General Dental Practices
A Guide for Child Protection
Arrangements in General Dental Practices
Author: Mrs Dilys Calder – Designated Nurse for Child Protection and
Looked After Children – NPHS Mid & West Wales
Date: September 2007 / Version: 3
Status: Final
Classification: NHS Wales (Intranet) / NPHS (Intranet)/Child Protection Team
Applicability: National Public Health Service/ Child Protection Team
Meeting Date: 27 November 2007 / Review Date: September 2010
Relevant Previous Documents:
Ref: SMT 09-06 JG2
Sponsor: Dr Judith Greenacre – Regional Director NPHS
Purpose and Summary of Document:
This guidance was issued as a working draft in September 2006, and there has been some redrafting in response both to comments received and to relevant Welsh reports. The guidance has informed the clinical governance tool that was developed by the NPHS for General Dental Practice and is now available to support monitoring visits to General Dental Practices by LHB’s.
Publication/Distribution:
- Publication in NPHS Child Protection Document Database.
- Link from NPHS e-bulletin.
- Link from Stakeholder e-newsletter.
- To be distributed to the LSCB’s via the Designated Professionals.
- To be distributed through the LHB’s to those General Dental Practices who have NHS Contracts. The Designated Professionals will provide the LHB’s with updated contact telephone numbers for their area if appropriate.
Author: Mrs Dilys Calder
Designated Nurse Child Protection & Looked After Children / Date: 27/11/2007 / Status: Final
Version: 3 / Intended Audience: NHS Wales (Intranet) / NPHS (Intranet) / Child Protection Team
Public Health Division – Velindre NHS Trust / A Guide for Child Protection Arrangements in
General Dental Practices
A Guide for Child Protection Arrangements in General Dental Practices
ContentsPage
A Guide for Child Protection Arrangements in General Dental Practices (title page)..
1 Introduction..…………………………………………………………………………...3
2Responsibilities of Dental Practices......
2.1Appropriate Environment
3Managing Child Protection Issues within Dental Practices
3.1Employment Practice
3.2The Appointment
4Data Protection and Information Sharing
4.1Sharing Information
4.2Confidentiality
4.3Record Keeping
5Child Protection Conferences
6Prevention and Health Promotion
7Protection of staff working with children and young people
8Training
9Dental Treatment Under Conscious Sedation
10 Looked After Children
Appendix 1: The Role of the LHB and Dental Practice in Relation to Child Protection
Appendix 2: Child Protection Referral Information for the LHB………………………15
Appendix 3: How to Respond if you Suspect Child Abuse or Have Concerns About a Child’s Protection …………………………...……17
Appendix 4: Recognition of Abuse: Possible Presenting Features……………………………………… 20
Appendix 5: Contact Numbers...... 22
Appendix 6:Guidelines for Recruitment ……………………….……………………....24
Appendix 7:Child Protection Flow Chart for Dental Practices …………………… ..25
1
Author: Mrs Dilys CalderDesignated Nurse Child Protection & Looked After Children / Date: September 2007 / Status: Draft
Version: 2 / Page: 1 / Intended Audience: NHS Wales (Intranet) / Public Health Child Protection Team /
Public Health Division – Velindre NHS Trust / A Guide for Child Protection Arrangements in
General Dental Practices
1Introduction
The Carlile Report, “Too Serious a Thing”, that reviewed in 2002 the safeguards for children and young people treated and cared for by the NHS in Wales, made reference to the role and responsibilities of general dental practitioners within the child protection process.
The new Children Act 2004 very firmly places children and their safeguarding at centre stage, and states that all health staff have a duty to safeguard children. General Dental Practices will have to demonstrate that they are meeting these responsibilities and also those set out in “Health Care Standards for Wales (2005)”; which states, “Healthcare organisations comply with national child protection guidance within their own activities and in their dealings with other organisations” (standard 17)
The dental professions own standards advise “Find out about local procedures for child protection. Make sure that you follow these procedures if you suspect that a child may be at risk because of abuse or neglect” (1.8)
Within the Dental Practice there is a need to ensure that facilities and staff are appropriate for the examination and treatment of children. In addition dentists and their staff have a role in identifying children about whom they have concerns regarding their welfare and/or abuse.
This guidance seeks to clarify those roles and responsibilities for general dental practitioners. It sets out how the practice personnel can work together with other agencies, to promote children’s welfare and to protect them from abuse and neglect.
The All Wales Child Protection Procedures form the basis of how individuals and agencies should act and work together in order to keep children safe from harm and take action to protect them when this is necessary. Everygeneral dental practice in Wales has been issued with a copy and will be provided with the information as to how to access the rewrite that will be published at the end of 2007.The All Wales Child Protection Procedures are essential reading for all staff and will not be summarised in this document.
