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 Local Safeguarding Children 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.
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 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 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.
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, 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 Child Death Overview Panel (CDOP), which provides an overview of all child deaths (under 18 years) in each LSCB.
Where a child dies unexpectedly, all registered providers of healthcare services must notify the Care Quality Commission of the death of a service user - but NHS providers may discharge this duty by notifying NHS England.
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. Sharing information appropriately is at the heart of effective child protection.
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 which have taken place should be well documented. You must record the decision not to immediately share information, along with your reasons and any advice you have received.