Document Title Safeguarding Adults Policy Document Description Document Type Policy Service Application Trust Wide Version 2.0 Name Jennifer Robinson Lead Author(s) Job Title Lead Nurse for safeguarding adults Executive Director / Director / Manager If you are assured that the correct procedure has been followed for the consultation of this policy, sign and date below: Name Ms Rachel Overfield Date 27/07/2016 Signature Change History Version Date Comments 1.0 22/10/07 New policy CNST Requirements for Acute Trust certain Trust policies 2.0 13/03/10 Due for full Policy Ratification CI/M001 July 2010 Community Trust Policy 3.0 16/03/11 Update acute trust policy 1.0 November New organisation and merger of two polices 2011 1.1 May 2013 Minor amendments to policy 1.2 September Minor amendments to policy 2014 2.0 April 2016 Minor amendments to policy section 5.13- made reference to - Making Safeguarding Personal appendix 1 revised safeguard concern form CQC Essential Standards Care Act (2014) Links with External Standards Essential Standard for Quality and Safety outcome 7 Safeguarding people who use services from abuse Key Dates DATE Ratification Date Trust management board April 2015 minute number 42/15 Review Date April 2018 Page 1 of 41
Document Title: Please Tick () as appropriate Executive Summary Sheet Safeguarding Adults policy This is a new document within the Trust This is a revised Document within the Trust What is the purpose of this document? This policy sets out clear and direct procedural guidance to members of staff within Walsall Healthcare NHS Trust (Hereon referred to as the Organization) if they suspect or have reason to believe abuse has occurred. In addition, ensuring that the organization is effective in making suitable arrangements to safeguard adults from abuse and promote the welfare of vulnerable adults. In addition, show evidence of partnership working What key Issues does this document explore? All adults at risk of abuse or neglect should have access to public organisations for appropriate interventions. Walsall Healthcare NHS Trust is committed to ensuring the safeguarding of vulnerable adults who may be at risk. Preventing, recognising and reporting abuse is the duty of all staff who work for Walsall Healthcare NHS Trust. Priority should be given to fostering a culture of good practice through support and care provision, commissioning and contracting. Who is this document aimed at? This policy is aimed at all staff members who work within Walsall Healthcare NHS Trust. The policy is to support staff to deal with vulnerable adults age 18 years and over. What other policies, guidance and directives should this document be read in conjunction with? Consent policy Disciplinary procedure policy Deprivation of Liberty Safeguards (DOL s) operational policy Dignity Policy Incident policy for reporting and investigating adverse incidences and near misses Induction policy Mandatory training policy Mental Capacity Policy NHS Employment Standards Vetting & Barring Policy Raising Concerns Policy Recruitment and Selection Policy Serious Untoward Incident policy Safeguarding Children Policy Whistle Blowing Policy Care of the Dying Policy How and when will this document be reviewed? Every three years by the Adult Safeguarding committee or suitably appointed individual by the Director of Nursing Page 2 of 41
CONTRIBUTION LIST Key individuals involved in developing the document Designation Jennifer Robinson Angela Copestick Andrew Colsan Lead Nurse Older People and vulnerable Adults Adult Safeguarding practitioner social care Patient safety and safeguarding lead Walsall CCG Circulated to the following for consultation Name/Committee/Group/ Designation Trust safeguarding committee Trust safeguarding committee Quality teams Women s and Children s Clinical Support services, Medicine& Long term conditions, Division Of Surgery Policies and Procedures Members Version Control Summary Significant or Substantive Changes from Previous Version A new version number will be allocated for every review even if the review brought about no changes. This will ensure that the process of reviewing the document has been tracked. The comments on changes should summarise the main areas/reasons for change. When a document is reviewed the changes should using the tracking tool in order to clearly show areas of change for the consultation process. Change History Version Date Comments 1.0 22/10/07 New policy CNST Requirements for Acute Trust certain Trust policies 2.0 13/03/10 Due for full Policy Ratification CI/M001 July 2010 Community Trust Policy 3.0 16/03/11 Update acute trust policy 1.0 November 2011 New organisation and merger of two polices 1.1 May 2013 Minor amendments to policy 1.2 September Minor amendments to policy 2014 2.0 April 2016 Minor amendments to policy section 5.13- made reference to - Making Safeguarding Personal Page 3 of 41
Document Index Pg. No 1.0 Introduction 5 2.0 Scope of Policy 6 3.0 Statement of intent 6 4.0 Roles and responsibilities 8-12 5.0 Procedure 13 19 6.0 Audit / monitoring arrangements 19-24 7.0 Training 25 8.0 Definitions 25-26 9.0 References 27 10.0 Related policies 27 Appendices Pg. No 1 Adult safeguarding Concern Form 34 37 2 Adult safeguarding Reporting Procedure 38 3 Risk assessment tool 39 4 Access to Web page 40 Page 4 of 41
1.0 Introduction Walsall Healthcare NHS Trust is committed to ensuring the protection of vulnerable adults. 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. All adults at risk of abuse and neglect should have access to public organizations for appropriate interventions which enable them to live a life free from fear, violence and abuse. It is recognized that some adults who may be eligible for care services might need additional support to access such services and support systems. The adult experiencing, or at risk of abuse or neglect will hereafter be referred to as the adult throughout this policy. Part 1 of the Care Act 2014 came into force on 1 st April 2015; this establishes a clear legal framework for how local authorities and other statutory agencies should protect adults with care and support needs who are at risk of abuse or neglect. New duties include the Local Authority s duty to make enquiries or cause them to be made, to establish a Safeguarding Adults Board; statutory members are the Local Authority, Clinical Commissioning Groups and the Police. Safeguarding Adults Board must arrange Safeguarding Adult Reviews (SARs) as per defined criteria; publish an annual report and strategic plan. All these initiatives are designed to ensure greater multi-agency collaboration as a means of transforming adult social care. Making Safeguarding Personal requires all agencies to evidence that the person s wishes and feelings are central to the development of outcome focused safeguarding, which balances the need for safety with the person s views on quality of life This policy sets out clear and direct procedural guidance to members of staff within Walsall Healthcare NHS Trust if they suspect or have reason to believe abuse has occurred. This policy sets out a framework in accordance with the Department of Health publication Care Act April 2014 chapter 14 relates to safeguarding and provides guidance on sections 42 46 of the Care Act 2014 which replaces the No secrets guidance The document should be read in conjunction with the Multi Agency Policy and Procedures which underpins the west midlands multi agency safeguarding adults policy which the organization has signed up to implement. The Trust policy should be seen as an extension of this document in order to give staff direct guidance on their responsibilities regarding Safeguarding Adults at risk. The policy should also be read in conjunction with Safeguarding Children Policy and any other relevant documentation. Page 5 of 41
