SAFEGUARDING ADULTS Policy. With reference to the Care Act 2014 and London Multi Agency Policy & Procedures 2016

Transcription

1 SAFEGUARDING ADULTS Policy With reference to the Care Act 2014 and London Multi Agency Policy & Procedures 2016 Version: V2.3 Ratified By: Policy Working Group Date Ratified: 03/05/2016 Date Policy Comes Into Effect: May 2016 Author: Louise Rabbitte Trust Safeguarding Adults Lead Responsible Director: Responsible Committee: Target Audience: Trust Director of Social Care Trust Safeguarding Adults Committee All Trust Staff Review Date: April 2019 s Equality Impact Assessment Assessor: Louise Rabbitte Date: 30/03/15 HRA Impact Assessment Assessor: Louise Rabbitte Date: 30/03/15

2 Document History Version Control Version No. Date Summary of Changes Major (must go to an exec meeting) or minor changes Author V1.0 10/09/2008 Trust Policy Ratified by Governance Exec. Martin Baggaley V2 December 2013 Revised Trust Policy Approved by Trust Safeguarding Adults Committee Louise Rabbitte V2.1 February 2014 Revised Trust Policy changes to Section 4.1 Executive Leadership Approved and ratified by Trust Executive Committee Louise Rabbitte V2.2 March 2015 Revised Trust Policy minor amendments to the policy specific to the Care Act 2014 V2.3 April 2016 Revised Trust Policy amendments to the policy specific to the Care Act 2014 and 2016 Pan London Multiagency policy and procedures Policy will be re-written later in 2015 once new Pan London safeguarding adults policy & procedures are published via SCIE. Approved by Trust Safeguarding Adults Committee. Ratified by Trust Policy Working Group. Heather Williams Louise Rabbitte Consultation Stakeholder/Committee/ Group Consulted Date Changes Made as a Result of Consultation Trust Safeguarding Adults Committee & SLAM borough Heads of Social Care 11/04/16 Minor changes to some wording. Plan for Dissemination of Policy Audience(s) Dissemination Method Paper or Electronic All Trust Staff Trust Intranet & Policy Electronic Update Person Responsible Trust SA Lead Page 2 of 48

3 Contents 1. Introduction Purpose and Scope of the Policy Definitions Roles and Responsibilities Policy Specific Information Trust Procedures Monitoring Compliance Associated Documentation (correct as of April 2016) References - source documents are available on the SLAM Safeguarding Adults Intranet site: Freedom of Information Act Appendix 1: Supplementary Note on Domestic Violence (from Pan London Multi-Agency Adult Safeguarding Policy & Procedures 2016) Appendix 2: Good practice guidelines for promoting the sexual safety of service users on SLAM mixed sex wards Appendix 3: Safeguarding Adults Concerns: EPJs Documentation Checklist Appendix 4: Decision Pathway Pressure Ulcers and Safeguarding Adults Appendix 5: Equality Impact Assessment Appendix 6: Human Rights Act Assessment Appendix 7: Checklist for the Review and Approval of a Policy Page 3 of 48

4 1. Introduction 1.1 Safeguarding adults from abuse, neglect and improper treatment is a core duty of the Trust. By the nature of services provided within the Trust, it is likely that staff will have contact with adults who are at risk of such abuse. This Policy provides guidance for staff to ensure that the principles of safeguarding adults are embedded in all aspects of Trust practice. 1.2 This document is intended to be read in conjunction with and refers to the new Pan London guidance which sets out procedures for organisations in all the London Boroughs to work together to safeguard adults at risk. (London Multi-Agency Adult Safeguarding Policy & Procedures ADASS, London 2016). This can be found on the Trust Safeguarding Adults Intranet page Since April 2015, the Care Act 2014 has provided the statutory framework for adult safeguarding. The Care Act introduced for the first time specific statute for adult safeguarding activity. This legal framework supersedes the previous No Secrets statutory guidance (DH 2000). Chapter 14 of the Care and Support Statutory Guidance (updated March 2016) covers safeguarding adults in relation to Sections 42 to 46 of the Care Act The Health & Social Care Act 2008 (Regulated Activities Regulations 2014) introduced the statutory duty of candour as well as fundamental standards of care for regulated providers. This includes the NHS. This forms the basis of CQC inspections and powers of enforcement. Regulation 13 of the fundamental standards relates to safeguarding service users from abuse and improper treatment The Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework (NHS England 2015) provides guidance for the health service on their responsibilities for safeguarding children, young people and adults from harm, neglect or abuse. It outlines that safeguarding must be a core function of any NHS Organisations business. This guidance can be found on the Trust Safeguarding Adults Intranet pages. ty%20and%20assurance%20framework%20june% pdf 2. Purpose and Scope of the Policy 2.1 The purpose of this policy is to ensure that service users are protected from abuse and improper treatment. This policy supports the Trust in outlining robust arrangements to ensure that adult safeguarding becomes fully integrated into local systems and practices. This will result in greater openness and transparency, learning from safeguarding concerns that may arise within the organisation, clarity on reporting and investigating concerns and improved partnership working. This policy recognises each person s right to live a life free from abuse or neglect and is of relevance for all staff irrespective of discipline or role as safeguarding is everyone s business.this policy is for use with all client groups, as well as any other adult that staff may have a professional or personal awareness of, with particular reference to those individuals who may have care and support needs and who are considered to be at risk of harm or abuse. 2.2 Aims To ensure that all staff working within the Trust know and understand their responsibilities in working together to safeguard adults. To ensure that staff work to prevent harm and reduce the risk of abuse and neglect to adults with care and support needs Page 4 of 48

5 To ensure that all staff are able to identify both an adult with care and support needs and situations where actual or potential harm or abuse to such adults may occur. To ensure that all staff know how to respond to such concerns and know where to seek appropriate advice or support. To ensure that all staff know to whom the Care Act Section 42 safeguarding duty applies regarding a concern in relation to an adult. To ensure that staff are aware of how to make a safeguarding adults referral and where required, to undertake an appropriate enquiry under Safeguarding Adults multi-agency policy & procedures. Some Local Authority employed staff working within integrated services may also have a role in deciding if a safeguarding concern requires an enquiry under Section 42 of the Care Act and in supporting and overseeing such an enquiry. 2.3 In keeping with the Pan London safeguarding adults policy and procedures, this local policy also supports the following safeguarding principles: Empowerment a presumption of person led decisions, capacity and consent. Protection support and representation for those in greatest need. Prevention it is better to take action before harm occurs Proportionality the least intrusive response that is appropriate to the risk presented. Partnerships local solutions through services working together with their communities. Communities have a part to play in preventing, detecting & reporting neglect and abuse Accountability and transparency in delivering safeguarding 2.4 Prevention Regulation 13 of the fundamental standards (section 13.2) requires that the Trust has systems and approaches in place that are effective in preventing abuse of service users. The Care Act also places a duty of Local Authorities to work preventatively in delaying the development of or reducing care and support needs. The Trust seeks to provide safe and quality services to reduce the risk of abuse or improper treatment of service users. Staff should ensure they are up to date with safeguarding training, policy and guidance. Staff should be able to recognise and respond to concerns about abuse. This should be embedded within robust risk assessment and management. Staff should demonstrate best practice with regard to safeguarding activity, reporting safeguarding concerns in a timely and appropriate manner and in undertaking any necessary enquiries. The Trust works in partnership with aligned Local Authorities and CCG s via local Safeguarding Adults Boards to promote and embrace strategies that support action before harm can occur 2.5 The Care Act also introduces the principle of Wellbeing. All agencies involved in safeguarding adults must promote wellbeing when carrying out their care and support functions in respect of a person. It is the guiding principle at the heart of care and support. It applies equally to adults with care and support needs and their carers. Within the broad concept of wellbeing is regard to the need to protect people from harm or abuse. The Trust s vision states; Everything we do is to improve the lives of the people and communities we serve and to promote mental health and well-being for all. 2.6 Duty of Candour Following recommendations made from the Francis Inquiry (2013) into Mid Staffordshire NHS Foundation Trust, the 2014 amendments to the Health and Social Care Act (2008) brought a statutory responsibility to NHS organisations to demonstrate a duty of candour. Good safeguarding practice requires openness and transparency. This is vital in relation to any safeguarding concerns involving Trust staff or services. More information can be found in the SLAM Being Open and Duty of Candour Policy This document is available on the Intranet - Clinical and Patient Safety Policies page. %20of%20Candour,%20v4%20-%20July% pdf Page 5 of 48

