Policy Document Control Page Title: Safeguarding Adults Policy Version: 4 Reference Number: CL18 Supersedes: Adult Protection Policy V3 Description of Amendment(s): Categories of Abuse Disclosure and Barring Service (replacing ISA) Details re procedures for managing safeguarding adults Flowchart responding to allegations of abuse against professionals PREVENT details Training Originated By: Chris Phillips Designation: Head of Patient Safety Mandy Fieldhouse Safeguarding Adults Operational Lead Equality Impact Assessment (EIA) Process Equality Relevance Assessment Undertaken by: Chris Phillips ERA undertaken on: 10/6/13 ERA approved by EIA Work group on: Where policy deemed relevant to equality- YES EIA undertaken by: Chris Phillips EIA undertaken on: EIA approved by EIA work group on: Page 1 of 34
Integrated Governance Group Referred for approval by: Safeguarding Adults Board Date of Referral: Approved by: Trust Safeguarding Adults Board Approval Date: Date Ratified at IGG: Executive Director Lead: Medical Director Circulation Issue Date: Circulated by: Corporate Governance Issued to: (see over) Policy to be uploaded to the Trust s External Website? YES Review Review Date: June 2015 Responsibility of: Chris Phillips/ Mandy Fieldhouse Designation: Head of Patient Safety/ Adult Safeguarding Operational Lead An e-copy of this policy is sent to all wards and departments (Trust Policy Pack Holders) who are responsible for updating their policy packs as required. This policy is to be disseminated to all relevant staff. This policy must be posted on the Intranet. Date Posted: Page 2 of 34
Section Contents Page 1. Introduction 5 2. Key principles of the policy 5 3 Legal framework, National policy and local procedures and policy 6 3.1 The disclosure and Barring Service (DBS) (2012) 3.2 Referrals to Professional & Regulatory Bodies 4 Definitions of Adult Abuse 5 Multi agency Risk Assessment Conference (MARAC) for domestic abuse 13 7 8 10 Multi Agency Public Protection Arrangements (MAPPA) Mental Health Act and Mental Capacity Act Mental Capacity Act 2005 Consent & Involvement of the Adult at Risk Areas to be considered whilst attempting to safeguard an individual who has capacity and the legal right to make decisions 14 14 15 16 16 Adults at risk who lack capacity to make certain decisions 16 Human Rights Act 1998 17 Deprivation of Liberty 17 IMCA 17 6 Roles and Responsibilities 18 7. Standard Procedures 21 Process to follow when Adult Safeguarding Concerns are raised 22 8. Information Sharing and Confidentially 24 The code of practice 24 9. Safeguarding Procedures and Pressure Ulcers 25 Page 3 of 34
10. Abuse between Service Users or Users and Carers 11. Training 12. Seconded Staff/Bank and Agency Staff 13. Record Keeping and documentation 14. Implementation 15 Monitoring 16 Review Appendix 1 Pressure Ulcer Safeguarding Triggers 25 26 26 27 27 27 28 29 Appendix 2 Flowchart for responding to allegations of adult abuse against Pennine Care staff 32 Appendix 3 Clinical Governance & Adult Safeguarding Integrated Governance Flowchart 33 Page 4 of 34
1. Introduction This policy s aim is to ensure Pennine Care NHS Foundation Trust meets the standard of compliance required by national guidance for Safeguarding Adults. It is intended that all staff and volunteers safeguard the welfare of an adult at risk and, where there are adult protection concerns, to ensure they are protected and safeguarded from further harm. The Government guidance on adult protection is contained in the document No Secrets (DoH 2000), which sets out the requirements with regard to establishing a multi-agency framework and procedures, and to investigating individual cases of abuse. Throughout this policy the term adults at risk has been widely used replacing the term vulnerable adult in order to reflect existing government guidance. The Safeguarding Adults: (2005) set out a National framework of standards for good practice & outcomes in adult protection. The co-ordinating responsibility for safeguarding adults rests with local authorities and Pennine Care is fully signed-up to the multi-agency procedures agreed in each Borough. This policy encompasses Pennine Care s Adult Safeguarding requirements whilst acknowledging the multiagency links with all the Borough s. The following information clarifies the processes for each Borough. Search adult safeguarding on the home page: www.tameside.gov.uk www.bury.gov.uk www.stockport.gov.uk www.rochdale.gov.uk/safeguardingadults www.oldham.gov.uk www.trafford.gov.uk 2. Key Principles in this policy: All safeguarding work with adults is ultimately about a safe risk management process and should be based upon the following principles: This policy aims to maximise the empowerment, consent and involvement of the adult at risk. The empowerment of adults at risk underpins all adult safeguarding work Every person has the right to live a life free from abuse, neglect and fear Safeguarding adults at risk is everyone s business All reports of abuse will be taken seriously Every person should be able to access information about how to gain safety from abuse and violence All adult safeguarding work aims to prevent abuse from taking place and to respond quickly and effectively to investigate this and take appropriate action where abuse is taking place or suspected Page 5 of 34
All partner agencies will work together actively Staff involved in supporting adults at risk have the appropriate knowledge, skill and training to undertake their responsibilities in relation to adult safeguarding Support and review is in place for adults at risk to prevent abuse from occurring 3. The Legal framework, National policy and Local Policy Procedures. Pennine Care recognises that it has a wider responsibility to safeguard and promote the welfare of those adults at risk s who come into contact with the services. In terms of Safeguarding Adults, Pennine Care discharges its responsibilities through a range of policies and processes that continue to evolve and develop. At the present time they include: Clinical assessment and risk management http://penninenet/intranet/documents/5718.pdf Care Programme Approach CPA/Recovery Approaches to Care http://penninenet/intranet/documents/3368.pdf Mental Health Act Policies and Procedures http://penninenet/intranet/documents/3310.pdf http://penninenet/intranet/documents/3287.pdf http://penninenet/intranet/documents/3175.pdf Whistle-Blowing Policy http://penninenet/intranet/documents/2342.pdf Patient Advice Liaison Service (PALS) http://penninenet/intranet/department.asp?deptid=242 Complaints policy http://penninenet/intranet/documents/3243.pdf Physical Health http://penninenet/intranet/documents/2756.pdf Medicines Management Policies http://penninenet/intranet/documents/2751.pdf Managing Violence and Aggression Policies http://penninenet/intranet/documents/2765.pdf Health and Safety Policies http://penninenet/intranet/documents/3258.pdf Page 6 of 34
