PUBLIC PROTECTION POLICY Authors: Anne Marie Knox. Nurse Consultant, Safeguarding Children and Young People Paula Shiels. Senior Nurse, Mental Health, Learning Disabilities and Adult Protection Review Group: NHS24 Child and Adult Protection Action Group Review Date: March 2018 Last Update: March 2016 Document No: Issue No:
NHS 24 Policy Page Introduction 3 Policy Statement 3 Policy Context in Scotland regarding Children and Young People 4 Policy Context in Scotland regarding Adults 5 The Purpose of the NHS 24 Public Protection Process 6 Reason for Initiating a Well-being Concern 6 Reason for Initiating a Child Protection Concern 7 Reasons for Initiating an Adult Support and Protection Concern 7 Considerations 8 Organisational Responsibility 9 The NHS 24 Team around the Vulnerable Person 11 References 12
INTRODUCTION NHS 24 is Scotland's National Telehealth and Telecare Service. NHS 24 recognises its responsibility with regard to concerns about the care, protection and wellbeing of vulnerable people across the lifespan. NHS 24 acknowledges that it is their duty to ensure that a patient's health and wellbeing is not compromised by acts of commission and omission. NHS 24 recognises that it is vital that its staff work with their partners towards providing protection for vulnerable individuals at risk of harm. This document has been produced in partnership with the NHS 24 Child and Adult Protection Action Group and external local authority and health partners. The Scottish Government views the protection of vulnerable people as a priority. This policy is informed by legislation and guidance issued by the Scottish Government. At the centre of this policy is the principle that the welfare of vulnerable individuals is paramount. POLICY STATEMENT This policy applies to all NHS 24 staff, including staff in local centres. NHS 24 is committed to ensuring that all staff are supported in providing a service where the welfare of vulnerable individuals is of upmost consideration. NHS 24 is committed to sharing information and working with partner organisations to promote the welfare of vulnerable individuals. The term child in Scotland often means those below the age of 16 although the general definition in the Children (Scotland) Act 1995 and the Children and Young Persons (Scotland) Act 2014 is person below the age of 18. The age and circumstances of the individual will determine what legal measures can be applied. For the purposes of this policy and for public protection practice within NHS 24 the following applies: For Child Protection concerns: Unborn babies All children below the age of 16 For Wellbeing Concerns: All children and young people up to the age of 18 who are still enrolled in school For Adult Protection concerns: Those young people and adults aged 16 years and beyond.
POLICY CONTEXT IN SCOTLAND RELATING TO CHILDREN AND YOUNG PEOPLE The United Nations Convention on the Rights of the Child (UNCRC) is the cornerstone of policy and legislation concerning children in the United Kingdom and most of the rest of the world. The Convention changed the way children are viewed and treated, i.e., as human beings with a distinct set of rights rather than objects of care and charity and, following its ratification and acceptance by UK Government over 25 years ago, subsequent legislation and policy concerning the lives of children has incorporated and reflected this. Child Protection in Scotland has to be seen in the context of the wider Getting it right for every child (GIRFEC) approach, which promotes action to improve the wellbeing of all children and young people. The overarching concept of GIRFEC is a common approach across all agencies in Scotland, which supports the delivery of appropriate, proportionate and timely help to all children and young people, as they need it. GIRFEC is enshrined within legislation-the Children and Young People (Scotland) Act 2014, which is expected to be fully operational by autumn 2016. The Act places a duty on organisations (including NHS 24) to recognise wellbeing concerns and to communicate such concerns with the child's Named Person. The named person is responsible for making sure that every child or young person has the right support in place to maintain their wellbeing and to encourage them to reach their developmental potential across each key life stage. For babies and children until they enter school this will be the Health Visitor. For school age children the named person will be someone in a promoted post within education. More information about GIRFEC and the new legislation can be found here: http://www.gov.scot/topics/people/young-people/gettingitright There are many other laws which govern the lives of children in Scotland. As well as the Children and Young People Act, the most relevant to NHS 24 staff in respect of their child protection practice remains the Children (Scotland) Act 1995. This act provides the legislative framework for Scotland's child protection system. It sets out parental responsibilities and rights, as well as the duties and powers public authorities have to support children and intervene if there are concerns about a child. It is vitally important that staff understand and distinguish between those children where there are concerns about the likelihood or risk of significant harm from abuse or neglect which would lead to an urgent child protection referral and request for social work intervention; and those children where there are concerns relating to wider non urgent wellbeing issues. These wellbeing concerns should be shared with the child's Named Person. There are also two key documents from Scottish Government that provide all staff with guidance in respect of their child protection practice. These are: National Guidance for Child Protection in Scotland (updated 2014) http://www.gov.scot/resource/0045/00450733.pdf Child Protection Guidance for Health Professionals (2013) http://www.gov.scot/resource/0041/00411543.pdf POLICY CONTEXT IN SCOTLAND RELATING TO ADULTS Scotland has several legislative frameworks that provide support and protection to vulnerable adults, Adults with Incapacity Act (Scotland) 2000, Mental Health (Care and
