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Guidance on reporting under age sex is confusing
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     The BMA is reporting a surge in telephone calls from doctors who are confused about new guidance that compels health professionals to report evidence of under age sexual activity to social workers and the police. Doctors are concerned that new guidance, already in use in some areas, does away with a child抯 right to confidential sexual health advice and could lead to an increase in under age pregnancies and sexually transmitted infections.

    A number of area child protection committees have issued protocols, including the London Child Protection Committee, which covers all London boroughs, and Sheffield City Council. In parallel, the government is examining proposals to change the current national child protection guidance, Working Together to Safeguard Children, and compel health professionals to report all sexual activity in under 16 year olds to social workers and police, regardless of the circumstances (BMJ 2005;331:918, 22 Oct).

    The London guidance states that all under age sexual activity in children younger than 13 must be reported: "Since the Sexual Offences Act 2003 children under the age of 13 are considered of insufficient age to give consent to sexual activity. For this reason all cases must be referred to children抯 social services and the police as a potential case of rape."

    A spokesperson for the London Child Protection Committee said that, despite publishing them on its website, the protocols were not yet formally approved.

    The BMA has said that as a result of the new guidance regarding under 13 year olds and the new proposals regarding under 16 year olds, many members had contacted them seeking further direction in dealing with their patients who are under 16.

    Current Department of Health guidance for health professionals makes clear that people younger than 16 have the same rights to confidentiality as adults. The exception is children not considered mature enough to understand what they are doing or at risk of exploitation.

    Michael Wilks, chairman of the BMA抯 ethics committee, said, "Mandatory reporting of non-abusive relationships threatens the trust that underpins the relationship between doctors and patients. This will deter young people from seeking medical care to reduce the risks of pregnancy and sexually transmitted diseases. Where there is a risk of harm, doctors need to act swiftly to ensure that young people are protected. It is vital however that health professionals have the discretion to act in the best interests of young people."

    Last week, the BMA backed a new campaign by Brook, a charity that helps teenagers, to uphold young people抯 right to confidentiality. A survey by the charity found that two thirds of young people said that they would be less likely to seek advice on sexual health if information about sexual activity could be passed on to social workers.

    The General Medical Council is also supporting Brook抯 campaign. The head of standards and ethics, Jane O払rien, said, "Of course we accept that confidentiality is not an absolute, and circumstances can arise where information must be disclosed quickly in order to protect the patient. In most cases, however, doctors can work with patients, and reach joint decisions about when and how to involve parents and other agencies."

    The government review of current guidance, Working Together to Safeguard Children, is due to close at the end of this month. Findings are expected to be published in January. The review comes in the wake of the Bichard inquiry into the killing of two young girls, Jessica Chapman and Holly Wells, who were murdered in the village of Soham in Cambridgeshire. The inquiry recommended that the government should produce national guidance to inform decisions on whether underage sexual activity should be referred to the police. Ian Huntley, the Soham murderer, had had sexual encounters with under age girls.(London Rebecca Coombes)