The duty to report FGM
Louise Hunt
Tuesday, March 29, 2016
Professionals working with children now have a duty to report cases of female genital mutilation (FGM). Louise Hunt investigates progress so far.
Since the mandatory duty for reporting Female Genital Mutilation (FGM) came into effect on 31 October last year, there have been tentative signs that the numbers of reports are increasing alongside applications for protection orders. But safeguarding experts say more training is needed before all professionals are confident about their new responsibilities.
Under the duty, regulated health and social care professionals and teachers in England and Wales are obliged to report to the police “known” cases of FGM in under-18s to the police – where the practitioner has observed physical signs of FGM or a victim has disclosed the abuse.
Reports must be made before the close of the next working day. Failure to do so could result in disciplinary measures and ultimately lead to professionals being barred from working. Detailed guidance on mandatory reporting was published by the Home Office in October 2015.
“The mandatory reporting duty is one of the key elements to preventing further offending and protecting future victims,” says detective chief superintendent Gerry Campbell, the FGM deputy lead at the National Police Chiefs’ Council (NPCC).
With heightened awareness as a result of the duty and an expansion last year in the collection of NHS data on FGM to include GPs and primary care (see box), he would expect to see an increase in reports of FGM and a corresponding increase in protection orders.
No central records
But, as FGM reports are currently not centrally recorded, it may be a while before data showing any increase is available.
Protection orders for FGM were introduced in July last year. These are applied for through the family courts and contain legally binding conditions and restrictions to protect the person at risk of FGM, such as confiscating passports and banning family members from making arrangements with “cutters”.
Initial data from the Ministry of Justice shows that from July to September 2015, 28 applications were made and 18 protection orders granted. The next figures will be published on 31 March, which may shed more light on the impact of the reporting duty so far.
Not all reports will lead to a protection order being granted because the intelligence from a referral may turn out to be unfounded after assessment, says Campbell. But they are an important mechanism in tackling FGM abuses and preventing harm to others at risk.
“What we’re working towards is preventing young girls from facing FGM,” says Campbell. “In the future, if we’re talking about protection orders then we’re already too late.”
However, implementing a policy to stop a deeply-rooted practice – by its nature hidden – is not without challenges.
The duty was introduced because of a lack of consistency in cases identified by practitioners and referred to safeguarding boards, says Janet Fyle, a professional policy adviser at the Royal College of Midwives, who was instrumental in developing recommendations for professional accountability that led to the duty.
“Reporting, if it happened, was very rare, and usually by people who had come across it before,” she says. “In all other areas of child abuse, professionals were working diligently to prevent it happening, but with FGM there seemed to be some barriers around political correctness and concern patients may not come back.”
Professionals were worried they would not know what to do if they uncovered cases and there was a general lack of awareness of what FGM involve. Fyle believes the duty should help overcome these issues.
“This is not about demonising a community, it’s about protecting children at risk – a safeguarding issue, not a cultural issue,” she says. “The law has taken away the difficult decisions practitioners faced over whether to report cases. Now it’s not about their judgment, they have to follow the regulation.”
But Karen Goodman, professional adviser at the British Association of Social Workers, says practitioners are still finding this aspect a struggle, along with incorporating FGM referrals into already stretched caseloads.
“Anxieties around cultural sensitivities will take time to overcome,” she says. “Yes, social care professionals can say ‘I have to do this by law’, but even so people are concerned about how mandatory reporting impacts on trust with the families they work with.”
Potential implications of a legal duty to report are also a concern for FGM prevention organisation ForwardUK.
Executive director Naana Otoo-Oyartey, says victims may be deterred from disclosing abuse now a report has to go to the police as well as safeguarding teams. “We’re concerned the duty could backfire if girls who would normally have made a disclosure are not doing so because they fear they could be putting their family in serious trouble,” she says.
Early indications from the organisation’s facilitators who work in schools and communities suggest a decrease in disclosures since the duty came in. “We’re collecting data to understand the impact – this is something we need to watch,” says Otoo-Oyartey.
Effective training for all professionals and organisations with responsibilities under the duty could help avoid such negative impacts. This should include advice on taking a measured approach to cases and ensuring good communication between families and agencies, including using interpreters if needed.
However, the duty has not come with a national strategy for training, with some professions appearing to have better access to it than others. Health professionals such as midwives and paediatricians say they have received a good level of training on FGM, whereas schools appear to be lagging behind.
“It is essential all school staff are trained in FGM awareness,” says Lisa Zimmerman, director of Integrate Bristol, which delivers youth-led training on FGM. “Many schools are still not doing this. Young people need to be able to have that conversation in schools, as they’re unlikely to speak about it at home.”
BASW’s Goodman says many social care practitioners need further training to feel confident in the complexities of FGM and how it is practised. “There needs to be multi-agency training – with teachers, social workers, police, health professionals and community groups – to ensure those difficult and sensitive issues are understood and the barriers are broken down,” she says. Local safeguarding children’s boards should be ensuring both single and multi-agency training on FGM is provided.
The National FGM Centre, which launched in March last year, aims to develop good practice and share learning through its web-based Knowledge Hub, training programme, consultancy and events.