6 2.7 Co-operation and Information Sharing The Trust works in partnership with Local Authorities and other agencies as part of a wider interagency approach to ensure effective safeguarding across our local communities. The Trust contributes to local Safeguarding Adults Boards in a number of local boroughs and has Director level representation at the boards. The Care Act places the legal duty on Local Authorities to act as the lead co-ordinating organisation. The Trust co-operates with other partners on both a strategic and individual level to ensure effective safeguarding. The Trust has a clear Information Sharing Policy as well as some local Information Sharing Agreements with specific Safeguarding Adults Boards. Staff should work to ensure that relevant, necessary and proportionate information in relation to safeguarding concerns are shared in a timely manner in line with Trust policy. (See section to of the Pan London Multi-Agency Guidance via link in para 1.2 above) 3. Definitions 3.1 Safeguarding describes a range of activities focused on adults who are at risk of abuse as they are less able to protect themselves. Safeguarding means protecting an adults right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and the experience of harm, abuse or neglect. This means also ensuring that the individuals wellbeing is promoted, including where appropriate, having regard to the adults views, wishes, feelings and beliefs in deciding on any action. 3.2 Safeguarding adults is core to delivering quality, innovative, preventative and productive services required by the NHS. It is diverse in nature and responses to safeguarding adults concerns will be equally diverse and individualised, taking into account: The nature and degree of the safeguarding concern The source of harm, abuse or neglect Importantly, the wishes of the patient and the outcome they seek to achieve Exploring what being safe means to the adult and how this can be best achieved. 3.3 The purpose of safeguarding is to prevent harm and reduce the risk of abuse or neglect to adults with care and support needs. The statutory framework introduced under Section 42 of the Care Act applies specific safeguarding duties to any person aged 18 or above whom: Has need 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 Section 42 safeguarding duty applies to all adults who meet the above criteria regardless of their mental capacity to make decisions about their own safety or other decisions relating to safeguarding processes and activities (Pan London Guidance 2016 section 2.2). An adult with care and support needs may therefore be a person who: Has mental health needs including dementia or a personality disorder Misuses substances including alcohol Has a long term condition or illness Has a learning disability Has a physical disability and/or a sensory impairment Is elderly and frail due to ill health, physical disability or cognitive impairment Is unable to demonstrate the capacity to make a decision and is in need of care and support Page 6 of 48

7 3.4 Making Safeguarding Personal refers to person centred and outcome focused safeguarding practice. This means that professionals are assured by the adult at risk, that any safeguarding intervention or activity has made a positive difference to the adult. Professionals should be able to demonstrate that actions taken are in relation to what matters to the adult and is personal and meaningful to them. The trust-wide safeguarding adults process documentation seeks to capture and record the desired outcomes of the adult in relation to the specific safeguarding concern and enquiry. 3.5 In the context of safeguarding adults, the vulnerability of the adult at risk is related to how able they are to make and exercise their own informed choices free from duress, pressure or undue influence of any sort and to protect themselves from abuse, neglect and exploitation. Vulnerability can be seen as a continuum this approach reflects the shifting nature of vulnerability and encourages practitioners to identify the potential of acquired vulnerability due to wider circumstances in that a client can be temporarily vulnerable. Vulnerability may be an important factor in safeguarding concerns relating to Domestic Abuse. Staff should refer to additional guidance Adult Safeguarding and Domestic Abuse A guide to support practitioners and managers (ADASS 2015). This guidance and the Trust Domestic Violence Policy are available on the SLAM Intranet via Safeguarding Domestic Violence pages. der=%2fchildprotection%2fdomestic%20violence%2fuseful%20guidance%20and%20research&f olderctid=&view=%7b7a61841c%2d9bdf%2d4ee3%2d8943%2de6e8ffd65add%7d 3.6 Capacity is the ability to make a decision about a particular matter at the time the decision needs to be made. It is important to note that people with capacity can also be vulnerable. Section 59 of the Safeguarding Vulnerable Groups Act (2006) describes how an adult is vulnerable in the context of the setting in which they are situated or the service they receive such as; Those in residential accommodation provided in connection with care or nursing or in receipt of domiciliary care services Those receiving healthcare Those in lawful custody or under the supervision of probation services Those receiving a welfare service of a prescribed description or direct payments from a social services authority Those receiving services or taking part in activities aimed at people with disabilities or special needs because of their age or state of health Those who need assistance in the conduct of their affairs Capacity is considered to be decision and time specific For additional information on this and Best Interests decisions, refer to the SLAM Mental Capacity Act Guidance For Staff booklet. This can be found here The SLAM Mental Capacity Assessment form can be found within EPJs Events templates. Assessments of capacity and best interests in relation to specific safeguarding decisions should be clearly documented in EPJs. 3.7 What is abuse? The CQC, in outlining Fundamental Standard 13 (see para 1.4 above) defines abuse as meaning; Any behaviour towards a service user that is an offence under the Sexual Offences Act 2003 Ill treatment (whether of a physical or psychological nature) of a service user Theft, misuse or misappropriation of money or property belonging to a service user Page 7 of 48

8 Neglect of a service user In addition, Fundamental Standard 13 requires that care or treatment for service users must not be provided in a way that; Includes discrimination against a service user on grounds of any protected characteristic (as defined in Sec4 of the Equality Act 2010) Includes acts intended to control or restrain a service user that are not necessary to prevent or not a proportionate response to, a risk of harm posed to the service user or another individual if the service user was not subject to control or restraint Is degrading for the service user, or Significantly disregards the needs of the service user for care and treatment Fundamental Standard 13 also requires that a service user must not be deprived of their liberty for the purpose of receiving care or treatment without lawful authority. For further guidance, refer to the SLAM Mental Capacity Act (Including Deprivation of Liberty) Policy 2015 this is available on the SLAM Intranet Clinical & Patient Safety Policies page olicy%20including%20deprivation%20of%20liberty%20safeguards,%20v2%20- %20%20May% pdf Abuse can be a single act or repeated acts. It may also occur through deliberate targeting or grooming of vulnerable people and may be carried out by individuals or groups of people. Abuse can occur in any relationship. Abuse may be on-going and long term or may be a one off opportunistic act. Much abusive behaviour may constitute a criminal offence and should be reported to the Police. All suspected abuse must be reported via agreed local mechanisms such as Datix and a Safeguarding Concern if the individual meets the safeguarding duty criteria outlined in para 3.3 above. Action must be taken to respond to the concern and ensure robust risk assessment and management. 3.8 Categories of Abuse The Care & Support Statutory Guidance 2016, section outlines abuse in terms of particular categories. Pan London Safeguarding Policy 2016 Section 2.3 outlines categories of abuse in further detail Physical e.g.: hitting, pushing, pinching, shaking, scalding, misuse of medication, misuse or illegal use of restraint, inappropriate physical sanctions Domestic Abuse Psychological, physical, sexual, financial, emotional; so-called honour based violence. Every member of staff has a responsibility to respond to issues of domestic violence where it has been disclosed. Domestic Violence and abuse is defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to the following types of abuse: psychological, physical, sexual, financial and emotional. Refer to Appendix 1 of this policy for supplementary information. See also the Trust Domestic Violence Policy and the ADASS Adult Safeguarding and Domestic Abuse 2015 guidance (see para 3.5 above) Female Genital Mutilation (FGM) this involves procedures that intentionally alter or injure female genital organs for non-medical reasons. FGM is a crime in the UK it is unlawful to practice FGM or take girls who are British Nationals or permanent residents of the UK abroad for FGM. All cases of FGM in girls and young women (under 18 years) MUST be reported to the Page 8 of 48

9 Police. NHS staff have a legal mandatory duty to report any known or suspected cases of FGM in a minor. Female children and young relatives of adult women who have themselves been subject to FG could be at risk. Staff should be aware of the issue. See Trust FGM Policy (2016) for further information and guidance Forced Marriage this refers to a marriage where one or both parties are married without their express consent or against their will. Responses to such a concern for someone deemed to lack capacity should involve both the Police and multi-agency safeguarding processes. Refer to Section 2.3 of the Pan London guidance for further detail Sexual direct or indirect involvement of the adult in sexual activity or relationships which: They do not want and have not consented to They cannot understand and lack the mental capacity to be able to give consent to They have been coerced or pressurised into for example by another service user or because the other person is in a position of trust, power or authority for example, a care worker They may have been forced into sexual activity with someone or may have been required to watch sexual activity Sexual Exploitation - involves exploitative situations, contexts and relationships - see Pan London Guidance Section 2.3 for more detail. People who are sexually exploited do not always perceive that they are being exploited. See Appendix 2 - Trust Good Practice Guidelines for Promoting Sexual Safety of Patients on Mixed Sex Wards Psychological This is behaviour that has a harmful effect on the persons emotional health and development or any form of mental cruelty that results in: Mental distress The denial of basic human and civil rights such as self-expression, privacy and dignity Negating the right of the adult to make choices and undermining their self-esteem Isolation and over-dependence that has a harmful effect on the persons emotional health, development or wellbeing Financial or Material - The use of a person s property, assets, income, funds or any resources without their informed consent or authorisation or due to coercion. Financial abuse is a crime. It includes: Theft Fraud Internet scamming Exploitation Undue pressure in connection to wills, property, inheritance or financial transactions The misuse or misappropriation of property, possessions or benefits The misuse of enduring power of attorney or lasting power of attorney or appointeeship Neglect and acts of omission Neglect is the failure of any person who has responsibility for the charge, care or custody of an adult to provide the amount and type of care that a reasonable person would be expected to provide. Neglect can be intentional or unintentional. Behaviour that can lead to neglect includes ignoring medical or physical needs, failing to allow access to appropriate health, social care and educational services. Withholding the necessities of life such as medication, adequate nutrition, hydration or heating Discriminatory abuse exists when values, beliefs or culture result in misuse of power that denies opportunity to some groups or individuals. It can be a feature of any form of abuse of an adult, but Page 9 of 48

