Doctors’ responsibilities in child protection cases
June 2004
Part 5: serious case reviews
Where a child dies, and abuse or neglect is known or suspected to be a factor in the death, local agencies, including the health services should consider immediately whether there are other children at risk of harm who need safeguarding, such as siblings or other children in an institution where abuse is alleged, and take appropriate action. Subsequently, the Area Child Protection Committee (ACPC) has a responsibility to convene a case review panel (commonly known as Part 8 reviews). Case review panels are also convened where a child commits suicide. ACPC’s also have the discretion to convene a case review in cases of serious injury to a child where abuse or neglect is considered to be a factor, and the case gives rise to concerns about the way in which local professionals and services work together to safeguard children. The purpose of these reviews is to:
- establish if there are lessons to be learned about the way in which local professionals and agencies work together to safeguard children
- identify clearly what those lessons are, how they will be acted upon and what is expected to change as a result, and therefore
- to improve inter-agency working and to better safeguard children
Confidentiality and serious case reviews
It is important that doctors and health professionals contribute to serious case reviews where they have had responsibilities for the care or treatment of the child. Questions arise, however, about the extent of doctors’ duties to release confidential information to Part 8 reviews without consent. This can be further complicated, in some instances, by ongoing criminal proceedings, and concerns about prejudicial disclosure.
Where criminal proceedings have been commenced, it is important that those responsible for co-ordinating the review discuss with the relevant criminal justice agencies how it should best take account of the proceedings. This would include matters such as the timing and structure of the review, which individuals should contribute at what stage, and whether some information should be withheld until criminal proceedings have finished. Where doctors have concerns about releasing information in these contexts, they should ensure they discuss the matter with the professionals co-ordinating the review. The Trust’s designated professional can also be a useful source of advice.
In terms of confidential patient information, it is important to recognise that as the goal of the review is to analyse the way in which local professional agencies work together, much useful work can be done without releasing confidential information. Having said this, those conducting the review frequently ask for copies of the records of any children, parents or carers who may have been involved with the child, as well as the records of the deceased or injured child concerned. In these circumstances, doctors should initially ask for the consent of the person involved. Where the records relate to a child who does not have the capacity to make the decision, then ordinarily someone with parental responsibility should give consent. Where consent is not forthcoming, doctors will need to carefully balance the need to maintain confidentiality to the child, family members and others with the responsibility to provide relevant information in the public interest to those with a legitimate need to know. As the purpose of the review is to look at inter-agency working, it is unlikely that the information will need to be released without consent for the immediate protection of a child. Nevertheless, there is a genuine public interest in ensuring that relevant information is exchanged in order to ensure the proper protection of children, and this will need to be weighed in the balance. Decisions will need to be made on a case-by-case basis, but doctors need to recognise that without consent, confidential information should not be released without either a legal obligation, such as a court order or statutory obligation, or where there is a strong public interest justifying disclosure. A decision to disclose on the grounds of public interest is likely to be based at least in part on a balancing of several moral imperatives, including the risk and likelihood of harm if no disclosure is made, and the need to maintain the trust of the patient. Doctors should bear in mind that advice can always be sought from the Trust’s nominated professional, or from professional and indemnifying bodies. For further information on disclosure of confidential information, go to the BMA’s guidance note, Confidentiality and disclosure of health information.