Safeguarding Adults at Risk Policy Part 1

Safeguarding Adults at Risk Policy Part 1 Effective from 06/17

Policy Title: Executive Summary: Supersedes: SAFEGUARDING ADULTS East Cheshire Trust is committed to the welfare and safeguarding of adults at risk. This policy details the safeguarding arrangements and responsibilities for all staff of East Cheshire Trust Version 3. Safeguarding Adults at Risk in East Cheshire Trust April 2015 Description of Amendment(s): To update policy in new format Remove No Secrets and reference The Care Act 2014 This policy will impact on: The work of all employees and volunteers working at East Cheshire Trust Financial Implications: Non Known Policy Area: Patient Safety Document SARV v4 16 Reference: Version Number: 4 Effective Date: 09/2017 Issued By: Nursing, Review Date: 05/2020 Performance & Quality Corporate Business Unit Author: Chris McGinley Impact Assessment Date: 06/2017 Consultation Phase: APPROVAL RECORD Group Director of Nursing, Quality and Performance Date 06/2017 Hospital Social Care Team 06/2017 Safeguarding Operational Group 06/2017 Legal Services 06/2017 Hospital Social Care Team 06/2017 Approved by: Integrated Safeguarding Group 05/09/2017 Received for information: Risk Management sub-group 09/2017 2

Safeguarding Team East Cheshire NHS Trust Board Level Director Director of Nursing, Performance & Quality Tel: 01625 661624 East Cheshire NHS Trust Deputy Director of Nursing and Quality Tel: 01625 661788 East Cheshire NHS Trust Named Nurse Safeguarding Adults at Risk Tel: 01625 661347 Clinical Specialist Practitioner Safeguarding Adults at Risk Tel: 01625 663619 East Cheshire NHS Trust Safeguarding Team Support Team Secretary / Secretary to Named Nurses Tel: 01625 661774 Generic Safeguarding email address ecn-tr.safeguardingmacclesfield@nhs.net 3

Table of Contents 1. Introduction 6 2. Purpose 7 3. Responsibilities 7 4. Processes and Procedures 8 Definitions 8 Categories of Abuse 9 Safeguarding Process 10 Referral 11 Information Sharing 12 Confidentiality 13 Consent 13 Mental Capacity Act 2005 14 Independent Mental Capacity Advocate (IMCA) 14 Deprivation of Liberty Safeguards (DoLS) 15 Assessment under the Mental Health Act 1983 15 Covert Medication 15 Missing patient s with Dementia, Confusion or Vulnerability 16 Self-Neglect 16 Chaperone Policy 17 Disagreement between Professionals or Agencies 18 Request for a Change of Support 18 Allegations of Abuse made Against a Worker and any Serious Untoward 18 Incident Against an Adult at Risk Confidential Counselling Service 18 Female Genital Mutilation (FGM) 19 Forced Marriage and Honour Killing 20 Domestic Abuse 21 Hate Crime 22 Modern Slavery and Human Trafficking 22 PREVENT Exploitation by Radicalisers who Promote Violence 24 Transition from Children s Services to Adult s 24 Risk Assessment 25 Training Framework 26 Associated Documents 31 Implementation 31 5. Monitoring Compliance with the Document 31 6. References 32 7. Appendices Page 11 4

Page 12 Appendix 1 Principles to Safeguard the Service and Staff Duty of Care 34 Appendix 2 When an adult attends A&E with physical injuries, which are suspected to be inflicted personally or by another person or where there are concerns around substance misuse 35 Appendix 3 Adult Safeguarding Flow Chart v4 36 Equality and Diversity Form 37 1. Introduction East Cheshire NHS Trust as with all other NHS bodies has a statutory duty to ensure that it makes arrangements to safeguard and promote the care it provides to reflect the needs of the adult they deal with. In discharging these statutory duties/responsibilities account must be taken of statutory guidance on making arrangements to safeguard and promote the welfare of adults at risk (The Care Act 2014) and the policies and procedures of the Local Safeguarding Adults Boards (LSAB s). Principles of Safeguarding These are the principles that you should follow as part of your responsibility in safeguarding adults at risk. Adult at risks are listened to and what they say is taken seriously and acted upon in an appropriate manner. Adults have a right to privacy, to be treated with dignity and to be enabled to live an independent life. Adults should have choice about how they lead their lives and have their rights upheld, regardless of ethnic origins, gender, sexuality, disability, age, religious or cultural background and beliefs. You should assume an adult has capacity (in accordance with the Mental Capacity Act 2005) unless an assessment of capacity shows otherwise. Adults who have capacity have a right to make their own choices irrespective of how unwise their decision is construed. Where adults lack the capacity to safeguard themselves, other people will need to make those decisions and should do so in their best interest. This policy is mandatory and should be read in conjunction with the following East Cheshire NHS Trust policies: 1 Administration and Disposal of Medicines Policy 7 Prevent Anti-Terrorism and Radicalisation Policy 2 Chaperone Policy 8 Restraint Policy 3 Domestic Violence and Abuse Policy 9 Safeguarding Children s Policy 4 Equality and Human Rights Policy 10 Sexual Offenders Management Policy 5 Female Genital Mutilation (FGM) policy 11 Supervision Policy 6 Mental Capacity Act 2005 including Deprivation of Liberty Safeguards Policy 5

Cheshire Local Safeguarding Adults Boards web based Procedures which can be accessed via www.cheshireeast.gov.uk and www.cheshirewestandchester.gov.uk websites. This policy applies to all employees of the East Cheshire NHS Trust including Locum, Bank, Agency Staff and volunteers. It is recommended that this guidance is used by independent contractors. 2. Purpose The aim of these policies/procedures/protocols is to set out a clear framework for East Cheshire Trust staff to work effectively with adults who are in need or at risk. These policies / procedures and protocols should be used in conjunction with the Cheshire East and Cheshire West and Chester Safeguarding Adults Board Procedures 3.0 Responsibilities In developing this policy East Cheshire NHS Trust recognises that safeguarding adults is a shared responsibility with the need for effective joint working between agencies and professionals that have different roles and expertise if those at risk groups in society are to be protected from harm. In order to achieve effective joint working there must be constructive relationships at all levels, promoted and supported by: 1. the commitment of directors and senior managers to safeguarding adults at risk and at risk children 2. clear lines of accountability within the organisation for safeguarding 3. service developments that take account of the need to safeguard service users, which is informed, where appropriate, by the views of service users 4. Learning and development and continuing professional education in order that staff understand their roles and responsibilities, and those of other professionals and organisations in relation to safeguarding adults at risk and at risk children. 5. Safe working practices including recruitment, vetting and barring procedures 6. Effective interagency working, including effective information sharing East Cheshire NHS Trust should ensure that systems are in place, which will enable all staff to comply with the two LSAB Procedures and The Care Act 2014. East Cheshire NHS Trust has a named nurse to whom allegations of abuse against adults who work with adults at risk should be reported in line with the procedures. Social Care hold overall responsibility. East Cheshire NHS Trust has LSAB safe recruitment and selection practices in accordance with Safe Recruitment A Guide for NHS Employers (NHS Employers 2010) NHS Employment Check Standards (NHS Employers 2014) and should ensure that appropriate Disclosure & Barring Service (DBS) checks are undertaken for new staff and volunteers including registered translators who have contact with adults and children at risk. Appendix 1 - Procedure to safeguard the service and staff. 6