Equality and Diversity Policies http://penninenet/intranet/documents/3444.pdf Trust Prevention Falls Strategy CL48 http://penninenet/intranet/documents/3280.pdf Training and Organisational Development Strategies http://penninenet/intranet/documents/3266.pdf Self-Harm Best Practice Guidance http://penninenet/intranet/documents/3766.pdf Police and CRIMINAL Evidence Act (1984) Family Law Act ( 1996) Sexual Offences Act (2003) Domestic Violence Crimes and Victim Support Act (2004) Protection from Harassment Act (1997) Anti Social Behaviour Order s- Crime and Disorder Act (1995) Lasting Powers of Attorney introduced by MCA (2005) The Deprivation of Liberty Safeguards introduced as part of MCA (2005) The Human Rights Act (1998) No Secrets (2000) Mental Capacity Act Procedures (Code of Practice) Legal Powers to intervene Civil Liberties Draft Care and Support Bill (2012) Health and Social care ( 2008) The Disability Discrimination Act 1995 Note: This is not an exclusive list but underpins the umbrella of guidance required for Adult Safeguarding processes. All national guidance can be found by visiting www.legislation.gov.uk 3.1 The Disclosure and Barring Service (DBS) (2012) DBS helps employers make safer recruitment decisions and prevents unsuitable people working with vulnerable groups. It replaces ISA and has been set up to strengthen safeguarding arrangements. Safeguarding Vulnerable Groups Act 2006 recognises the need for a single agency to vet all individuals who want to work or volunteer with vulnerable people. It sets out the legal provisions in connection with the protection of children and adult at risk Page 7 of 34
DBS is responsible for processing the requests for criminal records disclosure deciding whether a person to be placed on or removed from a barred list. Pennine Care Human Resource support are responsible for ensuring Safe Recruitment processes are in place. 3.2 Referrals to Professional and Regulatory Bodies This would include the Nursing and Midwifery Council ( NMC), General Medical council ( GMC) and Health Care Professional Council ( GSCC) where decisions will be made about their fitness to practice. Where concerns are identifies to Professional bodies referral to Disclosure and barring should also take place. For further information visit: www.gov.uk/disclosure and barring service 4 DEFINITIONS OF ADULT ABUSE 4.1 The draft Care Bill (2013) refers to a adult at risk as someone who: 1 Has need for care and support 2 Is experiencing or at risk of abuse or neglect 3 As a result of those needs is unable to protect him self or her self against the abuse or neglect or risk from it. Safeguarding Adults procedures apply to all adults aged 18 and over, and to all adult at risk Some people are more vulnerable because of the situation that they may find themselves in. However, it is important to remember that a person is not inevitably at risk just because of age, fragility disability. It is important to note that people who have capacity are free to make choices and take risks in their lives. It is important to recognise possible abuse taking place and ensure risk management/ adult safeguarding principles are applied. Every person has the right to live a life fee from abuse exploitation and neglect in whatever circumstance or situation they find themselves in. 4.2 No Secrets (2000) defines a vulnerable adult as a 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 Adults at Risk Page 8 of 34
A person aged 18 or over and who: Is eligible for or receives any adult s social care service provided or arranged by a local authority; or Funds their own care and has social care needs; or Otherwise has social care needs that are low, moderate, substantial or critical; or Falls within any other categories prescribed by the Secretary of State and Is at risk of significant harm, where harm is defined as ill-treatment or the impairment of health or development or unlawful conduct which appropriates or adversely affects property, rights or interests Community care services are taken to mean all care services in whatever setting or context.) Pennine Care has signed up to multi agency procedures for each of the boroughs within the Pennine Care footprint and contributes to the joint partnership arrangements for each Adult Safeguarding Board. The duty to investigate would apply to an adult at risk, which would be defined through four elements: (i) The person must appear to have health or social care needs, including carers (irrespective of whether or not those needs are being met by services). (ii) The person must appear to be at risk of harm, rather than significant harm set out in the existing statutory guidance. (iii) The person must appear to be unable to safeguard themselves from harm as a direct result of their health or social care needs. (iv) The local authority must believe it is necessary to make enquiries. 4.3 What constitutes Abuse?..Abuse is a violation of an individual s human and civil rights, by any other person or persons. Abuse may consist of single or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or can not consent. (No Secrets 2000) For descriptions of the forms that abuse may take please see below Abuse of adults can take place in place or setting perpetrators of abuse can be informal cares partners family members people in a position of trust people paid to care or offer care services strangers and organisations can cause abuse or harm. Page 9 of 34
