4.8 Strategy Discussions and Section 47 Enquiries
- 1. Strategy Discussions and Meetings
- 2. Timescales of Strategy Discussion/Meeting
- 3. When a Face-to-Face Meeting is required
- 4. Recording of a Strategy Discussion/Meeting
- 5. Duty and Decision to Undertake Section 47 Enquiries
- 6. Integration with an Assessment
- 7. Single Agency or Joint Enquiry/Investigation
- 8. Surrey Children's Services - Single Agency Enquiry
- 9. Police Single Agency Investigations
- 10. Joint Investigation
- 11. Seeing and Interviewing the Child
- 12. Inability to Access the Child
- 13. Parental Involvement and Consent
- 14. Medical Assessments
- 15. Outcome of the Section 47 Enquiries
1. Strategy Discussions and Meetings
Whenever there is reasonable cause to suspect that a child is suffering, or is likely to suffer Significant Harm, there should be a Strategy Discussion/Meeting involving Surrey Children's Services and the Police, Health (Named Nurse and/or Named Doctor) and other bodies as appropriate (for example, children's centre/school and, in particular, any referring agency.) In the case of a pre-birth Strategy Meeting (see Pre-Birth Child Protection Procedure), this should involve the Midwifery Service.
If the child is in a hospital setting (in-patient or out-patient) or receiving services from a child development team, the Paediatric Consultant responsible for the child's health should be involved, as should the senior ward nurse where the child is an in-patient. When a medical examination may be necessary, or has taken place, a senior doctor from those providing services must also be involved.
When required, a legal adviser should also be invited.
Where a Strategy Discussion/Meeting is being convened in relation to a child who is ordinarily resident in the area of another Local Authority, her/his home authority must be informed as soon as possible, and be involved as appropriate in the Strategy Discussion /Meeting.
The Strategy Discussion/Meeting should be convened by Surrey Children's Services and those participating should be sufficiently senior and able, therefore, to contribute to the discussion of available information and to make decisions on behalf of their agencies. Unless otherwise specified in a procedure, Strategy Meetings will be chaired by a Team Manager or Assistant Team Manager.
A Strategy Discussion may take place following a referral, or at any other time (for example, if concerns about Significant Harm emerge in respect of child receiving services under section 17). The discussion should be used to:
- Share available information;
- Agree the conduct and timing of any criminal investigation;
- Decide whether section 47 enquiries should be initiated and therefore an Assessment be undertaken under section 47 of the Children Act 1989, or continued if it had already begun under section 17 of the Children Act 1989;
- Plan how the Section 47 Enquiry should be undertaken (if one is to be initiated) including the need for medical treatment and who will carry out what actions, by when and for what purpose;
- Agree what action is required immediately to safeguard and promote the welfare of the child, and/or provide interim services and support. If the child is in hospital decisions should also be made about how to secure the safe discharge of the child;
- Determine what information from the Strategy Discussion will be shared with the family unless such information sharing may place a child at increased risk of suffering Significant Harm or jeopardise police investigations into any alleged offence(s); and
- Determine if legal action is required.
A Strategy Discussion/Meeting should be considered:
- When new information on an existing case indicates that a child has suffered, or is likely to suffer Significant Harm;
- When a Child Assessment Order or Emergency Protection Order has been made;
- When a child returns to the care of or resumes direct contact with, an adult who may have previously caused Significant Harm to this or another child;
- When an adult or young person assessed as presenting a risk to children has moved into or is about to move into the child's household or such a person is regularly visiting or about to have sustained contact with the child;
- When the risks to an unborn child may be such as to indicate the need to develop a Child Protection Plan before birth;
- When the death of a child in family, in which abuse or neglect is suspected, is confirmed and there are other children in the household;
- When a child lives in, or is born to, a household in which resides another child who is currently the subject of a Child Protection Plan;
- When a child who is currently the subject of a Child Protection Plan in another area moves into Surrey, unless the other authority is to retain responsibility for the case;
- When a child has sexually assaulted another child or there is a risk of such an assault occurring to another child in the same household or in regular contact with the household (in which circumstances a Child Protection Conference should be held on both children).
