Policy responses and statements

Name of organisation:

Scottish Executive

Name of policy document:

Joint Inspection of Services for Children and Inspection of Social Work Services Bill - Code of Practice for Joint Inspections of Child Protection Services

Deadline for response:

24 March 2006

Background: On 19 January, this Bill passed its third stage and has now been submitted for Royal Assent. In October, the Scottish Executive wrote to the College with an early draft of the proposed protocol and regulations. Following consideration by Parliament, a number of significant amendments have been introduced to the Bill, with the aim of both providing reassurance that confidentiality will be a prime concern of the Joint Inspection Team and building confidence in the Joint Inspection process.

These amendments include the introduction of a duty of confidentiality on the face of the Bill and the requirements that Scottish Ministers will publish a Code of Practice for the conduct of Joint Inspections. In the first instance, this Code of Practice will cover the conduct of Joint Inspections of Child Protection Services. A further Code will be prepared to support the Joint Inspection of wider children's services over the course of this year.

The Scottish Executive has enclosed this draft Code of Practice that reflects the amendments made to the Bill and the views received earlier on the draft protocol. For ease, they have also enclosed the Bill as amended and the draft regulations.

The Executive requested comments on the Code of Practice and suggested thatofficials could meet with the College if that would be helpful.

COMMENTS ON
SCOTTISH EXECUTIVE JOINT INSPECTION OF
SERVICES FOR CHILDREN AND INSPECTION OF
SOCIAL WORK SERVICES BILL - CODE OF PRACTICE FOR JOINT INSPECTIONS OF CHILD PROTECTION SERVICES

The Royal College of Physicians of Edinburgh is pleased to respond to the Scottish Executive on its consultation Joint Inspection of Services for Children and Inspection of Social Work Services Bill - Code of Practice for Joint Inspections of Child Protection Services.

The College welcomes initiatives which will improve child protection services for children. This process of joint inspection should lead to improvements in multi-agency working in this difficult field.

General comments

The code is improved from earlier drafts. In using the principle of implied consent for access to records, the process will be much more acceptable to patients and health professionals. However, it will still be important to evaluate the views of the patients and carers about the acceptability of the process.

This way of working falls short of the usual standards of consent for research or medical procedures, and may discriminate against those with literacy or language problems and others who may not receive or understand the information and may be unaware of their right to withhold consent. Care would need to be taken in meetings with children and families not to reveal information without consent, and in explaining which records have been seen.

The legal position on who is competent to give or withhold consent to access to health information will need to be closely adhered to. HMIE may need to discuss this with relevant practitioners.

It will also be necessary to clearly inform all health professionals of the nature of the inspections and the code which will be followed before inspections commence. Increasing awareness of the process will be crucial to achieving effective cooperation between the different professional groups, particularly given the recent change in the legal position regarding access to health records.

It has been suggested that the code should be reviewed earlier than after four inspections. However, it will be essential to ensure that changes to the protocol are subject to full and open consultation, with health professionals in particular, due to the sensitive nature of this endeavour. This has happened in a piecemeal way with the draft protocols and code.

Specific points are made below regarding raising awareness of the process, confidentiality and consent and resource implications.

Raising Awareness

The proposed leaflet will need to clearly indicate that non-health professionals may be involved in the process, including the police, and that confidentiality may be broken for the purposes of criminal investigation. This will also need to describe the records which may be accessed. Implied consent should still be informed consent. The wording of the leaflet should be agreed with health organisations.

The involvement of children and families as users of the services is to be welcomed and, again, the time allocated to preparation and support for children should be considered.

Confidentiality and consent

Confidentiality statements will need to be changed, and that should be completed before inspections begin. This must be done in a clear manner, describing the records to which it potentially applies. Many teenagers access adult services, and these services are all potentially included.

It may be appropriate that the notes should be initially anonymised prior to allowing the inspectors to see them, in particular to allow the removal of third party information, and others not relevant to the investigation eg blood test results. In most cases it is intended that only core records will be inspected. However, in many ‘high profile’ cases, the child has had multiple health contacts and some will have complex medical conditions that result in extensive hospital and Primary Care medical notes that presumably will be inspected.

Although implied consent is regarded as adequate, there is no indication how the consent of both the child and the parent is to be sought, other than by a public awareness leaflet about the inspection process. As with all consent, the child or young person should have the right to be involved and, if cognate, to give or refuse consent in their own right.

In many children’s health records there is information about their parents’ health or other private matters that the parents may not wish to be shared with inspectors of Children’s Services. There is no indication that the possibility of such conflict of consent has been addressed in a way that recognises the right of a parent to have their health record kept confidential. Parents will know that if an inspector finds evidence of an offence, this will be reported. Given that the inspectors may be police officers, this may again cause additional anxiety to parents whose offending behaviour, although unrelated to child protection, could have been recorded in medical notes when a child is admitted to hospital (eg parent who had used illegal drugs in the past).

The College would be interested to have confirmed how the inspection process will handle situations where it is deemed to be in the best interests of the child to proceed without implied consent. Will these individuals be notified? Also, will the holder of the record or health professional be involved in taking this decision? From the wording of the code, the College understands that this would only occur where there is some evidence of risk to the individual child, rather than for the more general purpose of completeness of the inspection.

Resource Implications for health professionals

The Code of Practice and template indicate a process that is very detailed and inevitably very lengthy. The practical demand for time and human resources to comply with this Code of Practice will be very difficult to provide in the hard pressed agencies involved. There is no mention of the frequency of inspections, but the background information included suggests this will be a recurring demand on services.

The time taken to achieve a recent multi-agency audit was considerable and exceeded the time expected. The timescales in the protocol therefore appear optimistic. It may be helpful for one or both inspectors accessing health records to be a health professional with the skills and experience to extract relevant information quickly from health records. This would also be sensible from the point of view of understanding and interpreting notes and making fair comparisons.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324    ext 608
Fax: 0131 220 3939

[27 March 2006]