4.4 Categories of abuse: Types Physical Abuse Sexual Abuse Financial Abuse Discriminatory Abuse Definitions inappropriate or careless handling during the course of restraint, hitting, slapping, pushing, kicking, misuse of medication, or inappropriate sanctions, unwarranted enforced isolation or captivity; including rape and sexual assault or sexual acts to which the adult at risk has not consented, or could not consent or was pressured into consenting by a person in position of power including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits; Including racist, sexist, that based on a person s disability, and other forms of harassment, slurs or Possible Indicators would include unexplained bruising non accidental injury, slap marks, bite marks, punch or grab marks, person flinching on physical contact, reluctance to undress, history of unexplained falls or minor injuries, excessive use of medication, deterioration in physical self care, unexplained pressure ulcers, malnutrition. redness, swelling in the genital area Unexplained sudden inability to pay bills unexplained sudden withdrawal of money from bank accounts lack of knowledge of income finances or assets discrepancies between income and assets unsatisfactory living conditions Page 10 of 34
Domestic Violence Emotional Abuse Forced marriage Institutional Abuse similar treatment. abuse of power and control by one person over another within their relationship. This may include physical violence, emotional or psychological abuse, sexual violence and abuse, financial control and social isolation. It also includes Forced Marriage and Honour Based Abuse. including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks; Hostility or rejection from a care giver when a person is dependent on them This takes place when the Bride or groom or both do not wish to get married but they are being tricked to go abroad to do so or physically threatened or blackmailed. Involves the collective failure of an organisation to provide an appropriate service to vulnerable people arising from the prevailing practices, customs and cultures within a professional care organisation or part of it. withdrawn overly compliant fearful withdrawn depression overly compliant fearful anxious Patients woken too early to suit staffing requirements and shifts. Lack of choice and flexibility in care environment, Lack of privacy and dignity Lack of access to drinks and snacks. Lack of advocacy Not listening to patient s complaints and concerns. Patients unable to raise concerns safely Page 11 of 34
Neglect or acts of omission Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating, and hygiene. Privacy and Dignity. Enforced social isolation Loss of weight, inadequate heating and lighting pressure ulcers soiled or wet clothing not addressed. Dehydration, withholding of pain relief and other medications to manage well being. Radicalisation/ PREVENT Radicalisation is about vulnerable people or groups who may be cohersed and or persuaded into terrorism or terrorists acts, cults, or acts of criminality. PREVENT is part of the UK counter terrorism strategy that aims to reduce the risk Great Britain faces from terrorism. The work of PREVENT is about recognising, supporting and protecting people that may be subject to radicalisation changes in mood and / or behaviour, increased or sudden interest in terrorist information. Note: there is no specific profile or indicator but staff have to remain vigilant 4.5 Honour based violence A referral to the Police should be considered if Honour based violence is suspected. Women are predominately the victims (but not exclusively) and the violence is often committed when it is felt that the victim has brought dishonour to the family. Many victims are so isolated and controlled that they are not able to contact statutory organisations for assistance. Violence is often committed with a degree of collusion from other family members. Alerts/ concerns about Honour- based violence include domestic abuse, forced marriage or enforced house arrest. A referral to the Police should always be a consideration. The situation is complex and a degree of clinical expertise is needed to manage the risk for all concerned. 4.6 Female Genital Mutilation Page 12 of 34
Female Genital Mutilation (FGM) involves procedures that include the partial or total removal of the external female genital organs for cultural and other non therapeutic reasons. The reasons for practicing FGM include the notion that it brings status and respect to the female, it preserves the females virginity, its part of being a woman, it is a rite of passage, it provides social acceptance, the family may get a sense of status in the community, it is traditional, it is cosmetically desirable and helps women to remain clean. FGM is a form of child abuse and violence against women and girls and therefore should be managed as part of existing structures for Adult and Child Protection. FGM is illegal and is not a matter that can be left to be decided by personal preference. It is acknowledged that some FGM practicing families do not see it as an act of abuse but it has significant physical and emotional consequences in both the long and the short term and it is often embedded in cultural practice. 4.7 Hate Crime Incidents- refers to any incident that is perceived as being racist, homophobic, transphobic or due to a person s religious beliefs, identity or disability. Note- this definition is based upon the perception of the individual and is not reliant on evidence. Incidents do not have to constitute a crime. All incidents of hate crime should be reported to the police. The decision to share information can be made at the multi agency strategy discussion and again every effort to obtain consent from the victim should be sought. 4.8 Human trafficking If an identified victim of human trafficking is also an adult at risk the response can be coordinated under Adult Safeguarding procedures and organisations that have a role to play will form part of the strategy meeting. Generally the Police will take a lead role but other organisations such as Health, Local Authority immigration officials may be involved. 