East Cheshire NHS Trust will ensure the provision of training which meets the standards and objectives of and LSAB training requirements and has been accredited and endorsed by the LSAB training sub-group. All staff who are likely to come into contact with adults at risk or their families in the course of their work have access to and receive appropriate level of training, updating and access to professional advice and support. East Cheshire NHS Trust will promote a culture of listening and engaging in dialogue with adults at risk in the formulation of all Trust policy options and proposals, consideration should be given to the impact on the adult at risk. Communicating with the adult at risk will be appropriate to their understanding. When child abuse is suspected in an adult admitted to East Cheshire NHS Trust any medical condition must be treated as a priority. The adult at risk must be afforded the same degree of sensitivity and respect as others. The Chief Executive East Cheshire NHS Trust through the Chief Executive Officer and the Trust Board has a duty under The Care Act 2014 to ensure their functions are discharged with regard to the need to safeguard and promote the welfare of adults at risk. Safeguarding adults is an integral part of the Clinical Governance framework with a clear line of accountability within the organisation. The Director of Nursing, Performance and Quality East Cheshire NHS Trust has a Board Level Director who has executive responsibility for safeguarding adults as part of their portfolio of responsibilities (The Care Act 2014). The Executive Director at East Cheshire NHS Trust holding this responsibility is the Director of Nursing, Performance and Quality. Engagement with the Local Safeguarding Adult s Board (LSAB) at strategic level is required of East Cheshire NHS Trust. The Trust is represented on the two LSAB s by the Director of Nursing, Performance and Quality and the Associate Director of Nursing and Quality. Associate Directors It is the responsibility of the Associate Directors to ensure that their areas of management and accountability deliver safe and effective services in accordance with statutory, national and local guidance for safeguarding adults and that all service specifications, invitations to tender and service contracts fully reflect safeguarding requirements as outlined in this policy. Senior Managers It is the responsibility of managers to ensure that all their employees are aware of their responsibilities under this policy, and that it is fully implemented within their area of responsibility. Managers have a responsibility to ensure that all staff, including administrative staff are given opportunities to attend local courses in safeguarding and promoting the welfare of adults at risk or ensure that safeguarding training is provided within the team. Managers responsible for recruitment and selection decisions must ensure that all staff working with adults apply for enhanced screening by the Disclosure and Baring Service (DBS) prior to appointment if appropriate. Managers must ensure that staff have access to advice and support. Clinical supervision should be available to all staff. Where adult abuse is suspected they must follow the guidance in this policy. 7

Named Professionals Deputy Director of Nursing and Performance Is the trust s operational lead for adult safeguarding and reports directly to the trust executive director in matters relating to adult safeguarding. Adult Safeguarding Team Adult Safeguarding Team which consists of the Named Nurse and Specialist Clinical Nurse, have a key role in promoting good professional practice within the organization, and provide advice and expertise for fellow professionals. They have specific expertise in adult safeguarding and local arrangements for safeguarding and promoting the welfare of vulnerable adults. The Adult Safeguarding Team support the organisation in its clinical governance role, by ensuring that audits on safeguarding are undertaken and that safeguarding issues are part of the trust s clinical governance system. They also have a key role in ensuring a safeguarding training strategy is in place and is delivered within the organisation. They are also responsible for providing effective support to staff within the organisation. The Adult Safeguarding Team are responsible for conducting the organisations internal management reviews, except when they have had personal involvement in the case when it will be more appropriate for the designated professional to conduct the review. Named professionals should be of sufficient standing and seniority in the organisation to ensure that the resulting action plan is followed. Responsibility of all Employees All health employees should be alert to the potential indicators of abuse or neglect for adults at risk and know how to act on those concerns in line with local guidance; Be responsible for having knowledge of the LSAB procedures. They should know how to contact Named Professionals for guidance and support and should be familiar with and follow their organisations policies/procedures for promoting and safeguarding the welfare of adults at risk in their area. All health employees are responsible for accessing training relating to safeguarding adults appropriate to their role so that they maintain their skills and are familiar with procedures aimed at safeguarding adults. All health employees should understand the principles of confidentiality and information sharing in line with local and government guidance and should contribute to, when requested, the multiagency meetings established to safeguard and protect adults. Comprehensive and contemporaneous records of all concerns, discussions and decisions made including telephone conversations in relation to safeguarding adults at risk should be maintained in line with East Cheshire Trust policy on records and record keeping. Non-Executive Director A Non-Executive Director participates in the safeguarding agenda and is a member of the Trust s assurance group which is a sub-group of the Board. 8

4.0 Processes and Procedures DEFINITIONS An adult is defined as someone who has reached their 18 th birthday The safeguarding duties apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect. Safeguarding means protecting an adult s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances. Adult at risk: A adult at risk is any person aged 18 or over who is or may be in need of community care services by reason of: Mental or other disability, age or illness; And Who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation Who Decides, 1997 Abuse: a violation of an individual s human and civil rights by any other person or persons which results in significant harm DH, 2000 Significant Harm: Ill treatment (including sexual abuse and forms of ill treatment which are not physical) The impairment of, or an avoidable deterioration in physical or mental health and/or The impairment of physical, intellectual, emotional, social or behavioural development. DH, 2000 CATEGORIES OF ABUSE Physical Abuse: Includes hitting, slapping, pushing, kicking, misuse of medication, restraint. Sexual Abuse: Includes rape and sexual assault or sexual acts to which an adult at risk has not consented, or could not consent, or was pressured into consenting. Psychological Abuse: Includes emotional abuse, threats of harm or abandonment, i.e. unlawful deprivation of liberty, restriction of lifestyle and contact with others, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation. Financial or Material Abuse: Includes theft, fraud, exploitation, pressure in connection with wills, property or inheritance or the misappropriation of property, possessions or benefits. 9

Neglect or Acts of Omission: Includes ignoring medical or physical care, failure to provide appropriate health, social care, the withholding of the necessities of life such as medication, heating and adequate nutrition. Discriminatory Abuse and Hate Crime: Treating a person who does not respect their race, religion, age, gender, disability, culture, ethnicity or sexual orientation. Institutional Abuse: Where routines and rules make a person alter their lifestyle and culture to fit in with the institution. The collective failure of an organisation to provide appropriate care and services to at risk individuals. SAFEGUARDING PROCESS Initiating Safeguarding Procedures Protecting people from abuse, harm and exploitation is one of the Trust s key priorities. Establishing whether abuse has taken place is not always straightforward. This section aims to support/guide frontline managers and staff to distinguish between poor practice and abuse. Poor practice will always require a response because if not challenged it can result in a further deterioration in standards leading to longer-term difficulties or even catastrophic consequences for some individuals. Where poor practice is felt to have occurred within the Trust, the Trust will take appropriate action via its internal systems or make a report to Social Care if concerns are regarding care in the community e.g. Care home or private home. Where abuse is identified the safeguarding procedures should be implemented. On receiving a safeguarding alert it is important to determine whether it is appropriate for the concern to be dealt with under safeguarding procedures. Before safeguarding procedures are initiated, some questions must first be considered: does the possible abuse relate to an adult at risk? does the adult have capacity to consent to what has occurred, but if so did they do so under duress? is there evidence of wilful neglect? has the adult experienced significant harm? Significant harm is defined as " illtreatment (including sexual abuse and forms of ill treatment that are not physical); the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, emotional, social or behavioural development". [Law Commission 1995] What degree of abuse justifies intervention through Safeguarding Procedures? In determining what degree of harm justifies intervention through Safeguarding Procedures, the factors to consider will include: the vulnerability of the victim 10

