West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures

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1 West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures Published April 2013 Version

2 West Yorkshire Multi-Agency Policy and Procedures to Safeguard Adults from Abuse Produced by the West Yorkshire Safeguarding Adults Project Group on behalf of: Bradford Safeguarding Adults Board Calderdale Safeguarding Adults Board Kirklees Safeguarding Adults Board Leeds Safeguarding Adults Board Wakefield Safeguarding Adults Board Endorsed by the Social Care Institute of Excellence (SCIE) Version

3 Contents Foreword... i Acknowledgements... ii Glossary and acronyms... iii Introduction... vii Local implementation... viii Structure... viii Review viii PART ONE: POLICY 1 1 Adult at risk and abuse Definition of an adult at risk Abuse Harm Types of abuse Physical abuse Sexual abuse Psychological/emotional abuse Financial and material abuse Neglect and acts of omission Discriminatory abuse Institutional abuse Self-neglect Patterns of abuse Who might commit abuse? Abuse by another adult at risk Abuse by carers who are relatives or friends Abuse of trust Abuse by children Principles and Values Principle 1: Empowerment Principle 2: Protection Principle 3: Prevention Principle 4: Proportionality Principle 5: Partnerships Principle 6: Accountability Prevention Responsibilities of organisations, employees and volunteers Roles of Safeguarding Partners Safeguarding Adults Boards (SABs) Local authorities Lead councillor for adult social care Director of Adult Social Services (DASS) Lead coordinating agency Version

4 4.2.4 Emergency Duty Teams (EDTs) Complaints officers NHS funded services Clinical Commissioning Groups (CCG) Safeguarding role of health service managers and boards Health service practitioners Patient Advice and Liaison Services (PALS) and complaints departments Yorkshire Ambulance Service NHS Trust West Yorkshire Police Crown Prosecution Service (CPS) West Yorkshire Fire and Rescue Service Housing and Housing Related Support Organisations The Coroner The Probation Service Care Quality Commission (CQC) Community, Voluntary and Private Sector Providers Responsibilities of all organisations Specialist Support Services And Linked Agendas Specialist support services Court of Protection Office of the Public Guardian (OPG) Deprivation of Liberty Safeguards (DoLS) Trading Standards Service Department of Work and Pensions (DWP) Linked agendas Domestic violence and abuse Forced marriage Honour-based violence Human trafficking Prevent agenda: exploitation by radicalisers who promote violence Hate crime Anti-social behaviour Multi-Agency Public Protection Arrangements (MAPPA) The Health and Safety Executive (HSE) Safeguarding children and young people Commissioning Commissioning governance Commissioned services Personal budgets and self-directed care Managing Safeguarding Arrangements Human rights Mental capacity Principles of the Mental Capacity Act Risk assessment and management Protection plan Version

5 7.5 Support for those involved within the safeguarding adults procedures Involving the adult at risk Independent advocacy Independent Mental Capacity Advocates (IMCAs) Witness support and special measures Victim support Keeping families and others concerned informed and supported Responsibilities to those who are alleged to have caused harm Information sharing Equality and diversity Duty of care Defensible decision making PART TWO: PROCEDURES 45 8 Safeguarding Adults Procedures Introduction to the safeguarding adults stages Designated roles within the safeguarding adults procedures Stages flowchart Safeguarding stages Stage One: Alert What is an alert? Making a safeguarding alert Safeguarding alerts from organisations Raising a safeguarding concern In an emergency or out of hours Whistle-blowing Public Interest Disclosure Act The role of alerting manager (organisations only) Alerting manager flowchart Gather information in order to inform your decisions Take action to ensure the immediate safety of the adult at risk Preserving evidence Deciding whether to report an incident to the police Deciding whether to make a safeguarding alert Mental capacity to consent Making a safeguarding alert without the consent of the adult at risk Document the incident and any actions or decisions taken Ensure key people are informed Provide support for the person raising a safeguarding concern How to make a safeguarding alert Stage Two: Safeguarding Adults Referral Purpose of the safeguarding adult referral Information gathering Overview of information gathering and referral decision making Referral decision considerations Assessing harm Version

