SCOPE OF THIS CHAPTER
This chapter outlines the procedure for undertaking an enquiry under Section 47 of the Children Act 1989, involving all relevant agencies. It also contains guidance on undertaking medical assessments, and involving the child and family.
Derbyshire and Derby City Practice Guidance on Bruising in Babies and Children (see Documents Library, Keeping Babies Safe)
Guidance on managing babies with suspected birth marks (see Documents Library, Keeping Babies Safe)
In June 2021, additional detail has been included in Section 3, Strategy Discussions / Meetings in relation to forming a professional judgement as to whether a referral to social care and a strategy discussion is required, particularly in relation to accidental bruising in a non-independently mobile baby or child.
Further detail has been added in relation to Urgent Strategy Discussions and the process for conducting Paediatric Assessments in Section 9, Paediatric Assessments.
- Duty to Conduct Section 47 Enquiries
- Immediate Protection
- Strategy Discussions / Meetings
- Section 47 Thresholds and Multi-Agency Assessment
- Initiating a Section 47 Enquiry
- Involving Children, Parents and Family Members
- Referrals to the police
- Visually Recorded Interviews / Achieving Best Evidence
- Paediatric Assessments
- Outcome of Section 47 Enquiries
- Disputed Decisions
1. Duty to Conduct Section 47 Enquiries
When a local authority:
- Is informed that a child who lives, or is found, in their area (i) is the subject of an Emergency Protection Order, or (ii) is in police protection; or
- Has reasonable cause to suspect that a child who lives, or is found, in their area is suffering, or likely to suffer, Significant Harm.
The local authority shall make, or cause to be made, such enquiries as they consider necessary to enable them to decide whether they should take any action to safeguard and promote the child's welfare.
Responsibility for undertaking Section 47 Enquiries lies with the local authority Children's Social Care in whose area the child lives or is found. 'Found' means the physical location where the child suffers the incident of harm or neglect (or is identified to be suffering or likely to suffer harm or neglect), For the purposes of these procedures the local authority Children's Social Care in which the child lives, is called the 'home authority' and the local authority Children's Social Care in which the child is found is the child's 'host authority'.
Whenever a child is harmed or concerns are raised that a child may be suffering or likely to suffer harm or neglect, the host authority is responsible for informing the home authority immediately. The home authority should be invited to participate in the Strategy Meeting / discussion to plan action to protect the child. Only once agreement is reached about who will take responsibility is the host authority relieved of the responsibility to take emergency and on-going action. Such acceptance should occur as soon as possible and should be confirmed in writing.
Any agreed Safety Plan should be shared with all key parties involved.
Responsibilities of all agencies
Each agency has a duty to assist and provide information in support of child protection enquiries. When requested to do so by local authority Children's Social Care, practitioners from other organisations have a duty to cooperate.
2. Immediate Protection
Where there is a risk to the life of a child or the possibility of serious immediate harm, an agency with statutory child protection powers (the police and local authority Children's Social Care) should act quickly to secure the immediate safety of the child.
Emergency action may be necessary as soon as a referral is received from a member of the public or from any agency involved with children or parents. Alternatively, the need for emergency action may become apparent only over time as more is learned about a child or adult carer's circumstances. Neglect, as well as abuse, can cause significant harm to a child such that urgent protective action is needed.
When considering whether emergency action is required, an agency should always consider whether action is also required to safeguard and promote the welfare of other children in the same household (e.g. siblings), the household of an alleged perpetrator, or elsewhere. Consideration should also be given to any adults at risk within the property.
Responsibility for immediate action rests with the host authority where the child is found, but should be in consultation with any home authority (as described in Section 1, Duty to Conduct Section 47 Enquiries).
Emergency action will normally take place following an immediate strategy discussion between police, local authority Children's Social Care, health and other agencies as appropriate (see Section 3, Strategy Discussions / Meetings).
Immediate protection may be achieved, for example by:
- A parent taking action to remove an alleged abuser;
- An alleged abuser agreeing to leave the home;
- The child not returning to the home;
- The child being removed either on a voluntary basis or by obtaining an Emergency Protection Order (EPO);
- Removal of the child/ren or prevention of removal from a place of safety under police powers of protection;
- Gaining entry to the household under police powers to assess the situation.
When police powers of protection are used, an independent police officer of at least Inspector rank must act as the designated officer.
Where an agency with statutory child protection powers has to act immediately to protect a child, a strategy meeting / discussion should take place within 1 working day of the emergency action to plan the next steps.