2.0 Scope This policy is applicable to all staff members who work within Walsall Healthcare NHS Trust. The policy is to support staff to deal with adults age 18 years and above. Walsall Healthcare NHS Trust is committed to ensuring the safeguarding of adults who may be at risk. Preventing, recognizing and reporting abuse is the duty of all staff who works for Walsall Healthcare NHS Trust. This policy can only be effective if all agencies share timely and relevant information. All staff is bound by the information sharing protocol. Also by ethical and statutory requirements covering confidentiality and data protection. All staff are also governed by Caldicott principles. 3.0 Statement of Intent This policy sets out a framework in accordance with the Department of Health publication Care Act April 2014 chapter 14 relates to safeguarding and provides guidance on sections 42 46 of the Care Act 2014 which replaces the No secrets guidance 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. (Care Act 2014) The introduction of Mental Capacity Act 2005 and Deprivation of Liberty Safeguards has gone even further in strengthening the Safeguarding Adults agenda by providing robust statutory systems for agencies to implement Walsall Healthcare NHS Trust is committed to ensuring the protection of adults who may be at risk. Also preventing, recognizing and reporting abuse is the duty of all staff who works for Walsall Healthcare NHS Trust. Staffs need to be aware that Abuse can take place anywhere: a person s own home, day or residential centres, supported housing, educational establishments, nursing homes, clinics and hospitals and also that Perpetrators of abuse may be relatives, carers, Trust staff or healthcare workers from another organisation, volunteers, visitors, celebrities or anyone with the opportunity to carry out abuse. Page 6 of 41
The policy aims to: To provide an efficient and effective service that is proactive in the prevention, identification, recognition and referral of suspected or actual abuse To ensure that Staff at Walsall healthcare NHS Trust work in partnership with members of all agencies to provide safeguard adults that access services or receive care provided by the Trust To ensure that the adult at risk receive the correct support and advice if abuse has occurred. To ensure that staff know what policy to follow if abuse is suspected and are able to link into and follow the Multi-Agency Adult Safeguarding Procedures Ensure that Staff consider the wishes of those individuals who choose to accept a degree of risk in their living arrangements taking into account his or her capacity to take this decision. The decisions as to whether a person has capacity will only be made following a thorough multi-disciplinary assessment in accordance with the Mental Capacity Act 2005. Staff must consider these issues, but still have a duty to raise concerns as per this Policy To ensure that the law and statutory requirements are known and used appropriately so that any person s thought to be at risk of abuse receive the protection of the law and access to the judicial process. Adult Safeguarding Procedures are governed by the six key principles set out in the Statement of Government Policy on Adult Safeguarding (DoH, May 2013) and are embedded in Statutory Care Act Guidance Chapter 14 (October 2014) empowerment: presumption of person-led decisions and informed consent; consulting the person about their desired outcome throughout the safeguarding process protection: ensuring that people are safe and that they have support and representation as necessary during the process prevention: minimising the likelihood of repeated abuse and recognising the person s contribution to this in safeguarding plans proportionality: the ways in which the safeguarding procedure is used are proportionate, as unobtrusive as possible and appropriate to the risk presented partnership: people can be satisfied that agencies are working constructively to make them safe accountability: the way in which the safeguarding process is conducted should be transparent and consistent; it should always be borne in mind that safeguarding procedures may be subject to external scrutiny (e.g. the courts). This policy links into the west midlands safeguarding adults procedures which have been adopted by the Trust and all other partner organizations on the Walsall Safeguarding Adult Partnership Board (WSAPB) The Walsall council hyperlink will take you to this page. Page 7 of 41
4.0 ROLES AND RESPONSIBILITIES 4.1 Chief Executive The Chief Executive has overall responsibility for Adult Safeguarding in Walsall Healthcare NHS Trust and delegates this responsibility and the role of implementing and monitoring this policy to the Director of Nursing. The Chief Executive has responsibility:- To ensure adequate resources are made available for the effective implementation of the policy. To ensure that the organization not only takes into account its clinical responsibility for safeguarding but that it exercises a public health responsibility in ensuring the health and wellbeing of adults at risk across Walsall. To ensure that safeguarding and promoting the welfare of adults at risk is identified as a key priority in all strategic planning processes. To ensure the organization has developed local strategic objectives, priorities and targets for safeguarding adults at risk that complement those set nationally. Ensure the organization co-operates with the Local Authority and shares responsibility for the effective discharge of its functions in safeguarding and promoting the welfare adults at risk. Ensure there is an open culture between local agencies and good direct communication between senior managers so that they accept and address concerns brought to their attention. 4.2 Lead Director Director of Nursing The Director of Nursing has overall responsibility for the implementation, monitoring and compliance with the policy. This includes reporting to Trust Executive groups or the Board any recommendations made by the Walsall safeguarding adult partnership board. The Lead Director is responsible for ensuring policy is reviewed and revised as per timescales on the cover page. The Lead Director, on behalf of the Trust as the regulated activity provider (RAP), must inform the Independent Safeguarding Authority (ISA) of any staff member who has caused harm to a patient. 4.3 Lead Nurse adult safeguarding The lead nurse for adult safeguarding within the acute part of the organisation and has responsibility for: Page 8 of 41