6 Risk of abuse Poor practice and abuse Institutional abuse Large scale investigations Abuse of one adult at risk by another Repeated allegations Abuse in relation to a person without mental capacity Recognising individual circumstances Mental capacity and consent Safeguarding referral without consent Alternatives to proceeding to strategy discussion/meeting Risk and protection planning Deciding whether to report an incident to the police Who should be informed of the decision Recording the referral outcome Stage Three: Strategy Discussion Or Meeting Purpose of the strategy discussion or meeting Deciding whether to hold a strategy meeting or discussion Who should be involved in a strategy discussion/meeting Assessment of risk and protection planning Deciding whether to proceed to a safeguarding investigation Safeguarding investigation plan Additional guidance on coordinating multi-agency responses Determining the safeguarding investigating officer The service provider manager as safeguarding investigating officer Recording and sharing information Distribution of strategy discussion/meeting minutes Types of investigation or risk assessment and agency responsible Stage Four: Investigation Purpose of the investigation Risk Assessment and Protection Planning Role of the safeguarding investigating officer Investigative activities Amendment to the safeguarding investigation plan Planning interviews Medical treatment and examination Investigation delay Standards of proof Compiling the safeguarding investigation report Stage Five: Case Conference Purpose of the case conference Case conference meeting or discussion Case conference discussion Case conference meeting Version

7 13.5 Invitations to case conference meetings Role of legal representatives at a case conference meeting Information provided through the safeguarding investigating officer s report Views of the adult(s) at risk Views of the person(s) or organisation alleged to have caused harm Case conclusions Case conclusion for each type of abuse Overall case conclusion Case conference discussion decision making Case conference meeting decision making Assessment of risk Agreeing a protection plan Action to be taken if the person causing harm is also an adult at risk Case conference minutes Case conference discussion/meeting minutes timescales: Feedback to the adult at risk (if not present) Feedback to the person or organisation causing the harm (if not present) Decision to close or review Stage Six: Review Purpose of the review Who should attend Actions required during the review Recording and feedback Exiting the Safeguarding Adults Procedures Actions on exiting the safeguarding adults procedures Record keeping and confidentiality Complaints Serious Case Review Appendix A: Information required when making a safeguarding alert Appendix B: Safeguarding adults contact points (Each contents heading is a hyperlink) Version

8 Foreword This policy and procedures have been agreed and endorsed by four out of the five West Yorkshire safeguarding adults boards with the Bradford board being in the final stages of their decision making process. They mark a big step forward in joint working to protect adults within our communities. Based on the guidance contained within No Secrets (DH 2000) and the standards set out in Safeguarding Adults (ADASS 2005) it also includes best practice from our existing procedures across West Yorkshire, and from joint procedures in other areas. The main statutory agencies local councils, the police and NHS organisations need to work together to promote safer communities, to prevent harm and abuse, to promote independence, well-being, dignity and choice and to deal effectively with suspected or actual cases of abuse. We also need to ensure that we are linking with other initiatives that safeguard our communities such as, for example, children s safeguarding, domestic abuse, and disability hate crime. By coming together to develop joint safeguarding adult policies and procedures this will: improve consistency in safeguarding practice across West Yorkshire benefit joint working with partners, particularly those that work across the whole area such as police, probation, fire and ambulance services provide a stepping-stone to national consistency help us prepare for other national developments, including for example, statutory safeguarding boards serve as a building block for more joint initiatives in the future The responsibility for co-ordinating safeguarding adults arrangements lies with councils with adult social care responsibilities. However, the operation of the procedures is a collaborative responsibility and all agencies are accountable. The work potentially involves a broad range of organisations, service areas and workers, all of whom need to be aware of their roles and responsibilities on both an internal and multiagency basis. It is vital for the successful safeguarding of adults that the procedures in this document are understood and applied by all organisations. Effective communication and training will be required to embed the new ways of working. This document will be reviewed in 6 months. Bradford Safeguarding Adults Board Calderdale Safeguarding Adults Board Kirklees Safeguarding Adults Board Leeds Safeguarding Adults Board Wakefield Safeguarding Adults Board Version i

9 Acknowledgements The development of this West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures has only been possible due to the shared vision, mutual support and cooperation of various individuals and organisations across the West Yorkshire region. Special thanks are owed to each of the following: The Bradford, Calderdale, Kirklees, Leeds and Wakefield Safeguarding Adults Boards for their expertise, shared vision and commitment of time and resources to the project The Social Care Institute for Excellence ( who have kindly given permission for sections of text to be reproduced from The SCIE Adults Services Report 39: Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse and have in addition reviewed and endorsed these West Yorkshire Multi-Agency Safeguarding Adult Policy and Procedures All those individuals and organisations that have contributed, advised and supported the development of these West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures in its various drafts Version ii