This document offers specific additional guidance for dental practices and should be read alongside the All Wales Procedures. The guidance suggests ways of managing concerns about child abuse and neglect issues within dental practices, however, all individual health staff will also be aware of their own responsibilities.
For the purpose of this guidance the Children Act 1989 definesa child as being up to the 18th birthday.
Consideration should also be given to the following legislation, and other international and national regulations and guidance.
- The Children Act 1989
- The Children Act 2004
- The United Nations Convention on the Rights of the Child 1989
- Safeguarding Children: Working Together under the Children Act 2004 (2006 Welsh Assembly Government)
- Standards for General Dental Professionals, Dental Council May 2005
- “Child Protection and the Dental Team” COPDEND 2006 DOH,
- Report of a Review of Child Protection Arrangements across NHS Wales – Hospital Care and Commissioning, HIW 2007
- Towards a Stable Life and Brighter Future, WAG June 2007
2 Responsibilities of Dental Practices
Child protection concerns may arise within almost all areas of work. All staff within the dental practice have a role in managing welfare and abuse concerns associated with children.
Staff in contact with any patient have a duty of care towards that patient.
2.1 Appropriate Environment
Dental practices are encouraged to provide a child friendly and safe waiting area for children, with appropriate play facilities for young children.
The waiting area should allow for safe supervision by parent/carers.
Parents/carers should be encouraged to remain with their child at all times. Where this is not possible, the child should be chaperoned and due consideration should be given to ensure that the child does not become isolated in the care of one individual practice employee.
3 Managing Child Protection Issues within Dental Practices
It is recommended that the Local Health Board (LHB) is the primary source of support, advice and leadership in matters concerning child protection issues. Each dental practice should have a named Child Protection Lead (CPL), preferably a general dental practitioner, who should be identified to the LHB officer who carries responsibility for child protection.
TheCPL within the practice is not expected to be an expert in child protection, but a central person who will enable the other members of the practice to be aware of all relevant guidance that relates to child protection. This will include ensuring that a copy of the All Wales Child Protection Procedures is accessible to all staff within the practice.
The CPL also has a potential role, in assisting staff to identify their child protection training needs and in facilitating attendance at appropriate child protection training events.
The CPL should ensure that the practice is aware of the contact numbers for obtaining advice in respect of any concerns and is also knowledgeable in how to make a child protection referral to the statutory agencies. The LHB will be informed of any child protection referrals made to social services in order that it can monitor the quality of child protection work within its primary care contracted services as recommended by Healthcare Inspectorate Wales
Appendix 1: gives information and guidance on “The Role of the LHB and Dental Practices in Relation to Child Protection”.
Child protection is a continually evolving and developing area and following changes to legislation and government guidance, and where practices have a significant proportion of child patients(or have a contract to undertake paediatric dental anaesthesia) it is appropriate that the lead child protection dental role is identified and established.
.Appendix 2 provides a Proforma for completion to the LHB of any child protection referral made by dental practices (no patient identifiable information to be included)
Appendix 3 gives information and guidance for staff who suspect child abuse.
Appendix 4 gives guidance on “Recognition of Abuse: Possible Presenting Features”.
Child protection concerns can arise within almost all areas of practice. It is the responsibility of each individual to be familiar with child protection procedures and act upon them accordingly.
The Designated Doctor and Nurse (Child Protection Service (CPS) National Public Health Services (NPHS) ofWales) on behalf of the LHB are available to practice staff for advice and support when required
Appendix 5 provides contactdetails for CPS (NPHS).
The local NHS Trust Named Doctor and Nurse are also available for advice about specific children who may be known to them, and should be informed of any child protection referral to social services. Where dentists have concerns about non-attendance by young children or about dental neglect they should refer to the health visitor or to the school health service that can help and support the family.
All staff should receive training on child protection issues at least once every three years (see Para.8).
The CPS/NPHS will request that the GDC consider regularly updated child protection training as a core essential of the training required for the evaluation of registered dental staff i.e. that within the GDC revalidation cycles, GDPs should have received child protection awareness training within the previous three years.
3.1 Employment Practice
As employers the practice must ensure that staff working with children and vulnerable adults are safe to do so, and a robust recruitment policy and method for its implementation must be in place. Staff and potential employees should be aware that posts are exempt from the Rehabilitation of Offenders legislation.
Staff working with children must be carefully selected to ensure that as far as possible they are suitable to work with children in compliance with Welsh Assembly Government Circulars: Safer Recruitment – A Guide For NHS Employers/Mandatory Criminal Records Bureau (WHC (2005)071) /CRB Checks For AllEligible New NHS Staff(WHC (2005)029.Prior to employment all staff with access to children should have a Criminal Records Bureau (CRB) check carried out as set out in the policy of the Local Health Board and also be checked against the Protection of Children Act list 99 (POCA).NB this will be replaced by future vetting and barring lists which will be developed in 2008 followingtheSafeguarding Vulnerable Groups Act royal assent on 8 November 2006.