3. Strategy Discussions / Meetings
Whenever there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm there should be a strategy discussion or meeting. Where there is any uncertainty advice should be sought from the Line Manager.
The age and stage of development of the child are crucial considerations in forming a professional judgement as to whether a referral to social care and a strategy discussion is required. Accidental bruising is strongly related to mobility, and as such injuries and bruising to a non-independently mobile child, such as a baby who is not yet crawling, bottom shuffling or cruising, or child with a disability and who is not able to move independently, raises a concern about the possibility of child abuse.For this reason, a strategy discussion should take place where injuries or bruising are observed in a non-independently mobile baby or child. Professionals within the strategy discussion will have an evidence-based discussion considering other relevant factors such as presentation, explanation, the voice of the child, and any other known vulnerability factors to support further decision making and safety planning.
The strategy discussion / meeting should involve local authority Children's Social Care (including the placement provider if the child is Looked After), police, health and other bodies such as the referring agency. This might take the form of a Multi-Agency meeting or phone calls; more than one discussion may be necessary. A strategy discussion can take place at any time following a referral including during the assessment process.
The purpose of the strategy discussion / meeting is to determine the child's welfare and plan rapid future action if there is reasonable cause to suspect the child is suffering, or is likely to suffer, Significant Harm.
A local authority Social Worker and their manager, an appropriate health professional and a police representative should, as a minimum, be involved in the strategy discussion. Other relevant professionals will depend on the nature of the individual case but may include:
- The professional or agency which made the referral;
- The child's school or nursery; and
- Any health services the child or family members are receiving.
All attendees should be sufficiently senior to make decisions on behalf of their agencies.
The strategy discussion / meeting should be used to:
- Share available information;
- Agree the conduct and timing of any criminal investigation; and
- Decide whether an assessment under Section 47 of the Children Act 1989 (Section 47 enquiries) should be undertaken.
Where there are grounds to initiate a Section 47 enquiry, decisions should be made as to:
- What further information is needed if an assessment is already underway and how it will be obtained (including the need for a medical assessment or treatment) and recorded;
- What immediate and short term action is required to support the child, and who will do what by when. If the child is in hospital, decisions should also be made about how to secure the safe discharge of the child; where the child is to be separated from family members, consideration should be given to contact and supervision; and
- Whether legal action is required.
Relevant matters include:
- Determining what information from the strategy discussion / meeting will be shared with the family, including whether such information sharing may place a child at increased risk of significant harm or jeopardise police investigations into any alleged offence/s;
- Agreeing who should be interviewed, by whom, for what purpose and when. All sexual abuse allegations should be jointly investigated by the police and local authority Children's Social Care. When a criminal offence may have been committed against a child, the timing and handling of interviews with victims, their families and witnesses can have important implications for the collection and preservation of evidence. See Section 8, Visually Recorded Interviews / Achieving Best Evidence;
- Agreeing the visiting and interviewing arrangements for the child as part of the Safety Plan;
- Agreeing, in particular, when the child will be seen alone (unless to do so would be inappropriate for the child) by the Social Worker during the course of these enquiries and the methods by which the child's wishes and feelings will be ascertained so that they can be taken into account when making decisions under Section 47 of the Children Act 1989;
- Consideration should be given to any disabilities and the race / ethnicity of the child and family, and how these will be taken into account. It should be established if an interpreter will be required;
- Consideration of the needs of other children who may be affected in the same household (e.g. siblings), the household of an alleged perpetrator, or elsewhere.
Urgent strategy discussions
There may be circumstances where a strategy discussion may need to take place immediately to create a Safety Plan for a child. In this situation, as a minimum, the three key partners will be required to participate. There is a likelihood in these circumstances that a further strategy discussion may be convened to discuss the broader safeguarding issues and decision making.
For any new cases, the health professional to be involved in strategy discussions within normal working hours will be the Health Advisors in the Derby City Multi-Agency Safeguarding Hub (MASH) or Derbyshire Starting Point. Where the child is an open case to Social Care, the Named Nurse Safeguarding Children on call for Derby City or Derbyshire County should be contacted. Where the child is an inpatient or within the ED department of a local hospital, the Named Nurse Safeguarding should be contacted. Please see the links to the Child Protection Medicals for UHDB/ DHCFT and Chesterfield Royal Hospital and the Local Contacts document for contact details in the Documents Library, Guidance Documents)
The Consultant Paediatrician on-call for child protection should be consulted if the following circumstances apply:
- Outside normal office hours;
- If there is a concern about abuse or neglect and it is not immediately clear whether a medical examination is required;
- Where there are medical concerns about a child who is subject to the strategy discussion.
