Dilemma: Demand for information on vulnerable child
The Local Safeguarding Children Board decides to hold an internal audit of its procedures and requests a complete chronology of all contact with a particular child’s family. Can they do this, and how should you act if they do so without patients’ consent?
Dr Kate Barusya: It is important that you pass on the information the Board asks for
The Local Safeguarding Children Board (LSCB) is a statutory body that has the safeguarding responsibilities for a Local Authority, and is ‘…well placed to identify emerging problems through learning from practice and to oversee efforts to improve services’ as the final report from the Munro Review states.1
Section 27 of the Children Act 1989 puts responsibility on partner agencies to cooperate, so if a chronology of all contact is requested, then it is important that this is shared.
It is good practice for the LSCB to draft a letter for practices to use to share with the child and his or her family regarding the need to access and share their records as part of the review process. The practitioner however needs to be honest with the family, unless it is a case of fabricated and induced illness, or child Sexual Abuse, that you will be sharing out their information and share the information as per GMC guidance.
Child protection is a social construct and information from different agencies that is shared so that the whole a picture is obtained. In response, a case review is commissioned, as part of learning, then partner agencies are expected to comply.
Dr Kate Barusya is is a GP in South Essex. At her practice she is the named GP for safeguarding children.
Dr Vimal Tiwari: If in doubt, consult the local safeguarding team
The forthcoming update of the RCGP/NSPCC Safeguarding Children Toolkit clearly states that GPs in England have statutory obligations under Section 11 of the Children Act 2004 and Working Together to Safeguard Children 2013 to ensure their organisation has arrangements in place to safeguard and promote the welfare of children and young people.
GPs as key safeguarding partners may expect to receive requests from their Local Safeguarding Children Board to complete self-assessment audits to ascertain compliance in meeting safeguarding standards. Compliance is mandatory. Failure to complete them or to provide information requested reflects adversely upon the organisation’s ability to work together with other agencies to safeguard children.
Single agency audits assess standards of organisational child protection and safeguarding arrangements. These help organisations understand where they need to improve their safeguarding arrangements and to ensure the work they undertake with children and young people up to the age of 18 meets legislation and regulatory requirements.
Multi-agency audits assess the quality of the child’s journey through the Early Help, Child in Need, Child Protection or local authority care systems. The objective is to discover what difference the services, strategies and interventions provided made to the lives of children and their families. This could involve providing extracts from patient records, including records of a child’s siblings, parents or other significant adults within the family or household, as evidence of action. It is good practice to seek patient consent before sharing records. However if the child is already in the child protection or care systems, records may be shared without consent.
If in doubt consult the local safeguarding team, or named GP for safeguarding; refer to ‘GMC Protecting children and young people: The responsibilities of all doctors’.2
Dr Vimal Tiwari is the RCGP´s Safeguarding Lead.
Dr Sarah Jarvis: Disclosure may be in the public interest
There is an expectation that doctors cooperate with safeguarding processes and ensure that the wellbeing of children is promoted. The GMC’s 0-18 years guidance also states that doctors should “participate fully in child protection procedures… and co-operate with requests for information about child abuse and neglect’.
While the information requested is confidential, in some circumstances disclosing patient information may be justified in the public interest, in order to protect the patient or other members of the public. For example, if the information is needed in order to detect or prevent a serious crime.
Before disclosing information about third parties, such as the child’s parents, you should usually try to get consent from the adults concerned, unless it is not practicable to obtain it or doing so would undermine the purpose of the disclosure.
If consent is withheld and you believe that by not providing the information, the patient or others would be at risk, then you may decide that disclosure is justifiable. In that case it would be usual to explain to the third party before disclosure is made, that you have decided to disclose against their wishes.
However, it is important to only disclose the relevant information needed by the safeguarding board, so you may need to clarify what the internal audit specifically requires.
You may wish to get further advice from the child protection lead in your practice, your Caldicott Guardian, your local child protection team and your medical defence organisation. You should keep a record of the reasoning behind your decision.
Dr Sarah Jarvis is a medico-legal adviser at the MDU.
1 HMG. The Munro Review of Child Protection, A Child-Centered System. 2011.https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/175391/Munro-Review.pdf
2 GMC. Protecting children and young people: The responsibilities of all doctors. 2012. http://www.gmc-uk.org/Protecting_children_and_young_people___English_0414.pdf_48978248.pdf