balance of power between victim and alleged perpetrator capacity of victim and perpetrator the nature and extent of the harm caused the impact on the person whether the harm caused constitutes a criminal offence whether others (adults or children) are at risk It is important to note that abuse may not be deliberate or intentional; however, where significant harm has occurred as a result of an act or omission, whether intentional or not, then Safeguarding Procedures should be initiated. Determining whether or not abuse of a person has taken place is not always a straightforward matter, particularly when the concerns relate to neglect. A judgement will be required about whether an act or an act of omission has caused significant harm. We need to differentiate between an accident, complaint or abuse. It is very important that a safeguarding alert is instigated if there is a possibility that abuse has occurred. Some very serious abuse only comes to light because people raising the alert have drawn the attention of social care or police to what may appear to be relatively minor concerns. In some cases it is the repetition of minor actions or omissions that collectively will amount to abuse. The expectation of the Trust is that anyone suspecting abuse is if in doubt report. This is when someone becomes aware of or has a suspicion of abuse. The concern should be reported as soon as possible using a First Account Form (FAF). For hospital in-patients an initial verbal referral to the hospital social care team should be made ext. 1503 in normal working hours. Community based patients an initial verbal referral should be made to the appropriate Skilled Multi Agency Response Team (SMART). In both areas the FAF must be completed for social care. A copy of the FAF must be sent to the adult safeguarding team either via email or fax: 01625 663055. Out of normal working hours the duty social work team should be contacted, see adult safeguarding flow chart. The FAF can be found on the Trust infonet Policies S Safeguarding Adults Policy PART 2 REFERRAL - What to do if you suspect abuse Who should take action? staff in all health care settings have a duty of care to respond to concerns of abuse or neglect towards adults at risks. What action should be taken? Ensure the person is safe and complete a FAF for social care. Seek immediate advice and support from the adult safeguarding team or social care if 11

needed. If the person s first language is not English and they require an interpreter DO NOT rely on the use of a family or friends to undertake interpretation this should be done by someone who is independent to ensure all relevant information is translated accurately to and from the adult at risk. The adult at risk should be seen on their own if at all possible, as they may have multiple abusers and family member s maybe colluding in the abuse. A DATIX should only be completed if appropriate action has NOT been taken First Account Form This is the point at which an alert is made to adult social care services. The decision to investigate will be made by them. Safeguarding Investigation Social Care will lead on this but they may ask the adult safeguarding team to do this on their behalf. Safeguarding Professionals Meeting A professionals meeting may be held to review the current situation and gather information from partner agencies. Best Interests Meeting This will be a multi-agency meeting to review the situation and develop a plan of action. The patient or their representative should be invited to this meeting to ensure the wishes of the person are represented. What happens when the referral has been made? Once the referral has been made the priority will always be the safety of the adult at risk and any others who may also be at risk e.g. children or other vulnerable adults. The relevant social services team will see the person and discuss with them the safeguarding concerns and find out what their wishes are. If there are concerns about the person s capacity then a capacity assessment must be completed for patients in the hospital or community setting. Social Care will advise on actions, management or discharge planning as appropriate however, a multidisciplinary meeting may be required before this can be done. INFORMATION SHARING Effective information sharing underpins integrated working and is a vital element of both early intervention and safeguarding. It is important that frontline practitioners understand when, why and how they should share information and follow: Sharing Information as Part of Preventative Services Explain to adult at risk and families at the outset, openly and honestly, what and how information will, or could be shared and why. And seek their agreement. Information must be accurate and up to date, necessary for the purpose for which it is being shared and only shared with those people who need to see it. 12

Sharing Information Remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately. 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 may be 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 an adult at risk through the prevention, detection and prosecution of serious crime likely to cause significant harm to an adult at risk. Information could also be shared without consent in the following circumstances: If the adult at risk at greater risk 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 Consider the likely outcome of sharing or not sharing information At all times the safety and wellbeing of the adult at risk is paramount Reasons for decisions to share, or not share must be recorded. Decisions require professional, informed judgment. If in doubt this should be discussed with a named professional for safeguarding adults or you may need to seek advice from the Trust s legal representatives. Recording and Sharing of Information It is extremely important that the recording of information about an adult at risk concern is written in a legible chronological order that reflect discussions with other professionals and agencies and complies with ECT record keeping Policies. CONFIDENTIALITY 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. There are some circumstances when employees may be expected to share information about an adult at risk, for example when sexual abuse is alleged or suspected. In such cases individuals have a duty to pass information on without delay in line with Local Safeguarding Board procedures. Disclosure should be justified in each case and guidance should be sought from the Named Professionals or the Trust s legal representatives in cases of uncertainty. Employees must document when, with whom and for what purpose information was shared. The main restrictions within the legal framework to disclosure are: Common duty of confidence Human Rights Act 1998 Data Protection Act 1998 The storing and processing of personal information about adults is governed by the Data Protection Act 1998. 13

CONSENT It is always preferable to gain the consent of the adult at risk but they must be deemed competent to give that consent. In certain circumstances this may not be possible e.g. when an adult has dementia or is incapacitated. In these circumstances a representative must be identified who can help support the decision to share information. For further guidance in relation to consent for adults at risk see Cheshire East Trust Consent Policy which can be accessed via the Trust Website MENTAL CAPACITY ACT 2005 (MCA) This law is designed to empower and protect any at risk person aged 16 and over, who is not able to make decisions at a particular time because of illness, injury, a disability or the effects of drugs or alcohol. For further information and guidance on the systems and processes in operation at the Trust to be used when the powers of the Mental Capacity Act are invoked the trust Mental Capacity Act 2005 Policy can be accessed via the Trust info net. There is always the assumption that adults have full legal capacity to make their own decisions unless it is shown that they do not. The Act is intended to assist and support people who might lack capacity and to discourage those who care for them from being overly restrictive or controlling. It also aims to provide an appropriate balance between an individual s right to autonomy and self-determination with the right to safeguards and protection from harm where that person lacks capacity to make decisions to protect him or herself. Any decisions made on behalf of the person who lacks capacity must be done in their best interests. 5 Key Principles of the MCA: 1. A person must be assumed to have capacity unless it is established that they lack capacity. 2. A person is not to be treated as unable to make a decision unless all practicable steps to help him (or her) to do so have been taken without success. 3. A person is not treated as unable to make a decision merely because he (or she) makes an unwise decision. 4. An act done, or decision made, under this Act on behalf of a person who lacks capacity must be done, or made, in his (or her) best interests. 5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person s rights and freedom of action. All decisions taken in the safeguarding adult s process must comply with the Act. Further information: Trust intranet site Left hand column Forms and templates Legal Services MCA Trust Lead Legal services Manager INDEPENDENT MENTAL CAPACITY ADVOCATES (IMCA) The Act gives some people who lack capacity a right to receive support from an IMCA. An IMCA safeguards the rights of people who lack capacity and: Are facing a decision about a long term move or about serious medical treatment; Lack capacity to make a specified decision at the time it needs to be made; and 14

