1.  The Royal College of General Practitioners welcomes the opportunity to submit written evidence to inform the Education and Skills Committee's Inquiry into Every Child Matters.

  2.  The Royal College of General Practitioners is the largest membership organisation in the United Kingdom solely for GPs. It aims to encourage and maintain the highest standards of general medical practice and to act as the "voice" of GPs on issues concerned with education; training; research; and clinical standards. Founded in 1952, the RCGP has over 21,500 members who are committed to improving patient care, developing their own skills and promoting general practice as a discipline.

THE PLACE OF HEALTH, SOCIAL SERVICES AND EDUCATION RESPECTIVELY WITHIN INTEGRATED SERVICES

  3.  As an educational body, the College has already recognised the increasing importance of child and adolescent health by enhancing this area of study in our new curriculum review. We are currently undertaking extensive consultation on a new College Postgraduate Curriculum Statement regarding the care of children and young people.

  4.  In the past it has been possible for doctors to enter General Practice without any paediatric training in a hospital or primary care setting, relying just on the GP registrar year.

  5.  We support the need for inter-professional education so as to improve communication between the Primary Health Care team and Social Services. This could occur in both primary and secondary care settings. The College also believes that it is important for all GPs to have a high degree of knowledge and skills regarding child health which could be obtained by placements in both secondary and primary care settings.

THE PRACTICAL IMPLICATIONS OF THE "DUTY TO COLLABORATE", INCLUDING THE EFFECT ON FUNDING STREAMS AND LOCATION OF STAFF AND FACILITIES

  6.  The College notes that the establishment of Local Safeguarding Children Boards (LSCBs) is an admirable objective but the fact that this is based on a voluntary and goodwill association supported by a duty to collaborate rather than a statutory auditable and criterion based system seems to us risking the effectiveness of the Boards in the longer term. This is particularly relevant as the LSCBs are intended to be proactive rather than reactive and will therefore be involved in primary, secondary and tertiary prevention. This implies an additional level of service provision than is currently the case and a level of liaison and co-operation which does not form part of the day to day responsibilities of the organisations which will be tasked with establishing LSCBs locally.

  7.  Following on from this consideration of LSCBs, it would be appropriate to consider whether the Performance Management framework for them should be made explicit, and that the strategic commitment must include genuine senior representation. Linked to this must be a requirement to adhere to guidance on policy and procedures, and steps should be taken to address business planning including ownership by the different agencies involved in the establishment of LSCBs.

  8.  We see some very exciting developments around "Every Child Matters", including the concept of "full service schools" and we see this as being predicated on an alliance between health social services and education which will not be forthcoming without greater central direction, and certainly far more direction than can possibly be offered by the Children's Trust Board (see below) to whom the LSCBs will report.

  9.  We have a concern about the proposed Children's Trust Boards. These devices offer an opportunity to improve the overall health of children within the wider community but this is predicated on an assumption that a "duty to collaborate" will be converted into demonstrable action by the current service providers in health, social services and education. In the absence of a sufficiently directive line on funding and the availability of staff there is a genuine risk that these developments will founder sooner rather than later.

  10.  Linked to this will be the need for groups who do not traditionally work together to act co-operatively and collaboratively and we suggest that this is dependent upon an appropriate and supportive educational environment in which individual professionals' contributions to the wellbeing of children is given due consideration.

  11.  We are clear that the role of the Children's Commissioner is very important but this role can only move towards effective delivery if there is a more concrete sign up to the "duty to collaborate" than now seems to be the case.

INSPECTION

  12.  In considering quality assurance, any such system needs a demonstrable resource basis if it is to be worthwhile. There needs to be penalties associated with failure as, in this way, health, social services and education can be reasonably expected to prioritise many of the currently unfunded issues unless mechanisms are introduced, including inspection, whish makes it clear that resources will be under threat unless demonstrable progress and appropriate quality standards are being applied at a local level.

THE CREATION, MANAGEMENT AND SHARING OF RECORDS, INCLUDING ELECTRONIC DATABASES

  13.  From what we have seen from current legislation before Parliament, there is no specific reference to medical records in a way that would allow General Practitioners and other medical practitioners to share their records within acceptable standards of medical confidentiality. This would impact on the effectiveness of any of the collaborative exercises currently being considered, such as Local Safeguarding Children Boards and Children's Trusts.

  14.  We would draw the Committee's attention to a report (copy attached) from a College workshop held on 27 January 2004: "Grasping the Nettle: The GP, The Child and Information Sharing". The workshop was set up at the request of the Department of Health, in response to recommendation 86 of the Climbie Inquiry, to explore the feasibility of extending the process of new child patient registrations to include gathering information on wider social and developmental issues likely to affect the welfare of the child. The report's conclusions included the fragility of the role of the GP in regard to eliciting information from children; the crucial part played by the statutory and professional regulatory framework in influencing the view of GPs on what information can and cannot be shared; and the difficulties and dilemmas faced by GPs in gathering and sharing information.

  15.  Also relevant to information gathering and sharing are issues considered around draft guidance in connection with Clause 12 (previously 8) (information databases) of the Children Bill (HL) which we have recently (September 2004) discussed with the Department for Education and Skills.

  16.  In this discussion we were supportive of the statement in the draft guidance that protecting children from harm and improving their lives generally, are integral. However, we acknowledged that introducing measures designed to do the former, if not handled sensibly and sensitively, can actually impact negatively on the latter. This fact must be borne in mind when formulating guidance, particularly when dealing with information sharing and the development of protocols to govern such processes.

  17.  An essential concept, that we would expect to see in any requirements or guidance for the gathering and sharing of information about children, is the need for organisations and individuals working within them to respect each other's professional regulatory frameworks.

  18.  Another crucial issue for those sharing information is that relevant organisations must incorporate a robust policy for information sharing within, and out with, the organisation. Such a policy should cover the concept of proportionality (as enshrined in Working Together to Safeguard Children 1999);

—  Who needs to know?

—  What level of information is to be shared?

  It must also take into account the secondary passage of information, ie to a third party or organisation via an intermediary.

  19.  In considering information sharing across agencies involved in the care and support of children and their families, health care workers retain a fear that they may be statutorily compelled to routinely divulge confidential information regardless of the concept of proportionality. This, as discussed in Grasping the Nettle, could gravely endanger the relationship between the professional and the child and the family.

9 November 2004