHS and local authorities


Ayeeshia-Jayne Smith.
Picture: Southwest News Service

So brutal were Ayeeshia-Jayne Smith's injuries, they were described as being of the kind normally seen after a car crash.

But the child had not been killed in a road accident, she was murdered by her mother. AJ, as she was known, was not yet two years old when she died, with her injuries including a heart laceration.

Last year, Kathryn Smith, of Burton, Staffordshire, was jailed for 19 years for her daughter's murder following a trial at Birmingham Crown Court. Her partner Matthew Rigby was jailed for three and a half years for allowing the death of a child.

Multiple presentations

In the recent serious case review, which takes place after a child dies or is seriously injured and abuse or neglect are thought to be involved, it emerged that the toddler had been seen multiple times in unscheduled care settings in the months leading up to her death on 1 May 2014.

On these occasions, her injuries had included marks on her face, a blister on her finger, a lacerated lip and a bald patch on her head. She had been taken to hospital with a life-threatening brain bleed.

The review found that social workers and health professionals had shown a 'lack of professional curiosity' in the face of signs that the child was in danger.

‘I’m convinced this information-sharing system would have made a difference in the Ayeeshia-Jayne Smith case. It offers a more complete picture of a child’

Caron Swinscoe

The report said: 'Emergency department and paediatric staff did not sufficiently consider whether child abuse or neglect was a possibility when AJ presented with medical issues during the last few months of her life.'

It added that social workers did not appear to consider the little girl to be their primary client, and they judged the parenting she received to be 'good enough' even while the risk to her from her mother was increasing.

Missing pieces

Caron Swinscoe, senior clinical lead for nursing at NHS Digital, which provides information and IT systems for health and social care, believes an information-sharing system that is now being adopted by agencies in England would have helped alert healthcare staff to the danger AJ was in. It would have provided missing pieces of information professionals needed, she believes.

‘I’m convinced it would have made a difference,’ Ms Swinscoe tells Nursing Standard. ‘It offers a more complete picture of a child.’

1,200

unscheduled healthcare settings and 80 local authorities in England don’t use the Child Protection – Information Sharing system yet

NHS Digital is leading the nationwide implementation of the Child Protection – Information Sharing (CP-IS) system for local authorities and healthcare organisations in England. The system can help identify at-risk children who might have been taken to hospital outside their local authority area to avoid detection of abuse or neglect.

The system creates a way to share information securely. When a child attends an unscheduled care setting, such as an emergency department or a minor injuries unit, it allows staff quickly to identify whether he or she is on a child protection plan or has ‘looked-after’ status. If either is the case:

  • The health team is alerted and can access social care team contact information.
  • The social care team is automatically notified the child has attended a healthcare setting.
  • Both parties can see details of the child's previous 25 visits to unscheduled care settings anywhere in England in the preceding year.

Ms Swinscoe says the system is the first of its kind in England and is now included in the standard contract for providers of NHS unscheduled care, and endorsed by the Care Quality Commission.

An unquestioning approach

During her short life, little AJ was the subject of child protection plans, supervision and care orders, and in 2013 spent several months in foster care. However, the serious case review found Queen's Hospital in Burton, Staffordshire, to which AJ had been brought in the months leading to her death, was not proactive in finding out whether the child was known to statutory services. This meant a hospital admission in February was never reported to AJ's social worker.

The review recommended Derbyshire and Staffordshire local authority and healthcare partners implement the CP-IS system.


CP-IS can help identify children who might be at risk of abuse or neglect

'These attendances from January onwards should have identified an escalation of concern,' the review report said. ‘There were several opportunities when minor injuries and care should have been considered in the context of neglectful/inadequate parenting in relation to child safety.’

Cooperation between authorities

There was no cross-border information sharing between the local authority in Derbyshire, which was responsible for AJ, and Queen’s Hospital in Staffordshire, where the child was taken on several occasions, including on the day she died.

March 2018

The deadline for 45% of unscheduled care settings and 65% of local authorities to start using CP-IS

Burton Hospitals NHS Foundation Trust chief nurse Paula Gardner says CP-IS will soon be implemented by the trust's hospitals, initially in the emergency department in early 2018.

'We have a duty to ensure all young people who require our services and care are adequately protected and the trust will continue to look at ways to enhance this safeguarding process.'

Similarly, a spokesperson for Derbyshire County Council says it is taking action to have the system installed in 2018.

‘Our discussions with NHS Digital and other local authorities, health providers and clinical commissioning groups to establish CP-IS across Derbyshire are well advanced,' he said.

Low uptake in healthcare

Although almost half of the 152 local authorities in England are now using CP-IS, only 227 out of 1,200 unscheduled healthcare settings, including emergency departments, walk-in centres and NHS 111, use it. A project board that includes NHS England, NHS Digital and others has set implementation targets to address this.

By March 2018, 45% of unscheduled care settings and 65% of local authorities must be linked to CP-IS, and by March 2019, at least 80% of unscheduled care settings and 90% of local authorities will be required to use it.

‘Nurses participating in early implementer sites have told us the system has been beneficial to front-line services'

Fiona Smith

‘At the centre of this, we have vulnerable children,’ says Ms Swinscoe. ‘It’s important that staff start getting a complete picture of these children. We have a national system to help protect them and help clinicians in conversations with families to understand which children are under protection.'

'It's easy to get started'

Ms Swinscoe urges safeguarding nurses to start work with CP-IS now, stressing the tool is free of charge and can take as little as six weeks to put in place. 

‘There is no reason to wait for other local authorities or trusts to implement, NHS Digital can help support you.’

49

serious case reviews were published in 2016, according to the NSPCC

RCN professional lead for children and young people’s nursing Fiona Smith says feedback from nurses already using CP-IS has been positive.

‘Nurses participating in early implementer sites have told us that CP-IS has been beneficial to them while working in front-line services.

‘The CP-IS system has enabled information-sharing between health providers such as A&E departments and social care, giving nurses more opportunities to safeguard infants, children and young people.'

System aids communication between professionals

Health and social care services in Hampshire – including the county council, two hospitals, the ambulance service and two GP out of hours services – have implemented CP-IS.

Kim Jones, designated nurse for safeguarding children in two clinical commissioning groups in Hampshire, has been helping with the implementation. 
 
She says: ‘CP-IS really does aid that communication between professionals which has been identified so often in serious case reviews.

‘When a child goes into an unscheduled care setting, children’s services get a notification to say the child has been there. It is really good at making sure those children who are vulnerable have better protection.’

 


Further information

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