The work of the Child Protection Service in

The work of the Child Protection Service in NPHS Wales

A New disease? Imagine a childhood disease that affects one in five girls and one in seven boys before they reach 18: a disease that can cause dramatic mood swings, erratic behaviour, and even severe conduct disorders among those exposed; a disease that breeds distrust of adults and undermines the possibility of experiencing normal sexual relationships; a disease that can have profound implications for an individuals future health by increasing the risk of problems such a substance abuse, sexually transmitted diseases, and suicidal behaviour; a disease that replicates itself by causing some of its victims to expose future generations to its debilitating effects.

A New disease? • Imagine what we would do as a society if such a disease existed. We would spare no expense. We would invest heavily in basic and applied research. We would devise systems to identify those affected and provide services to treat them. We would develop and broadly implement prevention campaigns to protect our children. • Wouldn’t we? • James Mercy, Centre for Disease Control, Atlanta

Role models/teachers Boosts economy rather that a burden Savings on health, criminal justice budgets Adult workforce fulfilling their potential Become competent parents and valued by society YP who mostly achieve their potential Goal Children who are valued and safeguarded and have healthy, valued and able parents

Child Abuse and the Public Health • Is Child Abuse a Public Health issue? • Consider the NPHS focus • • E Coli Cryptosporidium Flu Pandemic But how many children have been abused and murdered by people they know since the death Victoria Climbie? • Meanwhile the incidence of child sexual abuse is: • 21% girls • 11% boys • Most children never tell • 9 million adults in the UK have been sexually abused

The Public Health Focus 2005/06 E Coli • Mostly RCT 2005 • Total cases 157 • Children affected … 122 • Children hospitalised… 27 • Children transferred to tertiary care…. 9 • Deaths……. 1 • Public Inquiry Cryptosporidium • Gwynedd / Mon 2005/06 • 231 cases • Children < 16…. . 93 • Children hospitalised…. 0 • Deaths…none

Adverse Childhood Experiences Study Possible coping mechanisms • Smoking • Obesity • Alcoholism • Drug abuse • Depression • Attempted suicide • STIs Adverse Health • Heart disease • Cancer • Stroke • Diabetes • Fractures • Liver disease • Poor adult health Felitti et al—ACE study

The Abuse of a child • The Effect is not: • What was done to the child • But • What it did to the child and to the adult the child will become

Possible Adult Health Issues • • • Cardio -Vascular Disease Cerebro- Vascular Disease Diabetes Mellitus Chronic Liver disease and cirrhosis Malignant Neoplasms COPD Asthma and respiratory Gynaecological problems Urinary Symptoms Dental neglect due to dental phobia Injury to temporo-mandibular joint • • Depression and mental illness Eating Disorders Suicide Homicide HIV Alcohol/ Drug induced causes Chronic Pain syndromes – – – • Irritable bowel syndrome Headache Pelvic pain Pain in shoulders and neck Back pain / Hip and joint pain General chronic pain PTSD and old age All systems and all specialities

The Public Health • Child Abuse and Neglect are public health issues • Prevention would be better • Victims desperately need services • Offenders also need help • So where does the CPS fit in?

The Child Protection Service National Public Health Service • “Too Serious a Thing” (2002) Lord Carlile • Identified that the Designated Doctor and Designated Nurse, child protection, are functionally public health activities • recommended an All Wales NHS Child Protection Service • Established in April 2003 • the CPS/NPHS takes the strategic lead, ensuring that the Health Service in Wales meets its obligations under the Children Acts 1989 and 2004

National Public Health Service • • • Director of Public Health for Wales Lead Director, Team Leader and a Professional Lead 5 Designated Doctor Posts 5 Designated Nurse Posts 1 Children’s Safeguards Manager post 3 Primary Care Training Facilitator posts

CPSNPHS • Advice to LHBs on questions of planning, strategy and audit of quality standards • Local Safeguarding Children Boards • Serious Case Reviews • Develop Policy and Procedures • Development of services • Monitoring standards • Support key professionals • Support through regional fora • Facilitate training • Influence WAG • Wales wide and UK work

In Wales 22 LHBs Independent Contractors Health Commission Wales 13 NHS Trusts CPS/ NPHS 22 ACPCs /LSCBs 1 Ambulance Trust Welsh Assembly Government

The CPS across the Child sexual exploitation group Children In Wales Looking after Children Health Exchange UK Family Justice Councils Regional Nursing and Midwifery Committees CPS All Wales Child Protection Procedures Review Group NSPCC RCPCH/RCGP Committees All Wales Heads of HV group WAG

Working with Welsh Assembly Government WAGCSG Professional Abuse Hidden Harm CPS Safeguarding Vulnerable Children Review Domestic Abuse

Executive Nurse LHB Executive Nurse NHS Trust Named Nurse Senior Nurses LAC Nurses Named Doctor Lead Doctor Named Midwife Designated Doctor /Nurse CPS

EXAMPLE MODEL FOR NORTH WALES WAG Officials Minister Child Protection Service - NPHS LHB Boards Trust Child Protection Committees X 3 Trust Named / Lead Nurses Group CHILD PROTECTION HEALTH COMMITTEE/FORUM §Designated Doctor / Nurse §Children’s Safeguards Development Manager §PCT Facilitator §LHB Executive Nurses §Trust Named Doctors & Nurses §WAST Lead Professional Trust Named / Lead Doctors Group Joint Meetings Trust Named & Lead Doctors & Nurses LHB Child Protection Working Groups CLA Health Workers Forum § Designated Doctor/Nurse § Children’s Safeguards Development Manager § Specialist Nurse Practitioners § Specialist CAMHS Practitioners § Psychologist § YOT Health Workers

Some of our achievements • Regional child protection health fora established • National Child Protection Health Service Specifications • Children’s Safeguards Frameworks developed for use in NHS services • Contributed to the NSF, Welsh Risk Pool standard 39 and QOF • Produced or led on the development of many policy and good practice documents • Contribution to WAG groups

QOF Standard 39 Childrens Safeguards Frameworks HIW/CHI NSF

Pros and Cons • No conflict of interest • Free from operational duties • Can influence policy at the highest level BUT • CPS NPHS does not have statutory powers and responsibilities in its own right • Fragmentation of resources

Summing up the role of the CPS • Changing the culture • Snapping at the heels of organisations and individuals • Nagging