The strategy meeting
Meetings either face to face or via conference meeting facilities, rather than telephone discussions, are expected where:
- There is concern that the child is suffering sexual abuse, neglect or complex types of maltreatment;
- There is an allegation that a child has abused another child - the strategy meeting must address the needs and risks for each child separately (see Children who Present a Risk of Harm to Others Procedure);
- There are on-going, cumulative concerns about the child's welfare and a need to share concerns and agree a course of action;
- There are concerns about the future risk of harm to an unborn child;
- Where the child is an in-patient in hospital and abuse is suspected.
(Please note - this list is not exhaustive).
The Strategy Meeting should be convened and chaired by local authority Children's Social Care. In addition to the Social Worker and their Manager, the police and relevant health professionals, the meeting may need to involve the other agencies (e.g. schools and nurseries) which hold information relevant to the concerns about the child. In complex or unusual circumstances a Child Protection Manager may need to chair the meeting (see Section 7, Referrals to the police).
Professionals participating in strategy meetings must have all their agency's relevant available information relating to the child to be able to contribute it to the meeting, and must be sufficiently senior to make decisions on behalf of their agencies.
Where issues have significant medical implications, or a paediatric examination has taken place or may be necessary, a Paediatrician should always be included. If the child is receiving services from specialist health services, the meeting, if practicable, should involve the responsible Medical Consultant and, in the case of in-patient treatment, a Senior Ward Nurse.
If sexual abuse is being considered or FGM may be a factor, then the East Midlands Children and Young People's Sexual Assault Service (EMCYPSAS Tel: 0800 183 0023) should be contacted to invite them to participate in the strategy discussion. The EMCYPSAS website contains up to date information for both professionals and young people.A professional may need to be included in the strategy meeting who is not involved with the child, but who can contribute expertise relevant to the particular form of abuse or neglect in the case.
Strategy discussion / meeting record
It is the responsibility of the Chair of the strategy discussion / meeting to ensure that the decisions and agreed actions are fully recorded using an appropriate form / record and circulated at the conclusion of the meeting.
For telephone strategy discussions, all agencies should make a record of the outcome of the telephone discussion and actions agreed at the time. The record of the decisions authorised by the local authority Children's Social Care Manager should be circulated by e-mail as soon as practicable to all parties to the discussion.
Timing of strategy discussion / meeting
Strategy discussions / meetings should be convened within 3 working days of child protection concerns being identified, except in the following circumstances:
- For allegations / concerns indicating a serious risk of harm to the child e.g. serious physical injury or serious neglect, the strategy discussion / meeting should be held on the same day as the receipt of the referral;
- For allegations of sexual abuse where there might be forensic evidence, the strategy discussion / meeting should be held on the same day as the receipt of the referral;
- Where immediate action was required by either agency, the strategy discussion must be held within 1 working day.
Where the concerns are particularly complex e.g. organised abuse / allegations against staff, the strategy discussion / meeting must be held within a maximum of 5 working days, but sooner if there is a need to provide immediate protection to a child.
The plan made at the strategy discussion / meeting should reflect the requirement to convene an initial Child Protection Conference within 15 working days of the strategy discussion / meeting (or within 15 days of the strategy discussion / meeting at which it was decided to initiate the enquiry if there was more than 1 meeting). In exceptional circumstances, such as fabricated and induced illness for example, enquiries will be more complicated and may require more than one strategy discussion / meeting. If the strategy discussion / meeting concludes that a further strategy discussion / meeting is required, then a clear timescale should be set and be subject to regular review by the Social Work Manager bearing in mind the safety of the child at all times.
If the conclusion of the strategy discussion / meeting is that a Child Protection Conference is likely to be needed, a discussion should take place with a Child Protection Manager and a provisional date agreed for the child protection conference. Where there is no cause to pursue the Section 47 enquiry then consideration should be given to the needs of the child for any support services or services as a Child in Need; a clear and agreed plan of action should be recorded.
4. Section 47 Thresholds and the Multi-Agency Assessment
A Section 47 Enquiry must always follow when:
- There is reasonable cause to suspect that a child is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect;
- Following an Emergency Protection Order or when the use of police Powers of Protection is initiated.
An assessment should be initiated whenever a Section 47 enquiry has commenced. The local assessment protocol will provide the framework for gathering and analysing information for the enquiry. The conclusions and recommendations of the enquiry should inform the assessment. (see Derby City Council Children's Services Assessment Protocol (see Document Library, Protocols)) and Derbyshire Assessment Protocol (see Document Library, Protocols)).
