A and E database

[ZebraInHiding]

www.guardian.co.uk/society/2012/dec/27/every-child-accident-emergency-dabatase

I thought they did this anyway? Don't they senda note to your health visitor?

Do you agree with it or do you think it will make people worry more? Whilst I can see the good in it, I worry that kids just won't get taken for help any more. Not sure what the solution is though. :(

So many sad experiences. Interesting how many with rare conditions found this thread.

i was told that all children under 5, the health visitor was informed. but i never had a visit concerning a visit to a&e, and i spent a lot of time there with ds2 when he was little he was very accident prone, and even told a&e staff that "daddy did it" once ( daddy didn't even know we were in a&e).

I trained as HV and we got in letters from the hospital informing us of any children who had attended A&E. We would try to go out to visit but not always possible so would then try to phone to enquire how child was. If the child who attended was in any way a cause for concern, looked after, on the child protection register then they would get a visit. This was my experience training in one local authority. My own ds has been to A&E numerous times & no-one has ever phoned or visited or followed up.

Our last experience on A and E was DS3's infamous 'SuperBoffin' experience. This involved him leaping off the top of the sofa and knocking himself out whilst fracturing his knee. The child protection questions were so light touch and skilfully done I had to be impressed, as was the sneaky full body check for other damage. But that happened to be a consultant at work, and a very experienced one as well.

This is what should be happening, The personal touch, not the technological one. And more consultants in paediatric A and E.

Completely agree with boffinmum that more skilled professionals need to be there at ground level. Nothing is as good as skilled judgement & decision making based on what you see. All the checkboxes and technological assessments are only good if the person using them uses sound knowledge and good judgment and then this is followed up appropriately.

But in the absence of that, joining up info about a and e attends cannot be a bad thing. It won't be a threshold - three in a month and you're in trouble, it will simply be used to raise warning flags.

SPB unless the quality of the data is top notch it will do more harm than good. And I for one don't have any confidence in the data entry/purging process.

Looking at the DH announcement it only mentions two data groups:

• whether the child is the subject of a child protection plan or is a looked after child
• a list of attendances in unscheduled care.

Data quality for pure a and e attendance will be fine ie that they attended. Agree that any more than that, diagnosis etc, would be poor.

Looked after child will be fine. Plan more dodgy unless they will have a process to complete it retrospectively. Sounds like a big job though.

That said if this is part of the child and maternity data set which I strongly suspect it is, that will be part of the setup arrangements for that

What use would a simple 'attended A&E' be in a child's file? Unless a Dx is also included, then it is useless data.

From what I remember of the BP case, there was information sharing going on, however, some professional's input was valued much lower than others by SW. eg CM flagged up concerns, not taken into account by SW, despite CM being funded by SS as P on ARR. It would be nice to think this is no longer the case, but I doubt it.

Glad to see that SS and HS databases now 'talk' to each other, they didn't when I worked at a SW led CMHT, which meant either health or SS notes had to be copied across from one to the other, without a copy/paste facility.

Not 100% sure how this will prevent abuse to be honest. Prevention is about having enough properly trained people identifying and supporting families at risk, how this is done without adequate numbers of HVs is beyond me. Once a child is taken into a hospital A&E for NAI, there tends to have been a fairly long history of abuse and unreported injury, which may or may not have been flagged up.

My dc's elementary school (part of the Los Angeles Unified School District) started a central "joined up" attendance system a few years ago. My ds missed enormous amounts of school because of illness (5 weeks in 4th grade and 8 weeks in 5th grade). I was very diligent about making sure that the school secretary entered all his absences as "excused" which they were, but because i had a good relationship with the secretary, I wasn't required to provide doctor's notes. At the same time, I didn't follow up on my dd's attendance records because she only missed 1 day a year at most. At the end of last year, I got a letter from the central office stating that my dd had too many unexcused absences and that the next step would be a referral to ss. I tried to clear up what was clearly a mistake (she not only hadn't missed many days and I had given excuse notes for the days she had missed). Although the return address was from the school and the letter was in the principal's name, the school knew nothing about it and said it had been automatically generated by the central office's computer. They did not know how to correct the mistake (told me to contact central office, who said to contact the school) and were completely disinterested in the whole thing. The whole thing was a classic example of centralized, computerized monitoring gone wrong because no trained humans were involved in the process. The child who in theory should have been flagged because of his high level of absences was not because I manipulated the system, the child who was not absent was flagged because of data errors and in the end no one looked at the information or cared what the true story was or knew how to correct the mistake. I doubt that that system would actually catch and/or correct any neglectful parents. I think that the proposed A&E system would be similar in its lack of effectiveness.

