National Child Protection Inspections: 2019 thematic report

Foreword

Her Majesty’s Inspectorate of Constabulary and Fire & Rescue Services (HMICFRS) has been inspecting the child protection work of every police force in England and Wales since 2014. We do this as a single agency and alongside other inspectorates. The reports we publish are intended to provide information for the police, police and crime commissioners (PCCs), other safeguarding agencies, the government and the public on how well the police and their partners protect children and secure improvements for the future.

This is our second thematic child protection report. The first, in 2015, showed that despite clear commitment and some progress much more needed to be done to ensure that all children in need of help and protection received the right help at the right time.

I am pleased to say that since then we have continued to see an unambiguous commitment from police leaders, officers and staff to the protection of children. We have also found improvements (in some instances significant improvements) in the service received by children at risk. We have found that signs of vulnerability are more effectively recognised, and the assessment of risk is generally better. We have found that, broadly speaking, partnership working has matured and the quality of multi-agency planning and decision making has improved. This has resulted in improvements in the outcomes for some, though not all, of the most vulnerable children.

Responding promptly and effectively when children are abused or exposed to obvious risk is essential. However, this is only the beginning of effective safeguarding. It is not its definition nor its limit. Children deserve to be given the opportunity to thrive and realise their full potential. They are entitled to grow up in a safe environment, cared for and protected from harm. Many children have this. They are cared for by loving families and grow up cherished and unharmed, but far too many do not. Too many children are abused or neglected either by those responsible for their care, by other adults or other children. Some of them occasionally go missing, or end up spending time in places, or with people, that are harmful to them. However, children also lead increasingly sophisticated and complex lives. The availability of technology and accessibility of the internet and social media platforms have blurred online and offline spaces and realities. Children are now more connected with others than has previously been the case. While there are huge opportunities associated with the increasing interconnectedness of children’s lives with the wider world their enhanced visibility also presents risks.

Police leaders are now more aware of this complexity and the increased demand it creates. And while we found that the police and other agencies have been working hard to improve their responses to children in need of help and protection, we found that in many cases progress is too slow. Our inspections continue to find many of the same problems challenging forces and their partners again and again. This is in large part because the approaches of the police and their partners continue to be reactive with decisions based on the most recent incident. Too little emphasis is placed on identifying underlying issues or the cumulative impact on a child of multiple repeated instances of trauma. We have been pleased to find examples of innovative work taking place to protect vulnerable children at an earlier point in their lives. In Wales, the police are part of a programme to give early support to children exposed to adverse childhood experiences (ACEs).

ACEs are stressful events that occur during childhood, such as homelessness, domestic abuse or having a parent who is an alcoholic or abuses drugs. Children who have several adverse childhood experiences (or a single one that recurs) are more likely to need substantial, continuous support. Research shows that, in these cases, there are benefits to intervening early in a way that recognises the cumulative impact of trauma over time.

In England, the approach to early intervention isn’t consistent. The Vulnerability Knowledge and Practice Programme (VKPP) aims to address this by evaluating best practice. The government could help this work by recognising and promoting the benefits of early intervention by people who understand trauma.

The demands faced by the police are increasing constantly. The police along with other public sector agencies are facing increasing challenges in meeting these demands. The current reactive approach of the police and partners that too often places an excessive emphasis on the management of demand as opposed to the reduction of risk is unsustainable. Despite the promise of additional officers, the police cannot hope to manage the increasing demand and complexity that defines the responsibility to protect children alone. Police leaders recognise this, but greater consistency and pace is needed to ensure that children are given the opportunities they deserve to thrive.

However, the police can’t and shouldn’t be doing this alone. To achieve the best possible outcomes for children, leaders in all agencies need to come together to form clear local strategies to reduce risk and protect children at risk from abuse and exploitation. But to be truly effective, more radical approaches are required. Despite the efforts of dedicated staff in every force and partnership the current approach to risk and vulnerability places too much emphasis on addressing immediate risks and the symptoms of vulnerability. A new model is required that considers the root causes of vulnerability and take steps to address them. New statutory safeguarding partnerships (underpinned by legislation) represent such an opportunity. These arrangements require the three safeguarding partners, the chief officer of each force being one, to join up and achieve the best possible outcomes for children and families by ensuring targeted services are delivered to meet their needs in a local area in a co-ordinated manner. Police leaders must raise their gaze and embrace their potential. For our part, we will continue to evaluate the impact of safeguarding partnerships on the lives of vulnerable children.

Wendy Williams

Her Majesty’s Inspector of Constabulary

Her Majesty’s Inspector of Fire and Rescue Services

1. Introduction

In early 2014, we began a national programme of child protection inspections. These inspections are testing and rigorous. We examine the effectiveness of the decisions made by the police at each stage of their interactions with or for children, from initial contact through to the investigation of offences against them. We also scrutinise the treatment of children in custody, and assess how forces are structured, led and governed, in relation to their child protection services.[1]

In 2015, we published our first thematic report. This summarised the findings of the first eight of these inspections along with the findings of a further 13 inspections that we undertook either alone or with other agencies, and which had a child protection theme. Since then, we have undertaken a further 17 child protection inspections (listed in Annex A) of individual forces. We have also completed 21 reviews of forces to assess their progress against recommendations we made during our initial child protection inspections. In 2016, we, along with Ofsted, the Care Quality Commission and Her Majesty’s Inspectorate of Probation launched the joint targeted area inspections (JTAI) of child protection. These short, focused inspections consider the effectiveness of statutory partnership arrangements for the protection of children. Since 2016, we have published 26 reports about our findings from these inspections. Together, these reports provide a powerful analysis of how well police forces serve the needs of vulnerable children. This report aims to build on the findings of the previous report by exploring the key themes identified by the evidence we have gathered from all 64 inspections, and considers the ways in which the police service, its safeguarding partners and the government need to adapt and respond in order to meet the challenges they face.

This report will distil the findings from the inspections below into key themes and use these to explore opportunities for police leaders and partners to improve the protection of vulnerable children. These themes can be divided into five broad areas:

• The role of leaders and leadership
• The recognition of risk and vulnerability
• The response to risk and vulnerability
• Protecting children from those who pose a risk to them
• The detention of children in police custody.

How we inspect child protection

The statutory guidance, Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children, sets out what is expected of all partner organisations involved in child protection (such as the local authority, clinical commissioning groups, schools, and the voluntary sector) in England. The provision of social care services is a devolved responsibility in Wales. As a result, the Welsh Government is responsible for child protection. Under the Children Act 1989, the police service, working with partner agencies such as local authority children’s social care services, health services and education services, is responsible for making enquiries to safeguard and secure the welfare of any child within their area who is suffering (or is likely to suffer) significant harm. The All Wales Child Protection Procedures (PDF document) set out what is expected of all partner organisations involved in child protection.

The police are duty bound to refer to the local authority those children in need whom they find during their work. The Welsh Government guidance outlines how these duties and responsibilities should be exercised.

The specific police roles set out in both sets of guidance are:

• identification of children who might be at risk from abuse and neglect;
• investigation of alleged offences against children;
• inter-agency working and information-sharing to protect children; and
• the use of emergency powers to protect children.

Every officer and member of police staff should understand that it is his or her duty to protect children, as part of day-to-day policing. Officers going into people’s homes on any policing matter must recognise the needs of the children they may meet and understand what they can and should do to protect them. This is particularly important when they are dealing with domestic abuse or other incidents that may involve violence. The duty to protect children includes any children who are detained in police custody.

The areas of practice described above and how well the police understand their responsibilities are the focus of our child protection inspections.

As outlined above, there are two main inspection programmes – the National Child Protection Inspection and JTAI. In both programmes, we put the experiences of children at the centre of our analysis. We use that analysis to support learning and development. We assess decision making, leadership, training and awareness of safeguarding responsibilities.

We don’t make graded judgements, but our reports give forces a detailed blueprint describing in detail the nature and quality of the decisions made to protect children. We describe the strengths they should build on and where they can improve.

In 2017, we changed the way we work to improve the protection of children. We began to provide bespoke support before, during and after an inspection to support a force’s improvement activity. We now also host an annual vulnerability conference and quarterly regional learning events to share findings and disseminate best practice. At the same time, we also began to work more closely with strategic partners including the National Police Chiefs’ Council (NPCC), the Home Office and College of Policing to ensure that the findings from our inspections were informing longer-term planning and policy development.

2. Summary

The role of leaders and leadership

Leadership, management and governance

Nationally, the police’s senior leaders and staff are clearly committed to protecting vulnerable children better. Returning to police forces we had previously inspected, we found that every force had made some progress in achieving better results for children at risk of harm.

However, we found that too often the priority placed upon protecting those who are vulnerable is not translating into better decisions being made when children in need of help and protection are encountered.

Innovative work the police are doing to protect children

We have found many examples of good, innovative work to protect vulnerable children. In Wales, the police are part of a programme to give early support to children exposed to ACEs.

ACEs are stressful events that occur during childhood, such as having a parent who is an alcoholic or abuses drugs. Children who have several ACEs are more likely to need substantial, continuous support. Although the approach is relatively recent research shows that, in these cases, there are benefits to intervening early in a way that recognises the root causes of vulnerability and the cumulative impact of trauma over time.

In England, the approach to early intervention isn’t consistent. The new VKPP aims to address this by evaluating best practice. Its work would be helped by clear government recognition of the benefits of early intervention by people who understand trauma.

We are encouraged that the police are becoming more aware of the need to use child-centred approaches. In Camden, north London, the police have worked with partners to create the United Kingdom’s first ‘child house’, known as the Lighthouse. Based on an Icelandic model, it is designed to help make sure children who have been sexually assaulted aren’t further traumatised by the investigation of a crime.

The Lighthouse model provides medical, advocacy, social care, police and therapeutic support in one specially designed place. Setting it up has taken a lot of multi-agency work and investment. It is too early to assess its impact (and funding for this project has not yet been guaranteed), but the model has the needs of children at its heart.

The recognition of risk and vulnerability

Where the risk is immediate and obvious forces usually respond well, but complex or less obvious risks can be missed

The police do not recognise or evaluate risk to children well enough. Forces usually deal with straightforward cases of child abuse and neglect promptly and efficiently. However, the police often carry out more complex investigations badly and investigations can suffer delays.

Greater focus on safeguarding and the protection of vulnerable people has led to a better understanding and sense of responsibility. Too often, the focus is on the incident, missing the bigger picture. Incidents are dealt with in isolation. Cumulative and escalating risk is not spotted at the earliest opportunity. That delays the development of an appropriate protective plan.

Staff are more aware of safeguarding issues and what they need to do when they are encountered, but the context for their roles and responsibilities is often described in terms of completing a process (a DASH form for example).

We found that sometimes officers and staff haven’t had extra training before they carry out complex investigations. They don’t always have the necessary skills and experience to investigate effectively or to make effective plans to protect the child.

Linked to this, supervision is often focused on making sure that processes are completed on time. Reflective supervision that supports staff to make better decisions is underdeveloped. Adopting this approach is essential for the necessary fundamental cultural change in policing to take place.

Too often, children were not asked for their views and the impact of traumatic incidents (for example, domestic abuse) was not considered or recorded. This information can help professionals to develop better protective plans and helps to ensure that services are delivered with the child’s needs at their heart.

Police now understand that those children who go missing are at increased risk of exploitation, but responses still require improvement

We found that the police need to respond better when a child goes missing or is absent from home. The police often gave priority to initial efforts to find the child. But they didn’t then take opportunities to intervene as soon as possible or make long-term plans with other agencies to protect children.

