Safeguarding children and young people should be integrated into existing practice systems and processes for delivering care.
We will review this topic of safeguarding when we review the ‘safe’ key question which relates to regulation 13: Safeguarding service users from abuse and improper treatment.
Everyone who comes into contact with children and young adults at risk using health and care services have a responsibility to safeguard them from suffering any form of abuse or improper treatment while receiving care.
Part of our statutory duties to protect and promote the health, safety and welfare of people who use health and social care services. Risks to children and young adults using services are higher where systems and processes are weak and staff are not clear or do not know what to do when a safeguarding situation presents.
On inspection we will check what systems and processes are in place and how robust they are. This relates to key line of enquiry S1: how do systems, processes and practices keep people safe and safeguarded from abuse?
The Department for Education published the updated version of Working together to safeguard children in July 2018. This is statutory guidance which helps professionals understand what they need to do, and what they can expect of one another, to safeguard children. It focuses on core legal requirements and makes it clear what individuals and organisations should do to keep children safe. Safeguarding children is defined as:
- protecting children from maltreatment
- preventing impairment of children’s health or development
- ensuring that children grow up in circumstances consistent with the provision of safe and effective care
- taking action to enable all children to have the best outcomes
Each practice should have a designated lead for safeguarding children and young people. This key role in the practice:
- promotes good practice
- provides advice and support for fellow staff
- makes sure that fellow staff are suitably trained in safeguarding
The Royal Colleges give clear guidance about the appropriate competencies and levels of training in safeguarding children or child protection for different members of staff. The Royal College of Nursing published updated intercollegiate guidance Safeguarding Children and Young People: Roles and Competencies for Healthcare Staff in January 2019.
The Care Act (2014) clarifies expectations about safeguarding children training.
- Staff induction training should include awareness of how to identify a child or young adult at risk of actual or potential abuse and how to report it.
- Safeguarding children’s boards must work with their relevant partners, including CCGs, to provide this training.
- Dental practices must make sure that all staff working in the practice have the appropriate level of competence for their role. Formal face-to-face training is one way that practice staff can develop their knowledge.
Staff governed by professional regulation (for example dentists and dental nurses) should understand how their professional standards and requirements underpin their roles to prevent, recognise and respond to abuse and neglect:
For registered dental professionals, the General Dental Council (GDC) ‘Standards for the dental team (2013), stresses the need to raise concerns if patients are at risk.
- British Dental Association resource ‘child protection and the dental team’ – a practical workbook for dental teams.
What to expect on inspection:
When we inspect we need to see that dentists and all other practice staff can demonstrate their competence in safeguarding children and young people at risk.
We need to see evidence that:
- the practice gives sufficient priority to safeguarding children
- staff take a proactive approach to safeguarding and focus on prevention and early identification
- staff take steps to protect children and young people where there are known risks, respond appropriately to any signs or allegations of abuse, and work effectively with other organisations to implement protection plans
- there is active and appropriate engagement in local safeguarding procedures and effective work with other relevant organisations
Each practice should have a designated lead for safeguarding children and young adults at risk. They should be aware of the respective safeguarding children leads within the local clinical commissioning group (CCG) and the local authority safeguarding children team.
The competency framework set out in the intercollegiate guidance specifies six levels/competencies:
This sets out the minimum training requirements:
- Level 1: for all non-clinical staff (for example receptionists and practice managers)
- Level 2: for all dentists and dental care professionals
- Level 3: for paediatric dentists and paediatric orthodontists (those who could contribute to assessing, planning, intervening and evaluating the needs of a child or young person and parenting capacity where there is safeguarding/child protection concerns). This training is not normally required for dentists and dental care professionals working in general dental practice.
This guidance states that safeguarding training should be refreshed every three years. Level 1 and Level 2 training refresher can be done online. Level 1 training should last a minimum of two hours, level 2 a minimum of three hours.
Staff are not restricted to the minimum level of training identified as appropriate for their role. Practices may choose to offer a higher level of safeguarding training for some or all staff.
Notifying CQC of safeguarding incidents
Not all referrals the practice makes to the local authority need to be notified to CQC. Practices are only required to notify CQC of safeguarding incidents where the allegation of abuse is linked to their provision of care.
A mother visits with her 7-year-old daughter (patient N). N appears unkempt and is very dirty. During the examination, the clinician identifies bruising on the child’s face and neck. When asked about the bruising, patient N’s mother's 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 whilst the regulated activity was being provided (while at the surgery), and
- was not a result of the regulated activity.
Although we would not require a notification in this instance, the clinician must make sure that they follow the practice’s normal processes for safeguarding children.
Patient P visits with his child Q (a girl, aged 14). P is very upset and tells the clinician that the practice manager R has been contacting Q by telephone and tried to get to meet her. He has also written Q notes.
Is statutory notification to CQC required?
Yes. It is alleged that the abuse relates to one of the practice employees and therefore relates to the clinician carrying on his regulated activity.
In our Safeguarding Handbook we clarify when we expect statutory notifications of abuse. See Appendix 10.
Public Health England's guidance on safeguarding in general dental practice provides a toolkit for dental teams.