10 can also be motivated because of age, gender, sexuality, disability, religion, class, culture, language, and race or ethnic origin Organisational abuse is the mistreatment or abuse or neglect of an adult by a regime or individuals within settings and services that adults might live in or use, that violate the persons dignity, resulting in lack of respect for their human rights This includes hospital and residential placements. Organisational abuse includes neglect and acts of omission mentioned above in para as well as poor care or professional practice such abuse can be one off incidents or on-going improper treatment. It can also be a result of the structure, policies, processes and practices within an organisation Modern Slavery Encompasses slavery, human trafficking; forced/compulsory labour and domestic servitude. Human Trafficking Traffickers exploit the social, cultural or financial vulnerabilities of the individual and place huge financial and ethical obligations on them. The National Referral Mechanism (NRM) is a framework for identifying victims of human trafficking or modern slavery and ensuring they receive the appropriate support. The NRM was introduced in 2009 to meet the UK s obligations under the Council of European Convention on Action against Trafficking in Human Beings. At the core of the NRM is the process of locating and identifying potential victims of trafficking. From 31st July 2015 the NRM was extended to all victims of modern slavery in England and Wales following the implementation of the Modern Slavery Act Modern Slavery encompasses: 1. Human trafficking 2. Slavery, servitude and forced or compulsory labour From 31st July 2015, in all UK referrals, the Competent Authority (trained decision makers) must consider whether the person is a victim of human trafficking. In England and Wales, if someone is found not to be a victim of trafficking, the Competent Authority must go on to consider whether they are the victim of another form of modern slavery, which includes slavery, servitude and forced or compulsory labour. The NRM grants a minimum 45-day reflection and recovery period for victims of human trafficking or modern slavery. Trained decision makers decide whether individuals referred to them should be considered to be victims of trafficking according to the definition in the Council of Europe Convention. In England and Wales, further consideration is made to those who do not meet the definition of trafficking. Their cases are then considered against the definitions of slavery, servitude and forced or compulsory labour. The NRM process Referral to a UK competent authority (first responders) To be referred to the NRM, potential victims of trafficking or modern slavery must first be referred to one of the UK s two competent authorities (CAs). This initial referral will generally be handled by an authorised agency such as a police force, the National Crime Agency, the UK Border Force, Home Office Immigration and Visas, Social Services or certain NGO s (eh: The Salvation Army, The Poppy Project, NSPCC, Barnardos). The referring authority is known as the first responder. Page 10 of 48

11 The first responder will complete a referral form to pass the case to the CA. Referral to a CA is voluntary and can happen only if the potential victim gives their permission by signing the referral form. In the case of children their consent is not required. Salvation Army Human Trafficking 24 hour helpline for advice and information: Online resources: Also see the NHS Human Trafficking Information leaflet on the Guidance section of the Safeguarding Adults pages on the SLAM Intranet. 3.9 Other Safeguarding Issues Self-Neglect - A wide range of behaviour neglecting to care for one s personal hygiene, health or surrounding and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a Section 42 safeguarding enquiry. A decision as to whether a response is required under safeguarding processes will depend on the adults ability to protect themself by controlling their own behaviour. There may come a point where they are unable to do this without external support (section updated Care & Support Statutory Guidance HM Gov. March 2016). Manifestations of self-neglect are complex and encompass mental, physical, social and environmental factors. Differentiation between unwillingness and inability to care for oneself and capacity to understand the consequences of ones actions are crucial determinants of response. Professional tolerance of self-neglect as lifestyle choice should be reflected upon and due consideration given to assessing/reviewing the clients mental state and capacity on this issue. Capacity is a highly significant factor in both understanding and intervening in situations of selfneglect. Therefore clinicians should undertake a full assessment of an individual s decisional and executive capacity, in order to determine if a best interest s intervention is required to safeguard the person s wellbeing or the wellbeing of other people at risk. A failure to do so could leave the practitioner or service open to safeguarding concerns or allegations regarding an act of omission or wilful neglect. A multi-agency professionals meeting (either under Section 42 safeguarding processes or otherwise) may be required to assess and address the concern, particularly in relation to hoarding issues. Such multi-agency discussions should include representation from Housing Departments, Environmental Health as well as the London Fire Brigade as they can offer extremely useful support and advice to manage fire risks. Some Local Authorities have a specific Hoarding Panel that cases can be referred to. For further information, refer to section 2.6 of the Pan London Multi-Agency Guidance, see link in para 1.2 above. Additional recommended reading; Self Neglect & Adult Safeguarding: findings from research (SCIE Report ). This report can be found on the Trust Safeguarding Adults Intranet page Hate Crime The Metropolitan Police Service define hate crime as any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person s religion, belief, gender identity or disability. This definition is based on the perception of the victim or Page 11 of 48

12 anyone else and is not reliant on evidence. It also includes incidents that do not constitute a criminal offence. Therefore staff should work with other organisations to intervene under Pan London Safeguarding Adults policy and procedures to ensure a robust, coordinated and timely response to situations where adults at risk become a target for hate crime Radicalisation Prevent and Channel The revised Prevent strategy (2011) focuses on stopping people at risk of radicalisation, becoming terrorists or supporting terrorism. The strategy contains a number of initiatives that can proactively contribute to the protection and safeguarding of vulnerable individuals. The Counter-Terrorism and Security Act (2015) also introduced new legal duties for statutory organisations such as the NHS. Healthcare staff may meet and treat people who are vulnerable to radicalisation. People with mental health issues or learning disabilities may be more easily drawn into terrorism. We also know that people connected to the health sector have taken part in terrorist acts. The key challenge for health staff is to ensure that, where there are signs that someone has been or is being drawn into terrorism, healthcare workers can interpret those signs correctly and are aware of support that is available and are confident in referring the person for further support. Radicalisation is a process not an event and there is no single process or pathway to radicalisation. Preventing service users from becoming a radicalised or from supporting terrorism is no different from safeguarding vulnerable individuals from other forms of exploitation (DH 2011 Building Partnerships, Staying Safe). This document can be found on the Trust Safeguarding Adults Intranet pages. Channel is a multi-agency approach to provide support to individuals who are at risk of being drawn into terrorist related activity. The Channel process is a key part of the Prevent Strategy. Channel seeks to safeguard individuals who might be vulnerable to being radicalised, so that they are not at risk of being drawn into terrorist related activity. The Channel process identifies those most at risk of radicalisation and refers them via the Police or Local Authority for assessment by a multi-agency panel. The panel, chaired by the Local Authority considers how best to safeguard them and support their vulnerability through a support package tailored to the individual s needs. Partnership involvement ensures that those at risk have access to a wide range of support (from mainstream services such as health & education, as well as specialist mentoring or faith guidance and wider diversionary activities). Each support package is monitored closely and reviewed regularly by the multi-agency panel. For additional guidance related to Prevent and the Channel process, including raising a concern relating to radicalisation, refer to the SLAM Prevent Early Identification of People at Risk of Radicalisation Policy This policy is available on the Trust Intranet Clinical & Patient Safety Policies page. %20Early%20Identification%20of%20People%20at%20Risk%20of%20Radicalisation%20Policy,v1 %20-%20May% pdf Pressure Ulcers The development of pressure ulcers may be in some instances an indication of neglect by the care provider although it is recognised that even with the highest standards of care, it is not always possible to prevent pressure ulcers in particularly vulnerable people. However if it is considered that the harm caused by development of a pressure ulcer may be deemed as potential abuse as a result of neglect, then the safeguarding concern should be reported for investigation via Page 12 of 48

