‘A Healthier Dorset’ Safeguarding Children Primary Care Update September 22 nd 2011 Safeguarding Children: the role of Dentists

‘A Healthier Dorset’ Aims of the session Dental staff will understand what is meant by safeguarding and promoting the welfare of children Dental staff will understand their responsibilities to safeguard and promote the welfare of children Dental staff will understand the arrangements they need to have in place within their Practice to ensure children are protected Dental staff will be compliant with CQC standard 7.

‘A Healthier Dorset’ CGC Essential Standards of Quality and Safety March 2010 Outcome 7: Safeguarding people who use services from abuse 11.—(1) The registered person must make suitable arrangements to ensure that service users are safeguarded against the risk of abuse by taking reasonable steps to identify the possibility of abuse and prevent it before it occurs and responding appropriately to any allegation of abuse.

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use services from abuse Abuse means: Sexual abuse Physical or psychological ill treatment Theft, misuse or misappropriation of money or property Neglect or acts of omission which cause harm or place at risk of harm (Regulation 11 of the Health and Social Care Act 2008)

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use services from abuse Where any form of control or restraint is used in the carrying on of the regulated activity, the registered person must have suitable arrangements in place to protect service users against the risk of such control or restraint being either unlawful or otherwise excessive.

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use our services from abuse: how do we do this? A clear practice Safeguarding Children policy to identify the Practice lead (and deputy) for safeguarding children and how to get advice what abuse and neglect is what to do if concerns arise Where to get advice locally, (Safeguarding Children Teams, the child’s GP, the relevant Children’s Social care)

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use services from abuse: how do we do this? Local and government safeguarding children advice will be available to staff in your practice A system to monitor and review incidents, concerns and complaints which may become an abuse or safeguarding issue (eg Significant Event meetings) Report alleged abuse to the appropriate authority ( this also applies to managing allegations against staff)

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use services from abuse Act immediately to ensure abuse is stopped or suspected abuse is addressed Ensure that people using the service know how to raise concerns about abuse Review the person’s care plan to ensure they are properly supported following an alleged abuse incident

‘A Healthier Dorset’ Outcome 7: Safeguarding people who use services from abuse: how do we do this? Use the information from safeguarding concerns to identify non compliance or risk of non compliance with the regulations Identify what will be done to return to a state of compliance

‘A Healthier Dorset’ Outcome 7 Safeguarding people who use services from abuse: How? Staff will know how to recognise signs of abuse and neglect – Training to the appropriate level for their role Staff will know how to report/ seek advice within the Practice and be confident to act – Induction programme includes safeguarding / Practice policy The practice lead will know how to seek advice from specialist safeguarding named/ designated professionals

‘A Healthier Dorset’ Outcome 7 Safeguarding people who use services from abuse: The Outcome People using your services are protected from abuse/ the risk of abuse Their Human Rights are upheld and respected Children are human too! The needs of the child are paramount and over ride the duty of confidentiality owed to the parent/ carer

‘A Healthier Dorset’ The role of the dentist: Working Together to Safeguard Children 2010 (2.119) Dental staff may see vulnerable children Dental staff are in a position to identify injuries to the head, neck, throat, face, mouth and teeth Dental staff may identify other child welfare concerns Child Protection and the Dental Team provides guidance and learning including dental neglect/ general neglect

‘A Healthier Dorset’ The role of the dentist: Working Together to Safeguard Children 2010 (2.119) Dental staff need access to the Safeguarding Children Board Inter Agency Safeguarding Children procedures working-with-children/local-inter-agency- procedures/

‘A Healthier Dorset’ The role of the dentist: Working Together to Safeguard Children 2010 (2.119) The dental team must have the knowledge and skills to identify child welfare concerns They should know how to refer to Children’s Social care They should know how to get advice, including local named and designated professionals

‘A Healthier Dorset’ Dr Julie Doherty, Designated Doctor for Safeguarding Children, Consultant Paediatrician Dorset County Hospital via switchboard: and Pager Janet Bowen Designated Nurse for Safeguarding Children NHS Dorset and NHS Bournemouth and Poole Mobile Pager: Contact Details Safeguarding Children Advice

‘A Healthier Dorset’ Contact Details Safeguarding Children Advice Liz Chapman lead for safeguarding children Dorset Healthcare University Foundation Trust (DHUFT) Mobile: DHUFT Safeguarding Team

