Safeguarding Adults Policy

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1 Safeguarding Adults Policy

2 Safeguarding Adults Policy Policy ref no: CCG 003/15 Author (inc job Paulette Nuttall title) Designated Safeguarding Adults and MCA Lead Nurse Date Approved 25 th August 2015 Approved by Bristol CCG Governing Body Date of next 2017 review How is policy to HOT Group be disseminated Safeguarding Group Equality and Diversity Check list for Governing Body/approving committee Has an Equality Impact Assessment been completed? Has legal advice been sought? Have training issues been addressed? Are there financial issues and have they been addressed? How will implementation be monitored How will the policy be shared with: Staff? Patients? Public? Are there linked policies and procedures? Yes No yes No By the Safeguarding Adults and MCA Lead and Safeguarding Group CCG s Website Internal and External Complaints Policy Disciplinary Policy Incident Reporting policy Mental Capacity Act & Deprivation of Liberty Safeguards Policy Safeguarding Children policy Prevent Whistle Blowing Policy 2

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4 Contact Names for Guidance and Information Name Contact Numbers and s Role Bristol CCG Paulette Nuttall Designated Safeguarding Adults and MCA Lead Nurse Bristol CCG Pippa Stables Safeguarding Adults GP Lead Bristol CCG Rachel Griffiths MARAC Nurse Sarah Nicholson PA to Designated Safeguarding Adults and MCA Lead Nurse Bristol CCG Jo Kapp Continuing Health Care Programme Manager Bristol CCG Richard Lyle Programme Director Community, Partnerships & PPI Tele: Work Mobile: session per week at South Plaza on Thursdays C/o Tele: Work Mobile : Tele: Tele: Work Mobile : Tele: For advice and support to all CCG staff and GPs Safeguarding Adults Mental Capacity Act Prevent Training and Policy For advice and support for GPs For advice and support for GPs with regards to the Domestic Violence and MARAC process For managing messages and signposting For advice and guidance in relation to Deprivation of Liberty Domestic DOLs (only) For advice and guidance in relation to multi agency complex commissioning Bristol Care Direct Triage Team Bristol City Council Tracey Judge Safeguarding Adults Strategic Coordinator Bristol City Council Johnson Koikkara MCA and DOLs Coordinator Tele Fax: Tele Tele Mobile am to 5pm Monday to Friday (answerphone outside office hours). For advice and support Safeguarding Adults & Section 42 on the Care Act For advice and guidance in relation to the application of the Mental Capacity Act and Deprivation of Liberty Safeguards Police Telephone 101 In an emergency telephone 999 If a crime has been committed Care Quality Commission Tele: For General Enquires 4

5 Contents 1 Introduction Scope Purpose of the Policy Legislation and NHS Outcome Framework Adult Safeguarding what it means and why it matters Involving the adult in safeguarding Making Safeguarding Personal Safeguarding Principles Who do we safeguard? Types and patterns of abuse and neglect Domestic Abuse MARAC Hate Crime Forced Marriages Who abuses and neglects adults? Patterns of abuse Mental Capacity Statutory and Non-statutory Enquiries Statutory Enquiries Non-statutory Safeguarding Enquiries The Enquiry Criminal offences Prevent The CCG Prevent Lead Safeguarding Adults Reviews (SARs) Information Sharing Consent Statutory duties and responsibilities of the CCG Director/s of Transformation and Quality and Community and Partnerships

6 16.2 Designated Safeguarding Adults and MCA Nurse Lead Safeguarding Adults GP Lead Head of Quality Senior Managers Continuing Health Care (CHC) Medicines Management Commissioners All Line managers All Staff General Practitioners and Staff Commissioning Support Unit (CSU) Human Resources Commissioning Support Unit (CSU) Contracts Robust Complaints Procedures Managing Allegations Whistle Blowing Working Together for Safeguarding Bristol CCG Safeguarding Group Structure Flowchart...25 Information you need to give:...25 Bristol Safeguarding Adults Referral Form

