The Pharmaceutical Journal
Vol 275 No 7361 p169
6 August 2005

This article
Reprint   Photocopy

PDF 50K, Acrobat Reader

Child protection is everyone’s business

Lord Laming, who conducted the inquiry into the death of Victoria Climbie, said that every service has to play its part in the support and protection of children. Joy Wingfield, professor of pharmacy law and ethics at the University of Nottingham, looks at what this means for pharmacists

Most of us will have watched with horror and disbelief the unfolding of inquiries into child abuse, from Sonia Colwill to Victoria Climbie, over the last decade or so. Equally we may have been grateful to be pharmacists and not social workers, police officers or health visitors, many of whom came in for severe criticism of their action, or lack of action, in these cases. Soon, however, pharmacists will be among the vast range of professionals whom the public blithely class as the “they” who “should do something” to prevent these tragic failures in child protection.

The Children Act 2004 provides power to place a duty upon a host of public bodies, including those in the NHS, to “make arrangements to ensure that in discharging their functions they have regard to the need to safeguard and promote the welfare of children”. This duty complements an existing duty upon these bodies to co-operate with each other and receive co-operation from “relevant partners” with a view to improving the well-being of children. Consultation on statutory guidance (for England) on making appropriate arrangements was issued at the beginning of April, closes on 24 June and should come into force on 1 October. The statutory guidance is directed at chief executives and senior managers in the relevant bodies.

The guidance is in two parts: Part 1 covers general arrangements likely to be common to all or most of the agencies to which the duty applies; Part 2 deals with implementation in a number of specific agencies, including those in the NHS. Key features of effective arrangements are listed in the preface (see Panel) and bear some resemblance to the now familiar principles of clinical governance. By 1 June 2006, each local authority must establish a local safeguarding children board (replacing the child protection committee) to monitor and inspect the safeguarding and promoting welfare arrangements. Guidance on a third duty — to establish and operate information sharing databases between agencies — is due for consultation in 2005.

The publication of this guidance is another step in a lengthy programme of activity from the Department for Education and Science (see www.everychildmatters.gov.uk) to consolidate “commitment between central and local government and all key people and bodies that work with children to ensure that every child has the opportunity to fulfil their potential” and is safeguarded from risk. The guidance explicitly applies to strategic health authorities, designated special health authorities, NHS trusts, foundation trusts and primary care trusts, to their staff and to those contracted to provide services on behalf of these bodies, eg, pharmacy contractors. Therefore the guidance will fall under the Health and Social Care (Community Health and Standards) Act 2003, providing powers for the Healthcare Commission to monitor and improve the quality of health services. Already, standard 5 of the National Service Framework for Children, Young People and Maternity Services expects all NHS and PCTs to have a named doctor and a named nurse for safeguarding children to provide advice and expertise for fellow professionals. All staff in the trusts and those providing services under contract should receive training to be alert to potential indicators of abuse and neglect in children, know how to act on their concerns and fulfil their responsibilities as a health professional in line with local procedures. The Health and Social Care Standards and Planning Framework for 2005 also has a core standard C2 relating to safeguarding and promoting the welfare of children.

Practical guidance

Since May 2003, practical guidance, “What to do if you’re worried a child is being abused”, has been available from the Department of Health and is aimed at health practitioners who come into contact with children and families in their everyday work, including people, such as pharmacists, who do not have a specific role in child protection. Most of the document, however, presupposes that practitioners will be able to refer to “senior managers” or “your organisation’s procedures”, which may not be easily applicable to community pharmacy. No information is given within this DoH guidance to help pharmacists know what to look for as indicative of abuse although there is much information elsewhere on the DoH website (www.dh.gov.uk) for social workers and child welfare specialists about assessment frameworks for children in need. The Centre for Postgraduate Pharmacy Education produces training material on the supply of emergency hormonal contraception and on child health; both include information on child protection. Pharmacists may need to be particularly alert to excessive administration or withholding of drugs by parents, suspicious bruises on children or neglect of children by parents who are substance misusers or have mental health problems.

Issues of confidentiality are addressed in appendix 1 to the 2003 DoH guidance. This rightly points out the competing obligations to respect confidentiality of patient information, the wishes of parents and carers on disclosure, the need to prevent a possible tragedy and the justification you may need if you decide to disclose information against a parent’s or child’s wishes (and possible protection if your concerns turn out to be unfounded). A brief outline is given of the common law duty of confidence and of the statutory duties under the Human Rights Act and the Data Protection Act. Taken together, these do allow justification of disclosure if it can be shown that appropriate consent was given or there was an overriding public interest in disclosure to prevent harm, to protect the vital interests of the data subject or to comply with a court order or other statutory obligation. Generally, these defences to disclosure without consent would cover most situations that might be noticed by pharmacists, particularly in relation to supply of emergency hormonal contraception under a patient group direction. Support for this view has recently been confirmed in a House of Lords ruling that, on public policy grounds, health care professionals responsible for providing information surrounding an investigation into child abuse do not owe a duty of care to a parent suspected of an abuse, provided the investigation was carried out in good faith. In other words, a duty of care to the child outweighs a duty of care to the parent.