Safeguarding referral
12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong in this case. We recognise this was a difficult time for Mr U and his family and we will explain the reasons for our decision below.
13. Mr U complained the Trust raised a safeguarding referral after he asked the receptionist in the CED why they needed to know the name of his daughter’s school. He says he didn’t refuse to give the name of the school but was questioning why they needed to know it and who the information would be shared with.
14. In its complaint response. the Trust said in relation to Mr U’s daughter’s details being shared, it is not necessary to seek consent to share information for the purposes of safeguarding and promoting the welfare of a child, providing there is a lawful basis to process any personal information required. As GP’s and school nursing services are universal services, the collation of information from other agencies, such as the Trust assist in them in continuing care. The Trust said it is important they receive any information to assist them in promoting the health and welfare of children.
15. The Trust said it was appropriate for CED staff members to request information regarding his daughter’s school as part of her care at the Trust.
16. Guidance for information sharing in emergency settings states, ‘notification of attendance must be sent to the child’s primary care team (GP and health visitor or school nurse), together with any other professionals involved in the child’s care as per local arrangements, within 24 hours. Robust systems are required to inform the primary care team about each child’s attendance at an emergency care setting. This should include the GP community health visitor or school nurse’.
17. The Trust’s local child protection policy states, ‘the welfare of the child is paramount. The Trust has a duty to initiate the sharing of information when a concern has been identified and/or to co-operate as required with agencies to safeguard children. The policies and associated procedures are applicable to anyone who has not reached their 18th birthday and are therefore classified as a child.
18. The policy outlines how the Trust will fulfil its statutory duties under Section 11 of the Children’s Act, 2004 to safeguard and promote the welfare of children and young people and the detection and management of concerns in relation to child abuse.
19. Section 3.1 of the policy is about communication and information sharing and states, ‘Information sharing between agencies is essential for effective safeguarding and promoting the welfare of children. Poor information sharing has resulted in missed opportunities to act and keep children safe and is a key factor identified in many serious case reviews.
20. An information sharing agreement is in place with both Coventry and Warwickshire Safeguarding Partnerships. This specifies that information should be shared with relevant agencies and practitioners in the best interests of the child.
21. When sharing information staff need to consider what it is that needs to be shared, with whom and for what purpose (Data Protection Act 2018). It is important to note that General Data Protection Regulations (GDPR) and the Data Protection Act 2018 are not barriers to sharing information.
22. Section 3.4 of the policy is about the duty to refer to children’s social care, it states, ‘Staff must make a referral to children’s social care if there is a suspicion or an allegation that a child, young person or an unborn is suffering or is likely to suffer significant harm, or where the behaviour of the parent or carer is likely to impact on the child.
23. The following should raise suspicions about abuse and should lead to a discussion with the safeguarding team or on-call paediatric consultant:
• any injury, however minor to a non-mobile baby or child • history of the injury is inconsistent with the mechanism of the injury • changes to the history of the injury • inadequate explanation for the injury • where a developmentally inappropriate injury has occurred • delay in seeking treatment and there is a concern’
24. On 20 June 2023 the CED receptionist on duty spoke to the sister on duty regarding Mr U refusing to allow his daughter’s details to be shared with her school and GP. Mr U asked the sister why his daughter’s details needed to be shared. The sister advised it was a booking in requirement to enable the Trust to notify school and the GP of attendance at the CED. The sister explained it also allowed staff to check safeguarding systems to ensure all children receive appropriate care. The guidance for information sharing supports this.
25. Mr U stated CED staff were refusing to see his daughter. The sister explained they were not refusing to see his daughter, but they would need to speak to the safeguarding team as not allowing the Trust to notify the school or GP was a red flag.
26. Mr U gave the name of his daughters school but left the CED before his daughter could be triaged or treated saying he was going to seek private treatment.
27. The sister made the safeguarding team aware of what had happened and completed a Multi-Agency Referral Form (MARF).
28. On the MARF, under the heading ‘what are you worried about?’ the sister recorded, ‘dad presented to CED with his daughter who had an injury to upper extremity. Dad refused to give school details or address to receptionist. Receptionist was reduced to tears by his attitude. He did then give the details. Refused for child to be triaged, assessed or treated. Refused consent to share information about attendance at CED with the school or GP. Dad then left with his daughter before being triaged and refused to stay or sign the discharge form. Unknown mechanism of injury, unknown severity of injury and unable to treat.’
29. Under the heading ‘what needs to happen next’ the sister wrote, ‘child to be checked on to ensure how the injury occurred and treated. Dad to understand when attending ED, information sharing is confidential and in the best interests of the child’.
30. The sister was concerned Mr U’s daughter had left the CED with an untreated injury which they were unable to ascertain the severity or cause of. This led the sister to contact the safeguarding team and raise a safeguarding referral.
31. We consider these actions to be in line with the Trust’s child protection policy and the Children’s Act 2004. There is no indication of a failing here so we will not be considering this complaint further.
Consideration of historic incidents
32. The ‘Health Service Commissioners Act 1993’ (the Act) is a law that sets out our role, responsibilities and the things we must consider as the final step in the complaints process.
33. Section 9 (4) of the Act says we should not investigate a complaint if it is brought to us more than one year after the affected person first became aware of their reason to complain, unless we consider there is a good reason to do so.
34. Mr U asked that we investigate his most recent complaint in conjunction with historic complaints he made to the Trust about similar issues. We asked the Trust and Mr U to provide documents relating to his historic complaints in order to consider the timeline.
35. The Trust provided a final response dated 27 October 2021 stating Mr U had complained about staff in the CED asking to know his child’s address and school. Mr U responded to the Trust 0n 26 November 2021 advising he would be escalating the matter to the Ombudsman.
36. The Trust’s final response does not state the date of the incident, but does state Mr U had spoken to PALS about the matter on 22 October 2021. We will consider this to be Mr U’s date of knowledge.
37. With this and the Act in mind, the law says Mr U needed to make his complaint to us within a year. To be in time, Mr U needed to bring his complaint to us by 22 October 2022. Mr U brought his complaint to us on 1 July 2024. Therefore, his complaint is one year, eight months and one week out of time.
38. We have seen no evidence of any other historic complaints made to the Trust by Mr U.
39. We asked Mr U why he did not bring this complaint to PHSO in 2021 after he received the final response from the Trust signposting him to PHSO.
40. Mr U said throughout his interactions with the NHS, he has suffered greatly with his mental health and always sought to challenge departments to take responsibility rather then something long and drawn out. He said by threatening to go to the Ombudsman, he was attempting to save himself the mental anguish of having to deal with a protracted period where he would ultimately have to wait a long time for a resolution.
41. Mr U emailed the Trust on 26 November 2021 expressing his dissatisfaction with the final response and advising he would be escalating the matter to the Ombudsman. We have seen evidence Mr U was able to correspond with the Trust in November 2021 about this matter despite the mental health issues he describes and therefore had the ability at the time to also contact us.
42. With all the above in mind, we have not seen any evidence Mr U’s reasons for his delays in pursuing his complaint after he received the final response from the Trust in October 2021 are enough justification for us to set aside our time limit. There was a significant gap of one year, eight months and one week after receiving the final response in which Mr U could have brought his complaint to us but did not do so.
43. While we recognise this may be disappointing for Mr U, it is important we consider and act within the law and we regret any further upset this decision may cause.