7 1 Introduction Bristol Clinical Commissioning Group (CCG) is committed to working with partner agencies to ensure the safety and health and well-being of local people. Protecting the vulnerable is a key part of our approach to commissioning and together with a focus on quality and patient experience, is integral to how we work. Our approach to safeguarding is underpinned by a performance management culture, contracting systems and processes that aim to reduce the risk of harm and respond quickly to any concerns. 2 Scope The NHS is accountable to patients for their safety and wellbeing through delivering high quality care. Quality is defined as providing care that is effective and safe and which results in a positive experience. The NHS has particular duties for patients less able to protect themselves from harm, neglect or abuse. All commissioners and contractors have a responsibility to ensure that service specifications, invitations to tender, service contracts and service level agreements promote dignity in care and adhere to local multi-agency safeguarding policies and procedures. Commissioners must also assure themselves that care providers know about and adhere to relevant CQC Standards. Contract monitoring must have a clear focus on safeguarding and robustly follow up any shortfalls in standards or other concerns about patient safety. Commissioners will also want to assure that when abuse or neglect occurs, responses are in line with local multi-agency safeguarding procedures, national frameworks for Clinical Governance and investigating patient safety incidents. Therefore these services must produce clear guidance to managers and staff that sets out the processes for initiating action and who is responsible for any decision making. 3 Purpose of the Policy The Care Act came in to force on the April 1 st 2014 and is the most significant piece of legislation since the establishment of the welfare state; it replaces the patchwork of adult legislation that has arisen since the 1948 National Assistance Act. The Act requires local authorities to promote integration with the NHS and other key providers this includes working through local health and wellbeing boards. The Act fundamentally aims to place people at the centre of their care and support and to maximise their involvement. Adult safeguarding for the first time has been spelt out in the law of the Care Act and local authorities must make enquires, or cause enquiries, if they believe an 7

8 adult is, or is at risk, of being abused or neglected. This means that local authorities Must cooperate with each of their relevant partners as described in section 6 (7) of the Care Act and those partners Must also cooperate with the local authority, in the exercise of their functions relevant to care and support including those to protect adults. More importantly, as the Care Act (2014) brings adult safeguarding onto a statutory footing there are a range of new duties for NHS England (NHSE), the CCG and other NHS partners. The revised 2015 Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework document; has been rewritten to incorporate the safeguarding roles in relation to the statutory requirements of the Care Act (2014).Section Safeguarding replaces the No Secrets Guidance. Bristol CCG as commissioners of services and as an organisation a core statutory partner to the Safeguarding Adults Board; need to ensure that all its staff members have access to and the understand policies and procedures; including their roles and responsibilities in responding to any safeguarding adults concerns. This policy sets out Bristol CCGs statutory duties, roles and responsibilities of staff and volunteers employed by the organisation. This policy must be used in conjunction with the overarching Safeguarding Adults Multiagency Policy as agreed by Safeguarding Adults Board in BANES, Bristol City, North Somerset, South Gloucestershire and Somerset County. 4 Legislation and NHS Outcome Framework People have fundamental rights contained within the Human Rights Act Health services have positive obligations to uphold these rights and protect patients who are unable to do this for themselves. Other legislation particular relevant to safeguarding adults includes the: Mental Health Act 1983 Mental Capacity Act and DoLs 2005 NHS Act 2006 Safeguarding Vulnerable Groups 2006 Equality Act 2010 Domestic violence protection orders Care Act 2014 Deprivation of Liberty Safeguards Supreme Court Ruling 2014 Modern Slavery Act 2015 NHS Outcome Framework Domain 4 - Ensuring people have a positive experience of care Domain 5 - Treating and caring for people in a safe environment and protecting them from avoidable harm. 8

9 5 Adult Safeguarding what it means and why it matters Safeguarding means protecting an adult s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both risks and experience of abuse or neglect, whilst at the same time ensuring the adult s wellbeing is promoted. Also, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent and have unclear or unrealistic views about their personal circumstances. Organisations should always promote the adults wellbeing in their safeguarding arrangements. People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adults to establish what being safe means to them and how that can be best achieved. Professional and other staff should not be advocating a safety measure that does not take into account of individual well-being, as defined in section 1 of the Care Act. 6 Involving the adult in safeguarding 6.1 Making Safeguarding Personal The Making Safeguarding Personal programme, led by ADASS and LGA, with funding from the Department of Health, has gained widespread momentum. It follows the edict of no decision about me without me and means that the adult, their families and carers are working together with agencies to find the right solutions to keep people safe and support them in making informed choices. There must be enough capacity to provide an advocate to individuals when they are unable to speak for themselves without support (and meet the test set out in the Act) or an Independent Mental Capacity Advocate (IMCA) if they are subject to the MCA or an Independent Mental Health Advocate if they are subject to that Act. In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised. Making safeguarding personal means it should be person-led and outcomefocused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving the quality of life, well-being and safety. 9