5. Multi-agency Risk Assessment Conference (MARAC) for domestic abuse Domestic Abuse is defined as Any incident or pattern of incident of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality Each Borough has a Multi Agency Risk Assessment Conference (MARAC) The MARAC prioritises high risk domestic abuse cases and operates side by side the strategy / multi agency /professional meetings that take place for Safeguarding Adults. MARAC aim s is to share information between agencies and in order to protect adult victims of domestic abuse especially high risk cases where there is a danger of serious harm. Any agency can refer to MARAC where cases are discussed and the process is linked to referrals to safeguard children and adults. This process does not require the consent of the victim however the ideal is to have the victim s Page 13 of 34
cooperation. Individual consent to refer to or release information to MARAC should be sought where possible but is not essential. Disclosures to MARAC are made under the Data Protection Act and the Human Rights Act. Information can be shared when it is necessary to prevent a crime, protect the health and/or safety of the victim and/or the rights and freedoms of those who are victims of violence and/or their children. It must be proportionate to the level of risk of harm to a named individual or known household. For further information see the FAQs on disclosure of information at MARAC available at www.caada.org.uk. 5.1 Issues related to MARAC Does the victim need to know they are being discussed at MARAC? Whether you discuss the MARAC with your client will depend on whether you referred the case to MARAC. IF YOU ARE THE REFERRING AGENCY: It is good practice to discuss the referral with the victim if it is safe to do so. You will need to use your professional judgement to decide whether it is safe. IF YOU ARE NOT THE REFERRING AGENCY: You should check with the referring agency before contacting your client to gather relevant information to ensure it is safe to do so. 5.2 Multi Agency Public Protection Arrangements ( MAPPA) The purpose of a MAPPA is to reduce the risk poised by sexual and violent offenders in order to protect the public and previous victims from further harm. A MAPPA is led by Police, Probation and Prison services that have a duty to ensure that risk assessment and management of all identified MAPPA offenders (primarily violent offenders and people on the Sex Offenders register) are monitored and understood by all agencies that have contact with them. 5.3 Mental Health Act and Mental Capacity Act Mental Health Act (2007) -The Mental health Act 2007 amended Mental health Act 1983 The Mental capacity Act 2005 Domestic Violence, Crime and Victim Act 2004 Amendments to the mental health Act 1983 Definition of Mental disorder a single definition now applies throughout the Act and references to categories of disorder are abolished Criteria for Detention- it introduced a new appropriate treatment test which applies to all longer term powers of detention. As a result it is not now possible for patients to be compulsory detained, or their detention continued, Page 14 of 34
unless appropriate medical treatment and other circumstances of the case is available to the patient Professional role- it broadened the group of practitioners who can take on the functions currently preformed by the Approved social Worker and Responsible Medical officer Nearest Relative- it gives the patient the right to displace their nearest relative and enables the Court to displace nearest relatives who it thinks are not suitable to act as such Supervised Community treatment-(sct) it introduced a SCT for patients following a persons detention under a Section 3 MHA Independent Mental Health Advocates (IMHA) - were introduced. 5.4 Mental capacity Act (MCA) 2005 The Mental Capacity Act 2005 was introduced in April 2007 then fully in October 2007. The Act provides a statutory framework to empower and protect people who are not able to make their own decisions. Since its enactment the MCA has been amended by the Mental Health Act 2007. The MCA is underpinned by five key principles: 1) A presumption of capacity- every adult has the right to make their own decisions and MUST BE assumed to have capacity to do so unless proved otherwise 2) The right for individuals to be supported to make their own decisions- people must be given all appropriate help before anyone concludes that they cannot make their own decisions 3) Individuals must retain the right to make what might appear to be unwise decisions- 4) Best Interests- anything done for or on behalf of people without capacity must be with their best interest 5) Least Restrictive Interventions- anything done for or on behalf of a person lacking capacity should be the least restrictive of their basic rights and freedom The Act deals with the assessment of a person s capacity and acts by carers of those who lack capacity: The capacity assessment has to be: Decision specific and the time and date of the test specified Best interest- an act done or decision made for or on behalf of another The MCA deals with two situations where a designated decision maker can act on behalf of another person who lacks capacity: Lasting Power of Attorney (LPA)- allows a person to appoint an attorney to act on their behalf if they should loose capacity in the future and allows people to empower an attorney to make health and welfare decisions Court Appointed Deputy- provides for a court appointed deputy who can make decisions on welfare, healthcare, and financial matters as authorised by the new Court of Protection. Court of Protection- has jurisdiction relating to the whole act with its own processes and nominated judges Page 15 of 34
