Serious Incident Protocol
This protocol aims to engender a consistent approach between the various staff groups within the Families and Social Care Directorate to ensure a co-ordinated response to how serious incidents involving children are reported to senior managers. The protocol aims to provide a clear and unambiguous process that should be followed by all staff within FSC when a serious incident occurs in order to ensure that the Directorate operates a culture of shared accountability across FSC.
The protocol is supported by the guidance already in place for the Learning and Specialist Children's Services Groups (see section 7) and also the KSCMP Safeguarding Children Procedures and should be read in conjunction with those procedures.
2. What Constitutes a Serious Incident?
For the purposes of this protocol a serious incident requiring notification to the Managing Director is defined as:
- The unexpected or avoidable death of a child in receipt of services from FSC (see below);
- The death of a Child in Care or death of a child in a regulated setting (i.e. care home, registered early years, childminders, or out of school childcare provision);
- The death of a child subject to a child in need or child protection plan;
- An incident that is serious enough that it may lead to a Serious Case Review;
- An incident likely to result in significant media attention (e.g. a serious allegation against a professional)
- Any case which indicates organised or large scale abuse, which has resulted in the KSCMP organised and complex abuse procedures being invoked;
- An incident likely to raise concern about professional practice or implications for Government policy;
- Where a child has suffered serious harm as a result of a worker (employed by KCC) failing to follow procedures;
- An adverse incident which would require referral to the emergency planning procedures;
- Where a registered provider (residential or early years) is closed following enforcement action by Ofsted.
There are specific legal requirements concerning reportable accidents to children, where these arise out of, or in connection with, KCC's activities, such as a child falling from a school roof. Please see Appendix 3: Accident Resulting in the Death of or Serious Injury to a Child for guidance regarding how to report these issues.
This list is not exhaustive and other categories of incidents may also fall within the definition of a serious incident. Managers will need to ensure that consideration is given to other serious incidents that do not fall within this protocol and utilise their judgement as to whether the incident needs to be reported in line with this procedure.
3. Reporting Procedure to be Followed When a Serious Incident Occurs
All incidents involving children and young people should be reported immediately to a manager through the normal reporting and supervision arrangements. Managers are responsible for deciding which cases require notification to their Head of Service/Unit Manager/AEO. The procedure to follow when a manager decides that a case meets the criteria for reporting as a serious incident is set out in Appendix 1: Serious Incident Notification Process.
4. Guidance for Managing Staff Following a Serious Incident
It is essential to ensure that staff are effectively supported if they have been involved in, or are dealing with, a serious incident. Appendix 2: Guidance for Managing Staff Following a Child's Death and/or Serious Incident provides guidance for managers when considering how to effectively support members of staff following a serious incident (see Appendix 2: Guidance for Managing Staff Following a Child's Death and/or Serious Incident). Individual circumstances of staff may determine the nature of the response from a line manager.
5. How the Protocol Links with Other Notification Reporting
This protocol has been specifically designed to reduce duplicate notification processes across the Directorate, by providing a common framework for all staff within FSC.
In addition to the internal notification process, each division within FSC will also have a statutory or mandatory responsibility to notify some authorities/agencies when a serious childcare incident occurs within their service, or to invoke other procedures, including:
- Emergency Planning Procedure for Kent Schools;
- Emergency Planning for Early Years Providers;
- Children's Social Services Alerts Procedure;
- Families and Social Care Notifiable Events Procedure Under Schedule 8 Fostering Regulations 2002;
- KSCMP child death procedures and KSCMP Serious Case Review Procedures;
- KSCMP organised or complex abuse procedures;
- Ofsted Notifiable Incident reporting for residential settings as required by National Minimum Standards (NMS);
- Ofsted Notifiable Incident reporting for early years settings as required by Early Years Foundation Stage (EYFS);
- Notification to the Health and Safety Executive (RIDDOR) (see Appendix 3: Accident Resulting in the Death of or Serious Injury to a Child).
6. Effective Communication in the Notification Process
Safeguarding children is everyone's responsibility and on occasions this will mean that different Groups and Teams across the Directorate will need to share sensitive information. Successful reporting processes depend upon effective partnership working and appropriate information sharing between services. In some situations, practitioners and officers can feel constrained from sharing personal information by uncertainty about when they can do so lawfully.
It is essential therefore that practitioners understand the organisation's position and commitment to information sharing and have confidence in the continued support of their organisation where they have used their professional judgement and shared information professionally. Staff should refer to their Directorate's guidance for clarity regarding the parameters for information sharing or obtain further guidance at Kent Trust Web.
Appendix 1: Serious Incident Notification Process
Appendix 2: Guidance for Managing Staff Following a Child's Death and/or Serious Incident
This guidance is designed to ensure that there is a consistent standard for managing staff within Families and Social Care when responding to a serious incident involving children.
When a serious incident such as the death of a child occurs there is a two fold duty i.e. to ensure the effective management of any investigation alongside a duty of care to employees. This can be a difficult balance to manage as it is important to ensure that an investigation is carried out freely whilst at the same time ensuring that individual members of staff's needs are fully considered. Directors and managers will need to ensure that any investigation required can be carried out unimpeded whilst at the same time ensuring that people are neither left in, nor placed in, a potentially stressful situation. It is particularly important to be aware that there is a risk of increased stress if a member of staff is left isolated at such a vulnerable time.
