Dear I Nauheimer,

Thank you for your Freedom of Information enquiry, our reference
FOI/2019/1049.

The Trust’s response is as follows:

 1.Do health visitors and school nurses in Hertfordshire Community NHS
Trust receive information about ALL children that attend unscheduled care,
such as A&E or MIUs, in West Hertfordshire Hospitals NHS Trust, regardless
of the reasons for attending? Yes, this is undertaken by a bulk-upload
solution that uploads limited information onto the SystmOne health records
of all children 0 – 18 years who attend A&E or unscheduled care in West
Hertfordshire. . A vulnerability assessment process/pathway has been
developed that results in an e-mail alert to the duty health
visitor/school nurse team of attendance due to concerning presentations,
time of attendance ( 00.00 hours – 07.00 hours) or identified
vulnerabilities of the child that are identified through age, SystmOne
icons (CPP; CIN; LAC; Special needs). This allows a follow up upon risk
assessment to be considered in a timely way.

2.Could you provide copies of policy documents where the data sharing
policy, between Hertfordshire Community NHS Trust and West Hertfordshire
Hospitals NHS Trust, regarding children that attend unscheduled services,
is described? Sharing of information has been agreed by the Information
Governance & Data Protection Officers of both Trusts and using the NHS
England information sharing. A whole systems guidance was agreed between
both trusts (attached)

3.How is the information about children that attend unscheduled care in
West Hertfordshire Hospitals NHS Trust, passed on to health visitors and
school nurses in Hertfordshire Community NHS Trust (e.g. via email,
specialist software, fax)?  The information is uploaded directly onto the
child’s SystmOne health records via the data warehouse in the Child Health
Information Services. This process is all electronic. The e-mail alerts go
to the duty health visitor or school nursing team to where the child
lives. The whole process is secure.

4.a)When health visitors and school nurses receive information about
children who have attended unscheduled care (e.g. A&E and minor injuries)
in West Hertfordshire NHS Trust, I understand the Paediatric Liason IT
Solution is used to process the information. As part of this processing,
attendances at unscheduled care are filtered and flagged to identify
vulnerable children. Could you list all the filters or criteria that are
used by health visitors or school nurses to flag vulnerable children? As
cited in Appendix 1 of the whole systems guidance:

The Filter Criteria for the bulk up-load process

Filters applied by WHHT

1. All children under 1 year

2. All attendances between midnight and 06.59

3. All children with more than 3 attendances in A and E within last 6
months

4. All children where treatment:

•             Burns and reviews

5. All children where

Referral Source in:

•             Local Authority social Services

•             Police

•             Emergency services

Patient Groups :

•             Assault

•             Deliberate self-harm

•             Other accidents

•             Bought in Dead

Removal:

•             Died in department

•             Left department before being seen for treatment

•             Left department having refused treatment

Recode filters from SystmOne:

•             Any A&E attendance summaries on infants under 1-year

•             If there are three A&E attendance e in a 6-month period

•             Attendance between 12 mid-night – 06.00 hours.

•             Any child with a Child Protection or vulnerability icon in
place (ie CIN, special Needs  

And LAC.

•             Any child under Universal Plus or Universal Partnership Plus
service provision.

4.b)Could you provide copies of all policy documents and guidance
documents used by staff that describe and list these filters or criteria
used by school nurses and health visitors to identify vulnerable children
that have attended unscheduled care? See attached

5.Do all the children that are identified and flagged as vulnerable by
health visitors and school nurses, have information about them shared with
Hertfordshire County Council (including children's services and
education)? No, information is only shared when requested by HCC when
consent is agreed by parent and carer and is proportionate and in the best
interest of the child. Health professionals will share information with
HCC when the child is at risk of serious harm and safeguarding concerns
are identified, or when support is identified. Depending on the threshold
a CP referral may be made or a child in need of support services. Both a
completed electronically and ideally with parental consent unless this is
not in the best interest for the child as per HCSP and HCT policy.

6.If not all the children that are flagged as vulnerable by school nurses
and health visitors have information shared with Hertfordshire County
Council, then which of those categories of children that are flagged as
vulnerable have information about them shared with Hertfordshire County
Council (including children's services and education)?  As per question 5

7.How is information about the children that are flagged as vulnerable by
school nurses and health visitors, shared with Hertfordshire County
Council (including children's services and education)? (e.g. email, fax,
specialist software system) Depending on the situation, this can be
undertaken either by phone directly to customer services or directly to
the allocated social worker, in writing via e-mail or referral.

8.Could you provide copies of all policy documents that describe and list
which children that have attended unscheduled care (e.g. A&E and minor
injuries), have information about them shared by health visitors and
school nurses, with Hertfordshire County Council (including children's
services and education)? Attached

9.a)Are there any categories of children that always have information
about them shared with Hertfordshire County Council (including children's
services and education) by school nurses and health visitors, regardless
of the reasons for attending unscheduled care? No, this depends on the
information but most attendance of Children with CP Plans will be shared
with the allocated social worker.

9.b)Could you provide copies of all policy documents that describe these
categories of children? N/A

10.a)Do children that are NOT identified and flagged as vulnerable by
health visitors and school nurses after attending unscheduled care, have
information about them shared with Hertfordshire County Council (including
children's services and education)? Not usually unless there are concerns
in the information shared and following the risk assessment a referral may
be deemed necessary.

10.b)Could you provide copies of all policy documents that describe these
categories of children? Attached

11.) If there have been any changes to policy regarding how information
about children that attend A&E, is shared with Hertfordshire County
Council, since January 2013, could you please provide any documents that
describe the changes and the reasons for the changes? No changes.

Please note that the information provided remains the property of
Hertfordshire Community NHS Trust and is therefore subject to Intellectual
Property and Database Rights. In view of the Re-use of Public Sector
Information Regulations, should you wish to re-use this information for
commercial reasons, you are advised to obtain permission from us.
Agreement to use the information for commercial reasons may incur a fee as
the information is issued under licence. If you have any questions about
the process, please do not hesitate to contact the Information Governance
team in the first instance.

If you require further information please contact the Information
Governance team. If you are dissatisfied with this response or wish to
appeal, please write to:

The Company Secretary

Hertfordshire Community NHS Trust

Unit 1A Howard Court

14 Tewin Road

Welwyn Garden City

Hertfordshire

AL7 1BW

If you still remain dissatisfied with our response, you may appeal to the
Information Commissioner whose contact details are available together with
further information about the Freedom of Information process at
[1]www.ico.org.uk

Kind Regards,

Information Governance

Hertfordshire Community NHS Trust

Howard Court | 14 Tewin Road | Welwyn Garden City | AL7 1BW

FOI: [2][email address] | Access to Records: hct.[3][email address]

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