Learning from the Child Safeguarding Practice Review Panel’s fourth annual report

In case you missed it – last week, the Child Safeguarding Practice Review (CSPR) Panel released its fourth annual report which is described as a barometer of the health of the national safeguarding system, highlighting both strengths and areas for improvement in multi-agency practice. The report provides important insights into patterns in English safeguarding practice, examining learning from incidents where children have died or suffered serious harm due to abuse or neglect.

In the Foreword to the report, Annie Hudson, the Chair of the Child Safeguarding Practice Review Panel, reminds us that, “The children at the heart of this report endured shocking, almost indescribable, violence and maltreatment. We must never become inured or habituated to this. What happened to these children cannot be undone, but what we must do is assess how well agencies responded to their needs.”

The findings presented in the 2022/23 annual report are based on:

serious incident notifications (SINs) during the 15-month period of January 2022 to March 2023 with a focus on the 12-month period of April 2022 to March 2023
rapid reviews with incidents that occurred during the 12-month period from April 2022 to March 2023
a sample of Local child safeguarding practice reviews (LCSPRs) produced during the 15-month period of January 2022 to March 2023
letters to safeguarding partnerships from the Panel used to assess the quality of rapid reviews during the 12-month period of April 2022 to March 2023.

The review also draws on evidence in the 2 national reviews and 2 thematic reviews the CSPR published in 2022 and 2023.

The Panel received 393 serious incident notifications during this period, with 37% (146) related to child deaths and 58% (227) involving incidents of serious harm to children.

Review highlights vulnerability of babies

Babies under the age of 12 months old comprised the single largest age group within the sample of rapid reviews (36%, n=142).
Over a fifth (26%, n=25) of serious incidents involving children under one year old occurred in the 10% most deprived areas compared to 15% (n=7) of children aged 1 to 5 years old.

Parental and family stressors were the most significant factor in escalating risk when it comes to safeguarding children under 12 months old. Previous reports like the Myth of Invisible Men and Bruising in Non-Mobile Infants emphasised challenges in responding to this vulnerable group. The review builds on the key learning from the inquiry into the murders of Star Hobson and Arthur Labinjo-Hughes in highlighting the importance of professionals having the time to understand the context in which babies and young children are living:

“Knowing what life is like for children, highlighting the centrality of children’s voices and experience, and those of their parents, carers, and wider family members, but also the knowledge, skill and confidence required to build a full picture of children’s lives to enable the best safeguarding, support and protection.”

Understanding the roles and risks of all adults around very young children is crucial, given their dependence on caregivers and the potential for rapid escalation. The analysis also highlighted ongoing problems in effectively assessing and managing risks involving babies, with connections to domestic abuse, where pregnancy is a recognised risk factor in such relationships, posing challenges for professionals.

Parents’ and carers’ needs

Among the 393 cases reported to the Panel, 13% (n=51) involved parents under 25 years old, and 3% (n=13) had a history of being in the care system, although identification was sometimes challenging. This indicates a potential need for additional support from services like GPs and health visitors for these parents.

Conditions in practice

One of the main messages from the review is the importance of providing practitioners with the best opportunity to identify, assist and protect children. Specifically for health visiting, the following factors were found to hinder optimal practice and safeguarding decision making:

Major challenges in workforce recruitment and retention, most obviously in children’s social care and health visiting, which impact on the quality of practice. The review raises concerns about the year-on-year decline in the number of health visitors.
Increases in population numbers and levels of vulnerability – this includes evidence from the iHV Annual State of Health Visiting survey. Alongside the decline in workforce numbers, these place significant pressures on health visiting services in meeting the scale of need.
Limited GP input and incomplete health records in multi-agency meetings posed a common problem in recognising vulnerabilities affecting families. Inadequate information sharing between agencies, like neonatal units, midwives, health visitors, and GPs, especially in families with young children, significantly impacts the protection of children at risk of harm.
There was also evidence that questions about domestic abuse were not being asked during checks with mothers if fathers were present (this learning point applies regardless of sex and gender of both parents or main carers). While including fathers in checks and appointments is essential to avoid them becoming invisible to services, this finding emphasises the need to ensure that mothers can speak to health visitors alone in case the presence of the other parent inhibits disclosure.
The report emphasises the importance of working upstream to prevent situations reaching crisis point.

