mashSome local authorities are now implementing the MASH information sharing model – and lives could potentially depend upon its success. Andrew Chilvers reports.

In my first report on MASH (multi-agency safeguarding hubs) in the last issue I explained why information sharing is crucial for helping to overcome previous failings in protecting children. I also showed how this information sharing works between organisations and across boroughs.

Here, I look at the practical application of the MASH – with a particular emphasis on Devon County Council Social Services, and the Devon and Cornwall Police where the MASH has been pioneered – and how data is used for improved risk analysis and outcomes. Elsewhere, I highlight the work of a frontline health practitioner who was responsible for building the MASH from a health perspective at the North East London NHS Trust in Havering.

Going forward, and as with all early innovations, the MASH approach will undoubtedly bring challenges and raise questions. Many hope the MASH model has learned valuable lessons from the past and can now move forward and offer an effective way to implement modern safeguarding practice. This is really important because safeguarding children remains one of the most difficult of all practice areas, and reports show that successful information sharing
models need to work now more than ever.

MASH – a frontline perspective

When the NHS Confederation published its report on child health and wellbeing last December, a common thread running through the publication was the failure of the health service and its partners to protect children from abuse, violence and sexual exploitation. The report concluded that England has one of the highest mortality rates in Europe for children aged up to 14 years old; some 10% of children between five and 16 have a mental health problem; and England and Wales currently have the highest birth rate in 40 years, adding to pressure on all agencies.

Furthermore, according to the report, previous failings in safeguarding illustrate the dangers of a disconnected system and unclear procedures. Indeed, the reforms and reorganisation of the NHS have resulted in a greater degree of uncertainty around safeguarding. To overcome this confusion and concern, many in the health service have long believed that sharing information across organisations is not only essential to keep children safer, but is also, as the Confederation report confirms, a “statutory duty for all health and care organisations”. The report also says that serious case reviews repeatedly cite challenges relating to information as a factor of an “unsafe system”.

One of the report’s key recommendations is that “multiprofessional teams – working together, sitting in each other’s offices, sharing information – should become the norm.” It adds, “If social workers, health visitors and school nurses could do this, it would improve efficiency and should support the scaling up of early intervention.” The MASH approach, therefore, is one way of taking forward that recommendation.

Havering MASH – a health perspective

The London Borough of Havering convened a strategic meeting looking at how the MASH could operate. Afterwards, the health safeguarding lead decided that the health service in the borough should play a vital part of the formation of the MASH in Havering from the beginning, working closely with its partners in social care, the police and education. The day-to-day task of scoping the Havering health side of the MASH involved Anna Jones, a designated nurse for safeguarding children at NHS North East London and the City in Havering, who has been the project lead since February 2012.

For health professionals like Jones, early involvement in the MASH meant working together with colleagues in other organisations, and understanding how information sharing would work across the team. This was particularly important within a health context, as Jones was able to present briefings to health partners and assist social care workers in their understanding of health organisations and roles.

“When the MASH was set up in other areas across London, health wasn’t always included in the first round and came in at a later stage, which can make  things difficult,” Jones admits. “It is not that they weren’t included in safeguarding, but they weren’t thought of in relation to getting the MASH up and running.”

Implementing MASH within a health context

One of the tasks for Jones was to highlight the complexity of the wider health economy to her multiagency colleagues. This health economy includes the NHS as well as various health provider organisations, commissioning structures and IT systems across the borough. In Havering alone there are nine different IT systems working across health, which is not unusual.

“Sometimes you say health, but people perceive health as one organisation and are not aware of the different components like mental health acute trusts, community providers and GPs, for example,” Jones said. With membership of the MASH, she allocated several hours of her week to spending time working with her colleagues in establishing the requirements from a health perspective: “Initially, I gave up half a day per week to see how social care was working within a triage system.

“That helped me to identify what was needed from a health perspective regarding capacity – i.e. the necessary skills and experience of the health lead in the role – and other issues such as IT systems, confidentiality and ensuring that NHS London was kept up to date.”

The role of nurses

It quickly became clear that more than one health post within the MASH was needed in Havering. Jones recommended that more funding was required and that two part-time band 7 nurses would be needed to manage the health information and analyse the risks with the MASH partners. The role involved liaising with health practitioners (including GPs, health visitors and acute hospital trusts) and assessing the referrals that came through the door. A thorough knowledge of the local health economy and networks was also essential to address any concerns about a child or young person, and be able to challenge any decisions if appropriate.

Jones’s role now includes the supervision of health visitors working within the MASH regarding their safeguarding roles and implementing an escalation policy. Recently she has also co-presented a MASH health workshop at the London Safeguarding Children Board and is MASH lead for NHS London alongside the police MASH leads.

