Competencies

There are five competency levels for health care staff, and a competency level specific to senior management and executives, which are outlined below.

• Level 1 – Recognition
• Level 2 – Response
• Level 3 – Action and expertise
• Level 4 – Leadership role and additional responsibility
• Level 5 – Strategic oversight and system response
• Senior management and executive level – Accountability

It is important to note that:

• each level will have many professionals and staff, and their job title and role will be different across different specialities and in different areas of the UK; they will work across a wide range of settings,
• it is acknowledged that a range of knowledge, skills and competencies will be needed across the workforce with different levels of experience and expertise across the levels,
• the levels themselves describe a ‘complete’ set of expectations but acknowledge clinicians will be working towards more detailed levels of knowledge and will need to be up to date with emerging themes and refresh knowledge and skills across their career and commensurate to role,
• within level 3 there will be a cyclical refresh of knowledge and new skills, and competence related to emerging themes and areas of work. Specific levels of expertise may differ slightly e.g. a higher level of expertise for plastic surgeons regarding inflicted burns, maternity & gynaecology clinicians regarding Female Genital Mutilation (FGM)
• those with specific safeguarding duties are expected to have higher levels of competence and training.

Maintaining child safeguarding competencies is expected of every health care staff worker involved in the care of any child or young person, or who have any contact with, or responsibility for, children, or the care of adults who are parents/carers. All health care staff who deliver either a clinical service to under 18 year olds, or mental health and substance misuse services to adults who are parents/carers for children under 18 years old, should demonstrate level 3 competence. Health care staff who deliver specialist services, such as child protection medical assessments or statutory health assessments for children and young people in care, need more clinical expertise, and specific knowledge and skills, as described in level 3 competencies.

All health care providers delivering services, including mental health services, to under 18 year olds will be expected to have staff fulfilling level 4 (senior, experienced staff) and level 5 (strategic leadership) roles.
There will be a range of learning needs for health care workers, and therefore, training and resources should be appropriate for individual service requirements, whilst providing the basic knowledge and skills to meet the competencies. Level 1, 2 and 3 training should build on knowledge and skills. Therefore, staff trained and up to date at level 3 should also be assumed competent at levels 1 and 2; level 2 competent staff should be classed as also competent at level 1.
New starters to a health provider or service need to receive induction training in local policies and procedures that include referral pathways and mechanisms into appropriate local authority/council/health and social care trust safeguarding teams, as well as generic knowledge around safeguarding and children and young people in care. Level 1 and 2 competencies are expected to be covered in mandatory training programmes. A yearly update is recommended. This update can be obtained from a range of opportunities and should be based on adult learning principles. This could be delivered as whole lifetime (adult, child, young person) training and include transitional and contextual safeguarding.

All health care staff who encounter children and young people within their service, but do not provide direct clinical care to children and young people are expected to have level 2 competencies so that they can respond to vulnerable children and young people by seeking advice and/or escalating concerns appropriately.

All health care staff who deliver a clinical service to children and young people are expected to have level 3 competency. All the health care staff involved in the care of children and young people are expected to build on the core competencies gained in level 2 and become advocates for safeguarding children and children in care.

It is recommended that level 3, 4 and 5 competencies and learning related to safeguarding children and young people, and children and young people in care are discussed at annual appraisal. Where there are defined job roles, e.g. clinicians undertaking child protection medical assessments, and health assessments for children in care these roles should be reviewed specifically in appraisal or equivalent and include involvement in peer review. Clinicians at senior levels, e.g. levels 4 and 5 professionals, will require more expansive review in relation to expert knowledge, leadership skills, governance and outcomes.

Learning and mandatory training should have an individualised approach for the clinician to meet the needs of their job role, evolving evidence-base, national drivers and needs of the local population. At senior strategic level roles this needs to identify and address national drivers, enquiries and Government/NHS plans and legislation as well, standardising and improving quality across health providers. Applied learning is needed to understand local/regional challenges and work with partners.

Every revalidation cycle (3 – 5 years) should consider competence in safeguarding children and young people and children and young people in care, including all areas of experience, skills, and knowledge, with a relevant multi-agency working approach, and reflection across a range of adult learning activities.

These recommendations regarding competence and keeping up to date, apply to National Health Service (NHS) commissioned independent provision. Professionals working in independent providers have a professional responsibility to maintain appropriate competence. All children and young people are entitled to equal protection under the UN Convention on the Rights of the Child (UNCRC); therefore, Integrated Care Boards (ICBs) and Health Boards have a duty to ensure NHS service specifications reflect this.

To note: The job description data relating to time required for activities and time per population has not been updated. This was not in the remit of the review process. It should be acknowledged that it would be very difficult to accurately data capture time spent in these multifaceted leadership roles. The principles of responsibility and accountability are not restricted to outcome data and model job roles cannot be too prescriptive. Commissioners should ensure they recognise their duty to employ a workforce that is resourced to meet its statutory functions. Each health system area of practice must have senior leadership in place as safeguarding children and young people and children and young people in care are integral in general population health needs. Considering a public health approach and long-term planning every intervention for these cohorts of children and young people are also influencing what happens to the adult population of the future and cannot be quantified.

All health care professionals also need to maintain safeguarding competencies related to adults – see RCGP safeguarding standards for general practice and Adult Safeguarding: Roles and Competencies for Health Care Staff.

All health care professionals and staff who will have different levels of patient contact, as well as volunteers across health care services.

All health care professionals and staff who encounter children and young people, but do not provide clinical care to children and young people.

All health care professionals and staff who deliver a clinical service to children and young people. Mental health and drugs and alcohol rehabilitation services who deliver care to adults, but where the situation has significant impact and risk for children and young people/families, are included.

Professionals who deliver a senior leadership role within providers for safeguarding children and young people or children and young people in care. An understanding of ‘typical’ health, development, mental health, and behaviour, and how this is impacted in safeguarding children and young people and children and young people in care situations is needed. Although some roles have different titles across the four nations of the UK, the expectation of competence and expertise is the same, for example:

Professionals who deliver a senior leadership and strategic role within health care systems for safeguarding children and young people or children and young people in care.

There are a broad range of roles which are detailed in the job description outlined in the appendices, including advocacy for children and young people, assisting with service planning and commissioning, leadership, governance, information and data management, communication, training needs and supervision. Although some roles have different titles across the four nations of the UK, the expectation of competence and expertise is the same, for example: level 5 senior strategic lead/designated doctors and level 5 senior strategic lead/designated nurses including Associate and Deputy Director and ‘Head of’ roles.

General job role categories

• Executive and non-executive directors of organisations delivering NHS health care (see below)
• Senior managers in organisations delivering NHS health care
• Executive and non-executive directors of third sector organisations providing care to children and young people, mental health, hospices, residential care, family planning services, sexual health services
• Executive and non-executive directors of commissioned independent health care providers which may treat children and young people
• Senior managers in third sector organisations providing care to children and young people

Senior managers in commissioned independent health care providers which may treat children and young people