College responds to consultation on child safeguarding

Q 5: Is the range of ‘mandated reporters’ set out by the recommendation (people working in regulated activity with children under the Safeguarding and Vulnerable Groups Act 2006, people in positions of trust as defined by the Sexual Offences Act 2003 and police officers):

• Appropriate
• Too narrow
• Too broad
• Don’t know

Please provide details to explain your response:

Safeguarding children, young people and vulnerable adults is an overriding professional duty for all registered optical practitioners and practices in the same way as for other health and social care practitioners and providers.

Introducing a legal duty requiring regulated healthcare professionals such as optometrists to report child sexual abuse would be a duplication of measures that are already in place in the optical sector.

As the regulator for the optical professions in the UK, the General Optical Council (GOC) is setting standards that optometrists and dispensing opticians, optical students and optical businesses must meet to remain on the GOC registers and continue to practice in the UK:

- “Protecting and safeguarding patients, colleagues and others from harm” is one of the standards of practice that optometrists and dispensing opticians must meet as optical professionals. These standards of practice are those against which optometrists and dispensing opticians will be judged in any GOC Fitness to Practice hearing.

- “Protecting and safeguarding patients, colleagues and others from harm” is also one of the standards that all registered student optometrists and student dispensing opticians must comply with whilst training as optical professionals. Failure to follow these standards as students, may affect their ability to register with the GOC and practise as an optical professional when they qualify. In serious cases they may also be removed from their training course. As for qualified optometrists and dispensing opticians, if someone raises concerns about a student fitness to train, the GOC will refer to these standards when deciding if they need to take any action.

- The GOC sets out the standards that registered optical businesses must meet. As healthcare providers, optical businesses have a responsibility to ensure the care and safety of patients and the public and to uphold professional standards, including legal and professional responsibilities to safeguard patients from abuse and ensures that they and their staff are prepared and supported to do so. These standards are those against which optical businesses will be judged in any GOC Fitness to Practice hearing.

In addition, organisations in the eye-care sector (Optical Confederation) have published guidance on safeguarding children and vulnerable adults in 2014 (and updated in 2017 and August 2019). The guidance provides a simple five step guide to help optical practitioners to remain vigilant, and to be able to recognise and report abuse. Practitioners are also advised to refer cases of suspected neglect by family members or carers, and to prevent, detect and refer suspected abuse or neglect by an optical practitioner.

The College of Optometrists, as the professional body for optometry, provides guidance on safeguarding children and adults at risk in its Guidance for Professional Practice which sets out what is expected of optometrists. We recommend optometrists to follow the Optical Confederation guidance. The College also publishes Clinical Management Guidelines that recommend the need to assess for potential child sexual abuse when the aetiology and pre-disposing factors are associated with sexual activity.

Finally, The College of Optometrists offers free online safeguarding children training that must be completed before pre-registration trainees can register with National Health Boards or the National Performers List (England). National performers lists provide an extra layer of reassurance for the public that optometrists practising in the NHS are suitably qualified, have up to date training, and have passed other relevant checks such as with the Disclosure and Barring Service and the NHS Litigation Authority.

Accessible mandatory online training module on safeguarding children has also been developed for qualified optometrist and dispensing opticians by the Directorate of Optometric Continuing Education and Training (DOCET). Practitioners are required to repeat this mandatory training on safeguarding on a regular cycle.

Optical professionals already fully understand the need to act in the interests of children. We believe that the introduction of a mandatory reporting duty will not improve the quality of practitioners’ judgement about whether what they are seeing is abuse or neglect, and how best to respond, and will not improve compliance among our professions who already act to protect.

Q 6: At what level should mandatory reporting apply?

• Only at an individual level
• Only at an organisational level (bodies, institutions or groups)
• Both individual and organisational level
• General duty on adult population
• Don’t know

Q 7: [If you selected ‘Only at an organisational level (bodies, institutions or groups) / Both individual and organisational level’ in response to Q6]

Which organisations or groups should it apply to?