The way forward

Jones is adamant that the MASH is the only way forward for safeguarding children: “After Baby Peter and Victoria Climbie nothing really improved even though there were reams of recommendations. I think because of the efficiency savings, people are now all together in one hub, securely, and that has to help.”

Moreover, the two health visitors who started in October 2012 are already seeing benefits: “For example, they became aware of a mother who was experiencing depression that nobody else in health was aware of, apart from the GP. That enabled the health visitors in the MASH to expedite that information to another health visitor colleague in another area, which in turn enabled the records of the child to be transferred more rapidly. Then the GP communication occurred which enabled earlier intervention to the mother and child.” 

Likewise, GPs are beginning to become involved with the MASH: “Their main fears were around sharing information and the confidentiality issue, which does cause some anxiety. But explaining to them during training sessions, visiting them and going over it again, really helped and because the two health visitors are now making contact with GPs, they are aware who they are talking to and it is breaking down those barriers.”

Devon MASH – a social services perspective

In 2010/11 some 620 children and young people in Devon were in care and 431 had a child protection plan. Two years ago a further 4,318 were defined as children in need. It was with this background in mind and in a context where families were moving across local authority and county boundaries within Devon and Cornwall, that the MASH was created.

Several key components were identified as necessary for the initial Devon MASH model, including:
 ● A strategic buy-in
 ● Clear governance
 ● Specific aims and terms of reference
 ● Willingness to share and overcome issues
 ● Sufficient staffing
 ● Co-location of agencies and specialists
 ● Infrastructure provision.

Kate Soutter joined as Operations Manager at the Devon MASH and already sees clear benefits of information sharing, with the team managing 20 referrals a day. “For me it’s new to have agencies sharing information, but still having ownership of that information and having confidence that it will only be shared outside of the MASH if there’s a need to do so,” she said. “It enables people to focus on children rather than worrying about the information they’re sharing or that it might be used for anything different. It ensures that children and families are at the centre of everything we do.”

For Devon, it was vital to have a wide ranging number of agencies to give all team members a more “holistic” view of the children involved.  “There’s a lot of work to be done, but it’s about taking a new look at things and challenging people’s way of intelligence sharing,” Soutter said. “In the MASH I sit next to police officers and know what they need from referrals and how our processes need to adapt to take that into consideration.”

Assessment challenges in Devon

Devon County Council is a varied landscape covering urban as well as sparse rural areas, and tracking troubled families and children can be difficult across such a geographical spread. “Child sexual exploitation is a huge area that is developing right now in the national agenda, and has to be tackled,” Soutter adds. “Devon has taken a lead in employing an advanced professional to more effectively identify and work with missing children, and children at risk of sexual exploitation.

“There are specific areas, particularly around missing children and children at risk of sexual exploitation. It’s important that people are aware enough to go out there and do proper assessments, identify children at an early stage of risk.”

Furthermore, Soutter and her colleagues in the MASH want to support the development of partnerships across the southwest, including other authorities in Torbay, Plymouth and Cornwall. “There’s definitely a wish for a peninsula approach to developing our response to key areas, so we have a universal approach. We all experience similar demographics and geography, so it makes sense to pull all this together, pooling knowledge and experience,” she explained. 

She admits that developing a relationship with Torbay and Plymouth is a work in progress: “There are issues with cross-boundary families and agencies. But we’re always going to have families that move across boroughs and across counties. The aim is to make sure we don’t have any restrictions when it comes to safeguarding those children.” 

Commissioning and cost savings

Elsewhere, the MASH has clear cost saving benefits for commissioning services. One aspect vital to the MASH has been to streamline IT processes. To this end, Devon has partnered with a software provider to pioneer a MASH technology to play a critical role in identifying vulnerable children and the troubled families of the future. The idea is to use IT – in Devon it’s called MASHProtect – to help shape effective commissioning of preventative services.

“There’s a huge amount regarding commissioning information being gathered,” Soutter said. “How can we utilise that information? We should be using that and asking where is the high level of need, where are those needs and how to use the services we’ve got?”  To improve commissioning, Devon has carried out work around the cost analysis of troubled families, by asking, for example: “How much are these families costing us? If we intervene earlier we could be safeguarding risk and reducing the cost across the partnership. That’s education, health, the third sector, and the voluntary sector.

“It’s a really hard-hitting, fascinating piece of work in terms of what can be done regarding safeguarding and also saving money. So with MASH – along with positive outcomes for children and families – what I’d like to see is a real impact on the types of services that we provide, how we provide them, and the quality of the way in which we interact with children and families.”