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Welcome to the pod.

00:00:09:07 - 00:00:41:19
Steve Macabee - Host
Hello, everybody, and welcome back to the Pod, the Partnership podcast from the Somerset Safeguarding Children Partnership. It's good to have you back with us. And one of the things we talked about previously is explaining and introducing to you the various aspects of the partnership, remembering that the partnership encompasses all agencies who have a responsibility to safeguarding children. And I'm very pleased to to say that I'm joined in the studio by Dr. Joe Nicol, who is the designated doctor for safeguarding children for NHS Somerset.

00:00:41:24 - 00:00:42:14
Steve Macabee - Host
Joe, welcome.

00:00:42:17 - 00:00:43:21
Dr. Jo Nicholl
Hi, Steve.

00:00:43:23 - 00:01:03:07
Steve Macabee - Host
Thanks for joining me today. It's really good to have you in here in the studio and it'll be great to get to know, get to know you and get to know your role and how it continues for the partnership a little bit. So can you start us just talking to us about what is a what is the role of the designated doctor for safeguarding children?
It's something I'm sure you're familiar with, but many people will be sitting there scratching their heads thinking it's a great title. I have no idea what actually means.

00:01:10:08 - 00:01:49:06
Dr. Jo Nicholl
Sure, sure. Yeah. So the designated doctor is a strategic safeguarding role. So I don't do hands on safeguarding with children. But what I do is help the system to develop policies and procedures to safeguard children more effectively across Somerset. So obviously I'm a doctor, so I'm doing that specifically with a health focus, but I work together with colleagues in children's social care, the police, education and across the whole health system to sort of try and coordinate things so that we do things as effectively as possible between our agencies.
So, you know, that would be, you know, giving advice on the health impact of perhaps a policy that children's social care was developing or helping the health system understand police policy or, you know, sort of backwards and forwards between the the agencies. And I'm part of a team at the at NHS Somerset and we between us all provide support to practitioners who are getting stuck with some of the more tricky safeguarding cases.
So we often take calls from GP's or children's social care, sometimes education colleagues. Those would probably be the most common ones to just say, you know, I'm worried about this child, I'm stuck with this case, I don't know what to do with it. Can you help? So a lot of what we do is, is between those two roles really.

00:02:41:17 - 00:02:44:05
Steve Macabee - Host
Sort of consultation as well as the kind of strategic side.

00:02:44:05 - 00:02:52:07
Dr. Jo Nicholl
Sort of. Yeah, absolutely is. But is providing advice sort of one level above all. So that actually hands on with the child themselves. Yeah.

00:02:52:09 - 00:02:54:17
Steve Macabee - Host
You are practicing GP.

00:02:54:19 - 00:03:34:15
Dr. Jo Nicholl
I am a practicing GP. I work one day a week in a GP practice in Somerset and I come obviously from a GP background, which is a somewhat unusual position for the designated doctor. Normally it's a pediatric role, but because I've been doing safeguarding in the for NHS, Somerset was then the CCG for quite some time and I've always had an interest in safeguarding children and pediatrics through my GP career and I've done other sort of little jobs like I was police surgeon for a while and, and I've been a GP educator for quite a while.
So all those sort of bits and bobs I've done over the years kind of give me the skills I needed to do this role. So although it's somewhat unusual for a GP to be in the role, I think actually that the it does give me a perhaps a better overview of the whole system in some ways, but I, I'm conscious of the fact that I'm not a pediatrician, so I work very closely with our name doctor in the Trust and, you know, we kind of buddy up and do a lot of the work together.
So we get the strategic and the pediatric focus linked in.

00:04:14:02 - 00:04:36:19
Steve Macabee - Host
I've just curious actually here, we've talked previously in the previous episodes about the change from the safeguarding boards within the local authority to the safeguarding and partnership arrangements that came in from working together. Just what have you seen much of an impact in that within your role within health services? Obviously now there's kind of that equal shared responsibility.

00:04:36:20 - 00:04:39:00
Steve Macabee - Host
How have you sort of seen that change?

00:04:39:02 - 00:05:10:00
Dr. Jo Nicholl
Yes, I think it's given health a clearer voice at the table, if you like, when making decisions, but also clear responsibilities in safeguarding. You know, the the ECB has strategic safeguarding responsibilities for defined in working together. And one of the other elements of my job, I guess, is to make sure that the ICB are fulfilling their safeguarding responsibilities to the families in Somerset.
So, you know, I do give advice to our executive team alongside my colleagues in the Safeguarding Team, you know, and we also do a lot more assurance work than we used to. You know, we go out and visit practices and our providers who have contracts under the NHS and to make sure that their safeguarding is effective and appropriate for them, whatever service they're providing.