While officers do show better understanding of the increased risk of exploitation when children go missing, this wasn’t always evident in their decision making. When a child goes missing, decisions still tended to focus on what has just happened and on locating and returning them to their home. Officers didn’t always seek to understand the wider circumstances or risks faced by children, which often contribute to them going missing. Consequently, decision making, and protective planning does not yet fully recognise or consider at the earliest opportunity that children who go missing regularly from home may be at risk of being groomed for sexual and criminal exploitation and abuse. We also found that the provision of return to home interviews by local authorities continues to be inconsistent. These interviews, which are a local authority responsibility, provide valuable information about the reasons why children go missing. This undermines the ability of the police and their partners to develop the most effective protective plans.

The response to risk and vulnerability

Opportunities for the police and their partners to intervene at an earlier stage are recognised

Increasingly, we are finding evidence of the benefits of protective approaches to working with children. These focus more on prevention and repairing the long-term damage to child victims rather than repeatedly reacting to individual incidents. The police and other individual agencies can tackle these complex problems, but they can’t succeed alone or in isolation from one another. The police, in conjunction with their partners from social care, health and other agencies, such as youth offending teams and probation services, are often doing a good job to protect victims. But too little is done to prevent risk becoming acute or to repair the damage it causes afterwards.

Professionals have made progress in responding to issues related to the safety of children. However, acute abuse and vulnerability is widespread and needs a long-term strategy to reduce how often it happens. Due to the focus on immediate crises, agencies only consider the people at immediate risk.

Agencies share information with each other in various ways across force and partnership areas. It is important to ensure that information about risk is shared appropriately without breaking the rules on protecting personal data. But current inconsistencies create significant challenges.

The police have an opportunity to use new statutory local safeguarding arrangements, and the parity established with social care and health partners, to build more effective structures and arrangements to share information about risk and make joint decisions about the development of protective plans.

The response to criminal exploitation is evolving but too many exploited children are criminalised

We found that police forces have got better at recognising children at risk of criminal exploitation. ‘County lines’ offences see organised criminals move children across the country and coerce them into committing crime. The police aren’t yet using all the tools available to them to protect children who are forced to commit crime. In too many areas, children are still likely to be prosecuted despite clear evidence of coercion. As a result, too many children are being criminalised when they shouldn’t be. Too little consideration is given to the reasons why children commit crime when decisions are made about the appropriate response. Recognition of the root causes of criminality (whether it be exploitation or another vulnerability) may provide the opportunity for different, and more appropriate, resolutions to be considered when crimes occur.

Protecting children from those who pose a risk to them

Approaches to managing risks to children posed by others are inconsistent

The way that the police deal with people who pose a risk to children is inconsistent. It often takes too long to examine seized electronic devices. Some forces have equipment that can quickly identify which devices may have indecent images on them. But not all forces use this. As a result, images and other evidence of abuse can only be found by costly and time-consuming digital forensic examinations. Often, the police take no action to safeguard children until devices have been examined. We found that this leads to delays in children getting the support they need.

The sheer number of complex cases means that some are investigated by officers who don’t have the right training, skills or experience. The outcomes of these cases are almost always worse.

The number of indecent images of children on the internet means that the police need new approaches to identify suspects quickly and protect their victims. But the police can’t do this alone. The government, social media and technology companies should also reflect on what more they can do to support the police to protect children in need of help.

The detention of children in police custody

Police increasingly recognise the vulnerability of children in custody but too many are still detained unnecessarily

Children are still held in police stations when they shouldn’t be. This isn’t changing quickly enough.

It is almost always best for a child not to be held in a police station. Local authorities are responsible for providing accommodation which, in rare cases, might need to be secure. A 2017 Home Office concordat reinforced this, but it hasn’t led to more accommodation being made available.

Police forces now know they shouldn’t hold children in police stations. They ask for accommodation from local authorities more frequently. We found some evidence of forces using alternatives such as bail more effectively. But, in most cases where appropriate accommodation isn’t available, children are still detained until they go to court. This is often for a long time.

3. The context for child protection policing nationally

More people are reporting abuse and exploitation. It is a good thing that victims have more confidence to report these types of crimes but it increases demand on the police and other agencies. Nonetheless, in every force area we find senior leaders (with the support of their PCCs), frontline officers and staff who are committed to keeping vulnerable children safe.

Overall crime levels have recently stabilised after decades of sustained decreases. However, certain lower-volume but higher-harm crime types (such as offences involving knives or other bladed articles) have increased. In some (mainly metropolitan) areas those increases have been dramatic.

The number of sexual offences recorded by the police rose by 7 percent to 162,030 in the year ending March 2019, according to figures published by the Office for National Statistics. Sexual offences against children, including rape and sex assault, accounted for around 20 percent of the total increase. The police flagged 60,685 crimes as involving child sexual abuse and 13,133 as involving child sexual exploitation in the year ending March 2019. Yet, recent studies by the Children’s Commissioner for England have strongly suggested that the true scale of child sex abuse is likely to be significantly greater. In 2015, the commissioner estimated that only one in eight victims of sexual abuse in England comes to the attention of the police and children’s services.

At the same time, the demands facing the police reflect the increasing complexity of the risks faced by children in need of help and protection. The police are getting better at understanding the nuanced nature of the risks facing those who are vulnerable. For example, the police now understand that children can be criminally exploited as well as sexually exploited. Police leaders recognise the ways in which organised criminal networks can coerce those who are vulnerable to commit criminal offences, trafficking them across the country through the borders of police and local authority areas. It is positive that the police service nationally is beginning to understand the extent and prevalence of these issues and is acting to protect those at risk. However, this is placing additional strain on an already stressed system.

In addition, the number of wider non-criminal child protection and safeguarding matters investigated by the police is also increasing. Statutory guidance requires local agencies including the police to work together to safeguard and promote the welfare of local children including identifying and responding to their needs. The police are more effective at recognising and responding to children at risk. This is also true of others with a responsibility to safeguard children such as medical and school staff. This is positive. However, the police’s systems are struggling to meet demand for sharing information with their partners and for making decisions about an appropriate protective plan. Delays in making assessments and sharing information to inform decision making result in children being left at unmanaged risk. The Children’s Commissioner for England found in a report in 2019 on vulnerability that there are over 2.3 million children in England living in families with substantial complex needs. Of these, the report estimates that 1.6 million children have no established, or clear form of additional support. So, almost three-quarters of children who are vulnerable because of the circumstances they live in either do not come to the attention of agencies or, if they do, do not receive any support.

We have found that police leaders are dedicating increasing levels of resource and focus to the protection of those who are vulnerable. In 2017, Chief Constable Dee Collins of West Yorkshire Police told the Home Affairs Select Committee that “83 percent of my time in terms of delivering services is not about crime”, and referred to “real pressures around mental health, real pressures around [people] missing from homes, children and adults”. Her force had seen “almost a 300 percent increase in the number of missing people over the last three years”.[2]

However, we continue to find that police and wider safeguarding partnership systems are operating at, near or above their capacity. It is clear that the current system is unsustainable. This is because despite absolute commitment, strong partnerships and the promise of extra police officers, there is a disparity between reported child abuse crimes and the known child safeguarding needs and their likely actual levels.

The nature of partnership working is also changing in England. In June 2018, Local Safeguarding Children’s Boards (LSCBs) were abolished by the Children and Social Work Act 2017. LSCBs have been replaced by local safeguarding partnerships. The new statutory framework requires the three main safeguarding partners (children’s social care, the police and clinical commissioning groups from health) to jointly agree how they will work with other agencies to deliver protective services for children. The transition to these new arrangements was due to be complete by September 2019. Given the embryonic nature of these new arrangements it remains to be seen what challenges their implementation will bring. Through our single and joint inspection programmes we will continue to test the effectiveness of police and partnership working and the quality of services provided to children in need of help and protection.

Current child protection and safeguarding arrangements are too often reactive. Responses are limited to the latest incident rather than underlying causes. This is often a response to excessive demand but too often we found that this does little, if anything, to reduce risk or vulnerability. The evolution of systems and processes to focus on demand management as opposed to risk reduction is understandable and predictable. However, it is a false economy. The police and their partners cannot continue to do the same things in the same way with any real expectation of ever reducing demand or, far more importantly, improving the lives of children in meaningful and sustained ways.

To achieve this, a shift in focus is required to enable the police and their partners working together to develop approaches that focus on prevention and early intervention. Ensuring the police have the resources to protect children effectively is essential but it is only one part of a solution. In the State of Policing report 2018, we are reminded that Sir Robert Peel’s first principle of policing says that “the basic mission for which the police exist is to prevent crime and disorder”. Police leaders recognise the need to shift their focus, but they cannot and should not do this on their own.

4. The role of leaders and leadership

The commitment of senior leaders to protect children at risk is clear and unambiguous

Despite, or perhaps because of, the challenges highlighted in the previous section, in every force we have visited we find senior leaders, PCCs, frontline officers and staff who are committed to keeping vulnerable children safe.

Without exception, PCC police and crime plans, and force priorities reflect an unambiguous commitment to the protection of children and other vulnerable people. While we found that same commitment in 2015, we also found then that police leaders needed to better understand the way in which children experienced the services they provided and the impact that poor decision making, or processes could have on a child in need of help.

Strategic assessments inform a force’s intelligence requirement and how it will use that intelligence to utilise its resources. These assessments are increasingly including a greater focus on child protection, including domestic abuse. This is positive and represents a shift away from more traditional crime types, such as burglary and robbery, and reflects an increasing understanding among police leaders about the need to develop approaches that recognise and respond to risk at an earlier stage.

In many forces we have visited, internal governance and leadership arrangements have also been reviewed and similarly reflect an increased focus on vulnerability and recognition of the proportion of overall demand represented by safeguarding issues (including child protection). In many forces we have visited since 2015, we found strategic efforts to improve the ability to manage the demands from child protection. Many forces have significantly increased the level of resourcing allocated to public protection and child protection departments. However, we have also found that without exception these departments are operating at or beyond their intended capacity. This is unsustainable. Children are left exposed to unmanaged risk as a result of significant delays when backlogs of cases build up.

Despite clear commitment current approaches are unsustainable and place too little emphasis on early intervention

Police leaders cannot continue to do the same things in the same way. As the previous section illustrates, simply increasing staffing will not offer an effective solution to the number of children who may at some point need access to services and come to the attention of the police. Current internal police processes as well as partnership safeguarding arrangements are in many cases built around reacting to specific child protection concerns or incidents. This severely limits the ability of the police and their partners to develop more preventative approaches to spot vulnerability earlier and to reduce risk more effectively over time.

Police leaders do recognise that earlier and more effective interventions can prevent risk and vulnerability from escalating. And we have found many examples of good, innovative work to protect vulnerable children. As previously mentioned above in Wales, the police are part of a programme to give early support to children exposed to ACEs.

In England, the approach to early intervention isn’t consistent. We have found individual examples of good work by the police and partners. For example, in Lincolnshire the police and the local authority have invested in developing initiatives to give better support at a much earlier stage to children who may be at risk of neglect, domestic abuse or sexual exploitation. Bespoke interventions suited to the child’s needs and the context in which abuse occurs (referred to as contextual safeguarding) can address vulnerability before the risk becomes acute. These approaches reflect an increasingly sophisticated understanding and approach to reducing harm and while at an early stage, this work has demonstrated positive outcomes and may provide the basis for more effective long-term safeguarding. Over time, such approaches offer the best opportunity to improve outcomes for children. Their focus on risk reduction rather than reacting to individual incidents also helps to reduce demand in the system. Their work would be helped by clear government recognition of the benefits of early intervention by people who understand trauma.

