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Guidance - Key Topics

On this page all muti-agency national guidance, legislation and policy for key health topics are given.

Please use the links to the left in the navigation bar to access guidance for a particular topic or scroll down the page to view all guidance.

Adoption, Looked After Children & Unaccompanied Asylum Seeking Children (UASC)

For some looked after children, rehabilitation with birth family is not appropriate and adoption provides an opportunity for improved long term outcomes.
During the year ending 31 March 2016, 340 children were adopted from care in Wales. The National Safeguarding Team (NHS Wales) provides leadership for health professionals who work within the adoption field. 
Our Team has strong links with the Welsh Medical Group, the LAC Cymru Nurses Group, the All Wales Safeguarding NHS Network, the LAC Steering Group and represents the NHS on the National Adoption Service Advisory Group.
Looked after Children
Children and young people in the care of the Local Authority (LAC), including those with a plan for adoption, are a particularly vulnerable group.  The majority of children enter care because of neglect or abuse. 
On 31 March 2016 there were 5,662 LAC in Wales. The National Safeguarding Team (NHS Wales) provides leadership for health professionals who work with LAC.  Our Team has strong links with the Welsh Medical Group, the LAC Cymru Nurses Group, the All Wales Safeguarding NHS Network, the LAC Steering Group and represents the NHS on the Fostering Framework Strategic Steering Group.
Unaccompanied Asylum Seeking Children (UASC)
LAC Health professionals need to be aware of the situation regarding the UK Unaccompanied Asylum Seeking Children (UASC) Transfer Scheme and vulnerable refugee children and their families being resettled from Syria, the Middle East and North Africa as well as migrant camps in Europe. 
The National Safeguarding Team, through the LAC Steering Group, will be developing guidance on assessing and meeting the health needs of these children and signposting to useful resources.  In the meantime health professionals will find the following resources useful:

  • Letter from Health Professionals in Kent regarding UASC Transfer Scheme
  • RCPCH Refugee and Asylum Seeker Child & Young People: Paediatric Health Assessment
  • UASC Health
  • Wessex Refugee Resource
  • Overview of UK Government Resettlement Schemes Summary Table


Child Sexual Exploitation

Child Sexual Exploitation (CSE) is a form of sexual abuse that occurs in all settings across Wales. Health professionals have a responsibility to identify and refer children and young people who may be at risk of CSE and play a key role is supporting vulnerable young people. Given the consequences for the physical and mental health of some of the children and young people who have been sexually exploited, CSE constitutes a major public health concern necessitating a systematic approach to prevention and intervention across NHS Wales.
Multiagency guidance describes the role of health professional and the CSE Prevention Strategy for the NHS in Wales 2016-19 has recently been launched to further define the role of health organisations.



Female Genital Multilation

Female Genital Mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The practice is illegal in the UK under the Female Genital Mutilation Act 2003 and the Serious Crime Act 2015 and it is mandatory for staff in the NHS to report all cases in children (under 18s) to the Police via telephone number 101, staff are supported in this through the use of the All Wales FGM Pathway below.


Mental Capacity Act/ DoLs

The Mental Capacity Act (MCA) 2005, covering England and Wales, provides a statutory framework for people who lack capacity to make decisions for themselves, or who have capacity and want to make preparations for a time when they may lack capacity in the future. It sets out who can take decisions, in which situations, and how they should go about this.  The legal framework provided by the Mental Capacity Act 2005 is supported by the MCA Code of Practice (the Code), which provides guidance and information about how the Act works in practice. The Code has statutory force, which means that certain categories of people (including health care staff) have a legal duty to have regard to it when working with or caring for adults who may lack capacity to make decisions for themselves.
In some cases, people lack the capacity to consent to particular treatment or care that is recognised by others as being in their best interests, or which will protect them from harm.  Where this care might involve depriving vulnerable people of their liberty extra safeguards have been introduced, in law, to protect their rights and ensure that the care or treatment they receive is in their best interests. The deprivation of liberty safeguards were introduced to provide a legal framework around the deprivation of liberty. Specifically, they were introduced to prevent breaches of the European Convention on Human Rights (ECHR) such as the one identified by the judgment of the European Court of Human Rights (ECtHR) in the case of HL v the United Kingdom3 (commonly referred to as the ‘Bournewood’ judgment).

Mental Health

The impact of mental health problems and the related links to safeguarding are diverse and complicated.
They would include but are not limited to:

  • Increased risk of abuse due to vulnerability
  • Increased chances of suffering from a mental health problem if you have been or are currently being abused
  • Increased risk of neglect and abuse of others by a person suffering a mental health problem



PREVENT is a strand of the UK counter terrorism strategy known as the CONTEST strategy the aim of the strategy is 'to reduce the risk to the UK and its interests overseas from terrorism, so that people can go about their lives freely and with confidence'. CONTEST is split into four work streams that are known within the counter-terrorism community as the 'four P's': Prevent, Pursue, Protect, and Prepare.
The purpose of Prevent is to stop people from becoming terrorists or supporting terrorism. This includes countering terrorist ideology and challenging those who promote it, supporting individuals who are especially vulnerable to becoming radicalised, and working with sectors and institutions where the risk of radicalisation is assessed to be high. The deradicalisation programme is known as Channel.
The Counter Terrorism and Security Act 2015 introduced a duty on certain specified bodies, of which the NHS is one, that in the exercise of their functions, to have 'due regard to the need to prevent people from being drawn into terrorism'. The key challenge for the healthcare sector is to ensure that, where there are signs that someone has been or is being drawn into terrorism, the healthcare worker is trained to recognise those signs correctly and is aware of and can locate available support, including the Channel programme where necessary. Preventing someone from being drawn into terrorism is substantially comparable to safeguarding in other areas, including child abuse or domestic violence.
Local Safeguarding Teams in the Health Boards and Trust will be able to provide staff with relevant local information on how to proceed when staff have a concern.

