Safeguarding children

Correct as of December 2009

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 build up a picture of a child’s situation. This factsheet is designed to help MPS members know what to do and who to contact should they suspect children are at risk of, or are experiencing, 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 Child Protection Committees
• Policies, procedures and organisations that work to protect children and promote
  their welfare.

The Children (Scotland) Act 1995 makes provisions for children who are in need or whose welfare would be significantly impaired without the provision of services. It also covers children who are at risk or suffering harm. In such circumstances, the local authority has a duty of care towards the child.

Disclosing information

The Scottish Government’s Protecting Children and Young People: A Shared Responsibility – Guidance for Health professionals in Scotland sets out the processes involved when making and considering referrals in respect of children where it is believed they are at risk of harm:

Any concerns about child abuse or neglect should be shared with other relevant agencies involved with the child, including child protection services within the local authority and the police.

When sharing information, know who to contact in the police, education, health, school and local authority.

Try 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 harm.

Where information has been disclosed to partner agencies, agree with the recipient of the information that you will tell the children and their parents that said information has been disclosed, by whom and when.

If information is shared by telephone, confirm it in writing within 48 hours.

Personal information may be disclosed without consent if it is in the child’s best interest. The GMC states that “The risk of harm must, in your opinion, outweigh the privacy interests of your patient”. Essentially you need to be able to explain and justify any disclosures.

The Children (Scotland) Act 1995 gives social work services in local authorities overall responsibility for the welfare of children, but everyone who deals with children is responsible for their wellbeing. The aim is to promote co-operation between different agencies, such as the police and children’s services, in order to ensure the best possible outcome for children and their families.

Child deaths and significant cases

In those instances where a potentially significant case has occurred, an Initial Case Review (ICR) will be carried out by the Child Protection Committee in order to determine whether a Significant Case Review (SCR) is warranted. If no further review is necessary, findings are recorded and some follow-up action may take place.

Significant Case Reviews (SCRs) are set up and co-ordinated by local inter-agency Child Protection Committees to identify why a child has been seriously harmed, and to improve systems and services for children and their families. A “significant” case may be more than one event.

In the instance of unexplained, sudden child deaths, and where a death certificate cannot be granted as the cause of death is undetermined or suspicious, you, and/or the police if they have been informed, should forward the relevant information to the Procurator Fiscal. If there is cause for concern, a Significant Case Review may then be undertaken. In most circumstances, these reviews will satisfy the public interest test, allowing for disclosure of relevant information from the child’s medical records.

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.

Scotland has a 24-hour Child Protection Line, 0800 022 3222, for easy access to local child protection services. You can also visit a dedicated website for child protection in Scotland.