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Quality assurance of child protection in hospitals
  1. F Finlay,
  2. N Simpson
  1. Child Health Department, Bath NHS House, Newbridge Hill, Bath BA1 3QE, UK; fiona.finlaybanes-pct.nhs.uk

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    We are concerned that there will be practical difficulties in quality assuring the healthcare recommendations in Lord Lamming’s report1 following the Victoria Climbié enquiry. There are three recommendations where hospital chief executives are specifically tasked with monitoring and ensuring compliance:

    • 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 a paediatrician above the grade of senior house officer.

    • 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.

    • Recommendation 73: When a child is admitted to hospital and deliberate harm is suspected, the doctor or nurse admitting the child must enquire 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.

    Many hospitals will have developed protocols to address these recommendations; however it may be more difficult to develop effective and efficient systems to monitor and ensure compliance. This is because at present admissions to hospital are coded using the ICD 10 coding system in which there are no codes for “concerns about deliberate harm”. If Lord Lamming’s recommendations are to be quality assured, consideration needs to be given to introducing a method to record these children with concerns about deliberate harm in a systematic way. Perhaps an additional code should be introduced?

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