Treatment) (Scotland) Act 2003 (amended 2015), Adult Support and Protection (Scotland) Act 2007 and Public Bodies (Joint Working) (Scotland) Act 2014. Adult protection practice in Scotland is underpinned by The Adult Support and Protection (Scotland) Act 2007, which makes provision to protect those adult who are unable to safeguard his or her own interests. The Act came into effect in October 2008. Under the Act, local authorities have power to intervene, assess and make provision for adults at risk of harm. In accordance with Part 1 of the Adult Support and Protection (Scotland) Act 2007, adults at risk of harm are defined as any person sixteen years of age and over who: a) Are unable to safeguard their own well-being, property, rights or other interests b) Are at risk of harm c) Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected All three elements of this definition must be met. It is the whole of an adult's particular circumstances which can combine to make them more vulnerable to harm than others. The Adult Support and Protection (Scotland) Act 2007 describes the general principle which should be employed when considering interventions in the affairs of an adult at risk of harm. The general principle on intervention in an adult's affairs is that a Council Officer may intervene, or authorise intervention, only if satisfied that the intervention: a) Will provide benefit to the adult which could not be reasonably provided without intervening in the adult's affairs b) Is, of the range of options likely to fulfil the object of the intervention, the least restrictive to the adult's freedom (Adult Support and Protection (Scotland) Act 2007) Part 1 of the Adult Support and Protection (Scotland) Act 2007 introduces measures to identify and protect adults at risk of harm. Those pertinent to NHS 24 are: a) Report the facts and circumstances of the case to the council, where they know or believe that a person is an adult at risk, and that protective action is needed; Section 5(3) b) Co-operate with a council making inquiries and with each other where that would assist the council; Section 5(2) c) Provide information and records as requested; Section 10 The Adults with Incapacity (Scotland) Act 2000 introduced a system for safeguarding the welfare and managing the finances and property of adults (age 16 and over) who lack capacity to act, or make some or all decisions for themselves, because of mental disorder or the inability to communicate due to a physical condition. It allows other people to make decisions on behalf of these adults, subject to safeguards. The main groups to benefit include people with dementia, people with a learning disability, people with an acquired brain injury or severe and chronic mental illness, and people with a severe sensory impairment The Mental Health (Care and Treatment)(Scotland) Act 2003 details when an individual can be hospitalised or given treatment against their will, what their rights are and measures to safeguard that these rights are protected.
The Public Bodies (Joint Working (Scotland) Act 2014) introduced nationally agreed outcomes, which apply across adult health and social care, and for which Health Boards and Local Authorities will be held jointly accountable. They place a requirement on Health Boards and Local Authorities to integrate adult health and social care budgets, as well as a requirement on Partnerships to strengthen the role of clinicians and care professionals, along with the third and independent sectors, in the planning and delivery of services. The Bill aims to ensure that adult health and social care budgets are used effectively to achieve quality and consistency, and to realise a shift in the balance of care from institutional to community based settings. THE PURPOSE OF NHS 24'S PUBLIC PROTECTION PROCESS Triggers immediate action for those individuals assessed as being at risk due to vulnerability. Alerts other professionals to concerns. Tracks and confirms attendance at onward referral site. Prompts further action if failed attendance at onward referral site. Facilitates further action for vulnerable individuals thought to require additional assessment and support from health or social work colleagues. Supports sharing of information with partners in other agencies. Wherever possible, the vulnerable individual, parents or carers should be informed by staff of their concerns and of any planned action, including referral to other agencies. It is only in exceptional circumstances that the individual / family would not be informed, if for example, staff felt it might place the individual at additional risk. REASONS FOR INITIATING A WELLBEING CONCERN At the heart of the GIRFEC approach is an emphasis on early, proactive intervention in order to create a supportive environment and identify any additional support that may be required as early as possible. When a practitioner has concerns about a child s well-being, which indicate that while the child is not in need of protection he/she may be in need of additional support, these concerns and relevant information should be shared with the child s Named Person. Reasons for initiating a Wellbeing Concern may include: a) Young infant with feeding difficulties that the parents are finding difficult to manage b) Frequent calls in relation to a child or young person which indicate further support may be required c) Young person with low mood d) Children or young people with challenging behaviour e) Parental circumstances that affect the child's wellbeing NB: This list is not exhaustive.