When a child appears to be subject to sexual exploitation, including involvement in internet child abuse images consideration may need to be given to the need to seek advice from or invite a professional with expertise in the particular type of suspected Significant Harm. Where parents or adults in the household are experiencing problems such as domestic abuse, substance misuse or mental illness, it will also be important to consider involving the relevant Adult Services professionals.
The Strategy Meeting/Discussion should be used to:
- Ensure all relevant information is available to all participants. This may involve identifying further information required that is not currently available;
- Evaluate the information and decide whether or not the threshold is met for initiating Section 47 Enquiries;
- Plan the scope of the Section 47 Enquiry, including other children possibly at risk, who are members of the same household or in the household of, or in contact with, an alleged perpetrator;
- Agree the conduct and timing of any criminal investigation;
- Agree responsibility for the enquiries, including whether single or joint agency investigation;
- Agree when the child will be seen alone by the Lead Social Worker (unless inappropriate for the child) as well as any other arrangements to see/interview the child, including whether any particular factors such as race, ethnicity, language or disability should be taken into account and whether an interpreter will be required for the child and/or family, and whether this should be a joint video interview; if so, the lead interviewer must be nominated and a planning meeting arranged (see Section 11, Seeing and Interviewing the Child);
- Agree the arrangements for obtaining consents to interviews and assessments of the child (see Section 11, Seeing and Interviewing the Child and Section 13, Parental Involvement and Consent), (if the assessment is to take place during the course of Court proceedings, the Court's prior consent must be obtained) and any action necessary if parental consent for a medical assessment and/or interview is not given;
- Agree and timetable to discuss the concerns with the parents;
- Decide whether to interview the referrer or any other person and if so, by whom and when;
- Allocate tasks if any emergency protective action is required;
- Agree what action is required immediately to safeguard and promote the welfare of the child, and/or provide interim services and support. If the child is in hospital, decisions should also be made about how to secure the safe discharge of the child;
- Determine if legal action is required;
- Agree what information will be shared with whom and when, taking into account whether information sharing may place a child at increased risk of harm or jeopardise any criminal investigation. If urgent action is necessary, a decision will need to be taken about informing or consulting parents and child(ren), obtaining consents, taking legal action, accompanying the child and notifying parents - see Section 11, Seeing and Interviewing the Child and Section 13, Parental Involvement and Consent;
- When relevant, consider the implications for any possible disciplinary action e.g. use of evidence statements;
- In cases where information indicates a history of violence and threatening behaviour by the parents towards professionals, consider the risks to the child(ren) and to staff, determine a strategy for managing the risk and agree joint action as appropriate;
- Agreeing, in particular, how the child's wishes and feelings will be ascertained so that they can be taken into account when making decisions under Section 47 of the Children Act 1989;
- Agree the need for further Strategy Discussions and/or Meetings, in particular when circumstances are complex or further information is necessary to make a decision, for example about whether to initiate a Section 47 Enquiry;
- Any decisions about taking immediate action should be kept under constant review.
The plan should reflect the requirement to convene an Initial Child Protection Conference within 15 working days of the Strategy Discussion/Meeting, which decided to initiate a section 47 Enquiry.
Surrey Children's Services should record information, which is consistent with the information set out in the Record of Strategy Discussion. Any decisions about taking immediate action should be kept under constant review.
A Strategy Discussion may conclude that a Section 47 Enquiry is not required as there is insufficient evidence that the child has suffered, or is likely to suffer Significant Harm. This must be agreed by a Surrey Children's Services Manager, Detective Sergeant, Police Public Protection Investigation Unit and any other professionals involved in the discussion. The reasons for this decision must be fully recorded.
In reaching a conclusion as to the justification for Section 47 Enquiries, the Strategy Discussion/Meeting must consider the following factors:
- Seriousness of the concern(s);
- Repetition or duration of concern(s);
- Vulnerability of the child (through age, developmental stage, disability or other predisposing factor e.g. whether (s)he is a Looked After child);
- Source of the concern(s);
- Accumulation of sufficient information;
- Context in which the child is living - e.g. whether there is a child in the household already subject of a Child Protection Plan;
- Any predisposing factors in the family that may suggest a higher level of risk e.g. mental health difficulties, substance misuse of parent / carer or domestic abuse.
