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 of safeguarding varies across the individual nations of the United Kingdom. In Scotland, the terminology 'adult and child protection' is used, and it is structured and regulated by the following organisations:
- The Scottish Government sets out policy, legislation and statutory guidance on how the adult and child protection system should work.
- Health boards are responsible for multi-agency protection policy, procedure, guidance and practice.
- Health and Social Care Partnerships, (HSCPs) are organisations formed to integrate services provided by Health Boards and Councils in Scotland. Each partnership is jointly run by the NHS and local authority.
- Adult and child protection committees work with local agencies, such as children's social work, health services and the police.
- 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 adult and child protection who can organise training, advise staff and oversee the reporting of concerns.
- Adult and child protection policies that set out the practice's commitment to protect vulnerable patients which should then be regularly reviewed.
- Regular mandatory staff training in adult and child protection. Everyone in the practice team should be aware of their personal responsibility to report concerns and know the reporting process.
- Include adult and child protection 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 Scotland checks if staff work with vulnerable groups. Your duties as an employer also include providing information to the Disclosure Scotland about employees who may pose a risk, or who have harmed children or vulnerable adults.
- Membership of the Protecting Vulnerable Groups scheme applies to dental professionals under the scheme's definition of regulated work.
- Procedures for information-sharing and working with other agencies to protect adults and children at risk.
- Incorporate adult and child protection guidance into team meetings and ensure all members of staff know how to access 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 is safe to do so.
- Discuss with your local adult and child protection lead and implement your local adult and child protection 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 social work contact centre covering the Health and Social Care Partnership (HSCP) where the patient lives. However, if you believe a criminal offence may have been committed, seek advice from the DDU, and report it promptly to the police.
- If you're unsure whether or how to raise concerns, seek advice from your local adult and child protection lead, adult and child protection committee or the DDU.
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.
- Some health boards still maintain a 'named person' scheme - a point of contact whose existing role already involves providing advice and support to families.
- Local children's reporters are independent officials who can decide if any legal interventions need to be made to protect a child. They can also be contacted directly regarding safeguarding concerns. Children's Reporters offices can be found on the Scottish Children's Reporter Administration website.
Dental neglect in children
A decision as to whether a child is suffering wilful dental neglect should be made in consultation with the local child protection 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, 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.
- The Scottish National Whistleblowing Standards set out how the Independent National Whistleblowing Officer (INWO) expects all NHS service providers to handle concerns that are raised, and which meet the definition of a 'whistleblowing concern'.
Guidance
Legislation
The legislation informing safeguarding is diverse and varied. The prominent legislation is detailed below.
Adults
- The Adult Support and Protection Act (Scotland) 2007 places the lead role of the local council and its related powers and duties on a statutory footing. Section 4 of the Act requires local councils to make inquiries about a person's wellbeing, property or financial affairs where it appears that an adult at risk may need intervention and protections. It also includes provisions for assessment orders, removal orders and banning orders.
- The Adults with Incapacity (Scotland) Act 2000 provides a framework for safeguarding the welfare and managing the finances of adults who lack capacity. The Act provides for three types of protection when an adult lacks capacity; welfare guardianship, financial guardianship and power of attorney.
- The Mental Health (Care and Treatment) (Scotland) Act 2003 applies to adults living with a mental illness, learning disability or related condition referred to as 'mental disorder'. The Act sets out when and how people can be treated if they have a mental disorder.
- The Mental Health (Scotland) Act 2015 consists of 10 principles that should be upheld when safeguarding individuals with mental health issues, including that the person's background, beliefs and abilities should be considered, that a range of options for their care should be explored, and that any restrictions on the person's freedom are the minimum necessary in the circumstances.
- Domestic Abuse (Scotland) act 2018 serves to protect victims of both physical abuse and psychological abuse. Dental professionals who have been confided in or have significant suspicions can report concerns to the police. A court order or police request may require you to provide clinical records to assist in an investigation.
- Human Trafficking and Exploitation (Scotland) Act 2015 deals with the illegal trade of human beings for exploitation, which also encompasses the offence of slavery, servitude and forced or compulsory labour. Dental professionals would be expected to assist those that reach out for help and raise concerns where appropriate, always in the safest way possible for both parties.
Children
- Children's Hearings (Scotland) Act sets out the legal basis for the care and protection of children by the imposition of a Compulsory Supervision Order. The Act sets out the duties and powers of local authorities, police officers and others to make a referral to the Principal Reporter in relation to a child.
- The Children (Scotland) Act 1995 outlines the legislative framework for Scotland's child protection system. It covers parental responsibilities and rights, and the duties and powers local public authorities have for supporting and promoting the safety and welfare of children.
- The Children and Young People (Scotland) Act 2014 amends the Children (Scotland) Act 1995 to ensure children's rights are upheld.
- The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill will incorporate the United Nations Convention on the Rights of the Child (UNCRC) into Scottish law. This means that public authorities across Scotland will have to comply with children's rights in all the work they do (Scottish Parliament, 2021).
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.