PG28. Living Away from Home

2.1

When the concerns relate to a child placed in a foster home outside the area of the responsible local authority. See Children and Families Moving Across Local Authority Boundaries.

2.2

Where there is reasonable cause to believe that a child in foster care has suffered, or is likely to suffer Significant Harm in the foster placement, a Strategy Meeting will be held. If child protection concerns are raised about the care that a foster carer is giving to a child, the local authority in which the child is living has the responsibility to convene a strategy meeting / discussion, which should include representatives from the responsible local authority that placed the child; a representative from Ofsted should also be invited. At the strategy meeting / discussion, it should be decided which local authority should take responsibility for the next steps, which may include a S47 investigation.

2.3

In these circumstances, enquiries should consider the safety of any other children living in the household, including the foster carers' own children, grand-children or any children cared for by the foster carers in their home as well as any children whom the foster carers may be caring for or working with outside their home in a voluntary or paid capacity e.g. teaching, faith or youth work, scouts or many other groups.

2.4

As foster care is undertaken in the privacy of the carers' own home, it is important that children have a voice outside the family. Social Workers are required to see children in foster care on their own and evidence of this should be recorded on the child's records.

Good quality care

2.5

All commissioners and providers of services for children living in foster care are responsible for ensuring children are safeguarded. Commissioner contracts and provider procedures should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children's welfare. Local Safeguarding Children Partnerships should monitor the welfare of children living in foster care.

2.6

The standards for children living in foster care include that:

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the fostering service and the foster carers to the external world and external scrutiny, including contact with families and the wider community;
• Foster carers are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in foster care are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the foster care setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see Roles and Responsibilities, NSPCC);
• Foster carers recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• The foster carer is aware of the procedures for referring safeguarding concerns about a child to the relevant local authority children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
• Bullying is effectively countered (see Bullying);
• Recruitment and selection procedures for local authority foster carers are rigorous and create a high threshold of entry to deter abusers (see Safe Recruitment and Selection, and the Management of Adults who Work with Children Procedure);
• There is effective supervision and support, which extends to temporary or back-up carers, fostering service staff and volunteers;
• Clear procedures and support systems are in place for dealing with expressions of concern by foster carers and fostering service staff about other staff or carers (see Allegations Against Staff or Volunteers (People in Positions of Trust), who Work with Children Procedure);
• Organisations should have a code of conduct instructing foster carers and fostering service staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistleblower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Foster carers and fostering service staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Promoting and protecting a child's welfare

2.7

Foster carers should be provided with full information about the foster child and their family, including details of abuse or possible abuse and whether the child has harmed others, both in the interests of the child and of the foster family.

2.8

Foster carers should monitor the whereabouts of their foster children, including their patterns of absence and contacts. Foster carers should follow the recognised procedure of their agency on sharing general concerns about a child, and whenever a foster child is missing from their home. This will involve notifying the placing authority and, where necessary, the police of any unauthorised absence by a child. See Missing from Care, Home and Education Procedure.

2.9

Foster carers should have guidance on sharing more general concerns (e.g. alerting other professionals, considering child behaviour around contact, absences, school, moods etc.).

3.1

A private fostering arrangement is essentially an arrangement between families / households, without the involvement of a local authority, for the care of a child under the age of 16 (under 18 if disabled) by someone other than a parent or close relative (close relatives are parents, step-parents, siblings, siblings of a parent and grandparents) for 28 days or more.

3.2

Privately fostered children are a diverse, and sometimes vulnerable, group. Groups of privately fostered children include:

• Children sent from abroad to stay with another family, usually to improve their educational opportunities;
• Asylum seeking and refugee children;
• Teenagers who, having broken ties with their parents, are staying in short term arrangements with friends or other non-relatives;
• Children who stay with another family whilst their parents are in hospital, prison or serving overseas in the armed forces;
• Language students living with host families;
• Trafficked children (see also Trafficked and Exploited Children).

3.3

Private foster carers and those with parental responsibility are required to notify local authority children's social care of their intention to privately foster or to have a child privately fostered or where a child has been privately fostered in an emergency.

3.4

There will be circumstances in which a privately fostered child experiences physical, sexual or emotional abuse and / or neglect to such a degree that it constitutes significant harm. See Recognising Abuse and Neglect Procedure.