2. Timescales of Strategy Discussion/Meeting
Strategy Discussions / Meetings should be held within a maximum of 3 working days of the referral of the incident of concern for a child known to Surrey Children's Services, or decision by a multi-agency network that the Family Action Plan is not meeting the child's needs except in the following circumstances:
- For allegations / concerns indicating a serious risk to the child e.g. serious physical injury or serious neglect), the Strategy Discussion/Meeting must be held within three hours;
- During this time, the Referral Assessment and Intervention Team must decide on any immediate action to be taken, to protect the child in conjunction with Police Protection Investigation Unit;
- The child must be seen and spoken to (observed for non-verbal children), within twenty-four hours of the Referral to Surrey Children's Services;
- For allegations of penetrative sexual abuse, the Strategy Discussion/Meeting must be held on the day the Referral is received if this is required to ensure forensic evidence;
- When emergency action is or has been taken by the Police or Surrey Children's Services, the Strategy Discussion must be held within 1 working day;
- If the child is in a hospital setting and there are child protection concerns a Strategy Discussion/Meeting must take place within that setting before the child leaves it;
- When the concerns are particularly complex e.g. organised abuse, the Strategy Meeting must be held within a maximum of 5 working days, but sooner if there is a need to provide immediate protection to a child - see
3. When a Face-to-Face Meeting is required
A Strategy Discussion may take place at a meeting or by other means (for example, by telephone). In complex types of maltreatment a meeting is likely to be the most effective way of discussing the child's welfare and planning future action.
Face-to-face meetings must be held when there:
- Is likely to be a need for a joint investigation;
- Are suspicions of organised or multiple abuse - see Fabricated or Induced Illness Procedure;
- Are concerns relating to forced marriage - see Forced Marriage Procedure;
- Are concerns relating to female genital mutilation (FGM) - see Female Genital Mutilation Procedure;
- Are concerns relating to the future risk to an unborn child - see Pre-Birth Child Protection Procedure;
- Are concerns relating to child trafficking - see Trafficked and Unaccompanied Asylum Seeking Children Procedure;
- Are concerns relating to Significant Harm to a child caused by another child (separate meetings should be held in relation to each child) - see Children Displaying Harmful Sexual Behaviour Procedure;
- Are ongoing cumulative concerns about the child's welfare and a need to share concerns and agree a course of action.
4. Recording of a Strategy Discussion/Meeting
Agreed actions, the persons responsible and the agreed time scale must be recorded.
It is the responsibility of the Chair of the Strategy Meeting to write the Strategy minutes in the meeting using the Record of Strategy Discussion and including both information and actions. The minutes should be brief and will outline the risk factors clearly; the reasons for decisions made as well as actions and timescales should be included. This will be signed by all participants and photocopied and taken away by all.
For telephone discussions, a copy of the Record of Strategy Discussion authorised by the manager must be faxed to all participants.
5. Duty and Decision to Undertake Section 47 Enquiries
Surrey Children's Services has a statutory duty to undertake Section 47 Enquiries in any of the following circumstances:
- When for a child who lives or is found in its area, there is 'reasonable cause to suspect that a child has suffered or is likely to suffer Significant Harm';
- When a child is subject to an Emergency Protection Order;
- When a child is subject to Police Protection;
- When a person who has been convicted of or cautioned for an offence against a child and is considered to pose a risk to children moves into the household or has regular contact with a child.
Please also see guidance on Police Protection and Emergency Protection Orders, which can be accessed via the ‘SSCP website’ button on the left hand side of the screen.
Responsibility for undertaking Section 47 Enquiries lies with the Surrey Children's Services for the area in which the child lives or is found, even though the child is ordinarily resident in another local authorities area.
A decision to undertake such enquiries is usually taken following an assessment. However, a decision to undertake Section 47 Enquiries must be taken at any time when it is suspected the child is suffering or is likely to suffer significant harm. This may be:
- At the point of a Referral;
- During the early consideration of a Referral;
- During an Assessment; or
- At any time in an open case when the criteria are satisfied
6. Integration with an Assessment
An Assessment is the means by which Section 47 Enquiries are carried out and must be commenced whenever the criteria for Section 47 Enquiries are satisfied. The Assessment must be completed within 45 working days from the point of referral.
Section 47 Enquiries should begin by focusing primarily on the information identified during the Referral and Assessment, which appears most important in relation to the risk of Significant Harm. This should be recorded on Record of Outcome of S47 Enquiries.