It should apply to all optical businesses who are registered with the General Optical Council (GOC) and their representatives, such as practice owners, managers, employers, directors, or responsible officers of an optical business (whether they are a registered optometrist or not). This will ensure that non-registered representatives of the business are equipped to support registrants and have due process in place at an organisational level.

However, only bodies corporate using the protected terms ophthalmic optician, optician, dispensing optician and optometrist must register their business with the GOC by law. This duty should therefore also apply to all optical businesses carrying out restricted functions (‘restricted functions’ are those under Part IV of the Opticians Act 1989 – testing of sight, fitting of contact lenses and sale and supply of optical appliances) and for which business registration is not mandatory.

This would ensure a consistent approach of safeguarding duties across the profession and would enable businesses to assist, encourage and support their staff to comply with these duties as individuals.

Businesses have a part to play in facilitating their employees’ abilities to meet their own duties. Both individuals and businesses need to work together to effectively safeguard children at risk.

However, this should not result in double reporting which could lead to confusion. If a member of staff has reported abuse, the employer should not have to do so and vice versa. If mandatory reporting is to be introduced, this should be made clear in any guidance or regulation from the Home Office.

Q 8: If there was a mandatory reporting duty at an organisational level, should those impacted be required to report on their activity annually?

• Yes
• No
• Don’t know

Q 9: [If you selected ‘Yes’ in response to Q8] What form should that reporting take?

N/A.

Q 10: Should a mandatory duty to report go beyond the scope recommended by the Inquiry and cover other/all types of abuse and neglect?

• Yes
• No
• Don’t know

Q 11: [If you selected ‘Yes’ in response to Q10] Which types of abuse and/or neglect do you think should be covered?

N/A.

Q 12: What impacts (positive or negative) do you think a mandatory reporting duty would have on: (Please type your response in the space beneath each subheading)

- Children choosing to make a disclosure, either partially or in full:

Positive impact: children choosing to make a disclosure would have the reassurance that they are carefully listened to, their disclosure taken seriously and that their case would be swiftly, appropriately and effectively progressed.

Negative impact: The Implementation of a mandatory reporting duty may lead to an increased number of cases being reported. This may introduce delay and result in less consideration of the most appropriate cases by these agencies, to the detriment of children.

- Individuals within scope of the duty reporting known / suspected incidents:

Positive impact: These individuals would have a clearer understanding of what is expected from them, although there is currently a good culture in optometry of registrants contacting local safeguarding leads for advice on whether subtle concerns merit reporting. However, they should also be given the reassurance that they will be provided with the appropriate support to act and that their reporting will be appropriately managed, and the case progressed by the relevant local authority children’s social care.

Negative impact: This duty relates to a very sensitive and distressing topic for everyone that could lead to intensely stressful and emotional situations. Optometrists are already experiencing increasing pressure due to a heavy workload requirement, and they may fear missing out potential signs of abuse which could have dramatic consequences for children. The introduction of a bespoke criminal offence would add to this pressure and may lead to an over-reporting of cases. This over-reporting may create a backlog of cases and may result for those experiencing harm, having worse outcomes.

- Organisations within scope of the duty reporting known / suspected incidents:

Same as above.

- Individuals outside the scope of the duty reporting known / suspected incidents:

Negative impact: These individuals may assume that they do not have the right skills and experience to make judgments in this area, and that reporting should only be made by trained safeguarding practitioners.

- Organisations outside the scope of the duty reporting known / suspected incidents:

Same as above.

- Agencies in the wider safeguarding system that are required to respond to reports of abuse:

Negative impact: The Implementation of a mandatory reporting duty will lead to an increased number of cases being reporting. This may result in less consideration of the most appropriate cases by these agencies.

- Members of the public:

Positive impact: The public would have the reassurance that children will be better protected and that safeguarding children at risk would continue to be an overriding duty for all healthcare professionals.

Negative impact: Members of the public may assume that they do not have the right skills and experience to make judgments in this area, and that reporting should only be made by trained safeguarding practitioners.

Q 13: At what level of knowledge should a mandatory reporting duty apply?

