Consent to Medical Examinations

There have been number issues in relation to the undertaking of CP medicals and the need for consent prior to a medical taking place.

Medical professionals require informed consent from a person with Parental Responsibility or a direction from the court to examine children / young people beyond immediate treatment of life threatening emergencies.

If the role of taking consent is delegated, the person taking consent must be aware of and abide by the General Medical Council (GMC) guidance. The principles of this are that decisions about care should be made in partnership based on openness, trust and good communication. The person consenting should understand the benefits, risks and burdens of consenting to or refusing to consent to the treatment. Information should be provided in a way that the person can understand and be clear that they can change their mind about a decision.

In order to perform an appropriate assessment at the time of the medical examination, the paediatrician requires information about the past medical history and development to be provided by a person who knows the child well.

The medical opinion is only a part of the assessment and should not be the main factor to decide if action is needed to protect the child. The medical assessment does not therefore usually need to take place before a decision can be made to protect the child.

If, when individual cases are discussed, there is dispute or the most appropriate course of action is unclear, a named or designated professional’s advice should be sought.

1. When a medical examination is being considered there should be a Strategy Discussion with the paediatrician on call for Child Protection being party to the Strategy Discussion between Children’s Social Care and the Police. This will include discussion about the case, timing of the medical, and background to the case, risk assessment and issues around consent. For older children a planned clinic appointment for the medical assessment is usually best;
   1. The social worker will contact the relevant hospital and request a medical examination. The administrator will take a contact number and contact the consultant on call for child protection who will phone the social worker back. Clinics are Monday to Friday, mostly offering appointments in the afternoon;
   2. If the community consultant is not available the acute paediatric consultant can be contacted for advice and will arrange an appropriate appointment, usually in the next available Child Protection clinic;
   3. Out of hours the social worker should discuss the need for a medical examination with the acute on call paediatrician. If safe to do so the assessment will be deferred to the next child protection clinic.
2. A person with PR should be encouraged to attend the medical examination. It is recognised that this needs risk management by Children’s Social Care. If a person with PR cannot be available in person a contact phone number should be provided for the paediatrician to talk to them over the phone to take verbal consent. Verbal consent is recognised to be adequate with a view to getting consent confirmed in writing. If interpreters are needed this will need to be arranged. The interpreter should not be a family member. Whilst older children may be able to consent for themselves it is recognised that in cases of Child Protection it may be very difficult for the young person to be able to fully understand the consequences of consenting to the examination e.g. if it may result in being looked after or criminal prosecution of a family member and therefore it is usually preferable to have joint consent with a person with PR.
   When deciding whether a child is mature enough to make decisions, people often talk about whether a child is 'Gillick competent' or whether they are Gillick competent' or whether they meet the 'Fraser guidelines''. However best practice is to have parental consent;
3. The child or young person should have a suitable person to support them in the assessment. If it is not felt in the best interests of the child for the parent to be present alternative arrangements should be made for the doctor to speak/meet with the parent to gain information and consent;
4. Where parents / person with PR cannot be found or consent is refused and the social worker and paediatrician feel a medical examination would be in the best interests of the child, legal advice should sought in order to seek a court order directing the examination. It was recognised that on occasions offering the parents a discussion with the doctor may support parents to consent to a medical assessment;
5. The purpose of the medical examination should be carefully considered when deciding on timing. It is acknowledged that a medical examination does not usually need to happen before the child/young person can be protected e.g. if an older child has made a disclosure, or has obvious injuries that a professional can see, the child can be protected by being placed away from the alleged perpetrator and a medical examination to document the injuries arranged in the next 24-48 hour period. This would allow time to have sensitive discussions with family members and also allow the child to be interviewed by Children’s Social Care and /or the Police prior to the examination as per Achieving Best Evidence.