10 6.2 Safeguarding Principles The government has agreed safeguarding principles that underpin the work of adult safeguarding these are: Empowerment people being supported and encouraged to make their own decisions and informed consent Preventions it s better to take action before harm occurs Proportionality the least intrusive response appropriate the risk presented Protection - support and representation for those in greatest need Partnership - local solutions through services working with their communities who have a part to play in preventing, detecting and reporting neglect and abuse Accountability Accountability and transparency in delivering safeguarding 7 Who do we safeguard? Safeguarding adult s duties now applies to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect. 7.1 Types and patterns of abuse and neglect Physical abuse including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions. Domestic abuse including psychological, physical, sexual, financial, emotional abuse; so called honour based violence. Sexual abuse including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting. Financial or material abuse including theft, fraud, internet scamming, coercion in relation an adult s financial affairs or arrangements, including in 10

11 connection with wills, property, inheritance or financial transactions, or the misuse of misappropriation of property, possessions or benefits. Modern slavery encompasses slavery, human trafficking, and forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment. Discriminatory abuse including forms of harassment, slurs or similar treatment; because of race, gender, and gender identity, age, disability, sexual orientation or religion. Organisational abuse including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect of poor professional practice as a result of the structure, policies, processes and practices within an organisation. Neglect and acts of omission including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Self-neglect this covers a wide range of behaviour neglecting to care for one s personal hygiene, health or surroundings and includes behaviour such as hoarding. 7.2 Domestic Abuse In 2013, the Home Office announced changes to the definition of domestic abuse: Incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse by someone who is or has been an intimate partner or family member regardless of gender or sexuality Includes: psychological, physical, sexual, financial, emotional abuse; so called honour based violence; Female Genital Mutilation; forced marriage. Age range extended down to 16. Many people think that domestic abuse is about intimate partners, but it is clear that other family members are included and that much safeguarding work that occurs at home is, in fact, concerned with domestic abuse. This confirms that domestic abuse approaches and legislation can be considered safeguarding responses in appropriate cases. 11

12 Effective safeguarding is achieved when agencies share information to obtain an accurate picture of the risk is prioritised. In high risk situations it may be relevant to use the Multiagency Risk Assessment Conference (MARAC) process MARAC A MARAC is a meeting where information is shared on the highest risk domestic abuse cases between representatives of the local police, probation, health children and adults safeguarding bodies, housing practitioners, substance misuse services, independent Domestic Violence Advisers(IDVAs)and other specialists from the statutory and voluntary sectors. Aim of a MARAC To safeguard the victims who are at high risk of future domestic abuse ; To make links with other public protection arrangements in relation to children, people causing harm and vulnerable adults To safeguard agency staff, and; To work towards addressing and managing the behaviour of the person causing harm Statutory Guidance places duty on Community Safety Partnerships to make arrangements for Domestic Homicide Reviews. Health bodies are required to participate in these as requested (section 9 Domestic Violence, crime and victims Act 2004) 7.3 Hate Crime A hate crime is a criminal offence that is motivated by hostility or prejudice based upon the victims disability, race, religion or belief, sexual orientation and transgender identity. Hate crime can take on forms of physical attack; hate crime must be reported to the local police. 7.4 Forced Marriages Forced marriage is a term used to describe marriage in which one or both of the parties is married without their consent or against their will. A forced marriage differs from an arrange marriage, in which both parties consent to the assistance of their parents or third party in identifying a spouse. In situation where there is concern than an adult at risk is being forced in to a marriage they do not or cannot consent to, there will be an overlap between action taken under the provisions and the safeguarding adult s process. In this case action will be coordinated with he police and other 12

13 relevant organisations. The police must always be contacted in such cases as urgent action may need to be taken. 7.5 Who abuses and neglects adults? Anyone can carry out abuse or neglect, it can happen anywhere and in any setting for example, in someone s own home, in a public place, hospital, in a care home or in college. It can also take place when an adult lives alone or with others. Neglect can be intentional or unintentional and it is important to understand treat being unintentional does not mean it is not abusive. 7.6 Patterns of abuse Incidents of abuse may be one off or multiple and affect one person or more. Professionals and others should look beyond single incidents and or individuals to identify patterns of harm. Repeated instances of poor care may be an indication of more serious problem and of what we know describe as organisational abuse in order to see patterns it is important that information is recorded and appropriately shared. 8 Mental Capacity The Mental Capacity Act 2005 (MCA) provides a statutory framework to empower and protect vulnerable people who are unable to make their own decisions. It is essential that all CCG staff work in accordance to the MCA and in conjunction Mental Capacity and DoLS Policy and the MCA Code of Practice. An adult must be assumed to have capacity to make their own decisions, and have been given all practical support before they can be assessed as lacking capacity. Capacity assessments must always be time and decision specific. If an adult has been assessed to lack capacity then staff must follow the key principles of the MCA and ensure that any decisions made on behalf on an adult have been made in best interest and least restrictive. Safeguarding adults procedures do not replace the MCA. If an adult is part of a safeguarding procedure and lacks mental capacity it is important that any decisions relating to the protection plan for an adult at risk are made in line with the MCA. The MCA created the criminal offences of ill-treatment and wilful neglect in respect of people who lack the ability to make decisions. The offences can be committed by anyone responsible for that adult s care and support e.g. paid staff; family carers, people who have the legal authority to act on that adult s behalf i.e. persons with power of attorney or Court-appointed deputies. 13

