SAFEGUARDING ADULTS POLICY

SAFEGUARDING ADULTS POLICY (Working with adults who have care and support needs to keep them safe from abuse or neglect) Version Ratified By Date Ratified Author(s) FINAL APPROVED NHS Wirral CCG Commissioning Group Board Valerie Tarbath Responsible Committee / Officers NHS Wirral Clinical Commissioning Quality Committee Date Issue 26.04.16 Review date April 2018 Intended Audience Stakeholders of NHS Wirral Clinical Commissioning Group, NHS Wirral Clinical Commissioning Group members, governing body and employees. For publication on the CCG web site Impact Assessed Safeguarding Adults Policy 1

Further information about this document: Document name Category of Document in The Policy Schedule Author(s) Contact(s) for further information about this document This document will be read in conjunction with Published by Copies of this document are available from Safeguarding Adults Policy Corporate Valerie Tarbath Designated Nurse Manager Safeguarding Adults NHS Wirral Clinical Commissioning Group Lorna Quigley Director of Quality and Patient Safety NHS Wirral Clinical Commissioning Group Commissioning Policy Incident Reporting and Management Policy Commissioned Standards For Safeguarding Children And Adults at risk Disciplinary Policy and Procedure Policy for the Management of Public Interest Disclosure (Whistleblowing) NHS Wirral Clinical Commissioning Group Old Market House, Hamilton Street, Birkenhead, CH41 5AL Website: https://www.wirralsafeguarding.co.uk/. Copyright, 2012. All Rights Reserved Version Control: Version History: Version Number Reviewing Committee / Officer Date 1.0 NHS Wirral Clinical Commissioning Group Quality Performance & Finance Safeguarding Adults Policy 2

Contents Page no 1. INTRODUCTION 1 2. WHAT OUR COMMITMENT MEANS 2 3. SCOPE AND PURPOSE OF THE POLICY 2 4. SAFEGUARDING PRINCIPLES 3 5. ROLES, RESPONSIBILITIES AND DUTIES OF STAFF 4 6. LOCAL ARRANGEMENTS FOR MANAGING RISKS 8 7. REPORTING A SAFEGUARDING ADULT CONCERN 9 8. ALLEGED ABUSER AND VICTIMS WHO ARE BOTH SERVICE USERS 9 9. RESPONDING TO ALLEGATIONS AND SUSPICION OF ABUSE AGAINST STAFF 9 10. SAFEGUARDING ADULTS QUALITY AND AUDIT 10 11. INVOLVEMENT OF SERVICE USERS 10 12. TRAINING 10 13. SERIOUS CASE REVIEWS 10 APPENDIX A - WHAT TO DO IF YOU HAVE CONCERNS ABOUT AN ADULT 12 APPENDIX B - TERMS USED WITHIN DOCUMENT 13 APPENDIX C REFERENCES AND ASSOCIATED DOCUMENTS 16 Safeguarding Adults Policy 3

1. INTRODUCTION 1.1 1.2 Due to the changes within the Health and social care setting, It is essential that there is clarity about responsibilities and robust processes in place with regard to safeguarding vulnerable adults. and how the system can help drive continued improvement in practice and outcomes. 1.3 The introduction of The Care Act 2014 provides a clear legal framework for how Clinical Commissioning Groups (CCG s) work in partnership with other public services, to protect adults at risk placing Adult Safeguarding on the same statutory footing as children. 1.4 encourages an open culture to ensure clear understanding between partners at a local level when other agencies such as the Local Authority, Care Quality Commission (CQC) need to be involved in the safeguarding of adults. Promoting the health and well-being of those who are at risk of being abused or neglected in the services commissioned including the needs of the wider health and social care community. 1.5 Safeguarding means protecting a person s right to live in safety, free from abuse and neglect. As commissioners we must demonstrate the aims of adult safeguarding: a) To prevent harm and reduce the risk of abuse or neglect to adults with care and support needs b) To safeguard individuals in a way that supports them in making choices and having control in how they choose to live their lives c) To promote an outcomes approach in safeguarding that works for people resulting in the best experience possible d) To raise public awareness so that professionals, other staff and communities as a whole play their part in preventing, identifying and responding to abuse and neglect 1.6 commitment to the aims involves: a) Plans to train staff in recognising and reporting safeguarding concerns b) A clear line of accountability for safeguarding adults at risk, reflected in clinical commissioning group policies and governance arrangements c) Appropriate arrangements to co-operate with local authorities in the strategic approach to safeguarding including executive membership on the statutory Local Safeguarding Adult Board d) Having a Lead GP for Safeguarding Adults, a designated professional and a lead for the Mental Capacity Act including Deprivation of Liberty safeguards & PREVENT e) Safeguarding principles are embedded in the culture and values of the organisation Safeguarding Adults Policy 4

