At a glance 63: Partnership working in child protection: improving liaison between acute paediatric and child protection services

Published: October 2013

Key messages

  • Both in-hospital and community-based social work arrangements can be effective bases for joint working in respect of child maltreatment. [1
  • Effective joint working in either staffing model relies on shared vision and values in respect of child protection, and investment in, and commitment to, collaborative working.
  • Hospital-based clinicians’ ability to recognise the cases where child maltreatment needs to be considered is fundamental to effective joint work.
  • While neither hospital trust nor social work leads for child protection saw evidence that maltreated children are routinely being ‘missed’ in hospital, trust staff may need particular support and training to detect less obvious abuse and neglect.
  • Holistic assessment and information gathering, supported by training, awareness-raising and expert input, are critical to a comprehensive approach to identifying maltreatment.
  • Gathering information from hospital staff, social care and community health professionals is critical for making decisions about response and referral in cases of actual or suspected maltreatment, but can be challenging in complex, multi-agency environments.
  • Data on any existing involvement with social care can most usefully be used to ‘step up’, but not ‘step down’, the level of concern.  In other words, it should not lead to trust staff reducing concern or paying less attention to clinical signs of maltreatment when a child is not known to social care.
  • While trust staff report that their hospital colleagues typically know where and how to refer cases, quality of referrals can vary.
  • Pre-referral discussions, training, audit, post-referral feedback and multi-disciplinary meetings can help build partnership work that supports joint work, high-quality information sharing, a child-centred approach and appropriate referral.


This At a glance briefing summarises the report  ‘Partnership working in child protection: improving liaison between acute paediatric and child protection services’ [2] The research was carried out by SCIE, as part of the Department of Health-funded work programme conducted by the Policy Research Unit in the Health of Children, Young People and Families. The study described how acute paediatric and social care child protection services work together, identifying what is viewed locally as good practice, and why. The briefing explores the implications of the findings for policy-makers and strategic leads in health and social care services, drawing on:

The study identified current working arrangements, and the factors thought to help and hinder effective joint-working in cases of child maltreatment. Using the findings from the research, this briefing summarises findings on:

Staffing models

The study identified three main types of social work delivery models:

The study found that both in-hospital and community-based arrangements can be effective for joint working with respect to child maltreatment. Within any staffing arrangement, however, success relies on visible, tangible investment in collaborative working. Child protection needs to be an explicit priority at all organisational levels, and the culture should enable staff to understand what this means for their day-to-day work. The study also identified several likely success factors specific to each model.

Effective liaison with hospital-based social work staff needs to be underpinned by:

Effective liaison with community-based social work staff needs to be underpinned by:

Identification of child maltreatment

Challenges and opportunities

Hospital-based clinicians’ ability to spot the cases where child maltreatment needs to be considered is fundamental to effective joint work. Local authority and trust staff saw no evidence that opportunities to identify maltreated children are being regularly missed. They did, however, acknowledge that there are particular challenges in ensuring that all appropriate cases are identified and referred. Specifically, there can be:

Despite the barriers, the study identified some core activities trusts and local authorities are undertaking to  identify child maltreatment. These include:

Safeguarding roles within trusts

The study found that particular trust staff have a critical role to play in ensuring effective safeguarding, specifically:

Social work staff were often very positive about the emphasis and focus given to child maltreatment by safeguarding leads particularly named nurses and by safeguarding units. Safeguarding units vary in composition but typically:

It was also felt to be very important that clinical staff have round-the-clock access to senior staff with clinical expertise, in particular consultant paediatricians or paediatric registrars.

Referral process

In general, participants in the study were confident that trust staff know how and where to refer cases when they suspect child maltreatment. Referrals to social care are particularly useful when they come from frontline clinicians with full knowledge of the child and their context. The quality of referrals can vary, however, and referral thresholds can be the subject of debate between trust and local authority staff. In addition, staff sometimes do not know what to do with cases below threshold and refer these to social care inappropriately. 

This study found the hallmarks of a high-quality referral to include:

The process itself is also important. Trusts and local authorities working to improve joint practice and shared understanding of the referral process could usefully:

Implications of the findings

Central government may wish to:

Strategic leads in trusts and local authorities may wish to:


The preliminary study on which this At a glance briefing is based does not make claims to generalisability; rather, it is intended to illustrate current and helpful practice. The acute trust survey was relatively short and was completed by one respondent per trust. Case studies were necessarily few in number, and comprised two interviewees per site. Our findings indicate there may be considerable value in research exploring the experiences, practices and views of a wider sample of frontline practitioners, and to relate these findings to numbers and nature of referrals made to social care by trusts.


This briefing summarises an independent report commissioned and funded by the Department of Health and we gratefully acknowledge the financial support provided for the study. The views expressed are not necessarily those of the Department which has played no part in the design, data analysis or interpretation of this study.

We would like to thank the individuals and organisations who participated in the research, as well as members of the Child Policy Research Unit Executive Group and the study Advisory Group.

Related resources


  1. This study focused on the relationship between acute trusts and social work services. Findings relate only to Emergency Departments and Maternity Services in trusts.
  2. The full report can be accessed via: Full report - Partnership working in child protection: improving liaison between acute paediatric and child protection services
  3. It is worth noting that this study predates the Department of Health announcement that the ‘Child Protection – Information System’ will be rolled out in NHS hospitals from January 2015.


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