The comments by the former home secretary, the Rt Hon Sajid Javid, highlighting the need to develop a better understanding of a child’s likely routes into violence and crime in order to intervene more effectively are welcome. But the same argument needs to be applied to the wider safeguarding and vulnerability of children. Not all children who are vulnerable and in need of help will go on to commit crime. Without proper support many vulnerable children will simply fail to achieve their potential. But almost without exception, all children who commit a crime will have an identifiable need or vulnerability which, if addressed at the earliest possible opportunity, gives the best chance of preventing crime and criminality.

The NPCC, through the work of the Violence and Public Protection Board chaired by Chief Constable Simon Bailey, and the new VKPP aim to address this by evaluating and disseminating best practice. This portfolio has also produced a national vulnerability action plan to provide clear and consistent parameters for police leaders to improve their response to vulnerability. We also acknowledge the positive work the NPCC is undertaking to review the efficiency and effectiveness of its own national governance arrangements. However, more work is required to ensure that the benefits of earlier and more effective intervention are realised. Therefore, we intend to undertake a series of inspections in 2020/2021 as part of the JTAI programme to assess the effectiveness of multi-agency early intervention arrangements and pathways.

We are encouraged that the police are becoming more aware of the need to use child-centred approaches. In Camden, the police have worked with partners to create the United Kingdom’s first ‘child house’, known as the Lighthouse, based on an Icelandic model. It is designed to help make sure that children who have been sexually assaulted aren’t further traumatised by the investigation of a crime.

The Lighthouse model provides medical, advocacy, social care, police and therapeutic support in one specially designed place. Setting it up has taken a lot of multi-agency work and investment. It is too early to assess its impact, but the model has the needs of children at its heart.

Senior leaders recognise the need to test the quality of the response given to vulnerable children

Since 2015, we have found that police leaders are more aware that they need to understand the nature and quality of the decisions made and whether governance arrangements and internal processes support better outcomes for children. Performance management and quality assurance arrangements, while still mainly focused on quantitative measures (such as the number and timeliness of the response to child protection incidents), are increasingly being improved to test the quality of decision making. Some of the stronger examples of this also recognise the need to look at the whole system when building or reviewing child protection arrangements. These forces map children’s journeys through their engagement with the police and test the quality of service provided at every stage. This allows senior leaders to see if their clear strategic intent to improve is being translated into better decision making by staff that improves outcomes for children. Senior leaders can see, for example, whether the training that staff receive has been effective or if force processes are resulting in perverse behaviours, such as staff completing a form (as they have been trained to do) without capturing or even considering any information about risks to children. This can be summed up as a force ‘hitting the target but missing the point’. This kind of understanding however, is not easy. Police computer and information systems are not designed to work this way, but we are pleased to see senior leaders working hard to develop approaches that allow them to test the quality as well as the efficiency of their services.

Partnership working is generally effective but can be undermined by ineffective processes that hinder decision making and protective planning

For the most part, professional relationships, contributions to multi-agency working and engagement with partners, at both strategic and practitioner level, are described as positive and effective. Joint working has generally improved with better and more integrated approaches to information sharing and decision making. Where challenges exist, clear escalation processes are in place with a culture of healthy professional challenge. In these forces the police are fully engaged in the partnership and there is appropriate and consistent representation at meetings and evidence of the police recognising their responsibility to shape and inform the development of local partnership arrangements. We have also tended to find in these forces that strategic planning is more child centred. Information sharing, joint decision making, and the development of protective plans is based upon a clear and considered assessment of a child’s needs, including their own views.

However, we are concerned that inefficient and ineffective processes are sometimes undermining these arrangements despite a clear commitment to improve joint safeguarding working. This can significantly affect the development of appropriate protective plans. In several forces, we have found that referral thresholds are not properly understood or agreed across the partnership. At times, processes place emphasis on managing demand rather than mitigating risk. This happens where processes develop or are designed to move large volumes of information quickly and efficiently from the police to their partners without risk being properly assessed. The result of this is that meaningful joint decision making often does not take place or if it does it is not informed by a considered assessment of the wider risks and needs of a child because demand and the sheer volume of information being moved prevents deeper analysis. As a result, a joint plan to investigate the case and safeguard the child or children involved is often not recorded (or developed), leaving children at risk of significant harm.

Changes introduced by the Children and Social Work Act 2017 mean that senior police leaders now have a greater statutory responsibility to influence and develop local safeguarding partnership working. They can shape the nature of the arrangements in a more meaningful way than was previously possible. The Act also represents an opportunity for police leaders nationally and locally to work with partners to shift the emphasis away from reactive demand-based models to more effective risk and harm reduction.

How leaders oversee the effectiveness of child protection is developing

Since 2015, we have found evidence that forces know more about the wider context in which cases of child abuse occur. They also understand the importance of having comprehensive and overarching plans to tackle all the different features of the abuse and exploitation of children.

Many forces now undertake more comprehensive strategic assessments of demand that have informed decisions about how resources are used. Most of the forces we have visited also undertake strategic assessments of specific child protection issues such as child sexual exploitation, child sexual abuse, grooming and indecent images of children. These help senior leaders to understand the nature and scale of issues of concern in order to inform the development of force priorities.

We have also seen some evidence of senior leaders prioritising their response to children who may have been criminally exploited. This is positive but the nature and quality of this work is very inconsistent. We recognise that much effort is being made to address this weakness nationally, regionally and locally. However, too often senior leaders do not fully understand how often children are being criminally exploited across county lines.

In some areas the police do have processes to identify and respond to criminal exploitation, but they are not receiving the support they invariably need from partners. Some of our joint inspections have highlighted that local authorities can be unaware of the extent of criminal exploitation. They can offer nothing other than to refer criminally exploited children back to their home local authority. We have already mentioned that children are being unnecessarily prosecuted even when there are clear signs of exploitation. In our inspections we have found that children are being prosecuted in part because the criminal justice system offers the only route to intervening to prevent exploitation.

The system currently starts from the wrong place. How a child is dealt with will be a reaction to their involvement in an incident. So, where a child is a suspect, they will be dealt with through a criminal justice route. If the child is a victim, they will be dealt with through safeguarding. We have seen some (isolated) signs of change but this binary approach persists and fails to recognise the potential vulnerability of children who commit crime. The legislation that exists to legitimately discontinue prosecutions is being used appropriately in some instances and the guidance in the national protocol on reducing the criminalisation of children in care provides welcome advice that supports better decision making. However, we have found little evidence of this protocol being widely used and, in most cases, we have found that binary approaches to decision making result in missed opportunities to reduce risks to children and, in the long term, prevent crime. The police and their safeguarding partners must do more to consider the root causes of criminality in children and ensure their vulnerability is considered when decisions about prosecutions are made.

Staff are not trained or sufficiently empowered to routinely consider the child’s wider circumstances and, if appropriate, to make alternative decisions. There are many reasons for this. Cultural legacy, political pressure and the need to demonstrate efficiency to inspectorates, among others, all have a part to play. But different approaches to governance and decision making are required if senior leaders truly wish to build more effective models of policing that focus on crime prevention and harm reduction.

Performance information to understand outcomes for children requires further development

All the forces we have inspected had performance processes in place. Many of them, however, were limited to quantitative information. We have found that there is more emphasis placed on more qualitative measures that test the nature and quality of decision making, but it is often limited and focuses on discreet areas of the force’s work with children. Some forces conduct internal audits and some of these, such as missing persons and domestic abuse, include cases related to child protection and safeguarding. However, with a few notable exceptions these audits often focus on bureaucracy and form-filling. They are not currently undertaken consistently to provide senior leaders with analysis of the nature and quality of decision making or outcomes for children in need of help. Nor do they consider the way in which decisions are made about a child at each stage of their involvement with the police or safeguarding partners or what impact those decisions have on a child.

Consequently, senior leaders cannot be assured that staff are consistently making the best decisions for vulnerable children in all cases. The opportunity exists to use audits (particularly multi-agency audits) to understand a child’s journey and analyse the whole system to identify ways in which training, supervision and decision making can be improved.

Training for officers responding to child protection is widely available but understanding how that training is used by staff is underdeveloped

Nationally, we have found that since 2015 training for staff is putting more emphasis on the protection of children and other wider issues of vulnerability. Much of this training has been appropriate, some of it has been innovative and some of it excellent. Staff have a better sense of responsibility and a very clear understanding about their responsibilities to protect children. Yet we still find an inconsistent response to children who may be at risk or vulnerable. Despite a more explicit focus on vulnerability, we often find that staff have been trained to ensure (or consider their role to be) delivering a process, completing a form as opposed to collecting information about a child to make sure they are safe and to pass that information to specialists.

Officers and staff are often told to investigate incidents without having the right skills or experience to manage them effectively. Where complex cases are given to non-specialist investigators this can often lead to signs of risk being missed or a failure to identify other victims.

Record keeping about the training received by individual staff is inconsistent and in some places poor. As forces move towards models of omni-competence (where all officers and many staff can investigate a variety of crimes), understanding the capabilities of staff will be essential. The support and supervision received by officers and staff undertaking these complex investigations is variable. In most cases the focus is on compliance (with force policy or national guidance) with little evidence of consideration being given to the quality of decision making. Making complex decisions about children’s lives is difficult, stressful and challenging. Giving staff the opportunity to reflect on the quality of their work with their peers and supervisors can improve the decisions made about and for children and support staff more effectively.

While investigations carried out by specialist staff are generally of a higher standard, we are concerned that many ‘specialist’ investigators have received no additional training to carry out their role. Officers and staff conducting specialist child protection investigations should have completed the Specialist Child Abuse Investigators Development Programme. However, many of our inspections since 2015 indicate that significant numbers of staff in these teams have not received this training. In some cases, there has been no indication as to when the training will be provided.

5. The recognition of risk and vulnerability

Forces are better at recognising risk

Initial contact may be with call handlers (those who answer the telephones when the police are called), a police officer or a police community support officer in a public place, or at a suspect or victim’s home, or by arrangement, when an investigation is being undertaken by a specialist team.

We have found that police forces are better at recognising and responding to risk and the signs of vulnerability in children. Officers and staff who first encounter children who may need help and protection have training, skills and experience that have evolved and become more sophisticated. Risks are spotted sooner as a result.

In most of our inspections we have found that call handlers now use more sophisticated risk assessment processes (for example, the THRIVE process) to assess, prioritise and respond to signs of risk. Where the risks to a child were obvious, we found these processes are applied with greater consistency. Where risk or vulnerability is less obvious, we found there is still room for forces to improve their understanding of the nature and extent of the vulnerability of a child or children.

However, in general we found that increasingly forces are using the data they have at their disposal more effectively when making initial assessments. We have found increasing evidence of forces searching their various IT systems to identify the relevant information about a child. In the stronger forces this is then passed to the officer attending an incident. As a result, better decisions can be made about the wider context of risks and challenges faced by a child. More useful information is also being recorded, which specialists can use when they decide on an appropriate protective response.

Forces are better at testing the quality of the decisions made by staff. In many of our inspections we have found forces developing quality assurance processes, which support staff to continuously improve by reflecting upon decision making in specific incidents with their supervisors. They are also increasingly training staff to place a child or children at the centre of their decision making. This more child-centred approach is what Professor Eileen Munro, in her review of child protective practices, described as professionals doing the right thing as opposed to doing things right.