1.7 There are fundamental requirements for effective safeguarding in the delivery of NHS care: a) has responsibility to assure the quality and safety of the organisations with whom contracts are held with ensure that those contracts have explicit clauses that holds the providers to account for preventing and dealing promptly and appropriately with any example of abuse and neglect b) To prevent safeguarding incidents arising through the provision of high quality NHS care. Including NHS Outcomes Framework which set out the high-level national outcomes that the NHS should be aiming to improve, inclusive of standard 5 - Treating and caring for people in a safe environment; and protecting them from avoidable harm. c) To ensure effective responses where harm or abuse occurs through multi agency adult safeguarding policies and procedures. 1.8 In discharging these statutory duties / responsibilities account must be taken of: a) Data Protection Act 1998 b) Department of Health (2011) - The role of health service managers and their board. The Government reforms put patients and the quality of their care at the heart of the NHS. c) Department of Health (2000). No Secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Adults at risk from Abuse & Safeguarding Adults Report on the Consultation on the Review of No secrets d) Safeguarding Adults In Wirral - Inter-Agency Policy Procedures and Guidance part 1, 2 & 3 e) The Care Act 2014 (DOH 2014) f) Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour Guidance for NHS bodies (Care Quality Commission, November 2014) 1.9 As a commissioning organisation is committed to ensure that all health providers from whom it commissions services (both public and independent sector) have comprehensive single and multi-agency policies and procedures in place to safeguard and promote the health and wellbeing of adults at risk and that health providers are linked into the Local Safeguarding Board and that workers contribute to multi-agency working dependent on their roles and responsibilities. Safeguarding Adults Policy 5

1.10 Commissioning includes any service or part of service which the NHS is under a duty to provide. This includes Continuing Healthcare and the NHS contribution to Registered Nursing Care. 1.11 This policy details the roles and responsibilities of NHS Wirral Clinical Commissioning Group as a commissioning organisation and that of its employees. 2. WHAT OUR COMMITTMENT MEANS 2.1 Safeguarding our patients should always include consideration of children and young people. Think Family entails a cross generational approach to safeguarding, recognising that adults may be parents or carers, cared for by children or young people or represent a danger to children. 2.2 As commissioners making safeguarding adults at risk is integral to healthcare delivery and ensuring the assurance from providers that they are achieving good outcomes in preventing and effectively responding to harm, neglect and abuse. Putting patients first and ensuring their voice is sought and heard. Including the connection and interface between safeguarding and quality of service provision. 3. SCOPE AND PURPOSE OF THE POLICY 3.1 The Safeguarding Adult policy sets out NHS Wirral Clinical Commissioning Groups approach to ensure that: a) Everyone has the right to live their life free from violence, fear and abuse b) All adults have the right to be protected from harm and exploitation c) All adults have the right to independence, which involves a degree of risk 3.2 This policy applies to all employers and employees of NHS Wirral Clinical Commissioning Group and sets out their role and responsibilities as individuals within the organisation. 4. SAFEGUARDING PRINCIPLES 4.1 Six key principles underpin all adult safeguarding work 1. Empowerment Person-led decisions and informed consent 2. Prevention Taking action before harm occurs 3. Proportionality Ensuring that responses are proportionate, appropriate and as unobtrusive as they can be given the risk presented Safeguarding Adults Policy 6

