SAFEGUARDING ADULTS

1. SAFEGUARDING ADULTS Primary Care Teams Basic Awareness Training

2. Safeguarding Vulnerable Adults – BMA Toolkit Health professionals • Should be able to identify adults whose physical, psychological or social condition are likely to render them vulnerable • Should be able to recognise signs of abuse and neglect, including institutional neglect • Need to familiarise themselves with local procedures and protocols for supporting and protecting vulnerable adults

3. Resources for Primary Care • Training plan • Exemplar policy • Checklist • Contact details • Alerts

4. Scale of the problem • In 2010-11 there were 75,000 safeguarding adults referrals which met the threshold for investigation in England • The majority of people have a GP • Serious case reviews almost always demonstrate GP involvement • A tiny number of alerts are made by GP practices

5. Examples • Steven Hoskin (Cornwall) • Fiona Pilkington • Winterbourne View • Death by indifference report

6. What do we mean by Safeguarding Adults? ‘ All the work which enables an adult who is or may be eligible for community care services to retain independence, well-being and choice, and to access their human right to live a life that is free from abuse and neglect’ (Safeguarding Adults, ADASS,2005)

7. What do we mean by Vulnerable Adult ? • Aged over 18 • Who may need care services because of mental health issues, physical or learning disability, age or illness (elderly frail) • Who cannot always protect themselves from harm or exploitation

8. Factors Increasing Vulnerability • Frail elderly • Mental health disorder including dementia and personality disorders • Significant physical or sensory impairment • Learning disability • Severe physical illness • Unpaid carer who is under severe stress or is isolated • Homeless people • Living with someone with a drug or alcohol problem • Women as a result of isolating cultural factors

9. Categories of Abuse • Physical • Sexual • Psychological • Financial • Neglect • Institutional • Discriminatory

10. Definition of Abuse • Abuse is a violation of an individual’s human and civil rights by any other person or persons” (No Secrets 2000). • It may be intentional or unintentional • It may consist of a single act or repeated acts • It may cause harm temporarily or over a period of time • May occur in any setting • People who behave abusively come from all walks of life • It may be acts of omissions

11. Factors to Consider • One off event or repeated? • The impact on victim and others • The impact on others e.g. children and families • Intent of alleged perpetrator • Illegality of alleged actions • Risk of repeat to this victim • Risk of repeat to other vulnerable adults or children

12. The Jigsaw

13. Doreen • Doreen – mother of a man with mental health and alcohol problems • Discloses that he has hit her recently • What types of abuse are you concerned about? • What do you need to know? • What might be making her vulnerable? • What might protect her?

14. Responding to allegations or concerns • Ensure safety • Take seriously and remain calm • Preserve evidence • Avoid leading questions • Don’t confront alleged perpetrator • Keep records • Consider who else might have information • Seek advice

15. Examples of Legislation • Human Rights Act 1998 • Public Interest Disclosure Act 1998 (Whistle Blowing) • Data Protection Act 1998 • Youth and Criminal Evidence Act 1999 • Sexual Offences Act 2003 • Protection Of Vulnerable Adults (POVA) 2004 • Mental Capacity Act 2005 • Safeguarding Vulnerable Groups Act 2006 • Health and Social Care Act 2008

16. Mental Capacity Act Principles • Presumption of capacity • Maximise decision making ability • Freedom to make unwise decisions • Best interests • Less restrictive alternative

17. Assessing Mental Capacity (MCA1 form) • Is there an impairment of, or disturbance in the functioning of the individual’s mind or brain? • Complete assessment • Understand information • Retain information • Weigh up information • Communicate their decision

18. Decision Making Flowchart

19. How to Refer • Local Adult Social Services • Phone • Follow up with multi-agency alert form • Option of discussion and seeking advice

20. After referral • Initial information gathering and safeguarding decision (within 24 hours) • Strategy meeting or discussion (within 5-7 days) • Allocate responsibilities and agree initial protection plan • Protection plan meeting (within 28 days) • Review meetings and core group meetings

21. Doreen • What would you do?

22. What Makes It Difficult to Refer • Uncertainty as to what constitutes abuse • Uncertainty as to what will happen • Concern about impact on relationships • Lack of consent • Concerns regarding confidentiality • Not having the whole picture

23. Record Keeping • Document concerns and information in medical records • Document information received from other agencies • Document discussions and decision making e.g. assessment of capacity • Store case conference notes in medical records

24. Prevention • Training and awareness • Patient information • Asking questions • Consider in reviews e.g. chronic disease • Follow up non attenders e.g. QOF, repeat prescriptions • Carers policy • Flag records of vulnerable adults • Discuss concerns and significant events • Contribute to meetings

25. Practice Checklist • Safeguarding adults policy • Safeguarding adults lead • Highlight records of vulnerable adults • QOF exception reporting based on clinical decision • Patient information available • Regular training • Significant events discussed • Concerns shared within PHCT • Carers policy • Minimum safety criteria for staff employment • Complaints and whistle-blowing policy

26. Guidance • “No Secrets” DOH Guidance on implementing Multi-Agency Policy • Safeguarding Vulnerable Adults – a toolkit for General Practitioners. British Medical Association • Safeguarding Adults. The role of health service practitioners • National Competence Framework for Safeguarding Adults • Deciding Right (www.theclinicalnetwork.org)

27. Case Studies • What type of abuse? • What makes them vulnerable? • What would you do?