2.5.6 Safeguarding Flashcards
You have a professional, legal and moral duty to protect children from abuse or neglect and to work with other organisations and authorities to safeguard children. The following points (Table 1) may help with recognising signs of abuse or neglect; however, the list is not exhaustive and a series of minor factors could also be indicative of child abuse or neglect.
See Table 1 (check MEP book)
If child abuse is suspected, you should follow local child protection procedures where these are available. If not, the process outlined in Diagram 8 may be useful.
See Diagram 8
When the police should be contacted?
Where you consider the nature of the child abuse to be an emergency, otherwise…
Where you consider the nature of the child abuse to be an emergency, then the police should be contacted. Otherwise…
Make a decision on next steps, such as referring to local social services where appropriate or taking further advice. You should feel comfortable sharing concerns and suspicions of abuse, even where these are not proven facts, with social services.
Should not attempt to investigate suspicions or allegations of abuse directly?
No
You should not attempt to investigate suspicions or allegations of abuse directly. Instead…
You should make appropriate records of concerns and suspicions, decisions taken and reasons whether or not further action was taken on a particular occasion.
Children and young adults – signs of abuse or neglect
Physical abuse
Unusual/unexplained injuries, injuries in inaccessible places, bite marks, scalds, fingertip bruising, fractures, repeated injuries, age of injuries inconsistent with account given by adult, injuries blamed on siblings.
Neglect
Poor growth and weight. Poor hygiene, dirty and messy. Inappropriate food or drink.
Emotional abuse
Evidence of self-harm/self-mutilation, behavioural problems, inappropriate verbal abuse, fear of adults or a certain adult.
Sexual abuse
Indication of sexually transmitted disease, evidence of sexual activity or relationship that is inappropriate to the child’s age or competence,
Additional signs
Parent/carer delays seeking medical treatment or advice and/or reluctant to allow treatment, detachment from the child, lacks concern at the severity or extent of injury, reluctant to give information, aggressive towards child or children.
At what age is a child legally too young to consent to any sexual activity?
Children under the age of 13
Children under the age of 13 are legally too young to consent to any sexual activity. Instances should be…
Treated seriously with a presumption that the case should be reported to social services, unless there are exceptional circumstances backed by documented reasons for not sharing information.
Is sexual activity with children under the age of 16 an offence?
Sexual activity with children under the age of 16 is also an offence but may be consensual. The law is not intended to prosecute mutually agreed sexual activity between young people of a similar age, unless it involves abuse or exploitation.
Could you provide contraception (e.g on prescription or under PGD) or sexual health advice to a child or young person under 16?
You can, as long as, in England and Wales, the Fraser criteria are met, i.e., that:
TThey have sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
They cannot be persuaded to tell their parents or to allow the practitioner to tell them
They are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
Their physical or mental health is likely to suffer unless they receive the advice or treatment
The advice or treatment is in their best interests.
Could you provide contraception (e.g on prescription or under PGD) or sexual health advice to a child or young person under 16 in Scotland?
In Scotland, the Age of Legal Capacity Act applies similar criteria.
The general duty of patient confidentiality still applies, so consent should be sought whenever possible prior to disclosing patient information.
This duty is not absolute, and information may be shared if you judge on a case-by-case basis that sharing is in the child’s best interest (e.g., to prevent harm to the child or where the child’s welfare overrides the need to keep information confidential).
Remember that it is possible to seek advice from experts without disclosing identifiable details of a child and breaking patient confidentiality – and that where there is a decision to share information, this should be proportionate.
Further reading
FURTHER READING
Royal Pharmaceutical Society
Protecting children and young people.
www.rpharms.com
Children’s Society
Safeguarding children, young people and adults at risk of abuse: Policy and Procedure.
www.childrenssociety.org.uk
General Pharmaceutical Council
Female genital mutilation: Mandatory duty for pharmacy professionals to report.
www.pharmacyregulation.org
NHS England
Safeguarding.
www.england.nhs.uk
PROTECTING VULNERABLE ADULTS
You have a professional, social and moral duty to protect vulnerable adults from abuse or neglect and to work with other organisations and authorities to safeguard vulnerable adults.
When should the vulnerable adult’s wishes should be taken into account?
At all times as a key issue is patient consent. Vulnerable adults are people who are over the age of 18 at a greater risk of abuse or neglect.
Note that any person, including those who do not fall within the groups below, could be a vulnerable adult. There are various types of abuse or neglect and while the following lists may be helpful but are not exhaustive. The presence of one or more of these signs may not necessarily be caused by abuse or neglect.
They may fall into one of the following groups:
Suffers from mental or physical disability
Has learning difficulties
Is frail or elderly
Is in an abusive relationship
Is a substance misuser.
What procedures should be followed?
Local procedures may be available from your employer, the NHS trust, Health Board or local council, and you should follow these procedures where available when abuse or neglect is suspected.
The process outlined in Diagram 9 may also be useful.
Vulnerable adults – signs of abuse or neglect
Physical abuse Injuries which are unusual or unexplained. Bite marks, scalds, fingertip bruising, fractures.
Repeated injury.
Neglect
Failure to thrive – evidence of malnourishment. Poor hygiene, dirty and messy.
Emotional abuse
Evidence of self-harm/self-mutilation. Inappropriate verbal abuse. Fear of certain people.
Sexual abuse
Indication of sexually transmitted disease. Repeated requests for emergency hormonal contraception.
Financial abuse
Sudden changes to their finances, e.g., getting into debt. Inappropriate, exploitative or excessive control over the finances of the vulnerable adult.
Additional signs
Delays seeking medical treatment or advice and/ or reluctant to allow treatment of the vulnerable adult. Detachment from the vulnerable adult. Lacks concern at the severity or extent of injury or other signs. Is reluctant to give information. Aggressive towards the vulnerable adult.
When should a vulnerable adult’s wishes should be taken into account?
At all times.
What should you do before disclosing confidential information about them?
Obtain consent from the patient before disclosing confidential information about them.
When should obtaining consent from the patient before disclosing confidential information about them be overriden?
If there are overriding circumstances requiring you to take immediate action to ensure the safety of the individual or others the need for referral, even if they do not give consent, should be considered. If you are unsure of someone’s mental capacity to provide consent seek additional advice, e.g. from their GP.
Should you attempt to investigate suspicions or allegations of abuse directly or to discuss concerns with the alleged perpetrator of the abuse or neglect?
Should you make appropriate records of concerns and suspicions, decisions taken and reasons whether or not further action was taken on a particular occasion?
You should NOT attempt to investigate suspicions or allegations of abuse directly or to discuss concerns with the alleged perpetrator of the abuse or neglect.
You SHOULD make appropriate records of concerns and suspicions, decisions taken and reasons whether or not further action was taken on a particular occasion.
Further Reading
Royal Pharmaceutical Society
Protecting vulnerable adults.
www.rpharms.com
Care Information Scotland
Adult support and protection.
www.careinfoscotland.scot
Department of Health and Social Care
Mental Health Act 1983: Code of practice. 2015.
www.gov.uk
NHS England
Abuse and neglect of vulnerable adults.
www.nhs.uk
NHS Wales
Welsh Government - Mental Health Act 1983: Code of Practice for Wales Review
www.gov.wales
Office of the Public Guardian
Safeguarding policy.
www.gov.uk
Public Health Wales
National Safeguarding team (NHS Wales): safeguarding adults.
www.phw.nhs.wales
