Doctors’ responsibilities in child protection cases


June 2004

Part four: child protection cases conferences and follow-on Child protection case conferences
The child protection conference is a key feature of the child protection process. A conference is usually called after the social services and police have investigated some initial concerns about the welfare of a child (s.47 enquiries under the Children Act 1989) and decided they require further investigation. The case conference usually brings together a variety of professionals who have involvement with the child concerned.

The main role of the child protection conference is to assess the child’s well being, to consider whether they are suffering or are likely to suffer significant harm, and to decide what future action, if any, needs to be taken to support the child. A decision will also be made as to whether or not the child or children should be put on the Child Protection Register. The conference usually makes recommendations about whether it is necessary to take any legal action to protect the child, and whether the police should take any action if a crime has been committed. If the child is put on the register, the conference must also put together a child protection plan that sets out how the child’s needs are to be met in the future. This plan should make it clear what is expected of each agency involved in the child’s care and protection. The details of the care plan are usually decided at a core group meeting held after the conference, which is composed of those agencies who are most closely involved with supporting the child in the future. Once a child has been put on the Child Protection Register, an initial follow-up conference is usually held after three months, and then, if the child remains on the register, at six monthly intervals thereafter.

Membership of the initial child protection conference will usually include:
  • those with parental responsibility
  • the child
  • social/key worker and first line manager
  • police officer
  • health services involved with child or children
  • education services
  • standing members, if applicable, such as child protection officers
Doctors have a key role to play in child protection case conferences and the BMA considers it important that, as far as possible, doctors should attend them in person, rather than sending in a written report. The BMA recognises, however, the difficulties for GPs if such case conferences are called at short notice. Wherever possible, Area Child Protection Committees should give GPs adequate advance notice. Where doctors are unable to attend in person, they should pay due attention to the confidentiality of any written report they submit, taking into account the guidelines in the following section.

Child protection case conferences and confidentiality
The BMA receives many inquiries about the extent of doctors’ obligations to release confidential information at child protection conferences. The evidence and opinion that doctors provide at these conferences can be fundamental to an understanding of the child’s circumstances, but doctors often express concerns about the extent to which other participants are under a similar professional duty of confidentiality. Doctors attending case conferences should only release information that is both relevant to the purposes of the case conference and in the best interests of the child or children concerned. Occasionally, doctors may need to request that sensitive information is released in a limited fashion, either to selected individuals or to the chairman of the conference. Once a child protection conference has been convened, parents or carers should have been informed of the proceedings, and their co-operation should be sought when disclosing information.

When doctors are attending case conferences, it is important that, as far as possible, they present clinical information in a way that can be understood by all those attending the conference. It can be difficult for non-doctors to assess the significance of some clinical data and it is important that the conference reaches a decision based on sound and clearly understood evidence.

Action following the initial child protection conference
When a child is placed on the child protection register, one of the child care agencies with statutory powers, either the NSPCC or the social services, takes responsibility for the child’s case and designates a member of its staff as a key worker. Where doctors and other health care workers are professionally involved with children who have been placed on the register, they should identify the name and contact details of the key worker. This information should be placed in the child’s medical record. The key worker is responsible for acting as lead worker for the inter-agency work with the child and family. She or he should co-ordinate the contribution of health workers and other agencies in order to put in place the child protection plan.

At the initial child protection conference, a decision may be made that the child should not be put on the child protection register. This does not necessarily mean that the child or the family does not require additional support or protection. If they do require further support, it is important that a care plan is drawn up and that all professionals involved are clear about their responsibilities in implementing the plan.

Who should take the lead in child protection cases?
Doctors have no legal powers to intervene in the lives of children whom they suspect may be subject to abuse or neglect, and doctors and other health care workers do not therefore assume lead responsibility. Ordinarily, this responsibility rests with nominated individuals in one of the statutory bodies: the social services, the NSPCC or the police. Where doctors are involved in child protection cases, it is important that they identify the lead professional as soon as possible and ensure that lines of communication remain open. Nevertheless doctors often have a good relationship with the family and can be influential in encouraging good parenting and assisting the family in remaining together.

It is frequently the case that doctors, having passed on concerns about a child to the police or social services, will continue to see the child in a professional capacity. If the doctor considers that there is new evidence of abuse, or that initial concerns have not been listened to, then it is important to take action, even where another professional may have overall responsibility. Action could include further discussion with the lead professional or the Trust’s nominated child care professional. If the concerns are sufficiently serious, doctors may consider requesting that social services convene, or reconvene, a child care conference.

Where a doctor has raised concerns about deliberate harm, it is important that he or she ensures that, in any future appraisal, each of the concerns has been fully addressed, accounted for and documented. [Go to reference 16] Where doctors or other health care workers have been involved with caring for the child or family, or have taken part in enquiries, they have the right to request that social services convene a child protection conference if they have serious concerns that a child may not otherwise be adequately protected.

Collaborative working
Effective support and protection for vulnerable children can only be provided by an inter-disciplinary team of health and social care professionals, and the effectiveness of this team, in turn, depends upon good liaison and communication between separate agencies and professionals. All doctors who may have contact with vulnerable or at risk children must ensure that they are aware of whom to contact in the local hospital, health authority, social services and police should they need to raise any concerns. Another of the recommendations of the Climbié report was the need to develop a ‘common language’ to be used across different agencies in order to ensure that an evidence-based consensus could be reached by all those involved in decision-making. Health professionals have a responsibility to ensure that any communication they have with external agencies is expressed in language that is, as far as possible, clear to non-health professionals.

© British Medical Association 2008

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