Doctors must report concerns about child neglect or abuse even if they only have a 'hunch' something is wrong, new guidance has said.
Doctors seeing adults must always be suspicious of child abuse and neglect even though they may never have met the child, the General Medical Council has said.
Mothers with post natal depression and other serious mental health issues, people with alcohol problems, and drug addicts warrant further questioning about the welfare of children in their care, it was said.
All doctors have a responsibility to be aware of child protection issues and should report concerns even if they simply have a 'hunch or feel uneasy', Sir Peter Rubin, chairman of the GMC said.
Niall Dickson, chief executive of the GMC said failures in the past had highlighted the 'catastrophic' consequences of doctors, police and other agencies working in isolation and not talking to each other about concerns each had.
Mr Dickson said: "It is important that doctors treating adults are child protection aware. Their responsibility extends to patients they may not have seen. Doctors need to be aware of the environment and individuals who may increase the risk of harm."
Doctors should talk to children as young as five alone, without their parent, if they feel this would help them talk openly and concerns can be raised without seeking consent first if this may jeopardise the safety of the child, the guidance says.
Doctors should first raise concern with the parent or carer if appropriate, then seek advice from the doctor in charge of child protection in the area, and then to social services. In serious situations doctors can report directly to social service or in extreme cases the police.
The GMC reassured doctors that by raising concerns they were not 'making accusations' and the GMC would 'not come after them' as long as doctors acted honestly and through the proper channels even if the child is later found to be safe and well looked after.
Doctors have shunned working in child protection over high profile cases where complaints have been made against doctors and they have been struck off the register.
It is feared children at risk have been missed as a result, the GMC warned, even those such cases are rare.
Mr Dickson said the number of paediatricians appearing before fitness to practice hearings was 'vanishingly small' and the numbers sanctioned for wrongdoing was 'even smaller', he said. Yet many doctors feared reporting child protection issues because of complaints.
Prof David Southall, a paediatrician, appeared before the GMC on a number of occasions accused of serious professional misconduct. In one case he reported to police that he believed solicitor Sally Clark's husband Stephen had killed their children and not Mrs Clark.
Mrs Clark had been convicted of killing babies Christopher and Harry in 2003 but Prof Southall believed it was the wrong parent after watching a documentary on the case.
He was reinstated to the medical register after an Appeal Court ruling in May 2010.
The GMC guidance clarifies boundaries for doctors giving evidence in court as a witness of fact or an expert witness and said that they should not stray beyond their professional competency.
Concerns have been raised by doctors that reporting child protection matters breaches confidentiality or that it may attract a complaint from a parent or carer.
Dr Catherine Wills, medico-legal adviser with the Medical Defence Union, which defends doctors involved in legal action, said: “Doctors who call the MDU are often concerned that they are raising valid concerns to the appropriate agency.
"The new guidance from the GMC acknowledges that doctors taking action will be justified, even if it turns out that the child isn’t being abused or neglected, as long as their concerns are honestly held and reasonable and they take action through appropriate channels.”
A spokesman for the British Medical Association, which represents most doctors in Britain, said: “Child protection is an extremely challenging area for doctors and the BMA is pleased that the GMC has produced new guidance to help doctors. It is vital for doctors to know the processes they need to follow if they have concerns about children in their care.
“The GMC guidance complements the BMA’s own toolkit on this topic. Our overriding message is that where doctors believe a child is at risk of harm they must take appropriate action to protect the interests of the child.”
Katherine Murphy, chief executive of the Patients Association said: “This is an extremely difficult and challenging area for the GMC to regulate, and individual doctors must make a competent and considered judgement when looking at cases where a child may be at risk.
"We fully agree that whenever a clinician has a child protection concern they should raise it with the authorities.”
GMC: New guidance on Protecting children and young people
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By Keir Starmer, 06 August 2013
Cases of child sexual abuse have received unprecedented coverage over recent months and it is clear that the criminal justice system has not always got its handling of such cases right, writes director of public prosecutions Keir Starmer QC.
As head of the CPS, I am ensuring that our approach to tackling child sexual abuse changes.
The role of professionals who work to support and protect vulnerable children and victims of child sexual abuse is vital, which is why I think it essential that doctors take this opportunity to contribute to the process of reforming our procedures for tackling this issue.
I have recently published guidelines setting out the complexities of bringing these difficult cases to justice, proposing a new approach to the way the police and prosecutors handle cases of alleged child sexual abuse.
A key part of our new approach has to be the way we perceive the victims and the kind of issues they face which those in the medical profession will no doubt be familiar with. Many of the victims are vulnerable precisely because they are not only young, but they often display some or all of the following characteristics: they are unable easily to trust those in authority and still less able to report intimate details; they use alcohol; they return to the perpetrator of the offences against them; and, not infrequently, they self-harm. These characteristics were previously seen as reasons not to prosecute, but the draft guidance shows the fundamental change in approach. It is also becoming increasingly clear that the number of victims at risk may be considerably higher than previously thought.
Degree of caution is unjustified
These guidelines will ensure that my lawyers focus on the overall allegation, rather than the perceived weakness of the person making them. When victims report a burglary, we do not instinctively question their credibility, and nor should we when people report allegations of child sexual abuse.
Also, an over cautious approach has been adopted on some occasions in the past, perhaps reflecting an understandable concern for guarding against false allegations, but my view is that this degree of caution is not generally justified. The concern should not be ignored, but it is important that it is kept in proper perspective. The risk, otherwise, is of sexual offences being subjected to a different and, in reality, more rigorous test than that applied to victims of other crimes.
These cases are not easy, but recent experience has shown that by patiently building a case and dispelling myths and stereotypes about victims, the CPS can prosecute them successfully.
Doctors play a crucial role in helping to detect cases of child sexual abuse, encouraging reporting of such cases to the police, and offering invaluable to support to victims throughout the course of criminal proceedings. That’s why I am putting my new approach out to public consultation and I strongly urge you to share your views.
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