Safeguarding Adults Policy

Safeguarding Adults Policy Lead executive director: Name of originator / author and job title: Approved by: Approval date: 4 April 2014 Implementation date: 4 April 2014 Review date: April 2016 Date equality impact assessment carried out: Stephanie Dawe Chief Nurse and Executive Director of Integrated Care, Essex Susan Smyth, Interim Associate Director of Safeguarding Adults, MCA & DoLs Chief Nurse and Executive Director of Integrated Care, Essex and Director of Nursing Safeguarding 4 April 2014 Page 1 of 16

Document Control Sheet Policy title Policy number Assurance statement Target audience (policy relevant to) Links to other policies Safeguarding Adults TW/CL0063/v002 NELFT as a Trust is committed to safeguarding and protecting the welfare of all adults who use their services. The policy outlines the levels competence expected of all staff working within the health service. All NELFT staff (inclusive of those working in a temporary capacity, as a volunteer or commissioned by NELFT), must ensure that they possess the required knowledge, skills and competences as set out in these documents. This policy will identify roles and responsibilities of all NELFT staff, to ensure staff are able to recognise the indications of abuse or harm and are clear about what actions must be taken to safeguard and protect adults at risk. The aim of the policy is to ensure staff are supported to not only be competent in their role but are confident in safeguarding and protecting the welfare of all adults. All NELFT staff and contractors Confidentiality Policy Incident Reporting Policy Complaints Policy Disciplinary Policy Safeguarding Children Policy Domestic Violence and Partner Abuse Policy Information Sharing Policy Being Open and Honest Policy Whistle Blowing Policy Mental capacity act policy Conduct of staff Safer recruitment Domestic abuse Personal and Professional Boundaries Safeguarding Adults and Children Strategy Safeguarding Adults Training Strategy Version control Status Version Approval date Review date Final v001 August 11 August 14 Final v002 April 14 April 16 Page 2 of 16

Contents Paragraph Page 1. Introduction 4 2. Aims and objectives 4 3. Definitions 4/5 4. Roles and responsibilities 5/6 5. Reporting 6/7 6. Consent 8 7. Implementation process 8 8. Monitoring arrangements 8/9 9. Equality statement 9 10. Training 9 11. External references 9/10 Equality impact assessment screening tool 11/13 Appendix 1 Training needs analysis tool 14 EMT / Senior Leadership team approval checklist 15 Addendum 16 Page 3 of 16

1. Introduction North East London NHS Foundation Trust (NELFT) is committed to ensuring the wellbeing of all patients through adherence, in all its activity, to the six principles of adult safeguarding (DoH 2011). Empowerment Presumption of person led decisions and informed consent. Protection Support and representation for those in greatest need. Prevention It is better to take action before harm occurs. Proportionality Proportionate and least intrusive response appropriate to the risk presented. Partnership Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability Accountability and transparency in delivering safeguarding 1.1 North East London NHS Foundation Trust accepts the principles outlined within each Local Authority multi-agency Safeguarding Adults Policy and Procedure and is committed to partnership working. 1.2 The Trust is committed to meeting all requirements in relation to national guidance and policy and recognises the links between children s and adults safeguarding services. 2 Aims and objectives 2.1 The aim of this policy is to safeguard vulnerable adults by providing clear guidance to Trust staff through raising awareness of their responsibilities to ensure the safety of adults within their care and the actions to take when they suspect or identify that this has been compromised. 2.2 The procedures outlined within this policy provide an overarching framework and link with the Trust s Complaints, Incident Reporting procedures and the Local Authority Safeguarding Adults procedures. Local authorities are the lead agency and therefore staff in NELFT should refer to the appropriate local authority policy in the first instance. 3. Definitions 3.1 Patients It is recognised across NELFT that different terminology is used e.g. Service User, Client and Patient. Throughout this document the term Patient will be used to describe people who use NELFT services. 3.2 Adults at risk Adults who need community care services because of mental or other disability, age or illness and who are, or may be unable, to take care of themselves against significant harm or exploitation. The term replaces vulnerable adult. An adult at risk may therefore be a person who: is elderly and frail due to ill health, physical disability or cognitive impairment has a learning disability Page 4 of 16

