4.5 Out of Borough Cases |
Contents
1. Assessment Procedures
The Health Link Team works with a number of families who come from outside Kensington and Chelsea. Indeed, most of the Royal Brompton hospital families are from out of Borough, as are the children who attend Cheyne Child Development Service.
Long-standing agreements with Westminster, Hammersmith and Fulham and Wandsworth Family Services are that they cover their own work directly and come into the hospital to carry out the investigation as appropriately. In the case of Hammersmith and Fulham, the link worker should be contacted, either by the ward staff directly or by a member of the Health Link Team.
It is the Health Link Team’s responsibility to gather information about the needs of children and their families, and pregnant women and their families, and make referral to the responsible agency. It is also our responsibility to help out medical and ward staff as far as is possible. Our experience has led us to believe that it is more helpful to the hospital and to the service user, that we see patients and their families - from what ever Borough they come from - initially on the ward, to establish the nature of the need and which agency can meet this need. Ward staff find it very difficult to identify and contact the appropriate duty officer in Family Services, and we can be far more effective in helping families if we can make an Initial Assessment and make the referral if this is appropriate.
Some difficulty arises when families have come from outside London. In the case of children on the Neonatal ward, on the Burns unit and in the Royal Brompton hospital, these families would find it very difficult to access services from their own local authority. It is entirely reasonable that we provide support to families either by our own resources, or by getting in touch with the appropriate local authority. A difficulty arises in relation to financial support. We are unable to use our Section 17 budget to help these families, but we are able with permission to seek charitable grants held by the hospital social work department’s senior Business Support Officer or from the Team Manager at the Royal Brompton Hospital.
When there are concerns about a child or an unborn baby, and a Section 47 Enquiry is necessary, the case responsibility must lay at the door of the appropriate local authority, the home authority. This issue is clearly dealt with in the principles set out at 10.6.7 in the All London Child Protection procedures. It is expected that the home authority will chair the strategy meeting and make plans for the investigation. If emergency action is necessary it may be more appropriate after negotiation for Kensington and Chelsea to carry out the emergency action, but responsibility for the child will return to the home authority. There is emphasis that negotiation about responsibility must not cause delay in urgent situations. It is the Health Link’s responsibility to make sure that the local authority has the correct information about the concerns held by the hospital, and along with the Named Nurse and Doctor, encourage staff to record observation and evidence.
There are times when the situation is not so clear. Sometimes there is no clear home address and therefore it is difficult to find out which local authority is responsible. At times there are disputes between local authorities as to who will take responsibility for the case. Where the local authority is a long way away, it is reasonable that the hospital social work team take responsibility for some interim investigation and indeed for emergency duties to safeguard the welfare of the child. There have been circumstances where the local authority refused to take any responsibility for a family, and thus the Health Link team has initiated the Section 47 Enquiry.
The Health Link team based in Chelsea and Westminster hospital and the Brompton hospital has a responsibility to make sure that concerns about children do not get lost. This responsibility is shared with the Named Nurse and Named Doctor within the Hospital Trusts. If there is no agreement reached about action needed after one working day, then Kensington and Chelsea Family Services should arrange a strategy meeting if needed, while negotiations continue up the hierarchy.
When a referral is made from the Hospital about a child where there are concerns that he/she is at risk, then the appropriate Local Authority should be informed in writing. Normally referrals are first made by telephone, and then followed up in writing within 48 hours. Following discussion within the team, there is a recommendation that we also fax to the local authority a contact sheet stating what we have agreed with the home local authority, in terms of initial work and responsibilities. If a referral is made to our team about a child or family, where there are concerns, a letter should be sent acknowledging this referral.
2. Discharge Planning
Where there are concerns about the child or when the child and family have a number of complex needs, a discharge planning meeting is recommended. In terms of children at risk, a Child Protection Conference might be the appropriate forum where the discharge can be planned, and plans made to meet the child’s needs and protect children in the family. Normally discharge planning meetings are chaired by the home local authority, but held in the hospital.
Laming recommends (recommendation 61), that there is a responsibility for hospital social workers to attend all hospital meetings concerned with safeguarding of children. In practice the hospital social workers attend their own borough’s meetings, and the expectation is that the home local authority social worker attends their meetings. If the local authority refuses to attend the discharge planning meeting called by medical staff where there are concerns about a child, or there are disputes by the local authority about discharge planning and responsibilities, then it is appropriate for one of the Health Link Team to attend the meeting. It is then our responsibility to inform the Local Authority about the decisions made at the meeting.
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