3.5

Teachers, health and other staff working with children should make a referral to local authority children's social care and the police if:

• They become aware of a private fostering arrangement which is not likely to be notified to the local authority; or
• They have doubts about whether a child's carers are actually their parents, and there is any evidence to support these doubts (including concerns about the child/ren's welfare (see also Trafficked and Exploited Children Procedure).

It is likely that local authority children's social care will not have been notified of most private fostering arrangements.

3.6

When local authority children's social care become aware of a privately fostered child, they must assess the suitability of the arrangement. They must make regular visits to the child and the private foster carer.

3.7

Local authority children's social care should visit and see the child alone unless this is inappropriate; they must visit the parent of the child when reasonably requested to do so. The child should be given contact details of the social worker who will be visiting him/her while s/he is being privately fostered.

3.8

The Children (Private Arrangements for Fostering) Regulations 2005 and the amended s67 of the Children Act 1989 strengthens the duties upon local authorities in relation to private fostering by requiring them to:

• Ensure that the welfare of children who are privately fostered within their area is being satisfactorily safeguarded and promoted;
• Ensure that such advice as appears to be required is given to private foster carers;
• Visit privately fostered children at regular six weekly intervals in the first year and 12 weekly in subsequent years;
• Satisfy themselves as to the suitability of the private foster carer, and the private foster carer's household and accommodation. The local authority has the power to impose requirements on the foster carer or, if there are serious concerns about the arrangement, to prohibit it;
• Promote awareness in the local authority area of the requirement to notify, advertise services to private foster carers and ensure that relevant advice is given to privately fostered children and their carers;
• Monitor their own compliance with all the duties and functions in relation to private fostering, and to appoint an officer for this purpose.

3.9

Private fostering can place a child in a vulnerable position because checks as to the safety of the placement will not have been carried out if the local authority is not advised in advance of a proposed placement. The carer may not provide the child with the protection that an ordinary parent might provide. In many cases, the child is also looked after away from a familiar environment in terms of region or country.

4.1

All residential settings where children and young people are placed, including children's homes and residential schools, whether provided by a private, charitable or faith based organisation, or a Local Authority, must adhere to the Children's Homes Regulations 2001 (as amended by the Children's Homes (Amendment) Regulations 2015, associated guidance) and all other relevant Regulations and to the relevant Quality Standards.

Clear records must be kept and reviews and inspections must take place in accordance with Quality Standards and the Regulations.

4.2

Children in such settings are particularly vulnerable and must be listened to.

All such establishments must have in place complaints procedures for children and young people, visiting and contact arrangements with social workers and Independent Visitors (for Looked After children), as well as parents, and advocacy services.

4.3

Where there is reasonable cause to believe that a child in a residential setting has been harmed or is likely to suffer Significant Harm, a referral must be made to Children's social care in accordance with the Referral and Assessment Procedure. The concerns may be related to bullying, children who display harmful behaviour against other children or allegations about the behaviour of practitioners or volunteers.

Good quality planning and care

4.4

The welfare and safety of children living in residential care should be promoted and provided for at a minimum, in line with the relevant National Minimum Standards (see www.ofsted.gov.uk), in all residential care settings.

4.5

All commissioners and providers of residential care services for children are responsible for ensuring that children are safeguarded. Commissioner contracts and provider procedures should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children's welfare. Local Safeguarding Children Partnerships should monitor the welfare of children living in residential care.

4.6

Local authorities placing children in another local authority area are required to notify the host authority prior to placement.

4.7

As part of their statutory responsibilities for planning children's care, social workers are required to maintain a regular up to date assessment of child's needs, see looked after children in foster care on their own and take appropriate account of the child's wishes and feelings. Evidence of their engagement with the child must be recorded so that the plan for the child's care is kept up to date, with the child being offered the right services to respond to the full range of their needs.

4.8

Independent Reviewing Officers (IROs) are responsible for chairing meetings that must be scheduled at prescribed intervals to review the child's care plan. IROs have specific responsibilities to ensure that the plan has taken the child's wishes and feelings into account and that their care plan remains appropriate in view of the child's needs, including their need to be effectively safeguarded.