4. Protection Support and representation for those in greatest need 5. Partnerships Local solutions through services working with their communities 6. Accountability Accountability and transparency in delivering safeguarding 4.2 In developing this policy is committed to making sure that Wirral inter-agency Policy, Procedure and Guidance become operational by: a) Ensuring that there is a consistent and effective response to any concerns, allegations or disclosures of abuse b) Supporting staff in reporting and investigating incidents of adult abuse c) Ensuring that staff have the knowledge and understanding about adult protection and receive training on implementing safeguarding procedures d) Working in partnership with other organisations e) Monitoring and evaluating our own practices and those of providers with whom we commission care f) Contributing towards inter-agency adult protection investigations and risk management plans g) Encouraging staff and members of the public to report abuse or suspicions of abuse h) Working towards creating safer services. i) Encouraging people to report any suspicions they have about abuse by awareness raising, both in our respective organisations and amongst the general public 5. ROLES, RESPONSIBILITES AND DUTIES OF STAFF 5.1 Chief Executive Officer The Chief Officer of has responsibilities to: a) Ensuring that policies are fit for purpose b) Ensuring that the health contribution to safeguarding and promoting the welfare of children and adults is discharged effectively across the whole local health economy covered by NHS Wirral Clinical Commissioning Group. c) Identifying Director of Quality and Patient Safety as NHS Wirral Board Clinical Commissioning Group lead for safeguarding children and adults. Safeguarding Adults Policy 7

5.2 The NHS Wirral Clinical Commissioning Director of Quality and Patient Safety responsible for: a) Providing strategic leadership for adult safeguarding on behalf of the clinical commissioning group and ensuring that the governing body is fully informed about adult safeguarding issues in Wirral. The Director of Quality and Patient Safety will provide day to day line management of the designated nurse adult safeguarding b) Ensuring that the health contribution to safeguarding and promoting the health and well-being of adults at risk is discharged effectively across all its commissioned services c) Ensuring that the organisation contributes to the commissioning of specific clinical services d) Ensuring that safeguarding and promoting the health and well-being of adults at risk is identified as a key priority area in all strategic planning processes. This is closely linked to the Joint Strategic Needs Assessment e) Ensuring that safeguarding adults at risk is integral to governance and audit arrangements f) Ensuring that all staff knows what to do when they are concerned that an adult at risk is being abused g) Representing on the Local Adult Safeguarding Board with the chair of the Local Adult Safeguarding Board and contributing to its work h) Ensuring that all health providers from whom services are commissioned have comprehensive single and multi-agency policies and procedures for safeguarding children and adults at risk which are in line with Local Safeguarding Children and Adult Board procedures, and are easily accessible for staff at all levels i) Ensuring that contract specifications drawn up with NHS Wirral Clinical Commissioning Group as a commissioning organisation include clear service standards for safeguarding adults. These service standards (Commissioned Services Policy for Safeguarding Children and Adults at risk and audit tools) include standards for training, policies, and provide links to the Local Adult Safeguarding Board. That service standards are monitored thereby providing assurance that safeguarding standards are met j) Ensuring that all staff within the organisation have safeguarding adult training at the required level k) Ensuring that there are arrangements in place to hear the voice of the adult in safeguarding services l) Presenting the annual safeguarding report to the Governing Body members Safeguarding Adults Policy 8

5.3 The Designated Nurse Manager Safeguarding Adults is responsible for: a) Providing expert advice to all health professionals, the local authority, and the Local Adult Safeguarding Board b) Providing advice to ensure the range of services commissioned by NHS Wirral Clinical Commissioning Group take account of the need to safeguard and promote the health and well-being of adults at risk c) Ensuring that service plans/specifications/contracts/invitations to tender include reference to the standards expected for safeguarding adults at risk d) Providing advice on the monitoring of the safeguarding aspects of NHS Wirral Clinical Commissioning Group contracts e) Providing skilled advice to the Local Adult Safeguarding Board on all health issues and contributing to the work of the Local Adult Safeguarding Board through the board and its sub groups f) Promoting, influencing, and developing relevant training, on both a single and inter-agency basis to ensure the training needs of health staff are addressed g) Ensuring that all staff knows how to recognise abuse and how to report and respond to it. h) They should be trained and competent to be alert to the potential indicators of abuse and neglect and know how to act on those concerns in line with local guidance i) Providing skilled professional involvement in adult safeguarding processes in line with Local Adult Safeguarding Board procedures j) Providing expert health input to multi-agency safeguarding initiatives and developments k) Contributing to Serious Case Reviews, multi and single agency learning reviews, and multi-agency case audits l) Contributing to the dissemination of learning from case reviews and audits to all staff and health providers when appropriate m) As the nominated PREVENT lead for the CCG, Act as the single point of contact & make appropriate referrals to the Channel Programme n) Provide assurance commissioned services comply with the provisions of the Mental Capacity Act and Deprivation of Liberty Safeguards and that use of restriction and restraint is the least restrictive to meet the needs of the patient and that there is no unlawful deprivation of liberty. o) Ensuring staff can access safeguarding adult at risk procedures, policies and guidance. p) Ensuring staff are aware of their responsibilities under this policy, and that it is fully implemented within their area of responsibility. q) Providing leadership and support to staff that are providing services to adults at risk and their families. r) Ensuring that staff work effectively with professionals from other agencies and organisations. Safeguarding Adults Policy 9