13 local multi-agency safeguarding adults procedures. Significant damage is indicated by multiple lesions or a grade 3 or greater wound as defined by the European Pressure Ulcer Advisory Panel (EPUAP) classification system. Refer to Section 2.7 and Appendix 5 of the Pan London guidance (London Multi-Agency Adult Safeguarding Policy & Procedures ADASS/NHSE, London 2016). This can be found on the Trust Safeguarding Adults Intranet page. See link in para 1.2 above. Within SLAM, any pressure ulcers must be reported via Datix. This includes new patients to inpatient units or newly referred to CMHT s, where the service user is noted to have a pressure ulcer on admission/referral as well as pressure ulcers that may develop whilst under care of a SLAM service. There are internal Trust systems in place regarding prevention, monitoring and management of pressure ulcers, these include the availability of specialist Tissue Viability Nurse; weekly review of each Datix related to pressure ulcers; implementation of care plans for the treatment and management of pressure related skin damage. These systems also ensure that safeguarding concerns are considered and SA leads alerted. The Datix system triggers external reporting to commissioners. Please see flowchart in Appendix 5 and refer to the Trust Pressure Ulcer Identification and Management Policy this can be found on the Trust Intranet Clinical & Patient Safety Policies pages Safeguarding concerns involving allegations against Trust employees SLAM takes seriously allegations of harm or abuse by staff towards people who use our services. All allegations should be explored and investigated appropriately. This should involve discussions with HR and with due regard to relevant processes and policies. There may be a duty to inform the Local Authority as some allegations may require a formal S.42 multi-agency response in line with safeguarding processes. There may also be a duty to involve the Police and to report to professional regulatory bodies and the Disclosure and Barring service. Please refer to the Trust Policy on Managing Safeguarding Allegations Against Staff Ill treatment and wilful neglect The police will determine whether there should be criminal investigations by people in positions of trust where there is evidence of ill treatment and wilful neglect. There are a number of possible offences which may apply, including the specific offences mentioned below. Section 44 Mental Capacity Act 2005 makes it a specific criminal offence to wilfully ill-treat or neglect a person who lacks capacity. Section 127 Mental Health Act 1983 creates an offence in relation to staff employed in hospitals or mental health nursing homes where there is ill-treatment or wilful neglect. Sections 20 to 25 of the Criminal Justice and Courts Act 2015 relate to offences by care workers and care providers 3.12 Supervision Supervision is essential to supporting practitioners, and provides assurance for both the organisation and the practitioner. Workers should feel confident that they are supported to deliver safeguarding and have the right training and professional development through regular supervision and appraisal. Line Managers should ensure that staff receive management, clinical and professional supervision that affords them the opportunity to reflect on their practice and the impact of their actions on the adult at risk and others. Supervision should occur monthly, in line with Trust Supervision Policy guidance. SLAM Supervision Policy Section 7.2 outlines the following regarding content of supervision sessions safeguarding should be a standing topic for any discussions of clinical caseloads Adult safeguarding is discussed and recognised and clinical staff are clear about their roles and responsibilities in relation to safeguarding adults at risk Page 13 of 48

14 The safeguarding adults policy and procedures are followed as appropriate Clinical staff follow safeguarding procedures and have the level of training commensurate with their role Clinical staff must record safeguarding adult activity and use the respective Trust safeguarding documentation. 4. Roles and Responsibilities Recognise: All Trust staff, clinical and non-clinical have a duty to be able to identify both adults to whom the safeguarding duty applies and situations where actual or potential harm or abuse of adults may occur. Respond: All staff should know how to respond to such concerns and where to seek appropriate advice or support. Report: Relevant staff have a responsibility to be knowledgeable on how to raise an alert regarding a safeguarding adults concern Record: Relevant staff should be aware of how to raise and document a Safeguarding Adults concern and where required, relevant staff should undertake an appropriate enquiry under Safeguarding Adults multi-agency policy & procedures. 4.1 Executive leadership for Safeguarding Adults is provided by a board level Director. The Director of Nursing will assume this role and is also the organisation s identified senior manager for safeguarding adults. 4.2 The board level Director is supported by additional senior staff with responsibility for Safeguarding. The board level Director or Director of Social Care will chair the Trust Safeguarding Adults Committee. The board level Director, as the Trust executive with responsibility for safeguarding adults will ensure appropriate Trust representation and responses to local Safeguarding Adults Partnership Boards as required. 4.3 The Director of Social Care and the Trust Safeguarding Adults Lead will provide strategic direction for adult safeguarding across Trust services and oversee the development and audit of safeguarding adults policy and operational processes as an integral part of care delivery. 4.4 The Director of Social Care and Trust Safeguarding Adults Lead, will, along with the executive lead and respective Service Directors, ensure Trust representation at local Safeguarding Adults Partnership Boards and their various sub-groups as required. 4.5 The Trust Safeguarding Adults Lead is the senior person within the organisation who will review, revise and support implementation of Trust policy and procedures that reflect current statute, guidance and best practice for safeguarding adults. The Trust Lead will provide briefing, advice and guidance to staff, teams and services on safeguarding adults issues. The Trust Lead will provide advice and work collaboratively with other agencies and contribute to the work of the local Safeguarding Adults Partnership Boards to ensure that the Trust takes full account of its safeguarding responsibilities. The Trust Lead will work with the Trust Education & Training Department to ensure that mandatory Safeguarding Adults, Prevent/WRAP training and other relevant training are provided for staff. 4.6 Service Directors and their Deputies have a responsibility to ensure that a safeguarding approach is embedded within operational processes in their respective Clinical Academic Group and that each CAG has an identified appropriate Safeguarding Adults Lead. Service Directors also have a responsibility to ensure attendance at their respective aligned Local Safeguarding Adults Partnership Board as required. Page 14 of 48

15 4.7 Deputy Service Directors have a responsibility to ensure that safeguarding adults issues are addressed and monitored at aligned borough CAG interface and other governance meetings. 4.8 CAG Safeguarding Adults Leads have a responsibility to ensure that they are knowledgeable and up to date with current safeguarding adults policy and guidance and are familiar with the Trust Safeguarding Adults structure. CAG Leads have a role in supporting CAG staff and signposting to sources of appropriate safeguarding advice and guidance. CAG Leads have a role in attending the Trust Safeguarding Adults Committee and raising safeguarding adults issues within their respective CAG and relevant borough CAG interface and governance meetings. CAG Leads also have a role in raising safeguarding concerns and supporting complex Enquiries or investigations. 4.9 Borough Social Care/Safeguarding Leads should act as an initial source of safeguarding advice for staff within their borough. They may also, in complex cases, be required at undertake the role of Safeguarding Adults Manager (SAM). Social Care Leads have a responsibility to ensure that safeguarding adults at risk issues are addressed and monitored within their aligned integrated mental health teams and services in accordance with the respective borough safeguarding adults processes. Social Care Leads have a role in supporting Local Authority employees within integrated services in undertaking required roles in line with Section 42 Safeguarding Enquiries, such as SAM or Enquiry Officer. Also identifying and accessing Local Authority Safeguarding Adults training for relevant staff within their respective borough and monitoring compliance with required training Heads of Pathway/Service, Clinical Service Leads and Team/Ward Managers have a responsibility to ensure that; They act as an Alerting Manager, Enquiry Lead or Enquiry Officer as required, supporting the identified Safeguarding Adults Manager (SAM). They and their staff understand the strategic aims of safeguarding and ensure that the principles of safeguarding adults is reflected in care delivery. They and their staff are aware of their responsibilities within the safeguarding agenda and have the appropriate and required training commensurate with their role. That safeguarding training compliance is monitored. That safeguarding is included on the agenda in all case/clinical supervision sessions and discussions are documented That all clinical incidents, allegations and complaints are addressed in line with the appropriate Trust policies and that any safeguarding issues are identified and where appropriate, the Pan London multi-agency procedures are followed. That all necessary activity and data relating to safeguarding adults is recorded and monitored All staff have a duty to report suspected, alleged or actual harm or abuse involving an adult who is a service user or who may meet the safeguarding duty criteria outlined in para 3.3 above (e.g.: relative/carer etc.). Staff should be aware of and follow Trust policy and local procedures within each aligned borough or area. All clinical staff have a duty to accept that safeguarding adults concerns involve multi-agency working together to ensure that health and social care is appropriately co-ordinated and individuals are protected from potential or actual harm or abuse. Clinical staff and teams should maintain close and effective links with all relevant statutory and voluntary agencies to collectively ensure that adults are safeguarded. Clinical staff should ensure that potential or actual safeguarding adults concerns and issues are raised, discussed and recorded within regular clinical supervision and in regular team discussions, handovers and MDT review meetings. All staff have a responsibility to undertake required Trust mandatory training and aligned Local Authority additional safeguarding adults training commensurate with their role. Page 15 of 48

16 All staff have a responsibility to undertake safeguarding adult duties commensurate with their role in line with Pan London multi-agency procedures this may involve acting as an Alerter, Alerting Manager, Enquiry Officer or Lead Additionally all staff have responsibilities for; Empowering service users and their carers to be involved in their care and supporting them to be in control of their care as appropriate. Services users who may have substantial difficulty in understanding the safeguarding enquiry process should have access to an Independent Advocate (arranged via the Local Authority) if there is no-one appropriate who can support them. Seeking consent from service users in relation to safeguarding enquiry activity. For those service users unable to give their consent due to reasons of mental capacity, every effort must be made to involve them in the decision making process and supported with advocacy as appropriate. Any decisions made or actions taken for someone who lacks capacity must be demonstrated to be in their best interests. Ensuring that service users are provided with high quality care where abuse and neglect is less likely to occur. Staff must uphold the rights of clients, adhering to human rights principles of fairness, respect, equality, dignity and autonomy. Raising concerns about unsafe practices and responding to service users concerns about their safety and wellbeing. Being aware of policies and procedure that inform and govern practice to ensure patient safety and compliance with regulation. Comply with fundamental standards. If staff are unclear about their responsibilities, this must be discussed with their Line Manager and advice sought Role of the Local Authority The Local Authority should decide very early on in the process if Section 42 safeguarding duty applies and who is the best person/organisation to lead on the enquiry. The Local Authority retains the responsibility for ensuring that the enquiry is referred to the right place and is acted upon. If the Local Authority has asked someone else to make enquiries, it is able to challenge the organisation/individual making the enquiry if it considers that the process and/or outcome is unsatisfactory. In exceptional cases, the Local Authority may undertake an additional enquiry, for example, if the original fails to address significant issues. (Pan London guidance, Section 4 see para 1.2) Criminal Investigations Although the Local Authority has the lead role in making enquiries or requesting others to do so, where criminal activity is suspected, early involvement of the police is essential. Police investigations should be coordinated with the Local Authority, SAM and Enquiry Lead so that any safeguarding actions do not interfere with the Police led process. 5. Policy Specific Information This local policy should be read in conjunction with London multi-agency policy and procedures to safeguarding adults from abuse. That document outlines in full the procedures to be followed when undertaking a multi-agency Section 42 safeguarding adults enquiry. The Trust has legal agreements to deliver some social care services on behalf of local borough councils (i.e.: Lambeth, Southwark, Lewisham and Croydon), further underpinning its responsibilities for safeguarding adults. Therefore the Trust requires all staff working within integrated mental health services to be competent and capable of undertaking their respective roles and responsibilities in line with Section 42 requirements. The Trust works in close partnership with each of its aligned local authority departments of Adult Social Care to ensure that SLAM Page 16 of 48