A public Guardian is supported by the Office of Public Guardian (OPG) is the registered authority for IPA s and deputies. They supervise deputies appointed by the Court and provide information to help the Court make decisions. Advance Decisions to refuse treatment there are statutory rules with clear safeguards so people may make decisions in advance to refuse treatment if they lacked capacity in the future to do so Criminal offence- The MCA introduced a new criminal offence of ill treatment or wilful neglect of a person who lacks capacity. If convicted a prison sentence of up to five years can be given. Section 44 of the Mental Capacity Act (2005) means it is a criminal offence to ill-treat 1 or wilfully neglect 2 a person who lacks capacity. It is aimed at people in a position of trust, care or power and carries a maximum penalty of 5 years imprisonment 5.5 Consent and involvement of the Adult at risk An adult s legal right to consent marks the fundamental difference in approaches from Adult to children s safeguarding arrangements. Empowerment involves a proactive approach to seeking consent and maximising a person s involvement in decision making about their care and protection and it is not always possible to eliminate risk. The person s right to make the choice about their own safety has to be balanced with the right for others (including children but not exclusively) to be safe. 5.6 Areas to be considered whilst attempting to safeguard an individual who has capacity and the legal right to make decisions Are there others who could be at risk? Is there a legal restriction or over riding public interest issue? Are there issues of impaired capacity and decision making? 5.7 Adults at risk who lack the capacity to make certain decisions When a person lacks the capacity to make informed decisions about maintaining their safety professionals do have a duty to act in their best interest under MCA 2005. Adults at risk need to be able to make informed choices from the information they have been given and may require support in doing so from a variety of sources, i.e. a trustworthy friend or family member, Independent mental Capacity Advocate ( IMCA), a language interpreter or other communication aid/ assistance. Page 16 of 34
5.8 Human Rights Act 1998 Article 8 of the Human Rights Act (1998) covers an individual s right to privacy. A key sentence is Everyone has the right to respect for his private and family life, his home and his correspondence. This right is not absolute, but a breach of it must be justified. In order to justify interference; the public authority will need to show that it acted: In accordance with the law; In the pursuit of a legitimate aim; and In a way necessary in a democratic society. In practice, these criteria are readily met by anyone acting with good faith and in the public good. Consistently, courts have taken the view that they would only interfere if the decision to disclose information was palpably unreasonable and disproportionate to the circumstances. 5.9 Deprivation of Liberty (DOLs) Deprivation of liberty procedural safeguards were introduced in April 2009 to protect individuals from the unlawful deprivation of their liberty which is prohibited under article 5 of the European convention of Human Rights. DOLs procedures are managed by each local authority. http://www.cqc.org.uk/sites/default/files/media/documents/dols_report_- _main_-_final.pdf 5.10 IMCA Under the Mental Capacity Act (2005), the Government has identified an allegation of abuse of a adult at risk as a circumstance under which an Independent Mental Capacity Advocate (IMCA) can be appointed for a person with a lack of capacity. Unlike other circumstances, this can take place even if the person has family/friends to support them. The appointment of an IMCA should be made through the relevant local authority arrangements. IMCA s look at the way decisions are being made but do not make decisions on behalf of the person they represent. They are independent of all agencies and always aim to ensure that the best interests of the person are being considered Decision makers such as Attorneys and deputies still need to abide by the MCA 2005 and that not acting in the best interests may mean that there is a safeguarding issue. The office of Public Guardian investigates complaints regarding attorneys and deputies. Page 17 of 34
6. Roles and Responsibilities 6.1 No Secrets (2000) identifies 6 levels at which roles and responsibilities should be established. For Pennine Care they are: Operational; Supervisory line management; Senior management staff; Trust-wide; Chief Executive; Trust Board. Under the multi agency partnership arrangements established with local authorities, Pennine Care s responsibilities may extend into the investigation and assessment of Safeguarding Adults cases beyond what might otherwise be the case. The partnership arrangements will dictate the lead person for each investigation. 6.2 All Pennine Care Employers -The roles and responsibilities of ALL staff are as set out in the multi-agency procedures within each Borough. These provide the necessary guidance for staff with regard to the identification, investigation and assessment of abuse and the joint arrangements for decision-making. All paid and unpaid workers have a responsibility to recognise and report abuse which might be taking place- this is referred to as an alert or concern under Adult Safeguarding. All staff has a responsibility to report incidents or allegations of abuse. These must be reported through the Trust Incident Reporting System and Local Authority Alert processes. 6.3 Chief Executives have overall adult safeguarding responsibility within Pennine Care NHS Foundation trust this has been delegated to the Medical Director. 6.4 The Trust s Medical Director leads on the Trust Adult Safeguarding Group and agenda. The Safeguarding Adults Group will meet at least bi monthly and will report through established Trust procedures. Membership of this forum also includes a representative from the Human Resources Department. The medical director will receive regular briefings on Safeguarding Adults. 6.5 Trust Board all Trust Board members will be the local representation for their borough and have an operational and strategic level of understanding relating to governance and Safeguarding Adults structures. Team investigation reports will be processed via the Trust board by Head of Patient Safety. Page 18 of 34