REASONS FOR INITIATING A CHILD PROTECTION CONCERN All NHS 24 staff have a duty to act and initiate the child protection process, where they know or believe that an unborn baby, child or young person is at risk of significant harm the child protection process must be followed and all relevant information shared appropriate professionals including social work. Reasons which alert staff to initiate the child concern process include: a) Suspected non accidental injury, abuse(physical or sexual)or neglect of a child b) Parental or carer behaviours that place a child or unborn baby at risk, e.g. drug or alcohol misuse, parental mental health concerns c) Domestic Abuse identified during pregnancy or in families where there are children, even if the child is not present d) Disclosure by child, parent or third party of abuse or neglect of a child e) A child who is self-harming f) Known history of child protection / child welfare concerns e.g. child's name on Child Protection Register g) Suspicion of fabricated illness h) Suspicion that a child may be a victim of trafficking NB: This list is not exhaustive. Concerns about Parents or Adult Carers: a) If the clinical disposition warrants an adult receiving care outside the family home, NHS 24 staff will ascertain if there are any children in the home. In such circumstances, staff will confirm with the adult that arrangements can be made for the child to be looked after by an alternative adult b) In exceptional circumstances, NHS 24 staff may have to contact the police or emergency social work staff to arrange alternative care for the child c) If, in the course of a call an adult is displaying behaviours that would indicate a child in the home is at immediate risk of harm, NHS 24 staff will contact the police REASONS FOR INITIATING AN ADULT SUPPORT AND PROTECTION CONCERN All NHS 24 staff have a duty to act and initiate the adult support and protection process, where they believe that an Adult at Risk of Harm may be in need of care and/or protection. Reasons, which alert staff to initiate the Adult Support and Protection process, include: a) A vulnerable adult alone at home in a situation of risk b) Over frequent / inappropriate contact to the service c) Delay in seeking treatment d) Caller history e) Medication not administered as prescribed f) Indications during assessment of dehydration/malnutrition g) Increase in confusion h) Demonstration of fear, alarm or distress while alone or of another person e.g. domestic abuse i) Anxious behaviour by the adult j) Rejection / dismissive behaviour by the carer k) Third Party caller under the influence of drink/drugs
l) Evidence of unlawful conduct, which appropriates or adversely affects property, rights or interests e.g. theft, fraud, embezzlement, extortion or exploitation m) Known history of adult protection related concerns e.g. previous Adult Support and Protection referral process initiated n) Conduct that causes self-harm NB: This list is not exhaustive. Adults who have the Care of Children: a) If the clinical disposition warrants an adult receiving care outside the family home, NHS 24 staff will ascertain if there are any children in the home. In such circumstances, staff will confirm with the adult that arrangements can be made for the child to be looked after by an alternative adult b) In exceptional circumstances, NHS 24 staff may have to contact the police or emergency social work staff to arrange alternative care for the child c) If, in the course of a call an adult is displaying behaviours that would indicate a child in the home is at immediate risk of harm, NHS 24 staff will contact the police CONSIDERATIONS IN ALL CASES Based on all available information, the practitioner should carefully consider whether or not he/she feels that the vulnerable individual is at risk from abuse and/or neglect and if her/his concerns warrants initiating the welfare and public protection process. The following questions will help understand those concerns: 1. Why do I think this person is not safe? 2. What is getting in the way of this person being safe? 3. What have I observed, heard or identified from the individual's history that causes concern? 4. Are there factors that indicate risk of significant harm is present, and in my view, is the severity of factors enough to warrant immediate action? 5. In relation to an adult, are they more vulnerable to being harmed because they are affected by disability, mental disorder, illness or physical or mental infirmity? ORGANISATIONAL RESPONSIBILITY In February 2011, the Scottish Government introduced The Protection Vulnerable Groups Scheme (PVG Scheme). This helps to ensure that those who have regular contact with children and protected adults through paid and unpaid work do not have a known history of harmful behaviour. The PVG Scheme was established by the Protection of Vulnerable Groups (Scotland) Act 2007. A PVG check is required for NHS 24 staff who undertake 'regulated work' as defined within the PVG Act.