• Restricted to known incidents of abuse
• Both known and suspected incidents of abuse (based on recognised indicators of abuse)

Please provide details to explain your selection:

It is equally important to stop incidents of abuse and to prevent potential abuse to occur.

Q 14: What should be considered a ‘disclosure’ of abuse?

Children may disclose abuse in a variety of ways, including:

• Directly – making specific verbal statements about what’s happened to them.
• Indirectly – making ambiguous verbal statements which suggest something is wrong.
• Behaviourally – displaying behaviour that signals something is wrong (this may or may not be deliberate).
• Non-verbally – writing letters, drawing pictures or trying to communicate in other ways.
• Children may also make partial disclosures of abuse by giving some details about what they have experienced, but not the whole picture.

All of the above should be considered as a ‘disclosure’ of abuse.

Registered optical professionals are trained to spot these, and they are additionally trained on when it is necessary to break patient confidentiality to act in a child’s best interests.

Q 15: The Inquiry calls for ‘recognised indicators of child sexual abuse’, which are unspecified, to be set out in guidance and regularly updated – how would you rate your own personal level of confidence in spotting indicators of child sexual abuse? Indicate on a scale between 1-10 [1: low confidence, 10: fully confident]

N/A.

Q 16: How would you rate your sector’s current level of confidence in spotting indicators of child sexual abuse? Indicate on a scale between 1-10 [1: low confidence, 10: fully confident]

1 2 3 4 5 6 7 8 9 10

Please provide details to explain your response:

See our response to Q 5 above.

Q 17: What is your view on the Inquiry’s proposal that a breach of the mandatory reporting duty should constitute a criminal offence?

Strongly agree

• Agree
• Neither agree nor disagree
• Disagree
• Strongly disagree
• Don’t know

Please provide details to explain your response:

While we support the objective of the recommendation, we think that the introduction of a criminal offense is disproportionate and may be of limited value for protecting children. It could undermine effective practice by instilling risk-averse behaviour driven by the fear of sanctions, rather empowering the workforce to make the right decisions.

In addition, as mentioned in our responses to Q 5 and Q 16 above, Registered optical professionals already have very clear professional duties and guidance requiring them to act on concerns about child abuse or neglect. Optical professionals understand the need to act in the interests of children, and we believe the introduction of new sanctions would not improve compliance among the eye care sector professionals who already act to protect children.

As acknowledged by the Government in its response following its consultation on ‘Reporting and acting on child abuse and neglect’ in 2018, introducing a mandatory reporting duty would not improve outcomes for children. What would ultimately be most effective is improved information sharing, supported by better multi-agency working, better assessments, better decision making and better working with children at all stages of their engagement with the safeguarding system.

Q 18: Do you believe that any other types of sanction should apply to breaches of the mandatory reporting duty (for example professional disqualification for individuals, or regulatory action in respect of organisations)?

• Yes
• No
• Don’t know

Please provide details to explain your response:

We would recommend aligning this duty with the mandatory reporting duty which requires regulated health and social care professionals in England and Wales to report cases of Female Genital Mutilation (FGM). For health and social care professionals, failure to comply with this duty may be considered through fitness to practise proceedings by the regulator with whom the professional is registered. Regulators will use their frameworks to consider a professional’s ability currently to practise safely. The General Optical Council (GOC) can impose different types of sanctions, ranging from warning to erasure from the registers, that would be more appropriate and effective.

Q 19: What is your view on the exception to the duty described in the recommendation (to avoid capturing consensual peer relationships)?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

Don’t know

Please provide details to explain your response:

We believe that this exemption will be difficult to assess and implement. This would require a higher level of competence in applying judgements to any inter-personal relationships. If this mandatory reporting duty comes into force in the future, it should be as clear as possible and leaves no room for interpretation.

Q 20: Is this exception likely to cause any particular difficulties?

• Yes
• No
• Don’t know

Please provide details to explain your response:

See our response to Q19 above.

Q 21: Do you think there should be any other exceptions to the duty which mean sanctions should not be applied?

• Yes
• No
• Don’t know

Please provide details to explain your response:

See our response to Q19 above.

