The study, published today, found 45% of Trusts in England did not have (filled or vacant) a Named Doctor for Looked After Children role. Looked after children are among the most vulnerable people in society and Named Doctors provide a vital role in coordinating and delivering care.
The study also shows widespread gaps in the existence of Designated Medical Officers for special educational needs and disability (SEND). In England, 36% of Trusts don’t have a filled or vacant post for children with special educational needs and disability. Government guidance states all Trusts in England should either have the role in place or explain why it has not been advertised or appointed in their area. Given the rising demand for special educational needs provision, the absence of a Designated Medical Officer for SEND post in over a third of Trusts is of great concern.
Further gaps were found in the existence of Designated Doctor for Child Deaths roles. Government guidance states that every CCG (Clinical Commissioning Group) in England should appoint a Designated Doctor for Child Deaths, but 23% of Trusts surveyed stated that they did not have access to a Designated Doctor for Child Deaths. This suggests a concerning gap in service provision at CCG Level.
The non-existence of lead roles for looked after children, child deaths and special educational needs and disability increases the likelihood of clinicians being asked to fulfil duties for which they haven’t received the relevant training and places an already vulnerable group at greater risk.
Dr Alison Steele, our Officer for Child Protection, said the findings reveal a system struggling to deliver a reliable service for vulnerable children and young people:
In many parts of the UK, vital child protection roles simply don’t exist. Even where they do, they are too often vacant or filled by clinicians who have neither the time nor the support to deliver the duties of the role. The reality is we don’t have enough suitably trained paediatricians to fill all the vulnerable children posts. We are storing up significant future problems with our failure to adequately resource the specialty.
The paediatric workforce is facing growing demand and decreasing resources. In the most recent survey from RCPCH, demand for paediatric consultants outstripped supply by 21%. Furthermore, most child protection roles are filled by community paediatricians, a sub-speciality that is under-resourced by 25%. The most recent RCPCH census showed the proportion of consultants in community paediatrics positions declined from 18.5% of the workforce to 17.4% in 2017.
The RCPCH makes the following recommendations:
- Lead roles should exist without exception
- Guidance should be developed for roles in all UK nations
- Review the need for additional lead roles in areas where none currently exist
- Ensure holders of lead roles have the necessary experience, support and training
- Recruit and train more paediatricians