5. Initiating a Section 47 Enquiry
Local authority Children's Social Care is the lead agency for child protection enquiries and the local authority Children's Social Care Manager has responsibility for authorising a Section 47 enquiry following a strategy discussion / meeting. A local authority Social Worker has a statutory duty to lead that enquiry. The police, health professionals, teachers and other relevant professionals should support the local authority in undertaking its enquiries.
A Section 47 enquiry may run concurrently with police investigations. When a joint enquiry takes place, the police have the lead for the criminal investigation (see Section 7, Referrals to the police) and local authority Children's Social Care have the lead for the Section 47 enquiries and the child's welfare.
Multi-Agency welfare enquiries
Whenever a Section 47 enquiry is initiated, even when there has been a recent assessment, the local authority Social Worker must consult with their manager about how and when to inform the family of the cause for concern unless to do so would place the child at increased likelihood of suffering significant harm.
The Social Worker, together with their manager, must decide whether to seek parental permission to undertake Multi-Agency checks. Whilst it is good practice to seek agreement, this is not needed if it would be prejudicial to the child's welfare.
The Social Worker must contact the other agencies involved with the child and their parents / carers to inform them that a child protection enquiry has been initiated and to seek their views. The checks should be undertaken directly with involved professionals including parents / carers, GP's and the police, and not through messages with intermediaries.
The relevant agency should be informed of the reason for the enquiry, whether or not parental consent has been obtained and asked for their assessment of the child in the light of information presented.
Agency checks should include accessing any relevant information that may be held in other counties.
6. Involving Children, Parents and Family Members
Section 47 Enquiries should always be carried out in such a way as to minimise distress to the child, and to ensure that families are treated sensitively and with respect. Timings of interviews and medicals should be sensitive to the needs of the child. Local authority Children's Social Care should explain the purpose and outcome of Section 47 enquiries to the parents and child/ren (having regard to age and understanding) and be prepared to answer questions openly, unless to do so would affect the safety and welfare of the child.
The Social Worker has the prime responsibility to engage with family members. Parents and those with Parental Responsibility should be informed at the earliest opportunity of concerns, unless to do so would place the child at increased likelihood of suffering significant harm, or undermine a criminal investigation.
Missing or inaccessible children
If the whereabouts of a child subject to Section 47 enquiries are unknown and cannot be ascertained by the Social Worker, the following action must be taken within 24 hours:
- A strategy discussion / meeting with police;
- Agreement reached with the local authority Children's Social Care Manager responsible as to what further action is required to locate and see the child and carry out the enquiry.
If access to a child is refused or obstructed the Social Worker, in consultation with their manager, should co-ordinate a strategy discussion / meeting, including legal representation, to develop a plan to locate or access the child/ren, progress the Section 47 enquiry and to consider if an EPO is required. A missing child alert should be generated by Children's Social Care if appropriate.
See also: Derby and Derbyshire Runaway or Missing from Home or Care Protocol (see Documents Library, Protocols).
7. Referrals to the police
The primary responsibility of police officers is to undertake criminal investigations of suspected or actual crime and to inform local authority Children's Social Care when they are undertaking such investigations in relation to a child, and where appropriate to notify the Local Authority Designated Officer (LADO).
The police and local authority Children's Social Care must co-ordinate their activities to ensure the parallel process of a Section 47 enquiry and a criminal investigation is undertaken in the best interests of the child. This should primarily be achieved through joint activity and planning at strategy discussions / meetings.
At the strategy discussion / meeting, the police officers should share current and historical information with other services where it is necessary to do so to ensure the protection of a child.
All suspected cases of child abuse must be referred to the police as potential crimes. This will be the responsibility of Social Care when a referral has been made to them. Telephone referrals should be followed up within 24 hours by secure email to: RiskandReferralUnit@Derbyshire.PNN.Police.UK
The police will make a decision, based on the force threshold policy and following checks and information sharing, on whether to initiate a criminal investigation.
The following matters will always be investigated by the police:
- All alleged sexual assaults;
- Allegations of physical abuse amounting to offences of actual bodily harm (Section 47 Offences Against the Person Act 1861) and more serious assaults;
- Allegations of serious neglect / cruelty;
- Allegations and concerns involving minor offences where there are aggravating features.
For historical allegations refer to specific circumstance chapter Adults who Disclose Non Recent Abuse.
8. Visually Recorded Interviews / Achieving Best Evidence
Visually recorded interviews must be planned and conducted jointly by trained police officers and local authority Social Workers in accordance with the Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses, and Guidance on Using Special Measures (Ministry of Justice 2011).
