Safeguarding children
Summary
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 members know what to do and who to contact should they suspect children are at risk of, or are experiencing, harm.
Laming Report 2009
Lord Laming recently called for the Department of Health (DH) to work harder to raise the level of child protection expertise and to ensure doctors are proactive in doing all they can to keep children safe.
His report also found that the legislative framework for safeguarding children is basically sound – the problem lies in its implementation.
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 Local Safeguarding Children’s Boards (LSCBs) and Child Protection Committees
- policies, procedures and organisations that work to protect children and promote their welfare.
The Children Act 1989 makes the following provision for child safety:
- Section 17 – refers to children in need. This is defined as those children whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development, or their health and development would be significantly impaired, without the provision of services. It also relates to those who are disabled.
- Section 47 – covers children at risk or suffering harm, from physical, sexual or emotional abuse or neglect. In these circumstances, the local authority has a duty to investigate.
Disclosing information
You need to be able to explain and justify any disclosures
The Department for Children, Schools and Families’ (DCSF) What to do if you are worried a child is being abused sets out the processes involved when making a referral to Children’s Services:
- Any concerns about child abuse or neglect should be referred to children’s social care or the police. If the child is already known to children’s social care, inform the allocated social worker.
- If you are making referrals, know who to contact in the police, education, health, school and children’s social care to express your concerns.
- 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 significant harm.
- Agree with the recipient of the referral what you will tell the children and their parents, by whom and when.
- If you make a referral by telephone, confirm it in writing within 48 hours.
Each PCT or Health Board should have access to a paediatrician with responsibilities for advising on child death review processes. You should familiarise yourself with the DH’s Framework for the assessment of children in need and their families (2000).
Personal information may be disclosed without consent if it is in the public interest, eg, 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 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’s Act 2004 requires each local authority in England and Wales to promote co-operation between different agencies involved in the welfare of children. It also requires them to establish LSCBs of which NHS organisations are statutory members.
Serious case reviews (SCRs)
SCRs are set up to identify why a child has been seriously harmed and to improve systems and services for children and their families.
Child death review (CDR)
CDR processes became mandatory for LSCBs in England in 2008, and are being piloted in Wales, to try to understand why children die and put into place interventions to protect other children and prevent future deaths. Child deaths are reviewed by a rapid response team who enquire into and evaluate each unexpected death of a child, and by a panel which provides an overview of all child deaths (under 18 years) in each LSCB.
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 Children’s Services 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
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 which have taken place should be well documented.