14 9 Statutory and Non-statutory Enquiries 9.1 Statutory Enquiries Safeguarding enquiries carried out on behalf of adults who fit the criteria outlined in Section 42 of the Care Act Local authorities are required by law to carry out safeguarding enquiries for these individuals. The criteria for a Section 42 enquiry are an adult who is believed to: Have needs for care and support (whether or not the local authority is meeting any of those needs), and; is experiencing, or is at risk of, abuse or neglect, and; as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect. 9.2 Non-statutory Safeguarding Enquiries Safeguarding enquiries carried out on behalf of adults who do not fit the criteria outlined in Section 42 of the Care Act Local authorities are not required by law to carry out enquiries for these individuals; they do so at their own discretion. These enquiries would relate to an adult who: Is believed to be experiencing, or is at risk of, abuse or neglect, and; does not have care and support needs (but might have just support needs). These enquiries might be about a carer for example. 10 The Enquiry Local authorities must make enquiries, or cause others to do so, if they reasonably suspect any adult: Have needs for care and support (whether or not the local authority is meeting any of those needs), and; is experiencing, or is at risk of, abuse or neglect, and; as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect. The specific circumstances will determine the most appropriate person or agency to undertake the enquiry The Local Authority is responsible for referring the enquiry to the right person and ensuring the enquiry is acted upon. The Local Authority will set proportionate timescales and review outcomes of any enquiry undertaken. The Local Authority, in its lead and coordinating role, should assume itself that the enquiry satisfies its duty under section 42 and decide what action (if any) is necessary to help and protect the adult and by whom and to ensure that such 14

15 action is taken when necessary. If the Local Authority is not satisfied with the process of the enquiry it has the right to challenge this. If a crime is suspected and referred to the police, then the police must lead the criminal investigations. 11 Criminal offences Everyone is entitled to the protection of the law and access to justice. Behaviour which amounts to abuse and neglect, for example physical or sexual assault or rape, psychological abuse or hate crime, wilful neglect, unlawful imprisonment, theft and fraud and certain forms of discrimination also often constitute specific criminal offences under various pieces of legislation. A criminal investigation by the police takes priority over all other enquiries, although a multi-agency approach should be agreed to ensure that the interests and personal wishes of the adult will be considered throughout, even if they do not wish to provide any evidence or support a prosecution. The welfare of the adult and others, including children, is paramount and requires continued risk assessment to ensure the outcome is in their interests and enhances their wellbeing. (14.75) If the adult has the mental capacity to make informed decisions about their safety and they do not want any action to be taken, this does not preclude the sharing of information with relevant professional colleagues. This is to enable professionals to assess the risk of harm and to be confident that the adult is not being unduly influenced, coerced or intimidated and is aware of all the options. This will also enable professionals to check the safety and validity of decisions made. It is good practice to inform the adult that this action is being taken unless doing so would increase the risk of harm. CCG employees should always notify the police if a safeguarding concern relates to a criminal offence or if the adult is in immediate danger. 12 Prevent The Prevent strategy publishes by the government in 2011 is part of the overall Counter Terrorism Strategy CONTEST. The aim of the Prevent stagey is to reduce the threat to the UK from terrorism by stopping people becoming terrorists or supporting terrorism, In the ACT this has simply been expressed as the need to preventing people from being drawn in to terrorism: The Prevent Strategy has 3 specific strategic objectives 1. Respond to the ideological challenge of terrorism and the threat we face from those who promote it; 2. Prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support; and 15

