Chaperone Policy

1. Aims of Policy

• Ensure safety of patients during medical examinations
• Ensure the safety of clinicians during medical examinations
• Ensure chaperones have a full understanding of their roles and responsibilities

2. Scope

• 2.1.1 This policy applies to all healthcare professionals working within the organisation, including medical staff, nurses, health care assistants, allied health professionals, medical students, and complementary therapists working with individual patients in surgeries, clinic situations and in the patient’s home.
• 2.1.2 This guidance also covers any non-medical personnel who may be involved in providing care.

3. Introduction

• 3.1.1 This policy sets out guidance for the use of chaperones and procedures that should be in place for consultations, examinations and investigations.
• 3.1.2 This is also aimed at providing practical advice to healthcare professionals working in a variety of locations where availability of a chaperone may not always be possible.

4. When, and How, Should a Chaperone be Offered?

• 4.1.1 Information concerning the availability of chaperones is made to patient by:
  • Signs in each consulting and treatment room
  • Chaperoning information on practice website, patient information leaflet and registration pack
• 4.1.2 It will only be apparent that a chaperone will be necessary once the consultation is started. The triggers that make the offer of a chaperone necessary include:
  • when an intimate examination is deemed necessary. This offer should be accompanied by an explanation as to why the examination is required.
  • when an examination which is not intimate, but involves close proximity, physical contact or dim lighting is necessary and the clinician is concerned that a chaperone is necessary; this may be to protect him/herself, or if the patient is particularly vulnerable or at risk.
  • whether the patient and clinician are the same sex or not is not relevant; an offer of a chaperone should be made regardless. However, if the sex of both parties is the same it is likely that the clinician will less frequently consider themselves to need a chaperone present to proceed as the risk of allegation is reduced, though they must be aware it is by no means absent.

5. Who Can Be a Chaperone?

• 5.1.1 A friend or relative of the patient is an inadequate chaperone – they are neither trained nor independent; however in reality the clinician may well appropriately feel that their presence will reduce the risk of allegations, and may therefore allow an examination to proceed even if a chaperone is offered and declined; but a chaperone should still be ‘offered’.
• 5.1.2 An appropriate chaperone is otherwise any member of the Care Navigator team; all are trained appropriately and have a DBS check – both are requirements for them to be a chaperone.
• 5.1.3 The chaperone should be the same sex as the patient; otherwise the patients anxiety and risk of allegation will increase.

6. Role of the Chaperone

• 6.1.1 Their role can be considered in any of the following areas:
  • Providing emotional comfort and reassurance to patients
  • To act as an observer of the examination to protect the clinician from false allegation.
  • Empowered to alert their line manager should they feel any improper behaviour has occurred.
• 6.1.2 If the clinician requires practice assistance during the examination, for example during a coil insertion, they should request an HCA or nurse to support them, and that person would then provide both practical and physical support as well as implicitly acting as a chaperone.
• 6.1.3 In this case, they may be a differing sex from the client, but as they are providing a clinical function this is acceptable – a full explanation needs to be given to the patient and their agreement obtained.
• 6.1.4 The chaperone should introduce herself/himself to the patient giving their name and explaining that she is a member of the Practice who has received training to act as a chaperone.
• 6.1.5 The two parties should have a short conversation between themselves to ensure there is clear understanding of the role and expectations.

6.2 What is an intimate examination?

• 6.2.1 Obvious examples of an intimate examination include examinations of the breasts, genitalia and the rectum but it also extends to any examination where it is necessary to touch or be close to the patient, (for example conducting eye examinations in dimmed lighting, taking the blood pressure or palpating the apex beat).

6.3 Consultations Involving intimate examinations

If an intimate examination is required, the clinician will:

• 6.3.1 Establish there is a need for an intimate examination and discuss this with the patient
• 6.3.2 Give the patient the opportunity to ask questions
• 6.3.3 Obtain and record the patients consent
• 6.3.4 Offer a chaperone to all patients for intimate examinations (or examinations which may be construed as such). If the patient does not want a chaperone it will be recorded in the notes
• 6.3.5 Introduce the chaperone by name to the patient
• 6.3.6 Record the attendance of the chaperone (including their name) in the patients records
• 6.3.7 Allow the patient dignity to undress using curtains

6.4 Where will the chaperone stand?

• 6.4.1 The positioning of the chaperone will depend on several factors, for example the nature of the examination and whether or not the chaperone has to help the clinician with the procedure.
• 6.4.2 The clinician will explain to the patient what the chaperone will be doing and where they shall be in the room.
• 6.4.3 N.B The chaperone must always be able to properly observe the procedure so as to be a reliable witness about what happened during the examination/procedure. Should the chaperone have any concerns about anything which has happened during the examination they should raise it with the Patient Services Manager immediately