Advising learning and development on the training requirements for staff within WalsallHealthcare NHS Trust to support the partnership board educational framework Acting as a source of advice and support to staff Supporting the Trust in governance arrangements Implementation, monitoring and compliance with Policy and ensuring policy is reviewed and revised as per timescales on the cover 4.4 The Governance Department -Patient Safety The Governance Department has a responsibility for safeguarding and promoting the welfare of adults at risk as part of the organizations Clinical Governance and audit arrangements. The Governance Department will support the reporting structure and give regular updates on reported incidents. 4.5 Divisional Directors (DD) The Divisional Directors has the overall responsibility to ensure that the implementation, monitoring and compliance of this policy is carried out and ensuring staff within the division with specific responsibilities carry these out. 4.6 Director of Human Resources Director of Human Resources has the responsible for ensuring that on recruitment of staff working with vulnerable adults, or handling information on vulnerable adults, that references are always verified, a full employment history is always available with gaps in employment history being checked and accounted for, that qualifications are checked and that DBS checks are undertaken at the appropriate level in line with Safe Recruitment Recommendations. In addition, ensuring that Human Resource policies and practices provide adequate support for colleagues in reporting and dealing with safeguarding incidents. 4.7 Heads of Service (HOS) Heads of Service have the responsibility for: Demonstrating leadership, to be informed about, and take responsibility for the actions of their staff that are providing services to vulnerable adults. To ensure that annual service/team plans/contracts include reference to their contribution to safeguarding Ensure that the services are provided in a way that ensures a safe environment for adults at risk and minimizes any risks; this includes the need Page 9 of 41
to investigate clinical incidents and inform the members of the Operational Board of any incidents involving CCG- commissioned or provided services. Ensure safeguarding responsibilities are reflected in the KSF framework for all staff. Attend any training required as part of the Training Needs Analysis. Offer and co-ordinate support for all staff involved in an Investigation 4.8 Operational Managers/Team Leaders Operational Managers/Team Leaders have the responsibility to: Ensure that annual service/team plans/contracts include reference to their contribution to safeguarding. Ensure that their staff access safeguarding training and supervision and support relevant to their role and responsibilities; Ensure that the services are provided in a way that ensures a safe environment for adults at risk and minimizes any risks; this includes the need To investigate clinical incidents and inform the members of the Operational Board of any incidents involving CCG- commissioned or provided services. Ensure their staff members in contact with adults at risk are familiar with and implement local safeguarding policies, procedures and guidance. Ensure their staff members are clear about their professional roles and responsibilities in relation to safeguarding adults at risk. Ensure their staff makes comprehensive and accurate healthcare records for each adult where significant harm is suspected and/or confirmed. Ensure their staff members work effectively with professionals from other relevant organizations to safeguard adults at risk. Ensure their staffs working with adults at risk have a consistent understanding of the thresholds for intervention, including the requirement to share information appropriately. Undertake regular audit of safeguarding practices in conjunction with the Governance Team. Ensure safeguarding responsibilities are reflected in the KSF framework for all staff. Ensure safeguarding responsibilities are identified in appraisal and Personal Development Plans. Page 10 of 41
Ensure that staff members involved in safeguarding adults are adequately supported through supervision or referral to specific support areas where necessary. Ensure that all new starters are given a full local induction including any relevant information about Safeguarding Adults Attend any training required as part of the Training Needs Analysis. Offer and co-ordinate support for all staff involved in an investigation 4.9 Senior Sisters, Charge Nurses, Department Managers or Equivalent Staff is competent to implement the policy Records are kept as specified Ensuring incidents and issues are reported as specified 4.10 Other Managers / Supervisors The Matrons, Senior Nurses and Senior Sisters and Charge Nurses will be responsible for the day-to-day implementation of the policy and will ensure that all staff is aware of their role under the policy. Ensure staff receives a full local induction on commencement with the organization and take part in training, including attending Clinical updates so that they maintain their skills and are familiar with procedures aimed at safeguarding and promoting the welfare of adults at risk. 4.11 Individual Staff Members All Staff have a responsibility: to be aware of individuals or groups that are at risk, the types of abuse that may occur, to report any actual or suspected abuse in line with the policy and to adhere to recommendations and action plans specified in the protection plan Staff will be aware of the importance of listening to adults at risk, particularly when they are expressing concerns about either their own or other people s welfare. All front line practitioners working with adults at risk should access regular supervision and support in line with local procedures outlined below. Page 11 of 41
All staff working with adults at risk should maintain accurate comprehensive and legible records, with records being stored securely in line with local guidance (see Patient Records Policy on the intranet) All staff should know how to act on concerns that a adult at risk may be at risk of significant harm through abuse or neglect in line with local guidance. All staff should know who to contact to discuss or to report any concerns about an adult s at risk welfare. All staff in contact with vulnerable adults understand what to do and the most effective ways of sharing information in line with local and government guidance if they believe that a adult at risk may require additional services or are considered to be suffering or at risk of suffering significant harm. All staff members, as part of their work with vulnerable adults ensure that the needs of the adults are considered and that where necessary they are assessed and appropriate referrals made. All staff have a duty to report any adult safeguarding issues through the relevant channels Ensure that they are fulfilling KSF, PDR and Job description requirements with regards to safeguarding Adults. 