has a physical disability and/or a sensory impairment has mental health needs including dementia or a personality disorder has a long-term illness/condition misuses substances or alcohol is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse is unable to demonstrate the capacity to make a decision and is in need of care and support. (This list is not exhaustive.) (SCIE 2011). 3.3 Abuse Abuse can be broadly defined under the following categories. Physical: Non-accidental infliction of physical force that results in injury, pain, or impairment. This includes inappropriate use of restraint. Sexual: Direct or indirect involvement in sexual activity without consent. Neglect: Repeated deprivation of some assistance that the person needs for important activities of daily living. This does not include selfneglect. Psychological/emotional : Impinges on the emotional health and development of an individual. For example, name calling or intimidation. Financial/material: Unauthorised, fraudulently obtaining and improper use of funds, property or any resources of a vulnerable person. Discriminatory: when values, beliefs or culture result in a misuse of power that denies opportunity to some groups or individuals. It can be a feature of any form of abuse of an adult at risk, but can also be motivated because of age, gender, sexuality, disability, religion, class, culture, language, and race or ethnic origin. Institutional: the mistreatment or abuse or neglect of an adult at risk by a regime or individuals within settings and services that adults at risk live in or use, that violate the person s dignity, resulting in lack of respect for their human rights. 4. Roles and responsibilities 4.1 Chief executive The Chief Executive holds overall responsibility for safeguarding adults and children in NELFT. 4.2 The Chief Nurse, as Trust Board Lead for Safeguarding holds accountability, with responsibility delegated to the Directors to operationalise this policy within NELFT. 4.3 Directors All directors and general managers are responsible for the implementation of this policy into practice within their service areas and taking appropriate action should any breach of this policy arise. 4.4 Director of Human Resources is responsible for: Ensuring through normal Trust recruitment and other processes that all staff have appropriate checks (e.g. Disclosure and Barring Scheme (DBS)) before being allowed to have access to potentially vulnerable patients. Page 5 of 16

Ensuring adherence to the Trust Disciplinary Policy as appropriate to dealing with staff conduct. 4.5 Senior managers All Senior managers have a delegated responsibility for ensuring that this policy is known to all staff and that its requirements are followed by all staff within their directorate/division/department. 4.6 Heads of service and line managers 4.7 Staff Responsible for: bringing to the attention of their staff the publication of this document providing evidence that the document has been cascaded within their team or department ensuring this document is effectively implemented ensuring that staff have the knowledge and skills to implement the policy and provide training where gaps are identified Responsible for: adherence to this policy ensuring any training required is attended and kept up to date ensure any competencies required are maintained co-operating with the development and implementation of policies as part of their normal duties and responsibilities identifying the need for a change in policy as a result of becoming aware of changes in practice, changes to statutory requirements, revised professional or clinical standards and local/national directives, and advising their line manager accordingly identifying training needs in respect of policies 4.8 There are safe and robust operational arrangements in place for safeguarding adults in all services that are provided. Staff work in line with the Local Safeguarding Adults Board (LSAB) Safeguarding Adults Procedures. Representation at the LSAB s and associated sub groups are staff with appropriate levels of seniority that can make decisions for the organisation. To ensure NELFT as a health partner agency of the LSAB is represented effectively on the LSAB and sub groups, good governance systems and organisational focus on safeguarding adults is a priority. Ensuring all staff are trained, at a level commensurate with their roles and responsibilities in how to safeguard and promote the welfare of adults at risk, be alert to potential indicators of abuse and neglect in adults and know how to act on their concerns in line with LSAB procedures. 5. Reporting All safeguarding incidents should be reported on Datix the Trust incident reporting system. The safeguarding section should be completed as yes or to be determined. It is essential that staff complete the Datix as soon as possible Page 6 of 16

