Scheduled/Unscheduled Admissions to Acute Hospitals and Discharge Procedures
Scope of this chapter
These procedures apply if:
- Safeguarding concerns are raised when a child is present at an unscheduled health care setting;
- Safeguarding concerns are raised about a child admitted to hospital;
- For a maternity unit and midwifery service, if there has been a pre-birth assessment or subsequent child protection concerns.
See Health Trust Policy for detailed guidance.
If any staff members (of whatever profession and however junior) have concerns about the welfare of a child they must inform their manager/nurse in charge or senior doctor and record the discussion / consultation in the child’s records as well as recording actions taken and plan. You must follow your Trust’s protocol in respect of notifying the Trust’s Safeguarding Team.
If abuse or neglect is suspected the child must at a minimum be examined by a specialist registrar in paediatrics, who must discuss the case with the consultant paediatrician.
No child who is thought to have been abused or neglected should be sent home without being examined by a senior paediatrician or with the permission of, a consultant paediatrician:
If the child is presented in the night and admitted, it is possible to delay the consultation until the next day. In these circumstances, consideration must be given to potential safety issues of any siblings.
Once a concern is raised at the hospital, Children's Services must be informed without delay via Children’s Services’ referral process as soon as possible. If appropriate, the Police must also be informed.
If a parent wishes to discharge the child from hospital against medical advice and there are concerns for the welfare of the child, Children's Services must be contacted urgently. Hospital staff cannot prevent the parent from leaving the ward with her/his child, but Police and Children's Services must be contacted immediately. However, if a child is at risk of immediate significant harm it is only the Police who can prevent removing a child from hospital by exercising their powers of Police Protection under S46 of the Children Act 1989.
Consideration for a Strategy Discussion only relates to children where there are concerns relating to abuse and it is unclear whether an injury is non-accidental or there is a different of medical opinion about an injury.
A Strategy Discussion may be held whenever a professional or agency has raised safeguarding concerns about a child admitted to hospital, and this includes:
- Concerns relating to incidents or circumstances that may have arisen either prior to or during the hospital stay (including pre-birth concerns);
- Circumstances in which differing opinions are held between professionals about the origin of an injury or the risks to the child.
The participants should include the consultant in charge of the child (or suitable delegated health professional), Children's Services, and other relevant agencies and professionals.
Please see Escalation of Concerns and Professional Disagreements about Decisions, including Convening an ICPC Procedure.
The Strategy Discussion should consider (in addition to the normal Strategy Discussion agenda)
- Cause(s) for concern;
- Medical and nursing assessments;
- Safeguarding medical investigations;
- Medical opinion, if available;
- Timetable for discharge, if known;
- Pre-discharge planning required (see Section 4, Pre-discharge Planning Meetings / Reconvened Strategy Meetings);
- Need for further Strategy Discussions or a pre-discharge meeting (see Section 4, Pre-discharge Planning Meetings / Reconvened Strategy Meetings).
The above should be read in conjunction with the Strategy Discussion and Meetings Procedure
If it is unclear whether an injury has a non-accidental cause, or there is a difference of opinion within the medical team, the consultant in charge of the child's care should seek a second opinion either from the designated / named child protection doctor or from a specialist consultant.
If achievable the second opinion should be available to the Strategy Discussion.
Other agencies particularly Children's Services need to be made aware that a second opinion has been requested and the consultant in charge of the child's care should advise on the anticipated timescale.
Even if there is no clear diagnosis of non-accidental injury in the medical report, an assessment of need and risk, including the likelihood of the child suffering significant harm in the future, should be made.
Where it is decided not to proceed with a Section 47 Enquiry consideration should be given to specifying:
- Further information required and whether another Strategy Discussion should be held;
- Further assessments e.g. proceeding with an Assessment;
- Plans for future monitoring by agencies;
- Any services to be provided by agencies;
- The need for future intervention to be co-ordinated through the use of an LCS Initial / Child in Need Plan.
If the Strategy Discussion did not cover the discharge planning, a meeting must be arranged sufficiently early to ensure that a discharge plan is in place before the child becomes medically fit for discharge.
The discussions and outcome of discharge planning must be recorded in the child's health record and Children’s Services social care record without delay.