All events up to the time of the video interview must be fully recorded.
Visually recorded interviews serve two primary purposes:
- Evidence gathering for criminal proceedings;
- Examination in chief of a child witness.
Relevant information from this process can also be used to inform Section 47 enquiries or subsequent civil childcare proceedings.
In accordance with Achieving Best Evidence, all joint interviews with children should be conducted by those with specialist training and experience in interviewing children. Specialist / expert help may be needed:
- If the child's first language is not English (approved professional interpreters must be used instead of family members);
- They appear to have emotional or behavioural problems, or special educational needs;
- They have a physical / sensory / learning disability;
- Where interviewers do not have adequate knowledge and understanding of the child's racial religious and cultural background.
9. Paediatric Assessments
Where the child appears in urgent need of medical attention e.g. suspected fractures, bleeding, loss of consciousness, they should be taken to the nearest hospital Emergency Department.
The strategy discussion / meeting, which includes the relevant Health Professional, will determine the need and timing for a paediatric assessment. This should also be negotiated with the examining Paediatrician. Referrals should be made by the Social Worker or a member of the police, as appropriate.
If a child has been taken to a healthcare facility by parents / carers, and in the course of their health review / examination by a Paediatrician with the relevant competencies, has had an appropriate assessment, the child does not necessarily require another child protection medical in the presence of a Social Worker. In circumstances where this may happen it is of utmost importance that a referral to Children's Social Care is made without delay and information is shared between agencies at the earliest opportunity, this would result in a strategy discussion/meeting.
The need for a paediatric assessment of the siblings of a child who is to have a medical should always be considered. The decision may be made at any point in the process – such as during the strategy discussion / meeting, after the child's medical, or as information emerges.
For details of local arrangements when requesting child protection medicals for physical abuse or neglect, see the following links:
- Derby City and Southern Derbyshire; Local Guidance on Medical Examinations in Cases of Suspected Child Abuse (Documents Library, Guidance Documents);
- North Derbyshire: Arranging a Child Protection Medical at Chesterfield Royal Hospital (Documents Library, Guidance Documents).
Examinations for children who may have been sexually abused now all take place at the East Midlands Children and Young People's Sexual Assault Service (EMCYPSAS) based at Queens Medical Centre Nottingham Tel: 0800 183 0023.
Examinations of children who may have been subject to FGM are arranged through the East Midlands Children and Young People's Sexual Assault Service (EMCYPSAS) based at Queens Medical Centre Nottingham. Please follow the pathways in Appendix 1 FGM Flowchart (Documents Library, Flowcharts) and FGM clinical pathway Appendix 1a (Documents Library, Flowcharts).
- If there is any uncertainty regarding the need for paediatric assessment, advice is available from the relevant Paediatrician on call.
A paediatric assessment is necessary to:
- Identify the child's health needs;
- Determine the likelihood of child abuse on the balance of probability;
- Help to reduce the physical and psychological consequences of abuse or neglect;
- Facilitate the police investigation of a possible crime by documentation of clinical findings, including injuries arranging clinical investigations, that support a police investigation, relevant to all types of abuse;
- Work alongside the police’s Force Medical Examiner (FME) to take necessary forensic samples; and
- Contribute to the Multi-Agency assessment through sharing of information.
Consent for paediatric assessment or medical treatment
The person giving consent must be fully informed about:
- The reason for the assessment and what it will involve;
- How the information will be shared (including for court);
- The fact that consent can be refused to all or part of the assessment.
Consent or authorisation may be given by:
- A child or 16 years or over (Mental Capacity Act);
- A child who has the maturity and understanding to understand and make the decision (Fraser guidelines);
- A person with Parental Responsibility;
- The local authority when the child is the subject of a Care Order or is accommodated under Section 20 of the Children Act 1989, and the parent / s have abandoned the child or are physically or mentally unable to give such authority;
- A Court if the child is subject to an Emergency Protection Order, an Interim Care Order or a Child Assessment Order. (If proceedings are on-going, the court may determine the nature of the assessment and who will conduct it).
Consent should be provided in writing where possible, but verbal consent (e.g. by telephone) from a parent, carer or agency may be used in certain circumstances if it would delay examination or treatment. All decisions must be recorded in the medical record.
If a person with parental responsibility is unavailable to give consent, the decision to proceed should depend on the circumstances, including risk to the child. In this event paediatric assessment should be limited to that needed to save life or prevent serious deterioration in the health of a child or young person
Only one person with parental responsibility is required to give consent – however, if another person who also holds parental responsibility refuses consent and examination is in the child's best interest, or there is a public interest, then consideration should be given to applying for a court order.