4.12 Specialist or Advisory Roles The Adult Safeguarding Unit from Social Care and Inclusion will be available to offer further support and advice. In addition, they will provide knowledge and information to the Organization regarding individuals involved in Adult Safeguarding incidents and reporting to the Organization numbers of cases and progress of current cases on a monthly basis. The Adult Safeguarding Team will lead on investigations of high profile cases. Liaising with all organizations involved e.g. Police, Social Care inclusion. Contact details are available in the Multi- Agency Adult Safeguarding Procedures. 4.13 The Trust Safeguarding Committee The Trust Safeguarding Committee will take responsibility for the review and integration of clinical incidences, complaints and significant events into safeguarding. The committee will give strategic direction regarding adults and children s safeguarding in line with government legislation and national guidance. In addition, the committee will give assurance that safeguarding issues are being addressed within the organization Page 12 of 41
5.0 Procedure- Types of abuse This section considers the different types and patterns of abuse and neglect and the different circumstances in which they may take place. This is not intended to be an exhaustive list but an illustrative guide as to the sort of behaviour which could give rise to a safeguarding concern. Indicators of abuse are signs and symptoms that raise concern that abuse may be occurring. The presence of one or more indicators does not confirm abuse and may not be restricted to the following indicators, however a cluster of indicators may suggest the potential for abuse and a safeguarding referral must be made. Much abusive behaviour constitutes a criminal offence. All suspected abuse must be investigated. The Care Act (2014) provides definitions of 10 types of abuse and acknowledged that Incidents of abuse may be one-off or multiple, and effect one person or more. Abuse can be categorized into 10 domains, these consist of:- Physical abuse Sexual abuse Psychological abuse Financial or material abuse Neglect and acts of omission Discriminatory abuse Organisational abuse Domestic violence Modern slavery Self-neglect 5.1 Physical Abuse: hitting, slapping, pushing, kicking, misuse and overuse of medication, restraint or inappropriate sanctions Indicators of Physical Abuse Injuries that are not consistent with the history given Bruises on the face, lips, mouth, breasts, arms, buttocks, inner thighs and other areas of the body where accidental bruising is unusual Clusters of injuries forming a regular pattern or reflecting the regular shape of an article Unexplained burns especially on soles, palms or back Slap, pinch, kick or bite marks Unexplained fractures to any parts of the body Lacerations or abrasions to mouth, lips, gums, eyes, external genitalia Medical problems that go unattended Misuse of medication- Evidence of over-/under-medication Person wears clothes that cover all parts of their body or specific parts of their body. Page 13 of 41
5.2 Sexual Abuse: Rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not give valid consent to or was pressured into. The sexual exploitation of adults at risk involves exploitative situations, contexts and relationships where adults at risk (or a third person or persons) receive something (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of performing, and/or others performing on them, sexual activities. Sexual exploitation can occur through the use of technology without the person s immediate recognition this can include, being persuaded to post sexual images on the internet/a mobile phone with no immediate payment or gain or being sent such an image by the person alleged to be causing harm. In all cases those exploiting the adult at risk have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Indicators of Sexual Abuse: negative body image/language unexplained pain, itching, bruises, bleeding or soreness of the genital or rectal area unusual difficulty in walking or sitting torn, stained or bloody underclothing Sexually transmitted disease, urinary tract or vaginal infections bruising to upper thighs or upper arms Bites. significant change in sexual behavior or attitude signs of mental distress, e.g. crying or alternatively withdrawal accompanied by negative body image/language unexplained pain, itching, bruises, bleeding or soreness of the genital or rectal area A woman who lacks the mental capacity to consent to sexual intercourse becomes pregnant. Sexual exploitation Pressure to view pornographic material 5.3 Psychological Abuse: 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 Psychological abuse is the denial of a person s human and civil rights including choice and opinion, privacy and dignity and being able to follow one s own spiritual and cultural beliefs or sexual orientation. It includes preventing the adult from using services that would otherwise support them and enhance their lives. It also includes the intentional and/or unintentional withholding of information (e.g. information not being available in different formats/languages etc.). Indicators of Psychological or Emotional Abuse unexplained fear or flinching eating and/or sleep disorders without medical reason development of or increase in ritualistic behavior Over compliance or at the other extreme aggressive and destructive behavior. incontinence Page 14 of 41
deference emotional withdrawal or depression Low self-esteem. changes in behavior such as passivity or resignation 5.4 Financial or Material Abuse: Theft, fraud, exploitation, pressure in connection with wills property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits Indicators of Financial Abuse unusual or inappropriate financial activity sudden and unexplained inability to pay bills or maintain lifestyle Vulnerable adults lack belongings or services that they can clearly afford. recent changes of deeds or title of property Power of Attorney obtained when the vulnerable adult is not able to understand the purpose of the document they are signing recent acquaintances expressing sudden or disproportionate interest or affection for a person with means those close to the vulnerable adult do not appear to be concerned about the service users physical or emotional care but only asks the worker about financial affairs the person who manages the financial affairs is evasive or uncooperative a reluctance or refusal to take up care or services assessed as being needed A high level of expenditure without the vulnerable adult having appeared to benefit. 5.5 Neglect and Acts of Omission - 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 Indicators of Neglect Poor physical condition e.g. bed sores, pressure ulcers Malnutrition Clothing in poor condition e.g. unwashed, wet Poor or unsuitable accommodation Inadequate heating or lighting Failure to give prescribed medicine or appropriate medical care Inconsistent or reluctant contact with health and social agencies Refusal of access to callers or visitors Failure to ensure appropriate privacy and dignity. 5.6 Discriminatory Abuse: Racist, sexist, that based on a person s disability, age and other forms of harassment, slurs or similar treatment Indicators of Discriminatory Abuse Lack of respect shown to an individual Indications of a substandard service offered to an individual Page 15 of 41
