Expectation and job roles |
Expectation – strategic oversight and system response
At this level, clinical experience in safeguarding children and young people people and children and young people in care will be needed but experience may not be exclusively in children and young people’s health e.g. additional mental health or family practice experience.
The roles for safeguarding children and young people, and children and young people in care are distinct, requiring different expertise, and should have separate job descriptions with associated time and responsibility, acknowledging the breadth of knowledge and expertise needed.
Job roles – 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.
UK nation-specific job role titles |
England and Northern Ireland: level 5 senior strategic lead/designated doctor, level 5 senior strategic lead/designated nurse, Associate or Deputy Director and ‘Head of’ roles where they lead or manage level 4 staff.
Scotland: nurse team lead for Child protection, Nurse Consultant or Head of Child/Public Protection, lead clinician for child protection, designated doctor for child protection.
Wales: level 5 senior strategic lead/designated doctor and level 5 senior strategic lead/designated nurse for safeguarding, level 5 senior strategic lead/designated doctor for children and young people in care.
“You have the power to transform lives. For children and young people like me, the system can be the difference between struggling to survive or finding the confidence to thrive.”
Overview of level 5 |
Competency at this level is about individuals being able to:
- use knowledge and expertise related to children and young people, including an understanding of ‘typical’ health, development, mental health, and behaviour, and understand how this is affected in safeguarding and children and young people in care situations
- use knowledge of trauma-informed care, adverse childhood experiences, transition from children and young people to adult services to allow advocacy for children and young people, and effective service planning/commissioning
- use knowledge and skills in safeguarding children and young people and recognise what it means to be a child or young person in care or care leaver to deliver strategic needs analysis, develop training plans, advise commissioning decisions and contribute to national directives
- know their role and responsibility in demonstrating leadership, working together with other professionals to ensure the whole system meets the needs of vulnerable children and young people, managing significant escalations from trusts/providers
- take responsibility in system-wide governance and assurance, relating to safeguarding children and young people, and children and young people in care
- offer a supervisory and supportive role to staff members, recognising the emotional impact of this work, embedding a trauma-informed approach in clinical services. Professionals should recognise the impact being involved in safeguarding can have on their own personal and professional wellbeing and seek support when needed
- promote to senior staff and executives the vital importance of leadership, strategy, and assurance to keep children safe and reduce health inequalities for children and young people in care.
Level 5 core competencies |
Level 5 job roles for safeguarding children and for children in care may require similar leadership skills, but the expertise and knowledge required will be different:
- leadership and strategic working levels, legislation, processes, quality assurance
- partnership working is managed in different professional environments with different cohorts of professionals
- national and local reviews and enquiries will have discrete actions related to safeguarding children and children and young people in care
- responsibility, data analysis and reporting are separate
To be able to lead a system and advise about health needs and complexity expertly and appropriately, the job roles should be distinct. There are separate competencies for children and young people in care and safeguarding children and young people roles.
Health care staff at this level should:
- provide oversight and assurance that appropriate supervision (recognising there are different types, and different approaches may be needed for individuals and services) is in place for colleagues across health care services commissioned by the local authority/council/health and social care trust and provided by commissioned independent health care providers
- demonstrate and embed the use of trauma-informed practice and language across the system and in health providers
- draw on sufficient experience and knowledge and have credibility to deliver either the level 5 senior strategic lead/designated professional safeguarding children and young people role or children and young people in care role, professionals would need to have sufficient knowledge of how to meet the health needs of children, including those undergoing adoption
- demonstrate and promote compassionate and effective leadership skills to support development of colleagues
- demonstrate effective leadership skills to support succession planning for senior roles
- monitor services and outcomes across health care services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent providers to ensure adherence to legislation, policy, and key statutory and non-statutory guidance for each of the UK nations in relation to safeguarding children and young people or in relation to children in care
- deliver system leadership for transitional safeguarding working closely and collaboratively with colleagues in adult safeguarding
- be aware of cross-border/jurisdiction differences in legislation, guidance and practice throughout the United Kingdom and Ireland where appropriate
Additional Level 5 core competencies applicable to health care staff for safeguarding children and young people |
Health care staff for safeguarding children and young people at this level should:
- contribute at a senior/strategic level to training needs analyses, and be able to conduct the commissioning, planning, designing and evaluation of safeguarding children and young people single and multi-agency training; importance should also be given to children and young people in care, recognising they still need safeguarding and the increased vulnerability of care-experienced children
- provide advice and oversight, develop and lead on relevant safeguarding children and young people measures, and ensure quality of care and improved health outcomes for safeguarding/child protection across health care services, including health services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent health care providers
- lead innovation and change to improve practices for safeguarding children and young people, increasing awareness and response across health care services, including public health services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent health care providers