Have nobody else who is willing and able to represent them or be consulted in the process of working out their best interests, other than paid staff. Regulations under the MCA give local authorities and NHS bodies powers to involve IMCA s in other decisions concerning: A care review; and Adult protection procedures (even in situations where there may be family or friends to consult). Further information: Trust intranet site Polices M Mental Capacity Act 2005 Legal Services MCA Trust Lead Legal Services Manager DEPRIVATION of LIBERTY SAFEGUARDS (DoLS) The DoLS are part of the Mental Capacity Act (MCA) and the MCA Code of Practice is the foundation for all DoLS work. The five statutory principles remain very important. Staff are expected to be confident and competent in assessing capacity; in carrying out Best Interests decisions with considerable input from family, friends and carers; and understanding the practical meaning of the MCA requirement that all acts and decisions need to be done in ways that are less restrictive of a person s rights and freedom of action. East Cheshire NHS Trust remains responsible for being compliant with and having a good understanding of their statutory responsibilities in the MCA and DoLS, including making relevant and timely referrals to Supervisory Bodies for the DoLS and adhering to any DoLS conditions set. Further information: Trust Info net - Left hand column Forms and templates Legal Services MCA Trust Lead Legal services Manager ASSESSMENT under the MENTAL HEALTH ACT (MHA) 1983 The Mental Health Act 1983 Code of Practice (1999) sets out the guiding principles which underpin the administration of the Act which state that people should: Receive recognition for their basic human rights under the European Convention of Human Rights. Be given respect for their qualities, abilities and diverse backgrounds as individuals. Have their needs taken fully into account, though it is recognised that, within available resources, it may not always be practicable to meet them in full. Be given any necessary treatment or care in the least controlled and segregated facilities compatible with ensuring their own health or safety or the safety of other people. Be treated and cared for in such a way as to promote the greatest practicable degree their self-determination and personal responsibility, consistent with their own needs and wishes. Further information: www.dh.gov.uk/en/publicationsandstatistics/legislation In some cases the adult at risk or the alleged abuser may have a mental disorder that may require assessment or treatment under the MHA. Where it is felt that this may be the case the matter should be referred to the Liaison Psychiatry Service. 15

COVERT MEDICATION Covert Administration of Medicines (Disguising medication) 2.9.1 As a general principle, by disguising medication in food or drink, the patient or client is being led to believe that they are not receiving medication, when in fact they are. The registered nurse or midwife will need to be sure that what they are doing is in the best interests of the patient or client, and be accountable for this decision and should only be done in full consultation with healthcare professionals and family/carers or patient s representative e.g. Independent Mental Capacity Advocate (IMCA). 2.9.2 Covert administration should not be confused with the administration of medicines against someone s consent. This policy must be read in conjunction with the Trust s policy Consent to Examination or Treatment. Administering medicines covertly to patients should be carefully considered and there should be adherence to this policy. 2.9.3 A mental capacity assessment in relation to medicines MUST be undertaken, be decision specific (e.g. patient understands the need for medication and risks if not taken). The outcome of the mental capacity assessment, best interest decision and medication plan must be documented. The patient s mental capacity MUST be regularly assessed and appropriate adjustments made to the administration of covert medication. Advice can be sought from the Trust Legal Services Department or Safeguarding Team. If the patient has capacity to consent and refuses medication it cannot then be given covertly. If a patient has not got capacity to consent and refuses medicines then it may be appropriate to administer some medicines covertly. 2.9.4 Best Interest Decision - The decision to use covert medication must be made by the multidisciplinary team (including the presence of the pharmacist) including the views of family/carers or patient s representative e.g. Independent Mental Capacity Advocate (IMCA) and any advanced statement or directive made by the patient. For further information please refer to the Nursing and Midwifery Council advice by topic Covert administration of medicines: Disguising medicine in food and drink. http://www.nmc-uk.org/nursesand-midwives/advice-by-topic/a/advice/covert-administration-of-medicines/ Further information: Administration and Disposal of Medicines Policy MISSING PATIENT S with DEMENTIA, CONFUSION or VULNERABILITY If you suspect a patient with dementia, confusion or they are vulnerable is missing search the ward immediately, if they are not found contact security immediately they will instigate their protocol for searching the grounds and alerting the police. SELF-NEGLECT What is self-neglect? Self-neglect is recognised as the failure or unwillingness to provide oneself with the basic care needs required to maintain health Self-neglect occurs when an older person, by choice or due to a lack of awareness or ability, lives in ways that disregards his or her own health or safety. It can also include when an older person refuses needed care or help with daily activities. Examples of self-neglect include inadequate personal hygiene, not taking needed medication, poor and unsafe living conditions, lack of heat and proper nutrition. Self-neglect may occur in conjunction with other issues such as alcohol or drug problems, mental health challenges or dementia. 16

Older persons who neglect themselves can be more at risk for falls, medication errors, isolation and depression. Diogenes syndrome Diogenes syndrome, otherwise known as senile self-neglect syndrome, is used to describe an older adult living in squalor but with no sign of mental or cognitive impairment sufficient to explain the self-neglect. It is believed by some that the squalor and hoarding are just signs of obsessive-compulsive disorder, dementia, or other mental disorder, but many cases have no history of a previous psychiatric disorder. Self-neglect can affect many aspects of the person s life including: Physical living conditions (denoting inability to care for self or environment) Mental health Financial issues Personal living conditions (linked to the notion of lifestyle choice) Physical health Social network Personal endangerment Health care professionals should try and:- Understand the person s reasons for choosing the way the live Enlisting the individual as a willing participant in their own care Establishing if they are aware of the health concerns about their lifestyle Multi-agency working may be required and a First Account Form should be completed for Social Care to raise awareness of the self-neglect concerns. CHAPERONE POLICY All patients have the right, if they wish to have a chaperone present during an examination, procedure, treatment or any care irrespective of organisational restraints. Patients should be aware of the East Cheshire Trust chaperone policy. All Trust healthcare professionals must be aware of and comply with the Chaperone Policy. It is mandatory within the Trust that a formal chaperone is present for all intimate examinations on children and young people aged between 1 and 16 years old, the patient is unconscious or under the influence of drugs or alcohol or where there are concerns about the person s ability to understand or to consent to the examination, the patient lacks capacity or they are considered to be vulnerable. Staff should be sensitive to differing expectations with regard to race, culture, ethnicity, age, gender and sexual orientation and where ever possible the chaperone should be of the same gender as the patient. The need for emergency care will take precedence over the request and/or requirement for a chaperone. 17

Professionals may be asked to justify any failure to follow this policy Information Trust Infonet Policies C Chaperone Policy DISAGREEMENT BETWEEN PROFESSIONALS OR AGENCIES Designated professionals should be made aware of any professional or interagency disagreements. If the matter cannot be resolved by mediation then the matter must be escalated to the line manager of the service involved. REQUEST FOR A CHANGE OF SUPPORT Occasions may arise where relationships between patients, or other family members, are not productive in terms of working to safeguard and promote the welfare of the adult at risk. In such circumstances, organisations should respond sympathetically and a designated named point of contact may be a suitable alternative. ALLEGATIONS OF ABUSE MADE AGAINST A WORKER AND ANY SERIOUS UNTOWARD INCIDENT AGAINST AN ADULT AT RISK Allegations of this nature should be reported to the Matron/line manager for the respective area and the Safeguarding Adults at Risk Team as soon as possible during working hours, out of hours the senior manager for the hospital or community must be informed. The management of such an allegation should follow the procedures set out in East Cheshire Trusts Disciplinary Procedures. During working hours Social Care should be notified by phone on extension 1503 for both acute and community incidences. In Cheshire West contact the relevant SMART. Out of hours follow the reporting line as per Adult Safeguarding flow chart. A First Account Form must be completed for Social Care if the incident has occurred in the hospital the FAF will be collected from the ward area by Social Care. If the incident has occurred in the community the FAF must be faxed to relevant SMART. A copy of the First Account Form must be sent to the Safeguarding Adults at Risk Team either via Fax 01625 663055 or hard copy via internal mail to Silk Building, Macclesfield DGH, SK10 3BL. Allegations made against Agency Staff Nurse Bank should be informed as soon as possible and the Agency for that staff member will be notified. The Agency staff will be suspended from all further shifts at the trust until an investigation is completed. Reporting to Disclosure and Barring Service (DBS) If the Trust removes an individual (paid or unpaid volunteer) from the workforce because the person poses a risk of harm, the Trust must make a referral to the DBS. It is an offence to fail to make a referral without good reason. A Datix MUST be completed for all incidences involving staff. CONFIDENTIAL COUNSELLING SERVICE Where a staff member is aware of any circumstances in their private life which may adversely affect their ability to undertake their role within this health care organisation any such difficulties or problems that may affect their working relationships and their ability to safeguard adults at risk should be discussed with their line manager so that appropriate support can be provided. 18

