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What nurses need to know about raising suspicions of child abuse

For nurses, as for all people who work with children in the UK, there is a professional obligation to report any signs of physical or sexual abuse or neglect in the young people that they care for. 

According to Department for Education (DfE) figures, in 2015/16 there were more than 50,000 children known to the Government in England as needing protection from abuse. In 2014/15, reported incidents of sexual offences against children rose by 38% and incidents of neglect by 10% on the previous year, according to the National Society for the Prevention of Cruelty to Children’s (NSPCC) 2015 report, How safe are our children?

Under current legislation, however, there is no legal requirement for anyone working with minors in England, Wales or Scotland to report incidents of abuse and concerns to local authorities, children’s services or to the police. This has been the case for the past 60 years, during which time the majority of international policies have made such reporting mandatory.

Mandatory reporting is legislation that acknowledges the prevalence, seriousness and often hidden nature of child abuse and neglect, and enables early detection of cases that otherwise may not come to the attention of the authorities. 

This article will examine whether the UK could benefit from this law across the board.

NICE guidelines

NICE was asked earlier this year by the Department of Health (DH) and the DfE to provide guidance for all professionals on when to report signs of child abuse. 

‘The guidance tells you what to do if you’re worried. It shows you what to do when you have that first instinct that something is wrong,’ said Dr Danya Glaser, an honorary consultant child and adolescent psychiatrist and vice-chair of the NICE guideline committee, when the draft guidance was published in February.

The draft guidelines, due to be finalised and published in September, list ‘soft signs’ that should be considered as potential signs of abuse in children, such as low self-esteem, excessive clinginess and frequent rages at minor provocations.

The guidelines also indicate signals that should cause professionals to suspect abuse and instigate an investigation, such as a child regularly arriving to school unclean or with injuries, overtly sexual behaviour in pre-pubescent children and excessive physical punishments from parents. These indicators mean that health or social services should be contacted.

The guidance, however, will not have any legal clout when it comes into force. 

According to Mandate Now, a pressure group campaigning for mandatory reporting legislation in the UK: ‘The current lack of legislation in England, Wales and Scotland fails staff, children and parents. The Government needs to introduce a much stronger culture of prevention on which reliance can be placed.

‘No amount of improved training or better communications on their own will make this happen, despite this mantra being repeated after each child protection failure for the last decade. Meanwhile, thousands more children have been failed as a direct result of the destructive legislative inertia that continues today.’

What should nurses do if they suspect abuse?

The DfE says: ‘professionals should refer immediately to social care when they are concerned about a child. This happens every year in many thousands of cases and numbers of referrals have increased over recent years. Other countries have tried mandatory reporting and there is no evidence to show that it is a better system for protecting children.’

Dr Glaser says that professionals should ‘think critically and err on the side of curiosity’ if there are suspicions of abuse. ‘There are far more false negatives than false positives,’ she says.

National example: Australia

Between 1958 and 2007, parliaments in all of the Australian states and territories enacted mandatory reporting laws of some description.

This means that all nurses in Australia are required by law to report suspected child abuse.

The laws, although similar in design, are not the same across all jurisdictions. Some of the Australia territories also require reports where children are being exposed to domestic violence, for example.

In some Australian states, the legislation specifies that except for sexual abuse, where all suspicions must be reported, reporting is only required where there is ‘significant’ harm to the child’s health or wellbeing such that intervention is warranted.

International mandatory reporting law

In Northern Ireland, the Criminal Law Act 1967 makes it an offence to fail to disclose an arrestable offence – including those against children – to police. Under mandatory reporting laws, people who deal frequently with children at work, including nurses, are required to inform government authorities if they have a reasonable suspicion or belief that a child has suffered physical or sexual abuse. These laws place a legal responsibility on reporting, meaning that if you do not report a case of abuse, you will have to answer to the law.

However, mandatory reporting law also provides protection for those reporting abuse. In most countries where it is implemented, the legislation protects the reporter’s identity from disclosure. It also means that as long as the report is made ‘in good faith’, the reporter cannot be liable in any civil, criminal or administrative proceeding.