The assessment of risk will:
- Identify the cause for concern;
- Evaluate the strengths and weaknesses of the family;
- Evaluate the risks to the child or children;
- Consider the child's needs for protection;
- Consider the ability of the parents and wider family and social networks to safeguard and promote the child's welfare - this must include both parents, any other carers and the partners of the parents;
- Determine the level of intervention required both in the immediate and longer term.
This will inform the Assessment, which must cover all relevant dimensions in the Assessment Framework triangle and be alert to the potential needs and safety of siblings or other children in the household or with whom the alleged offender may have had contact.
Section 47 Enquiries/Assessment must be led by a qualified and experienced Social Worker from Surrey Children's Services, who will be responsible for its coordination and completion. The Social Worker must consult with other agencies involved with the child and family to obtain a fuller picture of the circumstances of all children in the household, identifying parenting strengths and any risk factors. Enquiries may also need to cover children in other households with whom the alleged offender may have had contact. All agencies consulted are responsible for providing information to assist.
At the same time, where there is a joint investigation, the Police will have to establish the facts about any offence that may have been committed against a child and collect evidence - see Section 7, Single Agency or Joint Enquiry/Investigation.
Enquiries and assessment should always involve separate interviews with the child and, in the majority of cases, the parents, and the observation of interaction between the parent and child. This will include interviews and observations of both parents, any other carers and the partners of the parents. Any discussions with children should be conducted in a way that minimises distress; leading or suggestive communication must be avoided and interviews during the process of a criminal investigation must follow the Achieving Best Evidence Guidance - see also Section 11, Seeing and Interviewing the Child and Section 13, Parental Involvement and Consent.
If the child is too young to be interviewed or communication is difficult for any reason, alternative means of understanding the child's wishes and feelings should be used.
7. Single Agency or Joint Enquiry/Investigation
See also the Section 47 Protocol between Surrey Children's Services and Surrey Police (which can be accessed by clicking on the 'guidance and protocols' button in the menu at the left hand side of the screen.
8. Surrey Children's Services - Single Agency Enquiry
Following a strategy meeting/discussion a decision will be made as to whether there is going to be a single or joint agency enquiry. This may involve any of the following referrals:
- Purely Emotional Abuse without any apparent physical indicators;
- Physical Abuse resulting in minimal or no injury (except pre-mobile babies);
- Minor or periodic Neglect insufficient to justify prosecution;
- Indirect suspicions of Sexual Abuse;
- Inappropriate sexualised behaviour of a child;
- Where a Risk to a Child Offender moves into a household but with no allegations made.
During the initial Strategy Discussion between agencies when a decision has been taken to pursue Section 47 Enquiries on a single agency basis, the arrangements for each agency to feed back to each other must be clarified at the outset.
If, at any point during the Single agency s.47 enquiries it becomes apparent that the joint investigation criteria are met, contact should be made with the Police and a joint investigation commenced.
Social Workers will therefore need to be aware of the need to:
- Keep accurate and contemporaneous notes of any interviews;
- Assess the child's willingness and ability to pursue a criminal complaint.
9. Police Single Agency Investigations
Police single agency investigations are usually appropriate when:
- They relate to the historical allegation of an adult who experienced abuse as a child; or
- The alleged offender is not known to the child or the child's family (i.e. stranger abuse); in these situations, Surrey Children's Services must always be made aware and serious consideration must be given to assessing the child victim's needs.
When Police undertake a single agency criminal investigation, officers are responsible for all the associated investigative activities, e.g. conducting interviews of witnesses and suspects; visiting crime scenes and, in conjunction with the Social Worker, arranging medical assessments.
During a Police investigation, the investigating officer must assess the risks posed by the alleged offender, consider the ongoing needs of any child victim and her/his family and make a Referral to Surrey Children's Services as appropriate, e.g. for supportive and therapeutic services.
If during the course of a Police investigation, it emerges that parental deficiencies in the care of a child have significantly contributed to the alleged offence, Surrey Children's Services must be contacted, a Strategy Discussion held and a joint enquiry / investigation commenced if appropriate.
If during the course of a Police investigation, a risk to other children is identified, a Strategy Discussion must be held and the need for a joint enquiry / investigation must be considered.