16 3. Work with sectors and institutions where there are risks of radicalisation that we need to address. Building Partnerships Staying Safe the Health sector contribution to HM Governments Prevent Strategy: guidance for health care organisations (DH Nov 2011) sets out guidance and toolkits for leaders, managers and workers in healthcare organisations. Providers must include in its policies and procedures and comply with the Prevent principles including the PREVENT Guidance Toolkit. P1 of the Safeguarding Adults Standard for Commissioned Services highlights the specific requirements health provider organisations must undertake The CCG Prevent Lead Ensure that best practice around PREVENT is promoted, implemented and monitored both within the CCG and within commissioned provider services. Ensure that safeguarding and PREVENT leads work within the local health and social care economies to influence local thinking and practice by working with partner agencies to provide joint strategic leadership on the PREVENT agenda Ensure that provider contracts specify compliance with the PREVENT Strategy and that commissioned services are supported and contract monitored for compliance. Additional information can be found by following this link: a/file/97976/prevent-strategy-review.pdf 13 Safeguarding Adults Reviews (SARs) Safeguarding Adults Boards (SABs) must arrange a SAR when: an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is a concern that partner agencies could have worked more effectively to protect the adult. (14.133) OR an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect. In the context of SARs, something can be considered serious abuse or neglect where for example the individual would have been likely to have died but for an intervention, or has suffered permanent harm or has reduced capacity or quality of life (whether because of physical or psychological effects), as a result of the abuse or neglect. SABs are free to arrange for a SAR in any other 16

17 situations involving an adult in its area with needs for care and support. (14.134) The SAB should be primarily concerned with weighing up what type of review process will promote effective learning and improvement action to prevent future deaths or serious harm occurring again. (14.135) Early discussions need to take place with the adult, family and friends to agree how they wish to be involved. The adult who is the subject of any SAR need not have been in receipt of care and support services for the SAB to arrange a review in relation to them. (14.136) SARs should reflect the six safeguarding principles. SABs should agree Terms of Reference for any SAR they arrange and these should be published and openly available. When undertaking SARs the records should either be anonymised through redaction or consent should be sought. (14.137) The following principles should be applied by SABs and their partner organisations to all reviews: there should be a culture of continuous learning and improvement across the organisations; the approach taken to reviews should be proportionate according to the scale and level of complexity of the issues being examined; reviews of serious cases should be led by individuals who are independent of the case under review and of the organisations whose actions are being reviewed; professionals should be involved fully in reviews and invited to contribute their perspectives without fear of being blamed for actions they took in good faith, and families should be invited to contribute to reviews. They should understand how they are going to be involved and their expectations should be managed appropriately and sensitively. (14.138) The process for undertaking SARs should be determined locally according to the specific circumstances of individual circumstances. No one model will be applicable for all cases. The recommendations and action plans from a SAR need to be followed through by the SAB. (14.141) The SAB should aim for completion of a SAR within a reasonable period of time and in any event within six months of initiating it, unless there are good reasons for a longer period being required; for example, because of potential prejudice to related court proceedings. Every effort should be made while the SAR is in progress to capture points from the case about improvements needed, and to take corrective action. (14.144) 17

18 14 Information Sharing Information sharing in Section 42 in enquiry General principles: Agencies can only work together to safeguard vulnerable adults from abuse if they are able to share relevant information. Information should only be disclosed on a need to know basis when it is in the best interests of the vulnerable person or other vulnerable adults who may be at risk of being abused. Article 8 of the European Convention on Human Rights gives everyone the right to respect for private family life, home and correspondence. Authorities can only interfere with this if they are working within the law, are pursuing a legitimate aim (including protecting the health and rights of others) and the action taken is no more than is needed to achieve the legitimate aim of protection. If the alleged abuse constitutes a crime then the police should be consulted before any information is shared so that evidence is protected and the risk to the vulnerable person minimised. 15 Consent Wherever possible informed consent to share information should be obtained from the vulnerable person.however there may be situations where consent is withheld or the person is unable to give informed consent Information may still be shared between professionals if consent is withheld if it is believed that there is a high risk of serious harm to the adult is at risk of abuse or neglect or that consent was withheld under duress or that other adults or children are at risk. Absolute assurances of confidentiality cannot be given, especially where others may be at risk. If the person is unable to give informed consent and information needs to be shared in order to prevent or protect them from abuse or neglect then the principle of need to know must be observed. 16 Statutory duties and responsibilities of the CCG Bristol CCG (BCCG) has a clear line of accountability within the organisation for work on promoting welfare and safeguarding of adults. Quarterly reports are submitted to the Bristol CCG Safeguarding Group, and the Quality and Governance Committee. Bristol CCG is responsible for ensuring that safeguarding is integral to service development, quality improvement, clinical governance and risk management arrangements. 18