However, despite clear improvements in the way in which risk is recognised and assessed at the first point of contact we still found that the initial response could have been better in many cases. Sending officers to see a child and ensure their safety is often delayed because of other ‘more pressing’ incidents or a lack of people to send. In general, we continue to find that only an immediate risk to a child is likely to guarantee a prompt or immediate response. Police are not yet routinely deciding whether to respond having considered the long-term or cumulative impact that ‘lower’ levels of risk or trauma have on a child (such as routinely being exposed to domestic abuse or having a parent of carer who abuses substances). A better understanding of how these ACEs affect a child’s physical and mental wellbeing, and the significant long-term risks this poses to them, would result in better and more child-centred decision making.

The behaviour and demeanour of children tells us important things about the risks they face, but this is not something considered or recorded consistently

When the concern is clear and specific, we have continued to find that officers often attend promptly. They are effective in carrying out preliminary tasks, such as ensuring the immediate safety of children and assessing how best to proceed. We also found officers to be good at making initial enquiries and using their powers to arrest or protect when necessary.

Officers have a greater sense of their safeguarding responsibilities at incidents involving children or where children may be present. However, we continue to find that children are often not spoken to and their behaviour and demeanour is not recorded.

Since our 2015 thematic report, in many of the cases we have reviewed, we often found that the police had not spoken to children consistently, recorded their concerns, or made a record of the children’s behaviour and demeanour.

How a child behaves provides important information about how an incident has affected them. This is especially true where the child is too young to speak to officers, or where there might be a risk for this to happen with a parent present. The police should watch how the child behaves, to inform both their initial assessment of the child’s needs and the decision as to whether to refer the child to children’s social care services.

Body-worn video is a helpful tool here. We have been pleased to find that officers increasingly recognise its importance to capture evidence, specifically in domestic abuse incidents. But in many forces, we have spoken to officers and staff who are frustrated that the equipment is unreliable and not always available. A key theme emerging from our inspections points to the opportunities that technology presents to the police to improve the way in which children are protected and how (at present) many of these opportunities are being missed or not fully realised.

Forces recognise their responsibility to share information with partners and contribute to the development of protective plans, but the complexity of these arrangements can often present challenges

As with our 2015 inspection, we have found that all the forces we inspected had arrangements in place to receive concerns about a child, make initial enquiries and assessments of risk and then share information with partner agencies about those concerns in order to consider next steps.

The Working Together and All Wales Child Protection statutory guidance defines the responsibilities of agencies with a safeguarding role. In broad terms, the police and other agencies are required to share information about risk and make agreed and joint decisions about how to respond to that risk. This could be the development and implementation of a joint protective plan or it could be (quite appropriately) taking no action at all.

The arrangements that the police (and their partners) have in place to discharge these responsibilities are often collectively known as the ‘front door’ into services. They vary significantly from force to force. Indeed, those forces that straddle multiple local authority boundaries may have multiple overlapping sets of arrangements. Police leaders and practitioners can struggle to adapt to multiple information sharing requirements. In some areas, senior leaders have developed co-located hubs while in others, agencies work remotely from one another.

The precise nature of these arrangements is informed by a number of different factors and issues. Each partnership, including the police, must work together to agree what works best for them. No single model is better than any other.

We have seen examples of remote and virtual multi-agency working, which is strong and effective. Equally, we have also seen very good practice to safeguard children where agencies are co-located.

However, we have also seen poorer examples of both models (and others) where partnership working has not effectively responded to the needs of vulnerable children, leaving them at risk.

This is because the nature of the arrangements is less important than what underpins them. Effective processes are important. But they are only one part of good and effective child protection; not its limit nor its definition.

Understanding why information is shared is critical to effective joint working

When building effective front-door arrangements the police and their partners need to agree clear principles that support the delivery of their shared objective (and statutory responsibility) to safeguard children.

In many of the areas we have inspected we have seen evidence of this and the benefits such an approach can have. In Wiltshire, for example, a daily domestic abuse conference call is held to discuss domestic abuse cases that have arisen during the previous 24 hours. This is leading to improved information sharing, meaning that all agencies are aware of emerging risks in relation to domestic abuse and the children exposed to it. But we have also seen examples where information sharing arrangements and partnership working placed too much emphasis on managing demand rather than mitigating risk and reducing harm.

Most forces will have a team, unit or department that is the focal point for multi-agency information sharing. Usually they manage large volumes of information. Often, though not always, they do so quickly and efficiently. In most of the forces we have inspected where the risks are obvious, we have found at least some examples of agencies working well together: identifying risks, making plans to reduce those risks and supporting children and families.

Thresholds that define when and how information is shared are essential to determine the point at which information about potential risks needs to be shared among safeguarding partners. Effective and agreed thresholds should ensure that only those children where a particular level of risk is reached (or exceeded) are referred for a multi-agency protective plan to be considered. Where there is professional disagreement about whether a threshold has been met, clear escalation pathways should enable the issue to be resolved. These were a defined part of previous statutory safeguarding arrangements but it is important that all safeguarding partners continue to make and review agreements about thresholds.

However, in a number of the forces we have visited we have had concerns (sometimes significant) about the effectiveness of the referral and assessment processes and the impact these inadequacies can have on the development of appropriate protective plans.

We regularly find that staff routinely pass information to the local authority. However, in a significant number of the cases we have reviewed there is no record of any police involvement in the assessment of longer-term risk or the development of protective plans. In some cases, there is also no evidence of a strategy discussion or meeting taking place and no detail of what (if any) joint assessment of need has taken place. The consequence of this is that a joint plan to investigate the case and safeguard the children involved was not recorded or developed, leaving children at risk of significant harm.

These processes evolve for a number of different reasons. Staff often tell us that some assessments can be delayed because referral processes are bureaucratic or staff are too busy. We have also found that the volume of work often leads to processes that focus on managing demand in a timely way by passing the information as quickly as possible to the local authority or other partners.

When a police officer or community support officer encounters a child who may be at risk, they usually must record this information along with any other relevant information that may suggest a risk. They may then be asked to assess the overall risk to that child. That information may then be passed to a local authority with no further assessment of the wider risks faced by that child based on searches of police computer systems. Unless the matter is a serious one, a local authority may well take no further action (as we have seen in a number of inspections) unless further information is available. This is particularly the case where there is no police involvement in these decisions. This may occur because the volume of work means that nothing other than this is possible if vast backlogs of information waiting to be shared are to be avoided.

However, training is also a factor. We have spoken to many staff working in these teams who have told us that they haven’t received any additional or specific training to carry out their role. The police have previously been criticised for not sharing information with partners about risks faced by children which, had they done so, could have prevented serious injury or death.

We have been impressed with the commitment of senior leaders to developing strong partnership working. However, many of the processes seem to have evolved to suppress demand or to avoid criticism by ensuring that information is passed on as quickly as possible to another agency. This is a clear case of attempting to hit a target while missing the point.

Effective information sharing isn’t necessarily about sharing everything, all the time. We have seen that this simply overwhelms the system, and risks to children – particularly risks that have not yet reached the acute stage – are missed.

Effective information sharing is about supporting better decision making. This needs better assessments to be made at an earlier stage about what all the information known about a child or incident means. Only then can the cycle be broken, and the police and their partners can shift to a model that reduces risk rather than simply services demand.

Supervision differs depending on the type of risk a child is exposed to

Since our previous report was published, we have seen better and more effective supervision when a child is clearly at risk. Forces have improved training to ensure supervisors have a better awareness of their responsibilities. However, we continue to find that the level and quality of supervision often depends on the situation in which a child is encountered. Where the risk clearly indicates a child protection matter, such as a sexual or physical assault, then supervision is more effective. Where the risk is less obvious, such as a child showing early signs of neglect, then the ability of supervisors to recognise risk and ensure their staff are responding to it is mixed.

We have also found improvements in the supervision of domestic abuse incidents involving children. When a child is present at a domestic abuse incident, the need to record this fact and consider the risks to the child are increasingly more carefully considered than they were in 2015. However, while we have seen an increasing awareness of the impact that domestic abuse can have on children and the subsequent need to ensure their presence is recorded, as we described in the previous chapter, we often still find that limited consideration is given to recording children’s behaviour and demeanour. We have not yet found that supervisors are routinely ensuring that these more nuanced factors are considered and reinforced with their staff.

Opportunities to intervene are missed where information-sharing in domestic abuse cases is based on risk to the victim not risk or harm to the child

We also continue to find that the assessment of risk, particularly in cases of domestic abuse is focused more on the adult victim. It is right that the risk to a victim is properly considered. However, we have not yet found that the cumulative risk that being routinely exposed to trauma can pose to children is properly or well enough understood.

If the incident is graded as lower risk, then in some places no referral to children’s social care about the child will be made unless or until further incidents (where the risk is assessed as being more significant) have occurred. This fails to recognise the significant impact that the exposure to this kind of trauma can have on a child. It means that interventions and support services are unlikely to be provided until the risk has reached an acute stage. By that point, the effectiveness of the support provided will have decreased.

In addition, although immediate safeguarding measures are routinely put in place for children living in families at high risk of domestic abuse and these cases are frequently referred to a multi-agency risk assessment conference (MARAC) for longer-term safeguarding plans to be put in place, when the incident is graded as being lower risk these cases are not referred as often as they should be.

The minutes we have examined from MARAC meetings across the country generally showed MARACs were well attended and information was routinely shared to protect both victims of domestic abuse and any children affected by it. However, we continue to be concerned that domestic abuse cases assessed as standard risk (lower risk) are not being reviewed by specialists before closure to identify escalating or cumulative risk. This means that children who are repeatedly witnessing domestic abuse are not being identified or referred on to MARAC at the earliest opportunity. Furthermore, the threshold for MARAC referral for cases is inconsistent. Where cases are referred it is evident that strategy discussions do not always occur, or at least do not occur before the meeting. This could leave children at risk because information is not shared, and joint action not taken at the earliest opportunity.

Where risk has escalated however, we have been pleased to find that separate care and support plans are increasingly being developed for affected children. Forces must ensure that there are clear and distinct care and protection pathways for the child and adult victims of domestic abuse.

Some forces have implemented Operation Encompass, a police and education partnership for early information sharing to notify schools when children are present at a domestic abuse incident. This is positive as schools often represent a source (often the only source) of stability in an otherwise chaotic and uncertain existence. This can be highly effective. However, we have found some forces who only pass on the details of high or higher risk incidents because of concerns about demand. While we acknowledge the challenges facing forces, such an approach fails to place children at the centre of decision making and means opportunities to support children in need of help and protection at the earliest stage are routinely missed.

Strategy meetings are held promptly and well documented when risk is clear

Where it is evident a child is at significant risk of harm, most areas and forces that we have inspected will contact children’s social care and health colleagues and hold prompt strategy discussions by phone, video conference or in person.

The outcome of these discussions is usually clearly documented on police systems. This means that officers dealing with subsequent incidents can make decisions based on a full understanding of the current risks and in line with joint protective plans.

However, as previously discussed, where risk is less clear there are often delays in developing protective plans. Where risk is more nuanced decision making is weaker. Rather than focusing on mitigating and reducing risk, there is an understandable but unacceptable focus on the management of continual demand and a lack of clarity about applying the appropriate thresholds for sharing relevant information.

