Safeguarding in Sport

All doctors have a professional duty to protect and promote the welfare of children and young people, and to act on any concern about their safety, and the General Medical Council sets out this responsibility clearly. The same principle of protection extends to adults at risk. In England, this means an adult with care and support needs who is experiencing, or at risk of, abuse or neglect and who, because of those needs, cannot protect themselves, and the legislation differs across the UK nations. In sport, safeguarding concerns can involve people in positions of trust, such as coaches, staff or other athletes, and the imbalance of power in these relationships is part of what makes safeguarding important. For a child, their welfare is the paramount consideration, ahead of the interests or wishes of others, including where a parent's or an organisation's wishes might place the child at risk. Adult safeguarding is normally person-led, taking account of the adult's capacity, consent, wishes and what is proportionate, so an adult's informed wishes are not simply overridden. Safeguarding is a shared responsibility, and the doctor is one part of a wider system that includes the club or organisation's safeguarding lead and statutory services. The doctor's role is not to decide whether abuse has occurred but to recognise concern and pass it on, so that those with the responsibility and training to assess it can do so. Each part of the UK has its own statutory framework and local safeguarding arrangements, but the underlying expectation is the same: professionals share information and work together to keep children and adults at risk safe.

Concerns can arise from what a doctor sees, is told, or comes to suspect. Abuse and neglect take several forms, including physical, emotional and sexual abuse and neglect, and in sport there are also context-specific concerns, such as harmful training practices, bullying, or an athlete being isolated or controlled. Signs that should prompt thought include injuries that do not fit the explanation given, a change in an athlete's behaviour or mood, a disclosure by the athlete, or unease about how an adult behaves around young people. No single sign is proof, and the doctor's task is not to reach a conclusion or to investigate, but to recognise when something is concerning enough to act on. A disclosure from a child or young person should be listened to and taken seriously, without pressing for detail or promising to keep it secret. Not investigating does not mean staying silent: the doctor may listen, ask a few open, non-leading questions needed to understand any immediate risk to safety, provide any necessary clinical care, and record what the person says in their own words. A doctor does not need to be certain, or to know the cause, before a concern is worth acting on; the threshold is a reasonable concern, not proof. Concerns may also arise about an adult in the sporting environment whose behaviour towards young people is worrying, even in the absence of a specific incident.

When a doctor has a safeguarding concern, the response follows a clear pattern. The doctor should not investigate or try to establish what happened, as this is the role of the local authority and, where relevant, the police. Instead, they should act on the concern by sharing it promptly with the appropriate person or agency. The organisation's safeguarding lead can support this, but is not always the endpoint, and where a child may be at risk of abuse or neglect the concern should be shared with the relevant statutory agency, such as local authority children's services, according to local procedures. The doctor should seek advice from an experienced colleague or a named or designated safeguarding professional if unsure. Where a child or adult is in immediate danger, the emergency services should be contacted without delay. The concern and the actions taken should be recorded clearly and factually. It helps to know in advance who the safeguarding lead is and how to contact statutory services, so that a concern can be acted on without delay.

Consider a team doctor who notices unexplained injuries and a marked change in a young athlete: the right step is not to question the athlete at length or confront anyone, but to share the concern with the safeguarding lead and record it. Acting on an honestly held, reasonable concern is justified even if it later proves unfounded, and safeguarding can justify sharing information that would otherwise be confidential.

A serious pitfall is doing nothing for fear of being wrong, when acting on an honestly held, reasonable concern is justified even if it turns out to be unfounded. Another is trying to investigate or gather proof, which can compromise a later inquiry and is not the doctor's role. Promising a child that a disclosure will be kept secret is a mistake, as the doctor may need to share it to keep the child safe. Allowing confidentiality to override safeguarding is an error, since protecting a child or adult at risk can justify sharing information. Finally, failing to record concerns and actions, or not knowing who the safeguarding lead is, leaves the doctor and the child unprotected.

• •Every doctor has a duty to act on concerns about a child or an adult at risk.
• •For a child, their welfare is paramount; adult safeguarding is normally person-led, weighing the adult's capacity, wishes and proportionality.
• •Recognise and act on concerns; do not investigate, which is the role of statutory services.
• •Share concerns with the safeguarding lead or local authority, and record them clearly.
• •Acting on an honestly held, reasonable concern is justified even if it proves unfounded.
• •Safeguarding can justify sharing information that would otherwise be confidential.