Staff Counselling is provided by the Staff Counselling Service Team at East Cheshire NHS Trust. Referrals can be made confidentially by the member of staff themselves or by their line manager or through occupational health by ringing the service directly on 01625 661972 or by e-mailing ecn-tr.staffcounselling@nhs.net. Information leaflets about the service and self help information is also available on the Cheshire HR Intranet site FEMALE GENITAL MUTILATION (FGM) Female genital mutilation (FGM) comprises all procedures involving the partial or total removal of the female external genitalia or other injury to the female genital organs for non-medical reasons. There are four types of FGM, ranging from a symbolic prick to the vagina to the fairly extensive removal and narrowing of the vagina opening. In the UK all forms of FGM are prevalent. FGM is also sometimes known as female genital cutting or female circumcision. However, circumcision is not an appropriate term. Communities tend to use local names for referring to this practice including sunna. It is known that the number of communities affected by FGM in the UK is growing with the increase in migration from countries where FGM is widely practiced. There are 28 countries in Africa, and also parts of the Middle East and Asia where FGM is commonly practiced. The highest prevalence rates are found in Somalia, Sudan, Egypt, Guinea and Sierra Leone. Although Cheshire East does not have a high population of these communities, staff must remain vigilant and be aware of any girls who may be at risk. Health professionals, particularly GPs, Midwives, School Nurses, Sexual Health Staff and Gynaecologists, are in a key position to identify female children in a family where women or girls have already undergone FGM. Health staff particularly school nurses and nurses working in vaccination clinics are in a key position to identify girls who may be visiting overseas and may be at risk of FGM. FGM is considered child abuse in the UK and a grave violation of the human rights of girls and women. In all circumstances where FGM is practised on a child it is a violation of the child s right to life, their right to their bodily integrity, as well as their right to health. The UK Government has signed a number of international human rights laws against FGM, including the Convention on the Rights of the Child. Female Genital Mutilation is illegal in the UK under the Female Genital Mutilation Act 2003. The Act also makes it an offence for UK nationals and those with permanent UK residence to be taken overseas for the purpose of female circumcision, to aid and abet, counsel, or procure the carrying out of Female Genital Mutilation. Practice points: aiding, abetting and counselling applies to those who assist or persuade a girl to perform FGM on herself even though it is not itself an offence for that child to carry it out on herself. Girl includes woman (Female Genital Mutilation Act, 2003) although not an offence for a girl or young woman to perform FGM on herself, consideration should be given to whether such self-harm is a safeguarding issue where the action may be the result of adult pressure Midwives need to note that it is illegal to reinfibulate a woman following the birth of her baby. 19

This is crucial Midwives and Obstetricians may become aware that FGM has taken place when treating a pregnant woman. This should trigger concern for any female child of the family and should be reported to the Safeguarding Children Team. All incidents of FGM must be recorded on the patients records and notified via the Datix system What to do if you suspect a child may be at risk of undergoing FGM Be aware that FGM is child abuse and that you must take action Discuss your concerns with the Safeguarding Team Follow Cheshire East LSAB (Local Safeguarding Adults Board) procedures Refer to Adult Social care/police This Guidance should be read in conjunction with East Cheshire Trust FGM Policy (available on the Trust infonet) and the Pan Cheshire FGM http://www.cheshireeastlscb.org.uk/professionals/female-genital-mutilation.aspx Further information: Maternity policies/procedures FORCED MARRIAGE AND HONOUR KILLING Definitions Arranged Marriage In arranged marriages the families of both spouses take a leading role in arranging the marriage but the choice of whether or not to accept the arrangement remains with the prospective spouses. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of their parents or a third party in identifying a spouse. Forced Marriages Forced Marriage is an abuse of Human Rights Universal declaration of Human rights Article 16 (2) A forced marriage is where one or both people do not (or in the cases of people with a learning disability or physical disability cannot) consent to the marriage and pressure or abuse is used. Hundreds of young people, some as young as 13, are taken abroad each year and forced into marriage Forced marriage can involve child and sexual abuse including abduction, violence, rape, enforced pregnancy and enforced abortion. Rejection can place a young person at risk of murder, also known as Honour Killing. Forced marriage is not sanctioned within any culture or religion. The guidance contained in the multi-agency practice guidelines, Handling cases of forced marriage (Home Office, 2009); recommends that cases involving forced marriage are best dealt with by child protection or adult protection specialists. In a situation where there is concern that an adult at risk is being forced into a marriage they do not or cannot consent to, there will be an overlap between action taken under the forced marriage provisions and the Safeguarding Adults process. In this case action will be co-ordinated with the police and other relevant organisations. For further information go to: http://www.cps.gov.uk/legal/h_to_k/honour_based_violence_and_forced_marriage/ 20

Honour BASED VIOLENCE Honour based violence is where the person is being punished by their family or community. They are being punished because of a belief, actual or alleged that a person has not been properly controlled enough to conformity and thus is the shame or dishonour of the family. Health practitioners working with victims of forced marriage and honour based violence need to be aware that they may only have one chance to speak to a potential victim and may only have one chance to save life. Health practitioners should try and create opportunities to see victims on their own so that the following questions can be asked: How are things at home? Do you get out much? Can you choose what you want to do and when you want to do it? Such as friends, working or studying? Do you have friends or family locally who can provide support you? Is your family supportive? If a disclosure is made health professionals should provide information about specialist advice and services or assisting by referring to the Police, Social Care, Support Groups and Counselling Services. There may be occasions when the level of concern or the imminence of marriage requires referral to Social Care. Within east Cheshire NHS Trust the Named person with the lead for supporting staff is the Head of Safeguarding. Accurate records must be maintained at all times documenting what has been said and done. National Contact numbers: Forced Marriage Unit: 0207 608 0151 Honour Network: 0800 5999 247 National Domestic Helpline: 0808 2000 247 Further information also available on: http://www.cps.gov.uk/legal/h_to_k/honour_based_violence_and_forced_marriage/ DOMESTIC ABUSE The majority of adults who experience domestic abuse are not at risk in terms of needing or receiving support services but where adults at risk are being abused by a family member they may need domestic abuse risk assessment and support. Where domestic abuse is identified a risk assessment (RIC), should be carried out to establish whether the case is high risk. High risk cases should be referred to the Cheshire East Domestic Abuse Hub. The Hub will allocate an Independent Domestic Advice Advocate (IDVA) and refer to the Multi- Agency Risk Assessment Conference (MARAC). Consent is not required for a high risk referral. 21