s) Ensuring operational implementation of this policy into practice and taking appropriate action should any breach of this policy take place. t) Ensuring that service plans / specifications / contracts include Commissioned Services Standards for Safeguarding Children and Adults at Risk. This document provides clear service standards against which healthcare providers (including independent contractors, voluntary, community and faith sector (VCFS) and Care Homes) will be monitored to ensure that all service users are protected from abuse and the risk of abuse. 5.4 The Lead GP for Safeguarding Adults a) Work collaboratively with the named & designated professionals for safeguarding adults across Wirral CCG & NHS England are Team in the provision of advice & support to health colleagues and partner agencies. b) Co-operate with each of the CCG s relevant partners in order to protect adults experiencing or at risk of abuse or neglect. Provide advice and support to local police, adult s social care and other statutory and voluntary agenices on health matters with regard to safeguarding adults/mca and DoLS. c) To act as a professional source of advice to the Wirral CCG Safeguarding Lead, Local Safeguarding Adults Board and its sub groups in relation to the GP s role in safeguarding and promoting the welfare of adults. d) To advise on and contribute to monitoring the implementation of CQC safeguarding standards for GP practices across the local health authority e) Unless directly involved, to provide the chronology and individual management report which will critically appraise General Practice involvement with an adult and their family where the case gives rise to a serious case review or critical incident review. f) To monitor the implementation of recommendations from serious case reviews and critical incident reviews relating to GP Practices. g) Support and advise colleagues in the clinical assessment and care of adults where there are safeguarding/adult protection concerns, as part of own clinical role, whilst being clear about other s personal clinical professional accountability. There must be an emphasis on sensible risk appraisal, not risk avoidance, which takes into account individuals preferences, histories, circumstances and life-styles to achieve a proportionate tolerance of acceptable risks. h) Access and evaluate evidence, write reports and present information to adult safeguarding conferences and related meetings. i) To establish and maintain networks/forums to facilitate the communication of safeguarding matters between GP s and their practice staff, Clinical Commissioning Groups, Local Medical Committee, CCG/AT Safeguarding Adults Board (SAPB) and its sub groups. j) To advise on and facilitate the audit of safeguarding practices and systems across General Practice. k) Provide advice on supervision systems and support for Wirral GPs and their practice staff.. Safeguarding Adults Policy 10