after the incident has occurred or been identified as occurring. 5.1 Where staff are unclear about the issue/concern they should contact the Safeguarding Adults team to discuss, or their line manager or the Emergency Duty Team in the relevant Local Authority if out of hours. This should happen within the same working day/shift once the concern has been identified. NELFT Safeguarding Adults Team: Telephone: 0300 500 1201 ext. 64715 Email: safeguarding.adults2@nhs.net Address: Suite 4, Phoenix House, Christopher Martin Road, Basildon ESSEX The emergency duty services in each local authority, where Safeguarding Adults issues should be directed out of office hours are as follows: Havering: 01708 433 999 B&D: 0208 594 8356 Redbridge: 0208 554 5000 Waltham Forest: 0208 496 3000 Essex: 0845 606 1212 Thurrock: 01375 372 468 5.2 Where the risk of harm is great or the patient has already been harmed it may be necessary to contact the Police. Support for this action can be sought from the NELFT Safeguarding Adults Team, the relevant local authority safeguarding team and through line managers in NELFT. This should happen within the same working day/shift once the concern has been identified. 5.3 The priority is ensuring the patient(s) safety and a risk assessment and management plan should be carried out and implemented and all action taken should be recorded in the patients case notes. 5.4 Where an adults safeguarding issue has been identified, staff are reminded to take account of any children or other dependents in the family setting who may also be at risk and to think family in all interactions and activity. 5.5 Where the incident has been identified as safeguarding this should be reported to the relevant local authority using the appropriate form. The referral forms are on the NELFT Safeguarding pages on the intranet or on the Local Authority websites. 5.6 Staff will be supported in this and the ensuing safeguarding process, as directed by local authority policy, by the NELFT Safeguarding Adults Team. LB of Waltham Forest- Safeguarding Adults Policy www.walthamforest.gov.uk LB of Havering Safeguarding Adults from Abuse, Policy, Page 7 of 16

Procedures and Practice guidelines www.havering.gov.uk LB of Redbridge Safeguarding Adults Policy and Procedures www.redbrige.gov.uk LB of Barking & Dagenham Policy and Procedures for Safeguarding Adults www.barkinganddagenham.gov.uk Essex County Council Safeguarding Adults Policy www.essex.gov.uk Thurrock Council Safeguarding Adults Policy www.thurrock.gov.uk 5.7 Allegations of abuse involving other members of staff should be directed to the safeguarding team and the operational line manager structure, some of the local authorities NELFT works in partnership have an adult Local Authority Designated Officer (LADO) where there is one this should also be reported to them. All staff should be aware and have access to Allegations against Staff policy and their responsibility to adhere to this policy. 5.8 It is important for staff to remember that they do not have to deal with safeguarding issues, which can often be complex and distressing, on their own and should seek support from line managers and the Safeguarding Adults Team. 6. Consent It is appropriate to seek the patients consent before any safeguarding process begins, however there may be issues with regards to capacity and these need to be addressed (see Mental Capacity Act Policy). The patient should always be foremost in the safeguarding process and the outcome should be agreed with them or decided in their best interests where capacity is an issue. 7. Implementation process 7.1 Staff will be made aware of any new approved policies/procedures/guidelines via the monthly team brief. Quality and patient safety team will be responsible for ensuring newly approved documents are sent to the communications team in order for them to insert into the team brief. 7.2 All senior managers/heads of service/team leaders need to ensure new policies and procedures are placed on team meeting agendas for discussion. There is an expectation that the team leader will develop local systems to ensure their staff are instructed to read all relevant policies and to identify any outstanding training deficits 8. Monitoring arrangements 8.1 Compliance with this policy will be monitored each month in the Safeguarding Children & Adults Groups, chaired by the Integrated Care Directors, in each locality, which reports to the Quality and Safety Committee. The Integrated Care Directors and the Associate Director of Safeguarding Adults, MCA and DoLs. Page 8 of 16

