Chaperone use for Intimate Examinations, Procedures and Care

NHS Borders promotes a culture that values dignity and privacy of all patients. In addition NHS Borders is committed to ensuring the environment in which care is delivered is one that both patients and staff feel best practice and safety are priorities.

Clinical consultations, examinations, investigations and interventions, particularly those of an intimate nature, can potentially prove distressing for some patients and may result in them feeling vulnerable.  In some instances, lack of understanding, on the part of staff, of the religious, racial, cultural or ethnic background of a patient can result in the patient experiencing confusion. It is important staff are also sensitive to the expectations of patients that may be associated with age, gender, sexual orientation or disability.

Staff providing health care and treatment are in a position of responsibility and trust.  In situations where examination, investigation or intervention is of an intimate nature, responsibility and trust is crucial in the relationship between the patient and health staff. Giving clear explanation, ensuring consent is obtained and providing as much privacy as possible, is paramount in all situations.  In addition, health professionals must ensure appropriate professional boundaries, as outlined by professional and regulatory bodies, are maintained at all times.

Following its report into the conduct of Dr Clifford Ayling, the Committee of Inquiry in 2004  looked into the role of chaperones and made the following recommendations:

• each board should have its own chaperone policy
• an identified managerial lead (with appropriate training)
• family members or friends should not undertake a chaperoning role the presence of a chaperone must be the clear expressed wish of the patient; patients have the right to decline a chaperone
• chaperones should receive training

A chaperone may be formal or informal depending on the role expected of them and the patient’s wishes.

A formal chaperone is a member of staff, either a health professional or support worker who has a specific role in respect of an examination or procedure. The role of the chaperone should be made clear to both the patient and the person acting as the chaperone.

This policy relates to the use of formal chaperones, particularly the role of formal chaperones in relation to intimate examinations.  The General Medical Council (GMC) defines a chaperone as usually being a health professional, who will:

• be sensitive and respect the patient’s dignity and confidentiality reassure the patient if they show signs of distress or discomfort
• be familiar with the procedure involved in routine intimate examination stay for the whole examination and be able to see what the health professional is doing, if practical
• be prepared to raise concerns about the health professional’s behaviour or

In respect of this policy the term health professional is applicable to registered and support staff.

Individual perception regarding what is intimate and/or embarrassing may vary.  An examination, procedure or care that involves touching breasts, genitalia or rectum is generally considered to be intimate.  However, health professionals and other staff should be aware that any intervention where it is necessary to touch or be close to the patient may be considered intimate by the patient.

The recommendations from the Committee of Inquiry report into the conduct of Dr Clifford Ayling states that the patient’s family or friend should not undertake a chaperoning role.

This pertains to the formal chaperone role; it is acceptable for a relative or friend of the patient to act as an informal chaperone. The role of an informal chaperone is to accompany the patient and if required can provide reassurance and emotional support as well as assistance with clothing.  They would never be expected to actively participate in or directly witness the examination process or a procedure.

Standard 1

Where it has been established that there is a need for intimate examination, procedure or care, staff must ensure that the patient’s participation in the decision making process in respect of this is positively promoted and

1. The patient will be provided with all relevant information about the nature of the examination, procedure or care and how this will be carried out
2. The patient’s consent must be obtained prior to commencement of the examination, procedure or Staff should refer to NHS Borders Consent to Treatment Policy.
3. Even when a patient has consented to an examination, procedure or care being carried out, they have the right to withdraw their consent at any point including after the examination, procedure or care has started
4. In instances where the patient is unable to fully understand the information given, it is the responsibility of the person undertaking the examination, procedure or care to explore alternative ways of presenting the information in a manner and format that will facilitate understanding e.g. in easy read material, in a different language (using an independent interpreter if required), using diagrams, pictures, or symbols etc.
5. People in Scotland aged 16 years and over are presumed to have capacity, however if the person undertaking the examination, procedure or care has any doubts about the patient’s capacity to consent to the intervention, the Adults with Incapacity (Scotland) Act 2000 must be referred to
6. In the case of a child, although in most cases consent would be sought from the mother or father of the child, depending on circumstances there are a variety of different people who may provide consent in relation to the Staff should refer to the Children (Scotland) Act 19951 and NHS Borders Consent to Treatment Policy.

NB A child under 16 years shall have legal capacity to provide consent if, in the opinion of the person responsible for undertaking the intervention, the child is able to understand the nature and possible consequences of the intervention.

Standard 2

Should a patient specifically ask for a staff member of the same gender to undertake the intimate examination, procedure or care staff will, as far as possible, try and support this request; it is recognised that it may not be possible to meet this request.

1. Should there not be a person of the same gender available to undertake the intimate examination, procedure or care, then the following must be taken account of:
   • the wishes of the patient
   • the consequences of the intervention not being carried out at that time
   • the urgency of the intervention e.” is it an immediate necessity?” any time delay that would result from waiting for a person of the same gender to be available.
2. Should the patient be unhappy for the intimate examination, procedure or care to be carried out by a person who is not the same gender, if clinically safe to do so, arrangements must be made for this to be carried out at another time when a person of the same gender is available

Standard 3

It is good practice to have a formal chaperone present whenever an intimate examination, procedure or care is to be carried out; therefore, the presence of a chaperone must be considered prior to any intimate examination, procedure or care being

1. A chaperone will be present when any intimate examination, procedure or care is being undertaken by a member of staff who is not the same gender as the patient
2. The gender of the chaperone, in theory, does not matter; the acceptability of the chaperone must be confirmed with the patient
3. If intimate examination, procedure or care is being carried out under Section 47 of the Adult with Incapacity (Scotland) Act 2000 certificate, there must be a chaperone present
4. If for any reason a chaperone cannot be offered, this must be explained to the patient and an offer made to delay the planned examination, procedure or care
5. The patient may decline to have a chaperone present during an intimate examination, procedure or care
6. If a chaperone is declined, the member of staff has the right to refuse to proceed without a chaperone present; the reason for refusal to proceed without a chaperone must be explained to the patient

Standard 4

NHS Borders staff required to act as a formal chaperone will receive appropriate training in relation to the role

1. Staff in a chaperone role will act as an independent observer during the intimate examination, procedure or care.
2. The chaperone will ensure, as far as is possible, they are able see what is happening throughout the intimate examination, procedure or care.

Standard 5

Details of the intimate examination, procedure or care must be documented in the patient’s health record and/or electronic maternity system

1. A record will be maintained of:

• • all information provided relating to the intimate examination, procedure or care and the manner in which this is given
  • patient consent having been obtained to the intimate examination, procedure or care being carried out
  • all discussion between the patient and member of staff regarding the presence of a chaperone and the agreement of the patient to the presence of a chaperone
  • the identity of the chaperone and any other persons present

Medical Director and Director of Nursing & Midwifery

Secure agreement on use of chaperones during intimate examination, procedure or care of patients to ensure best practice is complied with in relation to this.

General Manager/ Associate Directors of Nursing/Associate Medical Directors

Ensure dissemination of the policy within their areas of responsibility and seek assurance of compliance with the policy.

Ward/Departmental Managers

Ensure implementation of the policy within their ward or department.

Individual Clinicians

To read the policy and ensure their actions in relation to the delivery of intimate examination, procedure or care comply with the policy.