This week marked my first engagement as a Churchill Fellow and I reminded myself of the objectives of this project which you can find in the “About the project” section of this blog (https://drandrewrowland.wordpress.com/about/).
I’m going to try to update a few notes about my travels and activities as my journey progresses.
Due to the nature of the investigations I’ll be carrying out (related to the potentially sensitive subjects of child abuse and child protection) I will only be able to publicly report limited amounts of information so, in order to increase the amount of information I can discuss, where possible I will anonymise things so that I can talk about them.
This week I was invited to spend the morning at a Multi-Agency Safeguarding Hub (MASH). Section 47 of the Children Act 1989 places a duty on Local Authorities to investigate if they receive information which suggests that a child found in their area may be at risk of, or may have suffered from, significant harm (child abuse). Those investigations invariably involve a multi-agency approach with key representation from law enforcement and the local authority as well as health, probation, housing and education as appropriate.
Due to the fact that these are all separate agencies it is my experience that sometimes these investigations are not always handled in the most time-efficient and streamlined way. Many areas have developed MASHs to improve inter-agency communications as well as to deal with cases in an efficient way, ensuring standardisation of approach across the caseload. MASHs have multi-agency representation housed under the same roof to make it easier to discuss and action cases.
The MASH I visited this week is open Monday to Friday 0845 to 1700. Outside of these hours the traditional Local Authority Emergency Duty Team (EDT) takes over responsibility for the management of new cases.
There is representation from Social Work, Health Visiting, Education, Law Enforcement and Housing within the MASH. Probation services are involved on an ad hoc basis and there are plans to engage the youth offending team. A daily meeting is held to discuss cases from the previous 24 hours (that are able to wait for a discussion) although all referrals are graded as Red (action within 3 hours), Amber (action within 24 hours) or Green (action within 48 hours).
I was impressed with the detailed and transparent nature of the discussions that took place with excellent communication between all agencies and clear actions with defined timescales but there was a noticeable lack of medical involvement in this process – the clinical representation came from a specialist health visitor who was very used to carrying out developmental assessments but who won’t have carried out a ‘Section 47’ paediatric medical assessment before – as these are completed by doctors working in paediatrics.
As is usually the case in my experience, there are specific problems relating to those children aged 16 and 17 (bearing in mind that in the UK the Children Act 1989 defines a child as someone who has not reached their 18th birthday – regardless of whether they are in school, in custody, in the army, working, unemployed, living alone, living with family, living with friends or whether they have children of their own).
The really efficient functioning of the MASH I visited and the stark comparison that this provides to the service which children often receive out of hours did cause me to think about whether any audit data are available to look at the time of referral of children throughout the 24 hour period and whether this would support extension of the hours of operation of the MASH – and this is certainly something that ought to be looked at. I suspect, as ever, that money will be a crucial factor in deciding what hours the service can operate. But, then again, what price can we put on a child who is not dealt with using the same rigour and multi-agency approach that a MASH appears to provide, and who goes on to be harmed or killed…?
This first visit has left me with three areas to explore in future visits as this Fellowship progresses:
- Are there any models that deal with the specific issues of adolescents and 16 to 17 year olds?
- Could a pilot take place to see the impact of providing medical paediatric input into a MASH, and evaluating the effect of this?
- Are there any models of MASHs that have extended opening hours outside of 0845 to 1700 and how are these funded and organised
The meetings I have arranged with The Royal College of Paediatrics and Child Health, the Office of the Children’s Commissioner, the National Society for the Prevention of Cruelty to Children and an influential senior barrister will all be incredibly useful before I set off next weekend to the first of my overseas visits – Austin, Texas.