16.3 Safeguarding & Duty of Candour

What Is Safeguarding?

Safeguarding means protecting a child or adult at risk from abuse or neglect, and acting to ensure their wellbeing. Every dental team member has a duty to recognise the signs of abuse and to act on them.

The legal framework:

• Children Act 1989 / 2004 — defines child protection duties; the welfare of the child is paramount ('the child's welfare shall be the court's paramount consideration').
• Working Together to Safeguard Children — multi-agency guidance.
• Care Act 2014 — defines adult safeguarding duties.
• Mental Capacity Act 2005 — best interests for those lacking capacity.

Categories of Child Abuse

(NB: Child Criminal Exploitation and child sexual exploitation are increasingly recognised separately.)

Orofacial and Dental Signs of Abuse

The dentist is uniquely placed to see signs because so much abuse affects the head and neck:

• Unexplained or repeated facial/dental injuries inconsistent with the history.
• Bruising in a non-ambulant child (a baby who does not yet cruise should not have 'cruising' bruises).
• Torn upper labial frenum in a non-ambulant infant (may indicate a smack).
• Bite marks (measure and photograph).
• Burns (including scalds, cigarette burns) to the face/oral tissues.
• Delayed seeking of care, repeated missed appointments, failure to thrive.
• Sexually transmitted oral lesions in a child (e.g. oral gonorrhoea, herpes) are highly suspicious.

Bruises on a non-mobile infant are a red flag — the rule is: 'if they don't cruise, they don't bruise.'

A Caution on Single Signs

A single sign rarely confirms abuse — but patterns, inconsistencies, and failure to engage with care must prompt concern and discussion. Document objectively (site, size, nature, history given) — never speculate.

Adults at Risk

Under the Care Act 2014, an adult at risk is someone who, because of a mental or physical disability, illness, or condition, cannot protect themselves from abuse or neglect. The ten categories of adult abuse:

• Physical, sexual, psychological/emotional, financial/material, neglect, self-neglect, organisational, discriminatory, domestic abuse, modern slavery.

Common scenarios in dentistry: an elderly patient with signs of physical neglect or unexplained injury, financial control preventing them accessing care, or a learning-disabled adult showing signs of abuse by a carer.

Duty of Candour

The duty of candour is a statutory requirement (CQC Regulation 20) on registered health providers to be open and honest with patients when things go wrong.

Notifiable Safety Incident

A notifiable safety incident is an unintended or unexpected incident that occurred during care and, in the reasonable opinion of the provider, could result in or appears to have resulted in:

• death; severe harm; moderate harm; or prolonged psychological harm.

Provider's Duty

Where a notifiable incident occurs, the provider must:

1. Inform the patient (or their representative) in person, as soon as is practicable.
2. Provide a full and honest account of what happened, to the best of the provider's knowledge.
3. Give an apology.
4. Offer support and an explanation of further actions.
5. Provide this in writing.
6. Keep a record of the discussion and actions.

The duty is statutory (a legal requirement, not optional), and is additional to the GDC's ethical duty to be honest and to apologise. An apology is not, of itself, an admission of liability: in England and Wales this is set out in section 2 of the Compensation Act 2006, and in Scotland in the Apologies (Scotland) Act 2016.

Why It Matters

Duty of candour supports patient trust, learning from error, and early resolution of complaints — and reduces litigation. It complements clinical governance and significant event analysis.

The Safeguarding Pathway

When a concern arises:

1. Stay calm and ensure the patient's immediate safety (including separating from a suspected perpetrator where appropriate — never put the patient at further risk by confronting the abuser).
2. Document objectively — what you saw, what was said, dates and times.
3. Do not promise secrecy — be honest that information may need to be shared to protect them.
4. Discuss with the practice safeguarding lead (every dental practice must have a named lead).
5. Refer through the local pathway — children's social care, adult social care, or the police (999 in an emergency). Use the local safeguarding children partnership / safeguarding adults board contacts.
6. Do not investigate alone — safeguarding is a multi-agency process; the dentist's role is to recognise and refer.

Information Sharing

The GDPR/Data Protection Act permits sharing of personal data for safeguarding without consent where there is a legitimate aim and a lawful basis — safeguarding is recognised as such. Do not wait for consent where a delay would risk harm. Document what was shared, with whom, and why.

Domestic Abuse and Modern Slavery

Dental teams may also recognise signs of domestic abuse (controlling behaviour, repeated unexplained injuries, reluctance to speak in front of a partner) and modern slavery (signs of exploitation, lack of identification, fear). Both are safeguarding matters and may require referral to the police or specialist services.