The report concludes with a series of reflective questions for safeguarding leaders to support them in promoting the very high standards of safeguarding practice and makings sure that learning reviews drive longer term change to help children and families. These questions are organised around 6 key strategic themes:

Culture: creating an inclusive culture where professional challenge is promoted.
Clear partnership intent: ensuring clear and balanced partnership working.
Strategy to delivery: ensuring strategy is carried through to frontline practice.
Assessing effectiveness: evaluating impact of the safeguarding system.
Getting upstream: ensuring learning feeds into prevention, early intervention and the commissioning of services.
Workforce: working together effectively across agencies and promoting development.

Read the CSPR Panel report in full here

House of Lords publishes Select Committee response to Integration of Primary and Community Care consultation

Today, the House of Lords Primary and Community Care Committee published its report ‘Patients at the centre: integrating primary and community care’, in response to the consultation it held earlier this year.

The consultation explored the many challenges facing primary and community care and the sustainability of the NHS. These include high service demand, an ageing population, workforce shortages and insufficient preventative care. The Committee explored how integrating services could address these challenges and sought evidence from clinicians, community care services, local authorities, researchers and voluntary organisations from across the country.

The Institute of Health Visiting was asked to contribute to the consultation and we did this in a number of ways:

Alison Morton, iHV CEO, submitted written evidence in April 2023.
Professor Sally Kendall MBE, who is one of the iHV’s four founding health visitors and an Honorary Fellow, presented oral evidence as a witness.
Sarah Cartner, a member of the iHV’s Health Visitor Advisor Forum, and a health visitor from Newcastle Upon Tyne Hospitals NHS Foundation Trust, also represented the iHV at a roundtable event hosted by the Committee at the Palace of Westminster – read her Voices blog.

We were delighted to see that health visiting has been recognised as a key sector of the health service, within the report. The report also highlights the challenges of workforce shortages and fragmented models of care, alongside the hugely valuable service that health visiting provides to GPs and families. Evidence from Professor Campbell, Professor of General Practice and Primary Care at the University of Exeter is cited. He states, “Health visiting … has been hugely valued by GPs and their teams, but it is now no longer really part of general practice. Sadly, we have lost so many health visitors that we do not know who these people are or where they are. They provide a hugely valuable service, safeguarding and supporting families and people with long-term conditions.”

Alison Morton, iHV CEO, commented:

“We are delighted to see that health visiting has been recognised as a key sector of the health service by the Committee. The report also highlights the very real challenges of workforce shortages and fragmented models of care that are having a significant impact across the whole health and care system.

“In his evidence, Professor Campbell, Professor of General Practice and Primary Care, speaks for many GPs, highlighting how much they value health visitors and the work that they do to safeguard and support all families. He also raises valid concerns about the impacts of the depletion of the health visiting service in recent years which is hampering collaborative working. Close working relationships between health visitors and GPs are vitally important to support their collective work with all babies, young children and families, and particularly those living with complex conditions, risk and vulnerability. We share the Professor’s concerns and support the recommendations in this report. To deliver better joined-up care, we urgently need more health visitors.”

The Integration of Primary and Community Care Committee Report’s has 4 key recommendations:

Structures and organisation of NHS services need to be streamlined. Integrated Care Systems (ICSs) are a good starting point for collaborative working but their relationship with other healthcare bodies, public bodies, and local government must be based on mutual professional respect. The Department of Health and Social Care (DHSC) should evaluate ICS structures before implementing any major health service reforms.