If a person with parental responsibility refuses consent and the child is believed to be at immediate risk of harm, the police and local authority should consider whether to apply for an Emergency Protection Order.
A child who is of sufficient age and understanding may refuse some or all of the paediatric assessment, though refusal can potentially be overridden by a court. Parents must be informed by the Medical Practitioner as soon as possible and a full record must be made at the time.
Where circumstances do not allow permission to be obtained and the child needs emergency medical treatment, the Medical Practitioner may only provide treatment that is immediately lifesaving or that will prevent serious deterioration.
The Examining Doctor
The assessment should be carried out by a Paediatrician with at least Level 3 competencies Safeguarding Children and Young People; Roles and Competencies of Health Care Staff (2019). Where a speciality trainee carries out the assessment there should be a supervising consultant available.
Since April 2018 medicals for sexual abuse have been carried out by the East Midlands Children and Young People's Sexual Assault Service (EMCYPSAS Tel: 0800 183 0023), advice is available 24 hours a day.
The Forensic Medical Examiner may occasionally attend medicals for physical abuse at the discretion of the police.
Paediatricians do not conduct specialist assessments of emotional harm, and consideration should be given to referring to a suitably trained child psychiatrist or psychologist.
General Practitioners do not undertake formal child protection assessments, but in the event of a child protection concern, would be expected to document any findings, provide treatment as appropriate and refer to Children's Social Care for further investigation.
The timing of paediatric assessment will depend on a number of factors, including the nature and severity of abuse, the timing of the abuse and circumstances surrounding the child. This will include where a medical opinion is needed more urgently in order to secure parental agreement or a Court order to safeguard a child.
For physical injury: Children should be seen within 24 hours of referral.
For sexual abuse: the timing of this will be determined by the input from the police and EMCYPSAS at the strategy discussion.
The relative timing of any interviews to be undertaken by police and/or local authority Children's Social Care (under Achieving Best Evidence) will be dependent on circumstance and should be agreed at the strategy discussion.
- Non-urgent – most referrals are non-urgent and children should be referred in writing to the relevant Paediatrician and seen within 4 weeks of referral. Written background information should be provided at least 3 working days before the medical, including parental background and health and the nature of any specific concerns;
- Urgent – timing should be by negotiation, but urgent assessment may be needed, for example if the child is to be removed from home at short notice or there are particular concerns about the children's health. Written background information should still be provided unless the medical is within 7 days of the referral. Urgent requests should be by telephone call to the relevant Paediatrician or safeguarding team in the first instance;
- In any circumstances where the child is removed and placed in the care of others it is good practice for the child to be registered with their local GP as a priority.
In the event of dispute over the timing of a medical, the Derby and Derbyshire Multi Agency Dispute Resolution and Escalation Policy (see Documents Library, Guidance Documents) should be used without delay, raising directly with the relevant senior Paediatrician and if necessary Designated Doctor, or Nurse if they are not available.
The Paediatric Assessment
A paediatric assessment should demonstrate a holistic approach, considering the child's physical, developmental, social and emotional wellbeing in the context of background information provided by parents and carers, the child and by other agencies. It is likely to take at least an hour. Any injuries and the history around them should be carefully recorded. Contemporaneous records should be made. Photographs of significant findings should be taken (with consent) by a professional medical photographer, the examining doctor if appropriately trained, or the police photographer whenever possible.
It may be necessary to arrange investigations such as blood tests, x-rays or scans. If results are not immediately available and the result will influence the medical opinion as to the probability of abuse, the child may need to be safeguarded until the result is available. For example in circumstances where a skeletal survey is indicated, final X -rays are taken approximately 10 – 14 days after the initial survey. A further strategy discussion will be required to discuss any new findings and any further investigations that may be required.
An immediate conclusion form should be completed at the time of the medical and given to the police / Social Worker.
Parents must be kept informed throughout, and the conclusion of the medical must be shared in a way that does not compromise the investigation.
The Paediatrician must provide a report to the Social Worker and, where appropriate, the police. The report is usually copied to the General Practitioner, Health Visitor or School Nurse and the Named Nurse Safeguarding Children. Parents are not routinely sent a copy but the report may be shared with them by the Social Worker or police following consultation with the health organisation that produced the report.
The report should be dictated as soon as possible and certainly within 24 hours, and should be completed within 10 working days of the medical. Every effort should be made to provide a report if it is needed urgently for court, and in any event it must be received 2 working days before any Child Protection Conference.
