Dental mythbuster 29: Safeguarding adults, children and young people at risk

The safeguarding of adults, children and young people should be integrated into existing practice systems and processes for delivering care.

All people who have contact with vulnerable adults, children and young people have a responsibility to safeguard them from any form of abuse or improper treatment.

Our statutory duties include protecting and promoting the health, safety and welfare of people who use health and social care services.

Risks to adults, children and young people using services are higher where systems and processes are weak, and staff do not know what to do when a safeguarding situation occurs.

What we will look at when we inspect

We will check your systems and processes for safeguarding. We need to see that all practice staff can demonstrate their competence in safeguarding.

Each practice should have a member of staff who is the designated lead for safeguarding to provide advice and support for colleagues. This person should be aware of the respective safeguarding leads within the integrated care system (ICS) and the local authority safeguarding teams.

We need to see evidence that the practice:

• gives sufficient priority to safeguarding adults, children and young people at risk
• has active and appropriate engagement in local safeguarding procedures.

We also need to see evidence that staff:

• take a proactive approach to safeguarding, focusing on prevention and early identification, and take steps to protect people from known risks
• respond appropriately to any signs or allegations of abuse, and record this information
• work effectively with other organisations to implement protection plans.

Legislation and guidance

Practices must make sure that all staff have the appropriate level of competence for their role, including through face-to-face training.

Intercollegiate guidelines are available for safeguarding of adults and of children and young people. They provide a framework to support practitioners, employers and commissioners to understand the minimum training requirements that staff should complete, which are specific to their role.

The frameworks set out various training levels for staff. The groups of staff listed in each level are examples – not exhaustive lists. We expect practices to meet these requirements.

The General Dental Council (GDC) requires registered dental professionals to report safeguarding concerns when patients are at risk.

The Department for Education published Working together to safeguard children. This helps professionals to understand their responsibilities.

The British Dental Association’s resource Child protection and the dental team is a practical workbook for dental teams. You need to have a BDA account to access this – accounts are free and available to everyone working in dentistry.

Other useful resources include:

• Safeguarding accountability and assurance framework (NHS England)
• Information Sharing: Advice for practitioners providing safeguarding services for children, young people, parents and carers (Department for Education)

Notifying CQC of safeguarding incidents

Practices are only required to notify CQC of safeguarding incidents where the allegation of abuse relates to their provision of care. You don't need to tell CQC about all safeguarding referrals made to the local authority.

Example 1

A mother visits with her 7-year-old daughter (patient A). Patient A appears unkempt and is very dirty.

During the examination, the clinician identifies bruising on the child’s face and neck. The clinician asks patient A’s mother about the bruising, but her response does not explain the cause. The clinician makes a referral to the local authority safeguarding children’s team.

Is statutory notification to CQC required?

No. The abuse is not alleged to have occurred during regulated activity (while at the surgery) and did not result from the regulated activity.

Although we would not require a notification in this instance, the clinician must ensure that they follow the practice’s normal processes for safeguarding children.

Example 2

Patient P visits the practice with his 14-year-old daughter (patient Q). Patient P is very upset and tells the dentist that the practice manager has been contacting patient Q by telephone and tried to get her to meet him. He has also written patient Q notes.

Is statutory notification to CQC required?

Yes. The alleged abuse involves a practice employee and therefore relates to the dentist’s regulated activity.

Example 3

Ms L visits for a routine checkup. The dentist notices bruising on her cheek. She says that her partner has hit her.

Is statutory notification to CQC required?

No. It is not alleged that the abuse relates to the dentist’s carrying on of the regulated activity. However, the dentist must still follow the practice’s normal processes for safeguarding adults and domestic abuse.

Example 4

Patient G, an older patient with dementia, attends the practice and needs an injection. On seeing the needle, she becomes very agitated. The nurse attempts to calm the patient, but when that fails, the nurse forcibly restrains her to allow the injection. Patient G’s arm is bruised. Her son makes a formal complaint to the practice manager.

Is statutory notification to CQC required?

Yes. Staff allegedly committed abuse while carrying on the regulated activity at the practice. You should notify us even if the abuse is alleged and not yet proven to have happened.

We will review safeguarding arrangements when we assess the ‘safe’ key question. This relates to Regulation 13: Safeguarding service users from abuse and improper treatment.