5.6 The Quality Performance and Finance Committee is responsible for: a) Receiving adult safeguarding reports on a quarterly basis which will include, Wirral adult safeguarding progress reports, exception reporting, the progress of independent management reviews and serious case reviews together with action plans and lessons learned b) Providing exception reports on adult safeguarding to the governing body to highlight any key developments /achievements or potential risks/ issues c) Escalating adult at risk risks to NHS Wirral Clinical Commissioning Group Governing Body 5.7 Wirral Local Safeguarding Adults Partnerships Board are responsible for: a) Protect adults who have needs for care and support, who are experiencing or are at risk of abuse or neglect, and as a result of their needs are unable to protect themselves from abuse or neglect. This is whether or not the adult is having their needs met or they meet the local authority s eligibility criteria for care and support services b) Identify the role, responsibility, authority and accountability with regard to the action each agency and professional group should take to ensure the protection of adults at risk of abuse or neglect c) Establish how it will hold partners to account and gain assurance of the effectiveness of its arrangements d) Determine its arrangements for peer review and self-audit e) Establish mechanisms for developing policies and strategies for protecting adults at risk of abuse and neglect which should be formulated, not only in collaboration and consultation with all relevant agencies but also take account of the views of people who use care and support, families and carer representatives f) Formulate guidance about the arrangements for managing adult safeguarding, and dealing with complaints, grievances and professional and administrative malpractice g) Carry out safeguarding adult reviews h) Produce an Annual Report and an Annual Business Plan i) Promote multi-agency training. 5.8 All Staff are responsible for: a) Following both internal and local multi-agency safeguarding policies and procedures at all times, particularly if concerns arise about the safety or health and well-being of an adult at risk b) Participating in safeguarding adults training and maintaining current working knowledge c) Becoming familiar with, and implement/contribute to the implementation of Wirral Safeguarding Adults Multi-agency policy and procedure Safeguarding Adults Policy 11

d) Discussing any concern about the health and well-being of an adult at risk with their line manager e) Contributing to actions required including information sharing and attending meetings f) Working collaboratively with other agencies to safeguard and protect the health and well-being of people who use services g) Remaining alert at all times to the possibility of abuse h) Recognise the impact that diversity, beliefs & values of people 6. LOCAL ARRANGEMENTS FOR MANAGING RISKS ASSOCIATED WITH SAFEGUARDING ADULTS 6.1 Confidentiality and Information Sharing a) Confidential information about an adult at risk should never be used casually in conversation or shared with any person other than on a need to know basis b) There are some circumstances when employees may be expected to share information about an adult at risk, for example when abuse is alleged or suspected. In such cases individuals have a duty to pass information on without delay in line with Local Adult Safeguarding Board procedures. Employees must document when, with whom and for what purpose information was shared c) The main restrictions within the legal framework to disclosure are: Common law duty of confidence Human Rights Act 1998 Data Protection Act 1998 d) Disclosure should be justified in each case and guidance should be sought from the adult safeguarding lead in cases of uncertainty. The adult safeguarding lead may seek guidance from NHS Wirral Clinical Commissioning Group legal representatives e) In some circumstances the sharing of confidential information without consent would normally be justified in the public interest. These circumstances would be: When there is evidence that the adult at risk is suffering or is at risk of suffering significant harm Where there is justifiable cause to believe that an adult at risk may be suffering or at risk of significant harm To prevent significant harm arising to the adult at risk including through the prevention, detection and prosecution of serious crime likely to cause significant harm to the adult at risk f) Information could also be shared without consent in the following circumstances: If the adult at risk is at greater risk Safeguarding Adults Policy 12

If you or another health care professional is at risk If it would alert the perpetrator (in cases of sexual abuse or fabricated illness) If specific forensic evidence is needed g) At all times the safety and wellbeing of the adult at risk is paramount when considering the likely outcome of sharing or not sharing information. Reasons for decisions to share, or not share must be recorded. All decisions require professional, informed judgment. If in doubt this should be discussed with the adult safeguarding lead. The Adult Safeguarding lead may need to seek advice from NHS Wirral Clinical Commissioning Group legal representatives. 7. REPORTING A SAFEGUARDING ADULT CONCERN 7.1 All staff should exercise vigilance in their work to mitigate against the risk that adult at risk using services might be suffering from abuse. If any member of staff becomes concerned that an adult at risk may be suffering from abuse or neglect they must follow the guidance set out in the flow chart What to do if you have concerns about an adult Appendix A If in need of advice you should contact the adult safeguarding lead. a) If staff suspect that an adult at risk is being abused or at risk of abuse, they are expected to report concerns to a line manager (unless they suspect that the line manager is implicated in such circumstances the whistle blowing policy should be followed.) b) If at any time, staff feel that the person needs urgent medical assistance, they have a duty to call for an ambulance or arrange for a doctor to see the person at the earliest opportunity c) If at any time, staff have reason to believe that the adult at risk is in immediate and serious risk of harm or that a crime has been committed the police must be called d) All service users need to be safe. Throughout the process the service users needs remain paramount. This process is about protecting the adult and prevention of abuse e) Accurate records of events must be kept in accordance with the record keeping policy 8. ALLEGED ABUSER AND VICTIMS WHO ARE BOTH SERVICE USERS 8.1 It is important that consideration be given to a co-ordinated approach and partnership working, where it is identified that both the alleged abuser and the alleged victim are service users. If the person alleged to have caused harm is also an adult at risk they must receive support and their needs must be addressed. 8.2 Where both parties are receiving a service, staff should discuss cases and work together, however, meetings with both the alleged abuser and alleged victim in attendance, are not appropriate Safeguarding Adults Policy 13

