Health services urged to 'do more' for children at risk of harm

Article By: Melissa McAlees, News Editor

The Care Quality Commission (CQC) has issued a call to healthcare staff and leaders to do more to identify and listen to children at risk of harm.

The ‘Not seen, not heard’ report has revealed that health professionals have improved the way they assess risk and recognise safeguarding concerns, but services are not consistently protecting and promoting the health and welfare of children.

CQC’s chief executive, David Behan said: “Children and young people need to be listened to and need to feel that those looking after them care about them. The extent that children feel listened to significantly influences how safe and happy they feel, and it means they are more likely to achieve better outcomes in the next stage of their lives.

“Listening to and engaging children is often what identifies a good service and while most staff demonstrate passion and determination to keep children safe, the systems and the support they need are not always there and many areas are still not getting it right for children.

“Children must be at the heart of how services are delivered, their needs must be seen and their voices heard. No child should be left behind.”

Children at risk

This first national review of how well health services safeguard children considered 50 inspections carried out over the last two years. The inspections focused on the local area’s effectiveness to identify children at risk of harm in healthcare settings as well as the healthcare for children in care.

The findings from the reviews highlight that health services are not consistently protecting and promoting the health and welfare of children. Although health professionals have improved how they assess risk and recognise safeguarding concerns, problems were identified in how those risks were shared with different services.

Practitioners were often found to not articulate their views of the risks to the child or set out what they expect from the referral. As a result, actions were delayed or failed to take place at all.

Similarly, the extent of problems such as exploitation, parental ill-health and sexual exploitation are still largely unknown and how well children are being protected from them, even less so.

Children’s inspectors believe more must be done by health providers, including staff in hospitals, health visitors and GPs, as well as commissioners, to ensure that services are improving outcomes for children, strengthening the quality of information sharing and joint working.

Improving outcomes

The key recommendations from the CQC report include:

• Children and young people must have a voice – All health staff seek, hear and act on the voice of the child. They should involve children at each stage of their health care planning, and listen and respond to their views about what is important to them;

• The focus must be on outcomes – All services providing health care need to work collaboratively with children;

• More must be done to identify children at risk of harm - The risks to many children are not always obvious and require a continuous professional curiosity about the child and their circumstances;

• Children and young people must have access to the emotional and mental health support they need;

• Quality of information sharing in multi-agency working must be improved - Children experience more coordinated, joined-up and efficient care where there are arrangements for how to share information, make referrals and provide support.


Children and young people have the right to be protected from abuse and exploitation and to have their health and welfare safeguarded. In 2013, UNICEF reported the UK ranked 16 out of the 29 most advanced countries in the world in terms of overall well-being, health education, behaviours and risk, and housing and environment.

Although local authorities have overarching responsibility for safeguarding, every organisation and person who comes into contact with a child has a role to play and healthcare professionals are in a strong position to address children’s health and welfare needs and safeguarding concerns.

CQC’s chief inspector of general practice, Professor Steve Field said: “The number of children identified as having been abused or exploited is just the tip of the iceberg – many more are suffering in silence. As new risks emerge and more children are identified as being in need, it is more crucial than ever that staff across health and social care, education, the police and the justice system all work together.

“We know that with the right questions and support, services can discover the risks and harms that threaten many children, including those from parental-ill health, sexual exploitation and female genital mutilation.

“We owe it to the children. We must provide the support they deserve and the help they need to move forward with their lives.”

Children's views

Commenting on the report, Anna Feuchtwang, chief executive of the National Children's Bureau said: “This report underlines yet again that the health needs of children in care are not being met and that the health providers that serve them do not always properly value children's views and experiences.

“A substantial body of research confirms that looked after children are often deprived of the good health enjoyed by their peers, so it is deeply worrying that these problems persist in many parts of the health service. The health and well-being of looked after children remains in jeopardy despite the evidence being very clear about what needs to change.”

The CQC is the independent regulator of health and adult social care in England and make sure health and social care services provide people with safe, effective, caring, well-led and responsive care.

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