6218 An audit reviewing the timeline for child protection medicals between September 2021 and February 2023

Objectives There are increasing child safeguarding referrals made within the community. In 2022, there were 650,270 referrals to social services and this showed an 8.8% increase from the previous year.1 It is important to manage referrals appropriately as child abuse is strongly associated with chronic ill health and examples include: mental disorders, obesity and drug and alcohol misuse.2 Currently, social services make referrals to community paediatrics for child safeguarding concerns that do not need emergency medical attention. At Hillingdon Child Developmental Centre (CDC) in London, there were significant delays in receiving referrals from when the concern was first shared with social services. There were no local guidelines available to advise regarding time referrals should be made by. Additionally, vulnerable children: age under 5 years old, with neurodisability or known to social services; were experiencing the same delays. This audit aimed to evaluate the timeframe of child safeguarding referrals received by the Hillingdon CDC. A secondary aim included identifying if the referral pathway prioritises vulnerable children. Methods The data collection tool used gained approval the Hillingdon CDC team and the Central and North West London NHS Trust's audit team (see table 1). It did not require ethical approval or patient consent as no patients were directly involved. The audit was carried out during three time periods: September 2021 to February 2022 (Period A), June to September 2022 (Period B) and November 2022 to February 2023 (Period C). Data was collected from the case notes by the paediatric registrar working in CDC at each time period. The data recorded was on parameters as shown in table 1. Between each time period, educational sessions were organized and provided to both Hillingdon Social services and the CDC. Results There were significant delays experienced including children that were vulnerable or had signs of physical injuries. The total time taken from disclosure of abuse to social services to being examined took over 72 hours 53% in Period A. This improved to 30% in Period C as seen in table 2. In period A, children found to have injuries suspected due to physical abuse, were all seen after 72 hours, however, by period C, this reduced to only 17%. Conclusion This audit shows significant delays particularly in vulnerable children as well as those with physical signs of injuries. The Child Protection Companion3 advised children with physical injuries need to be seen within 24 hours of first suspecting child abuse. The child safeguarding referrals for examination are growing nationally. The delays seen can lead to inadequate prevention and management of harm as well as long-term co-morbidities to the child involved. Therefore more studies and guidance are required to prioritise and manage such referrals effectively. References Characteristics of children in need: 2021 to 2022, Department of Education, 27.10.2022. R Gilbert, et al. Burden and consequences of child maltreatment in high-income countries, 2009. Child Protection Companion, Child Protection Special Interest Group, 2013.