Integrated care boards (ICBs) would be well placed to determine what action must be taken to improve child safeguarding in emergency departments, the Healthcare Safety Investigative Branch (HSIB) has suggested.
Clinicians in emergency departments are likely to encounter children with injuries that may be non-accidental – such as those attained through abuse – and missed diagnoses may risk further harm to the child, the investigative body said.
However, making a judgement on such cases is complex and clinicians may be reluctant to make a formal diagnosis, it warned.
Now, in its major report into diagnosing non-accidental injuries, the HSIB found that the data captured in the Emergency Care Data Set (ECDS) relating to safeguarding is ‘is not currently sent to any team or body for review and action’.
As the safeguarding data is currently not used, it is not part of any data quality or validation process and ‘may well be poor’, the investigative body was told by NHS England’s system transformation team during the investigation.
Additionally, the data that is captured is limited, with no information detailed on family circumstance.
The HSIB therefore recommended that NHS England review the utility of the safeguarding data in the ECDS, agree a process for its quality assessment, and determine who is responsible for acting on the data.
The HSIB suggested ICBs assume this role, given their position as commissioners, to determine ‘local action to be taken based on the data’.
Matthew Mansbridge, HSIB’s national investigator, said: ‘We have recognised in our report that for staff these situations are fraught with complexity and exacerbated by the extreme pressure currently felt in EDs across the country.
‘The clinical staff we spoke to however were open and reflective – they acknowledged that the clinician’s experience and professional curiosity in these cases is important but that there are gaps in the way they are currently supported.’
He added: ‘The evidence from our investigation echoes what staff and national leads told us – that ED staff should have access to all the relevant information about the child, their history and their level of risk and that safeguarding support needs to be consistent and timely – gaps in information and long waits for advice will only create further barriers to care.’
NHS Providers director of policy and strategy Miriam Deakin said: ‘Emergency departments are under extreme pressure from ever-growing demand. As the HSIB highlights, an environment of heavy workloads, time pressure and demands on staff all have an impact and raise the risk that the signs of abuse could be missed.
‘This is yet another symptom of severe workforce shortages right across the NHS and social care. We need an action plan from the government as soon as possible to recruit many thousands more much-needed NHS staff.’
