Section 47 Enquiries

Within 24 hours a Strategy Discussion will take place between the Team Manager, Social Worker, Police, Education or Early Years Worker, and Health Professionals who have sufficient authority within their Agency to make decisions.

Roles / responsibilities:

• The Police City or County Referral Unit will be contacted for immediate telephone discussions and will allocate a Sergeant to attend any planned Strategy Discussion/Meeting. The need for a joint or single agency interview with child will be agreed through the Strategy Discussion;
• During normal working hours, the Health Professional to be involved in Strategy Discussions/Meetings will be the Named Nurse for Safeguarding Children within the relevant health organisation;
• During normal working hours (including non-term time), the designated safeguarding lead from the relevant educational setting will be contacted with the expectation that they will be involved in the strategy discussion/meeting;
• During normal working hours, for children aged 18 months or under, A&E should be contacted to arrange a Child Protection Medical. For children over 18 months, medicals should be arranged via the Safeguarding Children Unit, Health (DHCFT) in the following situations:
  • There is a concern about physical abuse with an injury present but it is not immediately clear that a medical examination is required;
  • There is a concern about sexual abuse but it is not immediately clear that a sexual abuse medical examination is required;
  • There are medical concerns about a child who is subject to the Strategy Discussion.
• Outside of normal office hours, the Consultant Community Paediatrician on call for Child Protection should be consulted in the following situations:
  • There is a concern about physical abuse with an injury present but it is not immediately clear that a medical examination is required;
  • There is a concern about sexual abuse but it is not immediately clear that a sexual abuse medical examination is required;
  • There are medical concerns about a child who is subject to the Strategy Discussion.
• Any decisions made outside these procedures should be recorded on a Management Decision Record in LCS, clearly explaining the rationale.

See: Derby and Southern Derbyshire: Local Guidance on Medical Examinations in Cases of Suspected Child Abuse.

Notes:

1. If a child has obvious severe and urgent medical needs then these should always be addressed in the first instance;
2. Medical advice should always be sought (see above):
   1. For any injury in a non-mobile baby (i.e. less than 1 year of age);
   2. If a child is in distress for more than a short time as the result of an injury;
   3. If an injury clearly needs attention (for example, because of bleeding);
   4. For any head or neck bruise in a child over 1 year but under 5 years of age;
   5. If there are obvious signs of ill-health, whether or not these are directly linked to the injury;
   6. If there are less obvious signs of ill-health in a child under 5 years, such as seeming vague, being unusually lethargic or drowsy, being off their food and/or complaining of pain.
3. For other injuries presenting late in the day or at weekends the following factors should be considered:
   1. A significant injury is unlikely to fade to the extent that evidence will be lost in the space of 24 hours;
   2. There may be an urgent need for assessment of visible injuries for statutory child protection processes, to secure the safety of the child in the short term;
   3. Capacity to conduct a medical may be limited and all may be subjected to a long and distressing wait, when an examination the following day may be preferable.
4. These factors should be discussed by the agency requesting the medical and the on-call paediatrician(s) in deciding when a medical examination should most appropriately be carried out;
5. Where a child presents with injuries to the genitals, sexual abuse should be considered and agreement reached in the Strategy Discussion as to whether a sexual abuse medical is required;
6. In the case of emerging health needs in neglectful situations normal channels for accessing health services will apply. The lead health professional in these cases will have the responsibility for co-ordinating health information for formal processes;
7. When considering if siblings of an index case should be medically examined, a discussion between the examining doctor and the Social Worker should take place and the following factors will need to be taken into consideration
   1. Sibling of any age with any concerning injuries will always need to be examined;
   2. Siblings under 5 years with any visible injuries should be examined;
   3. Any sibling over 5 years with visible injuries for which there is no clear explanation should be examined;
   4. Any sibling who makes disclosures of abuse should be examined;
   5. Siblings under 5 years about whom there are third party disclosures should be examined;
   6. If the index child has sustained a serious non-accidental injury (for example, fractures or a serious head injury) then medical examinations of all siblings under 5 years old should be undertaken and examination of older siblings should be considered;
   7. Where there is other information which indicates a sibling has been or is likely to have been harmed, an examination should be considered.

Any decision that a medical is required in cases of neglect should be made at the Multi Agency Strategy Meeting; and arranged through the Safeguarding Health Team, in consultation with the community paediatrician.

In most cases it is expected that medical examinations of siblings will be non-urgent, and timing can be discussed in the Strategy Meeting and agreed to suit the particular circumstances.

Where a child has presented with worrying injuries via a paediatric setting and has had a full paediatric assessment, this examination will be recorded on the structured pro forma and will be used for the report. A further "child protection" examination will not normally be needed in these circumstances and this will be addressed in the subsequent Strategy Discussion. The examining doctor should ensure that there is an opportunity to discuss their findings with the Social Worker, parents/carers and Police if involved at this stage. If a decision is made by the Police that a forensic medical examiner should see the child, this should be organised to enable the examining paediatrician to be present. The findings from this examination can be incorporated into the initial child protection report or be submitted as an addendum report.

Information from the medical examination will be shared with Children's Social Care Services as follows:

1. For physical injuries, the Immediate Conclusion and Agreement form will be completed by the examining doctor at the time of the examination and a copy will be given to the attending Social Worker. The doctor will discuss the proposed immediate safety plan with Social Work Team Manager and Police;
2. A full child protection report will be prepared based on the contemporaneous notes recorded on a structured child protection pro forma used at the initial examination. The report will be written by the examining doctor under the supervision of a Consultant Paediatrician in the case of the doctor being a trainee and will be sent to the Social Worker and relevant others as soon as possible with the aim to achieve a standard of within 5 working days where possible and in any event prior to any conference.

