At hygeia, we are committed to safeguarding children and vulnerable adults and to protecting them from harm. Our dental team accepts and recognises our responsibilities to develop awareness of the issues which may cause harm to children and vulnerable adults.
The Child Protection and Adult Safeguarding Lead at our practice is Joanne Giddy. Her deputy is Neil Phillips. They are the relevant points of contact for raising concerns. They also have responsibility for ensuring that our policies and procedures for safeguarding children and vulnerable adults are kept up-to-date and operated correctly.
We will endeavour to safeguard children and vulnerable adults by:
- developing an awareness of safeguarding issues;
- promoting good safeguarding practice through all our practice policies and procedures;
- following the guidelines set out below;
- making team members and patients aware that we take child and vulnerable adult protection seriously and respond to concerns about the welfare of children and vulnerable adults;
- sharing information about concerns with agencies who need to know and involving parents and children appropriately;
- following carefully the procedures for staff recruitment and selection (including referencing and DBS disclosure); and
- providing effective management for staff by ensuring access to supervision, support and training.
This policy is underpinned by the following principles:
- patients have access to information and knowledge to ensure that they can make an informed choice
- patients are given the opportunity to consider the various treatment options available to them and are encourage to fully participate in their care at the practice
- patients are supported to make their own decisions and to give or withhold consent to treatment – unless provided for otherwise by law, no-one can give or withhold consent on behalf of another adult
- information about patients held by the practice is managed appropriately and all members of the team understand the need for confidentiality
- the individual needs of the patient are respected
- the background and culture of all patients is respected
- practice procedures ensure the safety of patients at all times
- recruitment and selection procedures at the practice are followed routinely and ensure that all required checks are carried out.
We will review this policy and guidance annually.
IF YOU ARE A PATIENT AND THINK YOU ARE BEING ABUSED, PLEASE SPEAK TO JOANNE GIDDY OR ANY TEAM MEMBER ABOUT THIS. ANYTHING YOU TELL US WILL BE HELD IN STRICTEST CONFIDENCE AND WE WILL HELP YOU IN WHATEVER WAY WE CAN – INCLUDING GIVING YOU INFORMATION ABOUT AGENCIES AND ORGANISATIONS THAT CAN HELP.
YOU DON’T HAVE TO SPEAK TO US – BUT PLEASE SPEAK TO SOMEONE. OTHER ORGANISATIONS THAT CAN HELP ARE:
NSPCC Child Protection Helpline – 0808 800 5000 – nspcc.org.uk
Childline – 0800 1111 – childline.org.uk
The Samaritans – 08457 909090 – samaritans.org
Devon Social Services Multi-Agency Safeguarding Hub (MASH) – 0345 155 1071
Care Direct (for adults) – 0845 1551 007
- A child is anyone who has not yet reached their 18th birthday
- A vulnerable adult is a person aged 18 or over who is, or may be, in need of community care services or is resident in a continuing care facility by reason of mental or other disability, age or illness or who is, or may be, unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation.
Flagging of vulnerable adults in clinical records
That a person is a child will be immediately clear from their clinical records since we record their date of birth as a matter of course.
That a person meets the definition of “vulnerable adult” may not be immediately clear.
For this reason, we “flag” the possibility that someone may be a vulnerable adult, or alternatively, where they may appear to be a vulnerable adult but we do not consider them to be in immediate danger of harm or exploitation.
This means that in the event the patient interacts with a team member who does not know them (because, for example, that team member is new to the practice or is a locum/agency worker) the team member’s attention will be drawn to relevant safeguarding matters.
Flagging is discreet but obvious to anyone using the practice computer system. Safeguarding issues are recorded on the “Medical Alerts” tab so that, if there are any, the “Red Cross” icon flashes at the top of the screen. This is the same icon that denotes issues such as illnesses, medication, allergies, etc and is something that every practitioner would be expected to check as a matter of course before treating any patient. Hence the safeguarding issue would be very unlikely to be overlooked.
Entries are prefaced with the word “SAFEGUARDING” in capital letters. They should contain a brief factual resume of the reasons why the patient is or is not regarded as a vulnerable adult at risk of harm or exploitation.
Members of the dental team are in a position where they may observe the signs of abuse or neglect or hear something that causes them concern about a child or vulnerable adult. The dental team has an ethical responsibility to follow the procedures for safeguarding set out in this guidance wherever a child or vulnerable adult is or might be at risk of abuse or neglect: this includes a responsibility to ensure that children and vulnerable adults are not at risk from members of the profession itself.