There needs to be a more simplified and flexible system for awarding contracts and allocating funds within the NHS to encourage multi-disciplinary, integrated working. DHSC and NHS England (NHSE) should reform the contract process and ensure new contracts are flexible in the commissioning of primary care. The Government should explore different ownership models for GP practices to facilitate more joined-up and better care.

Efficient data-sharing is crucial to successful healthcare integration. Fragmented systems often require patients to repeatedly provide the same medical information, causing frustration. A properly maintained Single Patient Record (SPR) and the ability for intersectoral data-sharing between healthcare professionals are essential to tackle this issue. The DHSC must issue guidance to standardise data practices and clarify data sharing within privacy laws, to ensure timely patient access to medical data.

Equipping staff to work across multiple clinical disciplines through improved training will make integration of services easier. Currently, staff spend more time meeting everyday demand, rather than implementing new integration strategies. Clinicians should be introduced to the work of other services through job rotations. Social care needs should also be included in the NHS’s Long Term Workforce Plan to ensure that enough well-trained social carers are available.

Sally Kendall MBE, Professor of Community Nursing and Public Health at University of Kent, said:

“Despite some strong evidence to the Committee in relation to integration across all community services, it is disappointing that children’s health does not receive a lot of specific attention in the report. Childhood is lived in the home (wherever that may be), school, nursery and neighbourhood. There is a huge opportunity for ICBs to come together with local authorities and the NHS and voluntary sector to integrate health for all children and close the inequality gap. This opportunity may be lost for future generations of children if ICBs do not recognise the importance of the community services such as health visiting and school nursing and their navigational role with primary care and other community services to ensure that children’s health and safeguarding needs are met.”

Links for further reading:

Read iHV submission to Integration of Primary and Community Care Committee (April 2023)

Read Sarah Cartner's Voices blog:

iHV Submission to the Down Syndrome Act Guidance: call for evidence

iHV has submitted its evidence for the DHSC Down Syndrome Act 2022 guidance: call for evidence which closes at 11.45pm on 8 November 2022.

The evidence base of what families with babies and children with Down’s syndrome value from health and related services has increased in recent years and should be acted upon in the design of services including health visiting. People with Down’s syndrome have a genetic variation. Whilst they share some common features, it must be emphasised they are all individuals with their own abilities, needs, interests and aspirations. Down’s syndrome is not a disease and people who have Down’s syndrome are not ill.

In the document below, we provide evidence in response to the questions for professionals, about health services, and in relation to the health visiting service in England.

iHV evidence for Down's Syndrome consultation submission - October 2022

iHV has resources to support its members in practice – please see Good Practice Points below:

GPP – Supporting children with Down’s syndrome and their families

GPP – Supporting children with Down’s syndrome: growth, feeding and development

New evidence paper published by the National Children’s Bureau

New evidence paper published by the National Children’s Bureau: Impact of investing in prevention on demand for statutory children’s social care

The final report of the Independent Review of Children’s Social Care is expected imminently. To support the launch of the Review, the National Children’s Bureau (NCB) has worked with their academic partners to showcase the latest research on children’s social care.

The NCB’s new evidence paper (Impact of investing in prevention on demand for statutory children’s social care) demonstrates that investing in prevention, including family support and early help, can reduce demand for more expensive crisis support later, and also leads to better services overall.

The NCB says:

“We have a unique opportunity to strengthen families and invest in early intervention. We must seize this moment to transform children’s lives for the better. Rarely has the case for early investment been so clearly articulated. We have to seize the moment”.

Highlights from the evidence paper:

Increased spending on children’s social care preventative services (including family support and early help) has a positive impact on:
- Ofsted judgements
- Numbers of Children in Need
- Rates of 16–17-year-olds starting periods in care.
The distribution of local authority spending on prevention has become increasingly less well matched to need.
Two recent papers have reinforced the contributory causal relationship between family poverty and levels of child abuse and neglect and the demand for children’s social care services, including rates of entry to care.

The evidence paper concludes with a brief summary of further contextual research on the association between household income and intervention, and on systems-thinking in children’s social care.