6.6 Local representation Each Borough, for mental health, community services and Specialist Services has a nominated local representative for Safeguarding Adults who will attend the Trust Safeguarding Adults Group. The nominated local representative will act as a link for the Trust to ensure local integration and representation at the Trust Safeguarding Group and lead on local safeguarding adults activity within their designated borough. 6.7 The Trust s Medical Director leads on the Trust Adult Safeguarding Group and agenda. The Safeguarding Adults Group will meet at least bi monthly and will report through established Trust procedures. Membership of this forum also includes a representative from the Human Resources Department. 6.8 Service Line Managers are responsible for ensuring that this policy is applied and that the Trust contributes effectively to the multi-agency procedures in conjunction (where necessary) with the Service Director. For Rehabilitation and High Support Services the Senior Manager responsible is the Divisional Director, although their links to multi-agency arrangements are via Service Line Managers 6.9 Trust Head of Patient Safety Will lead and support the medical director with the Safeguarding Adults agenda and clinical governance for Pennine Care 6.10 Trust Operational Safeguarding Adults Lead is responsible for the provision of clinical expertise in the field of Adult Safeguarding.; ensuring that Pennine Care contributes to all the Borough s Adult Safeguarding Board, raise the profile and understanding of Adult Safeguarding across the Trust which includes training and maintaining information on Trust Intranet system. Assurance to the Trust Board will be provided by means of an annual report. 6.11 Trust Safeguarding Adults Group The responsibilities of the Safeguarding Adults Group are to: Develop and review the implementation of Safeguarding Adult s policy and procedures Set strategic direction for the development of Safeguarding initiatives within the Trust. Act as the Trust s expert advisor on Safeguarding Adults matters; Receive Team Investigation reports on Borough Safeguarding Adults activity and lessons learned. Establish links with Safeguarding Adults activity across Pennine Care; Page 19 of 34
Provide a forum for the sharing of lessons learned and dissemination of views, innovations and best practice in Safeguarding Adults. Ensure a framework is in place to support staff in their duty to report concerns relating to Safeguarding Adults and in particular what is expected of staff. In addition to contributing to the work of the Safeguarding Adults group, Safeguarding Adults representatives will also: Provide advice and expertise to staff; Promote professional practice in relation to safeguarding adults. 6.12 Operational line managers are responsible for overseeing and supervising investigations carried out by staff and the collaboration by staff with other agencies that may be investigating abuse concerns that involve a Pennine Care service user. Managers, as well as staff, must be familiar with local multi-agency procedures and ensure that they receive the appropriate training. Managers will be available to discuss issues with front-line staff local managers in the first instance and then the Safeguarding Adults Lead with cover from other Boroughs if necessary. Allocated responsibility for Safeguarding Adults will be clear and that where Safeguarding Adults issues are current the required action, supervision and necessary expertise will all be discussed and appropriate time and resources made available. All issues, discussions, action and decisions including team meetings and supervision notes with regard to Safeguarding Adults will be recorded, and actions notified to managers. Discussion of cases concerning Safeguarding Adults issues will be routinely undertaken as part of professional supervision, and records checked by the manager. Managers will ensure all staff receives appropriate training as identified in the Trust Training Needs Analysis. Staff may have particular concerns when they identify and/or investigate institutional abuse or abuse by individual staff members. The Trust s Whistleblowing Policy (2003) states that: All employees have not only a right, but a duty to raise any matter of concern they may have about unacceptable conduct within the Trust. http://penninenet/intranet/documents/2342.pdf Page 20 of 34
Ordinarily, where concerns relate to the behaviour or actions of Pennine Care staff, an investigator will be appointed as a result of the incident management and investigation process. This will be negotiated when necessary with Local Authority investigators. (It is important that those appointed are aware of and familiar with this policy and local Safeguarding Adults procedures). 6.13 Support Systems The Trust recognises that reporting and dealing with Safeguarding Adult issues can be very stressful, and it undertakes, therefore, to ensure that staff are supported and that there are effective professional governance arrangements Service Managers are responsible for ensuring that staff have access to the recognised appropriate staff support such as supervision and counselling as appropriate http://penninenet/intranet/documents/4738.pdf Deleted:. Allegations or instances of abuse, particularly those involving Pennine Care. staff members, MUST be reported to senior managers medical director and recorded on the Trusts electronic incident system. Where this is in relation to LA staff working within Pennine Care this will be done jointly between LA and Pennine Care Please see appendix 2 for procedures when Safeguarding concerns involve Pennine Care staff. 7. Standard Procedures Whilst Pennine Care is linked into Multi agency procedures with each Local Authority the standard process s of risk management will always be adopted where concerns for patient safety are raised. It is importance to reinforce that when any clinical incident occurs involving abuse of a adult at risk a Trust Electronic incident form will require completion alongside following local Borough Adult Safeguarding processes. Pennine Care is a full partner in those systems and procedures and is committed to their effective operation. All staff that comes into contact with users and carers should be familiar with their local multi-agency policies as well as this Pennine Care policy. Any member of staff who has grounds to suspect the abuse of a adult at risk (whether a Pennine Care service user or not) must: Report it to their manager Record their concerns, actions and discussions and the outcomes. Report the incident on the Trusts Incident Reporting system. Report to their borough multi agency adult safeguarding processes if appropriate\te to do so i.e. alerts raising concerns Page 21 of 34