10 Glossary and acronyms Abuse is a violation of an individual s human and civil rights by any other person or persons. It can take many forms, including physical, sexual, emotional/psychological, financial, neglect, discriminatory and institutional abuse. ADASS - Association of Directors of Adult Social Services is the national leadership association for directors of Local Authority Adult Social Care Services. Adult At Risk means adults who need community care services because of mental or other disability, age or illness and who are, or may be unable, to take care of themselves against harm or exploitation. The term replaces vulnerable adult and alleged victim Advocacy is taking action to help people say what they want, secure their rights, represent their interests and obtain services they need. Alert describes the action of reporting concerns and allegations into the multi-agency safeguarding adult contact point. Alerter is the person who alerts the multi-agency safeguarding adult contact point that an adult is being, has been, or is at risk of being abused or neglected. This could be the person themselves, a member of their family, a carer, a member of staff or any other person. Within an organisation, the alerter will usually be the alerting manager. Alerting Manager is the person within an organisation to whom any member of staff (or volunteer) should report their concerns. The alerting manager will make an alert by reporting the concerns to the multi-agency safeguarding adult contact point. Carer refers to unpaid carers, for example, relatives or friends of the adult at risk. Paid workers, including personal assistants, whose job title may be carer, are called staff within this policy and procedure. Case Conference Meeting is a multi-agency meeting held to discuss the outcome of a safeguarding investigation and to put in place a protection plan. Case Conference Discussion is held where a case conference meeting is not required. It is held to discuss the outcome of the safeguarding investigation and to put in place a protection plan. This can be held in a number of ways, including a face to face meeting, by telephone or by . Clinical Governance is the framework through which the National Health Service (NHS) improves the quality of its services and ensures high standards of care. CPA - Care Programme Approach requires health authorities, in collaboration with social services departments, to put in place specified arrangements for the care and treatment of people with mental health problems in the community. CPS - Crown Prosecution Service is the government department responsible for prosecuting criminal cases investigated by the police in England and Wales. Version iii

11 CQC - Care Quality Commission is responsible for the registration and regulation of health and social care in England. Disclosure and Barring Service is a public body set up to help prevent unsuitable people from working with children and vulnerable people. It is an amalgamation of the Criminal Records Bureau and the Independent Safeguarding Authority. DoLS - Deprivation of Liberty Safeguards are a legal safeguard for people who cannot make decisions about their care and treatment when they need to be cared for in a particularly restrictive way. They apply to people in care homes or hospitals when they are deprived of their liberty. EDO - Emergency Duty Officer is the social worker on duty in the Emergency Duty Team (EDT). EDT - Emergency Duty Teams are social services teams that respond to out-of-hours alerts where intervention is required to protect a child or adult at risk, and where it would not be safe or appropriate to delay that intervention to the next working day. Harm is defined in No Secrets (2000) as not only ill treatment (including sexual abuse and forms of ill treatment which are not physical), but also the impairment of, or an avoidable deterioration in, physical or mental health, and the impairment of physical, intellectual, emotional, social or behavioural development. HSE - Health and Safety Executive is a national independent regulator that aims to reduce work-related death and serious injury across workplaces. IDVAs - Independent Domestic Violence Advisers are trained support workers who provide assistance and advice to victims of domestic violence. IMCAs - Independent Mental Capacity Advocates are a legal safeguard for people who lack the mental capacity to make specific important decisions, including making decisions about where they live, serious medical treatment, safeguarding adults, care reviews and Deprivation of Liberty Safeguards (DoLS). IMCAs are mainly instructed to represent people where there is no one independent of services, such as a family member or friend, who is able to represent the person. Informed Consent is the voluntary agreement of a person who has mental capacity to a course of action based on an adequate knowledge of the purpose, nature, likely effects and risks of that intervention, including the likelihood of its success and any alternatives to it. Investigation is a process of gathering evidence to determine whether abuse took place. Large Scale Investigation is the term used to describe the investigation response within the safeguarding adult procedures where a number of adults are at risk. This may be required, for example, where there are concerns about how a service provider is caring for a number of its service users. MAPPA - Multi-Agency Public Protection Arrangements are statutory arrangements for managing sexual and violent offenders. Version iv