You can read more in the NCB’s evidence paper here.

You can join the iHV in raising awareness of the publication of the NCB’s evidence paper and share on social media using the prepared tweet below:

The imminent #CareReview is our chance to secure a future where every child feels safe, secure & supported @NCBtweets’ new evidence paper shows how investment in preventative services can help build that future, saving money in the process. https://bit.ly/3yO2Y2D

iHV presents at APPG for Conception to Age Two

If you missed yesterday’s All Party Parliamentary Group (APPG) for Conception to Age Two meeting held online, you can watch it on the link below.

Yesterday’s APPG meeting was chaired by Tim Loughton MP, and the topic was ‘Midwives, Health Visitors and Family Hubs’. Alison Morton, Executive Director iHV, gave evidence on the challenges and opportunities facing health visiting – you can listen to Alison at 1:10:52 until 1:23:00.

Go to YouTube to watch the APPG

iHV welcomes Early Years Commission – A Cross-party Manifesto

We’re delighted to see yesterday’s cross-party support for the early years published in the Early Years Commission: A cross-party manifesto – #EarlyYearsManifesto. Yet more evidence for the case for investment.

Alison Morton, Executive Director iHV, who provided evidence on health visiting as a witness to the commission commented:

“The importance of getting it right for every child cannot be over-emphasised. I am delighted to see such strong cross-party agreements and a cross-departmental commitment to prioritise the earliest years of life set out so clearly in this report. The commission has highlighted the importance of tackling the root causes of siloed working alongside the benefits of investing early, rather than ‘firefighting’ and tackling emergencies. With so much attention on the early years at the moment, action to start to put this right cannot come soon enough”.

The manifesto outlines how our country must give every child the best start in life, and right now we are falling short. Despite improvements among some children, too many continue to fall behind in their first few years, particularly those living in poverty. Many are not ready to learn by the age of five and struggle with their health and wellbeing, leading to damaging long-term consequences. It is this reality which obstructs our country’s path to a more prosperous future. We will never truly level up if we don’t recognise this. There are steps we can take now to help those children, even though they and we may not realise the benefits for decades.

It is good to see health visitors mentioned as a key workforce that requires strengthening in order to achieve these ambitions.

Through their Cross-party Manifesto, The Early Years Commission calls on central and local government, community organisations, the private sector, parents, and society as a whole to come together to achieve this goal.

Read Early Years Commission: A cross-party manifesto

Help improve new standards for community and public health nurses

The Nursing and Midwifery Council (NMC) has launched their public consultation for specialist community public health nursing (SCPHN) standards – building on ambitions for community and public health nursing.

The new NMC standards offer the opportunity to build on the advances in the evidence base for universal child and family health visiting for the pressing public health challenges of our times. It is vitally important that the views of health visitors are heard and shape these new standards.

We will be responding from the iHV – as well as submitting your own response, look out for our mailings on ways that you can help shape the iHV’s response.

The standards, for specialist community public health nursing (SCPHN) and specialist practice qualifications (SPQs), will equip the next generation of community and public health nurses working in health and social care with the right proficiencies to care for people in a rapidly changing world.

These essential education standards were last updated over 15 years ago. But we need fit for purpose standards that reflect the realities of modern nursing in health and social care now

These draft standards, which have been co-produced with subject experts, will provide the right proficiencies these professionals need to support and care for people in a rapidly changing world.

The consultation will run until Monday 2 August 2021. Normally these NMC consultations run for 12 weeks but they’ve extended this one to more than 16 weeks to give you and your colleagues more time to take part given the continued pressures on services caused by the pandemic.

Go to NMC public consultation - Building on ambitions for community and public health nursing

Call for abstracts

Call for abstracts for iHV Evidence-based Practice Conference “Looking ahead to a fairer future” – 21-22 September 2021

The iHV is delighted to offer you the opportunity to present your practice development or research at our 5th evidence-based practice conference – “Looking ahead to a fairer future”. This 2-day virtual conference is being held on 21 and 22 September 2021.

