Children visiting inpatient and residential units within the trust policy

1 Introduction

Maintaining contact with children, it is important that any child or young person who has a significant relationship with someone who is an inpatient within trust services is able to maintain contact during the inpatient stay. However, in maintaining this contact consideration must be given to the therapeutic benefits of any visit to both the child, and patient, and the suitability of the environment in which the visit is to take place.

Duties, the trust has specific duties under section 11 of the Children Act 2004 to make arrangements to safeguard and promote the welfare of children and is committed to these responsibilities.

Written policy, the Mental Health Act 1983 and its revised Code of Practice (DoH, 2015, chapter 11) states that Hospitals should have written policies on the arrangements for visits by children, and that these should be drawn up in consultation with local authorities and local children social services. A visit by a child should only take place following an assessment that concluded that such a visit would be in the child’s best interests. Decisions to allow such visits should be regularly reviewed.

Planning the visit of a child, in planning their visits, ‘the safety of the children concerned will be the paramount consideration. Child-friendly environments should be provided to facilitate visits by younger children. It is noted within the Mental Health Act 1983 Code of Practice (11.21) information about visiting should be explained to children and young people in a way that they are able to understand. The maintenance of contact with family and friends, and respect for privacy in these contacts is especially important, subject only to consideration of the safety and well-being of the patients and their families (DoH, 2007).

To allow or deny a visit, the decision to allow or deny planned visits will be based on risk assessment. In general, decisions will be easy to make and will support the planned visits of children. However, in a minority of cases where risk assessment identifies concerns, detailed planning will be required, which may involve other agencies. In accordance with the Children Act 1989 and the Children Act 2004, the welfare of a child is paramount and takes primacy over the interest of any and all adults.

Local safeguarding policies, this policy should be read in conjunction with the trust’s safeguarding children policy and local safeguarding children services (The Children’s Multi Agency Resilience and Safeguarding (CMARS) board in North Lincolnshire, the Rotherham Safeguarding Children Partnership and the Doncaster Safeguarding Children Partnership) policies and procedures which apply in the geographical locations in which the trust provides services.

Definition of a child, in this policy as defined in the Children Acts of 1989 and 2004, ‘a child is anyone who has not yet reached their eighteenth birthday’. Therefore, the term ‘children’ as used throughout this policy means ‘children and young people.’

Safeguarding, to safeguard is a term used to denote measures to protect the health, well-being and human rights of individuals, which allow people especially children, young people and vulnerable adults to live free from abuse, harm and neglect.

Is the child related to the patient? there are times when a residential unit or an inpatient unit is approached by a child requesting to see a patient. It is highly recommended that the parent or the authority with Parental Responsibility is contacted to seek permission. It would be recommended that the RDaSH Safeguarding Children’s team is consulted with and to seek advice.

What is parental responsibility? all mothers and most fathers have legal rights and responsibilities as a parent which is known as ‘parental responsibility’ parental rights and responsibilities (opens in new window). Some of the patients within RDaSH inpatient settings are parents of course.

In the case of a child who is looked after and subject to a care order (with parental responsibility shared by the local authority and parent(s)), the local authority has a responsibility for providing consent (following consultation with those with parental responsibility). Where a child is looked after but not subject to a care order, the person with parental responsibility is required to give their consent.

The RDaSH Safeguarding Children’s team can offer further support clarity and guidance.

2 Purpose

The purpose of this policy is to:

set out the trusts standards and expectations in respect of children visiting
ensure that the interests and safety of any children visiting are protected at all times
provide guidance to staff on how to reach a decision regarding the appropriateness of such visits so that they have a clear understanding of their roles and responsibilities, the emphasis of which is on the importance of facilitating contact between children and their family and friends
reinforce the good practice required so that the needs and interests of children as well as patients are taken into account by:
- formulating and implementing care plans in professional practice
- the provision of appropriate facilities for when children visit

The contents of this policy also support the policies and procedures set out by the local Children’s Multi Agency Resilience and Safeguarding (CMARS) board or Safeguarding Children Partnership’s in the geographical locations in which the trust provides inpatient or residential services, and supports the trusts safeguarding children policy.

3 Scope

This policy sets out the trusts approach to ensuring legal requirements are met and best practice is adopted regarding arrangements for patients within inpatient and residential settings across the trust.

Every member of staff has an individual responsibility for the protection and safeguarding of children. All levels of management within the trust must understand and ensure the implementation of the children visiting inpatient and residential units within the trust policy.

4 Responsibilities, accountabilities and duties

4.1 Chief executive

Overall accountability for the policy for children visiting inpatient and residential units within RDaSH lies with the chief executive.