The database will only work if there is only one way of using it and every Hospital/Trust is made to use the same one.

Currently there is a computer system in place which GPs, HVs and Child Info Depts use which is meant to link one another together so for example a GP can read what a HV has written about a child during a visit.

However there are so many different ways in which this system (Government initiated I believe) can be used and not every Trust has been made to use the same system so not all areas of the country can be linked up.

This is beyond ridiculous because if you move from say London to Leicester the computer systems used are different so any information which has been recorded onto the computer will not follow you as more Trusts are becoming 'paper free'. This leads to the possibility of abuse which has been identified in London by the HV not being known by the HV in Leicester.

CaptChaos, it would be used as a simple warning indicator. Children who have attended A&E over a certain no of times in a certain period will be followed up (probably as simple as ensuing this HV phone call/visit hapens)

No need to use the same dataases. The child and matrnal dataset will be a minimum dataset and will be mandated. Whatever system they use will have to be ale to output for it. Already need to do this for other datasets anyway, so this will be a small exercise for the software suppliers.

Hv phone call is Fine for under 5s, what about older children?

Health visitors already get that information about under 5s so why would this change anything? In the 25 or more trips to A and E DS has had we have had one call from the HV. Simply having that information on a database wouldn't change the responses.

they can notify the school
Some areas are very good at notifying HV, others less so. Plus in those areas that is bog standard after one attend - nothing to tell you where a child has had mutiple attendances, possibly in different areas

So what are the school going to do with the information?

I know my area notifies the HV, they send a copy of the letter to me aswell and it is in much more detail than a database which simply says they attended a and e

It's just more information to add to the bigger picture. If they aready had low level concerns this may be important information.

I don't know that that is how it's going to work anyway, just my assumption/guess

18 years ago I saw three hvs. Not one was capable of providing accurate advice in relation to bf, growth or immunisation. Not one was able to record info in the red book accurately, not one was able to answer a simple question. One even told me the baby had lost weight when the scales were set at minus 10 oz when the baby went on. And had the cheek to get arsy when I asked for them to be reset and the baby reweighed.

From what I read on here I don't think the service has improved. If a health professional has a concern can't they pick up a phone and draw it to the attention of someone more senior in their own or a corresponding department and follow it up proactively.

Baby P died because a foreigb dr failed to diagnose his broken back. Thankfully he's now struck off. His colleagues must have known he was incompetent and couldn't communicate. We need a less PC system with proactive staff not a database. And the hV service needs a root and branch overhaul to make it fit for purpose.

But an argument would be why not use the information we already do have more wisely?

My kids are like Ben from Outnumbered.

I have seen the inside of A&E departments around the world, multiple times in Sydney and in London.

It actually concerns me a bit how their injuries are laughed off. I mean yes in my case it is because the little snots have to run at speed everywhere and are incapable of actually thinking about whether something is a good idea before doing it - they are fast as well so even with constant supervision they manage to injure themselves. We have a saying in our house 'costume does not enable wearer to fly', but neither of them believe it...

But what if they weren't just normal childhood things? Why has no one ever questioned me properly? Why has no one called to follow them up? What if I were abusing them and these were not accidents? Because I am pleasant and calm and give them cuddles when there? Hopefully someone is paying close attention and I have just not noticed it.

Joined up thinking about this stuff could be a good idea.

Exactly. The vast majority of parents will be like you, have children that sometimes move faster than the speed of sound. Some will be neglectful or even abusive. Data are already collected. Tweaks to the submission service means this can happen behind the scenes

Baby P did not die because of the failure of one (female) doctor. I suspect he wouldn't have survived the injuries he went in with. But one of the reasons the doctor did not undress him and examine him was because it wasn't made clear on his notes - or at least the ones she saw - that he was a child at risk. So a big part of the reason why his mother and her boyfriend were able to beat him to death was lack of proper record keeping and analysis of his situation. I am not confident a database is the cure for this.