Expectation and job roles |
Expectation – Response
Building on level 1, training at this level should incorporate level 1 competencies outlined earlier.
Job roles – all health care professionals and staff who encounter children and young people, but do not provide clinical care to children and young people.
Introduction |
Individual staff undertaking level 2 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 2 competencies for all Health care staff. All staff at this level will need adequate and appropriate knowledge and skill to be aware of issues related to safeguarding children and children in care and how to respond to concerns.
“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”.
“Sometimes you just need one person to care about you to make you believe that you matter.”
Examples of staff |
Groups of staff included in level 2 – nurses, doctors, allied healthcare practitioners, clinical support and assistant staff, maternity support staff, reception staff, healthcare, allied health care, nursing and medical students, patient advocate, phlebotomists, technicians, clinical scientists and clinical technologists, perioperative care pathway staff and operating department practitioners (ODPs). Areas of work include – adult learning disability, non-registrant ambulance staff, audiology, optician services, pharmacy, all other adult orientated acute secondary care healthcare professionals not directly caring for children or young people.
Groups of staff whose role may span levels 2 and 3 depending on area of work, site and duties include – optician services, dental services, anaesthetic staff, radiologists and diagnostic radiographers, ambulance/paramedics, pharmacists, abortion services, hospice staff and continuing care in community staff.
Overview of level 2 |
Competency at this level is about individuals being able to:
- use knowledge and understanding of safeguarding children and young people and what it means to be a child and young person in care, or care leaver, to consider their additional vulnerabilities and needs and how to respond to them
- know their role in working with other staff to meet the needs of vulnerable children and young people including knowledge of local safeguarding/Child protection referral pathways
- apply professional curiosity and proactively respond to safeguarding concerns or undertake additional intervention as needed for children and young people in care
- recognise and respond to a wide range of vulnerability factors and indicators of possible harm and report concerns in a timely way and seek advice from appropriate personnel, and/or escalating concerns.
Level 2 core competencies |
Health care staff at this level should:
- understand that the presentations of different forms of child abuse and/or different forms of child sexual abuse can be complex as they often involve multiple individuals, generations, networks, and potential criminality that surrounds the baby/child/young person/family; staff should recognise that these complexities can change across time and place, and are often influenced by broader issues present in society
- recognise the potential impact of previous adverse childhood experiences and their effects, including possible speech, language and communication needs and that adjustments may need to be made
- understand that adverse childhood experiences can have immediate, medium, and lifelong impacts on all areas of a baby’s, child’s, young person’s and adult’s physical and emotional development, health, ability to learn, work and thrive as well as often resulting in a shortened life expectancy; staff should recognise that responding to the needs of individuals and families at the earliest opportunity can support resilience and recovery from trauma
- understand why vulnerable children, including but not limited to a child or young person seeking asylum or refuge (CYPSAR), and children and young people in care, have increased vulnerabilities that may continue to affect their physical and mental health throughout their lives, recognising health care issues indicating signs of child abuse, child sexual abuse or neglect that may relate to previous maltreatment or life experience should be proactively assessed
- 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) may present in different ways with additional communication needs
- understand practices such as cupping, FGM and non-medical circumcision in children and young people from different ethnic and cultural backgrounds; appreciate that disease and injury present differently in different coloured skin
- understand that children and young people in care experiences are likely to influence how they engage with and respond to staff and health care settings, and the need to provide trauma-informed practice
- have an awareness and familiarity with the flagging/coding system used by local agencies for children at risk if in place; several systems are in place across the UK and staff must be able to recognise the ways of identifying a child or young person at increased risk, sharing this information, and helping to ensure accuracy of these ‘flags’
- recognise 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 therefore, document, seek advice or refer for support e.g. early help referral, when working within adult services is particularly important, as well as escalating and seeking support and advice if the situation is urgent e.g. child or young person at immediate risk, evidence of current abuse
- identify and refer a child or young person at risk (including children and young person in care) or suspected to be a victim of exploitation
- identify and refer a child or young person at risk of female genital mutilation (FGM) (where there is an intention for an adult to arrange travel aboard for the procedure) or having been a victim of FGM. There is a mandatory duty to report known cases of FGM in under 18year olds to the police
- understand parental rights and responsibilities and who has the right to make decisions and consent to health care decisions for a child or young person, including a child or young person in care
- recognise and practise the careful balance required to protect a child or young person, whilst maintaining confidentiality, acting as an advocate, and protecting the child’s rights; all staff are expected to adhere to professional responsibility/accountability to report, respond, and act on suspicions of all forms of child abuse and child sexual abuse
- document care concerns as well as safeguarding and child protection concerns, to be able to inform the relevant staff and agencies as necessary while maintaining appropriate record keeping with differentiation between fact and opinion. Recognise the challenges of online access relating to safeguarding and ensure appropriate decision making to restrict information from online patient access
- understand the need for a multi-agency approach to respond to complex cases, and that this can require internal advice and escalation and external referrals and decision making
- Understand 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
- recognise and act when the threshold is met for a referral to social care when a concern is identified; staff should be able to refer, if needed, and to discuss with senior colleagues and appropriate safeguarding or children and young people in care colleagues
- share relevant information, with accurate documentation of facts, opinions and action/plan
- share information appropriately considering consent and confidentiality issues related to safeguarding, children in care, and care leavers
- confidently resolve disagreements and, if unable, ensure the child’s needs are met and appropriate agencies and staff are involved
- recognise that, despite enhanced recruitment processes, there are individuals working within health care systems/settings who seek to abuse, coerce, and control, children and young people
- recognise that, whilst it is understood that individuals who pose a risk to children are responsible and accountable for their own actions, all those working in health care settings are required to remain aware of the reality of the risk and feel enabled to seek further support and advice where concerns arise. This includes knowledge of referral pathways managing allegations against staff/professionals in a position of trust (PiPoT)
- utilise clinical and/or professional knowledge to ensure that, children and young people in care, receive effective and timely health care, including statutory health assessments and recommendations, and ensuring that babies, children and young people in care do not lose out if they move area as part of the local authority/council/health and social care trusts plan
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.