4.9

The standards for children living in residential care include that:

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the residential care service to the external world and external scrutiny, including contact with families and the wider community;
• Residential care and support staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in residential care are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the residential care setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see Roles and Responsibilities, NSPCC);
• Residential care and support staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• Here are clear procedures for referring safeguarding concerns about a child to the relevant local authority children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
• Bullying is effectively countered (see Bullying Procedure);
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers (see Safe Recruitment and Selection, and the Management of Adults who Work with Children Procedure);
• There is effective supervision and support, which extends to temporary staff and volunteers (see Learning and Improvement Framework);
• The residential care service contract staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by residential care and support staff about other staff or carers (see Allegations Against Staff or Volunteers (People in Positions of Trust), who Work with Children Procedure);
• Organisations have a code of conduct instructing residential care and support staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistleblower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Residential care and support staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Promoting and protecting a child's welfare

4.10

It is important that children have a voice outside the residential unit. Social workers are required to see children in residential units on their own (taking appropriate account of the child's wishes and feelings) at regular intervals and evidence of this should be recorded.

4.11

Residential carers should be provided with full information about the child and their family, including details of abuse or possible abuse and whether the child has harmed others, both in the interests of the child and of the staff and other children in the residential unit.

4.12

Residential carers should monitor the whereabouts of the children, including their patterns of absence and contacts. Residential carers should follow the recognised procedure of their agency on sharing general concerns about a child, and whenever a child is missing from the unit. This will involve notifying the placing authority and, where necessary, the police of any unauthorised absence by a child. See Missing from Care, Home and Education Procedure.

4.13

Residential carers should have guidance on sharing more general concerns (e.g. alerting other professionals, considering child behaviour around contact, absences, school, moods etc.).

4.14

The local authority's duty to undertake s47 enquiries, when there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm, applies on the same basis to children in residential care as it does to children who live with their own families.

4.15

Such enquiries will consider the safety of any other children living in the residential unit. If child protection concerns are raised about the care in a residential unit, the local authority in which the child is living has the responsibility to convene a strategy meeting / discussion, which should include representatives from the responsible local authority which placed the child; a representative from Ofsted should also be invited. At the strategy meeting / discussion, it should be decided which local authority should take responsibility for the next steps, which may include a s47 investigation. If the case appears to be a complex one, see Organised and Complex Abuse.

5.1

An adopted child may divulge when s/he is in placement, that they have been abused at some time in their previous history. An adopted child can also be vulnerable to physical, sexual or emotional abuse and / or neglect whilst they are placed for adoption. The child may thus already have suffered, or can suffer, to such a degree that it constitutes significant harm. See Recognising Abuse and Neglect Procedure.

Good quality care

5.2

All commissioners and providers of services for children who have a care plan for placement for adoption are responsible for ensuring that each child is safeguarded. Commissioner contracts and provider procedures should reflect the provisions and guidance relating to the Adoption and Children Act 2002.

They should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children's welfare.

Promoting and protecting a child's welfare

5.3

The period prior to the transfer of full Parental Responsibility on the making of an Adoption Order can be very challenging and prospective parent/s can under-report worrying behaviours seen with their new children. In addition it is common for these children to be placed at a significant distance from their home local authority, making close monitoring of the placement more challenging.

5.4

It is essential that children and their adoptive families receive good support services:

• Placements are visited and reviewed regularly;
• Children are seen alone;
• All those who use adoption services are aware that they are entitled to an assessment for support services (including therapy for the child), to meet their needs;
• There are effective processes in place to address, challenge and monitor the quality of practice.

5.5

Where an allegation of past or current abuse or neglect is made in respect of a child placed for adoption or in respect of a prospective or approved adopter, the following actions must be taken:

• Where a child is placed with prospective adopters and any allegation of past or current abuse or neglect is received, a referral must be made, in line with the Referral and Assessment, to the local authority children's social care where the child is placed (the host authority);
• Where child protection enquiries are made in respect of a child by the host authority, full co-operation must be given by any other local authority with information about that child;
• The registration authority must be notified of the instigation and outcome of any child protection enquiry;
• Consideration must be given as to the implications of the outcome of any allegation, and any necessary measures taken in order to protect children placed with prospective adopters;
• Adoption agencies must ensure that appropriate individuals working for the purposes of the agency, prospective adopters and children placed by the agency all have access to information to enable them to contact the host local authority children's social care, plus the registration authority in respect of any concern about child welfare or safety relating to an adoptive placement.

