Safeguarding Vulnerable Adults - the national and local picture

1. Safeguarding Vulnerable Adults - the national and local picture Sue Darker Assistant Director - Learning Disability and Mental Health Hertfordshire County Council

2. Statutory Guidance and Legislation No Secrets - Department of Health 2000 Vulnerable Groups Act Mental Capacity Act Deprivation of Liberty Safeguards

3. Statement of Government Policy on Adult Safeguarding • Empowerment - Presumption of person led decisions and informed consent. • Protection - Support and representation for those in greatest need. • Prevention - It is better to take action before harm occurs. • Proportionality – Proportionate and least intrusive response appropriate to the risk presented.

4. Statement of Government Policy on Adult Safeguarding (2) • Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. • Accountability - Accountability and transparency in delivering safeguarding. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126748

6. What does HSAB do? • Works together to safeguard and promote the welfare of vulnerable adults. • Works together to prevent abuse of vulnerable • adults • Ensures action is taken when individuals are harmed • Raises awareness of adult abuse

7. Who are the HSAB? • Hertfordshire County Council (HCS / CS/ Fire and Rescue/Trading Standards) • NHS Hertfordshire • West Hertfordshire Hospitals NHS Trust • East & North Hertfordshire Hospitals Trust • Hertfordshire Partnership NHS Foundation Trust • Hertfordshire Community NHS Trust • Hertfordshire Constabulary • Hertfordshire Probation Service • POhWER • District Councils

8. HSAB structure • Chaired by Assistant Director Health and Community Services • Agencies represented at director level • Memorandum of Understanding • Quarterly meetings

9. Annual Business Plan

10. Safeguarding adults from abuse in Hertfordshire Inter agency procedure which must be followed by all services in Hertfordshire who work with vulnerable adults. • Reporting and investigating abuse • Roles and Responsibilities • Serious concerns about providers • Serious case reviews • Good practice guidance

11. Hertfordshire policy All agencies and individuals involved in safeguarding adults, including managers, professionals, volunteers and staff working in public, voluntary and private sector organisations must :- • work together to prevent and protect adults at risk from abuse • empower and support people to make their own choices • support adults and provide a service to adults at risk who are experiencing abuse, neglect and exploitation.

12. Procedures The procedures aim to make sure that:- • the needs and interests of adults at risk are always respected and upheld • the human rights of adults at risk are respected and upheld • a proportionate, timely, professional and ethical response is made to any adult at risk who may be experiencing abuse • all decisions and actions are taken in line with the Mental Capacity Act 2005.

13. Protection Once abuse has occurred how do we:- work together to investigate actual or suspected abuse and neglect and secure the best outcome for the individual?

14. Hertfordshire ProceduresCase Studies March 2012 Patricia Orme Head of Adult Safeguarding Health and Community Services

15. Head of Adult Safeguarding • work with managers and staff in social care to improve safeguarding practice • lead on the development of safeguarding policies and procedures • member of the Hertfordshire Safeguarding Adults Board

16. John John is a man in his fifties who has Asperger's syndrome. A young woman, Jane has befriended John. This friendship is important to John and he gives her money. John’s home care worker reports that John has said he gives Jane and fifty pounds every week. What action would you take?

17. Caroline Caroline is a resident at your nursing home. She has learning disabilities and has diabetes which requires two different types of insulin twice daily. The nurse administering this gave the wrong dosage. The nurse realised the error immediately and called an ambulance. Caroline was taken to hospital and was discharged the following day having suffered no harm. What action would you take?

18. Freya Jones • Mrs Jones has been a traveller from childhood. She was been admitted to a care home. She is frail and has diabetes. You are the manager of the care home and one of your staff Sam tells you that Freya has told him that the night care assistant, Josie “smacked” her and called her a ‘dirty gypsy’ because she had messed herself. What action would you take?

19. Sarah Roberts Mrs Roberts has Parkinson’s disease and needs daily assistance with personal care. Her care worker, Sue, also does a regular food shop for Mrs Roberts. Sue is admitted to hospital and a new care worker, Maddy, supports Mrs Roberts. After the second visit Mrs Roberts tells Maddy how pleased she is that her shopping bill has gone down so much since Maddy has been doing the shopping and she seems to be getting more for her money. Maddy tells you she is getting the same items from the same supermarket as Sue did. What do you do?

20. Identifying concerns What should you consider • What is the nature of the possible or actual abuse. • Is there a reasonable explanation. • Is medical attention or examination needed. • What are the current risks to the vulnerable adult. Direct contact should be made with the police if:    • There is an immediate risk to life. • There is a serious injury. • A crime has been committed

21. Safeguarding alert/making a referral Key actions to be taken • Immediate protection of the vulnerable adult • Record clear factual information • Contact the investigating team • Notify CQC • Notify commissioning team if the vulnerable adult is funded by another local authority

22. What happens next? The team manager must decide whether a safeguarding investigation is needed within one working day of the alert. A decision not to investigate might be made because there is sufficient information to indicate that: • the situation does not involve abuse, neglect or exploitation • the adult at risk is not an adult covered by these procedures • the adult at risk has the mental capacity to make an informed choice. • No other vulnerable adults are a risk or potentially at risk The referrer should be informed of the outcome of the referral

23. Strategy discussion or meeting If an investigation is needed a strategy discussion or meeting should be held within 3 or 10 working days depending on the seriousness of the incident. This is arranged by the investigating team. A risk assessment and risk management plan must be completed once the decision to investigate is taken.

24. Strategy discussion or meeting Purpose • agree a multi-agency plan to investigate the allegations • assess the risk to the person • put a protection plan in place In most cases If the vulnerable adult lives in a care home, or attends a particular service, the care provider will be invited to the strategy meeting.

25. Investigation In most cases the investigation will be lead by a member of the social care team who will carry out interviews with the alleged victim. If the police are not investigating the allegation of abuse as a crime then the responsible person to carry out the interview will be decided at the safeguarding strategy meeting. Where the alleged abuser is a member of staff (paid or a volunteer), this is likely to be the care provider.

26. Reconvened strategy meeting Purpose • review the findings of the investigation • Decide whether the allegation is substantiated or unsubstantiated • review the protection plan • agree post investigation monitoring and support

27. Care provider involvement • Protection plan • Strategy meeting • Safeguarding investigation • Disciplinary investigation • Reconvened strategy meeting • Post investigation monitoring and support

28. Prevention - safeguarding challenges The Social Care Institute for Excellence has published guidance which suggests that most safeguarding activity relating to care provision occurs as a result of poor practice and poor quality of service rather than malicious intent. “The impact of poor practice and neglect can be just as significant as intentional abuse and yet it is arguably far easier to prevent “ http://www.scie.org.uk/publications/guides/guide46/index.asp

29. Social Care Institute for Excellence • The guidance:- • identifies the issues that commonly lead to safeguarding referrals from care providers • sets out underlying causes • provides prevention checklists are provided to help providers reduce the occurrence of these issues

30. Common themes • Maladministration of medication • Pressure sores • Falls • Rough treatment, being rushed, shouted at or ignored • Poor nutritional care • Lack of social inclusion • Institutionalised care • Physical abuse between residents • Financial abuse

31. Underlying causes • Recruitment • Staffing levels • Adherence to policy and procedure • Training • Choice of service • Record-keeping • Dehumanisation

32. Summary As providers and commissioners of care we need to work together to prevent abuse occurring and to take prompt action to protect vulnerable adults if abuse takes place.