When there has been an initial Strategy Discussion but a decision has been taken to pursue a Police single agency investigation, the arrangements for the agencies to feed back to each other must be clarified at the outset.
On occasions, in urgent criminal cases (critical incidents), the Police may conduct a single agency investigation out of hours as a result of their duty to respond and take initial action to protect either a child or criminal evidence.
If this occurs, Surrey Children's Services must be informed as soon as possible and a Strategy Discussion held to consider the need for a joint investigation if appropriate.
10. Joint Investigation
Joint investigations are conducted by Surrey Children's Services and the Police. A joint investigation must always commence when there is an allegation or reasonable suspicion that one of the criminal offences described below has been committed:
- Any suspected sexual offence committed against a child aged up to and including 17;
- Serious neglect or ill-treatment or emotional harm actionable under Section 1 of the Children and Young Persons Act 1933;
- Serious physical injury to a child, aged up to and including 17 - this includes murder, manslaughter, any assault involving actual or grievous bodily harm, repeated assaults involving minor injury (this includes bruising and/or mental trauma although if the injury is mental trauma, there must be medically recognisable signs before a prosecution can be contemplated.);
- Offences involving organised or institutionalised abuse, including allegations against teachers, Local Authority staff, health professionals, foster carers, prospective adopters and volunteers - see Child Protection Plan or a Looked After child;
- Injury to a pre-mobile child.
For other cases of minor injury, the following factors must be considered in determining seriousness of allegation or concerns and whether the threshold for joint investigation has been met:
- Vulnerability of the child (including age, disability and special needs);
- A previous history of minor injuries;
- Intent of the assault e.g. strangulation may leave no marks but is very serious or the perpetrator intended to cause more serious harm than actually achieved;
- Use of weapons;
- Previous concerns from another caring agency;
- Consistency with and clarity or credibility of the child's accounts of the injuries;
- Other predisposing factors about the alleged perpetrator e.g. criminal convictions, alcohol/drug.
Following a full assessment of the available facts, the Police and/or Crown Prosecution Service (CPS) may decide at any stage to terminate a criminal investigation and will inform the Social Worker of the decision.
Where there is a joint investigation, there should be a separate Surrey Children's Services record of all Section 47 Enquiries. A copy of the Police record along is not sufficient.
11. Seeing and Interviewing the Child
Children who are the subject of Section 47 Enquiries should always be seen and communicated with alone by the Lead Social Worker. In addition all children within the household must be directly communicated with during Section 47 Enquiries by either the Police or Surrey Children's Services or both agencies, so as to enable an assessment of their safety to be made.
The children who are the focus of concern must be seen alone, subject to their age and willingness, preferably with parental permission (see Section 13, Parental Involvement and Consent).
The Strategy Discussion / Strategy Meeting must decide where, when and how the child or children should be seen and if a video interview is required. The Strategy Discussion / Meeting must ensure that the SSCP leaflet Child Protection Enquiries: Information for families will be provided to the child, if appropriate and the parents/carers.
When the child is the subject of ongoing Court proceedings, legal advice must be sought about obtaining permission from the Court to see the child.
Surrey Children's Services and the Police should ensure that appropriate arrangements are in place to support the child through the enquiry / joint investigation. Specialist help may be needed if:
- The child's first language is not English;
- The child appears to have a degree of psychological and/or psychiatric disturbance but is deemed competent;
- The child has a physical/sensory/learning disability;
- Interviewers do not have adequate knowledge and understanding of the child's racial, religious and cultural background;
- Unusual or bizarre abuse is suspected.
It may be necessary to provide information to the child in stages and this must be taken into account in planning the Section 47 Enquiries.
Explanations given to the child must be brought up to date as the Section 47 Enquiry/joint investigation progresses. In no circumstances should the child be left wondering what is happening and why.
The objectives in seeing the child are to:
- Record and evaluate her/his appearance, demeanour, mood state and behaviour;
- Hear the child's account of allegations or concerns;
- Observe and record the interactions of the child and her/his carers;
- See and record the circumstances in which the child is currently living and sleeping and, if different, her/his ordinary residence;
- Evaluate the physical safety of the environment including the storage of hazardous substances e.g. bleach, drugs;
- Ensure that any other children who need to be seen are identified;
- Assess the degree of risk and possible need for protective action;
- Meet the child's needs for information and re-assurance.
