Safeguarding children

Correct as of March 2010

The GMC states that “doctors play a crucial role in protecting children from abuse and neglect”. Surgery consultations, home visits, accident and emergency admissions and contact with other professionals who work with children help to create a picture of a child’s situation. This factsheet is designed to help members know what to do and whom to contact should they suspect a child is at risk of, or is experiencing, physical, sexual or emotional harm.

What you should be aware of

The GMC’s 0-18 Years: Guidance for all Doctors states that you should be aware of:

  • the use of frameworks for assessing children and young people’s needs
  • the work of the Area Child Protection Committees
  • policies, procedures and organisations that work to protect children and promote their welfare.

The Children (Northern Ireland) Order 1995 makes provision for children who are in need or whose health and development would be significantly impaired without the provision of services. It also covers children who are at risk of suffering harm from physical, sexual or emotional abuse or neglect. In these circumstances, the local authority has a duty to investigate. The child’s welfare is the paramount consideration.

Disclosing information

The Department of Children, Schools and Families has issued guidance in England called What to do if you are Worried a Child is Being Abused, setting out the processes involved when making a referral to Children’s Services. This guidance has been used in the development of the Department of Health, Social Services and Public Safety’s (DHSSPS) A Short Guide to Child Protection Policy and Procedures, specifically for Northern Ireland.

It is important to reassure the child but not make any promises regarding confidentiality

In summary:

  • If you have any concerns about child abuse or neglect, you must follow your own area’s policies and procedures and refer the matter to social services, the NSPCC or the police.
  • If you are making referrals, you should know whom to contact in the police, within the child’s healthcare scenario, and in school and children’s social care to express your concerns.
  • Physically see the child and attempt to talk to the child about your concerns appropriate to their age and understanding, and with their parents, unless you feel that this would place the child at an increased risk of significant harm.
  • Carefully consider the information that you are passing to the person to whom you are referring the matter.
  • It is important to reassure the child but not make any promises regarding confidentiality. Record all concerns, discussions, decisions made and the reason for any decisions with regard to the child.
  • You should discuss concerns with a manager or a colleague and if your concerns remain, you should make a referral.
  • Reach an agreement with the recipient of the referral what will be told to the children and their parents, by whom and when.
  • If you make a referral by telephone, confirm it in writing within 48 hours. Social Services should acknowledge your referral within five days. If after seven days you have not heard from them, contact Social Services again.

You should also familiarise yourself with Understanding the Needs of Children in Northern Ireland (UNOCINI).

With reference to children who have died, the HSC Board should have access to a paediatrician with responsibilities for advising on child death review processes. You should contact the HSC Board who will direct you to the appropriate person.

Personal information may be disclosed without consent if it is in the public interest, eg, if it is likely to reduce the risk of death or serious harm to the patient or a third party. This includes the prevention, detection and prosecution of a serious crime.

The GMC states: “The risk of harm must, in your opinion, outweigh the privacy interests of your patient.” If you are considering making a disclosure of personal information without consent, you must be able to explain and justify any disclosures. You should also consult with a colleague or more senior member of the clinical team to discuss your concerns and intentions.

In Northern Ireland, Area Child Protection Committees have been established to promote co-operation between health and social care services and other agencies in circumstances where a child has died. Case Management Reviews are set up to establish the facts of the case, whether there are any lessons to be learned and, if so, to identify how they will be acted upon and changed for the future, and improve inter-agency co-operation.

Child Death Review processes are currently being developed in Northern Ireland, to review unexpected deaths. The aim of the review is to try to understand why children die and put in place interventions to protect other children and prevent future deaths. Practitioners will be advised by the DHSSPS when these are due to be implemented.

In most circumstances these reviews will satisfy the public interest test, allowing for disclosure of relevant information from the child’s medical records.

Working with others

Everyone who deals with children is responsible for safeguarding children. Sharing information with agencies such as the Area Child Protection Committees and the police is important. It can ensure children get the help that they need.

What if I am unsure?

The information that you hold might be the missing link – a risk might only become apparent when a number of people share their niggling concerns. If you are unsure whether or not to share information, seek advice from an experienced colleague, a designated doctor for child protection, or call MPS for advice.

Even if you raise a concern that later becomes groundless, you can justify your decision so long as you have acted on the basis of reasonable belief and through the appropriate channels. Your first concern should be the welfare of children. You must be able to justify any decision not to share concerns and it would be advisable to take advice prior to doing so. Any decisions and discussions that have taken place should be well documented.

Further information

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