4.2 Care group directors who provide inpatient services

Care group directors who provide inpatient services are responsible for:

disseminating this policy to modern matrons or service managers’
the implementation of the policy
monitoring and reporting on compliance with the contents of this policy through the care groups
instigating the investigation of any reported instances of non-compliance with the contents of this policy
identifying the appropriate level of training required for staff using the Safeguarding Children and Young People: Roles and Competencies for Health Care Staff, Intercollegiate Document 2019 (Royal College of Nursing)

4.3 Modern matrons or service managers

It is the responsibility of the modern matrons or service managers to:

disseminate this policy to ward managers or team leaders
oversee the implementation of the policy
monitor and report on compliance with the contents of this policy within their service
assist in the investigation of any instances of reported non-compliance with the contents of this policy
apply the guiding principles (5.1 within this policy) into their practice for children visiting inpatient and residential units
monitor staff compliance with the identified training requirements for safeguarding children

4.4 War managers or team leaders

Ward managers or team leaders are responsible for the dissemination of this policy to clinical staff and its implementation and monitoring within their team.
Apply the guiding principles (5.1 within this policy) into their practice for children visiting inpatient and residential units.
They are also responsible for the release of staff to attend safeguarding children training as mandated on the individual staff members mandatory and statutory training (MaST).

4.5 Clinical staff working within the trust inpatient and residential units

It is the responsibility of clinical staff working within the trust inpatient and residential units to:

be aware of and implement the contents of this policy
apply the guiding principles (5.1 within this policy) into their practice for children visiting inpatient and residential units
consider the needs and arrangements for any children involved with the patient as part of the admission assessment and ongoing care of the patient. This should also include details of any child as well as any safeguarding concerns, and services already involved with the child or children
attend safeguarding children training as mandated on the individual staff members mandatory and statutory training (MAST)

4.6 Approved mental health professionals (AMHP)

As part of the AMHP’s role, the AMHP should consider in the case of patients who are subject to voluntary (s.131 Mental Health act 1983) or compulsory admission under the Mental Health Act 1983 (also noted in point 5.2.1 of this policy) the following:

as part of the AMHP’s assessment, the needs and arrangements for any children associated with the patient are considered
the details of any children associated with the assessed patient should be identified along with any safeguarding concerns and services which are involved with the children
as part of the AMHP’s role and responsibilities, should there be concerns about the safety or care arrangements of the child or children, the approved mental health professional must consult with or request that children social care services undertake an assessment
to communicate the details of any children associated with the patient who is being admitted into an inpatient or residential unit to the clinical team responsible for that patient

4.7 Named nurses or professionals for safeguarding children

The named nurses or professionals for safeguarding children are responsible for providing specialist advice and support to clinical staff in respect of any concerns about the safety and wellbeing of a child or young person.

5 Procedure or implementation

5.1 Guiding principles

The following principles need to be considered with regard to children visiting inpatient and residential units:

maintaining contact with children, it is important that any child or young person who has a significant relationship with someone who is an inpatient within trust services is able to maintain contact during the inpatient stay. However, in maintaining this contact consideration must be given to the therapeutic benefits of any visit to both the child, and patient, and the suitability of the environment in which the visit is to take place
any decisions involving children visiting must take account of the needs and wishes of the child as well as the patient
the views of those with parental responsibility (in some cases the local authority) are to be taken into consideration
to take into consideration the patient’s history and family situation
to take into consideration the patient’s current mental state (which may differ from an assessment made immediately prior to or after admission)
to take into consideration the response of the child to the patient’s mental distress or mental state. Would there be any long-term impact on the child? And would delaying a visit be in the best interest of the child?
the risk assessment process should swiftly ascertain the desirability of contact between children and patients, identifying any concerns and assessing any risks to the child
the process for facilitating children visiting should not be bureaucratic, nor cause delay. It should be supportive of both child and adult and maximise the therapeutic value of such contacts, whilst ensuring that the child’s welfare is safeguarded
all inpatient and residential unit services should ensure that there is an environment that is conducive to children visiting

5.2 Pre-admission

5.2.1 Patients subject to detention under the Mental Health Act 1983

When a compulsory admission of a patient is being considered, the needs and arrangements for any children involved with the patient will need to be taken into account and is usually part of the approved mental health professional’s assessment. This should also include details of any child safeguarding concerns, and services already involved. This information must be communicated to the inpatient clinical team responsible for the patient.

5.2.2 Voluntary patients within services inpatient services

If it is a planned admission, the needs and arrangements for any children or young people involved will need to be considered as part of the pre-admission assessment. This should also include details of any child safeguarding concerns, and services may already involved. For example, a health visitor, a school nurse, Early Help support and leads and any children’s social services. For help in identifying support that may be around the child or the family, seek support from the RDaSH Safeguarding Children’s team. This information will then be communicated to the inpatient clinical team responsible for the patient.