We have found that a lack of professional curiosity about the causes of risk is contributing to missed opportunities for earlier and more effective interventions.

The importance of participating in child protection case conferences is recognised but the quality of the police contribution remains inconsistent

Forces understand that child protection case conferences are important. They bring together family members, the child (where appropriate), and the professionals most involved with the child and family. But forces are inconsistent in their approach to managing the need to attend and engage in the decision making that goes on at case conferences. In some forces specialist child protection staff attend initial conferences. In others the responsibility rests with other staff or supervisors often from public protection units.

We take no particular view on the merits of one approach over another and acknowledge that attendance at initial conferences has generally increased. However, while attendance is important and an indicator of participation in the decision-making process, it is only the first stage of effective practice. Whichever approach they take to attendance, the value of being there is significantly reduced unless those who attend are aware of the circumstances and can make important decisions about how a child protection plan is to proceed.

We remain concerned about the protection of some children who regularly go missing from home

Although the initial response to locate the child is often appropriate, early intervention and long-term inter-agency planning can be ineffective. Many forces have good daily oversight of children who have been reported missing. This is more consistent than in 2015 and we have seen numerous examples of the good work of staff. However, we still find that children can be reported missing on numerous occasions with limited evidence of early intervention. In some cases, children, most notably those in local authority care, can be reported missing over 20 or even 30 times without any recognition of wider risks and vulnerability and with little action being taken to protect them. Officers will generally check the child’s immediate safety after a missing child was located, but some records contain scant information. However, more recently we have begun to see delays in officers attending, often because other incidents have been prioritised above the missing child.

We have also found that forces understand better the importance of independent return interviews as an opportunity to uncover information that can help protect children who have previously gone missing from home. These are the responsibility of the local authority and while they are available in most areas there are often delays in their completion, if they occur at all. The details of what was said were not always recorded on police systems. We were also disappointed that in many cases there was no evidence of the interviews being used to inform the development of protective plans. Interviews with children at this stage can provide a wealth of information about why they are running away, particularly when this is becoming more frequent and the child is reluctant to speak to police or other agencies.

We have been pleased to find that in general officers and staff recognise the signs that a child might be at risk of sexual exploitation. There is an increasing focus on assessing the nature and extent of the criminal exploitation of children nationally, regionally and locally. However, staff still do not consistently recognise that children who regularly go missing from home may be at risk of being groomed for sexual abuse or exploited by individuals or organised networks and coerced to commit criminal offences.

In many of the missing cases examined by inspectors, there were signs that the children involved could be at risk of sexual abuse or another form of exploitation. The police response too often focuses on the most recent episode rather than using all the information they hold from previous occurrences. In some cases, the high number of missing episodes is also seen as something of a mitigating factor and leads to an underestimation of risk and a lack of appreciation of the escalating or cumulative trauma being experienced by children.

6. The response to risk and vulnerability

We often find good individual examples of child-centred working

Since 2015, we have continued to find many good individual examples of police child abuse investigators displaying a good mix of investigative and protective approaches. Safeguarding of children remains central to their efforts while all criminal investigative opportunities are pursued. We are pleased that forces are generally recognising the need to develop more child-centred approaches. While this is not yet always translated into better decision making in every situation and circumstance, it is certainly welcome and evidence of a more positive trajectory.

Demand, reduced staff numbers and poor supervision continue to result in delays and a poor service for children in too many cases

We have routinely seen and been told by staff working in public or child protection teams that high demand makes their work difficult to manage. While we have found examples of good supervision, this is also inconsistent because of supervisors’ heavy workloads. Supervisors often report that much of their workload focuses on attending meetings and managing daily risk, to the detriment of supervising safeguarding investigations and supporting staff. We have routinely found that a lack of supervision contributes to delays in the investigation. Staff often report difficulties in managing the expectations of victims through not being free to give families and children information and guidance on what would happen next. Officers told inspectors that delays cause children and families to lose confidence in the police. With demand likely to increase further and police funding having fallen in real terms, police leaders increasingly need to consider different approaches to managing and reducing demand. The current model of reacting to demand is not up to the job. We have been pleased to see that nationally police leaders are exploring opportunities to recognise and respond earlier to vulnerability. Early evidence suggests that early help to address the causes of ACEs offers a better chance to reduce the impact of trauma. An increased emphasis on systems that support risk reduction offers an opportunity to sustainably reduce longer-term risk and demand over time and meaningfully improve the opportunities for children from vulnerable backgrounds.

Officers and staff can lack the skills and experience to carry out the investigations for which they are responsible

Some serious cases, for example sexual offences, are still being investigated by non-specialists who can lack the skills and experience necessary to effectively manage complex and risk-laden cases. As they try to more effectively manage demand, many forces now train officers and staff to undertake a variety of criminal investigations. Many of these staff have, or will receive, additional training to undertake new and additional responsibilities. However, we still find that too often the investigation of cases is poorer, with drift and an absence of longer-term protective plans. Officers and staff managing these sorts of cases often fail to identify wider risks, such as the identification of other children and suspects who may be a risk to other children. This continues to be a significant concern.

The understanding of child sexual exploitation has improved. However, while some investigations are good, further opportunities exist to improve the quality and consistency of the police response

All the forces we have inspected since 2015 have clearly recognised the need to improve their responses to tackling CSE. Many have developed sophisticated problem profiles to better understand the nature and extent of the issue. We have seen evidence of how these can be used to inform protective planning. We have also seen in many places the introduction of new multi-agency processes to co-ordinate safeguarding activity. These can give the police and their partners the ability to offer appropriate multi-agency planning and interventions. Where they have been most effective, they have complemented and worked in parallel with the statutory Working Together and All Wales Child Protection safeguarding processes. These bespoke interventions reflect the complexity of the circumstances in which many vulnerable children live.

We have also found forces developing better and more sophisticated approaches to the search for evidence of children being abused or exploited online. Many forces have created dedicated units to oversee these investigations. These specialist teams generally conduct investigations well with clear evidence of effective supervision. However, while the enquiries to locate and arrest suspected perpetrators are often thorough, there was less evidence of safeguarding planning for victims or children linked to suspects.

In many forces other types of CSE are not investigated by a dedicated team. In some forces child abuse detectives or non-specialist teams (such as neighbourhood and response teams) investigate these types of cases. In such cases, monitoring and supervision is often less apparent, which leads to poorer investigations. Signs of risk are routinely missed; lines of enquiry are either not followed up or took too long. There are failures to respond to information and intelligence and to pursue offenders.

When children are the suspected perpetrators of sexual offences, neither the reasons for their harmful sexual behaviour nor the risks they pose to other children are as fully considered as they should be. In many forces staff have told us that they have either not received any specific training to carry out the types of investigations for which they are responsible or did not feel they had received adequate training.

In most of the cases we assess, the immediate safeguarding measures are adequate but there is often a failure to identify wider risks both in terms of those faced by a child victim and those posed by the suspected perpetrator. In many of the poorer cases we have reviewed, CSE risk was either not identified or not acted upon, meaning that early opportunities to safeguard children were missed, sometimes repeatedly. As a result, proper safeguarding processes were not applied. We know that forces are struggling to manage escalating demand, but staff must have the skills and experience necessary to carry out their roles. As they ask ever more of their staff, senior leaders have a responsibility, perhaps now more than ever, to give them the tools they need to succeed.

Exploited children are still likely to be prosecuted for offences they are coerced to commit

Most forces now clearly recognise the vulnerability of those children who are or may be the victims of criminal exploitation. Children who are coerced to commit crime are frequently vulnerable and will often be moved away from their local area across county lines. This may be by an individual or organised network. We have been pleased to see an increase in the use of the national referral mechanism, a framework for identifying victims of human trafficking and ensuring they receive the appropriate care. Forces are developing more sophisticated ways to assess the nature and scale of the criminal exploitation of children in their areas. However, current approaches are often focused on the crime rather than the vulnerability of those children who are exploited.

Young children who come to the attention of the police are usually victims of offending. Many older children who regularly meet the police are likely to be both troubled and in trouble. Most European legal systems, including Scotland, recognise this with a single adjudication system for children about whom offending, or care concerns arise. In England and Wales, however, the distinction made between ‘offender’ and ‘victim’ or the designation ‘child in need’ leads to a divergence in both perception and treatment.

The focus of criminal justice is punishment and the reduction of offending. For social care the primary focus is the protection and wellbeing of the child. As a result, opportunities for the police to safeguard a child who comes to their attention because of offending may be lost. This is most acute where a child commits a criminal offence because of the influence of an exploitative adult.

This means that in many places children who commit criminal offences while being exploited are likely to be prosecuted for those offences despite a clear recognition of coercion taking place. Prosecuting children for offences they have committed may be appropriate in some, perhaps even many, cases. But, currently too little emphasis is placed on the reasons children may have committed offences. An understanding of the root causes of criminality whether it is coercion, or a long history of abuse and trauma should be used to inform decisions about the response. We have found examples of innovative work in this area being used successfully. We have found evidence of prosecutions being discontinued or interventions being provided because of the circumstances under which offences were committed. Even so, there is much more work to be done to ensure that vulnerable children are not unnecessarily criminalised.

If a child is arrested or prosecuted for an offence it is much less likely that any kind of safeguarding referral will be submitted. This means that the only support the child will receive will come from the criminal justice system. While some of the interventions they may receive will have a safeguarding element, as highlighted above, the primary focus will be reducing further offending, or punishment. Significant further work is required so that vulnerability is recognised and responded to for children who have been trafficked or coerced into committing criminal offences. Far too little use is made of the mechanism for discontinuing prosecutions where the public interest is not demonstrated. As a consequence, children who are the victims of abuse and exploitation are routinely criminalised unnecessarily. This is particularly the case for children in care. This is not in their best interest. It is not in the public’s best interest. Police leaders must do more to ensure that children are recognised as victims when they have been exploited or coerced.

The use of police protection powers was appropriate in most cases we audited

As in our 2015 report, we have found since that in an emergency, when a child might need to be taken to a place of safety, police decisions were generally well thought through, right for the child, and properly recorded. When a force clearly defines a case as a child protection matter from the outset, the police response is generally appropriate. We frequently see examples of officers and staff making effective decisions to protect children. When there are significant concerns about the safety of children, such as parents leaving young children at home alone, or being drunk while looking after them, officers handle incidents well. They use their powers appropriately to remove children from harm’s way. It is a very serious step to remove a child from a family by way of police protection. In the majority of cases we have examined, decisions to take a child to a place of safety were well considered and were made in the best interests of the child.

However, authorising officers often don’t record when and in what circumstances the power has been rescinded, or what the long-term protective plan is.

Record-keeping following the use of police protection powers was often poor

Although we found some examples where staff had carried out investigations promptly and effectively, they do not always record on police systems details about safeguarding and joint work with other organisations, or the fact that a discussion has taken place. It is therefore not clear what, if any, safeguarding planning happened following the use of police powers. Nor is it often clear whether all the appropriate agencies were involved in developing a protective plan. It is unclear whether a child is receiving the appropriate support, and the effectiveness of future decision making is undermined. Officers and staff won’t have all the information available about the circumstances and risks with which a child lives. This contributes to them not always taking sufficient account of patterns of abuse or vulnerability or the context within which it has occurred.

