Discharge Planning from Hospital when there are Safeguarding Concerns about a Child

When a child is in hospital and there are safeguarding concerns about the child, it is essential that effective planning between key professionals working with the child is undertaken before the child is discharged from hospital. This includes newborn babies through to young people before their 18th birthday.

Effective discharge planning promotes a child–centred and co-ordinated approach to safeguarding children. Plans for the child’s discharge should commence at the time the child is admitted to hospital where possible and build on other existing planning processes such as core groups, child protection conferences or child in need plan.

Discharge planning should include consideration of both the child’s health and safety. For children that are admitted with health concerns alone the main issue to consider prior to the child’s discharge is whether they are medically fit to be discharged back into the care of their parents / carers. For children that are admitted where there are health and safeguarding / child protection concerns or where safeguarding / child protection becomes an issue during admission the main issues to consider prior to the child’s discharge is both whether they are medically fit and that it is safe for them to be discharged back into the care of their parents / carers.

The purpose of this procedure is to ensure that all practitioners are clear about the steps to take to ensure that no child is discharged from hospital into an unsafe environment, where their health or well-being may be compromised or where further significant harm could occur.

When the criteria for convening a Discharge Planning Meeting (DPM) is met (as outlined in Section 2, Criteria for Convening a Discharge Planning Meeting) it is essential to ensure that the child is not discharged into the parent / carer’s care until he / she is medically fit and it is assessed as being safe for him / her to be discharged.

Consideration should be given to the wider environment the child will be returning to, including siblings and other members of the household.

A Discharge Planning Meeting must be convened before the child is discharged to return to their parent/carers care when:

• A child is admitted to hospital and there are identified safeguarding concerns;
• A child is admitted to hospital who is known to Children’s Social Care and there are identified current safeguarding concerns in relation to the child;
• A child is admitted to hospital following an incident / safeguarding concern and is subject to a Child Protection Plan;
• A baby is born and is subject to a Pre-Birth Assessment or Child Protection Plan or Pre-legal proceedings – for more information, see Safeguarding Unborn and Newborn Babies Procedure.

For a child who is subject to Section 47 Enquiries and is assessed as being at risk of Significant Harm, a Strategy Meeting should be re-convened before the child is discharged from hospital. This must contain a plan that includes arrangements for the safe discharge of the child.

If the safeguarding concerns about a child relate to Fabricated or Induced Illness, a Strategy Meeting must be convened or re-convened before the child is discharged from hospital.

If the safeguarding concerns about a child at risk of being subjected to illegal procedures, consideration should be given for whether a Strategy Meeting be convened or re-convened before the child is discharged from hospital. For example:

• Safeguarding Girls and Young Women at Risk of Abuse through Female Genital Mutilation or Breast Ironing Procedure;
• Safeguarding Children and Young People from Forced Marriage Procedure;
• Safeguarding Children and Young People from Honour Based Abuse Procedure;
• There are grounds for concern that a person may be a victim of human trafficking (see Children from Abroad, including Victims of Modern Slavery, Trafficking and Exploitation Procedure and National Referral Mechanism: guidance for child first responders (Home Office, August 2013)).

Consideration for convening a Discharge Planning Meeting should be given when:

• A child is admitted to hospital who is subject to a Child in Need Plan;
• The child is subject to a court order or in voluntary placement as a ’Looked After Child’ (LAC);
• A child or young person has been admitted because of mental health concerns including self-harm or suicidal ideation;
• Concerns have arisen during the child’s stay in hospital, such as poor nutrition, faltering growth, poor frequency of visiting by parents / carers, parental mental health or substance misuse, domestic abuse or other indicator of abuse or neglect.
  
  For more information, see:
  • Neglect Procedure;
  • Safeguarding Children at Risk Due to Faltering Growth Procedure;
  • Safeguarding Children of Alcohol Misusing Parents Procedure;
  • Safeguarding Children of Drug Misusing Parents Procedure;
  • Children of Parents with Learning Disabilities Procedure;
  • Safeguarding Children at Risk where a Parent has a Mental Health Problem Procedure;
  • Safeguarding Children at Risk because of Domestic Abuse Procedure.

If safeguarding concerns arise about a child during their stay in hospital, the situation should be discussed with the relevant Children’s Social Care Team Manager if the case is open to Children’s Social Care. If the case is not open a referral should be made to the Multi-Agency Safeguarding Hub (MASH) under the Referring Safeguarding Concerns about Children Procedure. Consideration should be given as to whether the threshold for Significant Harm has been met and a Strategy Discussions/Meetings Procedure.

If at any time there are concerns that the child has suffered or is likely to suffer Significant Harm the situation must be discussed with the relevant Children’s Social Care Team Manager if the case is open to Children’s Social Care. If the case is not open or social worker details not known, a referral must be made to the Multi-Agency Safeguarding Hub (MASH) under the Referring Safeguarding Concerns about Children Procedure. Consideration should be given as to whether the threshold for Significant Harm has been met and a Strategy Discussions/Meetings Procedure.