The protection of ‘good faith’ may be open to interpretation. However, it is more legal protection than any professional in England, Wales or Scotland can expect if they raise suspicions of abuse.

The only protection for those who disclose abuse in the UK is the Protection of Freedoms Act of 2012 – but Mandate Now founder Tom Perry says this is not helpful. ‘It’s a well intended black-letter policy’, he says. ‘In the UK, we are pushing the deck chairs around on the Titanic.’ 

Without mandatory reporting legislation, the situation is that of ‘an unexploded bomb’, Mr Perry adds.

CASE STUDY: Tom Perry, Founder, Mandate Now

Tom Perry was 12 when his abuse began at Caldicott School in Buckinghamshire.

The principal and several teachers targeted boys on the rugby team and in the choir throughout the 1960s and 70s. It would be 30 years before Mr Perry reported the sexual abuse to the police, after telling his GP. He was the first complainant on the case, but not the last.

Mr Perry, along with two other of the main complainants, participated in the 2008 BAFTA-winning documentary, Chosen, to share their stories of survival. Following an airing on Channel 4, more victims came forward.

In 2014, the former headmaster of Caldicott School, Peter Wright, was sentenced to eight years in prison for abusing pupils between 1959 and 1970. As an independent school, where several of the staff at the time were involved in the abuse of students, there was a culture of turning a blind eye to the situation. No staff member came forward and instead it was up to the children themselves to wait until they could report the crimes to the authorities and take their abusers to court.

Mr Perry founded Mandate Now, a pressure group that advocates for mandatory reporting legislation for England, Wales and Scotland. He argues that a mandatory reporting law would make it easier for professionals to speak up without fear of judgment or reprisals. ‘The unbearable thought of abuse continuing in schools – as it does – is why I now campaign for a law that would oblige any member of staff who suspects that a child is being harmed in school to report it to an independent authority,’ Mr Perry says.

Is mandatory reporting necessary in the NHS?

Sadly, in the NHS there are examples where whistleblowers of abuse are sometimes ignored. Sir Robert Francis, the chairman of the public inquiry into the Mid Staffs scandal, held the first independent review of mistreated whistleblowers in the health service.

Helene Donnelly raised more than 100 complaints about the way patients were being treated at Stafford Hospital while she was working there as an acute nurse. She became a key witness during the Mid-Staffordshire public inquiry into reports of poor care, abuse and neglect of care at the hospital.

In her evidence, Ms Donnelly said nurses in A&E were expected to break rules as a matter of course in order to meet targets. When she raised her concerns she was met with ‘threats and bullying’ by some of her more senior colleagues. 

Eventually, she had to ask family members to come at the end of her night shifts because she was afraid to walk back to her car alone.

Ms Donnelly was awarded an OBE in 2014 for her services to the NHS, and became an ambassador for cultural change at the Staffordshire and Stoke-on-Trent Partnership NHS Trust.

She says: ‘I am frequently contacted by individuals from all over the UK who have tried to speak out at their own trusts, but find they are ignored. Far too many who hold positions of power – and who could effect change – are still dragging their feet while patients and staff continue to suffer.’

Mandatory reporting aims to reinforce the moral responsibility to disclose suspected child abuse but it can also offer protection to the whistleblowers if colleagues do not want them to report. A legal obligation can take away the need to defend reporting to those who might disagree.

What would happen if mandatory reporting were implemented in the UK?

The introduction of mandatory reporting requirements can result in a substantial increase in the number of reports being made to child protection departments. If there are inadequate resources available to the responsible departments to respond to the increased demand, then the increasing number of reports may result in services being overwhelmed with cases to investigate and will lack sufficient staff to do so. 

Therefore, it would be key for the Government to allow for adequate provision.

It is important that mandated reporters receive training and accurate information to ensure they know what cases they have to report, and what cases they should not report. Since non-mandated reporters make a large proportion of all reports, it would also be important for the public to be made aware of the appropriate extent of their responsibility.