We acknowledge that police information systems are often clumsy and poorly integrated. They do not easily lend themselves to being able to draw together all the necessary and relevant information about a child. Staff are required to put information on more than one system or complete more than one form. Not all staff have access to the necessary information, for example, whether a child is on a child protection plan and the details of that plan. However, opportunities to intervene more effectively are routinely being missed because of the poor quality of information recorded (or not recorded) on police systems. This has not greatly improved since our last inspection.

The need to build trust and develop child-focused plans is increasingly understood and evident

It is important that children can trust the police. Since 2015 we have continued to find that police officers and staff working in specialist units are skilled in communicating with children and work hard with children to gain their trust. They consider carefully the child’s needs, build a trusting relationship and provide a route to other services. In most, though not all, child protection cases, officers consider carefully how best to approach a child and/or the parents or carers and explore the most effective ways in which to communicate with them. Such sensitivity builds confidence and creates stronger relationships between the child, those who care for them, and police. We have also found that forces often work well with external organisations, family members and other people to protect children when they need immediate safeguarding. Where this happens, the carefully considered and sensitive approach enables effective safeguarding outcomes for vulnerable children.

Some local neighbourhood and school police officers or community support officers were also trusted by children and able to perform this role. In 2015, we found individual cases of community officers and staff going the extra mile to build trust with children. Since then we have seen the development in some places of more sophisticated approaches. Some forces work closely with partners to jointly develop the ability to recognise and respond to risk at an earlier stage. These early help and intervention approaches focus on responding to the early indicators of risk and vulnerability before they reach an acute stage. Police leaders have recognised the critical importance of effective and integrated joint working arrangements when seeking to identify, assess and respond to the risks faced by children at risk of neglect and other forms of abuse. Working with partners, the police have invested significant time and resources in the development of innovative approaches. These include One Team, a pilot in south Bristol in which families are visited within 24 hours of a domestic abuse incident, and Operation TOPAZ, a proactive approach to identifying and engaging with children at risk of, or subject to, CSE and the identification and disruption of perpetrators. These approaches are leading to earlier identification of, and response to, neglect and vulnerability.

There is evidence to suggest that such approaches offer improved outcomes for children and the best opportunity to thrive and reach their potential. However, while this approach is advanced and well co-ordinated in Wales with the support of all partners and the government, the approach in England is embryonic and underdeveloped. We have found a small number of examples of innovative and effective work to engage and support children in need at an earlier stage, but far more work is needed to enable forces, their partners, and most importantly children, to realise the benefits of effective early intervention.

Forces also increasingly recognise the impact of trauma on a child, but greater consistency would improve outcomes

We have been pleased to find that forces are increasingly aware of the importance of providing services that recognise and reflect the impact that trauma can have on a child. The use of specially trained intermediaries to carry out interviews with children is more often considered than it was in 2015 but these experts are still not used (or considered) in every appropriate case. The use of such professionals can provide, particularly for young children, the support they need to describe often horrific abuse. This provides the best possible evidence for an investigation and can give the child an important first step towards recovery. However, we have also found that cost and lack of availability can lead to delays in the provision of these specialist services.

Such interviews are not necessary in every case. Officers and staff who investigate crimes with vulnerable child victims should have received specific training to conduct an interview with a child. These interviews are often conducted by the police alone but can be carried out jointly with children’s social care. Joint interviews where a child’s social worker is present can serve to build trust between the police and a child. They can also support more effective safeguarding and protective planning as the criminal investigation and the protective planning for a child are closely co-ordinated. We have been disappointed to find that since 2015 the number of joint interviews conducted has continued to decline.

The quality of police-only interviews with children varies wildly. We have found a small number of high-quality interviews, but most are inconsistent and occasionally poor. Efforts to build trust and confidence are limited with no clear recognition of the impact trauma has on a child. This is particularly the case where the child victims have chaotic lives with a number of pre-existing vulnerabilities. For example, where a child, who perhaps has a history of sexually harmful behaviour, reports they have been sexually assaulted we have found that the risks faced by that child can be minimised. In these cases, the impact of trauma is not always fully recognised. We have found many cases where the perceived poor lifestyle ‘choices’ of children have, in the assessment of the police, contributed to the child becoming a victim of a crime. This fails to recognise the nature of child trauma, highlights an insufficient focus on the root causes of vulnerability and fatally undermines trust in the police.

Child-centred practice is improving

Forces are universally recognising the importance of developing more child-centred approaches. We are pleased and encouraged by some of the examples of innovative practice to help make sure children who have been sexually assaulted aren’t further traumatised by the investigation of a crime. The Lighthouse project in Camden, north London, discussed earlier in this report, is one example. Other forces, with their partners, have also established dedicated facilities for children who have been abused and need specialist support, but the availability of these dedicated facilities is inadequate and inconsistent. We are encouraged that the VKPP is currently undertaking a national evaluation of initiatives to support vulnerable children. But more work and greater guidance from the government is required to ensure the needs of vulnerable children are prioritised and their trust is sought and gained. The protection of children should be done with them, not to them.

Forces are working to improve engagement with children in the community

We have also found many examples of forces and their partners making efforts to improve and develop the way they engage. The police and partners are establishing arrangements for capturing the thoughts and views of children as strategic plans and policies are made. In some places we have seen clear evidence that the voices of children are listened to carefully and have influenced decisions about the delivery of services. In York, the child sexual abuse assessment centre has used the observed experience of, and feedback from, children to ensure that the service provides an environment that is as welcoming as is reasonably possible. The use of ‘you said, we did’ posters encourages children to share their views and further develop this work, particularly as the posters feature the offer of hot chocolate and use of electronic tablets to help children feel welcome while waiting to be seen. There is a good range of helpful and well-considered guidance and information, including about services that relate to child sexual abuse in a family environment, on both the local safeguarding children’s board and York children’s trust websites. Children and young people have helped to shape this material and impressive hit numbers on the site reflect this.

7. Protecting children from those who pose a risk

Approaches to risk have been sophisticated but the capacity of specialist units remains a concern

All police forces have specialist teams dedicated to the management of sex offenders and violent offenders. They are dedicated to the oversight of multi-agency public protection arrangements, which includes the police, National Probation Service and Community Rehabilitation Companies and prison service to ensure the proper management and monitoring of sexual or violent offenders.

Since 2015, forces generally have a better understanding of the nature and scale of demand within these units. In many, though not all, places, staffing levels have risen to ensure that the ratio of offenders to individual offender managers is reasonable and manageable. National guidance is not specific, but it is generally agreed that a ratio of 50 offenders per single offender manager is appropriate. It is also stated that of this number no more than 20 percent (or 10 individuals) should be classified as higher risk offenders due to the additional work required.

In January 2017, the NPCC issued guidance that forces may use either active or reactive management approaches for registered sex offenders (RSOs). Active management requires visiting the offender. Officers receive training in the use of active risk management (ARMS) assessments. National practice is for police ARMS assessments to be completed at least every 12 months, or when something happens that may result in a major change to the current overall assessment and risk management plan for the offender.

A force may move individuals from active to reactive management. This can be done if an ARMS assessment suggests that an RSO presents a low level of risk, and the offender manager is satisfied that the offender has not committed offences or presented any risk for a three-year period. Since this system was introduced, we have seen significant and consistent increases in the proportion of RSOs who have received a proper ARMS assessment. This is positive because it allows forces to consider moving some offenders to reactive management approaches in order to prioritise higher-risk offenders.

The use of both active and reactive management, effectively carried out, should allow a force to focus on those RSOs posing the greatest risk. It may also ease demand to a limited extent by allowing reactive management for those RSOs who fit the criteria. Initial levels of ARMs assessments have been steadily increasing. However, we have begun to see early evidence that as demands on forces continue to increase the review of assessments has been less consistent. As a consequence, we have seen some (limited at this stage) examples of forces implementing reactive management approaches for offenders without an up-to-date, or in some cases any, ARMs assessment being conducted. In addition to being a significant deviation from national guidelines, the suppression of demand in this way means that some sexual and violent offenders may not be receiving the scrutiny they deserve. This approach places inappropriate emphasis on the management of demand at the expense of the mitigation of risk. We have also found that the wider risks posed to children can be missed.

We will monitor this closely in our future inspections.

We have also been pleased to find that increasingly forces are ‘flagging’ RSOs on their electronic information systems. This is positive and allows staff to make better and more informed decisions. However, this could be improved by making sure that this information is recorded on all the systems used by staff to gather information about risk. Many forces, for example, flag RSOs on their crime recording system but not on their command and control systems, which are used to manage incidents. This means that officers attending apparently unrelated incidents at addresses of RSOs would not necessarily know that they are already known offenders. As a result, forces may not notice that an offender should be moved from reactive to active management and miss the chance to act.

Better briefing of neighbourhood police teams will enhance intelligence gathering

As the numbers of registered offenders increase, collecting and sharing information about them, and managing them appropriately, has become increasingly demanding.

In 2015, we have found that links between specialist RSO management teams and neighbourhood teams were underdeveloped and inconsistent. Offender managers would often task and brief neighbourhood teams on an ad hoc basis to gather intelligence about specific individuals, but information about RSOs was not often routinely shared in briefing materials, and intelligence collection did not form part of day-to-day duties.

This was a missed opportunity and we are pleased that it has improved since 2015. Staff in neighbourhood teams play a vital role in the development of community intelligence, and so forces may be missing opportunities to gather information about people who pose a risk to children. These teams can be particularly helpful in supporting risk assessments and identifying when to move an offender between reactive and active management. While we still find some forces where this does not routinely occur and misplaced (though understandable) concerns about sharing information about RSOs persist, the way in which specialist RSO management teams and local teams co-operate and co-ordinate to reduce risk is improving.

There are often significant delays in investigating some suspects who have downloaded, shared or distributed indecent images of children online

Despite investigations within specialist units often being of a higher standard we continue to be concerned about the sometimes-lengthy delays in investigations involving indecent images of children. The increasing availability of abuse images of children has inevitably resulted in an increase in the number of cases for the police to investigate. While, as we outlined above, many forces have created dedicated teams to investigate these offences, we routinely find that the level of demand means that delays and drift can often occur. In most of the forces we have been to where a suspected perpetrator presents a clear risk to children, either because of their job or because they live with or have easy access to children, then these investigations are prioritised for action and are generally (though not universally) undertaken in a timely way. However, in those cases that are considered to be a lower risk we often find there can be a significant delay in even allocating the case to an investigator. This leaves children at an unmanaged and unassessed risk.

Although the risk assessment processes in most places should identify if a suspect lives or works with children, there is often no indication of whether the suspect may have other access to children. Children may be at risk from suspects in these cases for lengthy periods of time. Under this approach safeguarding planning for children linked to a suspected perpetrator is routinely deferred until a criminal investigation has begun. As a result, in addition to being left exposed to unmanaged risk, children do not receive safeguarding support at the earliest opportunity resulting in missed opportunities to minimise harm.

In addition, we have also found that many forces have ineffective processes for examining devices that are suspected of containing indecent images of children. This is partly due to the limited capacity of forces to conduct large numbers of costly and time-consuming digital forensic examinations. However, the situation is exacerbated by the lack of availability of technology to help officers to quickly scan devices to determine the likelihood of indecent images being present. This technology, known as ‘digital triage’, allows officers and staff to make better and more informed decisions and only submit devices for a full examination where the probability of indecent images is highest. The more consistent availability of this technology would, in the longer term, reduce demand and delays and give the police a better opportunity to protect children.

