Scheduled/Unscheduled Admissions to Acute Hospitals and Discharge Procedures

If any staff members (of whatever profession and however junior) have concerns about the welfare of a child/young person, they must inform their manager/nurse in charge or senior doctor and record the discussion / consultation in the child/young person'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/young person must at a minimum be examined by a specialist registrar in paediatrics, who must discuss the child/young person with the consultant paediatrician.

All children/young people where there is suspected physical abuse/neglect should be fully examined by a Paediatrician prior to discharge. If the child/young person 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.

If a child/young person attending an acute or urgent setting shared that they so not have a school place/is not attending school, a referral to the Children Missing Education Team should be made via the online referral form or email csf.cme@hertfordshire.gov.uk. Parental consent is not needed to make this referral to the CME team. For more details on CME please follow Children missing from education.

If a child/young person shares they are being educated at home, please inform the Elective Home Education Team by emailing EHE@hertfordshire.gov.uk. For more information on Elective Home Education Hertfordshire please follow Things to consider about home educating. Parental consent is not needed to make contact with the EHE team.

The 'Child Protection - Information Sharing' System is a national project that will improve the way that health and Children's Services work together across England to protect vulnerable children/young people. CP-IS links the IT systems of NHS unscheduled care to those used by Children's Service Child Protection teams, so that information can be shared about three specific categories of children/young people:

• Those supported by a Child Protection Plan (CP plan);
• Those classed as Children Looked After (CLA) / (i.e. children/young people with full and interim care orders or voluntary care agreements);
• Any pregnant woman whose unborn child has a pre-birth protection plan.

All children/young people who attend the hospital Emergency Department or Minor Injuries/Urgent care Centre/Maternity Services are checked on the national spine to establish if they have a CP alert. This is checked by the administrative staff at booking and checked by the nursing staff at triage, or is integrated into the Trust's electronic record. 

If a child/young person is supported by a CP plan or is CLA, Children's Services should be notified of all attendances by calling the local authority where the child/young person resides or is looked after - the details for this will be available on the national spine where the alert is located. Local trust policy on information sharing for these attendances must be followed. 

If a new safeguarding concern is identified - for example you have identified that the child/young person has suffered significant harm, or is at risk of suffering significant harm, then a referral to Children's Services is required. 

Consideration is required around discharge of CYP supported by a CP plan or CLA- especially for young people attending who live in semi-dependant living arrangements - liaison with the social worker is required regarding the discharge home arrangements.

Where a child/young person who attends an unscheduled care setting and no safeguarding concerns are noted, information relating to the child or young person's presentation is shared by the hospital safeguarding service to Children's Services via the online portal. 

If safeguarding concerns are raised, Children's Services must be informed without delay. Professionals must do so via the Online Referral Portal between 9am and 5pm, or by calling the Out of Hours team on 0300 123 4043 between 5.01pm and 8.59am. If appropriate, the Police must also be informed. If a child is in immediate danger with threat to life, call 999. 

If a parent wishes to discharge the child/young person from hospital against medical advice and there are concerns for the welfare of the child/young person, Children's Services must be contacted urgently. Hospital staff cannot prevent the parent from leaving the ward with their child or young person, but Police and Children's Services must be contacted immediately. If a child/young person is at risk of immediate significant harm it is only the Police who can prevent removing a child or young person from hospital by exercising their powers of Police Protection under S46 of the Children Act 1989.

(See Contacts and Referrals Procedure).

Strategy Discussions should take place in line Strategy Discussion and Meetings Procedure. This would include suspected non-accidental injuries, suspected exploitation/ sexual abuse / FGM/ Fabricated or Induced Illness (FII), significant mental health and exploitation. A Strategy Discussion would also be considered if there was a difference in medical opinions regarding a possible non-accidental injury. 

Any safeguarding concerns raised relating to an unborn baby would need to follow the Pre-Birth Protocol, Procedure and Guidance for Pre-Birth.

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/young person becomes medically fit for discharge.

The discussions and outcome of discharge planning must be recorded in the child/young person's health record and Children's Services 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/young person, 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/young people in the family;
• Clarify on-going medical care;
• Ensure the child/young person is registered with a GP;
• Identify support needed for those caring for the child/young person once discharged;
• Formulate a multi-agency plan in partnership with child/young person/parents/carers on discharge from hospital that address's the risks / needs raised in respect of the child/young person;
• Identify a Lead Professional;
• Agree contingency plans should the child/young person 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/young person is medically fit;
• Independent Sector Provider is included as relevant.

If Pre-discharge planning required (see Section 5, Pre-discharge Planning Meetings / Reconvened Strategy Meetings);

If there is need for further Strategy Discussions or a pre-discharge meeting (see Section 5, Pre-discharge Planning Meetings / Reconvened Strategy Meetings).

A Pre-discharge Planning Meeting must take place for any baby being discharged post-birth who is also supported by a Child Protection Plan, a Child in Need Plan, or who is currently under assessment by Children's Services.

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/young person's treating medical team to provide a discharge summary, which should include, as a minimum, the following concerns:

• Safeguarding concerns raised at admission and discharge plan, including multi-agency planning;
• Any medical issues;
• Any following medical appointments. 

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 Maternity Safeguarding Team as part of discharge planning to ensure provision of appropriate postnatal care.

Discharge planning from the neonatal unit should involve the Trust Safeguarding Team, the senior neonatal team, health visitor, Children's Services, and any other relevant agencies, 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 supported by a Child Protection Plan or a Child in Need Plan;
• If the mother is a Child Looked After.

See Pre-birth Protocol, Procedure and Guidance for Pre-birth Assessment.

Click here to view Unscheduled Emergency Visits to A&E Children Safeguarding Assessment Pathway Flowchart.