00:05:39:18 - 00:05:57:15
Steve Macabee - Host
Yeah, it's it's an interesting, I think quite often people talk about health, they talk refers to health within working together. But I think as we've seen in reviews and is important for for everybody to remember is health is not one single body is not.
A huge sort of multifaceted beast. And you've mentioned GP's already talked about paediatrics. You know, I think it's important when we're talking about the partnership, when we're talking about health is is for people to kind of recognize it is multifaceted and it's important to kind of make sure we're linking with the right people within that and getting the right voices.

00:06:18:00 - 00:06:41:03
Dr. Jo Nicholl
Yeah, it is a complex system. It's, you know, taken me a long time to understand all the bits fit together. And I completely sympathize with someone coming in from the outside thinking. So I need to actually speak to in this in this health system. I mean, really, it's about making sure you're getting the the right representative around the table to answer the question that you want to ask.
Yeah. So, you know, if you've got a child, for example, with complex disabilities, you want a specialist in that area to be advising you on what the impacts of that disability might be for that child. If you want somebody who can specialize in telling you about how the whole family work together, then you probably want either the GP or a public health nurse like me, health visitor who work with families, relatives and individuals.
So, you know, it's important that you just have a little think about what is the question that you're trying to answer and who is the best person to do that. And again, that might be something that someone would come to the ICB team and say, I don't need to have round the table to answer this question. And we could provide some advice and support with that element as well.

00:07:33:03 - 00:07:53:01
Steve Macabee - Host
No, thank you. I'm just wondering in terms of the health system feeding into the partnership arrangements, how do you kind of say health systems, best fees and feeding in and out of the you are part of a number of the subgroups from the partnership. Yeah. So I guess both in terms of your role sort of feeding into the partnership arrangements and sort of broadly in terms of health systems for feeding in.

00:07:53:06 - 00:08:25:08
Dr. Jo Nicholl
So it's I think it's important that there is a health representative on a lot of the committees and subgroups and things that we run because we're tripartite, you know, we we need to have the three elements of children's social care, police and health represented in the room. And I think from the point of view of strategic safeguarding the ICB team is well placed to provide that strategic oversight because we have that broad overview of the whole health system.
But we may also need to bring in specific individuals if we need a bit more advice about, for example, how midwifery might be contributing to whatever it is we're discussing. You know, that may be more specialist area.

00:08:41:13 - 00:09:03:12
Steve Macabee - Host
Thanks to you. I just think thinking about in terms of obviously you have very strong links with GPS, your role isn't just focused on GPS, but it is broad both. You've got those close links with GPS. How do you feel or what do you see in your practice about sort of that that best practice about how they can best support good safeguarding practices in relation to children?

00:09:03:14 - 00:09:34:12
Dr. Jo Nicholl
So I think one of the most important elements and that's been borne out by a number of the serious case reviews and local safeguarding practice reviews that we've done is to have that professional curiosity to dig a little bit deeper, asks questions, be curious about what's going on in people's lives. You know, we're in a very privileged position in primary care that we can be quite nosey and ask, you know, quite, quite sensitive questions very quickly after meeting somebody.
So that gives us that opportunities. That's kind of having your antenna raised for for safeguarding risks. And I think the way to get your antenna particularly attuned is to make sure your training is up to date and that you've really got an overview of what's going on in safeguarding both locally and nationally, what the themes are, I think is the other element is to communicate really well, and that's where the GP's Children's Safeguarding meetings can be very useful because you have the primary care team together talking about some of the families that they're worried about who seem to be struggling and thinking how can we support this family?

00:10:18:00 - 00:10:46:06
Dr. Jo Nicholl
And we're picking up anything that might make us worried about this family, that this child's at risk and just kicking that around as a team and saying, well, I've seen this, I've had this gives you a much bigger picture. And then, of course, you may need to bring in other professionals to get that wider picture. You may need to have conversations with children, social care or other health colleagues in the midwifery team, the health visitor team, the paediatric team.
So it was a good communication and really putting that jigsaw together so you've got a good overview is critical. And then when you've got a genuine safeguarding concern, it's really about making sure your views are represented in those discussions. So getting GP's to attend strategy meetings is really important. I appreciate how difficult because they are often very short notice and they're all very busy in primary care, but it's a really critical decision making meeting for that family and it's important that the health service is represented, but particularly the GP is represented because they've often, you know, may well have picked up the initial concern or have wider knowledge around the family and contributing to things like the Child Protection Conference report. Sadly, the pressure on primary care means that many GP's can't actually get to conferences physically, so so a good report really needs to represent what they say and then challenging things with colleagues. If you don't feel it's right, you know, if you're still worried with a about a family or a child and you don't feel you've had an appropriate response from a colleague, then then you know, you need to make your point again and challenge that a little bit.

