3.14 Managing Concerns about children and Young People (C&YP) where there are Medical and/or Complex Health issues and Escalating Safeguarding Concerns


The scope of the protocol relates to all individuals who work as ‘professionals’ with children, young people (YP) and carers in Norfolk and Waveney whether they are working in a paid or voluntary capacity in the statutory or voluntary sector. The protocol is to assist practitioners in working in a timely and coordinated way to underpin effective joint working, timely assessment and decision making where there is a child or YP with medical and/or complex health issues and escalating concerns about the child or YP’s welfare and/or safety.


Children with a disability or additional health needs can present challenges to the parents and carers, and can place great demands practically, emotionally and potentially financially on the parents/carers. Evidence suggests that disabled children are particularly vulnerable to abuse and neglect and the primary focus of interventions may be on a child and YP and their medical/complex health condition, indicators of abuse may be misinterpreted and the risk of significant harm go unrecognised (Department for Education (DfE) 2016). Moreover, children may be at risk of significant harm where they are present as follows:

  • Refusal and/or non-compliance with medication and/or treatment and understanding the impact of this on the child or YP e.g. Diabetes, Epilepsy, skin conditions, chronic head lice, Asthma, physical or learning disabilities.
  • Exaggeration / misinterpretation of chronic health conditions.
  • Recurrent attendances at Accident and Emergency Departments and/or avoidable admissions due to failure to adhere to medical advice.
  • Children with escalating emotional/behavioural issues which may include self-harm.
  • Child and YP not brought for Health appointments/dental appointments.
  • Lack of parental engagement with the child or YP’s therapies e.g. Child and Adolescent Mental Health Services, Speech and Language Therapy, physiotherapist.
  • Child or YP with escalating eating disorders.

This Protocol should be read in conjunction with:

2. Principles of Practice:

The philosophy of care should be based on supporting parents and strengthening families (DfE/Department of Health (DH) 2004). Practice should focus on keeping the child or YP at the centre of care planning using the Signs of Safety Framework (SoS) and Graded Care Profile (GCP) where appropriate. Where there is evidence of rapidly escalating medical or complex health issues the emphasis should be on the early identification of concerns and risks and a joint multi-agency assessment and agreed interventions to ensure a coordinated and timely response to the child or YP’s needs and the safeguarding concerns.

For professionals working with C&YP with medical/complex health and social needs, the NSCP Neglect Strategy and GCP should be embedded in practice and form part of the assessment process.
In the event of a young person or parent / carer refusing to give consent to information sharing and/or medical treatment, the practitioner needs to:

  • Act in the best interests of the child or YP.
  • Seek urgent safeguarding supervision or line management advice.
  • Work in accordance with section 47 safeguarding processes.

3.  Appendix