Focused Assurance Activity: Child Safeguarding in NHS Wales Health Boards and Trusts

This Terms of Reference outlines HIW’s focused assurance approach for child safeguarding in NHS Wales Health Boards and Trusts. It is aligned with the Wales Safeguarding Procedures (WSP), which details the essential roles and responsibilities of practitioners and leaders to ensure they safeguard children and adults at risk of abuse and neglect. 

This activity follows and draws on from a range of related assurance activities with partner inspectorates, including Joint Inspections of Child Protection Arrangements (JICPA) (2019-2024) and Child Protection Rapid Review (CPRR). In support of the findings from these activities and in co-ordination with a review being undertaken by partner inspectorates (CIW, Estyn, HMICRFS and HIW) in 2026-27, we will align the focus of this review to Section 5 of the WSP relating to allegations or concerns about practitioners whose role brings them into contact with children within the healthcare environment. 

This work will undertake a three-stage assurance model:

• Stage 1: Evidence Gathering Exercise 
• Stage 2: Evidence Review and Interviews
• Stage 3: Follow-up Interviews

Stage 1 – Intelligence Review and Evidence Gathering Exercise (May- June 2026)

We will create an evidence gathering tool for all organisations to complete. This request will be directed to senior staff and corporate safeguarding teams and will inform an important basis for our findings. The request will include obtaining:

• Each organisations arrangements for receiving, managing and escalating safeguarding concerns relating to individuals in positions of trust.
• Governance and oversight arrangements for safeguarding concerns, specifically Section 5 allegations.
• How each organisations assures itself that staff are competent, confident, and supported to respond to safeguarding concerns in line with their roles.
• How each organisations ensures individuals are suitable to work with children both at the point of recruitment and throughout their employment.
• How each organisations identifies, analyses and responds to learning from safeguarding practice, including Section 5 allegations.
• How the child’s lived experience, including their participation and how their views and wishes are recorded and used to influence safeguarding decisions and actions, where it was considered appropriate to do so by the Designated Officer.

Stage 2 – Evidence Review & Interviews (July 2026)

Upon receipt and review of the evidence collected during stage 1, we will use this information to inform our interviews with each organisation. The aim of the interviews is to build upon the evidence provided and to draw out key themes, including examples of good and developing practice. Topics and key lines of enquiry will be evaluative in nature and will focus on the areas set out in stage 1.

Stage 3 – Follow-up Interviews (July-August 2026)

Follow-up interviews will be scheduled with safeguarding leads from a sample of Health Boards and Trusts. Topics and key lines of enquiry will include reporting and escalation pathways; the internal management of allegations, including cases where thresholds are not met; involvement in strategy discussions, decision-making processes and multi-agency working. This will also include referrals to the Disclosure and Barring Service (DBS) and relevant professional regulators.

All organisations will be required to provide documentary evidence and data to support the above stages.

• A national thematic summary identifying cross Wales learning, systemic risks and good practice
• Organisation specific feedback letters where notable local learning or good practice has been identified.

This review forms part of HIW’s work to provide independent assurance on the quality and safety of healthcare services in Wales. The Health and Social Care (Community Health and Standards) Act 2003 (Part II, Chapter 4) gives HIW the power to carry out inspections, reviews and investigations of the NHS or services provided for the NHS. This terms of reference sets out our intended approach to the review.

Where we process personal data, this is in accordance with data protection legislation, including the Data Protection Act 2018 and the General Data Protection Regulations. Further information is set out in HIW’s privacy notice which can be found on our website https://hiw.org.uk/privacy-policy.

However, we recognise that this review involves sensitive information about individuals subject to professional concerns and other individuals, stakeholders and third-party investigations.  We will ensure that:

• HIW and Health Boards / Trusts must use Objective Connect secure messaging system as its default method of conveying evidence.
• Our findings will be reported on collectively in a national thematic summary and all due care will be taken to ensure that individuals and individual Health Boards / Trusts are not identifiable.