If a team member becomes aware of anything that makes them suspect a child or vulnerable adult is being abused, they must immediately refer the matter to the Child Protection and Adult Safeguarding Lead, Joanne Giddy. If it is not possible to refer the matter to her, the team member must refer the matter to the Deputy Lead, Neil Phillips. The Lead or the Deputy will decide the most appropriate manner in which to deal with the situation. If there is any doubt about how a matter should be handled, they can obtain additional information from the Child Protection and the Dental Team website or from local Social Services (0345 155 1071) or the Devon Safeguarding Adults Board.
Any allegations made against or suspicions about a team member must be reported to the Child Protection and Adult Safeguarding Lead in the same way as if they had involved a child’s parent, a vulnerable adult’s carer or another person. If an allegation is made against or you have suspicions about the Child Protection and Adult Safeguarding Lead, this should be reported to her Deputy. If an allegation is made against or you have suspicions about the Deputy Lead, this should be reported to the Child Protection and Adult Safeguarding Lead in the usual way. Where allegations involve any team member, the Child Protection and Adult Safeguarding Lead or her Deputy (as appropriate) will make decisions about the need for referral in the same manner as in any other case but may also invoke disciplinary procedures.
If neither the Child Protection and Safeguarding Lead nor her Deputy are available to consult, you may have to make a referral yourself. Here are flowcharts to help you do this in relation to:
Signs of abuse
The dental team is not responsible for making a diagnosis of abuse or neglect, just for sharing concerns appropriately, but here are some examples of what might amount to abuse, so that you have some idea of what to look for:
Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm. It may also be caused by a parent or carer fabricating the symptoms of, or deliberately causing, illness.
Emotional abuse is persistent emotional maltreatment causing severe and persistent adverse effects on emotional development. It may involve conveying to children or vulnerable adults that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of the other person. It may feature:
- age or developmentally inappropriate expectations;
- interactions that are beyond the child’s or vulnerable adult’s developmental capability;
- over protection and limitation of exploration and learning;
- preventing participation in normal social interaction;
- allowing a child or vulnerable adult to see or hear the ill-treatment of another;
- causing a child or vulnerable adult frequently to feel frightened or in danger; and
- exploitation or corruption.
Sexual abuse involves forcing or enticing a child or vulnerable adult to take part in sexual activities, whether or not they are aware of what is happening. The activities may involve physical contact, including penetrative (for example rape, buggery) or non-penetrative acts. They may include non-contact activities, such as involving children or vulnerable adults in looking at, or in the production of, pornographic material or watching sexual activities, or encouraging them to behave in sexually inappropriate ways.
Neglect is the persistent failure to meet basic physical and/or psychological needs, likely to result in the serious impairment of health or development. It may occur in pregnancy as a result of maternal substance abuse. Neglect may also involve a parent or carer:
- failing to provide adequate food, clothing and shelter;
- failing to protect a child or vulnerable adult from physical and emotional harm or danger;
- failure to ensure adequate supervision;
- failure to ensure access to appropriate medical care or treatment; and
- neglect of, or unresponsiveness to, basic emotional needs.
Financial abuse involves stealing from a vulnerable adult by, for example, a carer using benefit money to buy things for themselves.
You may become aware of potential abuse in a number of different ways:
- through a direct allegation (often referred to as a “disclosure”) made by a child, vulnerable adult, parent, carer or some other person
- through signs and symptoms which suggest physical abuse or neglect (see above)
- through observations of child behaviour or parent-child interaction
- through observation of a vulnerable adult and the relationship they have with their carer.
If you are worried about a child or vulnerable adult – practical steps
It is uncommon for dentists to see patients with signs of abuse but where you have concerns about a patient who may have been abused and there is no satisfactory explanation, prompt action is important: immediately discuss your concerns with the Child Protection and Adult Safeguarding Lead, Joanne Giddy, or her Deputy, Neil Phillips. They will decide whether a formal referral is required.
Permission to refer:
The Child Protection and Adult Safeguarding Lead or her Deputy will consider whether to seek permission to refer. It is good practice to explain concerns to the child or vulnerable adult and their parents or carers, informing them of the intention to refer and seeking their consent – being open and honest from the start results in better outcomes. Wherever possible, patients should be separated from the alleged abuser before such conversations take place.
