Doctors play a crucial role in protecting children from abuse and neglect. Surgery consultations, home visits, emergency department 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 how to act and who to contact when they suspect children are at risk of or are experiencing harm.
The Children (Northern Ireland) Order 1995 sets out responsibilities of the authorities to provide services to children in need and their families. It also defines a duty on local authorities to investigate children at risk and take appropriate action.
In 2012 the Area Child Protection Committees (ACPCs) were replaced by the Safeguarding Board for Northern Ireland (SBNI). The aim, to provide a co-ordinated and consistent approach to safeguarding and promoting the welfare of children in Northern Ireland, ensuring that organisational boundaries do not act as barriers in protecting children and young people up to the age of 18.
Section 5(1) of the Criminal Law (Northern Ireland) Act 1967 provides for a criminal offence of failing to disclose an arrestable offence to the police, which would include most offences against children. However the Act has been amended so that doctors are not under a duty to report sexual activity involving a child aged 13-15 years old where the other party is under 18 years of age.
Understanding the Needs of Children in Northern Ireland (UNOCINI) is an assessment framework created to support professionals in the assessment and planning to meet the needs of children and their families. This is intended as a tool to help identify needs at an early stage and prevent problems from escalating. It can be used to make referrals to Children’s Social Services and ensure that Agencies are provided with all important information that is required on referral.
GMC guidance – Protecting Children and Young People Responsibilities for all Doctors (September 2012) states “All children and young people are entitled to protection from abuse and neglect. Good medical practice places a duty on all doctors to protect and promote the health and wellbeing of children and young people. This means that all doctors must act on any concerns they have about the safety or welfare of a child or young person.”
The key points highlighted are the importance of being aware of the risk factors and to look out for signs that a child or young person may be at risk; the importance of communication both with children and young people, parents and other professionals; working in partnership with other professionals and agencies and understanding local child protection procedures.
Child protection is a difficult area; paragraph 32 of the GMC guidance Protecting Children and Young People the Responsibility of All Doctors, sets out what you should do if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect:
- Promptly tell an appropriate agency. This may be a local authority children’s services, the NSPCC or the police.
- Provide the identities of the child or young person, their parents and anyone else who may pose a risk to them.
- Provide any information related to your concerns – your reasons, information about the child or young person’s health and any relevant information about their parents or carers.
Confidentiality is central to the trust between doctors and patients however this is not an absolute duty and a breach in confidentiality with disclosure of information may be justified in the public interest; for example, if disclosure is likely to reduce or risk of death or serious harm to the patient or third party. The GMC states: “You must weigh the harm that is likely to arise from not sharing the information against the possible harm, both to the person and to the overall trust between the doctors and patients of all ages arising from the releasing of the information.” Essentially you will need to be able to explain and justify disclosure or non-disclosure.
However you should ask for consent before sharing confidential information, unless by doing so or by delaying information being shared you increase risk of harm to a child or young person. A child’s welfare is paramount.
Paragraph 61 of the GMC’s 0-18 years Guidance for All Doctors states: “Your first concern must be the safety of children and young people. You must inform an appropriate person or authority promptly of any reasonable concern that children or young people are at risk of abuse or neglect, when that is in the child’s best interest or necessary to protect other children or young people. You must be able to justify your decision not to share such a concern, having taken advice from a named or designated doctor for children protection or an experienced colleague, or a defence or professional body. You should record your concerns, discussions and reasons for not sharing the information in these circumstances.”
Child Death Review
The Safeguarding Board for Northern Ireland is required to undertake a case management review whenever a child dies, including death by suicide, and where abuse or neglect is known or suspected to be a factor in the child’s death. In addition it may be considered when a child has sustained serious and permanent impairment of health or development through abuse or neglect or important lessons for inter-agency working could be learnt. The Safeguarding Board Act (Northern Ireland) 2011 provides a statutory ability for the Board to obtain information, which would include medical records.
What if I am unsure? The information that you hold might be the missing link and 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 as long as you have acted on the basis of a reasonable belief and through appropriate channels. Your first concern must be the welfare of the 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. If you are asked to disclose information to another organisation such as police or Social Services, you may need to ask them further details in order that you can satisfy yourself of your ability to disclose in the public interest.