Ealing review

LNWUHT to review the strategies and protocols to ensure that they incorporate the whole family approach and update as appropriate. Train staff in A&E and HVs on the updated strategies and protocols.

LNWUHT to audit a sample of screening tools for domestic violence and mental health to ensure that they incorporate whole family assessment. Ensure the tools are used consistently and effectively.

Levels 2 and 3 safeguarding training to remind staff of the information-sharing procedures and the importance of analysis in a whole family approach.

LNWUHT to ensure staff supervision monitors use of assessment tools, new birth protocols and policies.

All clinical staff in A&E to have an awareness of multi-agency training provided by the Local Safeguarding Children’s Board, which is advertised as a multi-disciplinary training, ‘Working Together to Safeguard Children’.

Link the medical notes of family members so that practitioners have pertinent information to hand when assessing a patient.

Reception staff to confirm addresses and/or phone numbers whenever clients attend to avoid missed correspondence. Review with patients the surgeries’ modes of communication to identify any barriers such as literacy problems that would limit their engagement with the surgery.

Apply alerts to files where there are significant events related to one of the toxic trio: mental health, substance misuse or domestic abuse, in the patient’s life or the lives of family members so that issues can be adequately explored in consultations and a care plan can be devised where required to provide on-going support.

Explore the detail of hallucinations – the content, frequency, impact on the patient – to help assess the urgency of action.

Specifically ask and note the identity and relationship of any adult that accompanies a child into a GP consultation. This is important so that decisions are made with those who have parental responsibility.

Ask and note the identity and relationship of any adult accompanying an adult patient.

GPs to have targeted training on domestic abuse so that they can identify patterns of presentations and create opportunities to enquire about abuse.

Develop techniques for asking about experiences of violence, particularly for those who have come from outside the UK.

GPs to use the safeguarding template on SystmOne.

GP surgery to review this report together to allow a collaborative approach to learning and developing from this incident

GP surgery to undertake a pro-active approach to routinely ask children about their emotional well-being where there are mental health problems in the family, recurrent attendances for the same complaint or similar complaints from multiple siblings.

Recommendations from MH Review disseminated to the relevant hospital service line and an action plan created by their clinical improvement groups to address the care delivery problems noted.

West London NHS Trust Clinical Directors to regularly monitor the requests for carers’ assessments to ensure that carer’s needs and safety are addressed. This is to be managed within the local teams supported through supervision.

West London NHS Trust to strengthen Safeguarding Training to ensure staff are confident to apply the requirements of the new West London NHS Trust Domestic Abuse Policy.

Within a year of introducing the new domestic abuse policy West London NHS Trust to assess if staff feel confident to implement the policy, especially regarding asking the questions of service users and their families, and responding to disclosures from victims and perpetrators, and identifying when to ask questions regarding domestic abuse where the service user, intimate partner or family has caring responsibilities.

Social workers to question and record the evidence referrers have for ‘no safeguarding concerns for the children’ when the referral is based on concerns about the adults in the household.

Develop consistency in practice through improvements in the following and dip sample case files for improvements in 6 months:

Application of MASH thresholds

Development of lead roles on key areas by particular team members

Workshops on this and other cases where mental health is a feature to build team understanding about thresholds and consistent practice

Development of a format for visits to ensure all key areas are explore

Liaise with the elective Home Education/School Attendance services around how the interface with children’s social care may need to improve.

Information gathering and sharing. That West London NHS Trust, ECSC and primary care services review their intake, information sharing and referral processes and procedures to:

include gathering and regularly updating information on the schools that children in the family attend or whether they are home schooled. This would speed up information-sharing when there are risks identified and would remind agencies working with home-schooled children that there is not another agency with regular oversight of the children.

gain early consent to share information with other agencies in response to identified concerns.

West London NHS Trust staff to follow-up referrals of service users and their families for safeguarding children and safety planning to record if the referral has resulted in the service user and/or their family being supported.

Joint training with West London NHS Trust, ECSC and local DA service to understand each other’s roles, referrals, assessments of risk, thresholds and assessment processes and what information could/should be shared. Develop new protocols around joint working and referrals, particularly in response to non-engagement.

Ealing VAWG Strategic Group to incorporate findings from this report in its plans for delivering the Ealing VAWG strategy, in particular,

to engage the faith-based communities in this agenda and

to link DV service providers to immigrant and other community groups and

to provide information on the legal differences between religious marriages and religious marriages with civil registration.

Ealing VAWG Strategic Group ask agencies to audit their practices for a Think Family approach, specifically regarding practices around domestic abuse, mental health and sharing information. Practice should reflect the Think Family approach shown in their policies.

That the Ealing CCG raise with member GP practices as a practice point: where parents have mental health problems, suffer from domestic abuse or substance misuse, that GPs consider whether there is a role for health visitors in supporting the family and refer them if there is a role.

That the Ealing Safer Partnership regularly send final copies of DHRs to the Ealing Safeguarding Children Board and the Safeguarding Adults Board.