The purpose of the discharge planning is to:
- Consider the medical and social reports about the cause of concern;
- Consider the social work / multi-agency assessment(s) of the risks to and the needs of the child, including 'home safety' informed by a home visit by a social worker. Early Help worker or appropriate health professional;
- Consider the needs / risks in relation to other children in the family;
- Clarify on-going medical care;
- Ensure the child is registered with a GP;
- Identify support needed for those caring for the child once discharged;
- Formulate a multi-agency plan in partnership with child/YP/parents/carers on discharge from hospital that address's the risks / needs raised in respect of the child;
- Identify a Lead Professional;
- Agree contingency plans should the child not be brought to a planned follow up health appointment, or is not available for home visits as planned;
- Agree timescale for discharge, once the child is medically fit;
- Independent Sector Provider is included as relevant.
Children's Services Team Manager / Consultant Social Worker/Senior Practitioner or relevant health professional/safeguarding nurse should chair these meeting.
The potential members of a pre-discharge planning meeting are:
- Consultant (or designated deputy);
- Social worker(s);
- Children’s Services’ Consultant Social Worker, Senior Practitioner or Team Manager or assistant Team Manager;
- Police officer Joint Child Protection Investigation Team (JCPIT) if relevant;
- Ward staff who have had oversight of the care of the child;
- Paediatric liaison health visitor / health visitor and midwife (if child is new born);
- Staff from any specialist units to be involved post discharge e.g. burns unit;
- School nurse;
- GP;
- Safeguarding nurse/midwife;
- Any other professional with information to assist with decision making, e.g. Children Looked After nurses;
- Independent Sector Provider (ISP).
At every opportunity the child/YP/parents/carers should be involved with the discharge meeting.
The Chair should ensure there is a brief record of the discussion and 'agreed plan'. This record must be provided to all those attending within one working day and recorded on relevant multi-agency systems.
It is the responsibility of the agencies present to ensure appropriate onward communications (such as a discharge letter to the GP) is share with relevant professionals e.g. health visitor, school nurse. If the child is a Child Looked After, information must be shared with the Children Looked After nursing team.
If an incident number has been raised with the Police, this should also be recorded.
The social worker should ensure the decisions of the meeting are recorded on LCS within one working day and consider raising an out of hours alert.
As soon as medical staff are able to predict the child's fitness for discharge, they should convene the pre-discharge meeting and thus provide an opportunity for professionals to undertake checks, read files and attend the meeting.
In the rare occurrence that the child does not have a current GP registration, the parent/carer with parental responsibility should be requested to identify and register their child at the surgery in which they themselves are currently registered, as soon as possible. Information relating to the absence of GP registration should also be shared with the Public Health Nurse via usual information sharing processes.
Where the child is known to be subject to any local authority plan, including a Looked After Child, information regarding the absence of current GP registration must be shared with the lead Local Authority professional. Where a child is not known to be on a Local Authority plan, and there are safeguarding concerns, the information regarding GP registration status should be included in a new Children’s Services referral.
It is the responsibility of the nurse in charge at the time of discharge to ensure that follow up arrangements have been clearly documented in the patient hospital records.
It is the responsibility of the child's consultant to ensure that junior doctors write discharge summaries, which include any concerns:
- About the child's welfare, including safeguarding;
- As well as medical issues.
Follow up arrangements must include clear and specific documentation about what to do if the child is not brought to attend out patient appointments or any other health appointments.
A discharge summary must be sent to the GP outlining the safeguarding concerns and details of the lead professionals involved. (Can you be explicit whose responsibility it is to send the summary to GP)
The Trust must follow their protocol in respect of information sharing with other professionals involved.
Whenever there have been any safeguarding concerns about a new born baby (including concerns pre-birth), the ward should liaise with the Named Safeguarding Midwife as part of discharge planning to ensure provision of appropriate postnatal care.
Discharge planning from the neonatal unit should include liaising with the senior neonatal nurse, GP, health visitor and Children's Services so that appropriate follow up support is provided.
A discharge planning meeting (as described above) should be convened at the hospital before the baby is discharged if:
- Any new safeguarding concerns have arisen before, during or subsequent to the birth and an open assessment is in place;
- Any child who is subject to a Child Protection Plan or a Child in Need Plan;
- If the mother is a Child Looked After.
Last Updated: December 7, 2023
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