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Recommendations: 64 - 72 | 73
- 82 | 83 - 90
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This section brings together the recommendations that are to be
found in the Report. The way in which local authorities name committees
and officers can vary. For ease of reference, the recommendations
are expressed in the terms of the Local Authorities Personal Social
Services Act 1970. To the left of each recommendation is an indication
of the timescale for action:
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1 means the recommendation should be implemented within
three months.
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2 means the recommendation should be implemented within
six months.
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3 means the recommendation should be implemented within
two years.
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Of the 108 recommendations in this Report, 46 are under '1' and
a further 36 are under '2'. This means that some 82 of the recommendations
could be acted upon within six months.
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The paragraph numbers that follow the recommendations are cross-references
to the paragraphs in this Report in which they can be found.
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Recommendations: 64 - 72
| 73 - 82 | 83 - 90
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Recommendation 64 When a child is admitted to hospital
and deliberate harm is suspected, the nursing care plan must take
full account of this diagnosis. (paragraph 9.35)
Timescale for action 1 See table at top of page
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Recommendation 65 When the deliberate harm of a child
is identified as a possibility, the examining doctor should consider
whether taking a history directly from the child is in that child's
best interests. When that is so, the history should be taken even
when the consent of the carer has not been obtained, with the reason
for dispensing with consent recorded by the examining doctor.
Working Together guidance should be amended accordingly. In
those cases in which English is not the first language of the child
concerned, the use of an interpreter should be considered. (paragraph
9.39)
Timescale for action 2 See table at top of page
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Recommendation 66 When a child has been examined by a
doctor, and concerns about deliberate harm have been raised, no
subsequent appraisal of these concerns should be considered complete
until each of the concerns has been fully addressed, accounted for
and documented. (paragraph 9.60)
Timescale for action 1 See table at top of page
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Recommendation 67 When differences of medical opinion
occur in relation to the diagnosis of possible deliberate harm to
a child, a recorded discussion must take place between the persons
holding the different views. When the deliberate harm of a child
has been raised as an alternative diagnosis to a purely medical
one, the diagnosis of deliberate harm must not be rejected without
full discussion and, if necessary, obtaining a further opinion.
(paragraph 9.65)
Timescale for action 2 See table at top of page
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Recommendation 68 When concerns about the deliberate harm
of a child have been raised, doctors must ensure that comprehensive
and contemporaneous notes are made of these concerns. If doctors
are unable to make their own notes, they must be clear about what
it is they wish to have recorded on their behalf. (paragraphs 9.72
and 10.30)
Timescale for action 1 See table at top of page
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Recommendation 69 When concerns about the deliberate harm
of a child have been raised, a record must be kept in the case notes
of all discussions about the child, including telephone conversations.
When doctors and nurses are working in circumstances in which case
notes are not available to them, a record of all discussions must
be entered in the case notes at the earliest opportunity so that
this becomes part of the child's permanent health record. (paragraph
9.95)
Timescale for action 1 See table at top of page
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Recommendation 70 Hospital trust chief executives must
introduce systems to ensure that no child about whom there are child
protection concerns is discharged from hospital without the permission
of either the consultant in charge of the child's care or of a paediatrician
above the grade of senior house officer. Hospital chief executives
must introduce systems to monitor compliance with this recommendation.
(paragraphs 9.101 and 10.145)
Timescale for action 2 See table at top of page
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Recommendation 71 Hospital trust chief executives must
introduce systems to ensure that no child about whom there are child
protection concerns is discharged from hospital without a documented
plan for the future care of the child. The plan must include follow-up
arrangements. Hospital chief executives must introduce systems to
monitor compliance with this recommendation. (paragraphs 9.101 and
10.146)
Timescale for action 2 See table at top of page
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Recommendation 72 No child about whom there are concerns
about deliberate harm should be discharged from hospital back into
the community without an identified GP. Responsibility for ensuring
this happens rests with the hospital consultant under whose care
the child has been admitted. (paragraph 9.105)
Timescale for action 1 See table at top of page
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Recommendations: 64 - 72
| 73 - 82 | 83 - 90
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Recommendation 73 When a child is admitted to hospital
and deliberate harm is suspected, the doctor or nurse admitting
the child must inquire about previous admissions to hospital. In
the event of a positive response, information concerning the previous
admissions must be obtained from the other hospitals. The consultant
in charge of the case must review this information when making decisions
about the child's future care and management. Hospital chief executives
must introduce systems to ensure compliance with this recommendation.
