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Chaperones in Care Homes (England) Policy

Aim and Scope of Policy

This policy shows how this care service works in partnership with health services that include GP surgeries and hospital clinical teams in implementing their respective chaperone policies, as summarised in the next section.

It is needed because there could be occasions when a medical practitioner requests that a person who uses care services as their patient should be offered a chaperone in order to carry out an examination or to provide treatment, either at their clinical premises or when making a home visit.

In some circumstances, care staff could act in agreement with the responsible medical practitioner and the consent of the person who uses services as a chaperone as defined here in the procedures that are involved.

This policy outlines their potential roles, the circumstances in which they could act as chaperones, where it would be inappropriate, what the role involves and the guidance and training required.

The policy complements that on Escorting and Supporting Staff Outside {{org_field_name}}. It also relates to the policy on Intimate Personal Care and Contact which could require similar safeguards to those for which a chaperone policy is designed.

Background to the Chaperone Role

A “chaperone” is someone who acts as a guide and protector to another person, who is considered to be vulnerable in certain situations. Chaperoning has been introduced in healthcare practice to provide guidance, support and protection to patients who are vulnerable because of needing to undergo examination or procedures of the more intimate parts of their body, which is potentially distressing and embarrassing.

The purpose of having a chaperone present at an examination is twofold.

1. To provide reassurance to the patient that they are being treated correctly and professionally in line with expected standards of practice.
2. To provide reassurance to the health professional carrying out the examination or procedure that their actions are not being misinterpreted or misunderstood as unprofessional or even abusive.

By observing, and where appropriate helping with the procedure, the chaperone should help to achieve both aims.

A medical practitioner will offer a patient a chaperone when it proposes on clinical grounds any of the following:

• an examination of the breasts, genitalia or rectum, or procedure in relation to any of these more intimate parts of the body
• an examination under conditions where the patient might have difficulty in following what is being done to them, for example, when they involve dimmed lighting
• an intimate body examination conducted remotely by video as part of a virtual consultation.

Some medical practitioners could suggest a person is offered a chaperone in any examination or procedure, which the person might find distressing or in which they also might feel vulnerable to possible allegations of misconduct.

A chaperone is also helpful under particular circumstances, for example, where:

• the patient lacks or might lack mental capacity to understand or give their consent to the examination or treatment and the associated procedures
• the patient’s reactions to the examination or procedure might be unpredictable or challenging
• the patient expresses strong fears and anxieties about their treatment
• the patient has a known history of abuse or ill treatment
• the patient has a history of making complaints and allegations about their treatment
• the medical practitioner is uncomfortable or reluctant to carry out the examination or procedure without the presence of a chaperone.

Medical practices usually draw on one of two types of chaperone.

1. Formal chaperones.
2. These are usually other healthcare professionals or workers who have received training in the role, and who in addition to witnessing and supporting the patient can help the examining practitioner with the examination or procedure if required.
3. They might also help with the person to dress and undress and help the person to carry out these tasks in dignified ways and to support the person emotionally.
4. Care home staff would not usually be expected to be formal chaperones in the strictest sense without being appropriately qualified and trained, except possibly in nursing homes, which employ healthcare staff.
5. Informal chaperones.
6. These can be friends or relatives who have escorted the person to the examination, or in some situations care services staff whose role will be restricted to witnessing and supporting that person without any professional involvement in the medical procedures.
7. It is important to note that a person might not want a friend or relative to act as chaperone, or a friend or relative also might not consider it to be appropriate. Their wishes must always be respected, and alternative suitable chaperones found.

It would be acceptable for care staff to help with the personal care tasks and emotional support, which would be in line with their normal duties, and which could be combined with their main role as witness to the proceedings.

In most cases a formal chaperone will be the same sex as the patient, and, where possible and desirable, someone who shares their language, culture and religion, which will help to understand their likely anxieties, fears and areas of vulnerability.

The healthcare service should make a chaperone available regardless of where the examination is taking place. This would usually be in a medical centre such as GP practice of hospital clinic, where there is usually access to a suitable formal chaperone, but it could be in a patient’s own home or a care home, where, without special arrangements being made, the role is more likely to be carried out by an informal chaperone.

In every instance, the medical practitioner should offer the presence of a chaperone wherever they think is suitable or necessary (as described above). It is then for the patient to decide if they would want one. The GP or healthcare practitioner will record that a chaperone has been offered on the patient record. If the patient declines but the medical practitioner considers it to be unsafe to proceed without one, there will need to be some agreement about the way forward. The medical practitioner’s assessment of the risks of proceeding without a chaperone will usually prevail unless it is a medical emergency.

A health service, such as a GP practice or NHS hospital, will develop its own chaperone policy along the lines described above. It will communicate its policy to patients in appointment letters or by having prominently displayed notices in suitable formats on its premises.

The aim will always be to inform the patient of their right to a chaperone under the circumstances described in advance, though it should still be offered at the time of the planned examination or procedure if that was not possible.

It is sufficient for the patient to give their consent or to decline verbally. The responsible medical practitioner should record on the patient’s notes of having made the offer and the response.