12 MARAC - Multi-Agency Risk Assessment Conference is the multi-agency forum that manages high-risk cases of domestic violence, stalking and honour - based violence. Mental Capacity is the ability to make a decision about a particular matter at the time the decision needs to be made. NHS - National Health Service is the country s publicly funded healthcare system. OPG - Office of the Public Guardian, supports the Public Guardian in registering enduring powers of attorney, lasting powers of attorney and supervising Court of Protection appointed deputies. Organisation Alleged to Have Caused Harm is an organisation that is alleged to be responsible for abuse experienced by an adult at risk. PALS - Patient Advice and Liaison Service is an NHS body created to provide advice and support to NHS patients and their relatives and carers. Person Alleged to Have Caused Harm is a person who is alleged to be responsible for abuse experienced by an adult at risk. This term replaces alleged perpertrator Public Interest is determined by balancing the rights of the individual to privacy with the rights of others to protection. Referral involves the decision to proceed to a safeguarding strategy discussion or meeting to plan an investigation, assess risk and agree interim protection arrangements. Safeguarding Adults is used to describe all work to help adults at risk stay safe from abuse. It replaces the term adult protection. Safeguarding Investigating Officer is a member of staff from Adult Social Care (or an NHS organisation according to local arrangements) or a service provider manager who leads an investigation into the allegation of abuse and produces the safeguarding investigation report. The safeguarding investigating officer s role is overseen by the safeguarding coordinator. Safeguarding Adults Lead is the title given to the member of staff in an organisation who is given the lead for safeguarding adults. The role may be combined with that of alerting manager, depending on the size of the organisation. Safeguarding Coordinators are professionals within Adult Social Care or NHS organisations that have overall responsibility for managing the safeguarding arrangements. This includes the decision as to whether the multi-agency safeguarding adult procedures should be followed, managing the safeguarding adult strategy discussion/meeting, overseeing the protection plan arrangements/investigation, and convening the case conference discussion/meeting. SAB - Safeguarding Adults Board are joint working arrangements comprising statutory and non-statutory organisations that work together within a local authority area to provide strategic leadership to safeguard adults at risk. Version v

13 Serious Case Review is undertaken by a Safeguarding Adults Board (SAB) when there is the potential for significant multi-agency learning as to how safeguarding practice and systems can be improved. SI - Serious Incident is a term used by the National Patient Safety Agency (NPSA). It is defined as an incident that occurred in relation to NHS-funded services resulting in serious harm or unexpected or avoidable death of one or more patients, staff, visitors or members of the public. Strategy Discussion is a multi-agency discussion between relevant organisations and parties in order to agree how to proceed with the referral. This will include reviewing the need for an investigation, planning any investigation, assessing risk and agreeing interim protection arrangements. This can be held in a number of ways, including a face to face meeting, by telephone or by . Strategy Meeting is a multi-agency meeting with the relevant individuals involved, and with the adult at risk where appropriate, to agree how to proceed with the referral. This will include reviewing the need for an investigation, planning any investigation, assessing risk and agreeing interim protection arrangements Target Timescales establish standards of practice within the procedures that must be achieved wherever possible. Divergence from target timescales may be required in order to achieve safe and appropriate outcomes for the adult at risk. This may occur for example, due to the complexity of an investigation or where there are parallel processes such as criminal or serious incident investigations. Reasons for divergence from timescales should be recorded. Vital Interest is a term used within these procedures to describe actions critical to prevent serious harm or distress or in life-threatening situations. Version vi

14 Introduction These West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures represent the commitment of organisations in West Yorkshire to work together to safeguard adults at risk. Safeguarding adults refers to: All the work which enables an adult [at risk] to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect (ADASS, 2005 Safeguarding Adults). Building upon the recommendations of No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse Department of Health, 2000), ADASS highlighted that: Strong partnerships are those whose work is based on an agreed policy and strategy, with common definitions and a good understanding of each other s roles and responsibilities. These underpin partnership working in response to instances of abuse and neglect, wherever they occur (Safeguarding Adults, 2005). These West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures seek to achieve these aims by: establishing common procedures that enable adults at risk to receive the protection and support they are entitled to as citizens providing a consistent framework for multi-agency working and partnership providing a coherent framework for recognising and taking action to prevent the abuse of adults at risk defining the responsibilities of partner organisations in responding to safeguarding adult concerns/allegations providing common values, principles and practice that underpin the protection of adults at risk defining the different types of abuse, signs, symptoms and indicators setting standards of practice that safeguard adults at risk. These West Yorkshire Safeguarding Adult Multi-Agency Policies and Procedures apply equally to: all adults at risk as defined within this policy all organisations all settings, and all forms of abuse Version vii

