Expectation and job roles |
Expectation – Recognition
Job roles – All health care professionals and staff who will have different levels of patient contact, as well as volunteers across health care services.
Introduction |
Individual staff undertaking level 1 training may not all need the same knowledge to safely practise day to day duties. Training this staff group as a single audience should provide all the knowledge needed to meet the level 1 competencies for all health care staff. All staff at this level will need adequate and appropriate knowledge and skills to be aware of issues related to safeguarding children and young people and children and young people in care, and how to report concerns.
“It is not bad being in care and I feel safe, and I like it.”
“Being placed in a stable foster placement with people who care about me is what makes me feel, happy and settled and helps me to do well”
Examples of staff |
Groups of staff included in level 1 – domestic staff, caterers/kitchen staff, porters, transport staff, community pharmacist counter staff, laboratory staff, non-patient facing medical teams, e.g. pathologists.
Groups of staff whose role may span levels 1 and 2, depending on area of work, site and duties include – administrative staff, receptionists.
Overview of level 1 |
Competency at this level is about individuals being able to:
- demonstrate knowledge and understanding of safeguarding children and young people and what it means to be a child or young person in care, or a care leaver
- know what it means for health care staff and their role in working together with other staff to meet the needs of vulnerable children and young people (including those that are fostered, adopted, in residential care, within the youth justice service, and a child or young person seeking asylum or refuge (CYPSAR))
- recognise the indicators of possible harm and seek advice from appropriate personnel if they have concerns that a young person may be at risk.
Level 1 core competencies |
Health care staff at this level should:
- Be able to raise awareness of and recognise child maltreatment, including:
- physical abuse including perplexing presentations/FII (fabricated and induced illness) and FGM (female genital mutilation)
- neglect
- emotional abuse, forced marriage (including removal from the UK for this purpose), faith-based abuse, modern slavery, and grooming
- exploitation of children and missing children, including activities that support and/or commit acts of terrorism (known as “Radicalisation“, county lines, child trafficking into and outside of the UK
- child sexual abuse (CSA)
- sexual exploitation of children, young people, and missing children
- criminal exploitation
- domestic abuse
- understand that children and young people with any disability (visible, e.g. physical impairment, or hidden, e.g. intellectual disability or neurodevelopmental condition or mental health difficulty) are at greater risk of abuse
- have an awareness of the potential impact of a parent’s/carer’s physical and mental health on the wellbeing and development of a child or young person (including the unborn child) and:
- the impact of parental substance use, alcohol misuse, domestic abuse
- the risks associated with the internet and online social networking
- adverse childhood experiences and their effects
- have an awareness that child protection and children and young people in care practices in health settings are designed and delivered to adhere to relevant legislation, policies, and protocols; each of the four nations have different legislation which has evolved over time to meet the needs of children and young people and respond to significant events; this legislation also supports and protects staff
- understand the importance of balancing children’s rights to confidentiality against the need to protect children and young people, and act in their best interests in the context of safeguarding children and young people, and children and young people in care
- have an awareness and recognise that a child, (including a child or young person in care), not being brought to a health appointment may be a potential indicator of neglect or other forms of abuse, and recognising the potential impact on the wellbeing of children and young people of parents/carers not attending or postponing health appointments
- take appropriate action if there are concerns, including appropriately seeking advice, documenting, and reporting concerns effectively; know how to escalate to line manager if needed
- have an awareness of professional and organisational abuse by a Person in a Position of Trust (PIPOT) and have the freedom to speak up by accessing processes to raise concerns about conduct of colleagues, wherever it may occur
- have an awareness of transitional safeguarding in health services, the risk created by different approaches and criteria for safeguarding intervention by Local Authority teams as the young person transitions to adult services.
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.