If the risk level is lower, a referral should be made to the hospital IDVA who is part of the safeguarding team. Referrals can be made to the IDVA without consent as a safeguarding issue. For lower risk client s consent is required to refer to the Hub. If the IDVA is unavailable then referral should be made directly to the Cheshire East Domestic Abuse Hub. The Hub will triage victims to establish the level of risk and ensure the victim receives the appropriate services. Any professional or the Hub may also make a referral to the Multi-Agency Risk Assessment Conference (MARAC). The Cheshire East Domestic Abuse Hub and Hospital IDVA will also provide information and advice to practitioners responding to domestic abuse. Cheshire West Domestic Abuse Hub can be contacted on 0300 123 7047 option 2 Cheshire East Domestic Abuse Hub can be contacted on 0300 123 5101 Hospital IDVA can be contacted on 01625 663342 Information Trust Infonet Policies D Domestic Violence and Abuse Policy Hospital IDAV Cheshire East Domestic Abuse Hub HATE CRIME Hate crime is defined 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. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. In addition it includes incidents that do not constitute a criminal offence. Apart from individually charged offences under the Crime and Disorder Act 1988, local crime reduction partnerships can prioritise action where there is persistent antisocial behaviour that amounts to hate crime. The police and other organisations should work together to intervene under Safeguarding Adults policy and procedures to ensure a robust, co-ordinated and timely response to situations where adults at risk become a target for hate crime. Co-ordinated action will aim to ensure that victims are offered support and protection, and action is taken to identify and prosecute those responsible. For further information go to: http://www.homeoffice.gov.uk/crim/hate-crime MODERN SLAVERY AND HUMAN TRAFFICKING Modern slavery encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment. The Modern Slavery Act, 31 July 2015 consolidates and updates the existing criminal legislation on human trafficking, slavery, forced labour, cannabis farming, organ harvesting, forced begging and domestic servitude. Modern day slavery comes in many forms it is abuse and must be acted upon. Trafficking in persons means the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion for the purposes of exploitation. The recruitment, transportation, transfer, harboring or receipt of a person for the 22

purpose of exploitation is considered trafficking in persons even if this does not involve the threat or use of force or other forms of coercion. Most people (including children) are trafficked for financial gain. Most people believe they are being offered a better life or opportunities in the place they are being taken to. In most cases, the trafficker also receives payment from those wanting to exploit the person once in the UK. Some trafficking is carried out by organised gangs. In other cases individuals traffic people for their own personal gain. Trafficked may be for: Sexual exploitation Domestic servitude Sweatshop, restaurant and other catering work Agricultural labour, including tending plants in illegal cannabis farms Benefit fraud Involvement in petty criminal activity Organ harvesting Drug mules, drug dealing or decoys for adult drug traffickers Illegal inter-country adoption. Victims of trafficking may enter the UK in a variety of ways: Via internet transactions As domestic staff which is tantamount to slavery. There is thought to be considerable exploitation in situations of domestic service Bogus marriage for the purpose of forced prostitution Trafficking may also take place within the UK mainly for the purpose of sexual exploitation. Spotting the signs of Modern Slavery: It s important that people are aware of how to spot the signs of someone who may have been trafficked and is being exploited. Victims may: Look malnourished or unkempt Be withdrawn, anxious and unwilling to interact Be under the control and influence of others Live in cramped, dirty, overcrowded accommodation Have no access or control of their passport or identity documents Appear scared, avoid eye contact, and be untrusting Show signs of abuse and/or have health issues If an agency or a professional suspects that a person is the victim of Modern Day Slavery/trafficking, the Police or Social Care must be informed. If an identified victim of human trafficking is also an adult at risk, the response will be coordinated under the Safeguarding Adults process. This will include organisations that have a role to play in dealing with victims of human trafficking, including the police, health trusts, immigrations officials and other relevant support services including those in the voluntary sector. The police are the lead agency in managing responses to adults who are the victims of human trafficking. The early identification of victims of human trafficking is key to ending the abuse they suffer and to providing the assistance necessary. Front-line staff need to be able to identify the signs that someone has been trafficked. There is a national framework to assist in the formal identification and help to co-ordinate the referral of victims to appropriate services. For further information go to: http://www.homeoffice.gov.uk/publications/crime/referral-forms-human-trafficking/ 23

PREVENT - Exploitation by radicalisers who promote violence Individuals may be susceptible to exploitation into violent extremism by radicalisers. Violent extremists often use a persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits and embed their extreme views and persuade at risk individuals of the legitimacy of their cause. Raising Concerns about Patients/Service Users A concern that an individual may be vulnerable to radicalisation does not mean that you think the person is a terrorist, it means that you are concerned that they are prone to being exploited by others, and so the concern is a safeguarding concern. If a member of staff feels that they have a concern that someone is being radicalised, then they should discuss their concerns with their manager and/or relevant safeguard professional. If anyone has immediate concerns that an individual is presenting an immediate terrorist risk to themselves, others or property, then they should contact the National Counter Terrorism Hotline on 0800 789 321 or the Police on 999. The Home Office leads on the anti-terrorism strategy, CONTEST, and PREVENT is part of the overall CONTEST strategy, aiming to stop people becoming terrorists or supporting violent extremism. Local safeguarding structures have a role to play for those eligible for adult protection. Contact the Adult Safeguarding Unit if local concerns arise for advice and consideration of referral to the Channel Project. The Channel Project is co-ordinated from Winsford Police Headquarters and is a mechanism for individuals at risk to violent extremism to be referred to and assessed by a multi-agency safeguarding panel to decide on the most appropriate support for that person. Trust PREVENT Lead takes the concern forward by contacting: 1. Local Police Prevent/Chanel Lead for our area. Or if urgent 2. Counter-Terrorism Hot Line 0800 789 321 OR 999 The Trust Prevent Lead can be contacted on 01625 661788 or contact the Named Nurse for Safeguarding Adults at Risk on 01265 661347. Out of hours contact the Trust on-site manager who will inform the on-call manager IN ALL CASES if the concern is about a member of staff, contact Human Resources Department TRANSITION from CHILDREN S SERVICES to ADULTS Robust joint arrangements between children s and adult services will ensure that the medical and psychological needs of children moving into adulthood will be addressed. Young people who have been looked after by local authority as a child will remain the responsibility of the local authority until they are 21. However, where someone is 18, still receiving children s services and a safeguarding issue has been raised; the matter should be dealt with as a matter of course by adult safeguarding. Health transition to adult services will start before the age of 16 and should be completed by 16 in the majority of cases. Some young people with learning disabilities or other chronic illnesses 24