Where there is sufficient concern that a crime may have been committed the concerns should be discussed with a senior manager and the police notified. Where there is an immediate or continuing concern with regard to the harming of a adult at risk consideration must be given as how to reduce or remove that harm. Proactive immediate steps must be taken to reduce risks, these must be Effective; Timely; Appropriate; Necessary; Lawful; Consistent with the duty of care and terms dictated by Professional Body. What those steps might be will vary from case to case. Wherever possible they should be taken following discussion with managers and in line with multi-agency procedures. 7.1 PROCESS TO FOLLOW WHEN ADULT SAFEGUARDING CONCERNS ARE RAISED (SEE APENDIX 3) When an incident of concern is reported/received/observed (this could include a written complaint or verbal complaint from any person the following process should be implemented. Begin initial investigation with the service user who has been allegedly abused. 7.2 Fact finding re allegation of abuse. Ask open questions such as describe to me, tell me or explain what happened. Document questions asked and responses given using the exact language of the service user. Any witness s must be interviewed separately. Consider whether a crime has been committed. If a crime has been committed do not commence questioning the perpetrator and report to police immediately. Discussions should take place with the police to determine whether progressing the complaint might prejudice subsequent legal action. If member of staff is the alleged perpetrator the HR investigation will be put on hold pending police investigation. Remember, a criminal investigation by the police takes priority over all other lines of enquiry. Examples of criminal offence include assault whether physical or psychological, sexual assault and rape, theft, fraud other forms of financial exploitation, racial discrimination. Consider the person as central to the event and remove any immediate risks and look at support needs for individuals. It should be reported to Page 22 of 34
a senior manager where it has not been possible to put measures in place to protect a vulnerable person and the reasons why. Consider the capacity of the service user within the context of the incident. Remember capacity is situation specific and section 2 & 3 of the Mental Capacity Act must be adhered to when establishing capacity. Communicate the incident to a Senior Manager, Safeguarding Adults Lead, On-call Duty manager as appropriate. Complete an electronic incident form and document all details within the service user s health care record Take advice from senior managers safeguarding adults lead on who else this needs to be communicated to. Ensure that consent has been obtained form the client to pass on information to others. (please see section 8 for further detail on disclosure and information sharing.) ASK THE QUESTION IS THIS A SAFEGUARDING CONCERN? If the answer is yes: Identify Safeguarding Adults Lead This should be a registered practitioner who has received the required training. Report to Local Authority Safeguarding Partnership and complete appropriate notification/alert form to the appropriate person/team. (Please refer to local authority safeguarding policy procedure for details. Consider that Safeguarding must empower people and give them control of their safeguarding at each stage including the right not to be safeguarded. Arrange a Strategy Meeting include all relevant persons. Relevant information and reports should be made available to inform those attending and to guide the decision making process. Ensure that there is adequate support for the service user consider use of IMCAS / advocate. Consider the outcomes that the person wants from the Safeguarding process. However it is important to work with the Mental Capacity Act principles and Best Interests decisions to manage any associated risks. Update health care record with details of plans and actions to be taken. The plan should identify which individual or agency is responsible for each action with a review date and is incorporated into the service users care plan. Update Risk assessment and management plan of service user. Normal Trust polices will still apply and should be carried out in partnership with the Safeguarding process. Trusts governance arrangements will ensure appropriate notifications are made to the National Patient Safety Agency, and Commissioning Care Group (in accordance with national guidance) Page 23 of 34
