Improving information sharing in safeguarding: MASH in London

Citation

King, J., Henson, R., Dean, I., Ladbury, B., Ogunyankin, F., Boulton, N., Carthew, R. and Smith, R.P.a.I. (2014), "Improving information sharing in safeguarding: MASH in London", Advances in Dual Diagnosis, Vol. 7 No. 1. https://doi.org/10.1108/ADD-12-2013-0030

Improving information sharing in safeguarding: MASH in London

Article Type: News item From: Advances in Dual Diagnosis, Volume 7, Issue 1

Background

All child deaths due to maltreatment raise concern and provoke questions about what went wrong. However, some child deaths such as Dennis O'Neill (1945), Maria Colwell (1973) and Jasmine Beckford (1984) challenge a society's view of itself and its institutions to such an extent that they lead to changes in the law and policy.

The death of Victoria Climbie in 2000 was one such case. It was subject to an inquiry by Lord Laming whose report in 2003 (Her Majesty's Stationery Office, 2003) led to the passing of the Children Act 2004. This supplemented the Children Act 1989 and fundamentally changed the way services to children were delivered in England.

Section 10 of the Act requires co-operation between local authorities, the police, youth offending teams and the relevant health authority to improve the well-being of children in relation to their physical and mental health and emotional well-being, protection from harm and neglect, education, training and recreation, the contribution they make to society and their social and economic well-being. Section 11 obliges agencies to ensure that their functions are discharged having need to safeguard and promote the welfare of children. Taken together, these sections widened the definition of safeguarding and created a permissive legislative gateway for information sharing.

The majority of child deaths do not have this sort of impact; they are dealt with locally through Serious Case Reviews. These are local enquiries into the death or serious injury of a child where abuse or neglect is known or suspected to be a factor. They are carried out by Local Safeguarding Children Boards so that lessons can be learnt.

The Office of Standards in Education, Children's Services and Schools (Ofsted) conducted a review of 147 Serious Case Reviews between April 2009 and March 2010. As in more high profile cases, one of the consistent messages was that the failure to use and share all sources of information was a contributory factor in the death of children (Ofsted, 2010).

Safeguarding children in London

London, with its two million children under the age of 19 (Greater London Authority, 2013). has particular challenges to ensuring that information is shared effectively and children are safeguarded. The capital comprises 33 boroughs each with responsibility for safeguarding and promoting the welfare of children who live within its borders.

The population is transient and highly mobile with patterns of families accessing services in more than one borough (PriceWaterhouseCoopers, 2006). Although all London local authorities are bound by the relevant safeguarding legislation, they vary greatly in population and physical size, demographics and resources. Their boundaries are often not coterminous with their statutory partners. Each has its own Local Safeguarding Board and children's social care arrangements.

Overseeing this is a London Safeguarding Children Board (London Board) which has no responsibility for individual cases, but does provide strategic advice and support to the individual Local Authority Safeguarding Children Boards.

In order to support boroughs to carry out their duties under the Children Act and to implement the learning from serious case reviews, the London Board began an ambitious project of promoting the concept of Multi-Agency Safeguarding Hubs (MASH) in all London boroughs.

Discussions with key partners began in 2010 and a formal project was launched in April 2012 with a goal of supporting all London boroughs to implement the MASH model by March 2014.

Core elements

A MASH comprises a multi-agency team of people who continue to be employed by their individual agencies but who are co-located in one office. It operates on the basis of a "sealed" intelligence hub where protocols govern how and what information can be released to ensure that the welfare of children is safeguarded and promoted.

Notifications to a MASH are triaged and the local authority manager makes an initial judgement regarding the level of risk to a child. The category determines the timescale for a decision to be made ranging from a few hours (four in urgent cases) to a few days.

Information is gathered from relevant professionals and a decision is then made about what further action is required and which agency is best place to undertake the work. Sensitive information can be shared to make the best judgement about risk, but each organisation continues to "own" its information and the representative present can decide what is permitted to leave the hub for operational work and what should be retained. This decision is made based upon what is determined to be proportionate and relevant after a fuller picture has emerged.

In order to qualify as a MASH, each borough had to incorporate five core elements.

All notifications relating to safeguarding and promoting the welfare of children go through the hub

All concerns of whatever level are routed through the hub. This means that low-level repeat concerns from a variety of partners can be identified and addressed and ensures that there are effective interventions at the earliest opportunity. This helps to break down the "silo mentality". It ensures that children who are at risk and vulnerable either through the actions of adults, other children or their own actions are brought to the attention of a multi-agency partnership at the earliest opportunity.

A collocated team of professionals from core agencies (defined as children's services, police, health, education, probation, housing and youth offending teams) were brought together to deliver an integrated service with the aim to research, interpret and determine what is proportionate and relevant to share

This is critical to ensuring all partners have the confidence and trust to engage fully in effective working. The duty of care for agency information remains with the "owner" at all times and the decisions to share information are made on a case-by-case basis within the statutory framework to ensure information is available upon which to make the best decision. All information should be disclosed within the security of the hub.