NHS 24's recruitment procedures and staff monitoring processes comply with the Protection of Vulnerable Groups (Scotland) Act 2007 and the changes introduced by the government in 2011. All frontline NHS 24 staff will receive public protection training as part of the core induction programme. Public protection annual updates for frontline staff are mandatory. NHS 24 staff will have the opportunity to attend interagency public protection training. NHS 24 staff have a responsibility to identify any public protection needs as part of their continuous professional development. Organisationally NHS 24 will ensure that public protection training equips staff to deal with the protection of vulnerable groups activity. NHS 24 Public Protection training is underpinned by national guidance in relation to the roles and competencies for healthcare staff in safeguarding children and young people and protecting vulnerable adults at risk of harm. Following a call that involves a public protection issue, staff will be offered the opportunity to reflect on the call with their Team Leader. Further support is available to all staff from the Nurse Consultant Safeguarding Children and Young People and/or the Senior Nurse for Mental Health, Learning Disabilities and Adult Protection. The Scottish Government requires Chief Executives of Health Boards to have a responsibility for the delivery of high quality services to support Public Protection. This includes the overall strategic direction for public protection and strategic management of all adult and child protection health services delivered by the Health Board. The Chief Executive may delegate some of these responsibilities to an Executive Director / Lead for Public Protection. This Executive Director will report directly to the Chief Executive and will be responsible for the leadership, co-ordination and management of the public protection services in that Board. The Director of Nursing and Care has the executive lead for public protection within NHS 24. The Nurse Consultant Safeguarding Children and Young People and the Senior Nurse Mental Health, Learning Disabilities and Adult Protection reports to the Nurse Director and are responsible for ensuring that NHS 24 policies procedures and training are compliant with national legislation and guidance. Additionally the Nurse Consultant provides professional support to staff in relation to their child protection practice and the Senior Nurse provides support in relation to the adult support and protection practice. The NHS 24 Child and Adult Protection Action Group (CAPAG) meets quarterly. The CAPAG is responsible for ensuring the development of NHS 24 policies, processes and plans in respect of child and adult protection. This includes the full spectrum of activity from promoting welfare to active protection. The Public Protection Taskforce was formed in 2015 to act as the driver for identified public protection actions across the organisation. It is made up of a small group of key senior
managers, meets monthly and reports to the Director of Nursing and Care. Actions and developments are reported to and informed via CAPAG. The National Clinical Governance Group (NCGG) and the Clinical Governance Committee (CGC) are responsible for ensuring that robust governance processes are in place, and for the monitoring of public protection practice within the organisation. Reports are provided to both groups on a quarterly basis, together with an overarching annual report detailing public protection activities and developments.
THE NHS 24 TEAM AROUND THE VULNERABLE PERSON
REFERENCES Adult Support and Protection (Scotland) Act 2007 http://www.opsi.gov.uk Adult Support and Protection (Scotland) Act 2007, Proposed Revised Code of Practice (August 2013) http://www.scotland.gov.uk/publications/2013/08/6723/7 Adults with Incapacity (Scotland) Act 2000 http://www.gov.scot/publications/2008/03/25120154/1 Integration of Adult and Social Care Bill http://www.gov.scot/about/performance/programme-for-government/2012-2013/adult- Health-Bill Mental Health (Care and Treatment) (Scotland) Act 2003 http://www.gov.scot/publications/2004/01/18753/31686 NHS 24 (2013) Adult Support and Protection for all staff \\nhs24.net\data\ndcshared\kms\95adultsupportandprotection.pdf NHS 24 Child Protection e Learning Module GIRFEC NHS 24 Process 47. Child Welfare and Protection Process for all staff NHS 24 Process 95. Adult Support and Protection Process for all staff NHS Education for Scotland (2011) Core Competency Framework for the Protection of Children http://www.nes.scot.nhs.uk/education-and-training/by-discipline/nursing-andmidwifery/resources/publications/core-competency-framework-for-the-protection-ofchildren.aspx Public Bodies (Joint Working) (Scotland) Act 2014 http://www.legislation.gov.uk/asp/2014/9/contents/enacted Royal College of Paediatrics and Child Health (2010) Safeguarding Children and Young People: Roles and competencies for healthcare staff. Intercollegiate document. http://www.rcpch.ac.uk/sites/default/files/assetlibrary/education%20young%20people%2020 10G.pdf Scottish Executive (2010)Protecting Vulnerable Groups Scheme. Guidance for individuals, organisations and personal employers. http://www.disclosurescotland.co.uk/pvg/316389_v6_20100628.pdf Scottish Government (2014) National Guidance for Child Protection in Scotland http://www.scotland.gov.uk/publications/2010/12/09134441/0 Scottish Government (2013) Child Protection Guidance for Health Professionals http://www.scotland.gov.uk/resource/00411543.pdf Scottish Government (2012) A Guide to Getting it Right for Every Child http://www.scotland.gov.uk/topics/people/young-people/gettingitright