8.2 Compliance with policies and procedures will also be self-assessed and reported to the Local Safeguarding Adult Boards, as part of an annual audit carried out by each Local Authority. All partner agencies complete a self- assessment framework which is coordinated by the Associate Director of Safeguarding Adults, MCA and DoLs. 8.3 On an annual basis an audit of all NELFT safeguarding activity is carried out by an external auditor and this is reported to the Trust Board. 8.4 All actions/recommendations from audits form part of the Safeguarding Strategy and work plan, and the Associate Directors of Safeguarding Adults and Children are responsible for informing the Quality and Safety Committee and Trust Board of progress. 9. Equality statement This policy reflects the organisation s determination to ensure that all parts of our community have equality of access to services and that everyone receives a high standard of service as a service user, a carer or employee. This policy anticipates and encompasses the Trust s commitment to prevent discrimination on any illegal or inappropriate basis and recognise and respond to the needs of individuals based on good communication and best practice. We recognise that some groups of the population are more at risk of discrimination or less able to access to services than others and that services can often unintentionally put barriers in place that can limit or prevent access. The organisation is continually working to prevent this from happening. 10. Training The Associate Director of Training and Development is responsible for ensuring that staff are made aware of Training available via Local Authority and NELFT in order to support the delivery of this policy, and it is the responsibility of managers to ensure that their staff have access to Safeguarding Adults training. (Appendix 1) 10.1 Training is provided in line with the NELFT Training Matrix and the NELFT Safeguarding Adults Training Strategy, both of which are available on the Trust intranet. 10.2 10.3 Training compliance is monitored on a monthly basis in the Safeguarding Adults and Children s Groups that take place in each locality. The training target for compliance is set at 85% and this monitored monthly and reported in the NELFT Safeguarding Adults Compliance statement on the NELFT website. 10.4 Safeguarding Adults training is provided in line with the Trust s Education and Development Policy which indicates the processes for the management of training. 11. External references Page 9 of 16

Southend, Essex and Thurrock Safeguarding Adults Guidelines (2014) Protecting Adults at Risk: London multi-agency policy and procedures to safeguard adults from abuse Related legislation (this is inclusive but not exhaustive): Safeguarding Adults: The role of Health Service Managers and their Boards (DoH 2011) Safeguarding Adults: The role of Health Service Practitioners (DoH 2011) No Secrets Guidance HSC 2000 Mental Health Act 1983 Mental Capacity Act (including Deprivation of Liberty Safeguards) 2007 Human Rights Act 1998 Safeguarding Vulnerable Groups Act 2006 The Children s Act 2004 All anti-discriminatory legislation Sexual Offences Act 2003 Adult Safeguarding: Statement of Government Policy DoH 2011 Page 10 of 16

NORTH EAST LONDON FOUNDATION TRUST INITIAL SCREENING EQUALITY IMPACT ASSESSMENT FORM Directorate/Department Name of Policy/Service/Function New or Existing Policy/Service/Function? Name and role of Person completing the EQIA Corporate Safeguarding Adults Existing Susan Smyth, Interim Associate Director of Safeguarding Adults, MCA & DoLs Date of Assessment 31.3.2014 Please complete the following questions Yes/No What/Where is the Evidence to suggest this? 1 Does the Policy/Service/Function effect one group less or more favourably than another on the basis of: Race, Ethnic origins (including, gypsies and travellers) and Nationality Yes The policy promotes best practice in line with national and local safeguarding policy and procedures, and reflects a human rights framework that ensures protection of vulnerable adults in NELFT. The ethnicity and health report in 2007, examines the extent of ethnic inequalities in health for black and ethnic minority groups. There is evidence to suggest over representation of BME groups in mental health services and access to appropriate services. Staff should be culturally competent in meeting the needs of its diverse population, have access to interpreting and translation services, information leaflets should be available in different languages and BME people made aware of local support services available, e.g. for End of Care. Gender (males and females) Yes Women s mental health reports identifies the devastating effect life events can have on mental health and the increased risk of domestic violence and rape. Fear of being abused by patients or staff in inpatient care. Evidence also suggests older women being less financially well off and more in need of residential care than older men and not able to afford it. Domestic violence an affect 1 in 4 women in their lifetime, with 16% of these recorded violet crime. Age Yes Differences in the incidence of dementia with a higher proportion of men in the ages of 65 74 and in women aged over 75. Making this group particularly vulnerable and ensuring services are able to meet the needs of these groups more appropriately meet through a more robust assessment and treatment process. Religion, Belief or Culture Yes There is evidence to suggest some links between witchcraft and possession of spirits in particular faith groups. Prevalence of violence related to religion or Page 11 of 16

