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Female genital mutilation - caring for patients and child protection

• Everybody who works with children should be able to recognise, and know how to act upon, indicators that a child’s welfare or safety may be at risk. These indicators might become apparent through contact with children and also their families. For example have a young girl’s mother and sisters been subjected to female genital mutilation?
• Due regard must be given to the child and family’s rights to confidentiality.

• Doctors should know what services are available locally and how to access them; who to contact for sources of further advice and expertise and how, and when and how to make a referral to the local authority social services department.
• There should be a designated senior doctor and nurse in each health authority area to provide help and advice.
• Although help and advice are essential, doctors should not delay if emergency action is needed to protect a child.

• All concerns about a child’s welfare should be recorded in the child’s health record, even if no further action is taken.
• All discussions about the child’s welfare should be recorded in the child’s health record, including what has been agreed as future action, and who will take that action.

• If doctors believe that a child may be suffering, or may be at risk of suffering, significant harm, they should refer these concerns to the local authority social services department. In addition to the social services department, the police and NSPCC have powers to intervene.
• Doctors should aim to discuss any concerns with the family and, where possible, seek agreement to making referrals to social services unless to do so would place the child at increased risk of serious harm.
• Doctors should make a note of any referrals in the child’s health records and ensure that it is clear who will be taking what action (or that no further action will be taken).
• Following a referral, the social services department has responsibility for clarifying the nature of the concerns, how and why they have arisen and what the child and family need.
• If there has been a criminal offence against a child, it is the responsibility of the social services department (or the NSPCC if relevant) to inform the police at the earliest opportunity. The police should then work in partnership with social services and/or other child welfare agencies, and should take into account the views of those agencies in considering whether it is appropriate to take action. It is recognised that cases will arise where the best interests of the child are served by a social services led intervention rather than a full police intervention.

• This must be done within seven working days from the day of referral, and addresses the needs of the child, the parents’ abilities to respond appropriately to those needs, protection from significant harm, promotion of the child’s health and development and whether action is needed to safeguard and promote the child’s welfare. It is likely to involve speaking to the child and family.
• A course of action is decided upon based on the outcome of this assessment.

• Where there is a likelihood of serious immediate harm, the local authority, police or NSPCC will act quickly to ensure the immediate safety of the child, usually after a strategy discussion between the police, social services and other agencies as appropriate.
• Emergency action may involve removing the child to a safe place.

• Doctors may be asked to contribute to social services’ core assessment of a child. If to do so would not increase the risk of the child suffering harm, consent to disclosure of information should be sought. If consent cannot be sought, or is not forthcoming, doctors may release information essential to protect a child from serious harm in accordance with the GMC’s rules. [Go to reference 37]
• The local authority will make all reasonable efforts to persuade parents to co-operate with these enquiries. If they refuse, a court may direct the parents to co-operate with an assessment of the child.

• Enquiries must always be carried out in such a way as to minimise distress to the child and to ensure that families are treated sensitively and with respect.

• A conference will be convened if the agencies involved judge that a child may be at risk of suffering significant harm.
• The purpose of the conference is to assess all relevant information and plan how to safeguard the child and promote his or her welfare. This forms the child protection plan.

• All children who are considered to be at continuing risk and for whom there is a child protection plan are included on a child protection register.
• The purpose of the register is to make agencies and professionals aware of those children who are judged to be at continuing risk and in need of active safeguarding.