Doctors are encouraged to consider the effects of their actions, and the actions of their patients and colleagues, on vulnerable children and young adults – regardless of whether they are their patients. The situation of a vulnerable young person may be seen through surgery consultations, A&E admissions, or school and home visits.
Things to Consider
The GMC has guidance specific to the under-18s, highlighting the need for doctors to be aware of
- frameworks for assessing a child’s needs,
- the organisations and various policies and procedures that work to promote child welfare, and
- Local Safeguarding Children Boards and child protection committees.
In addition to the above, two sections in 1989’s The Children Act, make the following provisions:
- Section 17 covers ‘children in need’, or those who are vulnerable due to an unlikelihood of maintaining a satisfactory level of health due to disability, or a lack of care provision; and
- Section 47 covers ‘children at risk’, or those who are vulnerable due to a likelihood of suffering physical, sexual, or emotional abuse or neglect – and the obligation of the local authority to investigate.
The GMC recommends that a doctor who is concerned about an at-risk child should
- inform the appropriate agencies, such as the police or NSPCC, as soon as possible;
- provide agencies with the identities of the child, their parents, and anyone who may be posing a risk to them;
- provide all relevant information, such as the reasons for the report, information about the child in question’s health, and any information about their parents or carers.
Doctors should gain valid consent before sharing information, unless the act of doing so is likely to increase the risk of harm to the child, or the disclosure of information is in the public interest. Matters of public interest include harm to the child in question, harm to a third party, or any other serious crime.
There is also an expectation that doctors should follow up on their concerns if they have not been appropriately acted on. This could involve escalating the issue yet further.
Doctors must also be able to justify their decision to not share a concern, or to escalate. All justifications should be recorded in the medical record.
Serious Case Reviews
SCRs are established to find out why a child was seriously harmed, and how to improve the systems and services available to children and families.
Child Death Review
The process of implementing a CDR became mandatory in 2008. CDRs are reviews which attempt to unearth why children die, and try to prevent further deaths. The deaths are reviewed by a rapid response team, and the Child Death Overview Panel. When a child dies, all healthcare services must notify the Care Quality Commission.
Working with Others
The responsibility for safeguarding children lies with all those who are dealing with them. The sharing of information between responsible parties – such as children’s services and the police – can ensure children get all the help they need.
Given the importance of small pieces of information, it is vital that all concerns are raised. However, those who are unsure about whether to share information or not should seek advice from senior colleagues, a child protection-designated doctor, or their professional protection organisation. Even if raised concerns eventually turn out to be unfounded, as long as a doctor has acted on the basis of reasonable belief and can justify their actions.