The report should include:
- A brief statement of personal qualification, experience and current role;
- Date, time and place of examination and those present;
- A full paediatric history, including birth and developmental details / school progress and attendance, emotional and behavioural difficulties, immunisation, past health, family health, including information about parental domestic abuse, drug and alcohol problems, mental health, learning difficulties; where possible and social history;
- A record of the carer's and child's accounts of injuries and concerns noting any discrepancies or changes of story. A child's allegation must be taken seriously, even in the absence of supporting clinical evidence;
Observation of the child’s interaction with parents / carers and others present;
A full examination (with consent from the child and parents / carers);
Growth parameters, with centiles recorded;
- Documentary findings in both words and diagrams, where appropriate;
- Site, size, shape and where possible age of any marks or injuries;
- Other findings relevant to the child;
- Confirmation of the child's developmental progress (especially important in cases of neglect);
- Details of investigations;
- Any follow up arrangements made and the management / discharge plan;
- The Paediatrician should be prepared to state their opinion and the reasoning behind it. The opinion should state whether the findings are consistent with the explanation and, if an injury is believed to be non-accidental, opinion about the mechanism of injury. The conclusion of the report should include a differential diagnosis and a working diagnosis, and an indication as to whether the findings, on the balance of probability, are consistent with possible abuse, probable abuse or provide strong evidence for abuse – or if it is not possible to ascribe causation. A summary of any additional health needs / recommendations should be included;
- All reports and diagrams where relevant should be signed and dated by the Doctor undertaking the examination. The report should clearly indicate the name of the consultant responsible for the child.
If further information emerges following paediatric peer review, this must be forwarded to local authority Children's Social Care as soon as feasible with a discussion as to the implications of this new information.
The Royal College of Paediatrics and Child Health (RCPCH) have developed an online evidence-based resource for clinicians to help inform clinical practice and address key questions about the recognition and investigation of children with suspected physical abuse and neglect.
Evidence for criminal investigation
Where possible and appropriate, a police Officer, and/or an FME or police photographer, should also attend the Paediatric assessment, in order to review findings from a criminal perspective and collect evidence. As above, collection of forensic evidence will be agreed before the medical and taken by the examining Paediatrician or relevant police staff at the paediatric assessment.
If at the strategy discussion it is agreed that police attendance is not necessary or appropriate, the Social Worker should feedback the findings by the next working day. Children should not normally be subject to repeat examinations, tests and photographs, and where these are necessary, they should all be taken within a clinical setting.
10. Outcome of Section 47 Enquiries
Local authority Children's Social Care in consultation with partner agencies is responsible for deciding how to proceed with the enquiries based on the strategy discussion / meeting and taking into account the views of the child, their parents and other relevant parties (e.g. a foster carer).
During the enquiry the scope and focus of the assessment will be that of a risk assessment, using the Social Care Single Assessment format. An interim safety plan must be in place whilst section 47 enquiries are underway. The scope of the assessment:
- Identifies the cause for concern;
- Evaluates information from all sources and previous case records;
- Evaluates the strengths of the family;
- Evaluates the risks to the child/ren;
- Considers the ability of parents, wider family and social networks to safeguard and promote the child's welfare;
- Considers the child's need for protection;
- Considers how these risks can be managed.
It is important to ensure that both immediate risk assessment and long term risk assessment are considered.
Where the child's circumstances are about to change, the risk assessment must include an assessment of the safety of the new environment e.g. where a child is to be discharged from hospital to home the assessment must have established the safety of the home environment and implemented any support plan required to meet the child's needs.
At the completion of a Section 47 enquiry, local authority Children's Social Care in consultation with other agencies must evaluate and analyse all the information gathered to determine if the threshold for significant harm has been reached.
In Derby City the outcome of the Section 47 enquiries may reflect that the original concerns are:
- Not substantiated; although consideration should be given to whether the child may need services as a Child in Need or Early Help Support;
- Substantiated but child not likely to suffer significant harm, on consultation with the child protection manager agreement that no child protection conference is required. Consideration should be given to whether the child may need services as a Child in Need;
- Substantiated and the child is judged to be suffering, or likely to suffer, significant harm and an initial child protection conference should be called.
- Not substantiated on consultation with the child protection manager; although consideration should be given to whether the child may need services as a Child in Need or Early Help Support;
- Substantiated but child not likely to suffer significant harm, on consultation with the child protection manager agreement that no child protection conference is required. Consideration should be given to whether the child may need services as a Child in Need;
- Substantiated and the child is judged to be suffering, or likely to suffer, significant harm and, on consultation with the child protection manager, an initial child protection conference should be called.
