Every year in England thousands of children and young people are sexually abused. This includes children that have been abducted and trafficked, or beaten, threatened or bribed into having sex [1].

Child sexual exploitation is when people use the power they have over young people to sexually abuse them. Their power may result from a difference in age, gender, intellect, strength, money, or other resources.

But while police work to tackle the problem, child sexual exploitation continues to happen every day. It is important for the NHS to be able to recognise and understand what the warning signs of child sexual exploitation are.

NHS Safeguarding

Safeguarding means protecting people’s health, wellbeing, and human rights, and enabling them to live free from harm, abuse and neglect.

Kenny Gibson is National Head of Safeguarding for NHS England [2]. He believes that safeguarding in the NHS cannot move forward until there is an understanding that child sexual abuse and exploitation happens in all communities. There is no demographic that is untouched by this.

Within the NHS, designated professionals & named practitioners, national & regional safeguarding teams, national safeguarding steering groups, clinical reference groups and national safeguarding networks have the joint responsibility for safeguarding vulnerable people, young people, and children.

Safeguarding in 2020

The safeguarding challenges of 2020 were unique. People’s homes turned into pressure cookers and Covid-19 escalated the risks of child sexual exploitation and abuse in the home.

Abusers both online and offline target children of all ages, socio-economic backgrounds, genders, and abilities. The increased use of technology has provided offenders with new exploitative means, giving them direct access to the home environments of children worldwide. At the same time, offenders from all walks of life continue to target the children in their vicinity.

Professionals in the NHS saw safeguarding issues in 2020 that challenged social norms, that instances of child sexual exploitation were not treated as seriously as they should have been.

Out of 1.6 million staff in the NHS, many find it difficult to ask the uncomfortable questions surrounding child exploitation and abuse. There is not a common language around child abuse, and this is where the NHS has to learn from partners in policing and peer-advocacy services to have better conversations with victims and their family.

Legislation

In August 2020, the Prime Minister laid out a new set of priorities for the NHS to follow when forming improved safeguarding strategies:

  • Preventing domestic abuse
  • Preventing perpetrators of child sexual abuse
  • Tackling serious violence

It is critical that NHS staff know the right questions to ask and have the ability to challenge their own unconscious biases. Through this, they can support families and give them the knowledge to know what to do if child exploitation happens in their home.

Additionally, The Government’s Serious Violence Strategy, published in April 2018 [3] represents a step-change in the way the NHS thinks and responds to serious violence, establishing a new balance between prevention and law enforcement.

The strategy was published in response to increases in knife crime, gun crime and homicide across England. Since then there has been an eagerness to understand what has been done elsewhere to reduce violence in the community.

Child Protection Information System (CPIS)

Local authorities have informed the NHS that looked-after children are some of the most at risk of becoming victims of sexual exploitation and abuse.

The Child Protection Information System holds records of all children in care, logging any hospital admissions or alerts.

The system works across England and facilitates information sharing between the local authority and health services. It identifies and safeguards unborn babies and children attending unscheduled healthcare settings who are subject to a local authority Child Protection Plan.

How the system works:

  1. Basic information on the child recorded in social care systems is extracted to the NHS Spine
  2. When a child visits an unscheduled care setting, healthcare teams are alerted
  3. Healthcare teams can see contact information for the child’s social care team as well as details of the child’s last 25 visits to unscheduled care settings
  4. The social care team is automatically notified that the child has visited an unscheduled care setting and can see details of their last 25 visits to unscheduled care settings

Safeguarding Lookouts

There are certain forms of child abuse that NHS staff are consistently being trained on how to recognise. These include:

  • Female Genital Mutilation (FGM): All staff have a duty to report FGM, while ensuring that they empower and support victims. FGM should be addressed as part of wider violence against women & girls safeguarding strategies.
  • Children and County Lines: Children are being exploited by gangs in drug crimes through coercive control. The NHS should engage in conversations with the police so that language surrounding county lines can be recognised when children who are being exploited are in NHS care.

Aspirations for the Future

Kenny discussed the NHS’ goals for minimising child sexual exploitation. An aim is to train every member of staff in trauma-informed practice to strengthen the dialogue between staff and patients.

A trauma-informed conversation would involve asking the child or the family what is their journey, rather than asking what is wrong medically. Beginning to ask children and young people about their lived experience opens conversations that can inform staff of warning signs in future victims.

This information should be recorded in a contextual safeguarding database that is inclusive of information on survivors, perpetrators, and offenders.

Kenny concluded that the NHS can only effectively safeguard all children and young people from exploitation and abuse when all staff are trained in appropriate contextual safeguarding that promotes a lived experience narrative.

[1] NHS. How to Spot Child Sexual Exploitation

[2] Gibson, Kenny. National Head of Safeguarding, NHS England

[3] GOV. 2018. The Government’s Serious Violence Strategy

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Effective safeguarding arrangements seek to prevent and protect individuals from harm or abuse, regardless of their circumstances. This article discusses the NHS’ perspective on safeguarding child victims of sexual exploitation and abuse.

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