17 managed integrated services work within agreed multi-agency processes. This policy should also be read in conjunction with additional Trust policies available via the Intranet; Mental Capacity Act (including Deprivation of Liberty Safeguards) Policy via Clinical & Patient Safety Policies Domestic Abuse Policy - via Clinical & Patient Safety Policies Managing Safeguarding Allegations Against Staff Policy FGM Policy via Clinical & Patient Safety Policies Information Sharing Policy via Clinical & Patient Safety / Corporate Policies Policy for the Investigation of Incidents, Complaints and Claims via Clinical & Patient Safety Policies Potentially Exploitative Relationships at Work Policy via HR Policies Whistleblowing Policy via HR Policies Trust Media Policy via Corporate Policies SLAM Safeguarding Adults Posters and Patient Information leaflets can be found via the Intranet; /Leaflet_and_Poster_List.pdf Online Resources: Nursing & Midwifery Council website for specific information on safeguarding adults responsibilities for nurses: General Medical Council Safeguarding Adults and associated guidance for doctors: See the Social Care Institute of Excellence (SCIE) website for useful safeguarding practice advice and information for health and social care professionals: Page 17 of 48

18 6. Trust Procedures These procedures are revised and updated to reflect compliance with the Care Act 2014 and the London Multi-Agency Safeguarding Adults Policy & Procedures Dependent on role or service provided, staff will have different duties in relation to safeguarding adults procedures. Alerts that are raised in relation to allegations of harm or abuse which occur within inpatient units or other SLAM residential settings must be recorded via Datix and (particularly when the alleged source of risk is a Trust service or employee) may be more appropriately investigated under NHS serious incident (SI) investigation and/or HR Management Investigation procedures. However such incidents involving an adult to whom the S42 safeguarding duty applies must also be reported as a Safeguarding Concern. See the flowchart in Appendix 4 of this policy for Trust S.42 Safeguarding Enquiry & NHS SI Investigation Interface. If a Safeguarding Enquiry is required in relation to allegations outlined above, consideration should be given by the Safeguarding Adults Manager (SAM) as to whether it is appropriate to use a singleagency investigation using internal Trust processes to also meet most of the requirements of the Section 42 safeguarding enquiry. This should be decided and agreed at the Enquiry planning stage of the safeguarding adults process. See Pan London guidance (section 4.2). The SAM and the person leading the Enquiry should be sufficiently removed from the incident/allegation to be able to provide an objective view. Deciding who should act as the Enquiry Lead and/or Enquiry Officer in relation to safeguarding enquires within SLAM inpatient units should be agreed at a local level between the relevant Inpatient Clinical Service Lead or Ward Manager and the appropriate Safeguarding Adults Manager (for most SLAM services this will be a Practitioner with the aligned CMHT or Hospital linked Social Work provision however for services at BRH discuss with Bromley Local Authority Initial Contact Team and the SLAM National Services or SLAM home borough Social Care Lead). If unsure who to involve in an enquiry or which process to follow, advice should be sought from the relevant CAG or Trust Safeguarding Adults Lead or the borough Social Care/Safeguarding Lead. Such Leads will ensure that there is a coherent multi-agency approach to adult safeguarding across the health and social care systems. Further information and Trust documentation for Safeguarding Enquiries is available via the Intranet Safeguarding Adults pages. Page 18 of 48

19 Flowchart 1: Raising a Safeguarding Adults Concern Concern or allegation regarding potential or actual abuse Ensure the adult at risk is kept safe Speak with the adult to ascertain their views and wishes Is the Adult in immediate danger or in need of emergency assistance? Has a crime been committed/is there a need to protect forensic evidence? No Yes Contact Emergency Service; e.g. Police, Ambulance, Doctor Also follow Trust SI and/or Allegations process to investigate in tandem with Safeguarding Enquiry requirements. See flowchart in Appendix 4 of SLAM Safeguarding Adults Policy Feedback to identified SAM Consult with supervisor / line manager whether Safeguarding Adults duty under S42 Care Act is indicated? Need for Safeguarding Adults Concern confirmed? No No further action under S42 Safeguarding Adults procedures. Record details of concern and check if other processes apply (e.g. Datix Fact Find reporting / Complaint /SI / other investigation) Yes Inpatient concern/event involving SLAM service? No Yes Complete Datix and EPJS Safeguarding Concern & Event Raise a Safeguarding Concern * to appropriate Adult Social Care team / Local Authority /CMHT in line with specific local/borough referral process *EPJs Safeguarding templates via Risk tab If allegation involves concern regarding a member of staff, contact Service Lead / HR advisor. See additional policy. If allegation involves agency/nhsp staff, manager to make contact with agency. Document referral and save copy under Safeguarding EPJS Adults correspondence Policy V2.3 (if April external 2016 alert). Complete Safeguarding Concern via Risk tab* Page 19 of 48

20 6.1 All staff may have a role in raising a Concern A Safeguarding Adults concern is any worry about an adult who has or appears to have care and support needs, who may be subject to or appear at risk of abuse and neglect and who may be unable to protect themselves against this. A concern may be the result of a disclosure, an incident or other signs or indicators. A concern may be raised any anyone. This could be the person themselves, a family member, a carer, a friend or neighbour or a member of staff. 6.2 Heads of Pathway, Service Leads, Team and Ward Managers and their Deputies will have a role as the Manager reporting the concern The line manager is the person within an organisation to whom the person who becomes aware of a possible safeguarding issue is expected to report their concerns. It is the Manager who will in most cases make the safeguarding referral and take part in the safeguarding process. However safeguarding referrals should be made by any suitable member of staff in the absence of the relevant Manager if an unreasonable delay would occur. Referral a concern becomes a referral when it is passed on to a local Safeguarding Adults referral point and is accepted as a Safeguarding Adults Concern possibly requiring a multiagency response. The initial referral point is dependent upon local borough procedures. 6.3 Social Workers & Managers within AMH Integrated Teams will have a role as Safeguarding Adults Manager Safeguarding Adults Managers (SAMs) are suitably qualified and experienced practitioners or managers (usually in a Social Care or Community Mental Health Team) who have received Safeguarding Adults training of the appropriate level and who have the authority to undertake the Local Authorities decision making, oversight and scrutiny functions under Section 42 of the Care Act. SAMs are responsible for coordinating all safeguarding adults activity by services in response to an allegation of abuse and for deciding whether to undertake or cause others to undertake an enquiry. The role of SAM may only be undertaken by SLAM Team Managers/Service Leads within integrated community services which have a formal Section 75 agreement outlining local delegated safeguarding responsibilities under S.42 of the Care Act. 6.4 Heads of Pathway, Service Leads, Team and Ward Managers, Care Coordinators, and other relevant staff may have a role as the Enquiry Lead or the Enquiry Officer. Enquiry Lead and Enquiry Officer are the members of staff of within a team or service who leads the enquiry and who co-ordinates actions into the allegation of abuse. This is often a health or social care professional or manager in a service who has the duty or who are best placed to investigate the safeguarding concern. A line manager may have a role in acting as the Enquiry Lead in supporting the identified Enquiry Officer and SAM in undertaking safeguarding activity. For example, a Head of Pathway or Service Lead may be the Enquiry Lead whilst a Team or Ward Manager acts as the Enquiry Officer or a Team Manager may act as the Enquiry Lead whilst the Care Coordinator/Key or Named Worker/Therapist/AHP undertakes the role of Enquiry Officer. These are illustrative examples only and in each case a discussion should take place as to who is most appropriate to undertake the roles in relation to the specific safeguarding concern. 6.5 The Safeguarding Adults Manager will oversee the Safeguarding Adults Process under Section 42 of the Care Act and the identified Enquiry Lead will support the Enquiry Officer in undertaking the necessary actions as part of this process. Page 20 of 48

