Children Protection Data and Information: a better way of working

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• Children Protection Data and Information a
  better way of working

Dr David S Simpson Chris Walker Tees Primary
Care Informatics, Tees PCTs, Teesdale House,
Westpoint Road, Thornaby, Stockton on Tees, TS17
6BL
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What is Tees Primary Care Informatics?

• A shared service that works for North Tees,
  Redcar Cleveland, Hartlepool and Middlesbrough
  PCTs (Tees PCTs) and, therefore, supports 87
  practices, CHS, Prison and Community Services
• Working hard to support robust, reliable data and
  derived information through the maximisation of
  systems

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Background

• Inconsistencies between recordings on Social and
  Primary Care systems leading to
• Children not being identified as being at risk
  (and/or on CP register)
• Inappropriate children being coded as being at
  risk (and/or on CP register)
• Data communication problems between both
  organisations
• Problems with length, amount and clarity of
  information requested on the initial and
  follow-up forms sent out from Social Care to
  Primary Care
• Difficulties ensuring clarity within the forms
  returned from Social Care to Primary Care to
  ensure timely, accurate and comprehensive
  information
• Lack of local or national guidelines with regard
  to what practices should do with information
  received

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Data Reconciliation (1)

• Process
• Regular meetings/ongoing discussions with
  appropriate personnel and key specialists
• Preparation and amendment of letters and forms to
  be used to aid communication
• Caldicott Guardian data access and practice
  permission obtained

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Data Reconciliation (2)

• Social Care data aligned with Exeter registration
  data to allow identification of each childs NHS
  number and registered practice
• Preparation of information packs for practices

• Data reconciliation between Social and Primary
  Care data
• Practice visits with appropriate data

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Data Reconciliation (3)

• Searches to identify all children with coded
  entry (appropriate/inappropriate)

• Practices -
• provided with support to interpret data
• given new draft forms for information and any
  potential comments
• provided with guidance on how to code relevant
  data items and how to amend any inaccurate or
  incorrect data entries
• contacted regularly in person and via
  telephone/email to ensure the process of data
  reconciliation was being dealt with and the
  requisite support was being provided
• Data reconciliation, updates and analysis
  completed
• Collation of list of questions asked and issues
  raised that need local/national guidance

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For children aged 18Y and under Name/DOB/Sex/Addre
ss/NHS Number/Registered GP or practice
Name/DOB/Sex/Address/Date placed on register
Current child at risk registers
HSS
Exeter registration system
TPCI aggregated SS data (included details of
source)
SSS
MSS
Data reconciled by TPCI
RSS
TPCI worked with practices to generate top level
report of process and final outcome
Data checking supported by TPCI
Data taken back to all 59 practices in HPCT,
NTPCT and RCPCT
Data match
Communication with SS practice worked with SS
where possible to confirm accuracy of data held
on both systems and assessed current
communication mechanism to find why anomalies had
arisen and correct as appropriate. practice then
updated clinical system accordingly using guidance
Searches created and ran by TPCI in conjunction
with practices
Data on SS system, not practice
TPCI worked with practices to validate the
Safeguarding Children register. Data provided
back to SS as appropriate directly by practices.
Data on practice system, not SS
Data collection forms and coding guidance
provided and explained
Erroneous data
Data provided to MPCT
Data reconciliation process
Supporting ongoing maintenance of registers and
future audit of overall procedures
Support provided to MPCT data, supportive
materials and basic advice provided as required
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Next Steps

• Next Steps
• Templates will be built (if required) to support
  continuing standardised data entry
• A qualitative and quantative audit will be
  completed in each participating practice after a
  suitable length of time to assess the
  effectiveness of the new process and to monitor
  data quality
• TPCI will put in place searches to support this
  future audit (i.e. data assessment) of procedures
  in all practices as appropriate
• Support will be provided to practices moving
  clinical system to ensure all Safeguarding
  Children information is migrated appropriately
• Regional and national promotion of work (lessons
  learnt)
• Note support was provided to MPCT data,
  supportive materials and basic advice provided as
  required

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The list of children provided from Social Care
was aligned to Primary Care using Exeter
registration data
Since moved out of the area 8 children appeared
on 2 Social Care systems (this data was passed on
as appropriate) therefore the total number of
unique children was 358
 
Efforts were made so that each child was
accounted for
The number of children with
HPCT
RCPCT
NTPCT
MPCT
TOTALS
This process identified many anomalies between
demographics recorded on the 2 systems
Different surnames
9
1
11
4
25
Different forenames
1
0
0
3
4
Different dates of birth
11
0
7
0
18
Different addresses
17
0
5
1
23
Duplicate children
3
1
4
0
8
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(No Transcript)
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Social Care data matched to practices
Of these children The number of children coded
correctly as being on Safeguarding Children
register 118 (58)
203
Of these children The number of children with
further codes to indicate at risk 28 (14)
Totals adjusted to allow for 1 practice who
declined to participate (9 children)
Alarmingly, 85 children had NO Primary Care
record of currently being on the at risk
register
Searching for these codes also found a
further 734 children whose details needed to be
checked for clarification
Reassuringly, there were NO children found in
Primary Care who had been omitted from Social
Care registers
Note MPCT's data was securely passed on to the
appropriate staff in that organisation to deal
with and, because of differences in the way the
results were recorded, is not included in this
analysis.
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Observations and what next?