19 BCCG is also a key partner to the Bristol Safeguarding Adults Board and subgroups Director/s of Transformation and Quality and Community and Partnerships BCCG Safeguarding Adults works across two directorates Transformation and Quality and Community and Partnerships. The Designated Safeguarding and MCA Lead Nurse and the Safeguarding Adults GP Lead roles sit in the Community, Partnerships & PPI and reports directly to the Director of Transformation and Quality who has the lead for safeguarding. The Designated Nurse for Safeguarding Children, the Deputy Designated Nurse for Safeguarding Children, the Designated Doctor for Safeguarding Children, the Named GP for Safeguarding Children, the Lead Commissioner for Looked After Children and the Administrator for Safeguarding Children roles all sit in the Transformation and Quality and report directly to the Director of Transformation and Quality The Governing Body Lead is managerially accountable for the designated and named professionals ensuring that safeguarding adults and children is an integral part of BCCG s governance arrangements. They should also ensure that safeguarding is considered when planning or commissioning new services. The designated professionals are responsible for submitting an annual report outlining safeguarding activity to the BCCG Board Designated Safeguarding Adults and MCA Nurse Lead The Designated Safeguarding Adults and MCA Nurse provides strategic leadership in all aspects of adult safeguarding which includes all commissioned providers this will include: Working with Director of Quality and Transformation to ensure robust safeguarding assurance arrangements are in place within the CCG and providers services. Provide advice and expertise to the LSAB and Subgroups and to professionals across both NHS and partner agencies. Provide professional leadership advice and support to lead adult safeguarding professionals in each organisation. Represent the CCG on relevant committees, networks and multiagency groups charged with the management of safeguarding vulnerable adults Lead on investigation and provision of appropriate information to inform and support review including DHRs and SARs 19

20 Lead and support the development of adult safeguarding policy and procedures in the CCG in accordance with national, regional, local requirements Provide advice and guidance in relation to safeguarding adults training including standards Ensuring that quality standards for safeguarding adults are developed and included in all provider contracts and compliance is evidenced though contract monitoring Safeguarding Adults GP Lead The Safeguarding Adults GP Lead provides advice and guidance to other GP s, practice colleagues and other practitioners across the spectrum of health and social care settings in Bristol. This role includes providing support and advice to other health professionals on the management of complex safeguarding related issues, including, domestic violence, self- neglect, sexual abuse, honour-based violence and concerns regarding quality of services Head of Quality The Head of Quality, on behalf of the CCG Quality Team, is responsible for overseeing and providing professional and clinical advice and assurance on issues of quality and safety for Bristol CCG. A key part of the teams role is developing and maintaining effective working relationships with all contracted providers and ensuring a joined up, cohesive approach to quality across the Bristol health economy Senior Managers Senior managers have a responsibility in ensuring that adults safeguarding policy is implemented within their area of responsibility Senior managers will ensure that all staff undertake mandatory training at the appropriate level for their role and that a record of their training is maintained Continuing Health Care (CHC) The Continuing Health Care Programme Manager will be responsible for ensuring the provision of relevant and timely information for a Section 42 enquiry. The Continuing Health Care Programme Manager will ensure that CHC Quality and Contract team will implement a section 42 referral. 20

21 16.7 Medicines Management Bristol CCG has a medicines management team made up of experts in medicines. The team works with partners across the city, and nationally to ensure that medicines are used safely, and in an evidence-based and financially sustainable way. This work with local hospitals, general practice staff, mental health services, specialist nurses, and community pharmacy staff aims to ensure that we get the best for patients from our investment in medicines. The team has specific work streams to address safe and high quality use of medicines in care homes Commissioners Commissioners of services for both Adults and Children will need to include support from the safeguarding leads throughout all elements of the commissioning cycle from procurement to quality assurance; if appropriate services are to be commissioned to support adults at risk of abuse and neglect as well as effectively safeguarding their well-being All Line managers All Line managers are responsible for ensuring that staff has mandatory adult safeguarding training. They will ensure that staff are aware of this policy and the local Safeguarding Adults Multiagency Policy and procedures and understand how to raise concerns for an adult at risk of abuse and neglect All Staff CCG employees are responsible for actively co-operation with managers in the application of this policy to enable the CCG to discharge its legal obligations and in particular participating in safeguarding training to ensure: A new starter attend mandatory level 1 foundation safeguarding adults awareness training on induction, this is repeated every 3 years Staff undertake mandatory level 2 intermediate safeguarding adults training specific to job role, this is repeated every 3 years General Practitioners and Staff All Practices will have a nominated safeguarding adult s lead who will link directly with the CCG s Safeguarding Adults GP and Nurse lead. Safeguarding Adults Practice leads are expected to attend 3 yearly Safeguarding Adults training 21