5.6

The Local Safeguarding Children Partnership has a responsibility to ensure that children with plans for placement for adoption within or outside the local area have essential safeguards in place and that children placed in the area from other local authorities have essential safeguards in place.

6.1

A child in boarding school is vulnerable to physical, sexual or emotional abuse and / or neglect. If there are lapses in the care provided for them, the child can suffer to such a degree that it constitutes significant harm. See Recognising Abuse and Neglect.

Good quality care

6.2

The welfare and safety of children living in boarding school should be promoted and provided for at a minimum, in line with the relevant National Minimum Standards (see www.ofsted.gov.uk).

6.3

All commissioners and providers of services for children living in boarding school are responsible for ensuring that children are safeguarded. Commissioner contracts and provider procedures should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children's welfare. Local Safeguarding Children Partnerships should monitor the welfare of children living in boarding school.

6.4

The standards for children living in boarding school include that:

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the boarding school to the external world and external scrutiny, including contact with families and the wider community;
• Boarding school staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and knowledgeable about how to implement safeguarding children procedures;
• Children who live in boarding school are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the boarding school setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see Roles and Responsibilities, NSPCC);
• Boarding school staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant local authority children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
• Bullying is effectively countered (see Bullying);
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers (see Safe Recruitment and Selection, and the Management of Adults who Work with Children Procedure);
• There is effective supervision and support, which extends to temporary staff and volunteers (see Learning and Improvement Framework);
• The boarding school's contractor staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by boarding school staff about other staff or carers (see Allegations Against Staff or Volunteers (People in Positions of Trust), who Work with Children Procedure);
• Organisations should have a code of conduct instructing boarding school staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistleblower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Boarding school staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living in boarding school.

7.1

The Local Authority has the same responsibilities towards children in custody as it does to other children in the Local Authority area.

Under the Legal Aid, Sentencing & Punishment of Offenders Act 2012, whenever children under 18 are remanded they become ‘looked after’ for the period of their remand. Their home local authority must visit them at specified intervals and prepare a Detention Placement Plan (DPP). The DPP is reviewed in the same way as a Care Plan for a Looked After Child.

Each centre holding those aged under 18 should have in place an annually-reviewed safeguarding children policy which promotes and safeguards the welfare of children, and covers all relevant operational areas as well as key supporting processes, which would include issues such as child protection, risk of harm, restraint, separation, staff recruitment and information sharing.

Specific institutions in an area must ensure that there are links in place with the Local Safeguarding Children Partnership and local authorities.

The local authorities' responsibilities are set out in Local Authority Circular (LAC) 2004(26). See also guidance on the Legal Aid Sentencing and Punishment of Offenders Act 2012.

Click here for The Children Act 1989 Guidance and Regulations - Volume 2: Care Planning, Placement and Case Review.

7.2

Bullying is effectively countered - this is especially important in any institution providing accommodation and care for groups of young people (see Bullying).

Young offender institutions, Secure Training Centres and secure children's homes

7.3

The Local Authority has the same responsibilities towards children in custody as it does to other children in the Local Authority area.

Under the Legal Aid, Sentencing and Punishment of Offenders Act 2012, children who are remanded to Youth Detention Accommodation are considered to be looked after by the Local Authority and are managed within the statutory LAC framework.

Young Offenders Institutions which accommodate Juveniles (16-18) must have policies and procedures in place which set out their duties to safeguard and promote the welfare of the children and young people in their care.

Specific institutions in an area must ensure that there are links in place with the Local Safeguarding Children Partnership and local authorities. See the Standards set out in 'National Standards for Youth Justice Services 2013'.

7.4

All custodial settings which accommodate children should have internal policies and procedures, in line with these Procedures, to safeguard and promote the welfare of children. Accordingly, if information comes to light, from whatever source, that a young person has suffered or is likely to suffer significant harm, the professional who receives the information or has a concern must report this immediately to the safeguards manager or equivalent designated safeguarding children professional, and the Governor.