9. RESPONDING TO ALLEGATIONS AND SUSPICION OF ABUSE AGAINST STAFF 9.1 All such incidents should be reported to NHS Wirral Clinical Commissioning Director of Quality and Patient Safety or the Adult Safeguarding Lead. In the case of General Practitioners, the Medical Director should be notified in the first instance. Allegations of abuse made against a worker will be discussed with / referred to the Local Authority lead Officer in accordance with Wirral Adult Safeguarding Board procedures. 10. SAFEGUARDING ADULTS QUALITY AND AUDIT 10.1 has a process in place to ensure that all service plans / specifications / contracts / invitations to tender include reference to the standards expected for safeguarding adults at risk. The main providers complete a quarterly Safeguarding Assurance Framework. Safeguarding contracts are monitored through the meeting via exception reporting arrangements. a) Quarterly adult safeguarding update reports are provided and discussed at the appropriate contract monitoring meetings b) will contribute to Wirral Local Safeguarding Adult Board through the safeguarding lead. 11. INVOLVEMENT OF SERVICE USERS 11.1 is strongly committed to listening to and acting on the views of service users when commissioning services. Adults at risk and their carer s views and opinions will be heard through provider organisation audits. 12. TRAINING 12. 1 views safeguarding adult training as vital to ensure high quality and safe patient needs led assessments. Training requirements will be in line with Safeguarding Adults Roles and competencies for health care staff intercollegiate document Feb 2016. Different staff groups require different levels of competence depending on their role and degree of contact with individuals, the nature of their work and their level of responsibilities. Safeguarding Adults Policy 14

13. SERIOUS CASE REVIEWS 13.1 has a duty to work in partnership with the Local Adult Safeguarding Board, and / or any other Adult Safeguarding, in conducting Serious Case Reviews. 13.2 The adult safeguarding lead will inform the Area Team, the National Commissioning Board and the Care Quality Commission (CQC) when a Serious Case Review is commissioned. 13.3 will commission an Independent Management Review (IMR) with regard to any services delivered through independent contractors. This will be formally signed off for the organisation by the governing body lead for safeguarding (Nurse Representative) or their nominated deputy. 13.4 All Independent Management Reviews commissioned across the health economy will be submitted to the Nurse Representative. It is expected that each provider organisation will have a robust sign off process by their board level lead and that reports received will have been subject to this scrutiny process. 13.5 will ensure that individuals are given sufficient time and necessary support to complete both Individual Management Reviews. 13.6 The Governing Body must ensure the review and all agreed actions following the review are carried out according to the timescale set out by Wirral Local Adult Safeguarding Board Serious Case Review Panel scoping and terms of reference. 13.7 The Quality Improvement Committee Group will monitor the progress of identified recommendations and supporting action plans for issues relating to. Safeguarding Adults Policy 15

APPENDIX A - What to do if you are concerned about an adult in a Care Home Concern re: patient in a care home NO Is patient receiving Health Services YES GP Practice SG Lead (see list provided) Named GP 07771790605 Designated Nurse Safeguarding Adults Wirral Community Trust Safeguarding Team * WCNT.safeguardingadults@nhs.net Wirral University Teaching Hospital Safeguarding Team ** wih-tr.wuthsafeguarding@nhs.net (Contact whichever provider is involved) Cheshire & Wirral Partnership Trust Safeguarding Team *** * District Nurse, Physiotherapist, Occupational Therapist, Dietician ** Planned/Unplanned Hospital Care *** Adult Mental Health, Learning Disabilities Safeguarding Adults Policy 16

APPENDIX B - What to do if you are concerned about an adult Safeguarding Adults Policy 17