Repeated exclusion from rights afforded to citizens such as health, education, employment and criminal justice. 5.7 Organisaional Abuse: This may take the form of isolated incidents of poor or unsatisfactory professional practice at one end of the spectrum to pervasive ill treatment or gross misconduct at the other. It may take the form of limiting people s choices or regimes or routines that are designed for the convenience of the institution or staff rather than the service users. Institutional abuse can occur within a wide variety of settings including care homes, hospitals, supported or sheltered housing and prisons. Such abuse violates the person s dignity and represents a lack of respect for their human rights. Indicators of Institutional Abuse Lack of respect either verbal or behavioral Denial of visitors or phone calls Failure to ensure appropriate privacy or personal dignity Lack of personal clothing and possessions Service User left on the commode or toilet for long period of time Restricted access to clean clothing and bed linen Restricted access to toilet or bathing facilities Restricted access to appropriate health or social care Lack of stimulation Inappropriate use of power and control Inflexible services based on needs of the provider rather than the assessed need of the person receiving the service Change of accommodation without agreement Sensory deprivation e.g. denial of use of spectacles, hearing aid Lack of flexibility and choice in respect of mealtimes, waking and going to bed, choice of food 5.8 Domestic Abuse- domestic abuse is defined as 'Any incident or pattern of Incidents 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. (2013) this can encompass, but is not Limited to, the following types of abuse: psychological physical sexual financial Emotional Family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws or step-family. 'Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.' Whatever form it takes, domestic abuse is rarely a one-off incident and should instead be seen as a pattern of abusive and controlling behaviour through which the abuser seeks power over the victim. Children are also affected both directly and Page 16 of 41
indirectly and there is also a strong correlation between domestic violence and child abuse. A referral through to children s safeguarding is required at this point. The Government definition, which is not a legal definition, includes so called 'honour based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group. 5.9- 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 5.10- Self-neglect this covers a wide range of behaviour neglecting to care for one s personal hygiene, health or surroundings and includes behaviour such as hoarding. 5.11 Forced Marriages- Forced marriage is a hidden practice, where due to its nature the full scale of the issue is unknown. It can happen to both men and women, although most cases involve young women and girls aged between 16 and 25. 5.12 Honour-based violence covers a variety of behaviours (and crimes) where a person is being punished by their family and /or community for a perceived transgression against the `honour of the family or community. Issues such: as dress code, choice of friends, forced marriage, relationships with the opposite sex, kissing in public and false imprisonment; are issues which impact upon family honour and therefore can lead to violence and abuse. `Honour Based Violence can be distinguished from other forms of violence, as it is often committed with some degree of approval and/or collusion from family and/or community members. Alerts that may indicate honour-based violence include domestic violence, concerns about forced marriage, enforced house arrest and missing person s reports. If a concern is raised through a Safeguarding Adults referral, and there is a suspicion that the adult is the victim of honour-based violence, referring to the police must always be considered as they have the necessary expertise to manage the risk. 5.13 Exploitation by radicalisers who promote violence -Individuals may be susceptible to recruitment 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, embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause. The Home Office leads on the anti-terrorism strategy. PREVENT is part of the Governments counter terrorism strategy called CONTEST which is led by the Home Office. CONTEST is organized around 4 key principles i.e. Pursue: to stop terrorist attacks Prevent: to stop people from becoming terrorists or supporting terrorism Protect: to strengthen our protection against terrorist attack Prepare: to mitigate the impact of a terrorist attack Page 17 of 41
PREVENT is all about recognizing when adults at risk are being exploited for Terrorist related activities. Existing arrangements for reporting concerns are already in place i.e. governance and risk and safeguarding practices. Capacity, Consent and Protection Mental capacity means the ability to give consent and to exercise an informed choice. Consideration of capacity and consent issues must be made before any action or exchange of information. The framework used by law to assess capacity is based upon The 4 criteria for making a decision The Act states that a person cannot make a decision if they cannot do any of the following four things: Understand information given to them relevant to the decision Retain that information long enough to be able to make the decision Use or weigh up the information available to make the decision as part of the decision making process Communicate their decision by any means The law further emphasises that the disturbance in the functioning of the mind or brain can be permanent or temporary. It says that no-one can be labelled incapable by reference simply to a particular diagnosis or mental condition nor by reference to a person s age or appearance or aspect of their behaviour that might lead to an unjustified assumption about their lack of capacity. An adult is presumed to have capacity to make decisions and to be able to give consent unless proved otherwise. A person's capacity might vary in relation to the particular decision or activity being considered, for example, having the capacity to decide where to live but not the capacity to deal with financial affairs. Alternatively, a person may have the capacity to give consent to medical treatment but lack the capacity to give their full consent to sexual activity. (Mental Capacity Act 2005) In situations where an adult may be experiencing coercion or intimidation care must be taken to ensure that consent is being given freely. In any situation of alleged abuse it is important that the vulnerable adult fully understands the nature of the concerns and the options available to them. Independent Mental Capacity Advocacy Service (IMCA) When someone is assessed as lacking mental capacity to make key decisions in their lives they may have the help of a specialist independent mental capacity advocate (IMCA). This is a legal right for people over 16 who lack mental capacity and who do not have an appropriate family member or friend to represent their views. Information on how to access advocacy is located on the Trust mental capacity page on the intranet.to make a referral or for more information visit http://themanor.xwalsall.nhs.uk/mental-capacity.aspx Or telephone 0845 0175 198- Monday Friday 9-5pm An adult who has mental capacity may decide that they do not wish to involve other agencies such as Adult Social Care or the Police. This must never prevent a member of staff raising concerns or seeking advice on behalf of the adult and for Page 18 of 41