21 Flowchart 2: The Section 42 Safeguarding Adults Enquiry Process Stage 1: Section 42 Enquiry Start Conversation with the Service User Yes Has this completed the Enquiry? Stage 2: Plan the Enquiry No Appoint a safeguarding enquiry lead officer Undertake planned actions Enquiry lead receives and collates the information, including analysis and recommendations SAM quality checks the enquiry report Outcomes/evaluation of above Action with person alleged to have caused harm Yes SAM leads development of a safeguarding plan and arrangements for review (optional) Stage 3: Is a safeguarding plan required? No Any other actions required? Yes No Recommend to the Board for an SAR? Agree on any other actions needed and how to review them No Yes Yes Review SAM makes recommendation required? No Stage 4: End of Safeguarding Adults Enquiry Page 21 of 48

22 6.6 Safeguarding Adults Process refers to the decisions and subsequent actions taken on receipt of a safeguarding concern. This process can include a discussion or planning meeting, further enquiry, a case conference, a care/protection/safety plan and monitoring and review arrangements. The process includes recommended timeframes for completing each stage. 6.7 There are four stages in the Safeguarding Adults process: Stage One: Raising a Concern Stage Two: Enquires Stage Three: Safeguarding Plan and Review Stage Four: Closure 6.8 Trust Documentation Safeguarding Adults Process templates for each stage of a Section 42 Enquiry will be available on EPJs via the Risk tab. These templates should be used by SLAM teams/services who are undertaking an Enquiry with one of the four aligned SLAM local authorities (Lambeth, Southwark, Lewisham and Croydon). Where the Local Authority with SAM oversight is not an aligned borough (e.g.: LB Bromley) the SLAM Enquiry Lead should advise the identified SAM that SLAM staff will use the agreed Trust documentation. This can then be provided to the SAM as electronic copies. Concerns Enquiry Safeguarding Plan & Review Closing the Enquiry See Table A (below) of this policy for key stages and timeframes Page 22 of 48

23 Table A: SAFEGUARDING ADULTS PROCEDURES - Overview of stages, responsibilities & key decision points (Trust safeguarding documentation guidance is provided in Appendix 3) Stage Activity Responsibility Target Timescale Stage 1 Concern Actions & Decisions by SLAM Staff Concern comes to notice Act to safeguard anyone at immediate risk Report to line manager Report to the police, if a crime Record actions and discussions Take any immediate management action to identify and address the risk Decide if a referral is needed (if it appears S42 duty is met) - raise Safeguarding Concern to local LA/CMHT referral point If concern within SLAM,,also report as Datix. Everyone with a duty of Care All Staff Person in Charge Care Coordinator Key Professional Relevant Manager Immediately, if emergency or within one working day Immediately if emergency or one working day Actions & Decisions by Local Safeguarding Referral Point/SAM Stage 2 Enquiries Decisions Safeguarding Concern referral received Undertake checks on actions to address safety needs liaise with referrer Initial information gathering & lateral checks Contact with adult referred if safe to do so Concern screened to establish if adult meets criteria for Sec42 safeguarding duty? No Consider what other action might be needed Yes - Make Enquiries or cause them to be made Complete documentation for Stage 1 Identify who is best placed to lead and undertake an Enquiry What form will the Enquiry take can range from a conversation with the individual adult and others to a more formal multi-agency investigation might include SI process Gather initial information including views, capacity, consent* and desired outcomes of the adult *If the adult has capacity and refuses consent to engage with the Enquiry, discuss with the identified SAM about requirements of Sec9 (Duty to assess need) and Sec11 (Refusal of assessment) of the Care Act. Check if duty to provide Advocate Safeguarding Adults Manager with Local Authority legal responsibility (e.g.: within CMHT or Adults Social Care Locality Team) Proceed to Stage 2. SAM SAM and appropriate professionals identified to lead and/or undertake the enquiry. Enquiry Lead and Enquiry Officer Same working day that concern is received Within 5 working days Within 20 working days Page 23 of 48

24 Have initial conversations with key parties Evaluate risk and agree interim safeguarding plan Inform/share information with other agencies as indicated SI Office / Police/CCG/CQC/LA Departments e.g.: Brokerage Decide if a planning meeting is needed Undertake enquiry actions Analyse findings and enquiry outcomes with the adult and involved others Review desired outcomes and identify any on-going risks/safeguarding concerns SAM reviews Enquiry Report. Proceed to Stage 3 or 4. As above Stage 3 Safeguarding Plan* and Review Identify any further actions to be taken Closure of Enquiry or safeguarding plan needed? Complete documentation for Stage 2. Plan is person-centred & outcome focused Plan is proportionate & least restrictive Timescales for review and monitoring are agreed Key professionals responsible for delivery, monitor & review of plan agreed Clarity agreed about roles and actions. Complete documentation for Stage 3. SAM and Enquiry Lead/Officer with adult concerned and relevant other parties Proceed to Stage 4 Within 5 working days of Enquiry Report Optional review within 3 months sooner dependent on risk Stage 4 Closing the Enquiry Optional review of safeguarding plan evaluate effectiveness, outcomes achieved, on-going risks. If review identifies new concerns that require further enquiry, return to Stage 2 This can occur at any stage with agreement of the SAM. Ensure all actions have been undertaken and outcomes evaluated with the adult. Complete documentation for Stage 4. Other processes/investigations (e.g.: SI/HR/Police/Regulator) may be continuing SAM Immediately following decisions made at end of stage 1, 2 or 3 as appropriate. The Objectives of a Safeguarding Enquiry are: To establish the facts Ascertain the adults views, wishes and preferred outcomes Assess the need of the adult for protection, support & redress and how these might be achieved Page 24 of 48

25 Protect from the abuse and neglect in accordance with the wishes of the adult where possible Make decisions about follow up actions with regard to person/organisation responsible for the abuse/neglect Enable the adult to achieve resolution and recovery A Safeguarding Plan should set out: What steps are taken to assure the future safety of the adult at risk The provision of any support, treatment or therapy, including any on-going advocacy Any modifications needed in the way services are provided (e.g.: same gender care provision, appointment of a court appointed deputetc.tc) How best to support the adult through any action they may want to take to seek justice or redress Any on-going risk management strategy as appropriate When a concern does not lead to an enquiry The criteria in section 42 of the Care Act for a safeguarding adults enquiry might not be met, for example in circumstances where The adult is at risk of abuse or neglect but does not have care & support needs The adult has care & support needs, may have experienced abuse or neglect in the past, but is no longer experiencing or is at risk of abuse or neglect The adult has care & support needs, is at risk of abuse or neglect, but is able to protect themselves from abuse or neglect should they choose to. Where the criteria for statutory enquiry are not met, other types of action, or provision of advice/information, could be Referral for a needs assessment under s9 of the Care Act. Application for a Deprivation of Liberty Safeguards authorisation Referral for Mental Health Act assessment. Referral to other risk management processes, such as MARAC or MAPPA Referral or signposting to other agencies or support services, such as the Police, victim support, domestic abuse support services, counselling services, or a GP. Written information and advice on how to keep safe, or how to raise a concern in the future. Information about how to make a formal complaint, for example, about substandard care or treatment. Information sharing with regulatory agencies and commissioners to address service quality concerns. Service Provider to undertake appropriate internal responses, e.g. internal investigation, training, disciplinary process, audit & assurance activity. Concern is passed into other incident management processes, e.g. NHS Serious Incident process. Referral for Safeguarding Adults Review (Care Act s44 see below) Dealing with historic allegations of abuse or where the adult is no longer at risk One of the criteria for undertaking statutory enquiry under the Care Act s42 duty is that the adult is experiencing, or is at risk of, abuse or neglect. Therefore, the duty to make enquiry under the Care Act relates to abuse or neglect, or a risk of abuse or neglect that is current. Concerns relating to historic abuse or neglect where the person is no longer at risk will not be the subject of statutory enquiry under these procedures, but further action under different processes may be needed. All such historic concerns will be considered to determine whether they demonstrate a potential current risk of harm to other adults and also whether they require criminal or other enquiry through parallel processes (e.g. complaints, inquests, regulatory, commissioning, health and safety investigations). Where an adult safeguarding concern is received for an adult who has died the same considerations will apply and an enquiry will only be made where there is a clear belief that other identifiable adults are experiencing, or are at risk of, abuse or neglect. Page 25 of 48

26 In cases where an adult has died or suffered serious abuse or neglect, and where there is concern that agencies should have worked more effectively to safeguard the adult, there is a statutory requirement for the Safeguarding Adults Board to undertake a Safeguarding Adults Review under section 44 of the Care Act Refer to Section 4 of the Pan London guidance for detailed information on the safeguarding adults Enquiry process. Contact details for aligned Local Authority (including Bromley Bexley, Greenwich & Wandsworth) Adult Social Care Services & Safeguarding Teams, see Table B (below). Page 26 of 48