22 All staff who come into direct contact with patients in their practice should follow the guidance outlined in Commissioning Support Unit (CSU) Human Resources The CSU will ensure that the CCG has in place robust recruitment and vetting policies and procedures for all staff, including agency staff, students and volunteers in line with national and local guidance. Ensure that recruitment procedures will include thorough checks in terms of references, DBS checks (where appropriate) right to work and occupational health being carried out as part of the recruitment procedures, Ensure that any gaps in employment history will be checked and accounted for. Ensure qualifications required for the job and references checked and confirmed. Ensure that a Disclosure and Barring Service (DBS) check is undertaken and that where a review is mandatory on employment, these will be undertaken routinely at the appropriate level Commissioning Support Unit (CSU) Contracts The CSU have a number of roles to play in assisting the CCG in commissioning effective services which includes assuring the safety of those services. The CCG will ensure that the CSU will have access to safeguarding expertise when contracting patient specific services. 18 Robust Complaints Procedures The CCG has in place robust complaints procedures which may be used by service users and staff. The organisation assures that staff and service users using the complaints procedure will not prejudice their own position and prospects. The process of raising complaints can be found in the CCG complaints policy. 19 Managing Allegations Managing allegations when the alleged perpetrator is a member of staff: The CCG ensures that:- Staff are aware of their statutory duty to report any incident to the local authority, as the lead agency for coordinating a section 42 enquiry into allegations of abuse and neglect. Also, to report to the named Lead person for Safeguarding Adults in the CCG and the Head of Human Resources CSU (HR), who will provide support? There is a senior manager with named responsibility for managing allegations of abuse against people who work with vulnerable adults within both the CCG and CSU. 22

23 The CCG cooperates with any investigation into allegations of abuse as agreed via the safeguarding adults procedures, which may include an internal disciplinary investigation into the allegation or formal investigation by the police. 20 Whistle Blowing The CCG recognises that staff may be reluctant to express their concerns and must be reassured that by following the Whistle blowing policy to express their concerns, they will not be penalised for doing so. 21 Working Together for Safeguarding Safeguarding Adults at risk of abuse and neglect is a collective responsibility. Whilst individuals and organisations have distinct roles, the system cannot operate effectively unless the different individuals and organisations work together. Bristol CCG as a key statutory partner are members on the following Multiagency Safeguarding Board/groups Bristol CCG Safeguarding Group Bristol Safeguarding Adults Board Bristol Safeguarding Adults Sub groups Policy and Practice Quality Assurance Publicity and Information Training and Education Quality Surveillance Groups National Safeguarding Adults Network Multiagency Risk Assessment Conference MASH Programme Board and Project Group Care Quality Commission Multiagency Information Group 23

24 22 Bristol CCG Safeguarding Group Structure External Internal Local Authority Bristol CCG NHS England Health and wellbeing Board Governing Body Designated Doctor and Nurse Forum BSAB BSCB Quality & Governance Committee BSAB Sub Groups BSCB Sub Groups Safeguarding Group Named professional Group Links to relevant steering Groups Dementia, Care Homes, Mental Health and Children 24

25 23 Flowchart YES Is there immediate danger or a crime in progress? NO Bristol CCG Safeguarding Adults Referral Flowchart Safeguarding Concern? Call 999 YES NO Has a Crime Been Committed? Inform the police on 101 Uncertain? Discuss with your Line Manager in your relevant Directorate & The CCG Safeguarding Adults Lead Record as a Safeguarding concern, reconsider if situation changes, monitor situation Complete Bristol City Council Safeguarding Adults Referral Form on line : -care-and-health/report-suspectedabuse-safeguarding-adults-risk or download word the referral form. This form can be faxed or to Bristol Care Direct Fax: Please check that you have received a confirmation from Bristol City Council regarding your safeguarding adult referral Or Make a Safeguarding Concern Referral by Telephone Bristol Care Direct Triage team Making it clear that this is a Safeguarding referral Information you need to give: Why you're concerned The name, age and address of the adult at risk If anyone lives with them If they're getting help from any organisation Who may be doing the abuse You can also speak to a member of the Safeguarding Adults Strategic Team For advice and support with section 42 of the Care Act 25

26 Appendix 1 Bristol Safeguarding Adults Referral Form This form should be faxed / ed to: Bristol Care Direct Fax: Client details Name PARIS / RIO No. Date of birth Gender M F Ethnicity Permanent address GP name and practice details (including address) Unit / Ward (if applicable) Referrer details Name of referrer Contact tel. no. Contact Details of concern or incident Relationship to adult at risk Organisation/company (if applicable) Date of incident Placement address at the time of the incident (if different from above) Unit / Ward (if applicable) Date reported Type of service provided at the placement (if applicable) If Domiciliary Care please specify which agency Residential / nursing home Extra care housing Supported living accomodation Sheltered housing Hospital Hostel Other Dom Care 26

