News Roundup [abridged Versions Appear In The Paper Journal]

Report recommends tougher safeguards for children in NHS

BMJ 2002; 324 doi: (Published 09 March 2002) Cite this as: BMJ 2002;324:564
  1. Roger Dobson
  1. Abergavenny

    Sweeping changes designed to safeguard children treated by the NHS in Wales are urged in a new report.

    The report recommends establishing a director of children's healthcare services, an all-Wales NHS child protection organisation, two new charters for children, police checking of staff who come into contact with children, and protection of NHS whistleblowers.

    The review, carried out by a panel of experts and chaired by Lord Carlile QC, was set up in the wake of the north Wales child abuse inquiry, which heard allegations from former inpatients of a child and adolescent mental health unit in North Wales.

    Its 150 recommendations to the Welsh Assembly also include medical access to child protection registers, some access to health records by social workers, the establishment of complaints officers in every NHS trust, and a network of children's advocates.

    “Every child and young person being treated by the NHS should be safe, feel safe, be treated as individuals, and have their needs met by appropriately trained and sympathetic staff,” said the assembly's health and social services minister, Jane Hutt, at the launch of the report.

    She continued: “At the centre of the report is the need to put children and their safety at the heart of the NHS whenever and wherever they may have need to come into contact with it. It recognises the need to ensure that everyone who has contact with children and their treatment, from non-executive directors to doctors, nurses, and practice receptionists, is aware of the rights of the child and is alert to the possibility of abuse.”

    The report says that each general practice in Wales ought to have a written child protection procedure within six months, with nominated lead practitioners on child protection issues. Local health groups should ensure that singlehanded GPs keep up to date on child protection issues, and child protection ought to be a component of GP training.

    “We recommend that the General Medical Council should consider amending Good Medical Practice by adding a separate section reminding doctors of the need to inform themselves of child protection issues as a prerequisite of competent practice,” says the report.

    The report also looks at breaking down some of the boundaries between health and social care: “We recommend that NHS Direct Wales should be enabled to gain access to local authority child protection registers. Subject to secure password safeguards, accident and emergency outpatient and minor injury units staff should be able to gain access to local authority child protection registers, and social services should on reasonable request be given access to the relevant parts of a child's health records provided that disclosure is for the protection of the child's physical or mental health.”

    The report says that a national director of children's healthcare services needs to be appointed to promote improvements in clinical healthcare services for children. There should also be an all-Wales child protection service headed by its own director. In addition, every NHS organisation should have a designated person to liaise with the Welsh children's commissioner.

    The report recommends that all school nurses should be employed in the NHS and that their role should be strengthened with career paths developed to encourage nurses into the job.

    Sick children, says the report, should be placed in children's wards whenever possible: “If [they are] in adult wards, they should be nursed in a side room and access should be refused to other patients who are not their close relatives. Children should be removed from adult to children's wards as soon as possible. While on an adult ward, children should have the same access to parents, qualified staff and facilities that they should have on a children's ward. Total management should be overseen by the paediatric team.”

    The report also says, “We recommend that all existing NHS staff in Wales whose work brings them into contact with children should be police checked as soon as is compatible with the establishment and development of the Criminal Records Bureau.”

    It also urges the setting up of a pilot project in Cardiff based on the Philadelphia Children's Hospital in the United States, whereby the children's services of the University Hospital of Wales would take over the running of children's acute and community services throughout the Cardiff city and the county area.

    It recommends too that the National Assembly reviews urgently the inadequacy of therapeutic services for victims of abuse.

    An Implementation Group is now being set up to advise on the best way to deal with the report, which will be discussed at the next health and social services committee meeting.

    Review of Safeguards for Children and Young People Treated and Cared for by the NHS in Wales is accessible at

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