15 Local implementation Each West Yorkshire Safeguarding Adults Board has adopted these policy and procedures to ensure consistency of approach across the West Yorkshire region. Each local Board will have additional supporting policies, procedures, guidance and forms that support these policy and procedures. These can be accessed from their respective websites. Bradford Calderdale Kirklees Leeds Wakefield Structure This report is divided into two parts: Part One: Policy The policy section establishes the scope and guiding principles of the procedures, as well as the responsibilities of organisations and individuals. It includes sections relating to: adult at risk and abuse safeguarding principles and values prevention roles of safeguarding partners specialist support services and linked agendas responsibilities within commissioning responsibilities in managing safeguarding arrangements Part Two: Procedures The procedures section details the actions required of individuals and organisations to respond to suspected or actual abuse of an adult at risk. Actions within the procedures should be informed by the policy. Review The policy and procedures described here will be reviewed in 6 months by the West Yorkshire Safeguarding Adult Project Team. If you identify areas of omission or potential improvements to these policy and procedures, you can inform the review by ing your comments to: feedback.safeguardingadultswypp@kirklees.gov.uk Version viii

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17 West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures PART ONE: POLICY

18 PART ONE: POLICY 1 Adult at risk and abuse Part One: Policy ADULT AT RISK AND ABUSE 1.1 Definition of an adult at risk The term adult at risk is used within this policy in replacement of the term vulnerable adult. The term vulnerable adult has become criticised as it is felt that the term implies that the problem of abuse lies with the person themselves, rather than their circumstances or the person that caused the abuse or neglect. The term adult at risk is accepted as being more respectful to those to whom it refers. An adult at risk is defined as a person aged 18 years or over: who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against harm or exploitation (Department of Health, 2000, No Secrets). An adult at risk may therefore be a person who, for example: is an older person who is frail due to ill health, physical disability or cognitive impairment has a learning disability has a physical disability and/or a sensory impairment has mental health needs including dementia or a personality disorder has a long-term illness/condition misuses substances or alcohol is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse lacks the mental capacity to make particular decisions and is in need of care and support This list is not exhaustive. 1.2 Abuse For the purpose of the safeguarding adults policy and procedures the term abuse is defined as: a violation of an individual s human and civil rights by any other person or persons (Department of Health, 2000, No Secrets). Abuse may consist of: a single or repeated acts an act of commission or omission multiple acts, for example, an adult at risk may be neglected and also being financially abused Version

19 Part One: Policy ADULT AT RISK AND ABUSE Abuse may be intentional or unintentional. It involves the misuse of power and control that one person has over another. A number of abusive acts are crimes and informing the police must be a key consideration. 1.3 Harm Harm is the term used to justify intervention within the safeguarding adults procedures. The term harm is described within No Secrets as involving: ill treatment (including sexual abuse and forms of ill treatment which are not physical) the impairment of, or an avoidable deterioration in, physical or mental health and/or the impairment of physical, intellectual, emotional, social or behavioural development The importance of this definition is that in deciding what action to take, consideration must be given not only to the immediate impact and risk to the person, but also to the risk of future, longer-term harm. 1.4 Types of abuse Abuse can be viewed in terms of the following categories: physical sexual psychological/emotional financial neglect discriminatory institutional Many abusive behaviours will constitute a criminal offence Physical abuse Examples of physical abuse include: hitting, slapping, pushing, kicking, misuse of medication, illegal restraint or inappropriate sanctions. Restraint Unlawful or inappropriate use of restraint or physical interventions and/or unlawful deprivation of liberty is physical abuse. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where a person s freedom of movement is restricted, whether they are resisting or not. Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want to within a closed environment. Version