27 Table B: Local Authority Adult Social Care & Safeguarding Adults Contacts BOROUGH TELEPHONE Numbers ADDRESS & SLAM Integrated Borough Social Care Lead contact. Lambeth Lambeth AMH Social Care Lead = Philip Jones Lambeth Hospital SW pjones@lambeth.gov.uk Team ASC contact number Southwark Safeguarding Adults Coordinator ASC Contact number Lewisham Ladywell Unit SW Team Referrals; SLAM services users Lambeth are developing a Multi-Agency Safeguarding Hub (MASH) to receive safeguarding referrals. Until this is set up liaise with Lambeth Hospital SW Manager or the aligned Lambeth CMHT. Initial Contact Team for individuals who are not SLAM AMH service users; Adultsocialcare@lambeth.gov.uk Southwark AMH Safeguarding Adults Lead Practitioner = Emily Brunton emily.brunton@slam.nhs.uk All Referrals; safeguardingadultscoordinator@southwark.gov.uk Lewisham AMH Social Care Lead = Denise.O Brien@slam.nhs.uk Lewisham SLAM AMH Referrals; Other information Contact appropriate Lambeth CMHT or Lambeth Hospital SW Team for advice on correct local Safeguarding Referral point. Contact appropriate Southwark CMHT or Emily Brunton re: AMH Safeguarding Referrals in addition to LA Safeguarding Coordinator Contact appropriate Lewisham CMHT or Social Care Lead re: AMH Safeguarding Referrals ASC contact number Croydon ASC contact number safeguardingmhlewisham@slam.nhs.uk Other Referrals; SCAIT@lewisham.gov.uk Croydon AMH Safeguarding Adults Lead Practitioner = Patricia Clarke Patricia.clarke@slam.nhs.uk All Referrals; referral.team2@croydon.gov.uk Contact appropriate Croydon CMHT or Patricia Clarke re: AMH Safeguarding Referrals Bromley ASC contact number adult.early.intervention@bromley.gov.uk Contact LA Initial Contact Team re: Safeguarding Referrals *For patients at BRH also contact their placing & home authority. Page 27 of 48

28 Bexley ASC contact number Greenwich ASC contact number Wandsworth ASC contact number Kent Medway Contact LA Safeguarding Team re: Safeguarding Referrals Contact LA Safeguarding Team re: Safeguarding Referrals Contact LA Safeguarding Team re: Safeguarding Referrals Contact LA Safeguarding Team re: Safeguarding Referrals Contact LA Safeguarding Team re: Safeguarding Referrals *See Section of the London Adult Safeguarding Multi-Agency Policy & Procedures 2016 for guidance on Cross-boundary and inter-authority safeguarding adult enquiries Page 28 of 48

29 7. Monitoring Compliance What will be monitored i.e. measurable policy objective Method of Monitoring Monitoring frequency Position responsible for performing the monitoring/ performing coordinating Group(s)/committee (s) monitoring is reported to, inc responsibility for action plans and changes in practice as a result Incident Recording which document a Safeguarding Adults concern Datix Safeguardin g Adults Reports Quarterly CAG Safeguarding Adults Leads Trust Safeguarding Adults Lead CAG Governance Committees Trust Safeguarding Adults Committee Trust Safeguarding Adults Lead/CAG Leads/Trust Director of Social Care Safeguarding Adults Trust Mandatory Training Trust E&T WIRED Records Quarterly E&T Dept. Trust Safeguarding Adults Committee CCG s Trust governance arrangements in relation to Safeguarding Adults NHSE Audit Tool (SAAF) Reports SAB s to Annually Trust Safeguarding Adults Lead Trust Safeguarding Adults Committee Local Safeguarding Adults Boards Page 29 of 48

30 8. Associated Documentation (correct as of April 2016) Diagram of Trust & CAG Safeguarding Adults Leads and Integrated Social Care Leads Infrastructure: ADDICTIONS: Rosie Mundt- Leach PSYCHOSIS: Elaine Rumble MHOAD Jessica Rosen CROYDON: Paul Richards - HOSC Patricia Clarke Safeguarding LAMBETH: Philip Jones - HOSC MAP: Liz Pine Executive Lead: Neil Brimblecombe, Director of Nursing Director of Social Care Cath Gormally Trust SA Lead: Louise Rabbitte PSYCH MED: Liz Pine SOUTHWARK: Simon Rayner HOSC Emily Brunton Safeguarding LEWISHAM: Denise O Brien HOSC Felix Ogundeyin - Safeguarding B & D: Christine Hemmings CAMHS: Emma Addison Appendix 1: Key to Diagram of Integrated Trust, Borough and CAG Safeguarding Adult Lead Infrastructure: KEY: TRUST SAFEGUARDING ADULT LEAD ROLES: Trust Executive Lead Safeguarding - Director of Nursing Director of Social Care Trust Safeguarding Adults Lead includes role as Trust Prevent Lead BOROUGH SAFEGUARDING ADULT LEAD ROLES: CAG (Clinical Academic Group) SAFEGUARDING ADULT LEAD ROLES: Page 30 of 48

31 9. References - source documents are available on the SLAM Safeguarding Adults Intranet site: London Multi-Agency Adult Safeguarding Policy & Procedures 2016 Care & Support Statutory Guidance (Care Act 2014) Health & Social Care Act 2008 Regulated Activities 2014 Regulations Safeguarding Adults DH 2011 Self - Neglect & Safeguarding Adults SCIE 2011 Prevent Building Partnerships, Staying Safe DH 2011 Channel a guide for local partnerships Home Office 2012 Prevent & Channel Legal Duty Guidance Home Office 2015 Raising and escalating concerns Guidance for nurses and midwives NMC Freedom of Information Act 2000 All Trust policies are public documents. They will be listed on the Trusts FOI document schedule and may be requested by any member of the public under the Freedom of Information Act (2000). Page 31 of 48

32 Appendix 1: Supplementary Note on Domestic Violence (from London Multi-Agency Adult Safeguarding Policy & Procedures 2016) Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim. This definition includes so called Honour Based Violence (HBV) and Forced Marriage (FM), and is clear that victims are not confined to one gender or ethnic group. Family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family. By these means the perpetrators deplete the victim s self-worth, isolating them from others with the perpetrators exercising psychological and emotional control. Intimate partner violence which disproportionately affects women includes physical and/or sexual violence, intimidation, isolation and the micro management of everyday life. Financial abuse is a significant problem for people who are in abusive domestic arrangements. Control of money can sabotage efforts to gain independence through employment. This is usually linked to coercive and controlling behaviour. All domestic abuse falls under the remit of the Metropolitan Police Service including cases involving year olds. Where an offence has been committed officers should arrest the suspect where there are reasonable grounds to suspect their involvement in the alleged crime and the conditions under Section 24 of PACE are met. The exercise of arrest powers will be subject to a test of necessity based around the nature and circumstances of the offence and the interests of the criminal justice system. An arrest will only be justified if the constable believes it is necessary for any of the reasons set out in Section 24(5). Failure to arrest in appropriate circumstances may result in a neglect of duty or other failure in standards. Officers must fully justify any decisions not to arrest and clearly document their decision. This challenges and holds perpetrators to account for their actions. However, positive action also requires enhanced levels of victim care. The police strategy is that the safety of victims is paramount, particularly where children are involved and referral to independent advocates is part of police procedures. Positive outcomes for those affected by domestic abuse are achieved in many ways including: Successful prosecution; Reducing cases of repeat victimization, and; Prevention through other means such as the Sanctuary scheme, civil remedies, re-housing and Pro-active operations and referrals to support agencies Staff should refer to additional guidance Adult Safeguarding and Domestic Abuse A guide to support practitioners and managers (ADASS 2015). This guidance and the Trust Domestic Violence Abuse are available on the SLAM Intranet via Safeguarding Domestic Violence pages. Page 32 of 48

33 Appendix 2: Good practice guidelines for promoting the sexual safety of service users on SLAM mixed sex wards (Adapted from Psychological Medicine CAG; Triage Wards Guidance 2015) Background There have been a number of incidents where the sexual safety of service users on mixed sex wards has been compromised. In addition to investigations being undertaken into the incidents, focused work has been carried out with staff to reflect on and formulate good practice guidelines. The purpose of these guidelines is to clarify the steps staff should take to reduce the risk of these incidents occurring, and help service users to feel as safe as possible whilst under our care. The following Trust policies have been referred to in the development of the guidelines: - Clinical risk policy - Promoting safer and therapeutic services (PSTS) - Engagement and observation policy - Privacy and dignity policy - Safeguarding adults policy - Mental capacity Act policy Referral pathway/ Prior to admission - Screening of Risk - It is the responsibility of the referring team/clinicians to screen and discuss risk jointly with the admitting ward.* - Service users who are to be admitted to a mixed sex or triage ward should be provided information explaining that the ward comprises mixed sex accommodation. If, following discussion a patient is unhappy about being admitted to a mixed sex ward, all efforts will be made to facilitate admission to a single sex ward. Where this is not immediately possible the person will be made a priority to move to a single sex ward as soon as a bed becomes available. - Service users may have a documented advanced directive that has been agreed indicating that it is in their best interest or it is their choice not to be admitted to a mixed sex ward**. This may include religious or cultural reasons or because of previous trauma. Arrangements are therefore made for the person to be admitted directly to a single sex ward. This is also applicable where risk assessment prior to admission has identified for example that a person is/has vulnerable to sexual exploitation a known predatory risk markedly sexually disinhibited behaviour These risks may be identified by the referring clinician/team or triage ward team*. These decisions are made in collaboration with the patient and are clearly documented in the risk assessment tab on EPJS and where applicable on the alert tab on EPJS in line with Trust policy. On admission Page 33 of 48