12. Inability to Access the Child
If efforts to see and communicate with the child or children within the time scales agreed at the Strategy Discussion are unsuccessful, then the Social Worker and, where relevant, the Police officer should:
- Inform the relevant manger, and seek legal advice as appropriate;
- In consultation with her/his manager, arrange a further Strategy Discussion.
The Strategy Discussion must take place by the end of the working day on which the plan was to see the child, and must undertake a re-appraisal of the risks to the child and consequently the plan for completing Section 47 Enquiries in the light of not seeing the child. This must include agreement as to what further action is required to:
- Trace the whereabouts of the child (if unknown);
- See the child and carry out the s.47 enquiries.
13. Parental Involvement and Consent
The Social Worker has the prime responsibility to engage with parents and other family members to ascertain the facts of the situation causing concern and to assess the capacity of the family to safeguard the child. The SSCP leaflet Child Protection Enquiries: Information for families should be provided to the parents/carers.
The assessment of the parents must include both parents, any other carers and the partners of the parents.
Checks should be completed on a parent who assumes the care of a child during a Section 47 Enquiry.
In most cases, parents should be enabled to participate fully in the assessment and enquiry process, which must be explained to them verbally and also in writing by providing the Surrey SCP booklet 'Families' Guide to Child Protection'. If a parent has a specific communication difficulty or English is not their first language, an interpreter should be provided. Copies of the booklet can be translated into the family's first language via a request to the Professional Advisor, Surrey Safeguarding Children Partnership
Consideration should be given to the capacity of the parents to understand the information in a situation of anxiety and stress.
Parents must be involved at the earliest opportunity unless to do so would prejudice the safety of the child. The needs and safety of the child will be paramount when determining at what point parents or carers are given information. Parents must be kept informed throughout about the enquiry, its outcome and any subsequent action unless this would jeopardise the welfare of the child.
In explaining the process of Section 47 Enquiries to parents, the following points should be covered:
- An explanation of the reason for concern and when appropriate the source of information;
- The procedures to be followed (this must include an explanation of the need for the child to be seen, interviewed and/or medically assessed, consultation about the gender of the medical practitioner where time allows and seeking parental agreement for these aspects of the enquiry);
- An explanation of their rights as parents including the need for support and guidance from an advocate whom they trust (advice should be given about the right to seek legal advice);
- An explanation of the role of the various agencies involved in the enquiry and explanation of the wish to work in partnership with them to secure the welfare of their child;
- The need to gather initial information on the history and structure of the family, the child and other relevant information to enable an assessment of the injuries and/or allegations and the continuing risk to the child to be made;
- In situations of domestic abuse, the possibility of working with the parents separately;
- The provision of an opportunity for parents to be able to ask questions and receive support and guidance.
Any objections or reservations expressed by parents during a Section 47 Enquiry, and the response to these objections or reservations, must be clearly recorded.
14. Medical Assessments
When a Medical Assessment is Necessary
Strategy Discussions or Meetings must consider, in consultation with the Named Doctor/ Paediatrician (if not part of the Strategy Discussion or Meeting), the need for and timing of a medical assessment. Medical assessments should always be considered necessary where there has been a disclosure or there is a suspicion of any form of abuse to a child.
Additional considerations are the need to:
- Secure forensic evidence;
- Obtain medical documentation.
In cases of severe neglect, physical injury or penetrative sexual abuse, the assessment should be undertaken on the day of the Referral, where compatible with the welfare of the child.
Only doctors with appropriate child protection training may physically examine the whole child for the purposes of a medical assessment. Other staff should note any visible marks or injuries on a body map and document details in their recording.
Purpose of Medical Assessment
A medical assessment involves a holistic approach to the child and considers the child's well being, including development, if under 5 years old and her/his cognitive ability if older (educational psychologists can offer further expertise).
The purpose of a medical assessment is to:
- Diagnose any injury or harm and to initiate treatment as required;
- Document the findings;
- Provide a medical report on the findings, including an opinion as to the probable cause of any injury or other harm reported;
- Assess the overall health and development of the child;
- Provide reassurance for child, parent and Surrey Children's Services;
- Arrange for follow up and review of the child as required, noting new symptoms including psychological effects.