Managers and/or other employees may also be deeply upset but be striving to appear strong for the sake of their colleagues or their teams. Conversely, they may not be feeling upset and can be confused by this. Dealing with a serious incident is often unknown territory and therefore it is important to provide opportunities for people to discuss how they are feeling and not to assume that another person's feelings can be known.
Roles and Responsibilities
Direct Line Manager
Managers are responsible for deciding which cases require notification to their Head of Service/Unit Manager/Director, and for deciding how to communicate with their staff in accordance with the serious incident reporting protocol (attached).
In most cases, the direct line manager will be responsible for communicating with an employee throughout the process unless an alternative contact is more appropriate. They should inform the member of staff involved at the earliest possible time following the incident.
It may be necessary to consider disciplinary action but before any action can be taken an appropriate investigation must be carried out in line with KCC's Conducting Investigations Guidance for Managers and Investigating Officers January 2009.
The line manager should ensure that Personnel advice is sought whenever a serious incident occurs.
The role of Personnel is to advise and support managers to ensure that they carry out their duty of care to staff when a serious incident occurs. It is also to advise throughout an investigation and any disciplinary procedures.
Providing Support When a Serious Incident is Reported
Immediate Support: Individuals react differently in these situations and, depending on the circumstance, it may be necessary to arrange immediate professional counselling through Support Line for an individual. Frequent contact between the employee and their manager/contact person is vital. Ideally this should be for a few minutes daily either in person or by phone, perhaps at the end of the day. If more direct contact is difficult, a short personal note is better than no contact at all.
Managers must remember that any decision must take into account any equality and diversity considerations. For example, does the employee have a disability or is the employee pregnant? These are only two of the protected characteristics that mean that managers will need to support a member of staff in a particular way.
Equally it may be important to arrange professional help through Support Line for a team.
Where possible, a means of monitoring the take up and effectiveness of the support without compromising confidentiality or trust should be sought.
Managers should agree with Personnel how information will be shared and contact maintained with the member of staff e.g.
- Who the main point of contact will be for the employee i.e. whether it will be the manager or another named person;
- How support and counselling are to be offered;
- If and how an employee can remain in work and whether alternative work should be considered;
- Whether or not suspension is appropriate.
Depending on the facts as they are known at the time, it may be necessary to suspend the individual if no alternative course of action can be found. Arrangements for the suspension of staff are set out in the KCC disciplinary procedure. The decision to suspend will have a significant impact on an individual, therefore it is essential that considerations be given to:
- How the member of staff will be kept updated about the progress of an investigation;
- How they will be informed of any feedback from an investigation;
- How links will be maintained with the team so that the staff member is kept informed of other matters occurring within the team/unit.
Returning to Work: It is sometimes helpful to arrange a visit back to the office before the employee returns to work. For some people, returning on a part-time basis for the first few days can be helpful. It is natural for the employee to be less productive at first, and the manager should ensure that any health and safety and equality and diversity considerations are dealt with in situations where reduced powers of concentration could put the employee or others at risk.
Managers and Personnel should consider the impact on other people, including themselves. It can be particularly distressing to be involved in a serious incident such as the death of a child so support should be made available if appropriate.
Longer Term Monitoring: Depending on whether or not the employee has any personal support outside work contact may taper off over time, but it should be remembered that coping with the trauma of a serious incident can be long term.
Upon completion of all investigations the manager must ensure that members of staff receive feedback and debriefing in advance of the completion of the overview report of the KSCMP.
Related Personnel Policies
The following policies relate to this guidance:
- Emergency and Special Leave;
- Compassionate Leave;
- Flexible Working/Work-life Balance;
- Managing Sickness Absence (including the management of long-term health issues);
- Stress Management Policy;
- Violence at Work;
- Health and Safety guidance;
- Equality and Diversity.
Appendix 3: Accident Resulting in the Death of or Serious Injury to a Child
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations require managers, headteachers or people in charge of premises to notify the Health and Safety Executive when an accident occurs and:
- A child dies or is taken to hospital; AND
- The accident arises out of or in connection with our work activity.
Examples of “in connection with”:
- Work organisation, including supervision;
- Machinery or substances;
- The condition of the premises.
The notification must be by the quickest practicable means, which can be by telephone, on line or by fax (for fax, use form F 2508 from Kent Trust Web or the HSE website below).
Telephone: 0845 300 9923 - HSE's Incident Contact Centre
Fax: 0845 300 9924
Website: See HSE website for details
The Health and Safety Manager must be informed immediately if a child dies as the result of an accident in connection with KCC work activities. If this happens out of normal office hours, the Health and Safety Manager will decide if the HSE duty officer also needs to be informed.
Many accidents, whether or not they are serious, will need to be investigated by the responsible manager, in order to prevent future reoccurrence, if possible.
Guidance on accident investigation can be found on KNet. If assistance is needed with conducting an accident investigation, contact Families and Social Care Health and Safety Advice Line on 01622 694476.
Copies of all forms completed must be sent to Families and Social Care Health and Safety Unit at Sessions House, County Hall.
- HS 157 - KCC's accident and incident report form;
- F 2508 if you have reported it to the HSE;
- HS 160 investigation form if a simple investigation is required;
- Ask for other investigation pro forma if investigation is complex.