The hub is fire walled, keeping MASH activity confidential and separate from operational activity and providing a confidential record system of activity to support this

This provision is required to ensure sensitive information will remain in a confidential environment where only those who actually need to know get to see the information. Information is disclosed on a strictly "need to know basis".

An agreed process for analysing and assessing risk, based on the fullest information picture and dissemination of a suitable information product to the most appropriate agency for necessary action

This is a partnership giving itself the best opportunity to make effective and efficient decisions through having the most complete information at the earliest stage. By utilising a standardised risk assessment and threshold model a consistency and clarity of decision making will be achieved. MASH will provide proportionate and relevant information to the most appropriate agencies.

A process to identify victims and emerging harm through research and analysis

MASH provides a secure environment where information is subjected to ongoing research and analysis. This will identify victims and perpetrators by understanding repeat notifications and the identification of individuals who will suffer increasing levels of harm in the future. The identification of these individuals and the families around them will enable services to intervene at a much earlier time thereby providing opportunities to reduce harm and long-term costs. The provision of analysis within the MASH enables the commissioning and prioritisation of resources to improve safeguarding provision.

Progress

More than two-thirds of London boroughs have already attained MASH status and the remainder are on target to achieve it by the project end date of March 2014.

Qualitative feedback and anecdotal evidence indicate that benefits are already being realised. A culture of improved professional trust and shared responsibility for safeguarding has led to uncovered hidden harm. The intelligence gathering aspect of the MASH has permitted boroughs to identify and intervene much earlier when children and young people are at risk. One of the key benefits is the ability of professionals to gain an increased understanding of adult needs within the family to inform the decision about what service is best placed to respond.

Risk to children from parents and carers can be both active (inflicting harm) and passive (failing to protect from harm). While most parents with mental illness do not abuse their children and most adults who do abuse children are not mentally ill, parental mental disorder is associated with use of physical punishment and child abuse. Mental health problems or substance misuse is a factor in a third of cases of death of or serious injury to children (Royal College of Psychiatrists, 2011, p. 7):

It is estimated that elevated or cumulative risk of harm may exist for the 3.6% children in the UK who lived with a problem drinker who also use drugs and 4% where problem drinking co-exists with mental health problems (Manning et al., 2009).

The historic structural specialisation and separation of adult and children's services has meant that mental health services have focused on the client, neglecting the view of the patient as parent. Children's services have focused on the child, without full understanding of the parent as patient.

It is unrealistic to expect one person or agency to have the depth of knowledge required when a parent has a mental health/substance misuse problem. This problem is often compounded by a regularly changing structural landscape. By bringing knowledgeable professionals together for confidential discussions in the MASH, some of these difficulties can be overcome.

Given the mobility of London's population, it is anticipated that MASH to MASH inquiries will increase. Anecdotal reports indicate that cross border and nationally sourced intelligence provided by police is already proving invaluable to identifying harm and risk.

A study of pre and post implementation study of five boroughs was commissioned from the University of Greenwich and the results were circulated in December 2013. Although early indications are promising, further research into the effectiveness of MASH is required and areas for further research and development have been identified from the project (Crockett et al., 2013).

Balancing the right to privacy with the need to safeguard children, assessing risk and the nature and likelihood of possible harm and then determining what is proportionate and relevant to share are difficult tasks. It is inevitable that those working in a MASH will not always make the right decisions. Even when they do, the success or failure of any work undertaken will rest primarily with operation services who undertake the full assessment and intervention.

MASH cannot guarantee the safety of children; no system can. It can, however, give a better defined and enhanced picture of a child's circumstances to improve knowledge about the risks they face and the appropriate level of service required.

It has now been over a decade since the Laming Inquiry stated "Improvements to the way information is exchanged within and between agencies are imperative if children are to be adequately safeguarded" (Crown Copyright, 2003). Given the known consequences of the failure to share information across agencies, it would seem that a MASH is essential.

Jeanne King, Richard Henson, Ian Dean, Briony Ladbury, Florence Ogunyankin, Nigel Boulton, Richard Carthew, Rory Patterson and Ian Smith

References

Crockett, R., Gilchrist, G., Davies, J., Henshall, A., Hoggart, L., Chandler, V., Sims, D. and Webb, J. (2013), The Evaluation of MASH, University of Greenwich, London.

Greater London Authority (2013), 2001 Census First Results; London Boroughs' Population by Age and Sex, Greater London Authority, London.

Her Majesty's Stationery Office (2003), The Victoria Climbie Inquiry, Report of an Inquiry by Lord Laming, Her Majesty's Stationery Office, Norwich.

Manning, V., Best, D.W., Faulkner, N. and Titherington, E. (2009), New estimates of the number of children living with substance misusing parents: results from UK national household surveys", BMC Public Health, available at: http://www.biomedical.com/1471-2458/9/377

Ofsted (2010), Learning Lessons from Serious Case Reviews: Ofsted's Evaluation of Serious Case Reviews From 1 April 2009 To 31 March 2010, Ofsted, London

PriceWaterhouseCoopers (2006), Mobility and Young, PriceWaterhouseCoopers, London.

Royal College of Psychiatrists (2011), "Parents as patients: supporting the needs of patients who are parents and their children", College Report No. CR164, Royal College of Psychiatrists, London, January, p.7.