Consent for Medical Assessment/Treatment
Wherever possible any person with Parental Responsibility should be asked for their permission for the Paediatrician to undertake a child protection medical assessment. However there are occasions when other options need to be considered. These are listed below:
- If the young person is 16 and over and has given their permission;
- If a child is under 16 but a paediatrician considers (s)he has sufficient understanding to give informed consent and they have given their consent;
- The Local Authority when the child is the subject of a Care Order (although the parent / carer should be informed);
- The Local Authority when the child is Accommodated and the parent / carers have abandoned the child or are physically or mentally unable to give such authority;
- The High Court when the child is a Ward of Court;
- A Court as part of a direction attached to an Emergency Protection Order (EPO), an Interim Care Order (ICO) or a Child Assessment Order.
For a child subjected to Police Protection, the Local Authority would need to have sought one of the above orders before the child undergoes a child protection medical assessment, if the parent has not consented or unavailable to give consent, unless the child is Fraser competent to give the consent (See also Child Protection Medical Referrals Process flowchart).
In emergency situations where the child needs urgent medical treatment and there is insufficient time to obtain parental consent, the medical practitioner:
- May decide to proceed without consent; and/or
- May regard the child to be of an age and level of understanding to give her/his own consent.
In these circumstances, parents must be informed as soon as possible and a full record must be In non-emergency situations, when parental permission is not obtained, the Social Worker and manager must seek legal advice.
Arranging the Medical Assessment
When a decision has been agreed between Surrey Children's Services and the Police that a child protection medical assessment is required, guidance needs to be followed. (see Child Protection Medical Referrals Process flowchart)
The Social Worker or Assistant Team Manager should contact the relevant health centre during office hours. All health providers should have a contact point and telephone number for Surrey Children's Services and Police Teams to contact.
For Acute and Non acute sexual abuse medical examinations please contact SARC at Cobham Community Hospital.
For out of hours/bank holidays/weekends, the emergency duty team and police officer should contact the Paediatric Department of the acute hospital nearest to the child's home address.
Initial contact will be made with the receptionist at the appropriate health centre depending on the child's address. They must ensure that all health information (HV / School Nurse / Other) is collated and available in time for the scheduled medical assessment. When a referral is received, clear documentation of referral information should be completed with action taken.
The social worker should provide details of the child including his or her name, address, details of injury and who will accompany the child to the medical and, if time allows, send (via fax or secure email) information on the child and family.
A mutually agreed time for the medical assessment should be negotiated. 'Gold Standards' for safeguarding medical assessments are:
- Suspected non accidental injury - within 24 hours;
- Historic sexual abuse - within 3 working days;
- Chronic neglect - within 7 days of referral;
- Recent sexual assault - within 24 hours.
However, it is recommended that all child protection medical assessments should be undertaken within 24 hours if at all possible, depending on clinical need.
If there are concerns in respect of the timing of the medical assessment, the social worker or Assistant Team Manger should request to speak to the Named Doctor for Safeguarding. Should there be no appropriately trained Paediatrician available to undertake the medical assessment in a time frame deemed appropriate to the Police and social worker, a discussion needs to take place between the Named Doctor for Safeguarding and Assistant Team Manager and action agreed to secure a medical assessment as soon as possible given the needs of the child and the investigation.
If the named doctor is not available then the Designated Doctor for Safeguarding should be contacted.
If the Community Paediatrician is unable to undertake the medical assessment and the only alternative is to take the child to an A&E department, it is the responsibility of the Community Paediatrician to arrange for the medical assessment to take place with a hospital based Paediatrician and to tell the social worker who will be undertaking the medical.
If the social worker or Police officer subsequently decides a medical assessment is no longer needed they must make the examining Paediatrician aware at the earliest opportunity.
Should the estimated time of arrival of the child and professionals at the agreed medical centre/hospital change, the social worker and Police officer must inform the Paediatrician at the earliest opportunity. Every attempt should be made to see the child within 30 minutes of arrival for the medical assessment. It is not appropriate to keep the child waiting.
The social worker should provide as much information about the need to undertake a medical assessment and the circumstances that have lead to the decision to seek the medical assessment to the examining Paediatrician prior to the medical assessment taking place.