In some of the most concerning cases we have found that in addition to delays a lack of technology has resulted in prosecutions being discontinued and perhaps most troublingly of all devices returned that may have contained indecent images. However, simply buying technology isn’t the answer. In many places we have seen technology sitting idle that was bought by forces for this purpose. A lack of compatibility with other systems and training supervision means it becomes obsolete quickly. A better and more sophisticated approach to using technology to expedite examinations should be part of a wider and more coherent approach to digital policing. We are aware that the NPCC is working to improve digital investigations through its Digital Policing Portfolio and Policing Vision 2025; however, the government should give serious thought to how it can support the use of technology in policing in its next comprehensive spending review.

8. The detention of children in police custody

Delays in the attendance of appropriate adults to support children in custody and those with complex needs are not routinely referred to children’s social care

Many children brought into police custody have complex needs. They are likely to be vulnerable and in need of safeguarding support. In many cases a referral to children’s social care services is warranted. However, in many cases we reviewed there is no recorded evidence of referral forms submitted for children in custody. As mentioned earlier in this report, we find that the perception of a child as a suspect defines what they are thought to need and how they are assessed. Many children in custody suites who should have been seen by a doctor or nurse were not, despite clear signs of risk and vulnerability. This was despite the widespread availability of dedicated healthcare practitioners in custody suites.

Appropriate adults are routinely available for children who are detained. However, detained children often do not receive early support from them. Guidance contained in the Police and Criminal Evidence Act 1984 codes of practice states that once an appropriate adult is identified, that person should be asked to attend the custody centre as soon as practicable. In some cases, we found evidence of long delays before appropriate adults attend. Attendance generally coincided with the interview of the child, rather than the adult giving early support of their overall welfare needs, rights and entitlements. This can lead to significant delays in a child seeing someone other than the police. The focus is wrongly on managing demand as opposed to mitigating risk and placing a child’s needs at the centre of decision making.

The need to find alternative accommodation is understood, but this is not escalated when none is available

If a child is to be denied bail and detained, the local authority is responsible for providing appropriate alternative accommodation. Only in exceptional circumstances (such as during extreme weather) would a transfer to alternative accommodation not be in the child’s best interests. In rare cases, for example, if a child presented a high risk of serious harm to themselves or others, secure accommodation may be needed.

We have found that custody officers and staff now have a better understanding of the conditions under which bail can be denied. They also understand the responsibility of the police and local authority to seek, and be given, appropriate alternative accommodation where bail is considered unsuitable.

However, this has not led to more accommodation being made available. This is despite a 2017 Home Office concordat reinforcing this point and senior leaders in the police, along with partner agencies, understanding the issue better. While we found some evidence of forces using alternatives such as bail more effectively, in most cases where appropriate accommodation isn’t available, children are still detained, often for a long time, until they go to court.

Children are still held in police stations when they shouldn’t be. This is not in their best interests. It simply isn’t changing quickly enough.

Conclusion

Police senior leaders and staff are clearly committed to protecting vulnerable children more effectively. There has been, and continues to be, a strong focus on improving services for the protection of vulnerable people. This has clearly shaped services, planning and decision making since our last inspection. This clear focus is visible at all levels of the service and has translated into a better sense of responsibility from staff about their safeguarding responsibilities.

We have been consistently pleased to find that in every force we have returned to after a previous inspection there had been some measure of progress in achieving better results for children who were at risk of harm. However, despite the clear priority on protecting those who are vulnerable, the delivery of better and more effective outcomes is not as consistent as it should be. As a result, the police are not always making better decisions when dealing with children in need of help and protection.

The management and oversight of investigations remains inconsistent nationally. This affects the provision of safeguarding and ultimately leaves children vulnerable to harm. It continues to be the case that the majority of cases we examine are found to be inadequate or they require improvement. In a significant number, poor supervision and record keeping undermine decision making and safeguarding measures.

The police do not recognise or evaluate risk to children well enough. Forces usually deal with obvious cases of child abuse and neglect promptly and efficiently. However, the police often carry out more complex investigations badly and investigations can suffer delays. As previously highlighted, a greater focus on safeguarding and the protection of vulnerable people has led to a better understanding and sense of responsibility. Too often however, incidents are dealt with as a one-off. Cumulative and escalating risk is not recognised at the earliest opportunity and the development of an appropriate protective plan is delayed.

The response to children who regularly go missing from home also requires improvement, with a particular focus on early intervention and ensuring that officers and staff understand the link between children who regularly go missing and sexual exploitation. The police now understand that those children who go missing are at increased risk of exploitation, but the overall response still requires improvement to reduce the risks to children. Initial efforts to locate children were often prompt and effective. However, opportunities are often missed to make long-term plans with other agencies to protect children and reduce the risks they face until those risks become acute. The general understanding of the nature and extent of sexual exploitation has improved. However, the risk to individual children is still often underestimated, particularly as children move towards adulthood. In some rare instances, we still find children in effect blamed for exploitation by having their vulnerability described as a choice. The understanding and response to criminal exploitation, particularly where children are moved across county borders, is underdeveloped although it has improved considerably over the last year. But the police have much more to do to protect children who are vulnerable in these circumstances. The quality of the response to this issue varied widely in too many cases. Too often, children are still likely to be prosecuted despite clear evidence of coercion. The police aren’t yet using all the tools available to them to protect children who are forced to commit crime. As a result, too many children are being criminalised when they shouldn’t be.

The ways in which agencies share information with each other varies across force and partnership areas. It is important to ensure that information about risk is shared appropriately without breaking the rules on protecting personal data but current inconsistencies create significant challenges. The Home Office’s new national technology strategy, which seeks to significantly enhance the interoperability of police and other emergency services, is an opportunity to address these and other concerns. The police have an opportunity through the development of new local safeguarding arrangements to build more effective structures to share information about risk and make joint decisions about developing protective plans.

Since 2015, we have been pleased to find that forces generally understand better the demands facing the specialist teams that manage sexual and violent offenders. More sophisticated risk assessment and management processes have been introduced which, if properly applied, allow forces to place greater emphasis and scrutiny on those who pose the highest risk. However, we were concerned to find that inappropriate assessment of the risk posed by some offenders is being used to suppress demand. This will mean that some offenders will not receive the scrutiny that the level of risk they pose requires.

We have been pleased to find that the involvement of local and neighbourhood officers and staff has improved since 2015. These teams can be particularly helpful in supporting ongoing risk assessments and identifying when to move an offender between reactive and active management. Staff in neighbourhood teams have long played a vital role in the development of community intelligence. Forces who don’t share details about offenders in their areas may be missing opportunities to gather information about people who pose a risk to children.

The examination of electronic devices often causes delays. While many forces have been able to reduce the backlogs of devices awaiting examination, forces are not making the best use of technology to protect children. While some forces have equipment to quickly identify which devices may have indecent images on them, not all forces use this. Often, the police don’t take any action to safeguard children until devices have been examined. This leaves children exposed to unmanaged risk.

Children are still held in police stations when they shouldn’t be. This isn’t changing quickly enough. It is almost always best for a child not to be held in a police station. Local authorities are responsible for providing accommodation which, in rare cases, might need to be secure. A 2017 Home Office concordat reinforced this, but it hasn’t led to more accommodation being made available.

Forces now know that they shouldn’t hold children in police stations. They ask more frequently for accommodation from local authorities, which they are legally required to provide. We found some limited evidence of forces using alternatives such as bail more effectively. But in most cases where appropriate accommodation isn’t available, children are still detained until they go to court. This is often for a long time. This is clearly not in their best interests and is not in line with the codes of practice governing the detention of children in police custody.

Children are waiting too long for proper support from appropriate adults and healthcare professionals. The number of children entering police custody has decreased, prompted in part by changes in legislation but also, significantly, by an increased recognition that having a child in custody is not in their best interests. But those that do enter custody invariably end up staying longer than is necessary or appropriate.

The need to develop earlier and more effective approaches to those children who are vulnerable is well understood by the police. We found many examples of good, innovative work to protect vulnerable children more effectively. We were pleased that police leaders know that they can no longer continue to operate in the same reactive way and need to build different, preventative risk reduction-based models of working. This approach should start during childhood and remain a consistent and defining characteristic of an integrated public health and care system (of which the police and wider criminal justice system is a sub set).

In Wales, the police are part of a programme to give early support to children exposed to ACEs. In Scotland, the police are integral to a whole system approach to public health and care. In England, the approach to early intervention isn’t yet as consistent or well developed. The NPCC is working to develop more consistent approaches. This work would be helped by clear government recognition of the benefits of more effective preventative approaches. We have been working, and will continue to work, with government and other partners to use the findings from our inspections to inform wider national strategic decision-making processes to support this. The correlation between adverse experiences in childhood and a greater risk of needing acute safeguarding support later in life, suffering mental ill health or entering the criminal justice system (or all of these) is increasingly well understood. This continuum of risk and the traumatic paths it all too often and far too predictably takes people on must form the basis of a more coherent approach to reducing risk and preventing crime.

In conclusion, since 2015 we have seen the commitment and determination by officers and staff to protect children reinforced by a more nuanced understanding of the complex challenges facing them. We have been pleased to see improvements in many of the areas we highlighted in our previous thematic and a clear focus on continual improvement. Each force we have inspected and revisited has become better and more effective and they are to be commended for it.

Protecting children is not easy but the commitment we find from leaders and practitioners does not waver. However, in too many cases and in too many places the strategic aspiration to improve is not being translated into better outcomes for children in need of help and protection. In some cases, this might be understandable. But where children are concerned it cannot be excusable. We will continue to work alongside police forces and their leaders to support improvement, learning and the protection of children.

Recommendations

Annex A – The reports used for this thematic review

This thematic report will be based on the following reports.

Eighteen National Child Protection Inspections:

• Gwent Police – published June 2019
• Lincolnshire Police – published February 2019
• Sussex Police – published November 2018
• Merseyside Police – published August 2018
• Northamptonshire Police – published July 2018
• Northumbria Police – published June 2018
• Lancashire Constabulary – published March 2018
• Bedfordshire Police – published November 2017
• Cleveland Police – published September 2017
• Gloucestershire Constabulary – published June 2017
• Leicestershire Police – published June 2017
• Humberside Police – published April 2017
• Cumbria Constabulary – published January 2017
• Metropolitan Police Service – published December 2016
• Essex Police – published March 2016
• Surrey Police – published December 2015
• Devon and Cornwall Police – published September 2015
• South Wales Police – published July 2015

And the following 21 reviews of progress against our recommendations.

• Cleveland – National Child Protection post-inspection review – published November 2018
• Gloucestershire – National Child Protection post-inspection review – published May 2018
• Leicestershire – National Child Protection post-inspection review – published May 2018
• Humberside – National Child Protection post-inspection review – published April 2018
• Metropolitan Police Service – National Child Protection Inspection post-inspection quarter 4 update – published February 2018
• Metropolitan Police Service – National Child Protection Inspection post-inspection quarter 3 update – published November 2017
• Cumbria – National Child Protection Inspection post-inspection review – published September 2017
• Metropolitan Police Service – National Child Protection Inspection post-inspection quarter 2 update – published August 2017
• Metropolitan Police Service – National Child Protection Inspection post-inspection quarter 1 update – published June 2017
• Essex – National Child Protection Inspection Re-inspection – published February 2017
• Surrey – National Child Protection Inspection Re-inspection – published February 2017
• Devon and Cornwall – National Child Protection Inspection post-inspection review – published July 2016
• South Wales – National Child Protection Inspection post-inspection review – published June 2016
• West Yorkshire – National Child Protection Inspection post-inspection review – published March 2016
• Nottinghamshire – National Child Protection Inspection post-inspection review – published February 2016
• West Mercia – National Child Protection Inspection post-inspection review – published January 2016
• Dyfed-Powys – National Child Protection Inspection post-inspection review – published January 2016
• Greater Manchester – National Child Protection Inspection post-inspection review – published December 2015
• West Midlands – National Child Protection Inspection Re-inspection – published December 2015
• Norfolk – National Child Protection Inspection post-inspection revisit – published October 2015
• South Yorkshire – National Child Protection Inspection post-inspection review – published July 2015

Read more about National Child Protection Inspections, including inspection reports.