Concerns are not substantiated
Where the concerns are not substantiated, the local authority Children's Social Care Manager must authorise the decision that no further action is necessary, having ensured that the child, any other children in the household and the child's carers have been seen and spoken with. In Derbyshire this decision should be made following consultation with a Child Protection Manager.
The Social Worker should discuss the case with the child, parents and other professionals and determine whether early help or child in need services may be helpful. They should consider whether the child's health and development should be re-assessed regularly against specific objectives and decide who has responsibility for doing this. Arrangements should be noted for future referrals, if appropriate.
Concerns substantiated but the child is not likely to suffer significant harm
Where concerns are substantiated but the child is assessed as not likely to suffer significant harm, the Social Worker following discussion with their Manager must consult with a Child Protection Manager to agree that no child protection conference is required. This may include situations such as where the child has come into care, moved to a non-abusing parent, the perpetrator has left the household, or the parents are engaging positively, and the assessment is that this will afford sufficient protection to the child.
Where it is agreed that no conference is required there should be consideration about whether child in need services or any on-going monitoring is required. Where a child has complex or serious needs they will require a specialist in depth assessment and co-ordination via a Social Worker.
Concerns of significant harm are substantiated and the child is judged to be suffering, or likely to suffer, significant harm
Where concerns are substantiated and the child is assessed to be suffering or likely to suffer significant harm, there must be a Child Protection Conference within 15 working days of the strategy discussion / meeting at which Section 47 Enquiries were initiated. Suitable Multi-Agency arrangements / Safety Plan must be put in place to safeguard the child until such time as the initial child protection conference has taken place. The Social Worker and their line manager will coordinate and review such arrangements.
Consideration should also be given for whether immediate action is required to safeguard the child or the grounds are met to initiate legal proceedings or to take the case through Public Law Outline, and whether such action is necessary.
Feedback from enquiries
The Social Worker is responsible for recording the outcome of the Section 47 enquiries / strategy discussions or meetings consistent with the requirements of the relevant recording system. The outcome should be put on the child's electronic record with a clear record of the discussions, authorised by the local authority Children's Social Care Manager.
Notification, verbal or written, of the outcome of the enquiries, including an evaluation of the outcome for the child, should be given to all the agencies who have been significantly involved, the parents and children of sufficient age and appropriate level of understanding, in particular in advance of any initial child protection conference that is convened. This information should be conveyed in an appropriate format for younger children and those people whose preferred language is not English.
Feedback about outcomes should be provided to non-professional referrers in a manner that respects the confidentiality and welfare of the child.
If there are on-going criminal investigations, the content of the Social Worker's feedback should be agreed with the police.
11. Disputed Decisions
Where local authority Children's Social Care have concluded that an initial child protection conference is not required but professionals in other agencies remain seriously concerned about the safety of a child, these professionals should refer to the Derby and Derbyshire Multi Agency Dispute Resolution and Escalation Policy (see Documents Library, Guidance Documents). They should follow the outlined stages which include further discussion with the local authority Children's Social Worker, their manager and/or the nominated safeguarding children adviser. The concerns, discussion and any agreements made should be recorded in each agency's files.
If concerns remain, the professional should discuss with a designated / named / lead person or senior manager in their agency. If concerns remain the agency may wish to discuss the case with a Child Protection Manager who may agree to convene an initial child protection conference.
If this fails to achieve agreement, the issues should be raised with the Derby and Derbyshire Safeguarding Children Partnership Chair via the agency Partnership representative. This should always be a last resort after all other options have been exhausted.
A full written record must be completed by each agency involved in a Section 47 enquiry, using the required agency proforma, authorised and dated by the staff.
The responsible manager must countersign / authorise local authority Children's Social Care assessment.
Practitioners should, wherever possible, retain all original notes in line with local retention of record procedures until the completion of anticipated criminal or civil legal proceedings.
Local authority Children's Social Care recording of enquiries should include:
- Information sharing between agencies;
- Strategy discussion / meeting notes;
- Details of the enquiry;
- Body maps (where applicable);
- Assessment including identification of risks and how they may be managed;
- Decision making processes, including clear analysis and rationale;
- Safety Plans;
- Outcome / further action / medical investigations planned.
At the completion of the enquiry, the Social Work Manager should ensure that the concerns and outcome have been entered in the recording system including on the child's chronology and that other agencies have been informed.