20 Part One: Policy ADULT AT RISK AND ABUSE Use of restraint can be justified to prevent harm to a person who lacks mental capacity, as long as it is a proportionate response to the likelihood and seriousness of the harm. There is a distinction to be drawn between restraint, restriction and deprivation of liberty. A judgement as to whether a person is being deprived of liberty will depend on the particular circumstances of the case, taking into account the degree of intensity, type of restriction, duration, the effect and the manner of the implementation of the measure in question. In extreme circumstances unlawful or inappropriate use of restraint may also constitute a criminal offence. Providers of health and social care must have in place internal operational procedures covering the use of physical interventions and restraint, incorporating best practice guidance and the Mental Capacity Act, Mental Capacity Act Code of Practice and the Deprivation of Liberty Safeguards (DoLS) Sexual abuse Examples of sexual abuse include - rape and sexual assault or sexual acts to which the adult at risk has not consented, or could not consent or was pressured into consenting. Sexual acts, would include being made to watch sexual activity. Sexual abuse is not confined to issues of consent, the following factors should also be considered: Any sexual relationships or inappropriate sexualised behaviour between a member of staff and a service user are always abusive and should lead to disciplinary proceedings. A sexual act between a care worker and a service user with a mental disorder is also a specific criminal offence under Sections of the Sexual Offences Act Psychological/emotional abuse Examples of psychological/emotional abuse include - threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks. This is behaviour that has a harmful effect on the person s emotional health and development or any actions that result in: mental distress the denial of basic human and civil rights such as self-expression, privacy and dignity negating the right of the adult at risk to make choices and undermining their selfesteem isolation and over-dependence that has a harmful effect on the person s emotional health, development or well-being Psychological/emotional abuse can result from other abusive acts and therefore may occur as a result of or alongside other types of abusive behaviour. Version

21 1.4.4 Financial and material abuse Part One: Policy ADULT AT RISK AND ABUSE Financial and material abuse is a crime. It is the use of a person s property, assets, income, funds or any resources without their informed consent or authorisation. It includes: theft fraud exploitation undue pressure in connection with wills, property, inheritance or financial transactions the misuse or misappropriation of property, possessions or benefits the misuse of an enduring power of attorney or a lasting power of attorney, or appointeeship Neglect and acts of omission Examples of neglect and acts of omission include - ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Neglect and acts of omission concern the failure of any person who has responsibility for the care of an adult at risk to provide the amount and type of care that a reasonable person would be expected to provide. Neglect and acts of omission can be intentional or unintentional. Intentional acts involve: wilfully failing to provide care wilfully preventing the adult at risk from getting the care they need being reckless about the consequences of the person not getting the care they need If the individual committing the neglect or acts of omission is aware of the consequences and the potential for harm to result from the lack of action(s), then it is intentional in nature. Unintentional neglect or acts of omission could result from a carer failing to meet the needs of the adult at risk because they do not understand their needs, or may not know about services that are available or because their own needs prevent them from being able to give the care the person needs. It may also occur if the individual is unaware of or does not understand the possible effect of their lack of action on the adult at risk Discriminatory abuse Examples of discriminatory abuse include - abuse based on a person s race, sex, disability, faith, sexual orientation, or age; other forms of harassment, slurs or similar treatment or hate crime/hate incident. Discriminatory abuse exists when values, beliefs or culture result in a misuse of power that denies opportunity to some groups or individuals. It can result from situations that exploit a Version

22 Part One: Policy ADULT AT RISK AND ABUSE person s vulnerability by treating the person in a way that excludes them from opportunities they should have as equal citizens, for example, education, health, justice and access to services and protection Institutional abuse Institutional abuse refers to those incidents of abuse that derive, to a significant extent, inadvertently or otherwise, from an organisation s practice, culture, policies and/or procedures. Neglect and poor professional practice may take the form of isolated incidents of poor or unsatisfactory practice, at one end of the spectrum through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems and this is sometimes referred to as institutional abuse (No Secrets 2000) Self-neglect Self-neglect does not fall within the scope of these safeguarding adults procedures. Consideration should be given to whether people are making informed decisions about their needs, the risks associated with their actions/decisions and the available sources of support. Issues of mental capacity also need to be considered. Service responses should be clearly recorded and provide opportunities for support to be provided at a future time, if the person is declining assistance. Individual agency as well as multi-agency risk assessment and management responses may be appropriate in order to respond to issues of self-neglect. 1.5 Patterns of abuse Patterns of abuse vary and reflect very different dynamics. These include: serial abuse in which the perpetrator seeks out and grooms vulnerable individuals (this pattern is usually associated with sexual abuse as well as some forms of financial abuse) long term abuse may occur in the context of an ongoing relationship such as domestic violence between partners or generations opportunistic abuse - such as theft occurring because money has been left around situational abuse - arises because pressures have built up and/or because of difficult or challenging behaviour neglect of a person s needs because those around him or her are not able to be responsible for their care, for example if the carer has difficulties caused by debt, alcohol or mental health problems institutional abuse which features poor care standards, lack of positive responses to complex needs, rigid routines, inadequate staffing and/or insufficient knowledge based within the service unacceptable treatments or programmes which include sanctions or punishment such as withholding of food and drink, seclusion, unnecessary and unauthorised use of control and restraint or over-medication Version