such as cystic fibrosis or endocrine disorders may take up to 18 years of age to transition fully and this will be assessed individually as part of their transition process. The care needs of the young person should be at the forefront of any support planning and require a coordinated multi-agency approach. Assessments at this stage should include issues of safeguarding and risk. Care planning needs to ensure that the young adult s safety is not put at risk through delays in providing services they need to maintain their independence and wellbeing and choice. However it must be noted that not all children who receive a service from children s services will be eligible for a service from adult social care. To facilitate the transition process where safeguarding issues have been raised the Children s safeguarding team will share information with the Adult safeguarding team. The following should be considered: Supporting effective transition processes Acknowledging that dangers for a child can translate into risks for the adult. Managing risks as a phased process with awareness of the psychological and emotional issues in relation to the young person. Managing family and carer expectations (being clear about the level of support and resources available through adult services). Taking time to get to know the young person, family and carers, especially if they have communication difficulties. Acknowledging the rights of the young adult to take more responsibility for their decisions. RISK ASSESSMENTS It is vital that adults at risk receive the right service at the right time this is supported by The Care Act 2014. In order for this to happen, all professionals who have contact with adults at risk have a duty of care to identify issues at the earliest opportunity and assess what intervention is required. Assessment should be a dynamic process that identifies analyses and responds to the changing nature and level of need and/or risk faced by the adult at risk. A good assessment will enable practitioners to make a proportional response to intervene at the right time with the right level of support and to monitor and record the impact of any support or services required by the adult at risk. Continuous assessment and review is crucial in ensuring that the help and support being delivered is having the intended impact. All adult safeguarding referral documents are on Trust Info net in Policies S - Safeguarding Adults, Referral Forms and Documentation EDUCATION and TRAINING The content of the policy and its significance is included in mandatory safeguarding training; to inform staff of its importance and format. As a minimum requirement all staff will receive safeguarding training as a mandatory requirement every three years. Bespoke training will be completed, dependent on individual roles and responsibilities, as identified in the training framework. 25

TRAINING FRAMEWORK TRAINING FRAMEWORK FOR ADULT SAFEGUARDING - All training is in line with statutory and national guidelines Training level 1 Trust Induction Target Group Frequency of training Learning outcomes for induction Training Content Staff with contact with All staff complete Level 1 adults who may training as part of the Demonstrates an understanding of the term become aware of induction programme possible abuse or safeguarding adults neglect All staff and volunteers should receive basic safeguarding awareness sessions as part of their induction Level 1 staff will then continue to update this training via three yearly e- learning. Staff at level 1 should have refresher training equivalent to a minimum of 2 hours Demonstrates an understanding the types of abuse Demonstrates an understanding of appropriate referral mechanisms and information sharing i.e. knows to contact, where to access advice and how to report concerns All Employees will be aware of what to do if they are concerned about an adult s welfare or if an adult is being harmed, they will know who to contact for advice and supervision, they will be aware of the referral process and the stresses for families and carers. They will also know how to access Safeguarding Adults Policies and be aware of their responsibilities in relation to Safeguarding Adults. Understanding of keeping safe Method of delivery Integral part of ECNHST induction Face to face for new starters during Trust induction All staff should be made aware of additional training opportunities related to safeguarding even if it is not required by their job role It is the responsibility of the line manager to ensure this training is accessed

Training level 2 Awareness of Safeguarding Adults - Statutory and Mandatory Training Target Group Frequency of training Learning outcomes for induction Training Content As outlined for Level 1 plus additionally All clinical and non-clinical staff that have contact with adults using trust services. 2-3 hours This includes administrators for safeguarding teams, health care students, clinical laboratory staff, phlebotomists, pharmacist adult orthodontists, dentists, dental care professionals, audiologists, Doctors, Radiologists, Nurses, AHP s and all other adult secondary care professionals who may become aware of possible abuse or neglect. Board Members and Executive Team Method of delivery Via e- learning. Should be at as soon as practicable on joining the organisation Update every 3 years Demonstrates an understanding of appropriate referral mechanisms and information sharing i.e. knows to contact, where to access advice and how to report concerns Demonstrates accurate documentation of concerns i.e. First Account Referral Demonstrates an ability to recognise and describe a significant event/concern in adult safeguarding to the most appropriate professional or team Participants to demonstrate an understanding what constitutes adult abuse. Know about the range of adult abuse and the signs and indicators of abuse and neglect. To know about local policies and procedures. Know who to share their concerns with and the importance of information sharing and how to report any concerns. Workbook option is offered for those staff who are unable to access e- learning This training must be completed within three months of employment with the Trust It is the responsibility of the line manager to ensure this training is accessed All staff should be made aware of additional training opportunities related to safeguarding even if it is not required by their job role 27

Training level 3 Safeguarding Adults Specialist Practitioners Target Group Frequency of training Learning outcomes As outlined for Level 1 and 2 plus additionally Training Content Safeguarding specialist roles and named professionals Specialists and Named professionals should attend a minimum of 24 hours of education, training and learning over a 3 year period. Complete level 2 training 3 yearly Demonstrates advanced knowledge of national safeguarding practice and an insight into international perspectives Demonstrates contribution to enhancing safeguarding practice and the development of knowledge among staff Demonstrates knowledge of strategies for safeguarding management across the health community Demonstrates an ability to conduct rigorous and auditable safeguarding/child protection support and peer review, as well as appraisal and supervision where provided directly Demonstrates critical insight of personal limitations and an ability to participate in peer review Demonstrate knowledge of relevance of safeguarding to commissioning processes Ensure a safeguarding focus is maintained within strategic organisational plans and service delivery Demonstrates an understanding of appropriate and effective training strategies to meet the competency development needs of different staff groups Demonstrates completion of relevant specialist adult safeguarding education within 12 months of appointment Demonstrates an understanding and experience of developing evidence-based clinical guidance Demonstrates effective consultation with other health care professionals and participation in multi-disciplinary discussions Demonstrates participation in audit, and in the design and evaluation of service provision, including the development of action plans and strategies to address any issues raised by audit and serious case reviews/internal management reviews/significant case reviews/other locally determined reviews Participants to understand local and national requirements for adult safeguarding and how it informs the trust on both a local and strategic level. Demonstrate knowledge and understanding of the importance of audit, reviews and training 28

Method of delivery Level 2 via e- learning. Demonstrates critical insight of personal limitations and an ability to participate in peer review Demonstrates practice change from learning, peer review or audit. Demonstrates contributions to reviews have been effective and of good quality. Workbook option is offered for those staff who are unable to access e- learning Named professionals and specialist practitioners should attend a minimum of 24 hours of education, training and learning over a three-year period at an appropriate level. This should include non-clinical knowledge acquisition such as management, appraisal, and supervision training Participate regularly in support groups or peer support networks for specialist professionals at a local and National level, according to professional guidelines (attendance should be recorded) All staff should be made aware of additional training opportunities related to safeguarding even if it is not required by their job role 29

PREVENT Target Group Frequency Learning outcomes Training Content All employees and volunteers of East Cheshire Trust Method of Delivery Via e- learning. One off training To demonstrate an understanding of the national and local risk form radicalisation and extremism Demonstrates an understanding of appropriate referral mechanisms and information sharing i.e. knows to contact, where to access advice and how to report concerns To meet National training requirements For participants to understand what constitutes radicalisation and terrorism and the work being undertaken in counter terrorism. How to recognise and report concerns. Be aware of the local trust policy This training must be completed within three months of employment with the Trust. Annual update via briefing paper Competency Framework Compency Framework v2 09.16. 30

