1. Purpose
Young people have a right to confidential sexual health care, and that access protects their health. But a young person attending sexual health may also be at risk of exploitation or abuse, and the service may be the only place that risk is seen. This policy sets out how the Service provides confidential care to young people while recognising and acting on safeguarding concerns.
The Service must verify this policy against current GMC 0-18 guidance, the Fraser guidelines, and statutory safeguarding guidance before adoption.
2. Sources to verify before adoption
- GMC, 0-18 years: guidance for all doctors: https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/0-18-years
- The Fraser guidelines and Gillick competence (verify the current position)
- HM Government, Working Together to Safeguard Children: https://www.gov.uk/government/publications/working-together-to-safeguard-children--2
- BASHH / Brook, Spotting the Signs proforma for child sexual exploitation: https://www.bashh.org/
- Care Act 2014, section 42 (adults at risk): https://www.legislation.gov.uk/ukpga/2014/23/section/42
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 13 (safeguarding from abuse): https://www.legislation.gov.uk/uksi/2014/2936/regulation/13
3. Scope
This policy applies to:
- everyone under 18 who attends the Service, and adults who may be at risk
- the assessment of competence, consent and risk
- every clinician and member of staff, who all have a part in recognising and reporting concern
4. Competence and confidential care
- a young person assessed as competent to understand the advice and decision (using the Fraser guidelines for sexual health and contraception) can consent to that care and is owed the same confidentiality as an adult, subject to safeguarding
- the Service encourages a young person to involve a parent or trusted adult, but does not require it where the young person is competent and it is in their best interests
- where a young person is not competent for the decision, the Service acts in their best interests and involves those with parental responsibility as appropriate
5. Recognising risk and exploitation
Every contact with a young person includes thinking about risk. The Service uses a recognised tool (such as the Spotting the Signs proforma) and is alert to indicators of child sexual exploitation, abuse or coercion, including:
- a much older partner, or a partner in a position of power or trust
- alcohol, drugs, money or gifts linked to sex
- secrecy, control, or a partner who is not allowed to be discussed
- repeated infections, terminations or attendances
- signs of grooming, trafficking or county-lines involvement
6. Age thresholds
- a child under 13 cannot in law consent to sexual activity; any disclosure of sexual activity by a child under 13 is a safeguarding matter and is referred
- for a young person aged 13 to 15, sexual activity is assessed for signs of abuse, exploitation or coercion, and the power balance and the partner's age are considered, with referral where concern exists
- a young person aged 16 or 17 may consent to sexual activity, but the Service stays alert to exploitation, abuse of a position of trust, and the young person's vulnerability
The Service confirms the current legal thresholds against the Sexual Offences Act and statutory guidance.
7. Acting on a concern
- a safeguarding concern is shared with the Service's safeguarding lead and referred to the local authority children's social care, or to the police where a child is in immediate danger, following local procedures and timescales
- confidentiality does not prevent a safeguarding referral; the duty to protect a child or an adult at risk overrides the usual confidentiality, and the reason is recorded
- the young person is told what is being shared and why, unless doing so would increase the risk
- concerns about an adult at risk are referred under the Care Act section 42 route
8. Recording
The competence assessment, the risk assessment (including the tool used), the decisions made, and any referral and its outcome are recorded clearly. The record shows that risk was actively considered, not just that care was given.
9. Training
Everyone in the Service is trained in safeguarding children and adults to the level their role requires, in recognising exploitation, and in the referral routes, and is refreshed on the required cadence. A named safeguarding lead and deputy are in place. The Service records training and the next refresher dates.
10. Audit cadence
The Service checks, on a stated cadence, that:
- competence and risk were assessed and recorded for under-18 attendances
- the recognised exploitation tool was used and indicators acted on
- age thresholds were applied correctly, with under-13 disclosures referred
- safeguarding concerns were referred promptly under local procedures, with outcomes recorded
- staff safeguarding training and the named lead arrangements are current
The Registered Manager and the safeguarding lead review the results and record the improvement actions that follow.