Protecting children and young people: The responsibilities of all doctors

Identifying those at risk of, or suffering, abuse or neglect

Key points - chapter 2

  • Be aware of risk factors that have been linked to abuse and neglect and look out for signs that a child or young person may be at risk.
  • If you are treating an adult patient, consider whether your patient poses a risk to children or young people.
  • Keep an open mind and be objective when making decisions. Work in partnership with families where possible.
  • If you are not sure about whether a child or young person is at risk or how best to act on your concerns, ask a named or designated professional or a lead clinician or, if they are not available, an experienced colleague for advice.

Roles of all doctors

2

You must consider the safety and welfare of children and young people, whether or not you routinely see them as patients. When you care for an adult patient, that patient must be your first concern, but you must also consider whether your patient poses a risk to children or young people. You must be aware of the risk factors that have been linked to abuse and neglect and look out for signs that the child or young person may be at risk. Risk factors include having parents with mental health or substance misuse issues, living in a home where domestic violence takes place, or living in poverty.15 But these circumstances do not necessarily lead to abuse or neglect, and child protection issues exist in all sections of society.

15

For more information see the Munro review of child protection.

3

Identifying signs of abuse or neglect early and taking action quickly are important in protecting children and young people. Working in partnership with parents and families can help children and young people to get the care and support they need to be healthy, safe and happy, and to achieve their potential. You should look out for signs that a family may need extra support, and provide such support if that is part of your role, or refer the family to other health or local authority children’s services so they can get appropriate help.16 

16

You should follow the guidance in Confidentiality: good practice in handling patient information when sharing information with other agencies.

4

You must know what to do if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect or, in the case of a pregnant patient, that the child will be at risk of abuse or neglect after birth. This means you should have a working knowledge of local procedures for protecting children and young people in your area.17 You should know who your named or designated professional or lead clinician is, or you should have identified an experienced colleague to go to for advice, and know how to contact them.

5

You must act on any concerns you have about a child or young person who may be at risk of, or suffering, abuse or neglect (see paragraphs 32 - 38).

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

33

When telling an appropriate agency about your concerns, you should provide information about both of the following:

  1. the identities of the child or young person, their parents and any other person who may pose a risk to them
  2. the reasons for your concerns, including information about the child’s or young person’s health, and any relevant information about their parents or carers.
34

You should ask for consent before sharing confidential information unless there is a compelling reason for not doing so. For example, because:

  1. delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person
  2. asking for consent may increase the risk of harm to the child, young person, you or anyone else.
  3. you have already decided that disclosure is justified in the public interest.
35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).
36

You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential. 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.

37

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons,  and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.

38

If you share information without consent, you should explain why you have done so to the people the information relates to, and provide the information described in paragraph 35, unless doing this would put the child, young person or anyone else at increased risk. You should also record your decision as set out in paragraph 54.

Roles of doctors who work with children or young people

6

If you work with children or young people, you must have the knowledge and skills to recognise signs and symptoms of abuse and neglect,2 3 4 9 11 12 13 and to take appropriate and prompt action if necessary.

2

General Medical Council (2013) Good medical practice London, General Medical Council, paragraph 42.

3

References to ‘parents’ in this guidance include people who care for or look after children or young people. This might include carers, other family members or adults who live in the same household (see the definitions of ‘children’, ‘young people’ and ‘parents’ of this guidance).

4

See JD v East Berkshire Community Health Trust & Ors [2005] UKHL 23 (21 April 2005) paragraphs 85, 87.

9

General Medical Council (2017) Confidentiality: good practice in handling patient information London, General Medical Council.

11

The professional standards describe good practice, and not every departure from them will be considered serious. You must use your professional judgement to apply the standards to your day-to-day practice. If you do this, act in good faith and in the interests of patients, you will be able to explain and justify your decisions and actions. We say more about professional judgement, and how the professional standards relate to our fitness to practise processes, appraisal and revalidation, at the beginning of Good medical practice.

12

The Equality Act 2010 specifies nine protected characteristics that cannot be used as a reason to treat people unfairly. These are age, disability, sex, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, and sexual orientation.

13

For guidance on competency see the intercollegiate report on safeguarding children and young people.