themselves as the worker involved. There are circumstances, although limited, where action can be taken against their wishes such as: Where a serious criminal offence or serious harm has taken place. Where compulsory hospital admission Making Safeguarding Personal Making Safeguarding Personal (MSP) is a shift in culture and practice in response to what we now know about what makes safeguarding more or less effective from the perspective of the person being safeguarded. It is about having conversations with people about how we might respond in safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Integral to effective person-centred approaches to adult safeguarding is engaging the adult in a conversation about how best to respond to their situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Engaging with the adult in a meaningful way, at as early a stage as possible, is key to promoting good person-centred practice. From the very first stages of concerns being identified, the views of the adult should be gained. This will enable the person to give their perspectives about the potential abuse or neglect concerns that have been raised, and what outcomes they would like to achieve. These views should directly inform what happens next and there must be a clear record of these views as well as a record if a decision is taken to override the wishes and feelings of an adult (e.g. because it is not safe to gain this view, or others are at risk of harm.) 6.0 Procedure(s) 6.1 The Stages of Reporting Procedures If actual or suspected abuse is identified then staff should take the following steps as identified in the Multi Agency Adult Safeguarding Procedure http://cms.walsall.gov.uk/index/health_and_social_care/social_care-2/adult_safeguarding.htm These can be identified as: Alerting Reporting Enquiries Safeguarding Plan 6.2 Abuse is suspected or known to be happening. In the event of a Serious Incident (SI) refer to the Adverse Events Policy Inform / discuss with (the most appropriate) Line Manager, Duty Manager, or Registered Medical Officer. Contact Named Lead for Safeguarding Adults or Adult Social Care (Emergency Duty Team out of hours) Page 19 of 41
All staff members have a responsibility to report any safeguarding adults suspicions through the appropriate route. These should be reported via the Trusts incident reporting system and via completion of the safeguarding adults initial referral form through to adult social care (see appendix 1) Operational lead should receive a copy of the referral form, The seriousness or extent of the abuse is not always clear and therefore the following factors need to be taken into consideration before intervening: The vulnerability of the individual The nature and extent of the abuse The length of time it has been occurring The impact upon the individual The risk of repeated or increasingly serious acts involving others If a disclosure of abuse is received: In the first instance it is recommended that the staff member discuss the situation with their peer/line manager or senior person on duty. Staffs also have access to adult safeguarding lead for advice, support and guidance Some situations can be resolved by seeking guidance and alerting concerns followed by implementing interventions as part of good practice. More serious or complex situations require reporting externally through agreed processes. It is assumed that adults have the capacity to consent even to the alleged abusive act, situation or relationship, unless it has been proved otherwise. Even for adults who have capacity to consent to such acts, the use of adult safeguarding procedures should always be considered and discussed with the relevant line manager, particularly if there are concerns of public interest where the alleged perpetrator may be engaged in abusive acts, situations, or relationships with others. If the service user has capacity and does not wish to proceed further under adult safeguarding that decision needs to be respected. If staffs are informed of a suspicion or actual abuse then it is good practice to notify Adult Safeguarding Unit for the incident to be recorded. If the abuse is a public interest issue it must be reported through the appropriate channels. If the incident occurs out of hours then staff should contact the Initial Intake Team from Social Care and follow advice given by the social worker identified. Staff should gather facts about the incident but should not attempt to investigate the incident at it could have implications if the abuse is subject to a criminal investigation. Any investigations will be carried out in conjunction with the Social Worker. Staff should request medical photography (where available) if the concern is in relation to specific injury, i.e. pressure ulcers, bruising, clear documentation and body mapping is essential Make a clear and factual record of the disclosure and events. Page 20 of 41
6.3 Reporting Complete an adult safeguarding concern form available on Trust Safeguarding Adults webpage A copy of the referral form must be sent to the Trust Lead for Safeguarding Adults. Staff should complete an incident form as per Trust policy and store in the patients notes ensuring that the safety of the service user is not compromised if they are patient held records. Up to date contact numbers are available on the Walsall council safeguarding adults web page Referrals can be emailed to InitialIntake@walsall.gov.uk or they can be telephoned through on the 0300 555 29922 number. Support and advice for staff reporting or involved in actual or suspected abuse can be obtained from: Human Resources department Occupational Health department Trade Unions Professional Bodies Adult Safeguarding Unit in Social Care and Health 6.3.1. When the (alleged) perpetrator is a member of staff- Positions of trust All incidences of abuse should be reported on a Clinical Incident form and should be completed as soon as possible after the event. Information should include: Date, time and setting in which the allegation was made incident witnessed Name, details of anyone else who was present at the time of disclosure or who witnessed the incident. Information recorded should be factual and clear. The incident should be escalated to the matron / heads of nursing (on site manager out of hours) immediately and a decision will be made in relation to the member of staff being subject to investigation under the Trust Disciplinary Procedure. The Deputy Nursing director and Director of Human Resources hold meetings where safeguarding issues relating to staff are discussed. These will be convened on an ad hoc basis within 2 working days of a Positions of Trust allegation being received. Identified safeguarding incidents within the Trust will be reported to CQC by the Director of Nursing (or as delegated). If someone is removed by being either dismissed or redeployed to a non-regulated Page 21 of 41
