The GMC states that “Whether or not you have vulnerable children or young people as patients, you should consider their needs and welfare and offer them help if you think their rights have been abused or denied.” 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.
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.
The Scottish Government’s National Guidance for Child Protection in Scotland (2012) sets out the key joint roles for all services working with children and/or their families/carers:
- Have information, advice and training to make them aware of risks to children and understand their particular responsibilities in keeping children safe.
- Have ready access to appropriate, relevant and up-to-date guidance that tells them what action to take if they are concerned about a child’s safety or welfare.
- Understand what, how and when to record and share information to keep children safe, and be able to do so.
- Know what action to take if families with children whose names are on the Child Protection Register, or about whom there are significant concerns, fail to attend services or agreed appointments.
- Be given information, advice and training to help them understand key child protection processes and the roles and responsibilities of staff in their own and other services who may play a significant role in protecting children.
- Have appropriate support from managers when they are concerned about a child or when they are involved in child protection processes.
Paragraph 32 of the GMC guidance Protecting children and young people: the responsibilities 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 the local authority children’s services, the NSPCC or the police.
- Provide the identities of the child or young person, their parents and anyone 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.
You should ask for consent before sharing confidential information, unless by doing so, or by delaying information being shared, you will increase the risk of harm to the child or young person. 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: “You just 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 doctors and patients of all ages, arising from releasing that information.” Essentially you need to be able to explain and justify any disclosures.
You should also follow up your concerns if you believe that your concerns have not been acted on appropriately, leaving a child or young person at risk of, or suffering, abuse or neglect. This may involve taking your concerns to the next level of authority. Paragraph 61 of the GMC’s 0-18 years: guidance for all doctors says: 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 a child’s best interests or necessary to protect other children or young people. You must be able to justify a decision not to share such a concern, having taken advice from a named or designated doctor for child protection or an experienced colleague, or a defence or professional body. You should record your concerns, discussions and reasons for not sharing information in these circumstances.
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.