7. Recording of Chaperone Offers

• 7.1.1 Whenever the clinician feels a chaperone may be necessary, it should be offered.
• 7.1.2 Whenever the offer is made, that fact should be recorded on EMIS, together with either the fact that it was declined, or the name of the person performing the role of chaperone entered in the associated free text box.
• 7.1.3 If the offer is declined, but the clinician feels they are at risk without a chaperone being present, it is appropriate and correct them to:
  • further explain why a chaperone is necessary and re-offer one
  • refuse to proceed with the examination and ask the patient to rebook with a clinician of the same sex; this is the best possible scenario for the examination to be safely performed, but even then it may be that a same sex clinician will also feel a chaperone is necessary and again decline to proceed; these cases must be dealt with individually, but the clinician has no obligation to proceed with an action which he is uncomfortable in doing. The patient insisting it is done is not a sufficient justification to put clinicians at risk. All these decision processes and explanations must be recorded on EMIS.
• 7.1.4 The only exception to this is if there is an urgent medical need for the examination to proceed – in this scenario patient safety may and should override clinician’s assessment of their own risk.

8. Where a Chaperone is Needed But Not Available

• 8.1.1 If the patient requests a chaperone, but an appropriate one is not available, the appointment should be re-booked at a time when one is available.
• 8.1.2 The only exception is when there is urgent clinical need – this should be explained to the patient and alternate actions taken (for example referral to other specialist providers).
• 8.1.3 If the doctor wants for whatever reason a chaperone to be present, but one is not available, then again the appointment should be re-scheduled unless there is overriding medical need when each case should be taken individually (again referral to other specialist providers could be considered), or the clinician may consider the clinical need overrides his own risk to exposure.
• 8.1.4 Careful recording of all decision making processes must be made.

9. Issues of Consent

• 9.1.1 Consent may be implicit in attending a consultation – for example, a patient attending with a breast lump may reasonably be assumed to expect a breast examination. However, it is always prudent to obtain consent after explanation before all intimate examinations. Verbal consent is sufficient and must be documented in the record (for more information refer to HGH Consent Policy).
• 9.1.2 The clinician may assume that the patient is seeking treatment and therefore consenting to necessary examinations. However before proceeding with an examination, healthcare professionals should always seek to obtain, by word or gesture, some explicit indication that the patient understands the need for examination and agrees to it being carried out. Consent should always be appropriate to the treatment or investigation being carried out.
• 9.1.3 The clinician must however be aware that:
  • an assessment of capacity may occasionally be necessary to ensure consent is valid.
  • that if consent is given, either actual or implied, this is nothing to do with the offer of a chaperone. A patient may consent to an intimate examination, but still request, assume or prefer a chaperone to be present so a chaperone offer should still, always, be made.

10. Special Circumstances

• 10.1.1 If there are medico-legal reasons for the examination, for example after alleged assault, or perhaps because of abuse, the clinician should be aware that written consent may be necessary for the examination to be valid. The clinician should make appropriate enquiries first.
• 10.1.2 This will be an unusual and rare occurrence.

10.2 Issues Specific to Children

• 10.2.1 In the case of children a chaperone would normally be a parent or carer or alternatively someone known and trusted or chosen by the child.
• 10.2.2 Patients may be accompanied by another minor of the same age. For competent young adults the guidance relating to adults is applicable.
• 10.2.3 The age of Consent is 16 years, but young people have the right to confidential advice on contraception, pregnancy and abortion and it has been made clear that the law is not intended to prosecute mutually agreed sexual activity between young people of a similar age, unless it involves abuse or exploitation. However, the younger the person, the greater the concern about abuse or exploitation.
• 10.2.4 Children under 13 years old are considered of insufficient age to consent to sexual activity, and the Sexual Offences Act 2003 makes clear that sexual activity with a child under 13 is always an offence.
• 10.2.5 In situations where abuse is suspected great care and sensitivity must be used to allay fears of repeat abuse.
• 10.2.6 Healthcare professionals should refer to their local Child Protection policies for any specific issues.
• 10.2.7 Children and their parents or guardians must receive an appropriate explanation of the procedure in order to obtain their co-operation and understanding.
• 10.2.8 If a minor presents in the absence of a parent or guardian the healthcare professional must ascertain if they are capable of understanding the need for examination.
• 10.2.9 In these cases it would be advisable for consent to be secured and a formal chaperone to be present for any intimate examinations.
• 10.2.10 Further information about confidentiality, data protection and consent can be found at www.doh.gov.uk/safeguardingchildrenand Working Together to Safeguard Children (Department of Health 1999).