A care home should make people aware of their right to ask for a chaperone and to expect one to be offered in those situations that fall within the scope of the policy.

Policy Statement

This policy is in line with the following Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Regulation 9: Person-centred Care — requires service providers to ensure that the care and treatment of people who use the services must be appropriate, must meet their needs and must reflect their preferences.
• Regulation 10: Dignity and Respect — requires that people who use the services must be treated with dignity and respect, including being treated in a caring and compassionate manner; personal preferences, lifestyle choices and choices relating to care and treatment of people who use the services must be respected by staff at all times.
• Regulation 11: Need for Consent — requires that care and treatment — including intimate personal care — is only provided with the consent of the relevant person.
• Regulation 13: Safeguarding from Abuse and Improper Treatment – requires that comprehensive measures should be taken to keep people who use the services always safe from harm.

The thrust of these regulations is to give the person choice and control, to enable them to receive the right care, treatment and support, have their diversity and/or disabilities considered, and always be kept safe from harm.

Accordingly, {{org_field_name}} will work with health service partners to ensure that people who use our service are being treated with respect and sensitivity when subject to intimate and other potentially distressing medical examinations and procedures, which require offering the presence of a chaperone:

• to respond to any requests or alerts from the person who uses services or medical practitioner that they might need a chaperone on specified occasions
• to identify who the chaperone should be, their role and who should be the best person to act as chaperone
• to help with any arrangements to provide a suitable chaperone as needed by individual needs
• to have staff available to act as chaperone if needed through offering suitable training and instruction
• to be clear as to which staff can act in formal or informal chaperone roles and to provide suitable training for each.

On every request for a chaperone from the medical practitioner or agreement that one should be available, {{org_field_name}} will try to meet fully the individual’s preferences so that they are given optimum support.

It will co-operate with the medical practitioner over any decisions that must be taken under mental capacity law and follow all required assessment and decision-making procedures.

{{org_field_name}} will actively help the medical practitioner form their knowledge and understanding of the individual to address any cultural or religious issues that might hinder the person from consenting to the examination, and to overcome any communication or language barriers. These might also be factors in identifying a suitable person to act as chaperone.

All care staff who might be involved as chaperones will have had enhanced DBS checks.

{{org_field_name}} will keep records of the medical situations requiring care staff to act as chaperones and will monitor and review the arrangements to check that they are working effectively as planned.

Procedures

Care staff could be a chaperone to a person who uses services either when supporting a person at a medical appointment outside of the home at the GP surgery or hospital, or when a GP or other medical practitioner visits the person at the home. There are different implications for the role of chaperone under these different circumstances.

a) Medical visits to {{org_field_name}}

1. When a GP/other medical practitioner plans to visit their patient at {{org_field_name}}, we will check if the nature of their visit will require:
   a. the person being asked if they would like a chaperone
   b. finding out in what capacity a chaperone might be needed
   c. a care home staff member/some other person acting as a chaperone.
2. If a care staff member is required as chaperone, we will:
   a. find and choose a suitable person, ie who:
   1) is known to the person
   2) has been involved in their personal care
   3) has the person’s trust and confidence
   4) can communicate well with the person
   5) matches the person’s preferences in terms of sex and, where relevant, cultural and ethnic background and religion
   b. check that they are suitable to act in this role and know what is expected particularly in respect of maintaining patient confidentiality
   c. check that they are available at the time required.
3. Record their involvement (taking into account the need to respect patient confidentiality).

b) Escorting people who use the services to appointments outside the home

1. We will check if the clinical setting where the person is being examined or treated, eg GP surgery/outpatients appointment could require an escorting staff member to act as chaperone, taking into account that it might have its own chaperone arrangements.
2. If it is agreed that {{org_field_name}} staff member should act as chaperone as their escort, it will identify a suitably competent person and brief them in what they should expect.
3. We will ask the care staff member to provide a record of the event.

In the event of a care staff member as chaperone being concerned at the treatment of the person using the service, we will expect them to report their concerns so that {{org_field_name}} can take the appropriate action, which could involve, depending on the nature of the concern:

• discussing the matter with the responsible medical practitioner
• making a complaint to the healthcare provider’s management
• registering a concern with the Care Quality Commission
• registering a concern with the relevant professional body
• raising a safeguarding alert with the local authority.

Training

In order to carry out the chaperone role as defined and discussed in this policy we will expect our staff who act as chaperones to understand:

• what is meant by the term “chaperone”
• the circumstances under which a medical practitioner could consider that their patient might need a chaperone
• why chaperones need to be present
• their duties and specific tasks as chaperone
• how they can support the person who uses services physically and emotionally during the examination or procedure
• how they should support the person to exercise their rights to be treated with respect and dignity
• the importance of the person needing to consent to everything taking place
• the importance of maintaining confidentiality and the circumstances under which information can be shared
• how to record the occasion
• how to report and raise any concerns.

Care home staff who are sufficiently basically qualified to act as formal chaperones will be expected to complete a full CPD accredited training module.

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