Q 22: Can you foresee any overlap or tension with your or others’ existing duties or professional requirements which may be introduced by a mandatory reporting duty?

• Yes
• No
• Don’t know

Please provide details to explain your response:

See our response to Q 5 above. This mandatory reporting duty overlaps with registered optical practitioners’ existing duties and professional requirements.

Q 23: Do you believe the introduction of a mandatory reporting duty raises any equalities considerations? For example, positive or negative impacts on groups with protected characteristics.

• Yes
• No
• Don’t know

Please provide details to explain your response:

N/A.

Q 24. What, if any, kind of protections do you think would need to be in place to ensure individuals making reports in good faith do not suffer personal detriment as a result?

When a case is misidentified, it can result in considerable upset and a breakdown of trust between the clinician and the service users and their families. Clinicians may face threats of violence, be targeted on social media or subjected to negative review campaigns. Clinicians with one or more protected characteristics may be at a greater risk of abuse following a false positive identification.

There is very little that can be done to protect against this, other that additional support by the police and a commitment by the Crown Prosecution Service to act robustly against those who threaten and abuse clinical staff.

Introducing a mandatory reporting duty will increase the number of cases being reported and increase the risk of misidentification of cases. We can therefore expect an increased risk for clinicians who may be threaten or abused by families.

Ultimately, this may exacerbate and add to the challenges faced by the optical workforce, and result in more people leaving the profession.

Q 25: Should any additional reforms should be implemented to ensure that a mandatory reporting duty successfully safeguards and protects children?

• Yes
• No
• Don’t know

Please provide details to explain your response:

As mentioned in our response to Q 5, Q 12 and Q 17, mandatory reporting will not itself improve the quality of practitioners’ judgement about whether what they are seeing is abuse or neglect, and how best to respond.

Furthermore, if a mandatory reporting duty is introduced, we must expect an increase in referrals that risks creating a ‘needle in a haystack’ effect in which it is less likely that the social care system will identify key cases. The increasing number of referrals may also result in less consideration of the most appropriate cases, to the detriment of children.

Increased funding would be required to tackle child sexual abuse better and effectively by improving information sharing, supported by better multi-agency working, better assessments, better decision making and better working with children at all stages of their engagement with the safeguarding system.

Q 26: Where should reports be made to?

• Local Authority
• Police
• Elsewhere (please specify)

Please provide details to explain your response:

Both local authorities and, for healthcare workers, the NHS have trained and nominated safeguarding officers which is where the expertise lies to approach each case with the child’s interests being paramount and to avoid putting them further at risk.

Q 27: The Inquiry recommended that “reports from suspicions or knowledge of abuse should be made as soon as practicable”. Should timescales from the point of suspicion/knowledge be defined more specifically?

• Yes
• No
• Don’t know

Please provide details to explain your response:

We agree with this inquiry recommendation as it aligns with the GOC Standards of practice for optometrists and dispensing opticians, and the Standards for optical students, requiring them to “act quickly” in order to prevent further risk of harm and to “promptly raise concerns” if patient or public safety might be at risk.

Q 28: Would your organisation need to make any changes in order to ensure the successful implementation of a mandatory reporting duty?

• Yes
• No
• Don’t know

Please provide details to explain your response:

The College of Optometrists would need to review and update its relevant guidance and training materials on safeguarding children.

Q 29: Would you as an individual need to make any changes in order to ensure the successful implementation of a mandatory reporting duty?

• Yes
• No
• Don’t know

Please provide details to explain your response:

N/A.

Q 30: Are there any concerns, including the need for additional support, that you would like to flag for your sector?

• Yes
• No
• Don’t know

Please provide details to explain your response:

N/A.

Q 31: Are there any additional considerations to ensuring that your sector’s workforce or volunteers can meet any new mandatory reporting responsibilities?

• Yes
• No
• Don’t know

Please provide details to explain your response:

N/A.

Q 32: Besides introducing mandatory reporting, are there any changes that could improve disclosures/ reporting / investigations and prosecution of child sexual abuse?

See our responses to Q 5 and Q 17.