Joint Targeted Area Inspections

In 2016, a programme of joint targeted area child protection inspections was launched. These short, focused inspections are carried out on a multi-agency basis, led by Ofsted and also involving HMICFRS, the Care Quality Commission and Her Majesty’s Inspectorate of Probation.

• Joint targeted area inspection – Bracknell Forest – published March 2019
• Joint targeted area inspection – Islington – published January 2019
• Joint targeted area inspection – Shropshire – published January 2019
• Joint targeted area inspection – Cornwall – published November 2018
• Joint targeted area inspection – York – published November 2018
• Joint targeted area inspection – Durham – published August 2018
• Joint targeted area inspection – Dorset – published July 2018
• Joint targeted area inspection – Southend-on-Sea – published May 2018
• Joint targeted area inspection – Greenwich – published May 2018
• Joint targeted area inspection – Haringey – published January 2018
• Joint targeted area inspection – Stockton-on-Tees – published January 2018
• Joint targeted area inspection – Bristol – published December 2017
• Joint targeted area inspection – Cheshire West and Chester – published November 2017
• Joint targeted area inspection – Peterborough – published August 2017
• Joint targeted area inspection – Wokingham – published July 2017
• Joint targeted area inspection – Hounslow – published June 2017
• Joint targeted area inspection – Bradford – published April 2017
• Joint targeted area inspection – Hampshire – published February 2017
• Joint targeted area inspection – Wiltshire – published December 2016
• Joint targeted area inspection – Lincolnshire – published December 2016
• Joint targeted area inspection – Salford – published October 2016
• Joint targeted area inspection – Liverpool – published August 2016
• Joint targeted area inspection – Croydon – published June 2016
• Joint targeted area inspection – Central Bedfordshire – published May 2016
• Joint targeted area inspection – Oxfordshire – published May 2016
• Joint targeted area inspection – South Tyneside Metropolitan Borough – published April 2016

By the end of March 2019, we had carried out joint in-depth inspections in 28 local authority areas. These focused on child sexual exploitation, children living with domestic abuse, children at risk of neglect, children at risk of criminal exploitation, and those at risk of sexual abuse in the family environment.

We continue to find examples of good joint working, but agencies can do more. All children and young people, in all areas, should get consistently good support. We still find examples of poor practice by some professionals and agencies. Some children who are at risk of exploitation and abuse still don’t get the response they need as quickly as they should.

At the end of each theme we publish a report of our findings which draws together the findings of each inspection. The reports for all the themes except child sexual abuse in the family environment have been published.

Children at risk of sexual exploitation

In September 2016, we published a report covering five inspections of the multi-agency response to children at risk of sexual exploitation.

We found evidence of progress being made in many local areas, which is resulting in better support for children at risk of, or subject to, child sexual exploitation.

There is, however, no room for complacency. Poor practice by some professionals and some vital agencies means that some children at risk of exploitation still do not get the response they need quickly enough.

In most cases reviewed, police responses were effective, and in some instances, impressive. However, there were a small number of cases where there were significant delays in police responding to children who had reported child sexual exploitation. All children deserve the kind of responses we have seen in some areas, where responses from the police are timely and focused on the needs of the victim and where professional skill and diligence results in the conviction or disruption of perpetrators and good support for victims.

Children living with domestic abuse

In September 2017, we published a report covering six inspections of the multi-agency response to children living with domestic abuse.

We were pleased to find that professionals (including the police) have made progress in dealing with the immediate challenges presented by the volume of cases of domestic abuse. However, domestic abuse is a widespread public health issue that needs a long-term strategy to reduce its prevalence.

Accepted best practice in tackling social problems like domestic abuse is to prevent, protect and repair. While much good work is being done to protect children and victims, far too little is being done to prevent domestic abuse and repair the damage it causes.

Work with families that we saw on inspection was often in reaction to individual crises. Agencies can be overwhelmed by the frequency of serious incidents, particularly higher risk ones. However, keeping children safe over time needs long-term solutions.

The focus on the immediate crisis leads agencies to consider only those people and children at immediate, visible risk. As a result, agencies are not always looking at the right things, and in particular, not focusing enough on the perpetrator of the abuse.

Older children who are living with neglect

In July 2018, we published a report covering six inspections of the multi-agency response to older children living with neglect.

We found that agencies have been working hard to improve their responses to child neglect. However, their work has largely focused on younger children. Our inspections showed that agencies, including adult services, need to work together to identify and respond to the neglect of older children.

To achieve the best possible outcomes for children, leaders in all agencies need jointly to form a clear local strategy to deal with neglect. This should include the neglect of older children. Leaders should make sure all partners and professionals have the same understanding of how neglect of older children manifests itself. All partners and professionals also need to be clear about their role in identifying and responding to neglect. Decisions about how to respond to neglect must be informed by good evidence, and by listening to the experiences of the children themselves.

Children at risk of criminal exploitation

In November 2018, we published a report covering three inspections of the multi-agency response to children at risk of criminal exploitation. This partially revisited the theme of children at risk of sexual exploitation but included specific recognition of the variety of ways in which children can be exploited and abused (including being coerced into criminality).

We found that preventing and responding to child criminal exploitation and sexual exploitation are big challenges for agencies and professionals nationally and locally. It can be done, but agencies must ensure that they have the building blocks in place to work effectively and quickly.

When a child commits a crime or other concerning behaviour where exploitation or coercion may be a factor, professionals need to be curious and compassionate and seek to understand the reasons behind their behaviour.

The police and their partners need to do more to understand the nature and extent of criminal exploitation locally. If they have not already done so, partners need to work together to plan how to respond to criminal exploitation. Everyone involved must understand local issues of exploitation and gangs so that responses can be carefully co-ordinated to meet local need.

Partnerships need not only to identify and respond to the risk of exploitation, but also to raise awareness and work with children, parents and local communities to prevent exploitation. Professionals must not give up on children or their families. Both are in danger and need their help, support and protection. In too many cases we found that a child who has committed a criminal offence is still likely to be prosecuted even where there are clear signs of exploitation.

Annex B – Child protection inspection methodology

Objectives

The objectives of the inspection are:

• to assess how effectively police forces safeguard children at risk;
• to make recommendations to police forces for improving child protection practice;
• to highlight effective practice in child protection work; and
• to drive improvements in forces’ child protection practices.

The expectations of organisations are set out in the statutory guidance Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children. The specific police roles set out in the guidance are:

• the identification of children who might be at risk from abuse and neglect;
• investigation of alleged offences against children;
• inter-agency working and information-sharing to protect children; and
• the exercise of emergency powers to protect children.

These areas of practice are the focus of the inspection.

Inspection approach

Inspections focus on the experience of, and outcomes for, children following their journey through the child protection and criminal investigation processes. They assess how well the police service has helped and protected children and investigated alleged criminal acts, taking account of, but not measuring compliance with, policies and guidance.

The inspections consider how the arrangements for protecting children, and the leadership and management of the police service, contribute to and support effective practice on the ground. The team considers how well management responsibilities for child protection, as set out in the statutory guidance, have been met.

Methods

• Self-assessment of practice, and of management and leadership.
• Case inspections.
• Discussions with officers and staff from within the police and from other organisations.
• Examination of reports on significant case reviews or other serious cases.
• Examination of service statistics, reports, policies and other relevant written materials.

The purpose of the self-assessment is to:

• raise awareness in the service about the strengths and weaknesses of current practice (this forms the basis for discussions with HMICFRS); and
• initiate future service improvements and establish a baseline against which to measure progress.

Self-assessment and case inspection

In consultation with police services the following areas of practice have been identified for scrutiny:

• domestic abuse;
• incidents in which police officers and staff identify children who are in need of help and protection, e.g. children being neglected;
• information sharing and discussions about children who are potentially at risk of harm;
• the exercising of powers of police protection under section 46 of the Children Act 1989 (taking children into a ‘place of safety’);
• the completion of section 47 Children Act 1989 enquiries, including both those of a criminal nature and those of a non-criminal nature (section 47 enquiries are those relating to a child ‘in need’ rather than ‘at risk’);
• sex offender management;
• the management of missing children;
• child sexual exploitation; and
• the detention of children in police custody.

Annex C – Definitions and interpretations

In this report, the following words, phrases and expressions in the left-hand column have the meanings assigned to them in the right-hand column. Sometimes, the definition will be followed by a fuller explanation of the matter in question, with references to sources and other material that may be of assistance to the reader.

Term	Meaning
child	person under the age of 18 years
multi-agency public protection arrangements (MAPPA)	mechanism through which local criminal justice organisations (police, prison and National Probation Service) and other bodies dealing with offenders work together in partnership to protect the public from serious harm by managing sexual and violent offenders; established in each of the 42 criminal justice areas in England and Wales by sections 325 to 327B of the Criminal Justice Act 2003
multi-agency risk assessment conference (MARAC)	locally held meeting of statutory and voluntary agency representatives to share information about high-risk victims of domestic abuse; any agency can refer an adult or child whom they believe to be at high risk of harm; the aim of the meeting is to produce a co-ordinated action plan to increase an adult or child’s safety, health and well-being; organisations that attend vary, but are likely to include the police, probation, children’s, health and housing services; over 250 MARACs currently in operation throughout England and Wales
multi-agency safeguarding hub (MASH)	working location in which public sector organisations with responsibilities for the safety of vulnerable people collaborate; it has staff from organisations such as the police and local authority social services, who work alongside one another, sharing information and co-ordinating activities to help protect the most vulnerable children and adults from harm, neglect and abuse
Office for Standards in Education, Children’s Services and Skills (Ofsted)	non-ministerial department, independent of government, that regulates and inspects schools, colleges, work-based learning and skills training, adult and community learning, education and training in prisons and other secure establishments, and the Children and Family Court Advisory Support Service; assesses children’s services in local areas, and inspects services for looked-after children, safeguarding and child protection; reports directly to Parliament
police and crime commissioner (PCC)	elected entity for a police area; responsible for securing the maintenance of the police force for that area and securing that the police force is efficient and effective; holds the relevant chief constable to account for the policing of the area; establishes the budget and police and crime plan for the police force; appoints and may, after due process, remove the chief constable from office; established under section 1, Police Reform and Social Responsibility Act 2011
registered sex offender (RSO)	person convicted or cautioned for a sexual offence as set out in Schedule 3 to the Sexual Offences Act 2003, or who has otherwise triggered the notification requirements (for example, by being made subject to a sexual offences prevention order), who is required to provide personal details to the police, including details of movements (for example, if going abroad) and, if homeless, where they can be found; registered details may be accessed by the police, probation and prison service

References

[1] Read more about our rolling programme of child protection inspections.

[2] Policing for the future: Tenth Report of Session 2017–19 (PDF document), House of Commons Home Affairs Committee, 2018, page 45.

Back to publication

National Child Protection Inspections: 2019 thematic report