00:12:01:15 - 00:12:26:24
Steve Macabee - Host
And that's where we've got these organizational differences, practical solutions. And because that's a framework we've all signed up to and it's so important we get that right, because you see it time and time again locally and nationally where there have been disagreements and they haven't been sorted out and they haven't reached a resolution. And then as a consequence of which sometimes with, you know, weeks, months, years later, we're then sort of looking at that as a case review, which is a real, you know, a real challenge.
It's very difficult, but it's really important. And I'm just thinking sort of picking up from what you were saying about Child protection conference is and that being very challenging for GP's to physically attend, have you got any advice either for GP's or for for other professionals about how they can link in closer together, Understanding that is challenging for everybody.

00:12:52:07 - 00:13:23:00
Dr. Jo Nicholl
So I think there's something about writing reports and communicating with other colleagues in a way that uses a language that we can all understand. So I think when when things go wrong or there are disagreements between professionals or a message hasn't come across, clearly, perhaps in a a child protection conference, it's often because the health system are using how speak the social system are using social work speak, you know, the police are using police speak.
And we haven't really understood each other. So I think we need to be good at being clear in our communication and making sure that we've put things in such a way that really a layperson could understand it. And, you know, if you take the child Protection Conference report, for example, a really good child protection conference report from a GP would would be give kind of really pull out two elements.
One is what is the impact of the child's health problems on the safeguarding risk?

00:13:56:01 - 00:13:56:21
Steve Macabee - Host
What does this actually mean.

00:13:56:21 - 00:14:21:22
Dr. Jo Nicholl
Yeah. And also what is the impact of the safeguarding plan that you're proposing on the child's health or the risks if you don't do anything on the child's health? So you might give an example of, well, if if you don't address the the fact that this child's being exposed to domestic abuse at home, that's likely to have a long term impact on their mental wellbeing, their mental health.
But actually, we know that in a stress in childhood produces really poor outcomes in terms of physical health as well. And actually articulating those points clearly can really help a non health professional to understand why it's important to be addressing those, those problems. And you know, it may be that you want to say, well, your plans are not going to work because actually one of the parents has drug and alcohol use and wouldn't be able to engage with what you're suggesting because they're so co-op dealing with their own difficulties.
We need to think family and address that problem first. So it is up to a focus is, you know, what's what's the child's health needs and then what is the what is the impact of the safeguarding problem on that on their health.

00:15:12:12 - 00:15:32:14
Steve Macabee - Host
You are you seeing any what do you see within your role with working with GP's and other health practitioners? Do you see sort of common themes coming up time and time again? Are you seeing a kind of a rise in any particular themes, for example, or recent, fairly consistent over the years?

00:15:32:16 - 00:15:56:04
Dr. Jo Nicholl
I mean, we certainly had a spike in domestic abuse, particularly during the COVID lockdown, when, you know, it's really difficult time for families. They're all jammed in together, not able to go out and worrying about, you know, COVID, money, jobs, all sorts of things. A no release for the parents in terms of the children at school for a bit.
Give them a bit of a break. And, you know, that was a really stressful time for many families. So so I've certainly noticed that domestic abuse has been much more commonly recognized, whether whether some of it was there and we weren't picking out before.

00:16:14:07 - 00:16:15:16
Steve Macabee - Host
Yeah.

00:16:15:18 - 00:16:46:05
Dr. Jo Nicholl
So I think that's a definite theme. Sadly, the sort of child exploitation, particularly in terms of county lines and abuse outside the family, is is much more prevalent. As you know, the drug culture in the society has become stronger. And that's that's really challenging thing to to manage because you know it's not the parents fault usually some you know there's.

00:16:46:05 - 00:16:47:10
Steve Macabee - Host
Wider influences.

00:16:47:12 - 00:17:08:11
Dr. Jo Nicholl
It's not that you've got to you know, try and help the parents in a change. The way they're dealing with the child is completely out of their control as that's really tricky. So I think those those two particular themes have been perhaps more prominent in the last few years. And I remember them being back when I started my career in safeguarding.

00:17:08:13 - 00:17:28:15
Steve Macabee - Host
I'm just just curious, have you seen a rise in mental health needs for children, people or for for adults, for parents? Because again, you mentioned Koby just now, and that's something that I think was talked a lot about during the COVID period. And yeah, I'm just I'm just curious whether you have actually seen that in practice or not.

