Safeguarding and Adult Social Care.

1. Safeguarding and Adult Social Care. Richard Hill, Strategic Safeguarding Lead for Adults, Adult Social Care, Medway Council. September 2018.

2. Introduction: • This presentation covers information about accessing information about safeguarding, how to consider if a concern should be referred for a Section 42 Safeguarding Enquiry, who to discuss matters with, how to make a referral, what difference mental capacity makes, and some information on the self-neglect policy and safeguarding. I hope you will find it of some value and I always welcome discussions about safeguarding matters if useful decisions can be made.

3. How to access information on safeguarding: • Information on safeguarding is readily available on the Medway website by Googling ‘Adult Safeguarding Medway’ which should take you through to the safeguarding homepage. There are numerous links to information and other pages, including a link “Report Abuse” that takes you to the Safeguarding Adults Form (SAF) which is the online referral form for providers. LADO has just been added. • Another link will take you through to the ‘Kent and Medway Safeguarding Adults Board’ page, and on here is further information and policies for Kent and Medway, including the main ‘bible’ of safeguarding, the ‘Adult Protection Policy, Protocols and Guidance for Kent and Medway’ which can be downloaded. (You can Google the KMSAB page direct also).

4. The ‘Adult Protection Policy, Protocols and Guidance for Kent and Medway’: • If you have not accessed this document before, then I would really recommend downloading it from the Kent and Medway Safeguarding Board pages and looking through. The document is being rewritten over the coming months and currently is over a hundred pages long, so would advise considering not printing at this time. It is policy and procedure for everyone, from the public to the Chief Executive, and staff should be encouraged to familiarise themselves. The updated version should be on the website April 2019.

5. What is a SAF used for: • A SAF (Safeguarding Adults Form, see two slides previously) is the online referral form used when a provider (amongst others) needs to make a referral to Adult Social Care for an enquiry into safeguarding concerns. When it is completed and the ‘submit’ button is pressed, it is sent securely through to the Medway Council Access and Information team (also known as Customer First) who will process the referral and send to the appropriate team. A safeguarding referral will not be accepted from a service provider or partner organisation unless it is on the official SAF.

6. Do you want to discuss a referral before completing a SAF?: • Under the Adult Protection Policy, Protocols and Guidance for Kent and Medway, it is recommended that if you have any doubts about whether a situation is safeguarding or not, then you can call Social Care to have a ‘pre-referral consultation’ and I would very much recommend this. If the situation is a concern about someone that can be managed through social care intervention rather than safeguarding (somebody not looking after themselves and needing support, and willing to accept it for instance), then it will save you completing a SAF form, and saves social care staff opening and working through safeguarding episodes that we have to do, but are not relevant. Not all ‘vulnerable’ (term no longer used in Adult Social Care) people need the safeguarding mechanism (we now call them ‘adults’ or ‘adults at risk’). What is the criteria for safeguarding?

7. The criteria for a Section 42 Safeguarding Enquiry under the Care Act 2014: • The Care Act (Section 42) states that the Local Authority must initiate a safeguarding process for anyone who meets the following three criteria: (a) has needs for care and support (whether or not the authority is meeting any of those needs), (b) is experiencing, or is at risk of, abuse or neglect, and (c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. • It is really important to consider part (c) carefully, and this is something you may want to discuss in a ‘pre-referral consultation’.

8. How do you conduct a ‘pre-referral consultation’: • There are several ways you can discuss a referral before making it if you have doubts or just want to discuss: 1) You can call myself, Richard Hill, Strategic Lead for Safeguarding Adults, Medway Council on 01634 334470 or email me on richard.hill@medway.gov.uk (my out of office will alert you if I am not in the office), 2) You can call the duty manager on the Early Help and Prevention team (who deal with new referrals) on 01634 331670, or 3) If the person you want to discuss is already known to Social Services, you can call Access and Information on 01634 334466 and ask who the social worker is, or the team manager for the team that they are with, and then discuss the concern with them.

9. Mental capacity and safeguarding; discussion with the Adult: • The Mental Capacity Act (2005) is central to the work that is carried out by everyone who works with adults. It is important to consider if the person has the capacity to agree to a safeguarding or Adult Social Care referral being made in the first place. Ensure that an informed decision is made if possible, although undue pressure should not be exerted on the adult at risk to change their mind: a) The issue should be discussed fully and the adult should be given all the relevant information available in order to make an informed decision, including who will be involved and the various possible outcomes which might result from their decision. b) They should be reassured that their case would be dealt with sensitively and professionally under Safeguarding procedures and any specific concerns that they raise should be addressed.

10. Exceptions to needing consent from the adult: • There are four potential exceptions to the consent general rule: 1) If other people appear to be at risk of harm (adults or children), 2)If there is a ‘legal restriction’ or an overriding public interest, 3)If the adult is exposed to life threatening risk and they are unreasonably withholding their consent, and 4)If the adult has impaired capacity or decision making in relation to the safeguarding issues and the withholding of consent. • A ‘legal restriction’ in this context means that there may be exceptional circumstances where a service user makes a decision or intends to act in a way that is unlawful or where their care needs to be addressed under the Mental Health Act 1983. • An ’overriding public interest’ refers to a situation where it is essential to share information in order to prevent a crime or to protect others from harm (eg ‘Hate Crime’ –a statutory responsibility to report). This is supported by the Crime and Disorder Act 1998.

11. Self-neglect and safeguarding: • There is a ‘Kent and Medway Policy and Procedure to Support People who Self-Neglect’ on the same web pages as outlined earlier. The latest version updated in March 2018 and published June 2018 is now available on the site. If you have concerns about people who appear to be self-neglecting then call for a discussion and the best way forwards can be agreed.

12. When self-neglect is not safeguarding: • Refer back to the criteria for a Section 42 Safeguarding Enquiry: The adult: (a) has needs for care and support (whether or not the authority is meeting any of those needs), (b) is experiencing, or is at risk of, abuse or neglect, and (c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. • Consider mental capacity (see previous slides). • Use the Self-Neglect Policy and Procedures to help make the decision. Have a discussion with social services. The Policy and Procedure for self-neglect guides all parties through the process, it just means the ‘umbrella’ for this is not a Section 42 Enquiry, but working together to help the person using the guidance is still important.

13. Thank you and I hope you find the information useful. Richard Hill, Strategic Safeguarding Lead for Adults, Medway Council Adult Social Care. 01634 334470 richard.hill@medway.gov.uk