7

You must be open-minded when considering the possible cause of an injury or other signs that may suggest that a child or young person is being abused or neglected. For example, as part of the differential diagnosis you should consider whether an uncommon condition, including a genetic condition, might have caused or contributed to the child’s or young person’s injury or symptoms. You must also make sure that the clinical needs of children and young people continue to be met and are not overshadowed by child protection concerns.

8

You should work with parents and families, where possible, to make sure that children and young people are receiving the care and support they need. This is especially important for children and young people who are living in particularly stressful circumstances – for example, because they are caring for a parent or their parent is in hospital. You should be aware of services in your area that could provide appropriate help, including, for example, services provided by voluntary groups.

9

In some cases, it may be difficult to identify where parents’ freedom to bring up their children in line with their religious and cultural practices or beliefs becomes a cause for concern about a child’s or young person’s physical or emotional well-being.18 You should develop your understanding of the practices and beliefs of the different cultural and religious communities you serve.

18

See our guidance on personal beliefs for advice on male circumcision. Female genital mutilation – sometimes referred to as female circumcision – is a serious crime and a child protection issue. Multi-agency practice guidelines and procedural guidance for mandatory reporting for England and Wales have been published by HM Government. Multi-agency guidelines for Northern Ireland have been published by the Northern Ireland Executive. An FGM Action Plan has been published by the Scottish Government.

10

You must make sure your own cultural or religious background does not affect your objectivity. When deciding whether to raise child protection concerns with parents or with other agencies, you must consider the issues impartially and make sure your personal views about parents’ and other adults’ religious and cultural practices or beliefs do not affect your decisions about them or their family. If in doubt, you should ask for advice from a professional or voluntary organisation that has experience in working with a particular community. Or you should ask for advice from a named or designated professional or a lead clinician or, if they are not available, an experienced colleague.

11

If, having discussed the issues with the parents, you still have concerns that a child or young person is at risk of, or is suffering, abuse or neglect, whatever the cause, you must tell an appropriate agency (see the guidance in paragraphs 32–38).

32

You must tell an appropriate agency, such as your local authority children’s services, the NSPCC or the police, promptly if you are concerned that a child or young person is at risk of, or is suffering, abuse or neglect unless it is not in their best interests to do so (see paragraphs 39 and 40). You do not need to be certain that the child or young person is at risk of significant harm to take this step. If a child or young person is at risk of, or is suffering, abuse or neglect, the possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing your concerns with an appropriate agency might cause.

33

When telling an appropriate agency about your concerns, you should provide information about both of the following:

  1. the identities of the child or young person, their parents and any other person who may pose a risk to them
  2. the reasons for your concerns, including information about the child’s or young person’s health, and any relevant information about their parents or carers.
34

You should ask for consent before sharing confidential information unless there is a compelling reason for not doing so. For example, because:

  1. delay in sharing relevant information with an appropriate person or authority would increase the risk of harm to the child or young person
  2. asking for consent may increase the risk of harm to the child, young person, you or anyone else.
  3. you have already decided that disclosure is justified in the public interest.
35

You should ask the child or young person for consent if they have the capacity to give it. If not, you should ask a person with parental responsibility. You should also ask for consent from any adults you want to share information about. When asking for consent, you should explain why you want to share information and how it will benefit the child or young person. You should also explain all of the following:

  1. what information you will share
  2. who you will share it with
  3. how the information will be used
  4. where they can go for independent advice and support (see Sources of independent advice and support for parents and families for examples of organisations).
36

You can share confidential information without consent if it is required by law, or directed by a court, or if the benefits to a child or young person that will arise from sharing the information outweigh both the public and the individual’s interest in keeping the information confidential. 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.

37

If a child or young person with capacity, or a parent, objects to information being disclosed, you should consider their reasons,  and weigh the possible consequences of not sharing the information against the harm that sharing the information might cause. If a child or young person is at risk of, or is suffering, abuse or neglect, it will usually be in their best interests to share information with the appropriate agency.

38

If you share information without consent, you should explain why you have done so to the people the information relates to, and provide the information described in paragraph 35, unless doing this would put the child, young person or anyone else at increased risk. You should also record your decision as set out in paragraph 54.

12

If you are a named or designated professional or a lead clinician, you should make sure your colleagues know what help you can offer and how to contact you for advice and support.