5.2.3 Unplanned or emergency admissions within inpatient services

In the case of unplanned or emergency admissions, the needs and arrangements for any children involved will need to be considered as part of the admission assessment. This will need to include the details of any child, any safeguarding concerns, and services already involved such as health visitors, school nurses and children’s social services.

5.2.4 Adult general inpatient services

It is recognised that within inpatient wards supporting children visiting is an intricate part of the delivery of care which is provided to both the patient and their family, with the emphasis upon facilitating the contact between patients and their children. In the first instance, the decision to support children visiting will be achieved through considering any risk that would impact on a child visiting a patient during the admission. Where this assessment indicates concerns, the modern matron responsible for the service is to be informed, and then complete a formal risk assessment for which further guidance may be sought within the main body of this document.

5.3 On-admission

On admission to the ward the admitting nurse will make sure that any information gained preadmission in respect of any children involved with the patient is available in the clinical records. The admitting clinician will also give the patient details of the trust arrangements for children visiting, and such visits should be planned in advance. It must also be made clear to the patient and their carer that visiting by children will only be allowed if supervised by an adult, (not the patient) who is preferably a family member or the adult with parental responsibility, and that the accompanying adult is responsible for the child’s safety whilst visiting any of the trusts inpatient facilities.

To note 5.1 guiding principles within the policy.

5.4 Visiting arrangements

When a visit by a child or young person is anticipated, the multi-disciplinary team (MDT) should identify any concerns, taking into account information received and the completed risk assessments. Some issues which may need to be considered are:

the wishes and feelings of the child
the age, capacity and overall emotions of the child
consideration for the child’s best interest
the views of those with parental responsibility (this may not always be the biological parent or parents)
the patient’s history and family situation
to take into consideration the patient’s current mental state
to take into consideration the response of the child to the patient’s mental distress or mental state. Would there be any long-term impact on the child? And would delaying a visit be in the best interest of the child?
the risk assessment process should swiftly ascertain the desirability of contact between children and patients, identifying any concerns and assessing any risks to the child
the nature of the care environment and the patient population at the time

In the vast majority of cases where no concerns are identified, arrangements should be made to facilitate contact.

All decisions following risk assessment must be documented in the healthcare or clinical care records regarding children and young people visiting the individual.

5.4.1 Appropriate environment for the visit

Some services within the trust have designated family visiting rooms and these are to be used for any visit by a child or young person. It is expected that these services will have in place a locally agreed booking system for the family visiting room to allow visits to take place in privacy.

Facilities provided for visitors should be comfortable and welcoming and, for children, child friendly.

Within other services the location of the visit should be considered carefully, and where the ward environment or the care needs of patients would be likely to affect the visit, or create risks, arrangements should be made for the visit to take place away from the ward area.

Staff should be sensitive to the need for privacy, whilst taking into consideration the need to manage risk where appropriate.

Within the mental health and learning disability ward areas, children, as with all visitors, will not be permitted within the bedroom areas and in some cases not onto the ward.

5.4.2 Supervision arrangements for the visits

The multi-disciplinary team, based on all the available information, should determine the degree of supervision required for the visit.

Where supervision of a child is deemed necessary because of protection or welfare concerns in relation to a patient, this should be provided either by a responsible relative or by social services children and families services. At no time should trust staff accept responsibility for supervising a visiting child.

Within the mental health and learning disability services an assessment and review regarding children visiting an individual should be carried out at each MDT review meeting, and visits will be subject to any restrictions under the trust policy for the care of service users who are identified as being a significant risk to themselves or others.

5.5 Decision to refuse a visit

Decisions to refuse visits will only be taken exceptionally and should where-ever possible be made by the multi-disciplinary team. In exceptional circumstances, the nurse or clinician in charge of the ward may make this decision and should discuss this at the first available opportunity with the MDT.

Any decision to refuse a visit is to be given in writing as well as verbally and will need to be supported by clear evidence identified through risk assessment and recorded on the decision to refuse visit shown in appendix A. It is necessary for appendix A (children visiting inpatient or residential unit record of decision to refuse visit) to be completed and to be attached to the patients SystmOne record.

It is important that all involved with the child are consulted and advised of the decisions. It is anticipated that these decisions will be subject to review and any changes will be swiftly communicated to all concerned. This process must be visible and transparent, ensuring that the patient and others have the right to challenge any decision that is made. Further advice should be sought from the trust named nurses or professionals for safeguarding children and staff should refer to the trust intranet site for contact details.

Circumstances where a decision to restrict a visit may be made include:

where there is a clearly identified risk to the child of distress or emotional harm due to the patient’s mental state
risk of verbal or physical harm to the child
child witnessing domestic abuse type behaviours between parent or relative
actual or perceived risk of sexual harm
risk of exploitation of the child by the patient for example, where the action of the child puts the adult patient at risk, such as the bringing in of unauthorised medication, razors etc
in the case where there is failure to agree between the ward staff and the adult family member that they will supervise the child during visiting
where there is an infection outbreak on the ward or residential area

There may be occasions particularly when the patient is in the psychiatric intensive care unit (PICU), forensic unit or rehabilitation and recovery unit when it is not safe for a child to visit and alternative arrangements cannot be made. In this instance, alternative (such as virtual means) arrangements could be made.