27 Summary of incident / concerns What type of abuse is being referred? Physical Financial Discriminatory Sexual Neglect Institutional Psychological Self-neglect Relationship of alleged perpetrator to the adult at risk Partner Other family Neighbour Friend Fellow resident Landlord Employee Volunteer Stranger Social care worker (including social workers, care managers, home care assistants) Health care worker (including GP's, nurses, consultants) Is this domestic abuse? Is an urgent response required today? Other professional Yes No Is this a hate crime? Yes No Yes Further information No Is the person aware of this referral? Other notified agencies Police CQC Funding authority / Other LA (if necessary) Other agencies involved with the care of the adult at risk Source of funding BCC CCG Direct payment Supporting people Self funded Other authority (please specify) Any known views of the service user / carer? Has the adult at risk consented to the referral being made? Have they said what they wish to happen? Yes No 27

28 Details of any previously reported concerns 28

29 Appendix 2 Escalation protocol for solving disagreements between SAB partner agencies The Bristol Safeguarding Adults Board is committed to the principle that challenge on safeguarding issues between partner agencies is essential in order to deliver continuous improvement in services and the best outcomes for adults at risk. Escalation is important in resolving concerns about decision making and practice when working with adults at risk. If any partner agency has concerns about how another partner agency is delivering their role in an individual s safeguarding adults process they should follow the escalation process below. This process can apply to disagreements about decisions made by the Bristol City Council Adult Care triage team as well as concerns about the local authority or any partner agency. Escalation process to be used regarding concerns about how an individual is being safeguarded: Raise the concern with the relevant staff member in the partner agency In the case of Adult Care triage this should be the team manager see contact details below. If the concern is not resolved escalate to the BCC Adult care Service Manager for Strategic Safeguarding Adults/DOLS. If still not resolved escalate concern to BSAB chair who will take appropriate action to resolve. Do provide relevant evidence and documentation. If not resolved the concern must be reviewed via the BSAB and relevant regulator. Disputes between regulated agencies must be reported to CQC and where appropriate CCG/BCC commissioners. In the specific circumstances where agencies do not agree with the safeguarding adults threshold decision made by BCC triage team, if the matter cannot be resolved via the Service Manager for Strategic safeguarding Adults/DOLS the case should become a safeguarding adults referral and be the subject of a strategy meeting. The meeting must be attended by the referring agency. Contact details: Team manager, Front door services (Adult Care triage) Liz Nicholas. Service Manager, Strategic Safeguarding Adults/DOLS - Kate Spreadbury: Kate. 29

30 Appendix 3 Adult Safeguarding Training Adult Safeguarding Training for Staff Level Who What Learning objectives Foundation Level 1 Targeting all individuals Aimed at raising general awareness of the issues around adults at risk and MCA Understand who is an adult at risk what is abuse and how to report it Intermediate Level 2 Targeting all staff who have direct and regular contact with adults at risk including GP s and practice staff Aimed at raising general awareness of the issues around adults at risk, the potential for abuse and to develop an understanding of their role and responsibilities in relation to safeguarding issues, including the completion of an alert or cause for concern documentation As Level 1 plus Understand Person Centred Safeguarding Consent and Risk assessment MCA Principles and Capacity Assessments Best interests Supporting people to keep safe Human rights Domestic violence* MARAC* PREVENT Public protection MAPPA* Think family FGM Trafficking *See additional information 1

31 Adult Safeguarding Training for Staff Level Who What Learning Resource Targeting Advocates Aimed at developing a comprehensive Police officers understanding of a aspects of enquires into Social workers and Health alleged harm of adults at risk professionals who are likely to become involved in investigation stage Enquiry/Investigator Training Level 3 (You will ned to have completed level 2 MCA and DoLs training) As level 1 and 2 plus Understand: Working with advocates for adults at risk. Policy procedures and the referral process. Roles and responsibilities during the section 42 enquiry of the Care Act Gathering information Risk assessment Co-ordinator Training Level 4 Strategic Level 5 Targeting senior staff who have a lead responsibility in organisations and management of the adults safeguarding process including SAB members. chief executive/officers board members and strategic management staff elected member s safeguarding adults board member s service managers Aimed at developing a comprehensive understanding all aspects of coordinating safeguarding adults procedures aimed at developing safeguarding strategic leadership As level 1 and 2 and 3 plus Understand: Communication problems Thresholds decision-making 42 enquiry of the Care Act An outline of the civil and criminal Law as it will influence this stage of the procedures Understanding Procedures and roles and responsibilities of legal and policy requirements Section 42 Safeguarding Adults Review Prevalence Funding/resources Training issues Governance Legislative requirement Regulatory requirements 2

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