Anti-terrorist Hotline number: 0800 789 321

PRUDiC (Procedural Response to Unexpected Deaths in Childhood) 

The 2018 revision of the Procedural Response to Unexpected Death in Childhood (published in 2010 and first revised in 2014) sets out a minimum standard for the multi-agency response to the unexpected death of a child or young person. The aim of the PRUDiC is to ensure that this response is safe, consistent and sensitive to those concerned and that there is uniformity in the approach taken across Wales. The procedure should be implemented in all unexpected child deaths and followed to completion at the Case Review Meeting.
The 2018 revision was facilitated by the National Safeguarding Team (NHS Wales). Following a period of engagement with key stakeholders, a multi-agency workshop was held in November 2017 to agree proposed changes to the procedure.  The draft PRUDiC 2018 was circulated in January 2018 for comment via the Wales NHS Safeguarding Network and Regional Safeguarding Boards.  Amendments were made in response to comments and the final document was issued for implementation from April 2018.
This revision introduces a number of changes to the PRUDiC Process, which aim to strengthen partnership working around child death. It is envisaged that the involvement of the Regional Safeguarding Children Boards will ensure that the process is fully implemented in every case and that lessons learnt will be instrumental in preventing future child deaths.


Self Harm & Suicide

Self harm results in 5,500 admissions per year in Wales across all ages and is one of the top five causes of medical admissions. Much of this is unscheduled. It is estimated that approximately 8% of 14 to 19 year olds will self harm. Self harm is the strongest risk factor for suicide, the second leading cause of death in the 15 to 19 year old population. However, only a very small fraction of those who self harm go on to make suicide attempts or die by suicide. The risk factors for young people who self harm are consistent with other safeguarding risks such as child abuse and neglect, substance misuse, intimate partner violence and sexual exploitation.
Front line health professionals play a key role in the management of those who self harm. Often they are the first contact for the young person with support services and this has a significant impact on the outcome for the young person and future help seeking. Young people who have self harmed need to be cared for with compassion and the same respect and dignity as any service user.

Suicide and self harm prevention strategy 2015 to 2020 identifies the priorities for organisations in Wales.

Trafficking/ Modern Slavery

Child Trafficking is child abuse. When an agency comes into contact with a child who may have been trafficked local authority social services departments and the police should be notified immediately. All children, irrespective of their immigration status, are entitled to protection. In principle, all agencies and organisations who find themselves with grounds for concern that a person may be the victim of human trafficking have a responsibility for identifying the person as a possible victim and putting them in touch with the responsible authorities and support providers. For children, a formal referral into the National Referral Mechanism (NRM) is made by a first responder [Source: Welsh Government October 2013].
The Home Office has recently issued guidance which outlines the role of the first responders and how to refer the child to the NRM. The guidance can be found here. 
Modern Slavery
Modern Slavery encompasses slavery, servitude, forced and compulsory labour and human trafficking. Traffickers and slave drivers coerce, deceive and force individuals against their will into a life of abuse, servitude and inhumane treatment.



Gender identity refers to an individual’s subjective sense of being male, female, both, neither or something else. Assigned sex is given at birth based on the appearance of the genitals. Some children and adolescents experience distress because they feel that their behaviours or preferences do not fit the gender stereotypes society expects. The term transgender is used where a person’s gender identity is different to their sex assigned at birth. Gender Dysphoria (GD) describes the discomfort or distress that a person experiences when there is a mismatch between their assigned sex and the gender with which they identify. More information can be found by following the links below.



Violence against women, domestic abuse & sexual violence

The Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015 provides the strategic framework to improve arrangements for the prevention, protection and support of those affected by all forms of violence against women, domestic abuse and sexual violence. The purpose of the Act is to safeguard any child, young person or adult, at risk, or experiencing any form of violence against women, gender based violence, domestic abuse or sexual violence.


Forms of Domestic Abuse

Honour Based Violence
Honour based violence (HBV) is a form of domestic abuse which is perpetrated in the name of so called 'honour'. The honour code which it refers to is set at the discretion of male relatives and women who do not abide by the ‘rules’ are then punished for bringing shame on the family.
Forced Marriage
A forced marriage is where one or both people do not (or in cases of people with learning disabilities, cannot) consent to the marriage and pressure or abuse is used. It is an appalling and indefensible practice and is recognised in the UK as a form of violence against women and men, domestic/child abuse and a serious abuse of human rights.
The pressure put on people to marry against their will can be physical (including threats, actual physical violence and sexual violence) or emotional and psychological (for example, when someone is made to feel like they’re bringing same on the family). Financial abuse (taking your wages or not giving you any money) can also be a factor.




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