The abuse and neglect of adults and children is an emotive, sensitive, and often very difficult issue for dental professionals to deal with. There is an ethical and legal duty to act, and it helps to be aware of relevant guidance and available support.
The structure and regulation of safeguarding is different across the four nations of the United Kingdom.
In Northern Ireland
- The Northern Ireland Executive, via the Department of Health, is responsible for safeguarding in Northern Ireland.
- The Safeguarding Board for Northern Ireland (SBNI) coordinates and ensures the effectiveness of work to protect and promote the welfare of children.
- The Regulation and Quality Improvement Authority (RQIA) is the independent body that regulates and inspects the quality and availability of Northern Ireland's health and social care (HSC) services.
- General Dental Council: 'Standards for the dental team', Principal 8, describes the need to raise concerns if patients are at risk.
Detailed guidance and the diverse legislation informing safeguarding can be found later in this guide.
Recommended safeguarding arrangements in dental practice
- A named lead for safeguarding who can organise training, advise staff and oversee the reporting of concerns.
- A practice safeguarding policy that sets out the practice's commitment to protect vulnerable patients which should then be regularly reviewed.
- Regular mandatory staff training in safeguarding, as outlined in the RQIA training guidance for dental practice. Everyone in the practice team should be aware of their personal responsibility to report concerns and know the reporting process.
- Include safeguarding as part of the staff induction process.
- Safe recruitment practices and arrangements for dealing with allegations against people who work with vulnerable groups.
- Employers are obliged to obtain Disclosure and Barring Service (DBS) checks if staff work with vulnerable groups. Your duties as an employer also include providing information to the DBS about employees who may pose a risk, or who have harmed children or vulnerable adults.
- Procedures for information-sharing and working with other agencies to protect adults and children at risk.
- Incorporate safeguarding guidance into team meetings and ensure all members of staff know how to access the Safeguarding Board for Northern Ireland app.
Dental neglect in children
A decision as to whether a child is suffering wilful dental neglect should be made in consultation with the local safeguarding lead and local children's services. The following may be relevant:
- failure to take a child for dental care leading to severe untreated dental problems
- missing appointments
- failure to provide basic dental care at home
- repeated general anaesthetics to remove teeth.
Raising safeguarding concerns
If you have reasons to believe a person is being abused, neglected or is at risk, then consider the following steps.
- If your concerns arise during a consultation, establish the facts and the extent of the abuse as far as you can, if it's safe to do so.
- Discuss with your local safeguarding lead and implement your local safeguarding procedures.
- Concerns should be documented in the patient's record. Actions and outcomes should be documented. Records should be factual, contemporaneous, and avoid speculation or opinion.
- In most cases, concerns should be raised with the relevant Health and Social Care Trust (HSCT) Gateway Services team, adult, or child services. However, if you believe a criminal offence may have been committed, seek advice from the DDU, and this should be reported promptly to the police.
- Seek advice from your local safeguarding lead, safeguarding board or the DDU if you are unsure whether or how to raise concerns.
Adults
- If the patient has capacity, you should usually seek their consent before taking action.
- If a patient with capacity refuses consent for you to raise concerns, you might need to respect this, unless disclosure is required by law or can be justified in the public interest.
- If the patient lacks capacity and you believe they are being neglected or physically, sexually or emotionally abused, you must inform an appropriate responsible person or statutory agency, in line with local arrangements.
Children
- Explain to a child why you are unable to maintain confidentiality and explore the child's concerns about sharing information.
- Attempt to gain consent, as long as this does not endanger the child.
Sharing information with third parties
Information can be shared lawfully within the parameters of the Data Protection Act 2018 and the General Data Protection Regulation (GDPR)
- If the authorities request information about a vulnerable patient, you can share relevant information with the patient's consent, in line with local information-sharing protocols.
- Where information is shared against the patient's wishes (for example, to protect others at risk) the rationale for decision-making should be recorded.
- Seek advice from the DDU when making disclosures without consent.
- If you decide to disclose information without consent, you should inform the patient first, if it's safe and practicable to do so.
- Multiple agencies may share information: social care services, police, health visitors, schools, health providers, family justice system, NIGLA, probation services and others.
Allegations against healthcare staff
If you believe vulnerable patients are at risk within a healthcare setting, either from neglect or poor professional practice, you have a duty to raise your concerns.
Guidance
The Safeguarding Board of Northern Ireland provides comprehensive advice and guidance: Safeguarding is everyone's business.
Also of relevance:
Legislation
The legislation informing safeguarding is diverse and varied. The prominent legislation is detailed below:
Adults
Children
This page was correct at publication on 26/07/2022. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.