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The role of chaperones - risk and reality in primary care.

Marilyn Eveleigh,
Consultant Editor

The incidents took place over many years, in both hospital and general practice. All the patients who gave evidence were vulnerable, initially believing that the actions of their doctor were in their best interests. The Inquiry found that Ayling broke the boundaries of trust and integrity that patients have a right to expect of their doctor.
Moreover, midwives, nurses and other staff who worked alongside Ayling gave evidence of their unease with his overfamiliarity during sensitive and intimate examinations. His behaviour and actions were often distressing to patients and observers. Yet a prevailing culture of low empowerment in nursing and midwifery staff, combined with an ability of medical and management colleagues to recast reported concerns into acceptable explanations, meant they deceived themselves and failed patients.
Among the recommendations of the Inquiry, the role of chaperones was outlined as a concern and in need of greater clarity. This was especially so in the community setting, where there are sole practitioners and where staff are not so readily available to chaperone during consultations.
There is no clear definition of a chaperone in any professional sphere, be it health or police work. Definitions are categorised by the Inquiry team into: a safeguard for the patient; a physical and emotional comfort to patients; a monitor of unacceptable or unusual behaviour by healthcare professionals; and finally, as a protection for healthcare workers from potentially abusive patients.
Every reader will have, at some time in their nursing career, acted as a "chaperone" during a consultation. What did we think we were present for? Were we prepared for the responsibility it brought? Were we fully aware of the acceptable limits of professional procedures - and the justification for them? Few patients will be aware of the background and role of the chaperone who is called to be present during the examination - even if they are given the choice to have one or not.
The Inquiry recommends that the role of the chaperone should be guided by a policy developed and implemented into every trust and PCT- including GP practices. Patients should be made aware of this policy, and any deliberate breach of the policy should be considered as a disciplinary matter.
The Inquiry recommends that all patients undergoing sensitive or intimate examinations should be offered a chaperone. These chaperones should be trained for the role - a passive witness does not serve patients adequately; patient's friends and relatives do not constitute acceptable chaperones; nor do untrained administrative staff from GP surgeries.
All this will further the protection of patients and rebuild the public's trust in the profession, and it is a necessary requirement of clinical governance. For nurses working in primary care, however, prepare yourselves for requests to chaperone as doctors seek to reduce the risk to their professional position. In the competing need for clinical skills and expertise, this is a poor use of qualified nursing time.
Instead, identify and support chaperone training - training that ensures patients have a full and detailed explanation of the procedure, including what discomfort they can expect. Take every opportunity to teach chaperones the skills of empathy, observation and empowerment. It is what patients should expect.