APPENDIX B 1 - What to do if you are concerned about an adult AAPPENDIX 2 2 - The following terms are used in this document Term Abuse Adult Safeguarding Board Allegation Definition Abuse is a violation of an individual s human and civil rights by any other person or persons. Abuse may be physical, sexual or it may be neglect. It may be beneficial or psychological or discriminatory. It may be domestic violence or institutional abuse. Sometimes it may be unintentional abuse, where someone thinks that they are trying to help but in the wrong way. Abuse concerns the misuse of power, control and/or authority and can manifest itself as: Domestic violence, sexual assault or sexual harassment. Physical neglect/ Acts of omission discrimination and oppression. Institutional abuse. Financial abuse Emotional/ psychological many situations will involve a combination of different kinds of abuse. Is a multi- agency partnership of public, private and voluntary sector organisations which aim to safeguard all adults at risk in Wirral An allegation of abuse is where a person or agency states that a person or persons is or are being abused. Alerter or referrer Care Quality Commission The person who initially raises concern about the abuse. This person may need to act in the immediate aftermath of an incident, disclosure or allegation. The Care Quality Commission is the independent regulator of health and social care in England. The Commission regulates health and adult social care services, whether provided by the NHS, local authorities, private companies or voluntary organisations. Concern of Abuse The concern of abuse is where a person or agency suspects that a person or persons is or are being abused, but they are not certain in their concern and they may or may not know who is doing the abusing. Disclosure Domestic Violence A disclosure of abuse is where a person or persons state(s) that they are being abused or have been abused. Domestic violence is any threatening behaviour, violence or abuse between adults who are or have been in a relationship, or between family members. It can affect anybody, regardless of their gender or sexuality. The violence can be psychological, physical, sexual or emotional and can include 'honour-based violence', female genital mutilation and forced marriage. Safeguarding Adults Policy 18

APPENDIX B 1 - What to do if you are concerned about an adult Inter-agency Meeting Mental Capacity Patient Needs Led Assessment Inter-agency meeting to discuss the circumstances of a case of abuse, the legal context for intervention, roles and responsibilities of different professionals involved recommendations for the development of a protection or care plan and process for reviewing and monitoring the case. The ability of adults to make informed decisions about the way they live their lives and the risks they want to take. Lack of mental capacity may be a temporary, fluctuating or permanent condition and relates to the ability to make a specific decision at a specific time. A holistic assessment that takes into consideration a patient, physical, psychological and social needs. NHS Wirral Clinical Commissioning Group Organisations that commissions health services and ensure those services meet the needs of the local population. Partner Agencies Perpetrator Partner agencies who have a part to play in the protection of adults at risk at risk include: Commissioners and providers of Health and Social Care Services Providers of sheltered and supported housing Public Protection agencies like the Police, Probation, Fire Service and Trading Standards along with Crime and Disorder Reduction Partnerships Voluntary and Private Sector Organisations Local Authority Services Carer support groups, user groups and advocacy/advisory services and other organisations Supporting people who are suffering abuse Agencies offering legal advice and assistance The p e r s o n (s) responsib le for t h e a b u s e or criminal act. Professional Meeting Referring Agency An inter-agency meeting called after an initial or full investigation has taken place. A Professional Meeting is called to share and discuss concerns and to clarify facts. The agency or organisation that becomes aware of and reports concerns, allegations or disclosures of abuse. Safeguarding Safeguarding focuses on people who because of their vulnerable situation are least able to protect themselves from harm. Safeguarding Adults incorporates measures to reduce the likelihood of abuse and neglect occurring as well as adult protection i.e. making effective responses to protect adults at risk where abuse and neglect has occurred or is suspected to have occurred. Safeguarding Adults Policy 19