ASSOCIATED DOCUMENTS This policy should be read in conjunction with the following other documents: ECNHST Bed Management Policy Equality and Human Rights Policy ECNHST Consent to Examination, Treatment Complaints and PALS policies ECNHST Mental Capacity Act 2005 policy Mental Health Act 2007 ECNHST Restraint Policy ECNHST Safeguarding Children s Policy (Inc. FGM Guideline) ECNHST Management of Sexual Offenders Policy ECNHST Prevent Policy Cheshire East Multi-Agency Policy IMPLEMENTATION A policy announcement will be issued via email notifying an updated policy is available for cascade. A copy of this policy will be placed on the East Cheshire NHS Trusts NHS policy site on the Trust Info net. Via educational events particularly at Statutory and Mandatory and Induction of New staff sessions. 5.0 Monitoring Compliance with the Document Compliance with the requirements of this policy will be monitored through internal audit. Non-compliance with this policy will be reported through the clinical incident reporting system. This may result in a multi-disciplinary incident review and action planning meeting. Attendance at safeguarding adults training will be recorded by HR learning and development and monitored by departmental managers. Knowledge and Skills relating to safeguarding adults will form part of the KSF appraisal process and will be evidenced in personal performance plans where this is appropriate for the employee s role. The adult Safeguarding Team will review the quarterly data which will be monitored through the quarterly assurance dashboard. Measuring Performance Key performance indicators identified relating to this policy are as follows: All staff will be provided with adult safeguarding information on commencement of employment All frontline staff will complete the level 2 basic awareness training within 3 months of commencement All frontline staff will complete a 3 yearly update Bi-annual audits of safeguarding adults, quarterly knowledge of policy and reporting procedures and MCA/DoLS audits will be undertaken. The results 31

will be included in the quarterly assurance dashboard to the Commissioners and monitored through the Trusts assurance group. An annual report on Safeguarding Adults will review the key performance indicators for presentation to the Trust Board. 6.0 References 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 Adults and Children s Board. The Care Act 2014 Cheshire East Multi Agency Policy and Procedures to Safeguard Adults from Abuse. Available at: www.cheshireeast.gov.uk Cheshire West and Chester Multi Agency Policy and Procedures to Safeguard Adults from Abuse. Available at: www.cheshirewestandchester.gov.uk Cheshire West and Chester Safeguarding Adults in Cheshire West and Chester. Break the Silence. Safeguarding Adults Policy. Available at: www.cheshirewestandchester.gov.uk Action for Advocacy (2011): Serious Medical Treatment Decisions: Best Practice Guidance for IMCAs Dental Treatment. Available at: http://static.actionforadvocacy.org.uk/opendocs/a4a_smt_dental_treatment_g uidance.pdf Care Quality Commission (2010): Essential Standards of Quality & Safety. Available at: http://www.cqc.org.uk/sites/default/files/media/documents/gac_- _dec_2011_update.pdf Department of Health (2000): No secrets: guidance on developing and implementing multi-agency policies and procedures to protect adult at risks from abuse. Available at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyand Guidance/DH 4008486 Department of Health (2002): No secrets: the protection of adult at risks findings from an analysis of local codes of practice. Available at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspo licyandguidance/dh_4005604 Department of Health (2003) The Victoria Climbié inquiry: report of an inquiry by Lord Laming, London: DH. Available at: http://www.dh.gov.uk or http://www.victoria-climbie-inquiry.org.uk 32

Department of Health (2010): The Third Year of the Independent Mental Capacity Advocacy (IMCA) Service 2009/10. Available at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyand Guidance/DH_121877 Home Office (2004) Home Office circular 10/2004. The Female Genital Mutilation Act 2003, London: Home Office. Available at: http://www.circulars.homeoffice.gov.uk HMSO (1998): Public Interest Disclosure Act. Available at: http://www.legislation.gov.uk/ukpga/1998/23/contents HMSO (2005): Mental Capacity Act. Available at: http://www.legislation.gov.uk/ukpga/2005/9/contents HMSO (2006): Safeguarding At Risk Groups Act. Available at: http://www.legislation.gov.uk/ukpga/2006/47/contents HMSO (2007): Forced Marriage (Civil Protection) Act. Available at: http://www.legislation.gov.uk/ukpga/2007/20/contents Social Care Institute for Excellence (2009): Practice Guidance on the involvement of Independent Mental Capacity Advocates (IMCAs) in safeguarding adults. Available at: http://www.scie.org.uk/publications/guides/guide32/ World Health Organization (2000) Female genital mutilation. Information fact sheet (241), WHO: Geneva. Available at: http://www.who.int 33

Appendix Appendix 1 Duty of Care PRINCIPLES TO SAFEGUARD THE SERVICE AND STAFF All persons who work with, and on behalf of adults at risk are accountable for the way in which they exercise authority; manage risk; use resources; and safeguard adults at risk. Whether working in a paid or voluntary capacity, these adults have a duty to keep adults at risk safe and to protect them from sexual, physical and emotional harm. Adults at risk have a right to be treated with respect and dignity. It follows that trusted adults are expected to take reasonable steps to ensure the safety and wellbeing of adults at risk. Failure to do so may be regarded as neglect. The duty of care is in part, exercised through the development of respectful and caring relationships between the adult at risk and those caring for them. It is also exercised through the behaviour of those caring for the adult at risk, which at all times should demonstrate integrity, professionalism and good judgement. Employers also have a duty of care towards their employees, both paid and unpaid, under the Health and Safety at Work Act 1974. This requires them to provide a safe working environment for adults and provide guidance about safe working practices. Employers also have a duty of care for the well-being of employees and to ensure that employees are treated fairly and reasonably in all circumstances. The Human Rights Act, 1998 sets out important principles regarding protection of individuals from abuse by state organisations or people working for those institutions. Adults who are subject to an allegation should therefore be supported and the principles of natural justice applied. The Health and Safety Act 1974 also imposes a duty on employees to take care of themselves and anyone else who may be affected by their actions or failings. An employer s duty of care and the adult s duty of care towards children should not conflict. The general principles to safeguard the service and staff and to ensure professional integrity whilst working to safeguard adults at risk are: 1. East Cheshire NHS Trust has LSAB safe recruitment and selection practices in accordance with Safe Recruitment A Guide for NHS Employers (NHS Employers 2010) and should ensure that appropriate Disclosure & Barring Service (DBS) checks are undertaken for new staff and volunteers including registered translators who have contact with children and adults at risk 2. A recruitment procedure that includes the use of standard application forms, references, interview procedure and applicant declaration 34

3. East Cheshire NHS Trust has clear E safety policies and guidance in place about access to and the use of the internet 4. The Trust promotes a culture of listening and engaging in dialogue with children, seeking children s views in ways that are appropriate to their age and understanding. 5. We encourage staff to raise concerns either directly or if they feel unable to do this through the Raising Concerns at Work (Whistleblowing) policy available via the trust infonet. 6. Ensuring the staff and managers follow procedures for managing allegations and concerns regarding the suitability of persons adults who work with adults at risk in accordance with LSAB procedures for Cheshire. Including having a nominated Named Nurse who is the identified person to whom concerns regarding allegations of abuse against adults at risk are reported to in connection with his/her employment or voluntary activities. 7. Providing and monitoring access to training to safeguard adults in accordance Safeguarding Adults at Risk Policy and Mandatory Training Policy. 8. Ensure that all those involved in safeguarding work should have access to clinical supervision and peer review/support. Advice should also be available from Named professionals. 9. If there are language difficulties or communication difficulties it is essential that a formal interpreter service is used. Other family members are not suitable interpreters. See ECNHST Interpreting Policy via the Trust Infonet. Appendix 2 When an adult attends A&E with physical injuries, which are suspected to be inflicted personally or by another person or where there are concerns around substance misuse Staff must ask if any children live with them. If they do, then a referral must be made to the Liaison Health Visitor and consideration must be given to a referral to Children s Social Care if there are concerns for the welfare of the child. 35

Appendix 3 36