• Time consuming to initiate and maintain drive
• Four months to complete (initially intensive,
  then sporadically)
• Required expertise, resources, diplomacy,
  patience and lots of support to practices
• Trust and positive relationship with TPCI key
• Genuine opportunity to improve processes
• Number of crucial benefits
• Introduction of better way of working, data
  quality and future audit

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Issues (1)

• A number of children were coded as potentially
  being on the child at risk register in Primary
  Care (734) when, after investigation within the
  practice and discussion with Social Care and the
  local safeguarding children agency, it became
  clear the code was incorrectly entered. This
  inaccurate (and potentially damaging) data had to
  be corrected using standardised and agreed
  protocols and subject to clinical system
  requirements
• A significant number (85) of current Social Care
  at risk registered children were unrecorded or
  inaccurately coded on Primary Care systems
• Often within a social and healthcare setting it
  is important to understand the duration of a
  specific event. This can only be supported by
  correctly 'deregistering' the child (for
  comprehensiveness, it is important to enter, not
  only the deregistration code, but the actual date
  as well) - thus maintaining data accuracy within
  the clinical record

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Issues (2)

• Examples of practices coding any instance of a
  contact with Social Care and a child protection
  conference as the child being on the at risk
  register were evident. The potential implications
  of this data remaining on a clinical system are
  vast and the data had to be corrected
• Once identified as an error, data should be
  corrected as soon as possible and this process is
  completed most effectively if all parties
  involved are working together and have the same
  intrinsic goals. It is about achieving and
  maintaining data quality at all levels and this
  means getting it right on all the systems - even
  if it is sometimes difficult and time consuming
• The project unearthed many concerns and ongoing
  communication between Social and Primary Care was
  highlighted as a major problem. Added to this the
  practices identified the need for clear and
  concise guidance on coding, data retention,
  scanning, storage, data visibility, access, data
  transferring, security, confidentiality, and
  other issues

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What Child Protection documents do we expect to
receive from Social Care?
What are these documents about and what are we
expected to do with them?
What do I do with the backlog of old Child
Protection files?
What about the issue of consent for disclosure of
medical information?
What should we do with a childs records if they
are adopted?
Which codes should we be using?
What do we need to know about handling third
party information?
Should Child Protection information be kept
separate or filed within the patients GP notes?
How long should we keep Child Protection
information?
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Documentation

• Frequently Asked Questions
• Examples of practice protocol (2 versions for
  practices using 5 byte or CTv3 Read codes)
• Flowchart of information sharing process
• Initial letter and questionnaire
• Review letter and questionnaire
• Example of 'Information for GP' form (3 versions
  for different Social Care areas)
• Proforma for child (at risk) joining or leaving
  the practice
• Coding and system guidance
• Consent document (agreed with LMC and SC)

Flowchart
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Update
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Update
Aug 2006 data included for Hartlepool, Redcar
and Cleveland North Tees PCTs Feb 2008 data
included for Redcar Cleveland, North Tees and
Middlesbrough PCTs
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Update

• Comments received during semi-structured
  interviews February 2008
• 67/68 practices interviewed had a practice
  protocol in place for dealing with information
  received from Social Care. The interview in the
  remaining practice was with a person new to the
  role and she was unsure whether a protocol
  existed
• 14/68 practices (20.6) still experienced
  problems when communicating with Social Care.
  Their main concerns are
• Ongoing problems with the inclusion of 3rd party
  information
• Timeliness of requests
• Difficulties contacting Social Care
• Difficult to interpret what is meant on forms
  sometimes too many boxes are ticked giving
  conflicting information
• Some practices are still receiving purple forms
• Practices are not always told when a child is no
  longer subject to a Child Protection plan

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Update

• 42/68 practices (61.8) have access to and use
  the FAQs document provided by the project. All
  comments regarding the document were positive.
  However it is concerning that so many claim not
  to have access.
• When asked about opinions regarding the newly
  designed and used forms, the responses were
• 49 practices (72) were happy with the new
  forms, many expressing an appreciation of the
  improvements, one practice remarked that the
  changes Should have happened sooner!
• 14 practices (21) made no comments
• 5 practices (7) highlighted problems
• Sometimes incorrect contact details are included
  on forms
• Too many boxes are sometimes ticked giving
  conflicting and/or duplicated information
• One practice was unhappy with the LMC agreed form
  and the need to get parental consent

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Thank you for your time and attention
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Questions?