7.5

The Governor must ensure an assessment is undertaken by the safeguards manager or equivalent designated safeguarding children professional as soon as possible (but in any case within 12 hours) and overseen by the setting's safeguards committee. Local authority children's social care should be consulted for expert advice as required.

7.6

A referral to local authority children's social care should be made in line with Referral and Assessment. The Governor or the safeguards manager / equivalent designated safeguarding children professional should participate in the strategy meeting / discussion. If the child is involved with a Youth Offending Team, their supervising officer should also participate. See Child Protection Enquiries.

Transition into adult services or the community

7.7

Good safeguarding practice and resettlement planning requires that all the agencies involved with a child must work together to provide continuity of services when the child transfers into and out of the secure estate. This includes ensuring that the child has suitable supported accommodation, help with mental health and substance misuse issues and with identifying appropriate education, training or employment.

7.8

Transition to adult services for children in the youth justice system can be challenging due to the different thresholds for children's and adult services and the complexity of need posed by many young people in the youth justice system.

7.9

See Healthy Children, Safer Communities: a strategy and action plan to promote the health and well being of those in contact with the youth justice system. See also Lord Bradley's review of people with mental health problems or learning disabilities in the criminal justice system (April 2009).

8.1

This section should be read in conjunction with Hospitals (specialist) and, as appropriate, Psychiatric Care for Children.

8.2

The National Service Framework for children, young people and maternity services (Children's NSF) sets out standards for hospital services. It requires hospitals to have in place systems to ensure accountability for individual children's safety and well-being, including contemporaneous recording of concerns and discussions on a child's case and a safe discharge process.

8.3

Care must be provided in a safe environment which is child-friendly, healthy and well suited to the age and stage of development of the child/ren. Children should not be cared for on adult wards. Wherever possible, children should be consulted about where they would prefer to stay in hospital and their views should be taken into account and respected.

Hospital admission data should include the age of children so hospitals can monitor whether they are being given appropriate care in appropriate wards.

8.4

Hospitals are required to ensure their facilities are secure and that security arrangements are regularly reviewed. See National Service Framework for children, young people and maternity services.

8.5

For a child receiving a service from local authority children's social care or Youth offending services prior to / during their stay in hospital, a Lead Professional, or Lead Social Worker as appropriate, should be nominated to co-ordinate services for him/her.

8.6

When a child has been or is planned to be in hospital or accommodated by a Clinical Commissioning Group CCG for more than three months, under s85 of the Children Act 1989 the hospital or CCG is required to notify the child's home authority, that is, the local authority for the area where the child is ordinarily resident, (see Children and Families Moving Across Local Authority Boundaries). If it is unclear which authority that is, then the hospital should inform their own local authority or the local authority where their commissioning CCG is located.

8.7

Local authority children's social care in the home authority (see Children and Families Moving Across Local Authority Boundaries) must assess the child's needs.

Discharging children from hospital

8.8

Where professionals have concerns about a possible child protection issue,a strategy meeting and a multi-agency action plan to safeguard the child must be agreed and recorded before the child leaves hospital. - [The Inquiry into the death of Victoria Climbié (Lord Laming, 2003)]

8.9

As part of the plan:

• Local authority children's social care must assess and establish that the child's home environment is safe;
• The health professionals must ensure their concerns have been fully addressed and any plan for discharge of the child must be authorised by the child's consultant;
• The plan must provide for the ongoing promotion and safeguarding of that child's welfare;
• There must be follow-up arrangements to monitor compliance with the plan.

8.10

Particular attention is required in the discharge planning of newborns from neonatal intensive care units, since these babies are at high risk of re-admission to hospital. They need a properly co-ordinated programme of follow-up, with special attention to vision, hearing and developmental progress, as well as the co-ordinated input of services such as genetics.

Transition for children with long term conditions

8.11

Children with long term conditions need preparation for the move from children's to adult services.  All children with on-going health needs should have a plan developed with them for the transition of their care to adult services, which is coordinated by a named person.  If there are child protection concerns for such a child, the local authority vulnerable adults service should be informed as part of the transition planning.

9.1

This section should be read in conjunction with Hospitals and, as appropriate, Psychiatric care for children.