The Carlile report recommends that the Warner standards for recruitment andthe requirements of the Protection of Children Act should be followed in appointing all staff (see Appendix 6 Guidelines for Recruitment).
Dental practices are encouraged to implement these standards in order to safeguard children.
3.2 The Appointment
- The candidate should be clear that failure to disclose previous and new convictions is a disciplinary matter.
- The appointment should be subject to the information in 3.1 and Appendix 6.
- If the checks are not fully completed the appointing officer will need to make a decision on the appointment date and whether it is suitable for the appointee to commence but with no unsupervised access to children. The practice recruitment policy should cover these issues.
- A checklist, incorporating thesestandards, is attached (see Appendix 6) as a resource which practices may wish to use.
- Enhanced criminal records bureau checks should be taken up for all staff that have direct contact with children and vulnerable adults and/or those who manage/supervise such posts. This would include anaesthetists, dentists, dental hygienists and nurses. All other staff should be subject to the standard check.
4 Data Protection and Information Sharing
4.1 Sharing Information
“There is nothing within the Caldicott Report, the Data Protection Act 1998, or the Human Rights Act 1998, which should prevent the justifiable and lawful exchange of information for the protection of children or prevention of serious crime.” (Carlile Report)
When a decision is made to provide information to social services in respect of achild protection enquiry (Section 47 Children Act 1989) the information provided should be relevant and proportional. Consent whilst desirable is not a requirement for sharing this information.
Whensocial services undertake an initial assessment for children in need under the “Framework for Assessment” (Section 17 Children Act 1989) and contact a GDP to obtain information about a child or family, the GDP must ensure, before providing any information that social services have obtained parental consent. If the GDP makes the referral to social services under section 17 (Child in Need), then the practice should obtain parental consent prior to making the referral. Staff are encouraged to seek advice from the Designated Child Protection Professionals / Trust Named Child Protection Professionals, or their protection/defence organisation if in doubt about their record keeping or information sharing procedures.
Appendix 7 provides a flow chart to assist staff in making a child protection referral.
4.2 Confidentiality
Ethical and statutory codes concerned with confidentiality are to protect individual patients, but they are not intended to prevent exchange of information between different professionals and staff who have a responsibility for ensuring the protection of children.
In cases where there are child protection concerns there is a duty to share all relevant information with professionals and agencies who need to know. The protection of the child must take precedence over all other considerations. This may include disclosing information with or without the permission of the child or the child’s parents with other professionals who need access to that information for the purposes of protecting that child.
Those involved in child protection must be confident that both verbal and written information is confidential to the participants and will be made available only to those professionals whose need to know is in the best interests of the child where there are child protection concerns.
Consideration should always be given to achieving consent of the child (where the child is Fraser competent) or the child’s parent. Additionally working in partnership with families is essential to promoting the welfare of children. While consent is not necessary for child protection referrals it is desirable, and parents/carers would normally be informed of the referral.
However, in some circumstances informing the parents/carers may place the child at further/additional risk and in these circumstances consent should not be sought and the parent/carer not told of that referral.
Any decision made by staff in relation to these issues should be accurately recorded.
Children are entitled to the same duty of confidence as adults, provided that, in the case of those under 16 years of age, they have the ability to understand the choices and their consequences relating to any treatment. In exceptional circumstances it may be believed that a child seeking advice is being exploited or abused; in such cases confidentiality may be breached following discussion with the child. Consideration must be given to the wishes and feelings of the child.
Social Service departments will always provide advice and guidance when there are doubts about referrals.
If there is uncertainty about breaching confidentiality then the advice of the Designated Professionals for Child Protection should be sought (see Appendix 5).
4.3 Record Keeping
Accurate record keeping is an essential part of the accountability for child protection. It is an extremely important element to ensure effective inter-agency working. Documentation within dental practices should accurately reflect not only the care provided but also any concerns in respect of a child. This may include any injury observed (see below). Concerns may also be raised in respect of how an adult related to a child. Actions taken as a consequence of suchobservations must be recorded. All documentation should be contemporaneous, and differentiate between fact and opinion.
Accurate documentation of any injury or concern is essential, using photographs or diagrams wherever possible or appropriate. Documentation may include:
- Description of location of injury
- Nature of injury e.g. bruise; laceration
- Size (measured in centimetres)
- Shape of injury
- Photographs (if appropriate)
5 Child Protection Conferences
If staff members from the dental practice are requested to attend a Child Protection Conference they should be supported and advised by their designated professionals
Prior to attending the Child Protection Conference the staff member should provide relevant objective and factual information by way of a written report (Most social services will now provide a proforma for ease of completion). Wherever possible this report should be shared with parents and/or child (of sufficient age and understanding) prior to the conference.
If there are any concerns about the content or sensitivity of the report, advice should be sought from one of the designated professionals.