Debbie Ganguli considers provisions for dealing with cases of child neglect and abuse.
Debbie’s child neglect and abuse practice protocols
- Ensure that all the team understand and have signed up to practice policies regarding safeguarding, including confidentiality, consent and safeguarding itself
- Have regular updates of these policies at staff meetings and encourage an ethos that allows team members to discuss concerns with one and other
- As a policy, any child that has raised a concern within our practice is discussed with me or referred to me as the safeguarding lead. Similarly, if I have seen a child that has raised concern, I will often look to my associates for a second opinion without alerting the parent (as my thoughts could be nothing of importance) – it is always better to share information rather than try to deal with things alone
- We encourage all our children to see the therapist and also the OHE. In the case of the child raising concern, multiple contacts with team members allows for greater opportunity to assess a child and the care givers, helping us to formulate a better picture
- Where necessary I will liaise with GP, health visitor and even head teachers to get a better picture of a child’s health and social well being
- Reducing the recall interval helps to monitor a child more closely
- The team do not jump to conclusions, however we also do not waste time if there is a genuine concern and the details of our safeguarding board are close to hand.
We should also be confident that in the face of true neglect, or worse abuse, we are able to recognise it and act on it.
As I am sure that we are all aware, following a catalogue of errors including Shipman and Stafford, those of us who still work within the NHS are supposed to be in a new culture where whistleblowing is actively encouraged (BBC, 2015; NHS England, 2015). However, those of us who regularly read ‘MD’ in Private Eye might be a little bit more unsure as to how supportive this new beginning really is. And, this article is as relevant to purely private colleagues as I am talking about whistleblowing in the case of parental neglect.
Management of children’s care
It started me thinking: where do we draw the line in dentistry? When does a lack of care become neglect, or worse, downright abuse? How comfortable are we in involving the police or social services? Do we call them in too early and appear to be busybodies? Or do we (as I suspect many do), leave it too late and put children at risk? Is the fact that a child has never seen a dentist in 10 years neglect, or just a lack of understanding by parents/guardians of the importance of regular dental health checks as part of a child’s health and well being? Is an inherent fear of all things dental a good enough excuse for parents to avoid bringing their child?
How do we objectively measure this on some kind of scale so that all face a level playing field? I think that we also need to be aware of our own prejudices and expectations of the world too.
We have all come across cases where although we are involved in a conversation with a parent regarding the dental health of their little one, we feel as though we are either not being heard or just not understood. Time and time again we see children who we have treated to dental fitness to only have them return six months later with a recurrence of dental disease, despite numerous attempts to educate and prevent disease. Some people just don’t place the importance on dental healthcare that we do, whilst many do not see the connection and importance of dental healthcare with general healthcare.
Then there are the parents who do not have the time to bring their offspring to the dentist due to work or other commitments – children end up attending with grandparents, who unfortunately are unable to consent to treatments, thus delaying the provision of essential care; yet the same parents do have time to take the dog to the vet?
I am painting a somewhat grim picture of parents and as a parent and practice owner I do not apologise; I too am guilty of putting work first in many instances, but does that make me neglectful?
Guidance and protocols
I think as clinicians we have to be very careful before pointing the finger, and observe cases on a case-by-case basis making sure that if we have concerns we monitor them, and even liaise with other professionals before jumping to make that call that could potentially change a family’s life for ever. We should also be confident that in the face of true neglect, or worse abuse, we are able to recognise it and act on it.
Each practice will have their own set of guidelines and protocols when dealing with children and the possibility of neglect or abuse – I have included those I have set for our practice as an example. I think that we have to start with a clear set of guidelines that we stick to, and treat each case individually.
This is just the way I have chosen to train our team to approach safeguarding of children; it may not work for all practices. I hope that this is helpful in some way and I would be very interested to hear how others approach this very important area of practice management and the care of children in a time where safeguarding is as it should be – at the forefront of healthcare.
Dr Debbie Ganguli BDS (Lon) MFDS RCS Eng is the principal of Cherry Trees Dental Practice in Leighton Buzzard. The practice won ‘Best Community Project’ at the 2013 Private Dentistry Awards, and ‘Best Children’s Dental Health Initiative’ at the same awards in 2014.
The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of any agency of the NHS, Department of Health or other public body. If you have any specific questions for Debbie, you are more than welcome to send them to firstname.lastname@example.org.