9.2

There are a number of specialist hospitals in the London area. These provide specialist tertiary services, whether with a focus on paediatrics (e.g. Great Ormond Street Hospital) or in a particular health condition (e.g. the Royal Marsden Hospital). These hospitals have regional, national or international catchment areas. This means they are rarely a child's local hospital.

9.3

Children admitted to these hospitals can present with complex safeguarding and child protection issues. They may have sustained serious and life threatening non-accidental injuries or there may be concerns related to fabricated or induced illness (see Fabricated or Induced Illness/Perplexing Presentations). These children may have suffered, or are likely to suffer, significant harm through physical, sexual and emotional abuse and / or neglect (see Recognising Abuse and Neglect). Furthermore, if there are lapses in the care provided for the child, s/he can suffer significant harm whilst in hospital.

9.4

Most specialist hospitals have links with their local local authority children's social care, who may be able, dependent upon local arrangements, to liaise with the child's home authority (see Children and Families Moving Across Local Authority Boundaries) in child protection cases.

Some specialist hospitals offering tertiary care to children have children's social care teams on site, provided in partnership with the local children's social care service. In child protection cases, their role is to act as liaison with the home authority, except where they would be the lead agency - such as, when:

• The child is resident in the specialist hospital's local authority area;
• Incidents occur on the specialist hospital site;
• There are allegations against members of staff of the specialist hospital's Trust.

9.5

All Hospital Trusts should have in place protocols in line with these  Procedures, and which set out staff roles and responsibilities where child protection concerns are raised either prior to or subsequent to a child being admitted. Children in hospital must have appropriate protection, with referrals being made to local authority children's social care in line with Referral and Assessment. Failure to put immediate and appropriate safeguarding plans in place may leave a child at risk of harm.

9.6

Protocols should outline responsibilities and necessary actions in accordance with legal duties, procedures and accepted good practice:

• Case responsibility for the child rests with the home authority (see Children and Families Moving Across Local Authority Boundaries), and the home authority should work in partnership with the Trust and with the host authority children's social care service. If a difference of opinion occurs, this should be resolved by discussion between managers;
• Where the child is already known to the home authority, and child protection concerns exist, the child should have an allocated social worker who should make contact with the relevant hospital social work department;
• Where a child protection concern which is already known to the home authority exists, relevant child protection plans (which also detail any action the relevant hospital trust staff may need to take to protect the child) should be immediately passed to the hospital social work department or, if out of hours, the Trust's out of hours lead for inclusion in hospital and social work records;
• Where a child protection concern arises, or a pre-existing concern changes on or after admission, the home authority should act immediately, in line with procedures for a s47 enquiry, to ensure the child is appropriately protected. Where necessary, a strategy meeting / discussion should be held in line with procedural timescales. This may be held at the hospital and chaired by a local authority children's social care manager from the home authority;
• To ensure the safety of the child, members of the strategy meeting / discussion must consider and agree, in discussion with relevant Trust and social work management, the need for a legal framework to be put in place by the home authority. Any dispute should immediately be referred to senior management within the home authority and the Trust;
• A written care plan for the child must be immediately faxed or emailed to the hospital social work department. Similarly, strategy meeting / discussion minutes, any decisions (which must be in writing) and a copy of any legal orders must be sent to the relevant hospital trust (to the social work department during working hours and if there is one, or the Trust out-of-hours lead if out of hours) for inclusion in the child's records at the hospital;
• The care plan should be regularly reviewed, as appropriate, in a multi-agency / disciplinary meeting usually held at the hospital and chaired by the relevant person from the home authority;
• Where there are concerns about unauthorised removal of the child or unsupervised visiting by the parents to a child with injuries of a non-accidental nature, the senior hospital staff and senior staff from the home authority should discuss whether an immediate legal order is required to protect the child. If an order is required, the senior hospital staff and senior staff from the home authority should decide whether the home or host authority will make the application and on what grounds. If the risk to the child is potentially life threatening and the need for protection is immediate, the local police should be contacted to consider using their powers of police protection to ensure that the child is not removed from the hospital;
• The home authority needs to work in partnership with the specialist hospital;
• Where the child is admitted to the hospital from outside the UK, the child's home authority is the local authority in which the child has a temporary address (this could be an embassy address where an embassy has negotiated the contract with the hospital);
• A visiting non-UK citizen child should receive the same duty of care as a child resident in the UK (i.e. checks made, assessments completed, care plan initiated and reviewed).