23 Part One: Policy ADULT AT RISK AND ABUSE failure of agencies to ensure staff receive appropriate guidance on antidiscriminatory practice, including harassment, victimisation and hate crime failure to access key services such as health care, dentistry, prostheses misappropriation of benefits and/or use of the person s money by other members of the household fraud or intimidation in connection with a will or property or other assets Abuse can take place in any context. It may occur when an adult at risk lives alone or with a relative; it may also occur within nursing, residential or day care settings, within hospitals or other places previously assumed safe, or in public places. 1.6 Who might commit abuse? These procedures are relevant to all incidents of abuse, regardless of who has committed them. Anyone might be responsible for abuse, including: a member of staff, a proprietor or service manager a member of a recognised professional group a service user, or other adult at risk a volunteer a member of a community group such as place of worship or social club a spouse, relative, member of the person s social network or a carer; i.e. someone who is eligible for an assessment under the Carers (Recognition and Services) Act 1995 a child, including the person s own son or daughter a neighbour, member of the public or stranger; or a person who deliberately targets adults at risk in order to exploit them Abuse by another adult at risk It is the nature of the incident and its impact, rather than the nature of the relationship between those concerned that are the important factors in determining the need for the safeguarding adults procedures to be followed. Where such an incident occurs within a service, for example where both people are living in a care setting, the risk of harm may be compounded by the emotional distress of living with an abusive person. The safety of the adult at risk will be of primary importance. However, where the person causing harm is also an adult at risk, there may also be ongoing responsibilities for their welfare. Consideration may be required as to how their care and support needs are being provided for, and whether the incident reveals unmet needs. Such an assessment should be undertaken separately from the person experiencing abuse. It will be necessary for such an assessment to consider: the extent to which the person causing the harm is able to understand his/her actions the extent to which the abuse or neglect reflects the needs of the person causing the harm the likelihood that the person causing the harm will further abuse the victim or others the support/care needs of that individual Version

24 1.6.2 Abuse by carers who are relatives or friends Part One: Policy ADULT AT RISK AND ABUSE There is a difference between unintentional harm caused inadvertently by a carer and a deliberate act of either harm or neglect. In cases where unintentional harm has occurred this may be due to a lack of knowledge or due to the fact that the carer s own physical or mental health needs make them unable to care adequately for the adult at risk. The carer may also be an adult at risk. In this situation an outcome of the safeguarding adults procedures will be to support the carer and to help make changes in their behaviour, in order to decrease the risk of further harm to the person they are caring for. In such circumstances, a carer s assessment where required, should take into account the following factors: whether carer demands exceed the carer s ability or capacity the emotional and/or social isolation of the carer and the adult at risk communication difficulties between the adult at risk and the carer whether the carer is in receipt of any practical and/or emotional support from other family members or professionals financial difficulties whether the carer has a lasting power of attorney or appointeeship a personal or family history of violent behaviour, alcoholism, substance misuse or mental illness the physical and mental health and well-being of the carer Abuse of trust A relationship of trust is one in which one person is in a position of power or influence over the other person because of their work or the nature of their activity. Where the person who is alleged to have caused harm is in a position of trust, the adult at risk may be reluctant to make a complaint or take action out of a sense of loyalty, fear, of abandonment or other repercussions. Where the person who is alleged to have caused the abuse or neglect has a relationship of trust with the adult at risk because they are a member of staff, a paid employee, a paid carer, a volunteer or a manager or proprietor of an establishment, the organisation will need to invoke its disciplinary procedures as well as taking action under the safeguarding adults policy and procedures. A referral must also be made to professional bodies (where applicable) and the Disclosure and Barring Service if the employee or volunteer has been found to have harmed or put at risk of harm an adult at risk and the relevant criteria has been met. If the person who is alleged to have caused the abuse is a member of a recognised professional group the organisation will need to take actions under the relevant code of conduct for the profession as well as taking action under these policy and procedures. Version

