Occupational health professionals have a part to play in safeguarding children and vulnerable adults, but this is a sensitive and difficult area of practice. Sarah Silcox investigates.
Employees in public-facing roles may disclose a health issue to an OH professional that raises concerns about their ability to work safely with children and vulnerable adults. A working parent may disclose significant mental health problems to the OH team that could mean their children are at risk. Recent guidance from the Faculty of Occupational Medicine seeks to describe the role of OH in safeguarding, and how organisations can ensure that training and confidentiality concerns are addressed.
Recent prosecutions in historic child sex abuse cases, together with various investigations into the activities of Jimmy Savile and others, have placed employers’ safeguarding policies and practices centre stage. All organisations, but particularly those operating in sectors such as health, social care and the law, are re-examining safeguarding procedures.
New guidance published jointly by the FOM and the Royal College of Paediatrics and Child Health (RCPCH) (FOM and RCPCH, 2014) suggests that OH professionals should also consider their potential role in safeguarding.
OH role in child protection
The FOM’s guidance is aimed at OH professionals who have “child” clients, that is, 16- and 17-year-old employees, or adult employee clients who give rise to a concern about a child, either as a result of something they say during a session with an OH professional, or from their physical or emotional health status.
It sets out the circumstances in which an OH professional may have to consider a safeguarding issue, namely:
- The professional believes that there is a significant risk that an employee might harm a child not connected with the organisation and its work: for example, they state that a child is at risk. In most of these cases, the guidance suggests, there is time to reflect on the situation. In other circumstances, the employee may have a health condition that makes it difficult for them to look after their own children, or they disclose domestic abuse and the affect it is having on their children.
- The professional believes that the employee is a risk to children that they encounter during the course of their work: most organisations should have safeguarding procedures for all employees – and others involved with the organisation such as OH – to follow if they have concerns about a colleague working with children. The OH professional in this position should involve the employer’s HR function but also the local authority designated officer (LADO), who has a specific responsibility to investigate such concerns.
- An employee discloses historic abuse: the guidance argues that in the case of a disclosure of historic abuse, an employee should be encouraged to tell the police. If they decline, and the OH team believes the likely perpetrator could still be harming others, the professional should seek advice on whether or not to report it despite the client’s lack of consent.
- The OH professional supports the mental health of an employee working in the complex and sometimes distressing arena of safeguarding, for example, within the NHS, social care or local government: this is a very sensitive and contentious area and OH professionals need to recognise the stressful nature of this work and ensure appropriate support and counselling is available to those directly engaged in the field.
Consent and confidentiality
The guidance for OH professionals states that the normal rules for OH professionals on gaining client consent and client confidentiality should be applied particularly carefully when child protection concerns are present. For example, an exception to the normal rules around the provision of sensitive medical or personal information to line managers might apply if there is an overriding concern about the safety of vulnerable children.
Lynne Whitmore, an OH adviser working in education, says that child protection is “a very sensitive and difficult area” for OH professionals: “OH has a difficult dilemma around reporting issues, as the protection of confidentiality is entrenched in us. We need to be very careful not to try and be safeguarding experts, or to second guess cases; it is important that guidelines and policies set out where to go for specialist advice,” she adds.
Most organisations with an OH department will have their own policies on safeguarding children if relevant, and the onus is on the OH professional to check these to determine the protocol for raising concerns. The FOM guidelines suggest that OH professionals should only consider referring a case to local social services after they have sought advice from a senior OH colleague. Health providers and other organisations working in this area will have a named individual (usually a doctor or nurse in the case of an NHS employer) with responsibility for safeguarding. However, many other employers will not have an internal designated person so should get advice from the LADO.
Disclosure without consent
If an OH professional has concerns about an employee, they should make an initial, anonymous risk assessment after gaining the client’s consent, the FOM guidance recommends. After this initial assessment, the OH team may decide to make a formal referral to external social services, for example, because they judge that the employee’s family needs support. In these circumstances, consent is required. However, if there is a child protection issue, professionals should be prepared to refer without consent, but must always be clear about the justification for doing so.
Disclosing sensitive information on a client to a third party because of child protection concerns should be a rare occurrence, the guidance argues, and OH professionals taking this course should get advice from child protection experts. They should also inform the employee what information is being passed on, to whom and for what purpose, and should also outline the likely consequences.
All the documentation in such cases must be thorough and defensible. For example, if consent to refer is refused, the reasons for overriding the client’s wishes must be justified. Of course, if the professional considers that an employee is a risk to the life of a child, or that a child might be at risk of immediate harm, they must take action straight away.
Protecting psychological health
OH also has a role in protecting the health of employees working directly in the often distressing field of child protection, for example, police officers, social workers and NHS staff. The provision of support services, from OH or through an employee assistance programme, can ensure that individuals at risk of psychological harm and distress as a result of their work are helped to manage and mitigate this risk.
NHS Employers, the body representing health service organisations, believes that the Savile media coverage and other cases will “no doubt affect many members of staff, directly and indirectly”, and encourages employers to consider alerting “OH, psychological support and employee assistance programmes providers that some staff may seek to access support”. It also provides information in a number of allied areas, including employment check standards, the alert notice system, the disclosure and barring service and whistleblowing policies.
Occupational health and vicarious liability
Can the fact that an employer provides such support to employees working in child protection ever be a defence against a claim for personal injury by an employee? One group of people potentially exposed to secondary trauma as a result of working with victims of child abuse are lawyers. According to Lee Moore, a barrister working in the field, “several personal injury solicitors have already sought counselling and therapy as a result of working on these type of cases”.
Peter Garsden, president of the Association of Child Abuse Lawyers and a partner at family law firm Abney Garsden, is very aware of the potential impact of working in the safeguarding field on professionals’ mental health: “Listening to our clients means our staff absorb a lot of negative energy, which needs to have an outlet, and we provide access to free counselling through our firm.”
The fact that an employer provides access to OH and has other provisions to protect an employee’s mental health could show that it has behaved reasonably in the face of a risk arising from working in the safeguarding area, he suggests.
Historic child abuse
Bringing criminal charges in a case of historic abuse is difficult. For example, the alleged abuser may have died some time ago or witnesses have forgotten key pieces of information. This means victims often turn to the civil courts, suing the organisations that employed the alleged abuser.
These civil cases can revolve around a failure in the employer’s duty of care, for example, the organisation working with children did not have adequate safeguarding measures in place or was aware that an individual working within it posed a risk. The other main type of civil claim involves vicarious liability; an organisation is held to be vicariously liable for an abuser’s actions without playing a direct part in the abuse, or even being their employer. Gudrun Limbrick, a social researcher specialising in former children’s homes, believes both of these civil law concepts will be tested further.
All of the child abuse cases handled by Garsden’s firm involve personal injury against an organisation for vicarious liability: “Usually this means the client has told someone in the organisation they are being abused, and this is not acted on, resulting in a failure by the organisation to prevent an employee abusing. The fact that the organisation may have an OH service, an employee assistance programme or various safeguarding and whistleblowing policies is no defence in these circumstances,”
Faculty of Occupational Medicine, Royal College of Paediatrics and Child Health (2014). Safeguarding children – guidelines for occupational health professionals