10.3 Issues Specific to Religion, Ethnicity or Culture

• 10.3.1 The ethnic, religious and cultural background of some women can make intimate examinations particularly difficult, for example, some patients may have strong cultural or religious beliefs that restrict being touched by others.
• 10.3.2 Patients undergoing examinations should be allowed the opportunity to limit the degree of nudity by, for example, uncovering only that part of the anatomy that requires investigation or imaging.
• 10.3.3 Wherever possible, particularly in these circumstances, a female healthcare practitioner should perform the procedure.
• 10.3.4 It would be unwise to proceed with any examination if the healthcare professional is unsure that the patient understands due to a language barrier.
• 10.3.5 If an interpreter is available, they may be able to double as an informal chaperone.
• 10.3.6 In life saving situations every effort should be made to communicate with the patient by whatever means available before proceeding with the examination.

10.4 Issues Specific to Learning Difficulties/Mental Health Problems

• 10.4.1 For patients with learning difficulties or mental health problems that affect capacity, a familiar individual such as a family member or carer may be the best chaperone.
• 10.4.2 A careful simple and sensitive explanation of the technique is vital. This patient group is a vulnerable one and issues may arise in initial physical examination, “touch” as part of therapy, verbal and other “boundary-breaking” in one to one “confidential” settings and indeed home visits.
• 10.4.3 Adult patients with learning difficulties or mental health problems who resist any intimate examination or procedure must be interpreted as refusing to give consent and the procedure must be abandoned, unless the patient has been sectioned.
• 10.4.4 In life-saving situations the healthcare professional should use professional judgement and where possible discuss with a member of the Mental Health Care Team.

10.5 Lone Working

• 10.5.1 Where a health care professional is working in a situation away from other colleagues e.g. home visit, the same principles for offering and use of chaperones should apply.
• 10.5.2 In reality it is more likely here that a relative or friend will be available – this person may well be acceptable as a chaperone to both patient and clinician.
• 10.5.3 Where it is not appropriate or available, or the clinician feels unable to proceed with a formal chaperone, the clinician may need to rebook the visit and return accompanied by, for example, a district nurse or HCA to provide chaperone role, or request the patient attend the surgery at a later date.
• 10.5.4 If there is an overriding medical need and urgency, then this should take priority, or may cause the clinician to consider an alternative such as a referral to another specialist health provider.
• 10.5.5 Health care professionals should note that they are at a significantly increased risk of their actions being misconstrued or misrepresented if they conduct intimate examinations where no other person is present, especially in the patient’s home.
• 10.5.6 The clinician has every right, except in cases of dire emergency, to protect themselves from such risk.

11. Communication & Record Keeping

• 11.1.1 Details of the examination including presence/absence of chaperone and information given must be documented in the patient’s medical records.
• 11.1.2 If the patient expresses any doubts or reservations about the procedure and the healthcare professional feels the need to reassure them before continuing then it would be good practice to record this in the patient’s notes.
• 11.1.3 The records should make clear from the history that an examination was necessary.

12. The Rights of the Patient

12.1 Patient Entitlement

• 12.1.1 All patients are entitled to have a chaperone present for any consultation, examination or procedure where they feel one is required.
• 12.1.2 Patients have the right to decline the offer of a chaperone. However the clinician may feel that it would be wise to have a chaperone present for their mutual protection for example, an intimate examination on a young adult of the opposite gender.
• 12.1.3 If the patient still declines the doctor will need to decide whether or not they are happy to proceed in the absence of a chaperone.
• 12.1.4 This will be a decision based on both clinical need and the requirement for protection against any allegations of improper conduct.

12.2 What if the patient does not want a chaperone?

• 12.2.1 If the patient declines a chaperone and as a clinician it is felt that one is needed, explain to the patient that a chaperone is preferred and continue to arrange a chaperone to be present.
• 12.2.2 If the patient continues to decline a chaperone, consider transferring their care to an available colleague who would be willing to examine them without a chaperone.
• 12.2.3 Ultimately, the patient’s clinical needs must take precedence, and such arrangements must not cause a delay that would adversely affect the patient’s health.
• 12.2.4 The fact that the patient declined a chaperone must be documented on their notes accordingly.

12.3 The Patient can expect the chaperone to be:

• 12.3.1 Available if requested
• 12.3.2 Pleasant/approachable/professional in manner, able to put them at ease
• 12.3.3 Competent and safe
• 12.3.4 Clean and presentable
• 12.3.5 Confidential

13. Review

• 13.1.1 This policy is in line with current legislation at the time of writing and is subject to periodic review.
• 13.1.2 In the event of any incident linked to this policy; findings of an audit that identifies a gap or a need for a review or a change of legislation impacting on this policy, the policy will be updated and will supersede this policy.

14. Version Control

Version Number – 1.0

Key Changes – Introduced version control

Name – Andilla Jones

Position – Patient Services Manager

Date – 16/11/2021

Review date: November 2022