34 Risk assessment - Where the service user is already under the care of a CMHT or other service, it is the expectation that there is an up to date full risk assessment in place on admission including assessment of vulnerability and sexual safety. The assessment should be collaborative and where possible should involve family and carers/ CMHT and or other agencies. This should be reviewed by the ward team on admission an updated as per trust clinical risk policy. - Wherever possible a risk assessment/review and management plan of presenting risk should be completed jointly by the admitting doctor and a qualified nurse on the ward as part of the nursing assessment and medical clerking of the patient - For all unknown patients a full risk assessment is carried out by the multi-professional team (to include sexual safety and vulnerability). This is initiated at the first multi professional meeting and where possible is to involve the service user, family and carers GP and others as applicable - Zoning is to be used by all staff when assessing and planning the management of risk. Zoning criteria are to include vulnerability and sexual safety. Information on zoning criteria is to be made readily available and clear to all staff. - Risk management plans are reviewed by the multi-disciplinary team ward team on a daily basis and as required following a risk event/incident or on identification of new risk information - All risk assessments are clearly documented under assessment tab on EPJS and include a risk formulation and management plan documented clearly on EPJS under the plan/review tab. This is to be communicated clearly to all in the multi disciplinary team. - Any alerts are recorded on EPJS and communicated clearly to all staff at each hand over/ clinical discussion meetings - Mental capacity assessments are to be completed for all service users on admission and documented on the EPJS tab. - Where risks threatening the sexual safety of service users are not previously known but become apparent in risk assessment on the ward then the service user will be transferred as a matter of urgency and within 24 hours? to single sex wards.* Where it has been identified that a vulnerable service user should be transferred and the service user requests to stay on the ward there will need to be documented evidence that they have been assessed as having the capacity to make this decision. The rationale for the transfer will be clearly and sensitively communicated to the service user/s. whilst this is being arranged safeguards should be put in place to manage all identified risks via a personalised collaborative care /management plan. - The care plan may, for example include the instigation of increased or enhanced nursing observations (for one or more service users, dependant on assessed needs), - It will include ensuring that the person is aware of how to call a nurse for help in an emergency situation. It may also involve family support to the service user whilst on the ward for example a mother or sister visiting and supporting a female patient on the ward (with risk management plans in place) - The minimum standard of a 1:1 session to be offered to all service users on each shift - Other personalised care agreed - A copy of the care plan is given to the service user or is readily available to them. Page 34 of 48

35 - The plan is clearly communicated and readily available to all involved in the persons care and at all handovers.. Patient Information - Sensitive education of service users on admission regarding all aspects of their personal safety (including sexual safety) and encouragement given to raise any concerns they may have to any member of staff. - Information provided in the ward welcome pack regarding feeling safe - Notice boards displayed on the entrance to the male and female corridors explaining the importance of security for safety reasons and promoting privacy and dignity Visitors - All visits to patients are held in the ward visitor s room or communal lounge and service users are to be discouraged from visiting each other in their bedrooms - There is at least one member of staff allocated to be available to service users in the communal area Inquisitive enquiry - Regular enquiry by staff to all service users asking for example do you feel safe on the ward and staff acting on the feedback as to how they can make them feel safer (this may be part of Intentional Rounding where this is in place or within a 1:1 session) - General inquisitiveness when patients obscure the view of the privacy/observation panel as to what this is about - All staff to report and act upon any disinhibited or sexual behaviour observed/experienced - Being generally very vigilant and spending as much time in patient areas as practically possible - When completing the hourly environmental checks that the full hour allocated for his should be spent on the ward and with particular vigilance around the male /female corridor entrance. - Act on feedback from other service users who have concerns about others safety Safe management of the environment - Documented monitoring and assurance regarding the security of the key pad access to the male and female corridors, this includes ensuring regular spot checks in addition to the hourly environmental check, ensuring that the door has not been wedged open, is not faulty, and service users are not sharing the access number. - Immediate reporting of faulty door closures to request urgent repair * - Privacy curtains are replaced once identified as missing - Safe management of visitors on the ward signing in and out book, meet and greet and escort on the ward Page 35 of 48

36 - System in place for the supportive management of domestic staff to assure safety and privacy and dignity: - domestic staff are inducted and supervised in relation to privacy, dignity and safety - domestic staff report to the nurse in charge when they come on duty Safe staffing - Safe staffing concerns that may compromise safety to be escalated to senior managers Training The following training is up to date for all staff: Other - Safeguarding adults - Equality and diversity - Clinical risk training - PSTS - Mental Capacity Act - All nursing staff have Engagement and observation competency up to date. MDT is familiar with the policy and practice. All allegations of sexual abuse/exploitation should be reported and investigated in line with Trust Policy and Processes. Police should be involved immediately if a crime has been alleged. - Team leaders to share good practice at care pathway meetings and team leader forums - Where there have been incidents - recommendations from SI s, Safeguarding Enquiries and complaints should be shared and disseminated to all staff * Where there is a difference of opinion between the referrer and the ward team this is to be escalated to the on call Consultant and service manager where appropriate. **Any concerns that staff have regarding the implementation of the areas ** above should be escalated to their senior manager or if out of hours then to the on call manager Implementation Guidelines to be shared and agreed with all referring teams and clinicians and acute ward staff These good practice guidelines are to be included in all multi professional staff induction including NHSP staff and students. Ward managers to provide a copy to all staff on their ward and discuss implementation at relevant ward meetings and in supervision sessions. Spot checks are to be completed by CSL s, modern matron and head of nursing to provide assurance that good practice is being followed. Page 36 of 48

37 Appendix 3: Safeguarding Adults Concerns: EPJs Documentation Checklist - Once a safeguarding concern has been identified, please ensure the following are documented within EPJs Guidance documenting a safeguarding concern Record Timeframe Speak to the service user to ascertain their thoughts and wishes regarding the specific safeguarding concern. Ensure this is documented within EPJs in an Event. Mark the Event for Risk and tick the safeguarding adults boxes as applicable. If abuse is alleged or suspected, a Safeguarding Concern must be raised, even if the adult has capacity and declines support/intervention. EPJs Event Same day Complete a Datix if the concern relates to a clinical incident or SLAM staff/service. Complete the necessary Safeguarding Adults fields as applicable. Approving Manager to approve and complete mandatory fields regarding alert to local authority ASAP. Datix Within 24 hours Appropriate person (e.g.: Manager/Nurse in Charge/ Coordinator/ Key Worker etc.) to decide if a Safeguarding Concern needs to be made to a Local Authority (+/- CMHT). EPJs Safeguarding Concern template should be used and ed to respective local referral point. An Alert Form is available on the Intranet for sending to LA s not aligned to SLAM this should only be used for safeguarding concerns not occurring within SLAM. Complete Safeguarding Concern template via EPJs Risk tab Or Alert to Local Authority SLAM Form 1. Within 24 hours If SLAM Alert Form used, upload copy of the Alert to Local Authority onto EPJs (under Correspondence or 3 rd Party tab if contains sensitive information). Upload Alert/Form 1 Within 24 hours Document Risk Event if appropriate (this should be done for all safeguarding incidents occurring within SLAM services) EPJs Risk Event Within 24 hours Review and update the Risk Assessment to reflect the safeguarding concern and risk EPJs Risk Assessment Within 48 hours Ensure that the Care Plan reflects the safeguarding concern and the plan agreed with the service user to reduce or manage the identified issue of harm/abuse. Ensure that the care plan is devised in collaboration with the service user and reflects their capacity to engage with and agree to any plans made. EPJs Care Plan Within 48 hours Manager to complete Fact Find Report as required if the concern also involves a clinical incident/allegation. CAG/SI Office to decide if any Trust investigatory process is required, in addition to or in tandem with any potential formal multiagency safeguarding enquiry process. EPJs Event/Fact Find Report Within 48 hours The identified Local Authority referral point Safeguarding Adults Manager (in SLAM integrated services, this is likely to be a Senior Practitioner SW within or linked to CMHTs) should feedback to the Alerter within 5 working days as to whether a formal safeguarding enquiry is being opened. Alerting team should record feedback in Events. EPJs Safeguarding Concern template via Risk tab EPJs Event. Within 5 working days of alert being raised to Local Authority referral point. Local Authority SAM determines if a Section 42 multi-agency Safeguarding Adults Enquiry is required. Determine who is best placed to lead an Enquiry as required. Commence formal Safeguarding Process in line with policy and guidance. Record discussions and decisions within EPJs Events. Commence/complete Safeguarding Adults Enquiry stages using templates within EPJs Risk tab. SLAM Safeguarding Enquiry Process Stages 1-4 via EPJs Risk tab/epjs Event Within 20 working days of concern being raised to Local Authority referral point. Page 37 of 48

38 Appendix 4: Sec.42 Safeguarding Enquiry & NHS SI Investigation Process Interface Page 38 of 48