Expectation and job roles |
Expectation – Leadership role and additional responsibility
This is underpinned by the competencies, knowledge, and skills of levels 1 to 3. However, additional leadership and strategic thinking skills are also needed by all level 4 role holders. Practical/clinical experience in family health will be needed but may not be exclusively in children and young people’s health. Professionals working at level 4 will have clinical and leadership responsibility for safeguarding children and young people, and clinical and leadership responsibility for children and young people in care, to improve outcomes.
The roles for safeguarding children and young people, and for 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 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:
- Level 4 senior/named doctors and nurses
- Level 4 senior/named midwives (in organisations delivering maternity services)
- Specialist child psychologists and specialist child psychiatrists (in mental health trusts/providers)
- Level 4 senior/named health professionals in ambulance organisations
- Safeguarding Lead
- Specialist nurses (in residential homes, secure children’s homes)
- Named GP for safeguarding (supporting a health system)
England and Northern Ireland: level 4 senior/named doctors, level 4 senior/named nurses, level 4 senior/named midwives, level 4 named GP for safeguarding (England) (providing specialist safeguarding support to all general practice staff and GPs), medical adviser to adoption agency
Scotland: lead nurse for child protection, lead paediatrician for child protection, Child Protection Nurse Advisors
Wales: level 4 senior/named doctors, level 4 senior/named nurses, level 4 senior/named midwife or lead midwife for safeguarding, heads of safeguarding/Assistant Directors of Safeguarding, level 4 senior/named doctor for children and young people in care and adoption, medical advisers for adoption
“Your mental health impacts everything; everyday life, education, just getting up in the morning.”
Overview of level 4 |
Competency at this level is about individuals being able to:
- use knowledge and skills in safeguarding children and young people and what it means to be a child or young person in care, or care leaver to support and advise other health professionals; to offer expertise and resolve escalations for individual situations
- know their role and responsibility to demonstrate leadership and work together with other professionals to ensure the local system meets the needs of vulnerable children and young people
- take a role in trust/provider assurance, governance and training 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, which may include debrief meetings, clinical and restorative supervision. 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 frontline staff, senior staff and executives the vital importance of up-to-date competency, training and processes to keep children safe and reduce health inequalities for children and young people in care
Professionals (role titles may be different across four nations) who undertake statutory IHAs and other relevant health assessments for children and young people in care need a higher level of knowledge and understanding to deliver a thorough, trauma-informed assessment taking into account the impact of prenatal factors, family health, environment and abuse/trauma on development, physical and emotional health. Level 4 senior/named professionals for children and young people in care need appropriate expertise to advise and support individual situations.
Level 4 core competencies |
In some areas, the same competency can be described for level 4 safeguarding children professionals and level 4 children in care professionals, understanding that the knowledge and expertise required to meet that competence is different. When distinct competencies are required, these are listed separately as competencies for level 4 safeguarding children and level 4 children in care.
Health care staff at this level should:
- contribute as a member of the safeguarding children and young people and children and young people in care teams to develop strong internal policies, guidelines, protocols, and procedures
- facilitate and contribute (at the appropriate leadership level) to own organisation’s quality assurance activities and multi-agency meetings for effective safeguarding of children and young people and services for children and young people in care; this will involve multi-agency work and recognises the importance of individual organisation and service contribution, and also will include internal governance, learning events, statutory reviews, and inspections
- advise on local safeguarding of children and young people, and services for children and young people in care using knowledge, research and learning from audits, training, learning from poor and exemplary practice, and address areas where there is an identified training/development opportunity
- work effectively and collaboratively with safeguarding children and young people teams, children and young people in care teams, and partners in other agencies, to conduct safeguarding and children and young people in care training needs analysis, and to commission, plan, design, deliver and evaluate single and multi-agency training and teaching for staff in the organisations covered
- contribute to the implementation of national learning reviews; leaders in should lead on creation and implementation of action plans and learning where they refer specifically to children in care:
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- Child Safeguarding Practice Reviews (England), Child Practice Reviews or Single Unified Safeguarding Reviews (SUSR) (Wales), Learning Reviews (Scotland), Case Management Reviews (Northern Ireland)
- domestic abuse related death reviews involving 16-18 years old and/or children and young people e.g. domestic homicide reviews or domestic homicide & suicide reviews in Scotland
- individual management or agency reviews, and child death reviews, where requested
- be aware of cross-border/jurisdiction differences in legislation, guidance and practice throughout the United Kingdom and Ireland where appropriate
- advise and contribute to the development of Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) action plans, in relation to above reviews, using a root cause analysis approach where appropriate or other locally approved methodologies; these reviews may also consider safeguarding children and young people or children and young people in care practice
- understand the oversight and quality assurance process following the reviews detailed above with safeguarding children and young people and children and young people in care teams and, in addition, be able to hold leaders and organisations to account
