Only half of eligible NHS staff have basic training in child protection

BMJ 2009; 339 doi: (Published 20 July 2009) Cite this as: BMJ 2009;339:b2914
  1. Susan Mayor
  1. 1London

    The NHS must make substantial improvements to comply with measures to safeguard children who may be being abused, urges a review published by the Care Quality Commission in response to the death of a child after serious abuse was not tackled despite many contacts with health professionals.

    The secretary of state for health commissioned the review after the death of baby Peter, a 17 month old who died after sustained abuse despite 34 contacts with health professionals during his short life. An initial report after his death found systemic failings in the health care he received from NHS hospitals and GPs (BMJ 2009;338:b1967, doi:10.1136/bmj.b1967).

    The review, which is based on a survey of 392 NHS trusts, showed that most organisations had “the right people and systems” to help protect children. But it found “worrying shortfalls” in the numbers of staff who were up to date with mandatory training designed to help them identify and respond to concerns about potential child neglect and abuse.

    On average only half of healthcare staff eligible for training in child protection in each NHS trust were recorded as having up to date basic training. Fewer than 400 000 staff had up to date training out of a total of 851 000 staff eligible for level one training, which is designed to ensure that staff understand what constitutes child abuse and know what to do when they are concerned that a child is being abused.

    Only one third (35%) of GPs had up to date training, even though about one in 10 GP consultations is with children aged 14 or under. Just over half (58%) of eligible clinical staff in emergency departments were recorded as having received training. The commission found a lack of dedicated budgets for training in safeguarding, with only 37% of trusts having specific resources for this.

    The review also uncovered a lack of clarity in the roles of doctors and nurses with specific responsibility for safeguarding children. About one third (30%) of these doctors had no contract or service level agreement for their safeguarding work, and half did not have a defined set of competencies for safeguarding in their job description.

    Some NHS trusts lacked policies in key areas of child protection. For example, one third of acute trusts had no follow-up process for children who missed outpatient appointments, which was highlighted as an important factor in the recent report Why Children Die ( More than one in 10 trusts did not seem to comply with the statutory requirement to carry out checks with the Criminal Records Bureau for all staff employed since 2002.

    The review also found that health visitors’ caseloads were often more than recommended, with 29 out of 152 trusts reporting caseloads of more than 500 children for each health visitor. Lord Laming’s report on baby Peter recommended 400 (

    “It is clear that safeguarding has not been as high on the agenda of trust boards as it should have been. And that has meant in some cases that NHS staff have not been given the support they need in terms of training and clear procedures for handling concerns,” said Cynthia Bower, chief executive of the commission. “If that were to change it would be an appropriate legacy for baby Peter. We will be using every tool at our disposal to make it happen.”

    On the basis of the review, the Care Quality Commission has asked NHS trusts to urgently review their arrangements for safeguarding children, in particular the levels of up to date training among staff.

    The NHS Federation, which represents NHS trusts, said, “Despite the progress many NHS organisations have made, and the commitment of individuals working in the health service, there is clearly much more that can be done to make sure children are protected properly.” It considered that the boards of NHS trusts should ensure that staff working in safeguarding services have adequate time and training and agreed that all GPs should have training in safeguarding children.

    The commission is asking all NHS trusts to make public declarations of how they have performed against a core standard on safeguarding as part of annual performance ratings. The review noted that 29 trusts admitted that they did not meet this standard in the latest ratings, published last month.

    Inspectors from the commission will work with trusts that fail to meet the standard to check on action being taken. They are already following up trusts who claimed to meet the standard in annual ratings but where failings were found in the commission’s review.

    The commission is making results from its review on safeguarding children available for individual trusts so that organisations can benchmark themselves against others. It also plans to conduct week long inspections over the next three years that focus on safeguarding and the health of children.


    Cite this as: BMJ 2009;339:b2914


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