Serious case reviews

9.7

Specialist Hospital Trusts may be involved in serious case reviews because of the nature of the services they offer. Such hospitals should contribute to serious case reviews in line with Child Death Reviews.

9.8

Requests for a chronology and individual management reviews need to be made to the chief executive of the relevant Hospital Trust in cases where the specialist hospital is a non-local separate agency (in relation to the Local Safeguarding Children Partnership (LSCP) co-ordinating the review). The Chair of the LSCP in the local authority area for the specialist hospital should be informed of each request.

9.9

Depending on the level and nature of the relevant Hospital Trust's involvement in individual cases, they should be invited to send a representative to the serious case review panel meetings and given the opportunity to contribute to the terms of reference for the review.

9.10

Such hospitals should, where relevant, produce an individual management review, giving an holistic account of the hospital's involvement in the case and making recommendations.

9.11

The draft overview report should be circulated to the relevant hospital management board for consultation prior to completion.

10.1

This section provides additional guidance to Hospitals and Hospitals (specialist), and the sections should be read in conjunction with each other.

See also the National Service Framework for children, young people and maternity services (Children's NSF) which sets out standards for hospital services in respect of individual children's safety and well-being.

10.2

Children who require treatment as an in-patient in a psychiatric setting will usually be admitted on a voluntary basis, otherwise the Mental Health Act 1983 or the Children Act 1989 will apply. The admission criteria will differ, such as acute (crisis or short term), for eating disorders or challenging behaviour. Age ranges can vary considerably and some children may be admitted to an adult psychiatric setting. Catchment areas for some hospitals may cover a regional or national area depending on the specialism.

10.3

Where consent for treatment is required, it should be clarified by the lead professional (e.g. local authority children's social care, child and adolescent mental health services (CAMHS)) whether this is being carried out under the Mental Health Act 1983 or the Children Act 1989.

10.4

If any child who is considered to be Fraser competent is unwilling to remain as an informal patient consideration should be given to use the Mental Health Act 1983. For children under 16 where a Fraser competent child wishes to discharge him or herself as an informal patient from hospital, the contrary wishes of those with parental responsibility will ordinarily prevail. Where there is dispute consideration should be given to use the Act. Similarly if a 16 or 17 year old in unwilling to remain in hospital as an in-patient, consideration may need to be given whether he or she should be detained under the Act.

10.5

Children in psychiatric settings may need to be isolated from other patients or require control and restraint on occasions, and staff should be appropriately trained to meet their needs and safeguard their welfare. When a child is admitted to psychiatric settings where adults are inpatients, a risk assessment must be undertaken to avoid the child being placed in vulnerable situations.

10.6

Children admitted to psychiatric settings may disclose information about abuse or neglect concerning themselves or others. Disclosures may be made when the child feels it is safe to talk or when the child is angry, distressed or anxious. All allegations should be treated seriously and usual Referral and Assessment procedures followed.

See also Harmful Behaviour.

11.1

Children on foreign exchange visits and in some language schools stay with families selected by the school (or hosting organisation) in the host country and are vulnerable for reasons comparable to others living away from home (see Foster Care). If there are lapses in the care provided for them, the child can suffer to such a degree that it constitutes significant harm. See Recognising Abuse and Neglect.

11.2

Children may be at additional risk as the assessment and supervision that would apply if the child was privately fostered are not applicable because most exchanges last less than 28 days. It is unlikely the school (or hosting organisation) selecting the host family will have been able to conduct a thorough assessment of the suitability of the host family.

11.3

Advice and assistance can be given by the local authority children's social care to schools wishing to conduct more thorough assessments, for example the host family could be asked to give consent for checks of the local children and family social care service database, and also for checks with other local agencies (for example with GPs).

11.4

In the event that a pupil's host family has been the subject of s47 enquiries, unless or until there is a satisfactory resolution of concerns, the family should be regarded by the UK school as unsuitable to receive or continue hosting a pupil from an overseas school. See Allegations Against Staff or Volunteers (People in Positions of Trust), who Work with Children Procedure and Organised and Complex Abuse.

11.5

UK schools and agencies should take reasonable steps to ensure that a comparable approach is taken by relevant schools abroad.