Examining clinician(s) should check that all relevant information is available before conducting the medical assessment:
- Social Worker / Police information in relation to the circumstances of the injury or need for examination;
- Outcome of any Strategy Discussions;
- Health Visitor / School Nurse / CAMHS information.
Wherever possible, two Paediatricians will be available for the medical assessment. When this is not possible and only one is available the Paediatrician should consult with another Paediatrician (via phone) before offering a professional medical opinion in respect of any injury or need. Should the examining Paediatrician be unable to consult with another paediatrician, then the social worker and Police officer should be informed.
No hospital registrar should offer an opinion on the nature of an injury until they have discussed the situation with a consultant paediatrician.
If the medical assessment is performed by a paediatrician in training, the findings of the assessmentmust be discussed with the Consultant Paediatrician responsible before opinion and recommendation is given to Surrey Children's Services / Police Safeguarding Teams.
Where there is a need for ongoing medical opinions e.g., X-rays sent to another hospital, the examining Paediatrician has the responsibility for keeping the social worker and Police officer updated with any new information.
Should there be Strategy Meetings these should be convened in liaison with the Paediatric Team so that mutually convenient dates, time and venue could be identified to maximise attendance.
Recording of Medical Assessment
The examining paediatrician will provide verbal feedback together with a completed hand written summary report on the day of the assessment. A full typed report will then be provided within 3 working days of the medical assessment. If there is a delay in producing the typed report social worker should be informed of the reason. The reason should be clearly documented in the child's records.
The supervising clinician countersigning the medical report should quality assure the report.
Surrey Safeguarding Children Partnership's Safeguarding Medical and Examination Record Form must be used to record history / examination findings / opinion and recommendation. This report should be typed and distributed within 3 working days
The examining paediatrician will be responsible for the distribution of the report to other appropriate agencies e.g. GP.
15. Outcome of the Section 47 Enquiries
Section 47 Enquiries are concluded at the point when an informed decision is made taking account of all information available as to whether the child has suffered, or is likely to suffer Significant Harm or not.
When a joint investigation has been held, a Strategy Discussion or Meeting should be held to agree the outcome.
Section 47 Enquiries will result in one of 2 possible outcomes:
- Child protection concerns are substantiated and the child(ren) is/are considered to have suffered, or are likely to suffer Significant Harm, in which case an Initial Child Protection Conference must be convened;
- Child protection concerns are not substantiated and no further action is required OR the enquiries have revealed the child is a Child in Need for whom services, such as a Family Action Plan/Child in Need Plan, and/or further assessment may be required.
In all cases, the outcome must be authorised by a Surrey Children's Services manager who must decide if the Assessment should be or has been completed or should be continued.
Where the child has been judged to need further services as a Family Action Plan, a meeting of involved professionals and family members must be convened at the end of the enquiries / Assessment to agree what actions should be undertaken by whom and with what outcomes for the child's health and development. This must include whether a plan for ensuring the child's future safety and welfare should be developed and implemented, whether a Family Group Conference (FGC) should be held and/or whether other appropriate services should be provided.
Discontinuing s47 Enquiries
If it is clear that the criteria for Section 47 Enquiries are not / no longer satisfied, any decision to cease Section 47 enquiries must be taken in consultation with the Police and other involved agencies, in particular the referring agency after checks have been completed. This decision must be authorised by a Surrey Children's Services manager who must record whether the Assessment should be completed.
Recording Section 47 Enquiries
A full written record must be completed by each agency involved in Section 47 Enquiries, using any required agency pro-forma, signed and dated by staff.
Rough notes must be retained by practitioners until the completion of any anticipated legal proceedings.
Surrey Children's Services recording of enquiries must be carried out using the Record of strategy discussion and Record of outcome of S47 enquiries as recording tools. Notes of all contacts, visits, etc. must be made and these notes must then be transcribed into profile notes or used as the basis for the record on the case file. The Record of outcome of Section 47 Enquiries must include the date(s) when the child was seen alone by the Lead Social Worker, if not seen alone, who was present and the reasons for their presence.
If, following consultation with the Police during the investigation and planning stage, it appears that criminal or other legal proceedings are likely this must be recorded in the strategy record by the ATM's contemporaneous notes. (Contemporaneous - normally made with twenty-four hours of contact.)