Chaperone Policy

1. INTRODUCTION

This policy is designed to protect both clients and staff at Rebound Physiotherapy services Ltd from abuse or allegations of abuse and to assist clients to make an informed choice about their examinations and treatment/care arrangements.

This policy provides guidelines such that any possible misunderstanding can be avoided when treating or examining clients.

Adequate privacy must be provided and all effort must be made to maintain the client’s dignity during any close examination or procedure (see Section 7 below).

2. GOOD PRACTICE GUIDELINES.

• Staff (male and female) should always consider whether an intimate or personal examination of the client (either male or female) is justified, and whether this poses a risk of misunderstanding.
• Clients should routinely be offered a chaperone for such examinations.
• The client should be given a clear explanation of what the examination will involve.
• Always adopt a professional and considerate manner – be careful with humour as a way of relaxing a nervous situation as it can easily be misinterpreted.
• Always ensure that the client is provided with adequate privacy to undress and dress.
• If a client does not want a chaperone, good practice guidelines are outlined in detail at Section 8 below.
• Clients who request a chaperone should never be examined without a chaperone being present. If necessary, where a chaperone is not available, the examination should be rearranged for a mutually convenient time when a chaperone can be present.
• RELEVANT CQC FUNDAMENTAL STANDARD/H+SC ACT REGULATION (2014). Regulation 12: “Safe Care and Treatment”, Regulation 9: “Person Centred Care”

3. WHO CAN ACT AS A CHAPERONE?

A chaperone does not have to be professionally qualified but will need to be:

• sensitive, and respectful of the client’s dignity and confidentiality
• prepared to reassure the client if they show signs of distress or discomfort
• familiar with the procedures involved in a routine intimate examination
• prepared to raise concerns if misconduct occurs.

The role of a chaperone should be made clear to both the client and the person who is undertaking the role. 

Appropriate training should therefore be given to the chaperone. 

4. RECORD KEEPING

The member of staff should record any discussion about chaperones and its outcome. If a chaperone is present, that fact should be recorded and a note made in the client’s notes of their identity.

If the client does not want a chaperone, a record that the offer was made and declined should be made in the client notes.

5. ROLE OF CHAPERONE

All staff undertaking Chaperone duties will be competent for the role, and trained accordingly.  This training will include aspects such as:

• Confidentiality
• How to raise any Safeguarding or other concerns that they may have.
• What is meant by the term chaperone.
• What is an ‘intimate examination’.
• Why chaperones need to be present.
• The rights of the client.
• Their role and responsibility.  

In addition all chaperones will:

1. be sensitive and respect the client’s dignity and confidentiality 
2. reassure the client if they show signs of distress or discomfort 
3. familiar with the procedures involved in a routine intimate examination 
4. stay for the whole examination
5. be prepared to raise concerns if they are concerned about any aspect during the examination.
6. have had Enhanced Disclosure and Barring Service check
7. be trained appropriately for their role as a Chaperone.

6. CLOSE EXAMINATIONS AND PROCEDURES

Chaperones will always be offered for a ‘Close’ examination or procedure. 

A ‘Close’ Examinations is defined as –

• ➢ Examinations and/or interventions that may involve close bodily contact between patient and therapist, especially where the patient may be partially undressed.
• ➢ Examinations and/or interventions that may involve therapist handling of the patient close to intimate areas, the lumbo-sacral areas, and thoracic areas of female patients, especially where the patient may be partially undressed.
• ➢ Examinations involving complete removal of a patient’s outer clothing down to underwear.
• ➢ Examinations involving the partial undoing or total removal of a patient’s underwear e.g., bras.

In addition, any examination or procedure that the clinician or patient feels would benefit from a chaperone being present should fall within the terms of this policy. For example some patients may also be distressed by consultations involving dimmed lights or close proximity of the clinician to the patients.  Some individuals for personal or cultural reasons, may feel uncomfortable if the clinical examination requires them to undress and / or be touched and may feel vulnerable.

7. Children

Any person under 18 years of age attending for treatment most be accompanied by a chaperone, and they must be able to consent to their own treatment.

8.Lone Workers / Isolated working

Lone workers can occur in many professional contexts and include, community, domiciliary and/or clinic-based employees and self-employed members.

Isolated working can occur in conjunction with lone working, but may also occur when e.g. working in a clinic room at the end of a corridor, a room with a closed door, or a room with no receptionist within sight or earshot.

Physiotherapists may be at an increased risk of their actions being misunderstood if they conduct intimate and/or close examinations where no other person is present. This group of members may be vulnerable to complaint as the very nature of their work may mean that there are only two people present during examination or treatment, which may lead to a case of one person’s word or recollection of events versus another’s.

Physiotherapy Practice and the use of Chaperones –PD104–August 2023 5

Where it is appropriate, alternative treatment options may need to be provided when a chaperone cannot immediately be provided.

Employed lone-workers must ensure that they understand and comply with their employer’s policy for both lone-working and chaperoning.

Self-employed lone workers should have due consideration to the risks of lone-working, and in particular, risks posed by not being able to offer appropriate chaperoning services, and if necessary, consider the ability, or otherwise, to offer safe services to both their patients and themselves.

Options to consider:

• reschedule the patient’s appointment to ensure a suitable chaperone is present.
• the patient’s care may need to be transferred to another practitioner.
• the patient’s care may need to be transferred to another suitable venue.
• make arrangement for two professionals to attend the patient.
• it may not be appropriate to treat the patient, and their care should be transferred to another provider.

9.DECLINING A CHAPERONE

All patients should be provided with a chaperone if they ask for one, and one is available.

This policy does not say that physiotherapists must have chaperones for every examination they undertake, however clinicians should understand that some working situations may have a higher risk of regulatory complaint and that appropriate consideration must be given to that risk.

If the clinician or the patient does not want the examination to go ahead without a chaperone present, or if either of them is uncomfortable with the choice of chaperone, a delay in the examination to a later date when a suitable chaperone will be available should be offered.  This is subject to the delay not adversely affecting the patient’s health.

If the clinician does not want to go ahead without a chaperone present but the patient has said no to having one, the clinician must explain clearly why you want a chaperone present. Ultimately the patient’s clinical needs must take precedence, subject to the clinician staying within guidelines issued by The Chartered Society of Physiotherapy (CSP).

In addition, the clinician may wish to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as a delay would not adversely affect the patient’s health.

The clinician should record any discussion about chaperones and the outcome in the patient’s medical record. If a chaperone is present, the clinician should record that fact and make a note of their identity. If the patient does not want a chaperone, the clinician should record that the offer was made and declined.

Bibliography:

Equality Act 2010 http://www.legislation.gov.uk/ukpga/2010/15/contents

Mental Capacity Act 2005 http://www.legislation.gov.uk/ukpga/2005/9/contents

Medical Defence Union, Chaperones https://www.themdu.com/guidance-and-advice/guides/guide-to-chaperones

Society of Radiographers https://www.sor.org/learning/document-library/intimate-examinations-and-chaperone-policy-0

NHS Clinical Governance Team. Guidance on the role and effective use of chaperones in primary and community care settings. Model chaperone framework https://www.lmc.org.uk/visageimages/guidance/2007/Chaperone_model%20framework.pdf

Physiotherapy Practice and the use of Chaperones  CSP https://www.csp.org.uk/system/files/publication_files/PD104Chaperoning and Related Issues_2023_0.pdf