Safeguarding in England

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.

In England, safeguarding is structured and regulated by the following organisations:

• The Department for Education is responsible for child protection in England. It sets out policy, legislation and statutory guidance.
• The Department of Health and Social Care is responsible for government policy and legislation on safeguarding adults at risk.
• The Care Quality Commission. CQC Regulation 13: Safeguarding service users from abuse and improper treatment. This details the regulatory requirements for service users.
• General Dental Council: 'Standards for the dental team', Principal 8, describes the need to raise concerns if patients are at risk.
• Local Safeguarding Children/Adults Boards are multi-agency bodies set up in every local authority. They lead and coordinate the effectiveness of the safeguarding work of their members and partner agencies to protect children and adults 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. 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 NHS Safeguarding app for local safeguarding contact details.

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 local Safeguarding Board, 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.

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.

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 is safe and practicable to do so.
• Multiple agencies may share information: social care services, police, health visitors, schools, health providers, family justice system, CAFCASS, 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.

• The GDC's 'Standards for the Dental Team' Principle 8 covers raising concerns if patients are at risk.
• If you are concerned about a colleague, follow your organisation's procedures for raising concerns about staff members.
• NHS England's integrated whistleblowing policy for primary care is available here.

Guidance

Safeguarding in general dental practice (April 2019) from Public Health England gives an overview of the roles and responsibilities of everyone in the dental team relating to vulnerable adults and children.

It sets out the steps to follow in cases of suspected abuse, the guidance defines common terminology and different categories of abuse, sets out the legal and regulatory framework.

Also relevant:

• Adult Safeguarding: Roles and Competencies for Health Care Staff (2018). Sets out the competency framework for training healthcare staff.
• Health matters: child dental health (2017) from Public Health England describes issues relating to child dental health and defines dental neglect as 'the persistent failure to meet a child's basic oral health needs, likely to result in the serious impairment of a child's oral or general health or development'.
• The CQC Dental mythbuster 29: Safeguarding children and young people at risk.
• The CQC Dental mythbuster 28: Safeguarding adults at risk.
• The Department of Education's Working together to safeguard children.
• NICE guidance: Child maltreatment - recognition and management and updated Child abuse and neglect.
• The Royal College of Paediatrics and Child Health (RCPCH): Safeguarding children and young people: roles and competencies.

Legislation

The legislation informing safeguarding is diverse and varied. The prominent legislation is detailed below.

Children

• The Children Act 1989 provides the legislative framework for child protection in England.
• The Children Act 2004 places a duty on local authorities and their partners of service delivery and cooperate in safeguarding.
• Children and Social Work Act 2017, Child Safeguarding Practice Review Panel was established to review and report on serious child protection cases that are complex or of national importance. Local Safeguarding Children's Boards (LSCBs) has been replaced by local safeguarding partners who will publish reports on local safeguarding practice reviews.
• United nations conventions on the rights of a child UNCRC 1989 - the Convention has 54 articles that cover all aspects of a child's life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.
• The Female Genital Mutilation Act 2003 makes female genital mutilation (FGM) a criminal offence, and anyone assisting with the procedure faces prosecution.
• Mandatory Reporting of Female Genital Mutilation 2015 makes it mandatory for all regulated health and social care professionals and teachers in England to report 'known cases' of female genital mutilation (FGM) in under 18s to the police.

Adults

• The Care Act 2014 (England) establishes a framework for information sharing and cooperation to safeguard adults from abuse or neglect. Accompanying statutory guidance is available on the government website.
• Mental Capacity Act 2005 protects the rights of vulnerable adult patients to make decisions about their own care and treatment. The Mental Capacity Act 2005 made ill-treatment and wilful neglect of adults without capacity a criminal offence.
• The Modern Slavery Act 2015 extends to England and Wales and makes provision about slavery, servitude and forced or compulsory labour and about human trafficking.
• The Data Protection Act 2018 is relevant to adult safeguarding practice because it sets out when information should be shared, and lines of responsibility for the collection and processing of data.
• The Human Rights Act 1998: Articles 2 and 3 are of particular relevance to adult safeguarding - the right to life and the right to freedom from torture and inhumane or degrading treatment.

This page was correct at publication on 27/07/2022. 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.