5.6 Safeguarding children

Where staff have concerns regarding the safety or welfare of a child, the named nurse or professional for safeguarding children can be contacted for specialist advice.

If an immediate risk has been identified, and depending upon the urgency, the police are to be called and staff are to refer the matter to

Children’s social services. Children’s social services polices and documentation can be accessed through the safeguarding children’s page on the trust intranet or type into a search engine “worried about a child in … “ your locality area such as North Lincolnshire, Doncaster, or Rotherham.

6 Training implications

Familiarisation of this policy is critical and is to be part of inpatient or residential staff ward or residential based induction and the dissemination of policy through team or ward meetings.

Attending safeguarding children and adults training is mandated on the individual staff members mandatory and statutory training (MAST) or NHS electronic staff record (ESR). The trust complies with the Royal College of Nursing’s Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff Fourth edition: January 2019, intercollegiate document.

Safeguarding training starts from induction of new staff and continues on an ongoing basis. Compliance can be achieved using the blended learning approach via the RDaSH learning and development intranet.

7 Monitoring arrangements

7.1 Any incidents which occur in respect of children visiting the trust inpatient wards or residential units

How: Investigation of any reported incidents completion of incident report (IR1).
Who by: Modern matron or service manager for the area.
Reported to: Children safeguarding nurse or professional for the relevant locality.
Frequency: As and when there is a reported incident.

8 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

8.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, ‘not just clinically but in terms of dignity and respect’.

As a consequence the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

8.1.1 How this will be met

There is no requirement for additional consideration to be given with regard to privacy, dignity or respect.

8.2 Mental Capacity Act

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals capacity to participate in the decision making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

8.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005) (section 1).

9 Complaints

A formal system for considering representations about any decision not to allow a child to visit would be initially done by letting the member of staff delivering the service or their manager know that you are unhappy, so they can put things right at the time whenever possible.

However, it is understood that you may not always feel comfortable doing this therefore, you can contact the patient advice and liaison service (PALS), who can support you by contacting the service on your behalf. PALS can be contacted on:

Telephone: 0800 015 4334
Email: rdash.pals@nhs.net

More information can be found on our feedback and complaints page.

You can contact an advocate (details of how to contact Advocacy Services are detailed below) who offer a free, professional support service to those wishing to pursue a formal complaint about the National Health Service (NHS). If you are still unhappy you can make a formal complaint in writing, you do not need to write a very long and detailed letter, but you should include all the points you want to complain about. If you are unable to put your complaint in writing, you can contact the Patient Safety and Investigation team, and speak with the duty lead investigator, who will listen to your concern, and will make a typed account of your complaint. This will be sent to you to check for accuracy and to sign.

10 Links to any other associated documents

11 References

Children Act (1989) (accessed 23 July 21) (opens in new window).
Children Act (2004)(accessed 23 July 21) (opens in new window).
Department for Education (2018) Working Together to Safeguard Children, a guide to interagency working to safeguard and promote the welfare of children (accessed on 23 July 21) (opens in new window).
Department of Health (2007) Best Practice in Managing Risk (accessed 23 July 21) (opens in new window).
Department of Health (2015) Mental Health Act 1983 Code of Practice: Guidance on the Visiting of Psychiatric Patients by Children (accessed 23 July 21) (opens in new window).
Department of Health (2019) Guidance on the High Security Psychiatric Services (Arrangements for Visits by Children) Directions 2019 (accessed 23 July 21) (opens in new window).
Fallon, P, Bluglass, R, Edwards, B and Daniels, G (1999) Report of the Committee of Inquiry into the Personality Disorder Unit, Ashworth Special Hospital. London: The Stationary Office.
Royal College of Nursing (2019) Safeguarding children and young people: roles and competences for health care staff Intercollegiate Document. [Online] (accessed 23 July 21) (opens in new window).

12 Appendices

12.1 Appendix A

Appendix A Record of decision to refuse visit

Document control

Version: 9.
Unique reference number: 366.
Approved by: Clinical policy review and approval group.
Date approved: 5 October 2020.
Name of originator or author: Named nurse safeguarding children.
Name of responsible individual: Executive director of nursing and allied health professionals.
Date issued: 20 October 2021.
Review date: October 2024.
Target audience: Clinical staff within the trust inpatient and residential units.
Description of change: Scope reduced to provide more clarity, section 9 added covering complaints and other minor amendments.

Page last reviewed: April 30, 2024
Next review due: April 30, 2025

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