25 If a crime is suspected it must be reported to the police. Part One: Policy ADULT AT RISK AND ABUSE In all cases regard should be given to issues of consent, confidentiality and information sharing Abuse by children If an adult at risk is being abused by a child (including their own child), the response should involve the local authority children s services as appropriate, in order to respond to the risks of harm. Version

26 2 Principles and Values Part One: Policy PRINCIPLES AND VALUES The West Yorkshire Multi-Agency Safeguarding Adults Policy and Procedures are founded on the following safeguarding principles and values that govern how the safeguarding adults procedures should be implemented. These principles and values are based upon national guidance on achieving good outcomes for adults at risk. 2.1 Principle 1: Empowerment Empowerment is the principle that adults should be in control of their lives and consent is needed for decisions and actions designed to protect them. The purpose of safeguarding is to enable people to live a life free from abuse and neglect. It is therefore vital that if someone has mental capacity and is able to make their own decisions that they maintain control and that professionals support their decision-making at each stage of the process. This includes: working towards the outcome the person wants listening to the individual and ensuring their voice is heard taking actions with a person s consent, unless there is a clear justification for acting contrary to the person s wishes, such as for reasons of public interest or lack of mental capacity as detailed within the procedures ensuring they receive support to participate in all decisions about them (for example, with the support of friends/family/advocacy, personal assistants, translators) and due regard is given to issues of accessibility, equality and diversity enabling people to make informed decisions (for example, sharing assessments of risk, sharing information on available support options to reduce those risks, and providing support to weigh up risks and solutions) respecting the choices and decisions that people make allowing people to change their mind if their views or circumstances change In the event that a person is without the mental capacity to make a particular decision for themselves, a best interests decision should be made in line with the Mental Capacity Act 2005 and Code of Practice. They should continue to be involved to the fullest extent possible, and decision making must recognise their wishes, feelings, beliefs and values and ensure that they are appropriately represented. 2.2 Principle 2: Protection The safeguarding adults procedures provide a framework by which adults can be supported to safeguard themselves from abuse, or protected, where they are unable for reasons of mental capacity to make decisions about their own safety. Assessments of mental capacity and best interest decisions in relation to those without mental capacity must always be in accordance with the Mental Capacity Act 2005 and Code of Practice. Protection encompasses each and every person s duty of care and/or moral responsibility to act upon suspicions of abuse within the context of these procedures; and ensure that adults at risk as citizens receive the protection afforded to them in law. Version

27 2.3 Principle 3: Prevention Part One: Policy PRINCIPLES AND VALUES Prevention of abuse is the primary goal and members of the public, agencies, service providers, individual employees or volunteers and communities all have a role in preventing abuse from occurring. Prevention involves promoting awareness and understanding and supporting people to safeguard themselves from the risk of abuse. This includes helping people to identify and make informed decisions about risks and develop forward plans that keep them safe. Prevention also refers to the actions of organisations to ensure they have systems in place that minimise the risk of abuse. Prevention is associated with a broad range of responsibilities and initiatives; each associated with making safeguarding adults a core responsibility within the context of providing high quality services. More information about prevention is detailed in Section Principle 4: Proportionality The principle of proportionality concerns the responsibility to ensure that responses to alerts are proportional to assessed risk and the nature of the allegation/concern. Proportionate decisions need to take into account the principles of empowerment and protection. This principle of proportionality is also encompassed within the Mental Capacity Act 2005, where a person lacks mental capacity to make a particular decision; it must be made in the person s best interests. This includes the responsibility to consider if the outcome can be achieved in a way that is less restrictive of the person s rights and freedoms. 2.5 Principle 5: Partnerships Partnership means working together as partners to prevent and respond effectively to incidents or concerns of abuse. Partnership means working together effectively to support the adult at risk in making informed decisions about identified risks of harm and helping them to access sources of support that keep them safe. Partnership also includes working with relatives, friends, informal carers or other representatives such as advocates as partners, as appropriate, to achieve positive outcomes for the adult at risk. Partnership also means working cooperatively with other agencies to prevent, investigate and end abuse. Statutory, private, voluntary and specialist or mainstream services and their representatives should be considered partners within these procedures. 2.6 Principle 6: Accountability The principle of accountability involves transparency and decision making that can be accounted for. This involves each individual and organisation fulfilling their duty of care, making informed defensible decisions, with clear lines of accountability. It involves organisations, staff (and volunteers) understanding what is expected of them, recognising and acting upon their responsibilities to each other, and accepting collective responsibility for safeguarding arrangements. Version

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