It is a partnership between charity Barnardo’s and the Local Government Association, with funding from the Department for Education’s Children’s Social Care Innovation Fund. One of its strands of work is to develop a model for enabling social care teams to respond more effectively to FGM cases. It is doing this by placing social workers and project workers with specialist knowledge of FGM in six pilot local authorities – Norfolk, Suffolk, Essex, Hertfordshire, Thurrock and Southend.
Head of the centre Celia Jeffreys explains the pilot authorities were chosen as they are all in low FGM prevalence areas where the professional response to cases was typically weaker. In low-prevalence areas, practitioners may not have come across an FGM case before, or were not well-informed because it was not a priority issue.
“We spoke to social workers who didn’t really understand what the practice is. So how are we expecting them to be able to respond when a case comes in?” says Jeffreys, a midwife by background. “There was definitely a need to upskill and train professionals in those local authorities.”
Pilot schemes
At the pilot sites, intensive training is delivered over 1.5 days by the centre’s head of training. “We prefer it to be multi-agency to give everyone a rich understanding of how the different pathways should work together,” says Jeffreys.
“We are teaching a true understanding of what it means to work with a family with children at risk of FGM, including what the pressures might be on that family, how to risk assess the child and put together a multi-agency action plan.”
Angela Owens, a senior social work practitioner at the centre, explains expert social workers are on hand to advise children’s services teams on how best to deal with FGM cases.
“Because we’re based in the social care teams, we can check in with the risk assessor on whether they feel there is a high risk of the child being cut,” she says. “In some areas we undertake initial assessments and go out and meet families. Sometimes even if a high risk hasn’t been identified, we still go out and meet families because community engagement is a key part of tackling the traditional practices of FGM.”
At Thurrock Council, the approach is already making a difference, says Andrew Carter, head of children’s services. The area is predominantly white British, but diversity is increasing and some FGM cases had been picked up by midwives. “But before the pilot we weren’t getting a lot of these referrals through the multi-agency safeguarding hub,” he says.
Having an expert social worker within the hub is increasing the team’s level of awareness by providing a better understanding of the different degrees and forms of the practice, and the need to not only focus on women but engage with the men in families and community leaders, he adds.
“We have had the expert social worker with us for three months and since then we have identified more cases where FGM is a potential risk and are now in the process of seeking protection orders,” confirms Carter.
The local authority pilots are running for a year and the centre hopes the expert social worker approach and training will be commissioned more widely.
Multi-agency teams work with community advocates to tackle FGM in London
The Pan-London FGM Prevention Project is a year-long pilot across five London boroughs – Westminster, Kensington and Chelsea, Hammersmith & Fulham, Waltham Forest and Tower Hamlets. It is testing whether bringing together teams of specialist social workers, midwives, therapists and community health advocates can protect girls from being cut in the future.
The teams are based in FGM clinics run by hospital maternity services, but also work closely with voluntary organisations within affected communities.
“One of the most relevant risk factors in FGM is if the mother has been cut, so the social workers in the clinics look at the safeguarding aspects for existing and unborn children,” explains Debbie Raymond, head of safeguarding and quality assurance at the London Borough of Westminster. This approach was initiated in Westminster before being extended to the other boroughs as part of a wider pilot scheme on preventing harmful practices run by the Mayor’s Office for Policing and Crime (MOPAC).
Critical to the approach in Westminster has been recruiting health advocates from a Somali voluntary network called Midaye, which had already been working on improving health access for black and minority ethnic communities.
“We realise many of the women are really worried about their FGM and attending the clinic, so the health advocates help bridge that gap between statutory services and affected communities by explaining the purpose of the appointments to the women,” says Raymond. “If anything they are the real source of our success, they support women with the practicalities of attending the clinics and our ‘did-not-attend’ rates have dropped.”
So far, the approach has resulted in child protection investigations and self-disclosures. To date, 68 families across three of the boroughs have been risk- assessed, a third of whom are still under assessment. “It’s enabled us to apply statutory safeguarding measures in cases we would not previously have identified,” says Raymond.
Community engagement is a central plank of the prevention project across all the pilot sites. Community advocates alongside the statutory teams run FGM awareness sessions with boys and fathers, and events are held in schools and religious centres, which is helping to erase suspicion of statutory agencies and break down barriers, adds Raymond.
“When the women see someone from their community has a good relationship with a social worker it helps open up useful conversations,” she says. “We have learned a lot from this and developed much more confidence in dealing with FGM.”
The pilot has led to more referrals. “We have seen a big increase in referrals from partner agencies that we weren’t seeing before,” says Raymond. “I don’t believe this is down to the mandatory reporting duty, it’s having the extra capacity to talk about FGM.”
The MOPAC-supported element of the pilot ended in March, but all of the boroughs are aiming to continue the work.
FGM facts
- 60,000 girls under 15 in England and Wales were at risk of FGM, according to the most recent FGM prevalence study in 2011 – the number of girls at risk now is likely to be higher
- FGM is most commonly carried out when a girl is five- to eight-years-old
- The latest data from NHS trusts and GP practices for the three months from October to December 2015 shows there were 1,316 newly recorded cases of FGM
- In total, there were 2,238 attendances at health services where FGM was identified or a procedure for FGM carried out
- 11 newly recorded cases of FGM involved women and girls born in the UK
- 35 girls were aged under 18 at the time of their first attendance – three per cent of all newly recorded cases
Sources: City University, HM Government, Health and Social Care Information Centre