(paragraph 10.36)
Timescale for action 2 See table at top of page
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Recommendation 74 Any child admitted to hospital about
whom there are concerns about deliberate harm must receive a full
and fully-documented physical examination within 24 hours of their
admission, except when doing so would, in the opinion of the examining
doctor, compromise the child's care or the child's physical and
emotional well-being. (paragraph 10.41)
Timescale for action 1 See table at top of page
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Recommendation 75 In a case of possible deliberate harm
to a child in hospital, when permission is required from the child's
carer for the investigation of such possible deliberate harm, or
for the treatment of a child's injuries, the permission must be
sought by a doctor above the grade of senior house officer. (paragraph
10.73)
Timescale for action 1 See table at top of page
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Recommendation 76 When a child is admitted to hospital
with concerns about deliberate harm, a clear decision must be taken
as to which consultant is to be responsible for the child protection
aspects of the child's care. The identity of that consultant must
be clearly marked in the child's notes so that all those involved
in the child's care are left in no doubt as to who is responsible
for the case. (paragraph 10.105)
Timescale for action 1 See table at top of page
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Recommendation 77 All doctors involved in the care of
a child about whom there are concerns about possible deliberate
harm must provide social services with a written statement of the
nature and extent of their concerns. If misunderstandings of medical
diagnosis occur, these must be corrected at the earliest opportunity
in writing. It is the responsibility of the doctor to ensure that
his or her concerns are properly understood. (paragraph 10.162)
Timescale for action 1 See table at top of page
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Recommendation 78 Within a given location, health professionals
should work from a single set of records for each child. (paragraph
11.39)
Timescale for action 1 See table at top of page
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Recommendation 79 During the course of a ward round, when
assessing a child about whom there are concerns about deliberate
harm, the doctor conducting the ward round should ensure that all
available information is reviewed and taken account of before decisions
on the future management of the child's case are taken. (paragraph
11.39)
Timescale for action 1 See table at top of page
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Recommendation 80 When a child for whom there are concerns
about deliberate harm is admitted to hospital, a record must be
made in the hospital notes of all face-to-face discussions (including
medical and nursing 'handover') and telephone conversations relating
to the care of the child, and of all decisions made during such
conversations. In addition, a record must be made of who is responsible
for carrying out any actions agreed during such conversations. (paragraph
11.39)
Timescale for action 1 See table at top of page
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Recommendation 81 Hospital chief executives must introduce
systems to ensure that actions agreed in relation to the care of
a child about whom there are concerns of deliberate harm are recorded,
carried through and checked for completion. (paragraph 11.39)
Timescale for action 2 See table at top of page
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Recommendation 82 The Department of Health should examine
the feasibility of bringing the care of children about whom there
are concerns about deliberate harm within the framework of clinical
governance. (paragraph 11.39)
Timescale for action 2 See table at top of page
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Recommendations: 64 - 72
| 73 - 82 | 83 - 90
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Recommendation 83 The investigation and management of
a case of possible deliberate harm to a child must be approached
in the same systematic and rigorous manner as would be appropriate
to the investigation and management of any other potentially fatal
disease. (paragraph 11.53)
Timescale for action 2 See table at top of page
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Recommendation 84 All designated and named doctors in
child protection and all consultant paediatricians must be revalidated
in the diagnosis and treatment of deliberate harm and in the multi-disciplinary
aspects of a child protection investigation. (paragraph 11.53)
Timescale for action 3 See table at top of page
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Recommendation 85 The Department of Health should invite
the Royal College of Paediatrics and Child Health to develop models
of continuing education in the diagnosis and treatment of the deliberate
harm of children, and in the multi- disciplinary aspects of a child
protection investigation, to support the revalidation of doctors
described in the preceding recommendation. (paragraph 11.53)
Timescale for action 3 See table at top of page
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Recommendation 86 The Department of Health should invite
the Royal College of General Practitioners to explore the feasibility
of extending the process of new child patient registration to include
gathering information on wider social and developmental issues likely
to affect the welfare of the child, for example their living conditions
and their school attendance. (paragraph 12.29)
Timescale for action 3 See table at top of page
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Recommendation 87 The Department of Health should seek
to ensure that all GPs receive training in the recognition of deliberate
harm to children, and in the multi-disciplinary aspects of a child
protection investigation, as part of their initial vocational training
in general practice, and at regular intervals of no less than three
years thereafter. (paragraph 12.29)
Timescale for action 3 See table at top of page
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Recommendation 88 The Department of Health should examine
the feasibility of introducing training in the recognition of deliberate
harm to children as part of the professional education of all general
practice staff and for all those working in primary healthcare services
for whom contact with children is a regular feature of their work.
(paragraph 12.29)
Timescale for action 3 See table at top of page
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Recommendation 89 All GPs must devise and maintain procedures
to ensure that they, and all members of their practice staff, are
aware of whom to contact in the local health agencies, social services
and the police in the event of child protection concerns in relation
to any of their patients. (paragraph 12.29)
Timescale for action 2 See table at top of page
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Recommendation 90 Liaison between hospitals and community
health services plays an important part in protecting children from
deliberate harm. The Department of Health must ensure that those
working in such liaison roles receive child protection training.
Compliance with child protection policies and procedures must be
subject to regular audit by primary care trusts. (paragraph 12.57)
Timescale for action 2 See table at top of page
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