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Safety in service

8 November, 2012

Safety in service

Nicola MacPhail and Susan Hancock explain the review of safeguarding practice that won them the RCM award for excellence in initiatives in improving public health.
Midwives magazine: Issue 6 :: 2012

Nicola MacPhail and Susan Hancock explain the review of safeguarding practice that won them the RCM award for excellence in initiatives in improving public health.

Nicola and Susan

In response to the concerns highlighted by the Baby P case and following the results of a number of serious case reviews locally, we undertook an in-depth review of safeguarding practice in maternity and neonatal services. In November 2009, the safeguarding midwifery team was introduced. A number of areas were identified where improvements could be made, both to practice and to services for families with vulnerabilities.

Process – There was no clear process in place, meaning a lack of robust evidence that assessment had taken place. Families would often be referred to social care late on in pregnancy, thus causing stress and anxiety. A lack of clear planning also led to confusion for both staff and families.  

Training – Although staff were trained to the required level in child protection, there was a lack of structured support. There was also variation in the standard of report writing, and staff lacked knowledge of preventative measures to support vulnerable families, their default being to refer to social services.

Guidelines and policies – These required updating and communicating to all involved. There were none advising on domestic abuse or drug-using mothers. 

Working relationships – There was a lack of knowledge of the local agencies offering support to families. There was minimal use of the Common Assessment Framework process and insufficient communication between maternity and other agencies. 

Team approach – Agencies were not always working closely with expectant mothers. Plans were often poorly communicated to the mother and her family, resulting in the late and unexpected involvement of social services.

A number of actions were taken to address these issues. Our main objectives were to:

► Ensure a robust assessment throughout pregnancy

► Implement a clear, standardised process for the identification, referral and documentation of vulnerable families

► Ensure all staff in maternity and neonatal services are trained in the process and provided with appropriate supervision 

► Ensure all relevant current guidelines and policies were updated and communicated 

► Develop strong relationships and referral pathways with local agencies 

► Develop a team approach to supporting families through child protection procedures. 

Over the past two years, we have implemented unborn baby records for any family where vulnerabilities or safeguarding concerns are identified. All information regarding the assessment of need, ongoing communication between agencies, notes from social care meetings and case conferences are stored in this record and any staff member contributing to care can add to it. 

Templates for midwives attending safeguarding meetings have facilitated clear, concise note-taking. Key information about security issues, postnatal care planning while in hospital and clear procedures for discharge are now in place and documented in a universal way. A discrete sticker placed on records alerts staff to information regarding safeguarding concerns. 

The achievement of our objectives has resulted in a number of benefits for parents, staff and, most importantly, babies. Where concerns exist, early intervention and engagement with other agencies can often prevent the need for child protection proceedings. A clear pathway, appropriate guidelines and a universal documentation system have provided staff with the necessary structure to embrace their responsibilities in safeguarding children.

Nicola MacPhail, Maternity matron

Susan Hancock, Safeguarding midwife

Plymouth Hospitals NHS Trust

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