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5.4 The health sector

In recent years, a significant number of NHS organisations have been investigated following incidents of child sexual abuse. Most notably, a series of reports found that the famous media personality, Jimmy Savile, had sexually abused adults and children over many years in NHS hospitals and, in 2014, Dr Myles Bradbury was convicted of sexual offences against children who were his patients.[1], [2]

In July 2017, the Inquiry sought information in writing from around 50 health sector organisations about the measures that are in place to prevent child sexual abuse within healthcare settings, such as hospitals, GP practices and clinics. The issues raised in written submissions were subsequently discussed at a two-day seminar that took place in September 2017. Views were drawn from England and Wales to ensure that discussions recognised the structural differences between the health sectors in both countries.[3]

Responsibility for healthcare in England and Wales

England

The Department of Health and Social Care is responsible for health and adult social care policy and legislation in England.[4] The Department is supported by 28 agencies and public bodies, including NHS England, which leads the NHS in England.[5]

Wales

The Welsh Government’s Department of Health and Social Services is responsible for health and social services policy and legislation in Wales.[6] The NHS in Wales delivers services through seven local health boards and three NHS Trusts.[7]

The written submissions raised a number of issues about how current arrangements to protect children from sexual abuse within healthcare services could be improved.

The Inquiry was told that education and training tend to focus on equipping healthcare workers to recognise signs of abuse and neglect in the children they treat. Respondents to the request for written submissions and seminar participants suggested that training should be improved to help workers detect and respond to child sexual abuse that takes place within healthcare services, including child sexual abuse by colleagues.

Written submissions covered the responsibilities of healthcare workers to take action when they are concerned that a child is being sexually abused, or is at risk of sexual abuse. It was suggested that various factors may prevent workers from raising concerns or reporting sexual abuse. These included an unwillingness to challenge the actions of senior workers and fears of an unsupportive response from managers and colleagues. These factors were also cited during seminar discussions about barriers that might prevent workers from raising concerns. Simple reporting processes, effective line management and supervision of workers, and access to child safeguarding expertise and advice were noted by seminar participants as means of supporting healthcare workers who have concerns about the safety of a child.

The role of leaders and senior managers in creating a culture where workers are encouraged and expected to raise concerns was regularly raised in written submissions and emphasised throughout seminar discussions. These are important issues that are not unique to healthcare settings and the Inquiry will consider some of them in more detail at its seminar on mandatory reporting in 2018.

Written submissions also raised the role of statutory regulation of certain health professions. Regulatory bodies help to protect children by maintaining a register of those who are fit to practise a profession. They also set standards for professionals and take action when standards are not met. Respondents considered how the health sector could improve the speed and efficiency of decisions concerning a registered professional’s fitness to practise once they have been convicted of a sexual offence against a child. They also discussed how the health sector shares information about healthcare workers with the Disclosure and Barring Service (DBS) (the organisation that is responsible for maintaining a list of those who are barred from working with children). These are important issues and the Inquiry makes a recommendation on this area in Chapter 6.

Written responses and seminar discussions also emphasised the importance of providing children and their families with clear and accessible information about what to expect during treatment, in order to help them feel more confident in speaking up if they have concerns. Respondents and participants also explained that children are particularly vulnerable to sexual abuse when receiving health care and treatment in the same settings as adults, and that better arrangements should be in place to prevent unsupervised or inappropriate access to children during their care and treatment.

A number of written submissions explained the important role that chaperones play in helping to protect children from sexual abuse. Chaperones observe care and treatment and intervene if they have concerns about the safety or welfare of a patient. Several written submissions emphasised that the presence of chaperones reduces the risks of sexual abuse during the treatment of children. During the seminar, participants noted that while there is growing awareness that chaperones are needed to help protect children in healthcare services, in some organisations awareness remains low. The Inquiry was also told that healthcare services require substantial resources to train chaperones and ensure that they are available when needed. Respondents and participants suggested that, in some cases, resource constraints are preventing the consistent use of appropriately trained chaperones.

Both during the seminar and in the written submissions received, the Inquiry was told that, while good practice guidance is available, there are no national policies in place for the use of chaperones in healthcare services. The Inquiry has confirmed that national policies for the NHS and other healthcare services in England and Wales are not available.

The Inquiry considers that national policies for the training and use of chaperones across healthcare services would help to ensure that chaperones are used consistently and effectively to protect children from sexual abuse during treatment. A consistent approach would also help to provide clarity for children and their parents or carers about when they can expect a chaperone to be present. The Inquiry considers that such policies should apply to all healthcare services in England and Wales, and that the responsible government departments should address this so that policies cover NHS and private healthcare services. The Inquiry also considers that healthcare service regulators should assess compliance with the policies once they have been implemented.

Recommendations

England

The Chair and Panel recommend that the Department of Health and Social Care develops a national policy for the training and use of chaperones in the treatment of children in healthcare services.

The Chair and Panel recommend that the Care Quality Commission considers compliance with national chaperone policies (once implemented) in its assessments of services.

Wales

The Chair and Panel recommend that the Welsh Government develops a national policy for the training and use of chaperones in the treatment of children in healthcare services.

The Chair and Panel recommend that Healthcare Inspectorate Wales considers compliance with national chaperone policies (once implemented) in its assessments of services.

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