activity, from their role providing regulated activity following a safeguarding incident, or a person leaves their role (resignation, retirement) to avoid a disciplinary hearing following a safeguarding incident and the employer/volunteer organisation feels they would have dismissed the person based on the information they hold, the regulated activity provider has a legal duty to refer to the Disclosure and Barring Service. If an agency or personnel supplier has provided the person, then the legal duty sits with that agency. In circumstances where these actions are not undertaken then the local authority can make such a referral. 6.3.2 Raising a concern/suspicion of abuse when the alleged perpetrator is a carer, relative, or friend of the patient. Circumstances in which a carer (for example, a family member or friend) could be Involved in a situation that may require a safeguarding response include: a carer may witness or speak up about abuse or neglect; a carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals and organisations they are in contact with; or, A carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others. Any concern relating to a patient must be raised with the Team Manager and reported as an incident via the Incident Reporting Safeguard system. Consideration should be given to the alleged victim and their immediate safety. A risk assessment should be completed. Assessment of both the carer and the adult they care for must include consideration Of both their wellbeing. Section 1 of the Care Act includes protection from abuse and neglect as part of the definition of wellbeing. As such, a needs or carer s assessment is an important opportunity to explore the individuals circumstances and consider whether it would be possible to provide information, or support that prevents abuse or neglect from occurring, for example, by providing training to the carer about the condition that the adult they care for has or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing it. 6.3.4 Person alleged to be responsible for abuse or neglect When a complaint or allegation has been made against a member of staff, including People employed by the adult, they should be made aware of their rights under employment legislation and any internal disciplinary procedures. Where the person who is alleged to have carried out the abuse themselves has care and support needs and is unable to understand the significance of questions put to them or their replies, they should be assured of their right to the support of an appropriate adult if they are questioned in relation to a suspected crime by the police under the Police and Criminal Evidence Act 1984 (PACE). Victims of crime and witnesses may also require the support of an appropriate adult. Page 22 of 41
Under the MCA, people who lack capacity and are alleged to be responsible for abuse, are entitled to the help of an Independent Mental Capacity Advocate, to support and represent them in the enquiries that are taking place. This is separate from the decision whether or not to provide the victim of abuse with an independent advocate under the Care Act. 6.3.5 Immediate Investigation of Concerns (within 24 hours) Fact finding will be undertaken by the manager and staff member involved, the information to be collated should include the following: - Nature of abuse/details of incident - Has the person got capacity note mental capacity is decision and time specific? so more than one capacity test may need to be carried out see MCA 2005 & appendix 6 - Gather any previous reports of information/ changes in the individual s Behavior - Agree a process for what will happen and document e.g., will you just be monitoring the situation or will a formal investigation need to take place. A decision must then be made on how to proceed 6.4 Enquiries Following a referral to Adult Safeguarding Team further stages occur, these stages can be found in the Multi Agency Adult Safeguarding Procedures. Care Act (2014) section 42 requires Adult Social Care to make enquiries, or possibly request the Trust to do so. The enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect. The Police will have a helpful, supportive and informative role. They will advise on aspects of the law as to whether criminal action has, or is thought to be, occurring. If criminal action is suspected or confirmed the Police will take the lead role and investigate. A Strategy Discussion will take place within 3 working days of an alert being raised (can be held by telephone). A Strategy Meeting is a meeting of multi-agency professionals and needs to be arranged within 5 working days of the decision to have one. The purpose for both is to: Evaluate available information about the alleged abuse. Decide what immediate action is required to protect the vulnerable adult (including emergency action if warranted). Consider if there are risks to others. Agree on any further information that is needed. Devise a strategy for further action. As part of the legal duties under Care Act (2014), Trust staff and Lead Nurse for Safeguarding Adults will commit to involvement in Strategy Discussions and Meetings to support the enquiry. Page 23 of 41
Where the alleged abuse is of a physical nature - an examination by a General Practitioner or A&E Doctor must be undertaken within 24 hours of the allegation being made and with the patients consent. This will be documented in the patient's care records but not in the patient s hand-held (SAP) documentation. A Body Chart mapping any physical injuries will be completed. (See appendix 1) and a request for clinical photography submitted If the individual has injuries or bruising the consultant/ Other Professional must decide if a referral to the police is warranted- Taking into account the patient ability to consent and mental capacity. In the event of the individual dying and a concern has been raised a discussion with the coroner is required. However, if a safeguarding issue becomes apparent after Death, medical staff will be required to have a discussion and raise their concerns with social services, police and the coroner and clearly document in the patients medical records. Sensitive information must not be documented in the patient s hand-held documentation (Single Assessment Process) to prevent breaches of patient confidentiality and risk to the patient s safety. A clear record of events must be kept with other professionals involved contributing to the investigation. Photographs of any suspected physical injury must be taken within 12 hours and will require the individual s consent. The patient s GP will also need to be informed of the allegation. Out of hours this will occur on the following morning. Contact will be made with either the patient's own social worker or duty social worker within 12 hours. If agreed then a formal written referral will follow immediately. This must be clearly documented in the patient's records. If a formal investigation is instigated by the social services team Trust staff will provide information, where required, to the social work team. All investigations will be undertaken with sensitivity, ensuring the needs and wishes of the suspected victim are actioned and adhered to, recognizing the vulnerability of the individual. Next of Kin, families and carers will only be contacted and made aware of the allegation (where appropriate) once this has been discussed with the adult safeguarding unit (ASU). This will be done by the lead investigative officer. This is to ensure the alleged victim is protected against any potential evidence/ further abuse. 