Help in raising concerns about child abuse

A helpline for healthcare staff, funded by the government but run by the NSPCC, is the latest attempt to encourage professionals to speak up about suspected child abuse. Nurses have a duty to act if they suspect abuse, while employers must provide training and support.

Picture credit: Alamy

Rotherham, Jimmy Savile, Victoria Climbié, Baby P – all horrific cases involving child abuse, all subject to high profile enquires. And in every case, the professionals involved, including nurses, had serious concerns that things were wrong, but did not stop the abusers or protect the victims.

An estimated 1,400 children were abused in Rotherham between 1997 and 2013, and multiple opportunities to intervene were missed. Victoria Climbié was just one child, but the report into the awful circumstances surrounding her death show that she had been in contact with health services and abuse had been suspected, but again, opportunities were missed.

Such cases have triggered successive attempts to tighten safeguarding processes to prevent more vulnerable children from slipping through the gaps.

One of the latest moves from the Home Office in England is a whistleblowing helpline for healthcare staff who have concerns about child abuse.

The £500,000 helpline, funded by the government, but run by children’s charity the NSPCC, started taking calls in mid-February. Open from Monday to Friday, it handles calls from employees from any sector who are afraid to raise concerns about how their organisation deals with cases of suspected child abuse or who think they have exhausted all attempts to deal with employers directly.

The government committed to setting up the helpline in its March 2015 report on tackling child sexual exploitation (tinyurl.com/goajq6w)

Other commitments include updating training materials on safeguarding children for NHS staff, launching online training to help health sector staff identify and support children who may have experienced sexual exploitation, and publishing a resource pack for school nurses.

Home Office minister Karen Bradley says the helpline will highlight patterns of failure across the country and build on attempts by some employers to encourage greater openness: ‘No one should be afraid to report concerns about failures in child protection,’ she says.

In its first six weeks, the service handled 140 calls says NSPCC head of helplines Kamaljit Thandi. ‘It aims to ensure that professionals can raise concerns. Hopefully, this will mean that we can spot patterns at an early stage so that it would be possible to prevent another Rotherham.’

Ms Thandi is clear that the helpline is not a first port of call. ‘Nurses and other health professionals should first raise concerns with their line managers,’ she stresses. ‘If they fear that a child is at risk of abuse and they have raised it with management, but their concerns are not being taken seriously and they are not being supported, that’s what the helpline is there for.’

Nurses have a duty to raise concerns about child abuse, but some may find it hard. Ms Thandi is aware of the impact of whistleblowing on individuals and their careers, and says that, where relevant, callers to the helpline are referred on to the legal advice body Public Concern at Work so that they can be helped to protect themselves.

She stresses that, although calls are treated confidentially, whistleblowers’ anonymity cannot be guaranteed. However, each caller is given a unique identifying number to show they have made a protected disclosure under legislation to support whistleblowers.

The RCN has published guidance on safeguarding children and young people. It describes how to identify a vulnerable child, signs of abuse that nurses should learn to recognise (see panel), the role and responsibilities of nurses who have direct or indirect contact with children, and the responsibility of employers in this area.

The RCN’s guidance on safeguarding children and young people sets out some potential signs of child abuse. These include:

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Physical signs, such as hand-slap marks, bruised eyes, bruising in unusual areas, and bite marks

Poor physical care and inadequate hygiene, inappropriate dress, failure to seek appropriate health care, or repeated missed appointments or cancellations

Parents or carers who over-protect a child

Poor school attendance that cannot be justified by poor physical or mental health

A child who exhibits a fear of adults or of specific adults when approached, or who displays aggressive behaviour, self-harm or substance abuse

An adult’s story that is inconsistent with a child’s injuries

The suspicion that a parent or caregiver is fabricating or inducing illness

Repeated attendance of a child with different types of injury in a short period of time.

The guidance also makes clear that there is no single definitive sign, symptom or injury to suggest child abuse, adding: ‘A series of seemingly minor events can be just as damaging as any one event.’

Source: RCN guidance (2014). Safeguarding Children and Young People – Every Nurse’s Responsibility (tinyurl.com/gox5y4b)

According to the RCN’s professional lead for children and young people’s nursing, Fiona Smith, it is vital to keep the message and process as simple as possible.

In the first instance, nurses should raise concerns with their line manager or the nurse in charge. If they are unhappy with the response, they should take their concerns to the named nurse or doctor for safeguarding children. If their concerns are still not being addressed, there are a number of other routes open to them.

‘We would advise our nurses to seek advice from the RCN and ensure that they follow due process in terms of whistleblowing,’ says Ms Smith. ‘Speaking to RCN Direct can help nurses find a way forward.’

Most importantly, nurses should familiarise themselves with local processes, and act – and be persistent – if they have concerns.

But employers have a duty too, says Ms Smith, such as providing frequent education and training, including scenario-based training. ‘For example, you might have a young girl coming into a genitourinary clinic. She’s 13 and she’s with a 35-year-old man. She comes into the consulting room alone, but her phone is on, so he can hear every word of the consultation.’

In such a situation, the nurse should enquire whether the young person has a mobile and ask for it to be switched off or left outside, advises Ms Smith.

NSPCC Whistleblowing Advice Line

Open from 8am to 8pm Monday to Friday on 0800 028 0285 or you can email help@nspcc.org.uk

RCN Direct

Open from 8.30am to 8.30pm every day. Telephone 0345 772 6100 or (national rate) 0207 647 3456

Public Concern at Work

Telephone 020 7404 6609 www.pcaw.co.uk

She adds: ‘Front line nurses must have access to the right level of expertise, and they must be supported to act’.

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