Safeguarding arrangements for vulnerable children could become “more confusing, fragmented and possibly riskier” under government reforms, the NHS Confederation has warned.

It said there was “deep unease” in the NHS about the way the system for safeguarding was to be changed, given that previous examples of poor coordination between organisations had been identified as the root causes of major failings in child protection.

Under the reforms, the current system of safeguarding and child health commissioning and provision by primary care trusts and local authorities will be divided between four types of organisation and spread over six geographical levels.

The NHS Commissioning Board and the Public Health England will commission services for vulnerable children and young people at national level, while clinical commissioning groups and councils will have responsibility at local level. The NHS Commissioning Board and CCGs will also commission some specialist children’s services at a more regional level.

The confederation said overarching policy was needed to ensure child health and protection services were properly coordinated.

Confederation deputy policy director Jo Webber said: “We have ample evidence from the past of what goes wrong when organisations are not coordinated to work together properly.

“Through joint work between councils and the NHS, we have made great strides since then. There is deep unease in the NHS that, in reorganising the system, we are resetting to a model that is potentially riskier and certainly more fragmented.”

She added: “Vulnerable children with complex needs will now find the responsibility for their care and their safety spread out between a range of organisations – and on the NHS side, all of them will be completely new.

“We know through painful experience that it is between the gaps in responsibilities that the most tragic and difficult cases fall. With nothing making these organisations work together in the way they should, we have to be honest that the risk of us failing is more likely.”

A report published this week by the charity 4Children also claims that most councils do not have a child poverty strategy in place.

The report found that only 74 out of the 125 local authorities in England have such a strategy, despite them having a legal obligation to do so under the Child Poverty Act 2010.