We will not, however, discuss concerns with the parents or carers where:
- the discussion might put the child or vulnerable adult at greater risk;
- the discussion may impede a police investigation or social work enquiry;
- sexual abuse by a family member/carer, or organised or multiple abuse is suspected;
- fabricated or induced illness is suspected;
- parents or carers are being violent or abusive and discussion would place you or others at risk; and
- it is not possible to contact parents or carers without causing undue delay in making the referral.
Where there is serious physical injury arising from suspected abuse:
- we will refer the individual to the nearest hospital Emergency Department (in the case of a child, with the consent of the person having parental responsibility or care);
- advise the Emergency Department in advance (by telephone) that the patient is coming;
- if consent is not obtained, the Duty Social Worker at the local Social Services Department or the police should be told of the suspected abuse by telephone so that the necessary action can be taken to safeguard the welfare of the individual; and
- a telephone referral to Social Services must be confirmed in writing within 48 hours, repeating all relevant facts of the case and an explicit statement of why there are concerns. The telephone discussion should be clearly documented – who said what, what decisions were made and the agreed unambiguous action plan.
Where less serious injury is recorded or there is concern for the physical or emotional well-being of the individual, the Child Protection and Adult Safeguarding Lead (or her Deputy) will discuss the appropriate reporting procedures and our concerns with local Social Services (contact details below).
Recording and reporting
We will not attempt to investigate any allegations or suspicions ourselves but will instead refer matters to the appropriate authorities. It is important NOT to ask a child or vulnerable adult leading questions but to simply record what they say and what has happened. Asking leading questions may jeopardise any future criminal proceedings arising out of the allegation of abuse.
Where an injury is involved, reports will be restricted to:
- the nature of any injury;
- facts to support the possibility that the injuries are suspicious.
Attendance of the referring dentist may be required by the Social Services Department at a case conference or if there is a court hearing, so comprehensive written records of the injuries and its history (as reported) must be kept together with clinical photographs, where available.
Listening to children and vulnerable adults
We aim to create an environment in which children and vulnerable adults know their concerns will be listened to and taken seriously. We communicate this by:
- asking children for their views when discussing dental treatment options and seeking their consent to dental treatment in addition to parental consent;
- involving children and vulnerable adults when we ask patients for feedback about our practice; and
- listening carefully and taking them seriously if they make a disclosure of abuse.
Providing information to children and vulnerable adults
To support children, vulnerable adults, their families and carers, team members may consider offering information about:
- local services providing advice or activities (Devon County Child Protection Services – 0345 155 1071; Devon County Council emergency duty helpline – 0845 6000 388; Care Direct (for vulnerable adults) – 0845 1551 007); and
- sources of help in times of crisis, for example, NSPCC Child Protection Helpline, Childline, Samaritans (see the top of this policy for contact info).
Providing a safe and friendly environment for children and vulnerable adults
We will provide a safe and friendly environment by:
- taking steps to ensure that areas where patients are seen are welcoming and secure (with facilities for children to play where appropriate);
- considering whether young people or vulnerable adults would wish to be seen alone or accompanied by their parents or carers;
- ensuring that staff never put themselves in vulnerable situations by seeing young people or vulnerable adults without a chaperone; and
- operating safe recruitment procedures (refer to recruitment policy).
Other relevant policies and procedures
Clinical governance policies that we already have in place contribute to the practice being effective in safeguarding children and vulnerable adults. Relevant policies and procedures include:
- safe staff recruitment procedures: carrying out checks with the DBS, making job applicants aware of our policy on child protection and safeguarding vulnerable adults, checking gaps in employment history, requesting proof of identity, taking up references;
- our complaints procedure: so that children or parents attending our practice can raise any concerns about the actions of team members that may put children at risk of harm;
- whistleblowing policy (underperformance policy): so that team members can raise concerns if practice procedures or the action of colleagues put patients at risk of harm.
- confidentiality policy, consent policy, equal opportunities policy, equality and diversity policy, patient safety policy, etc.
Web version 7: 17.8.2018 (reviewed 11.11.2018)
Previous web versions: 11.2.2011 (Reviewed 26.1.2012); 29.2.2012; 14.3.2012; 26.5.2012; 13.3.2013 (Reviewed 19.6.2014; 5.6.2015); 4.8.2016 (Reviewed 1.9.2017)