Referral Flow Chart PRACTITIONER HAS CONCERNS ABOUT CHILD’S WELFARE Practitioner discusses with manager and/or other senior colleagues as they think appropriate No longer has concerns No further child protection action, although may need to act to ensure services provided Feedback to referrer on next course of action No further LA children’s social care involvement at this stage, although other action may be necessary, e.g. onward referral See flow chart 2 on initial assessment Still has concerns Practitioner refers to LA children’s social care, following up in writing within 48 hours Social worker and manager acknowledge receipt of referral and decide on next course of action within one working day Initial assessment required Concerns about child’s immediate safety See flow chart 3 on emergency action Guidance-on-Consent-Confidentiality-and-Information-Sharing.pdf

‘A Healthier Dorset’ Dental Flow Chart What to do if you are worried about the welfare of a child attending your practice. Draft for consultation

‘A Healthier Dorset’ Member of staff has concerns about a child Do you have concerns about possible neglect or the parent child interactions? Consider if you need to call 999 now to alert the Police and protect the child Is there a concern about an immediate risk of harm Or an identified injury which could be non accidental? Discuss with your Safeguarding Children lead immediately Do you need more information? Refer to Children’s Social Care by phone and follow up in writing within 3 working days Contact the child’s GPs to share your concerns and seek more information Yes No Discuss with your safeguarding children lead Concerns increased? Record clearly in the child’s record and save a copy of the referral form/letter Yes No Explain your concerns to the GP and ask for them to be recorded in the child’s main record Inform the child’s GP of the referral Yes police involvement needed now Call 999 at once and explain concerns Consider contacting the Safeguarding Children Professional for additional advice or information

‘A Healthier Dorset’ QUESTIONS and DILEMMAS A child repeatedly needs many restorations due to poor diet or oral hygiene measures When would this would signal "dental neglect“ When would we need to make a referral to child services How we would approach this Being in essence a business we may get a ‘bad reputation’ for being a practice that is always referring children to child services because they have bad teeth and scaring children even more about going to the dentist

‘A Healthier Dorset’ QUESTIONS and DILEMMAS if we are concerned is there a way of contacting children’s social care/ children’s services about a family or child to see if they are already considered at risk without the family knowing you have made the enquiry about them?

‘A Healthier Dorset’ QUESTIONS and DILEMMAS GDPs are not really trained in how to deal with this sensitive issue. Would it be better to train the dental community dept specifically in how to address the link between dental neglect and child neglect and they can assess whether the child needs a referral to child services We as GDPs could then somehow highlight how the dental condition is not improving and the possible lack of motivation of the parents to care for them in general, to the community dept, and to see if they agree and then as professional trained they can take the appropriate measures

‘A Healthier Dorset’ TO CHECK IF A CHILD HAS A CHILD PROTECTION PLAN OR IS KNOWN TO CHILDREN’S SOCIAL CARE If a professional has a concern about the welfare of a child and wants to know if the child is known to children’s services or has a child protection plan, they should contact the Designated Manager’ of the list of children with child protection plans. Each call is logged Two contacts to the manager generates an automatic referral to the local office where an assessment of actions needed is made.

‘A Healthier Dorset’ TO CHECK IF A CHILD HAS A CHILD PROTECTION PLAN OR IS KNOWN TO CHILDREN’S SOCIAL CARE The numbers for Dorset, Bournemouth and Poole are to be found below Dorset: Bournemouth: Poole:

‘A Healthier Dorset’ Useful Links children/local-inter-agency-procedures/INTERAGENCY PROCEDUREShttps:// children/local-inter-agency-procedures/INTERAGENCY PROCEDURES children/what-to-do-if-you-are-worried-about-a-child/ children/what-to-do-if-you-are-worried-about-a-child/ content/uploads/2010/05/DSCB-Safeguarding-Standards-2011.pdf (includes information to develop safeguarding children policy) content/uploads/2010/05/DSCB-Safeguarding-Standards-2011.pdf

‘A Healthier Dorset’ More useful links nginpartnership/maternity,childrenandyoungpeo plesservices/safeguarding.cfmhttp:// nginpartnership/maternity,childrenandyoungpeo plesservices/safeguarding.cfm primarydentalcare/howwilltheprocesswork/crimin alrecordchecks.cfmhttp:// primarydentalcare/howwilltheprocesswork/crimin alrecordchecks.cfm