- escalate effectively, supporting colleagues from other organisations, providing advice as appropriate, and be able to support resolution of professional differences using multi-agency guidance to raise concerns through a formal process
- possess sufficient expertise and experience to provide up to date, evidence-based advice and information about safeguarding children and young people or children and young people in care to the employing body including senior managers, executive directors and the Board, and should have the confidence to deliver oversight and assurance with a proactive and reactive approach
- provide specialist advice to practitioners, both actively and reactively, including clarification on national and local organisational policies, legal issues, e.g. relating to care orders or criminal investigations, and the management of complex safeguarding of children and young people situations
- possess expertise and communication skills to enable provision of supervision in safeguarding children and young people and children and young people in care, and engagement in peer supervision, and lead or ensure appropriate reflective practice is embedded in local organisations, including peer review for safeguarding children and young people
- possess expertise and ability to participate with a trauma-informed approach in sub-groups, as required in national guidance, of the Local Safeguarding Children Partnership (LSP)/the safeguarding panel of the health and social care trust/the Child (or Public) Protection Committee in Scotland/the safeguarding committee of the Health Board or trust in Wales
- lead/engage with risk management of the organisation’s ability to safeguard all children and young people, recognising additional needs of children and young people in care
- ability to understand and apply the Mental Capacity Act 2005 (c.9), Adults with Incapacity (Scotland) Act 2000 (asp 4) and Liberty Protection Safeguards (formerly Deprivation of Liberty Safeguards) (England and Wales only) and how this might apply to all 16-18year olds.
- possess knowledge and expertise regarding transitional safeguarding; work effectively with multi-agency colleagues
Additional Level 4 core competencies applicable to health care staff for safeguarding children and young people |
Health care staff at this level should:
- possess clinical expertise and knowledge to support and lead peer review in relation to child protection medical examinations (where this is part of their job responsibility)
- possess clinical expertise and knowledge to offer clinical advice in complex safeguarding cases
- be able to elicit, understand and consider the views of a child or young person and how these should be included in the service providing child protection medical examinations
- provide expertise and support, and escalation if needed, to enable child protection medical examinations and reports to be completed appropriately
- enable trauma-informed care to be embedded in practice acknowledging consequences of adverse childhood experiences and impact of child safeguarding
- support partnership working with social care and offer constructive challenge where safeguarding needs are not being met
- liaise and escalate as needed where processes are not working effectively and child safeguarding is not being met
- support professional colleagues where they have been instructed by Court or are involved in legal process
- act as an expert resource and source of support for those working at level 3
- possess expertise and ability to participate with a trauma-informed approach in sub-groups, as required in national guidance, of the Local Safeguarding Children Partnership (LSP)/the safeguarding panel of the health and social care trust/the Child (or Public) Protection Committee in Scotland/the safeguarding committee of the Health Board or trust in Wales
- support transitional safeguarding where appropriate, working collaboratively with colleagues in adult safeguarding. Possess expertise and knowledge about relevant adult issues e.g. how parental mental health issues and drug and alcohol misuse can impact on the safety and wellbeing of children. Support from a health perspective, as relevant to role, the management of those who pose a significant risk of harm to children
Additional Level 4 core competencies applicable to health care staff for children and young people in care |
Health care staff at this level should:
- possess clinical expertise and knowledge to be able to clinically support staff, offer quality assurance/peer review, clinically support in complex cases
- ensure staff working with children and young people can elicit, understand, and consider the views of a child or young person and how these should be included in the health assessment
- demonstrate oversight and quality assurance, and escalate if needed to enable health assessments to be completed within statutory requirements for children and young people in care
- support adequate service development and liaison with other health teams
- initiate interventions to facilitate and support child resilience and reduce risk of emotional harm, ensuring trauma-informed care is embedded in organisations and services
- act as a key conduit and contact for social workers, key workers at residential units, families, and local authority/council/health and social care trusts, where there are challenges accessing health services
- possess the ability to support networks of carers and families to deliver appropriate care and support, offering constructive challenge where health needs are not being met
- liaise with other agencies and escalate as needed regarding the health management of individual children and young people in care
- support professionals to contribute to Court reports or information used in other legal processes related to children and young people in care
- act as a resource and source of support for those working at level 3 and/or supervise staff working with children and young people in care
- have confidence and expertise to provide safeguarding advice from a health perspective for children and young people in care where safeguarding issues arise within the care system
- interpret regional, national, and local policy documents/reports and their implications for children and young people in care health and service provision
- work creatively with other specialist areas to deliver high quality services specific to the needs of children and young people in care
- work effectively with multi-agency colleagues to support young people leaving care or transitioning 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.