Disability mental, physical disability and Learning difficulties Sexual orientation including lesbian, gay and bisexual people Yes belief has also recognised by the home office. Other aspects include, forced marriages, domestic violence, honour killings. Research by Mencap (living in Fear 2000) report that 9 out of ten people with learning disabilities have been harassed or attacked, with 32% having experienced harassment or attacks on a daily basis and 23% have been assaulted. Adults with learning disabilities are at higher risk of sexual assault, rape and domestic violence than the general population. Awareness training of staff should be addressed a more thorough assessment for those with LD, so that information e.g. medication, care plans, care coordinator, services available, information leaflets are available in different formats, e.g. Easy Read, braille, large print, audio. Yes A study by the imperial college in 2004 demonstrates a possible link between levels of homophobic discrimination and mental ill health among lesbian and gay people, including self-harm. Negative attitudes towards gay, lesbian and bisexual people, incidence of violence related to homophobia and hate crime incidents amongst these groups are high. Married/or in civil partnership There is no evidence to suggest that those who are married or in a civil partnership are likely to be more vulnerable than those who are single. However, all the health and other issues addressed could be prevalent in these groups and should be assessed. Pregnant/maternity leave Yes The months surrounding the birth of a baby carry the greatest risk for women of developing mental illness and this can have a significant impact on the child and mother. The RCOG found 30% of domestic violence started in pregnancy. Transgender reassignment Yes The policy does not state any processes for managing safeguarding issues for transgender people. 29% of people seeking gender reassignment are adversely affected by the way they are treated by healthcare professionals. Staff should be made aware of the needs of transgender groups through awareness training sessions and made aware of support services nationally or locally. 2 Is there any evidence that some groups are affected differently? Is the impact of the policy/guideline likely to be negative? 3 Is there a need for additional consultation e.g. with external organisations, service Users and carers, or other voluntary sector groups? 4 If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? Yes Yes Yes See above. The guidance has been developed in order to ensure practices are consistent and coherent across all service in NELFT. Local Authority Local Safeguarding Boards, Domestic Violence Units, Mental Capacity Act managers, workers and health advocacy services. The other safeguarding aspect for adults is that some studies have identified that some adults experience mistreatment by family members, friends or care workers. 5 Can we reduce the impact by Yes Regular monitoring of services and recording of Page 12 of 16

taking different actions? diversity monitoring data of all patients, capturing the protected characteristics. Assessments for adults should consider the risk mentioned above. Audits to include monitoring data to analyse and look at trends for those with protected characteristics. Staff training to capture some of the evidence above and assessing the needs of these groups of people Assessor s Name: Susan Smyth Date: 31.3.2014 Name of Director: Diane Searle This section to be agreed and signed by the Equality and Diversity Manager in agreement with the Equality and Diversity Team Recommendation Full Equality Impact Assessment required: NO YES Assessment authorised by: Name: Harjit K Bansal, Equality and Diversity Manager Date: 4 th of April 2014 Page 13 of 16

Appendix 1 training needs analysis Staff Group Training topic Frequency Mandatory / Non-mandatory / In-house Bands 1-4 Referral and Recognition e learning 3 years Mandatory Bands 5-8b Safeguarding Adults Enhanced 3 years Mandatory Bands 8c and above Safeguarding Adults Strategic 3 years Mandatory Included in Trust induction (tick) Page 14 of 16

Approved? Y / N EMT / SENIOR LEADERSHIP TEAM APPROVAL SHEET Policy title: Author: Meeting Date of meeting Chair name and title Signature of Lead Director/ EMT Chair Reason for non-approval 4/4/14 Stephanie Dawe Chief nurse and Executive director of integrated care Y Once the form has been agreed/not agreed for ratification by the Lead Director or Chair of Executive Management Team please send back to policies@nelft.nhs.uk as confirmation of this via email Page 15 of 16

Addendum Date Section Change Agreed by 09.01.2014 Approval process Following the Health Economy restructure on 1 December 2013 all policies and procedures (after the required consultation period and any required changes being made by the author) will be presented at the Senior Leadership Team meeting for approval. Approved standing operating procedures will then be logged and placed on the Trust website and trust policies will be forwarded to the Executive Management Team for final ratification. The approval sheet has been amended to reflect this change. Alison Garrett Associate Director of Nursing for Quality & Patient Safety North East London NHS Foundation Trust Page 16 of 16