Nurses should not be given the job of carrying out checks to control who can enter wards, a national inquiry into child sexual abuse has heard following suggestions that hospital security needs to be tightened.
The wide-ranging inquiry, which is looking at child protection issues among a range of organisations in England and Wales, heard from nurses and other health professionals last month about what changes needed to be made to improve safeguarding in healthcare settings.
“The nursing staff would not be able to monitor that [security checks] on top of the day job”
The Independent Inquiry into Child Sexual Abuse, set up by the government in the aftermath of investigations into abuse by Jimmy Savile, was told by NHS England’s head of safeguarding that the responsibility for checking people onto wards should not lie with nurses.
“I think it would require an extra band of staff to actually monitor the door. The nursing staff would not be able to monitor that on top of the day job,” said Susan Warburton, head of safeguarding for NHS England.
Ms Warburton was responding to barrister Riel Karmy-Jones QC, one of the inquiry counsel team, who said the cases of Mr Savile and paedophile Dr Myles Bradbury had led to questions over whether access to children in healthcare settings needed to be more closely guarded.
“Maybe someone has tailgated you in through the door and as a parent you won’t necessarily check the person behind you”
“Those of us who have been in a children’s ward may recognise the scenario of just pressing a button and being allowed into the ward by a tired member of staff behind a desk who doesn’t check you at all,” said Ms Karmy-Jones.
“Maybe someone has tailgated you in through the door and as a parent you won’t necessarily check the person behind you,” she added, speaking at the two-day seminar on 26 and 27 September.
Helen Christodoulides, director of nursing at Leeds Teaching Hospitals NHS Trust, agreed there was problem with access to some wards.
“It strikes me in some wards and departments you can enter and be immediately very close to patients,” she said.
But any new security checks would have to be shared out across multidisciplinary teams, not just among nurses, said Ms Christodoulides.
“Apart from putting bouncers on doors it is almost impossible. And that doesn’t feel proportionate or correct”
However, she added it would be difficult to change the layout of wards or to empower staff to enforce any new checks.
“Apart from putting bouncers on doors it is almost impossible. And that doesn’t feel proportionate or correct,” she said.
Clarisser Cupid, designated nurse for safeguarding children at Southwark Clinical Commissioning Group, told the inquiry she also agreed ward buzz-in systems had to be rethought.
“Most wards will have a buzz-in system but it is, as we mentioned earlier, difficult to monitor that. But something has got to be done in order to provide a secure access,” she said.
But Christine Braithwaite, director of policy for the Professional Standards Authority – which oversees the work of health professional regulators – said that checking people who come onto wards would not ensure children were protected from abuse.
“The difficulty I see with verifying somebody on entry into a ward is, exactly what kind of check are you going to carry out?,” she told the panel.
“What confirming an identity of somebody…. doesn’t do is tell you what the intentions and the motivations of that person are”
“What confirming an identity of somebody, whether or not they have a genuine relationship with the child, doesn’t do is tell you what the intentions and the motivations of that person are,” she added.
She said a better approach would be to give staff and the public information about what kind of behaviour is acceptable and the signs of abuse to look out for.
Meanwhile, Dr Vimal Tiwari, representing the Royal College of General Practitioners, warned about adults sleeping on paediatric wards.
Despite the use of CCTV there were often areas hidden from surveillance, he said.
“There have been reports of abuse of children in those setting by adults who are not necessarily healthcare workers but adults visiting other children on the ward,” he said.
“Staff actually have no means of ascertaining whether the adult accompanying the child is actually related to that child. In hospitals we don’t ask for checks,” said Dr Tiwari.
As part of the two-day seminar the inquiry also considered the role of chaperones, a role designed to protect vulnerable young people during certain procedures that is often held by a nurse.
“[Chaperoning] is not as simple as people think…It is [not] just sort of almost going through a process because you know you have to”
Dr Alison Steele
A number of healthcare professionals told the inquiry that training for the role needed to improve, noting there were no national standards.
“[Chaperoning] is not as simple as people think,” said Dr Alison Steele, representing the Royal College of Paediatrics and Child Health.
“It is about actually understanding - really understanding what it is about, rather than just sort of almost going through a process because you know you have to do it,” she added.
Dr Tiwari added that it was often “challenging” for GP surgeries to provide the training required.
The independent inquiry is being led by Professor Alex Jay, a former director of social services, who also led the inquiry into child sexual exploitation in Rotherham.
It was set up in 2014 and is gathering evidence from and investigating a range of institutions including local authorities, the police, the BBC, schools, hospitals and children’s homes.
An interim report with initial recommendations is expected in 2018.