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Dealing with FGM
Female Genital Mutilation (FGM) is not new, but awareness of it has significantly increased over the last few years. FGM comprises all procedures involving partial or total removal of the external female genitalia for non-medical reasons. Tradition is often described as the most important factor in the continuation of the practice. It is an ingrained part of certain societies which has been passed through generations and is done without question. It is perceived by those who practise it that FGM is a rite of passage ensuring the social integration of a woman in the society. However, it is illegal in England and Wales under the FGM Act 2003 and is a form of child abuse and violence against women.
FGM Act 2003
The FGM Act introduced a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 as a result of the amendments brought through the Serious Crime Act 2015 and does not cover cases discovered before this date. ‘Known’ cases are those where either a girl informs the person that an act of FGM, however described, has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation.
It is a legal duty for regulated health and social care professionals and teachers in England and Wales to make a report of FGM to the police. Complying with the duty does not breach any confidentiality requirement or other restriction on disclosure which might otherwise apply. The duty is a personal duty which requires the individual professional who becomes aware of the case to make a report; the responsibility cannot be delegated. However if another professional has already made a report there is no requirement to report it again.
For the purposes of the duty, the relevant age is the girl’s age at the time of the disclosure/identification of FGM, it does not apply where a woman aged 18 or over discloses she had FGM when she was under 18. The duty does not apply in relation to at risk or suspected cases or in cases where the woman is over 18. In these cases, you should follow local safeguarding procedures. Where there is a risk to life or likelihood of serious immediate harm, professionals should report the case immediately to police, including dialling 999 if appropriate.
- Timescale – Reports under the duty should be made as soon as possible after a case is discovered, and best practice is for reports to be made by the next working day. In order to allow for exceptional cases, a maximum timeframe of one month from when the discovery is made6 applies for making reports.
- Making a report – reports can be made by calling 101, the single non-emergency number. There is no specific process for making a written report but local police teams appear to be issuing their own Police FGM Referral Form. Upon receipt of a report, the police will record the information and initiate the multi-agency response, in line with local safeguarding arrangements. The Practice’s designated safeguarding lead should kept updated.
- Informing the patient’s family – in line with safeguarding best practice, the girl and/or her parents or guardians should be contacted as appropriate to explain the report, why it is being made, and what it means. Wherever possible, this discussion should be undertaken in advance of, or in parallel to the report being made. Advice and support on how to talk to girls and parents or guardians about FGM is available in the multi-agency guidance on FGM – see link below. However, it is believed that telling the child and/or parents about the report may result in a risk of serious harm to the child or anyone else, or of the family fleeing the country, it should not be discussed. If there are any concerns, these should be discussed with the local safeguarding team.
Who the duty applies to
The duty applies to all regulated health and social care professionals and teachers in England and Wales including:
- Health and social care professionals registered with any of the regulatory bodies within the remit of the Professional Standards Authority for Health and Social Care, with the exception of the Pharmaceutical Society of Northern Ireland;
- Teachers in England and Wales. This includes qualified teachers or persons who are employed or engaged to carry out teaching work in schools and other institutions, and, in Wales, education practitioners regulated by the Education Workforce Council; and
- Social care workers in Wales (i.e. those registered with the Care Council for Wales).
The FGM mandatory reporting duty applies in England and Wales only. The duty does not currently apply to regulated health or social care professionals working in Scotland or Northern Ireland, and they should continue to comply with existing safeguarding responsibilities.
Compiling information for a report
There are various things to consider when making a report and, if the local police service hasn’t provided a specific reporting form then whoever is reporting the case should consider the following information:
- When was the child last seen by a healthcare professional? Has FGM already been reported?
- What is the reason for the referral? e.g. informed by the patient, observation of FGM, etc.
- When was the FGM discovered or disclosed?
- Was anyone else present at the time of observation or disclosure?
- Has the child’s family been made aware of the report to the police? Are there any concerns about this?
- Is the child happy with police involvement? If yes, are there safe contact details for the child?
- Are they known already to Children’s Services? If yes, are there details of their social worker?
- Has this also been referred to Children’s Services?
Following a report there may be a requirement to contribute to the multi-agency response or other follow up to the case which will follow the report but advice should always be sought from the local safeguarding team.
Female genital mutilation guidelines:
Alison Lowerson – QCS Expert GP Practice Manager Contributor