Our conference programme brings together local, national and international speakers focused on sharing best practice examples and research to improve health visiting practice. This conference will provide a much-needed time of reflection and learning from the COVID-19 pandemic and its impact on babies, young children and their families, and the services that support them.

In particular, the conference will focus on reducing inequalities and this will be explored through a variety of different practice-related topics. What have we learnt from the pandemic? And how can we focus our efforts as we look ahead to the future with a shared ambition to build a fairer society?

The presentations and workshops will reflect the breadth of health visiting practice, within a “whole system” public health approach, with the aim to equip health visitors to address key challenges in prevention and earliest intervention work with babies, children and families.

Abstract Topics

Health visitors provide a vital safety-net for all families, which is essential if we are serious about reducing inequalities.

We are open to abstracts which cover at least one of the following priority areas within the breadth of early years public health and health visiting practice, with a focus on reducing inequalities:

Transition to parenthood, including preconception care
Breastfeeding
Perinatal mental health (mothers, fathers and partners)
Infant and child mental health
Healthy nutrition, physical activity and healthy weight
Managing minor illnesses, building health literacy and prevention of Sudden Infant Death Syndrome (SIDS)
Reducing unintentional injuries
The uptake of immunisations
Primary prevention and health promotion in oral health
Child development 0-5 years, including speech, language and communication and school readiness
Sleep
Children with developmental disorders, disabilities and complex health needs
Tobacco, alcohol and substance misuse in the perinatal period
Healthy couple relationships
Teenage parenthood

Abstract Submission and Timeline

Abstract format:

The abstract should be no more than 350 words and provide an overview of your practice development or research, clearly indicating the impact on health visiting practice.
Please structure your abstract as follows:
- aim
- objectives
- method
- results/ outcomes
- conclusion
- recommendations.
Please submit your abstract as a Microsoft Word document to [email protected].

Abstract Timeline:

The abstract submission deadline is 10 May 2021.
After an iHV peer-review process, participants will be informed of acceptance of abstracts for either oral presentation or an e-poster by the end of May.
Full guidance on the e-poster and oral presentation delivery format will be provided if your abstract is successful.

It is important that you book to secure your conference place on or before the final registration deadline for accepting your offer to present.

Please note that our booking system is not yet live – so in the meantime, please hold the conference dates in your diary: 21 and 22 September 2021.

Early years healthy development review: call for evidence

The Prime Minister has asked Rt Hon Andrea Leadsom MP to lead a new review into improving health and development outcomes of babies and young children in England. The time from conception to the age of 2 is a critical time for development and can impact physical health, mental health and opportunity throughout life.

The consultation would like to hear from recent parents, including those who gave birth during the lockdown, and public health response to the coronavirus (COVID-19) pandemic, about the experiences of care and services you received.

They’d also like to hear from health service professionals, charities, volunteer groups and academics.

Your views can help to shape the outcome of the review – please use this opportunity and share to others to respond too.

The closing date for responses is 11:59pm on Friday 16 October 2020.

Go to Early years healthy development review: call for evidence

iHV submits powerful evidence to Government’s Comprehensive Spending Review

The Institute of Health Visiting has provided the Treasury with the latest evidence and cost benefits for new investment into health visiting as part of its Comprehensive Spending Review.

As the Institute submits its evidence to the Spending Review, Dr Cheryll Adams CBE, Executive Director iHV, said:

“We hope that this clear rationale and evidence for investing into the early years through the health visiting service will be taken seriously when the Treasury reviews all the submissions. There has never been a greater need to act to support young families as they face the secondary impacts of the COVID-19 pandemic. A loss of 30% of the health visiting workforce, since cuts to public health budgets, is impacting on our most vulnerable citizens and their families, but this will also have a significant long-term legacy for the country as a whole.”

Read iHV's Evidence for the 2020 Comprehensive Spending Review