APPENDIX B 1 - What to do if you are concerned about an adult Serious Case Review A serious case review should be conducted by The Safeguarding Adults at risk at risk RiskAdults at risk Partnership Board, in the following circumstances: a) When a vulnerable adult dies, (including death by suicide), and abuse or neglect is known or suspected to be a factor in the adults at risk at death. b) When a vulnerable adult had sustained a potential life threatening injury through abuse or neglect c) A case gives rise to concerns about the way in which professionals and services work together. Adult at risk Whistle blowing or Public Interest Disclosure No Secrets sets out the multi-agency arrangements to safeguard and protect adults at risk. Later policy has directly replaced the term vulnerable adult with adult at risk. This recognises that vulnerability does not lie with the individual but lies in a complex interconnection between the individual s personal qualities, their situation or environment and the social factors that may protect them or increase their risk. a person aged 18 or over who is in receipt or who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. No Secrets: DH 2000 The act of whistle blowing relates when a member of staff raises concerns about misconduct, illegal or underhand practices by individuals and/or organisations in line with the Public Interest Disclosure Act (1998) APPENDIX 3 References/ Resources and associated documents In developing this Policy account has been taken of the following statutory and nonstatutory guidance, best practice guidance and the policies and procedures of the Local Safeguarding Children and Adults Board. Care Act 2014 Department of Health http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf Care Quality Commission (2014) Regulation 5: Fit and proper persons: directors and Regulation 20: Duty of candour Guidance for NHS bodies November 2014 Safeguarding Adults Policy 20

APPENDIX B 1 - What to do if you are concerned about an adult http://www.cqc.org.uk/sites/default/files/20141120_doc_fppf_final_nhs_provider_guid ance_v1-0.pdf Department for Constitutional Affairs (2007) Mental Capacity Act 2005: Code of Practice, TSO: London Department of Health, Home Office (2000) No Secrets: guidance on developing and implementing multi-agency policies and procedures to protect adults at risk at risk from abuse (issued under Section7 of the Local Authority Social Services Act 1970) Department of Health (2009) Report of the consultation on the review of no secrets The NHS Outcomes Framework 2013/14 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/12710 6/121109-NHS-Outcomes-Framework-2013-14.pdf.pdf Ministry of Justice (2008) Deprivation of Liberty Safeguards Code of Practice to supplement Mental Capacity Act 2005, London TSO http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/socialcare/delivering Adultsocialcare/MentalCapacity/MentalCapacityActDeprivationofLibertySafeguards/i ndex.htm Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework Department of Health (2011) Safeguarding Adults: The role of health services. https://www.gov.uk/government/publications/safeguarding-adults-the-role-of-healthservices http://www.commissioningboard.nhs.uk/wp-content/uploads/2013/03/safeguardingvulnerable-people.pdf DH (June 2012) The Functions of Clinical Commissioning Groups (updated to reflect the final Health and Social Care Act 2012) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/15234 6/dh_134569.pdf.pdf DH (May, 2011) Statement of Government Policy on Adult Safeguarding http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyan dguidance/dh_126748 Law Commission (May, 2011) Adult Social Care Report http://www.justice.gov.uk/lawcommission/publications/1460.htm Safeguarding Adults Policy 21

APPENDIX B 1 - What to do if you are concerned about an adult NHS Commissioning Board (2013) Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework http://www.commissioningboard.nhs.uk/wp-content/uploads/2013/03/safeguardingvulnerable-people.pdf Safeguarding Adults The role of NHS Commissioners https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/14742 2/dh_125036.pdf.pdf Safeguarding Adults The Role of Health service Managers & their Boards https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/14742 0/dh_125035.pdf.pdf Safeguarding Adults Aide Memoir for CCG s - Teresa Fenech Deputy Chief Nurse NHS North Department of Health (2010) Clinical Governance and adult safeguarding: an integrated approach, Department of Health Department of Health (2006) Mental Capacity Act Best Practice Tool, Gateway reference: 6703 Local Safeguarding Adults Board - Wirral Local Authority Safeguarding Adults Policy 22

APPENDIX B 1 - What to do if you are concerned about an adult https://www.wirralsafeguarding.co.uk Care Quality Commission (2009) Guidance about compliance: Essential Standards of Quality and Safety http://www.cqc.org.uk/sites/default/files/media/documents/gac_- dec_2011_update.pdf Disclosure and Barring Service The primary role of the Disclosure and Barring Service (DBS) is to help employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups including children. http://www.homeoffice.gov.uk/agencies-publicbodies/dbs Social Care Institute for Excellence http://www.scie.org.uk/publications/reports/report41/ Safeguarding Adults Policy 23