- incorporate feedback/voice of children and young people to ensure that services are relevant and accessible, and ensure mechanisms are in place to effectively enable the consultation, participation, and involvement of children and young people, this includes specific services for child protection
- lead in ensuring that robust processes are in place across health care services to learn lessons from cases which have reached the threshold for learning reviews (where children and young people have died or were seriously harmed) at local or national level; where children and young people in care are involved there should be liaison with
- lead teams to ensure recommendations related to national reviews and/or Government–led enquiries involving safeguarding children and young people are reviewed, analysed, and disseminated with appropriate action plans
- effectively raise key issues with service planners, commissioners, and service providers to ensure all services commissioned meet the statutory requirement to safeguard and promote the welfare of children and young people
- effectively contribute to the strategic discussions at relevant boards and partnerships; provide expertise and leadership to wider children’s planning and NHS priorities across health care services commissioned by local authorities and provided by commissioned independent health care providers on all aspects of safeguarding children and young people
- give appropriate expert, strategic level advice about safeguarding children and young people and advising professionals working within organisations which deliver health services and other related agencies
- lead on transitional safeguarding where appropriate, including
- supporting and championing transitional safeguarding within local safeguarding partnerships (child and adult)
- working closely with local processes designed to protect both adults and children from significant harm e.g. (Northern Ireland)
- review, analyse and present data related to safeguarding children and young people. This should inform key performance indicators and local assurance, and support analysis and presentation of national level data. This may include production of an annual report/review that speaks to the effectiveness of safeguarding actions, related learning, and governance with an improvement focused plan
- analyse and provide system leaders with appropriate data/feedback as to whether all services commissioned meet the statutory requirements of safeguarding children and young people, this includes whether procedures, policies, professional guidance, and quality assurance activities are in place
Additional Level 5 core competencies applicable to health care staff for children and young people in care |
Health care staff for children and young people in care at this level should:
- contribute at a senior/strategic level to training needs analyses, and be able to conduct the commissioning, planning, designing and evaluation of children and young people in care in single and multi-agency training; significant specialist knowledge is required to include all areas of need and competencies required for care-experienced children and care leavers
- provide advice and oversight, develop and lead on relevant children and young people in care measures, and ensure quality of care and improved health outcomes for children and young people in care and care leavers across health care services, including health services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent health care providers
- review, analyse and present data related to children and young people in care. This should inform key performance indicators and local assurance, support analysis and presentation of national level data. This may include production of an annual report/review that speaks to the effectiveness of children in care actions, learning, governance with an improvement focused plan
- lead innovation and change to improve health outcomes and reduce disparity for children and young people in care across health care services, including public health services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent health care providers
- incorporate feedback/voice of children and young people to ensure that services are relevant and accessible, and ensure mechanisms are in place to effectively enable the consultation, participation, and involvement from children and young people in care who use their services. This should then inform the planning and delivery of those services
- lead in ensuring that robust processes are in place across healthcare services to learn lessons from local and national level child safeguarding reviews that include children and young people in care
- lead to ensure recommendations related to national reviews and/or Government–led enquiries involving children and young people in care are reviewed, analysed, and disseminated with appropriate action plans
- effectively raise key issues with service planners, commissioners, and service providers to ensure all services commissioned meet the statutory requirement to promote the health and wellbeing of children and young people in care
- effectively contribute to the strategic discussions at relevant boards and partnerships contributing to corporate parenting responsibilities; provide expertise and leadership to wider children’s planning and NHS priorities across health care services commissioned by local authorities/councils/health and social care trusts and provided by commissioned independent health care providers on all aspects of children and young people in care health and wellbeing
- give appropriate expert, strategic level advice about children and young people in care and care leavers, advising professionals working within organisations that deliver health services and other agencies
- clearly articulate and provide sound policy advice for children and young people in care across inter-agency and corporate parenting partnerships and appropriate structures, such as health and wellbeing boards or their equivalents
- deliver efficacy in achieving positive outcomes and ensure governance arrangements are in place for commissioning of specialist placements where a child or young person is placed away from the responsible local authority/council/health and social care trust
- be able to provide expert advice for situations where children and young people are in an inappropriate health setting
- understand and ensure continuity and quality of services for children and young people in care placed out of their local area – oversight and liaison required by the senior strategic health professional. Clarity of responsibility including local authority/council/health and social care trust/commissioner, is vital to ensure health needs of the child are addressed locally in a timely way with no additional delays. Acknowledge there is a reciprocal need and expectation for children and young people placed into local area
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.