There have been reports recently in the media of some high profile and shocking cases regarding safeguarding. In the majority of these cases the media have identified the many opportunities that health care professionals have failed to identify and report signs of neglect and abuse.
I am often asked what dentistry has to do with safeguarding and my response is that we are in the perfect position to identify any signs of neglect and abuse, we tend to see our patients three or four times a year, often from a young age into adulthood, we have access to the mouth where possible signs of abuse or neglect can be spotted. We have a professional relationship with carers and family members, and we can identify if there is a change in behaviour, physical condition and oral health. It may be the case that a disclosure is made or we hear something that gives us cause for concern.
What exactly is our responsibility?
According to the CQC, when they come to inspect your practice or organisation in regards to safeguarding there is one key question they will require evidence of:
Are services safe? Standard 3: what systems and processes are in place to keep people safe and safeguard them from abuse?
You and your team will need to demonstrate an understanding of the risks and types of abuse of an adult or child. let’s discuss this first.
The CQC will want to look at your training records to ascertain who has had training, when they had training and at what level of safeguarding training staff have received.
The CQC state that the minimum training requirements are:
- Level 1: for all non-clinical staff (e.g. receptionists and practice managers)
- Level 2: for all dentists and dental care professionals
- Level 3: for paediatric dentists and paediatric orthodontists (i.e. those who could potentially contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there are safeguarding / child protection concerns). Level 3 training is not normally required for dentists and dental care professionals working in general dental practice. Level 3 is also typically undertaken by the person in the practice who is responsible for recording information about any safeguarding incidents.
Training content should be refreshed every 3 years and non-clinical and DCP’s should renew their certification annually.
- Level 1 refresher can be undertaken online and a minimum of 2 hours
- Level 2 refresher can be undertaken online and a minimum of 3 hours
All staff will be expected to identify the different types of abuse and name who the safe guarding lead is in your organisation.
Types of abuse:
- Modern slavery
- Human trafficking
- Mental capacity and Deprivation of liberty
- Female genital mutilation (FGM)
- Cyber bullying
We understand that we have a duty of care to protect our patients, visitors and staff. And we understand that it is everyone’s responsibility to protect children and vulnerable adults, however the dental profession can often feel that they lack the confidence and the ability to deal with this tricky, awkward legislation. It has not been within our professional remit to tackle these difficult conversations in the past and many dental health care professionals are struggling to tackle this subject.
What is out there to help us?
Within The Care Act 2014 there are six safeguarding principles designed to give us guidance in fulfilling our responsibilities as dental health care professionals.
These principles are:
- Empowerment: people being supported and encouraged to make their own decisions and give informed consent
- Prevention: it is better to take action before harm occurs
- Proportionality: the least intrusive response appropriate to the risk presented
- Protection: support and representation for those in greatest need
- Partnership: local solutions through services working with their communities – communities have a part to play in preventing, detecting and reporting neglect and abuse
- Accountability: accountability and transparency in safeguarding practice
Using these principles, we can break down what the priorities are for us within our practices/organisations. The first of these would be
- Identifying the harm, for example is it physical, neglect or deprivation of liberty?
- Reporting the neglect, informing the safeguarding lead in your practice, the GP of your concerns, if the danger is immediate, the police, if a child is in potential danger social services.
- Supporting the person who has disclosed the abuse, informing them of your intention to report it.
- Monitoring patient wellbeing, for example a regular patient does not attend, this is out of character, ringing the patient to ensure all is well, don’t forget this could be a deterioration in their mental or physical wellbeing.
- Recording all concerns, whether disclosed or not. Keep accurate contemporaneous records of conversations between you and the discloser, what did they say? how did you respond? What action did you take? Who did you inform? What was the outcome?
As a dental professional, you are likely to notice injuries to the head, eyes, ears, neck, face, mouth and teeth, as well as other welfare concerns.
Finally, it is important to understand the assessment of physical injury, there are typical features of non-accidental injury that dental care professionals are best placed to identify. As upsetting as this can be, we have to assess these injuries and evaluate the risk to that child.
The Triangle of Safety is a really great resource in identifying the areas where accidental injury is unusual, the areas included are:
Ears, side of the face, neck and the top of the shoulders. Soft tissues of the cheek, could be an indication of a slap across the face. Intra oral injuries, these are areas that we have access and visibility to monitor.
What should be recorded?
Where the injury is sited, any patterns, e.g. bite mark
Ask the question, how did this injury occur? Ask the child directly. Does the injury match the explanation?
How is the interaction between the parent/ carer and the child, has the behaviour changed? Is the child anxious, visibly afraid of the parent/carer?
In conclusion, as difficult as it is, we cannot argue that dental healthcare professionals are and will remain in an invaluable position to safeguard. If ever you doubt your ability or your suspicions you do not need to manage this on your own, The Department of Health poster, ‘What To Do If You’re Worried A Child Is Being Abused: a flow chart for referral’ is a helpful resource.
And finally remember Victoria Climbié, Baby Peter, just a couple of the many cases where a child was not safeguarded by any healthcare professional they came into contact with.
Remember record everything!