In the case of a child whose medical presentation is central to decisions to be made about him/her, the examining doctor (and/or their supervising Consultant or named doctor in the case of a trainee) must be involved in decision making. This is especially important if the opinion is ambivalent or does not appear to be clearly stated.

Examining doctors will be routinely invited to initial and review conferences, and will receive copies of minutes.

Those cases where a medical input to the child protection conference is considered to be essential should be identified at the time of the medical examination and this should be recorded on the Immediate Conclusion and Agreement form. A direct contact number for the examining doctor should be written on the form at this time.

Social Care Services must contact the examining doctor by phone at the earliest opportunity to optimise the possibility of the doctor being able to be present at the conference. If attendance at the child protection conference is not possible, a Strategy Discussion should be arranged with the examining doctor prior to any conference.

A Strategy Discussion must also take place before discharge where a child has been admitted to hospital as a result of a suspicious injury, including where the conclusion is NOT NAI.

The examining doctor should also be consulted before any significant changes to an agreed safeguarding plan, before a conference or where a conference is not being called, especially where it is proposed to return a child home following NAI.

Follow-up by the examining doctor of any unclear marks is expected to ascertain if they were traumatic or of a different causation within an agreed timeframe.

N.B. If the above procedures are not followed, the Team Manager must document why.

If there is concern about a medical opinion, or if further information comes to light that might affect that opinion, the Social Care Worker and the doctor involved must discuss it at the earliest opportunity.

If the concern continues, or if any new concerns arise at any point, the following sources of medical advice should be consulted:

• Named Doctor for Royal Derby Hospital (University Hospitals of Derby and Burton);
• Named Doctor DHFT;
• Designated Doctor Derby City and Child Protection Lead for the community paediatric service.

The on-call Consultant Community Paediatrician if the need is urgent and the above doctors are not available.

These same sources of medical advice should be sought by doctors if they feel that their medical opinion is being disregarded or given insufficient weight at any stage of child protection processes, including legal proceedings.

• Strategy Meetings need to be clearly recorded at the time of the meeting on agreed documentation and are the responsibility of Children's Social Care. The typed report will be recorded on LCS and sent to agencies via PDF;
• All agency representatives attending the meeting must have a copy of the minutes within 24 hours or by the next working day. All actions / responsibilities are to be specific and clearly recorded; including the child's safety plan;
• Where a child is subject to S47 enquiries and the child has been admitted to hospital, the Strategy Meeting should be held at the hospital prior to the child's discharge;
• Where a child has been the subject of a child protection or sexual abuse medical the Consultant Paediatrician or Senior Registrar should be present to ensure clear communication of clinical issues;
• The Strategy Discussion/Meeting will plan any Achieving Best Evidence interview with the child.

The child must always be seen and communicated with alone in the course of a Section 47 Enquiry by the Lead Social Worker, unless it is contrary to their interests to do so.

Before a child is seen or interviewed, parental permission must be gained unless there are exceptional circumstances which demonstrate that it would not be in the child's interests, and to do so may jeopardise the child's safety and welfare. Relevant exceptional circumstances would include:

• The possibility that a child would be threatened or otherwise coerced into silence;
• A strong likelihood that important evidence would be destroyed; or
• That the child in question did not wish the parent to be involved at that stage, and is competent to take that decision.

In such circumstances, the Team Manager must take legal advice about how to proceed and whether legal action may be required, for example through an application for an Emergency Protection Order or a Child Assessment Order.

1. No Further Action
   
   Enquiries have revealed that there are no causes for concern. The child may be a Child in Need, but the family do not wish for services to be provided, in which case the case will be closed.
   
   
2. Family Support to be provided
   
   Enquiries have revealed that there are no causes for concern but that there are needs that could be met by further support from CSC, following the consideration of a new or updated Social Care Single Assessment.

1. Enquiries have confirmed that the child suffered Significant Harm, but it has been agreed between the agencies most involved, and the child and their family that a plan for safeguarding the child's future safety and welfare can be developed and implemented, without having an Initial Child Protection Conference or a Child Protection Plan. This decision must be endorsed by a Team Manager with a Child Protection Manager.
2. If further needs are identified that can be met by provision under Section 17 of the Children Act 1989, or other services provided then the process in 2.1(ii) will be followed.

1. Enquiries have revealed that the child is suffering or likely to suffer Significant Harm;
2. An Initial Child Protection Conference must be convened within 15 working days of the Strategy Discussion/Meeting where the decision to initiate a Section 47 Enquiry was made. The request to convene the conference must be supported by a team manager. For the detailed procedure in relation to Child Protection Conferences, see the Derby and Derbyshire Safeguarding Children Partnership Procedures;
3. Where immediate protective action is required, and there is no parental consent, the advice of Legal Services should be sought;
4. A Single Assessment should be completed in time for the initial conference alongside a Child Protection Report and Plan;
5. The Social Worker should ensure their assessment for conference is shared with parents and children where they are of sufficient age and understanding no less than 2 days prior to the Initial Conference;
6. The Assessment should be available to the Child Protection Manager and other Agencies and family members 2 working days prior to the date of the Conference.

N.B. If the above action is not taken, please document why.