There may be a reason for not holding a discharge planning meeting when a child meets the criteria for doing so. For example, there has been a very recent (within 72 hours of discharge) multi-agency meeting (e.g. Child Protection conference) where a robust plan was agreed, and the reason for admission is not linked to the concerns identified in the plan and there have been no concerns raised on the ward. This course of action requires agreement between senior managers in Rotherham’s Children’s Social Care Services and the Safeguarding Children Team, The Rotherham NHS Foundation Trust (TRFT) and the child’s Consultant. If a DPM is not convened, the reason for not holding a meeting and senior managers who have been consulted must be recorded on the child’s file.

There is no need to convene a discharge planning meeting if the reason for the current admission is unrelated to safeguarding concerns and involves routine medical treatment or intervention, e.g. a child subject to a Child Protection Plan is having their tonsils removed.

The process for discharge planning for a newborn baby is different to that for older babies and children. For more information about newborn babies see Safeguarding Unborn and Newborn Babies Procedure.

The Discharge Planning Meeting should be held no less than 24 hours prior to the proposed discharge and ideally 48 hours ahead of the proposed discharge. This may not always be possible; the reasons for not convening a Discharge Planning Meeting (DPM) within this timescale should be recorded on all electronic case management systems.

It is not good practice to discharge a child with safeguarding concerns over a weekend unless this has been agreed as part of a Discharge Planning Meeting. If a child is discharged over a weekend without a Discharge Planning Meeting being held, the decision must be agreed by Senior Managers from The Rotherham NHS Foundation Trust (TRFT) and Rotherham Children’s Social Care Services and the decision recorded on file.

Professionals should not give the impression to parents / carers that the DPM is merely a formality ahead of the child’s discharge taking place as professionals need to consider that the outcome of the meeting may be that whilst the child is medically fit for discharge it is not safe to discharge into the care of the parent / carer.

The meeting will be coordinated by the Nurse looking after the child/young person in consultation with the allocated Social Worker’s Team Manager who will chair the meeting. The meeting will be held in the hospital and parent/s must be invited unless Fabricated or Induced Illness is suspected – for more information, see Management and Safeguarding Children Where there are Perplexing Presentations (including Fabricated and Induced Illness/ FII) Procedure. The child should be invited to participate according to their wishes if of sufficient age and understanding.

Consideration should be given to inviting all practitioners who are involved in the support of the child, for example:

• Health professional for 0-19 years depending on the age of the child;
• GP (should be invited and contacted for relevant information by medical staff if required);
• Paediatrician;
• Professionals allied to medicine (e.g. CAMHS, Dietician);
• Midwife looking after the child/mother / Community Midwife;
• Primary Nurse to the child if on the paediatric ward;
• School or Education representative if relevant;
• Specific staff groups where expertise is required e.g. mental health, Independent Domestic Abuse Advisor (IDVA), drugs services, early help, probation, housing, police.

Please note that this list is not exhaustive.

The meetings should include health practitioners from both hospital and community services and other practitioners relevant to the child or family, and the parent or adult with parental responsibility.

If the relevant practitioners cannot attend, consideration should be given for the meeting to be adjourned and re-convened as soon as possible (the next day at the latest), with the senior managers from Social Care and Clinical Services notified. The child must not be discharged home until the DPM has taken place.

The meeting will be chaired by the Team Manager, Children’s Social Care responsible for the child. Where possible a minute taker will be provided by Children’s Social Care; however where this is not possible the minute taker will be agreed at the meeting.

The Discharge Planning Meeting should agree post-discharge action as appropriate:

• Legal advice is sought in a timely way;
• Placement from hospital is agreed and transport arrangements for this if necessary;
• Contact and supervision arrangements with parents is agreed if the child is not returning home;
• Timeframe for stay in hospital is agreed;
• Professional visiting arrangements are agreed;
• Post-discharge follow up medical and professional appointments for child / parents are agreed;
• Contingency arrangements are agreed;
• Review process is agreed.

If it is considered unsafe to discharge a child, Children’s Social Care will facilitate alternative accommodation in a time frame which is specified and agreed as part of the plan.

The Chair will ensure that written notes recording actions agreed at the DPM are circulated to all relevant people at the end of the meeting. The Chair will agree the minutes which will be typed and distributed to all relevant people within five working days.

The minutes will include a separate sheet which outlines the details (where, when and who with) of arranged medical and professional appointments for the child and family.

If changes have been agreed to the Child Protection Plan or Child in Need plan, those plans should be updated to reflect the changes. For children who are subject to a child protection plan or Looked After the social worker needs to discuss any significant issues with the IRO or Conference Chair.