00:17:28:15 - 00:17:51:14
Dr. Jo Nicholl
Yeah, very much so, particularly in the adolescent sort of group. You know, there's a there was a massive spike in in teenagers requesting support for their mental health, particularly not so much I think, during the pandemic, but when they also go back to school because they were feeling really isolated. They're worrying about friendship groups and, you know, they kind of got out of their routine.
A lot of them felt safe in their bedroom with a door shut and then going back out into the wider world. And that's continued to be the case. And we are also seeing, you know, some children with really quite complicated, challenging behavior that's very difficult to manage. So I think the schools have worked really hard to try and support these children.

00:18:16:17 - 00:18:25:24
Dr. Jo Nicholl
But there is a need for, I think, some more specialist resources across Somerset for some of these more complicated children.

00:18:26:01 - 00:18:44:06
Steve Macabee - Host
Thanks, Joe. I'm just I'm just learning about quite often we kind of focus on on sort of when things haven't worked out well on sort of poor practice about improving things, which is important. We do, you know, obviously focus on I'm just one. Have you got any examples, any kind of particular good practice that you've seen over the years?

00:18:44:08 - 00:19:18:13
Dr. Jo Nicholl
I think I mean, generally I've seen some real tenacity amongst safe colleagues in safeguarding. So be that, you know, pediatricians, GP's health visitors, midwives, children, social care, police, you know, people really just will not let go of something until they've actually made sure that child's got a better outcome. And and I think, you know, this this I see that quite regularly, you know, is people really pushing and pushing and they keep coming back and asking for support, challenging things.
This is still not right. You know, and I think there's a lot of that that goes on in the quietly in the background that we don't perhaps see, you know, in amongst these big cases because actually they go right rather than go wrong. But I think you do need to be, you know, have have that tenacity to safeguard children.
You've got to just keep going on and on and on until you get it right. And there are a lot of people out there who are working very hard to do that. So I think generally there's a lot of good work going on.

00:19:50:20 - 00:20:09:08
Steve Macabee - Host
Yeah, No, brilliant. Thank you. I just to just to just to round off, I think in terms of you and your role and I was for whatever you what advice would you give to to anyone who might be early on in their career and interested in becoming a designated doctor for for safeguarding children. What sort of advice would you give them?

00:20:09:10 - 00:20:38:03
Dr. Jo Nicholl
I think get stuck into safeguarding at an early stage in your career. And you know, there are lots of opportunities across the health system to do that. So, you know, of you could be asked to sit in, for example, on child protection medicals if you were working in one of the hospital trusts in the paediatric team, you can ask to attend strategy meetings or child protection conferences.
GP's can get involved with those as well. And you know, there's opportunities to shadow people across the system. I'm going to have some of the community paediatric trainees or junior doctors coming to shadowing me at the ICB soon, which I think is a great way of seeing them understanding the strategic safeguarding work that goes on. So I think there's there's lots of opportunities just to dabble into different bits of safeguarding, ask questions, sit in on things, talk to people about cases, talk to the, you know, come and talk to the ICB, talk to the name Doctors in the Trust about assault cases.
They're seeing a lot of the trusts also have peer review meetings where they go through the cases that they've seen in for child protection medicals and show the kind of injuries that children sadly have of sort of suffered as a result of abuse. But how they unpicked, what was abuse and what wasn't, you know, from a medical point of view.
So I think just just getting involved in all of that stuff and then, you know, and then hopefully it would it will lead on to two other things. If you've got an interest, you've just got to be an enthusiast for safeguarding. I think it is not for everybody. But I think if you can if you can get your teeth into it and just, you know, being teased tastic and tenacious, those are the most important skills that you need to do the job.

00:22:08:03 - 00:22:13:09
Steve Macabee - Host
Well, definitely it's not easy, but it's is good knowing that she you do make a difference.

00:22:14:07 - 00:22:35:19
Dr. Jo Nicholl
Yeah. It's a very interesting and rewarding job to do. I mean, you know, I can I can completely understand why people raise their eyebrows and think, why on earth would you want to talk all day about children are being abused, But it's not about that. It's about doing what we can as a system to stop that from happening and protect families and help them thrive and have happy lives.
And that feels like a really important thing to do.

00:22:38:23 - 00:22:58:02
Steve Macabee - Host
Yeah, absolutely. Jo, thank you so much for your time today. I really appreciate you coming in. I really appreciate you talking to me. And until contribute really about your role, I about the partnership and how we were all link in and I'm sure I will see you again very shortly in one of the partnership subgroups. But thanks very much for your time and we'll see you again.

00:22:58:04 - 00:23:22:13
Steve Macabee - Host
Bye bye. Bye bye. 
As always, if you'd like to find out more on the topics discussed in this podcast, go to the CCP website Somerset Safeguarding Children dot org UK as well as following the links in the description. All that leads me to say thank you again for listening and we look forward to you joining us here again next time at the people.

00:23:22:15 - 00:23:25:14
Speaker 1
Let's work together to help keep children safe.