Where there are concerns about abuse of a service user these must be incorporated into the risk assessment component of the full assessment, and any protection plan recorded alongside the care plan. 8. Information Sharing and Confidentiality In the absence of consent, confidentiality can only lawfully be breached if there is: A legal obligation to do so where the professional has no choice, e.g. a court order requiring disclosure; or An overriding public interest in disclosing the information where the professional must exercise judgement. Unless the patient consents, this means that the person considering disclosure must be satisfied that there is an overriding public interest which justifies breaching the relevant patient s confidentiality. 8.1 The Information Sharing Code of Practice advises that:.. staff are permitted to disclose personal information in order to prevent and support detection, investigation and punishment of serious crime and/or to prevent abuse or serious harm to others where they judge, on a case by case basis, that the public good that would be achieved by the disclosure outweighs both the obligation of confidentiality to the individual patient concerned and the broader public interest in the provision of a confidential service. Whilst it is important for the adult at risk s wishes to be taken into account there are circumstances when the Investigating officer will have to over-ride these. This would include:- if the alleged perpetrator is a member of staff If the alleged perpetrator has access to an Adult at risk. If the adult at risk has not got capacity to comprehend the potential/actual abuse which is occurring Where the vulnerable adult has capacity and does not wish to take action, but others maybe at risk. 9. Safeguarding Procedures and Pressure Ulcers Deciding whether to refer to Safeguarding Procedures There is a recognised link between safeguarding issues and pressure ulcers. Some pressure ulcers may be the result of neglect-either deliberate or by omission. Neglect is the deliberate withholding OR unintentional failure to provide appropriate and adequate care and support, where this has resulted in, or is highly likely to result in preventable skin damage. Page 24 of 34
All cases of actual or suspected neglect should be referred through the safeguarding procedures. Poor practice may also be considered as neglect and may need to be reported through the safeguarding procedures, to ensure areas of concern are appropriately addressed. Possible indicators of poor practice are. Failure to follow Trust Policy/Procedures National and local Guidance i.e. full assessment documented, care plan implemented, identifying prevention strategy for those at risk of pressure ulcers. Lack of appropriate equipment Equipment not maintained checked or set appropriately Nutritional assessment not undertaken Repositioning chart not completed Regular skin inspection of at risk areas not regularly carried out/documented. The initial assessment should consider the following 5 questions: 1.Has there been rapid onset and/or deterioration of skin integrity? 2. Has there been a recent change in medical condition, e.g. skin or wound infection, other infection, pyrexia, anaemia, end of life care that could have contributed to a sudden deterioration of skin condition? If so has a reassessment of risk and additional preventative measures been implemented? 3 Have all reasonable steps been taken to prevent skin damage? Are there any steps that could have been taken but haven t? 4 Is the level of damage to the skin disproportional to the patient s risk status? E.g. low risk but with extensive injury 5 Is there evidence of neglect (as defined above) or poor practice (see possible indicators)? The term patient has been used throughout however this also refers to residents in care homes and those living in their own homes. 9.1 Pressure Ulcers Safeguarding Triggers To determine if the identification of a pressure ulcer on an individual receiving professional support (in a care or nursing home, hospital or from a domiciliary care or nursing care agency) please see appendix 1 10. Abuse between Service Users or Users and Carers The requirements of No Secrets, the criminal law and disciplinary policies all apply just as much when victim and perpetrator are both service users or one is a service user and the other a carer. Page 25 of 34
Relationships between service users (particularly in in-patient settings) and between users and carers can be volatile, stressful, highly dependent or even mutually abusive. When dealing with everyday relationships and problems it is important to recognise that not all conflict is abusive. Also, sometimes it may be that behaviour or actions that could be seen as abusive are the result of a failure to cope or an expression of illness. Whilst still needing to be dealt with, they may be approached differently. Nevertheless, where actions or behaviour are in themselves abusive they must be recognised and identified as such before considering how to respond to them. Local Safeguarding processes should be adhered to an individual risk management places and safeguards kept up to date. 11. Training 11.1 Level 1 All newly appointed staff will receive Safeguarding Adults awareness training as part of the Trusts Induction All new staff are required to complete the e- learning Awareness raising for Adult Safeguarding. 11.2 Level 2 Safeguarding Adults training is provided to staff within the organisation please see TNA. Refresher training will be every three years. The Trust has in addition purchased an e-learning package on Safeguarding Adults. In addition Pennine Care staff can attend the Safeguarding Adults multi-agency training provided by each local authority. 11.3 Level 3 Staff who may undertake Safeguarding Adults investigations can attend the required multi-agency training provided by the Local Authority. Each Local authority provides multi agency adult safeguarding training in addition to the Trust s Safeguarding Adults training. The Local Authority will send notification letters at these pre booked training sessions to the authorising manager for action when people have not attended. Please see training needs analysis for details of all staff groups and level of training required. 12. Seconded Staff/ Bank and Agency Staff Pennine Care manages local authority seconded staff under formal and informal agreements in all Boroughs and may also, from time to time, manage staff seconded from other health organisations. Where such staff holds management or care co-ordination responsibilities they may be allocated to investigate Safeguarding Adults concerns on behalf of the Trust and are authorised to do so, including those that may involve the behaviour or actions of Pennine Care staff. Where there are Safeguarding Adults concerns that relate to the actions or behaviour of staff seconded to the Trust, investigation of such concerns must be carried out by the employing authority unless it has generally (via a Page 26 of 34