6.5 Safeguarding Plan Once the facts have been established, a further discussion of the needs and wishes of the adult is likely to take place. Focused safeguarding planning can enable the adult to achieve resolution or recovery, or fuller assessments by Health and Adult Social Care. Trust staff will commit to involvement in Safeguarding Plans to support the needs of adults. Further information can be obtained if required from the guidance notes in the Multi Agency Adult Safeguarding Procedures. Page 24 of 41
7.0 Alerts coming in to the Trust from an external source Alerts received from external sources can include: Safeguarding concerns about Trust provided care Requests for information to support safeguarding investigations into externally provided care / community services Information to help us care for someone who is already subject to a safeguarding protection plan Local Partners have been requested to send all safeguarding concerns regarding Trust provided care to the Trust lead for Safeguarding adults. If you are approached directly by social care or another external source regarding a safeguarding concern please direct them to the Trust Lead nurse for Safeguarding adults Any safeguarding alerts received externally in relation to any allegations will be received by the Lead nurse for Safeguarding adults. An incident form will be raised and the Executive Lead for Safeguarding will be informed. An investigation will be initiated and the relevant senior person responsible will be involved. The relevant Matron and Head of Nursing will also be informed. An investigation report will be completed and submitted to the Executive Lead for formal review. This will then be submitted to the Adult Safeguarding Unit. The Safeguarding Committee and Divisional quality teams will be aware the report. 8.0 Failed Visits/No Contact/No Access/Non Attendance (for Community Staff Only) Including non-attendance at out-patients appointments (OPD) within secondary care The welfare of the service users is imperative, especially if it is considered that abuse may have taken place or there is an element of vulnerability i.e. Adults with Dementia, Adults with learning disabilities. In the case of failed visits i.e. due to no contact, no access or non -attendance, all healthcare staff should follow a simple process to prevent potential further harm taking place in conjunction with a judgment on clinical risk. No Contact can be defined as unable to make contact with the service user after two attempts to do so. No Access can be defined as contact made but service declined by others on behalf of the service user. Non Attendance is where the service user does not comply with the agreed visiting program and two or more visits are defaulted. In addition, failure to attend out- patient department appointments. The term DNA includes all no contacts with the service user where no advance notice is given of the intention not to attend. Page 25 of 41
Cancellations should not be seen as any of the above if the service user indicates that they do not wish to participate in any further appointments. A letter advising of this should then be sent to the referrer advising of the situation. In relation to out - patients appointments the GP as the referrer will be notified. Consideration should also be given if cancellation is done by the relatives / next of kin- particularly for vulnerable adults. It is the responsibility of all healthcare staff to consider adult safeguarding issues and take appropriate action. This will be determined by the level of clinical risk. All decisions and actions should be recorded in the patient s notes All health care staff in the case of any of the above where access cannot be gained or contact made should: Check the accuracy of the details i.e. addresses, telephone number, etc. Leave a visiting card where appropriate giving details of the intention to call again within seven days, dependent upon the urgency of the contact. Check the referrals details to try to establish accurate information that can assist with the making a judgment about risk and urgency. Visit again at the date/time arranged previously If there is still no response after two unsuccessful visits then an appointment letter should be sent out advising of requesting that the service user make contact with the service. Healthcare staff should discuss the missed appointments with others involved in their care and the implications surrounding this. If there is still no response and there are no concerns by any professionals involved the service user can be discharged with a letter advising the service user and the referrer of this. If there are concerns about the welfare of the service users then a multi-professional conference must be co-ordinate to discuss the most effective actions to be taken and a plan formulated. This will need to be considered on a case by case basis and will be determined by level of need and risk pertaining to the circumstances and the vulnerability of the service user. A referral to Adult Safeguarding Team should be considered at this point. All information should be documented appropriately and all contacts recorded on the electronic system. Staff should also endeavor to keep their Line manager fully up to date with the situation and any actions taken. Page 26 of 41
9.0 Hospital discharge and transfer of care If staff within the acute hospital are aware that a safeguarding concern has been raised a discussion will need to take place with the social work team to assess the status of the investigation and whether it is safe for discharge planning to continue. Staff will be able to contact the integrated discharge team for information. 10.0 Restrictions on visiting within the hospital setting If a safeguarding concern has been raised a discussion will need to take place with the investigating social worker to assess if any restrictions on visiting need to be placed to maintain the safety of the adult. This is more important particularly in cases where the police have been involved and were there is a direct risk to the patient.once this has been agreed A risk assessment (appendix 3 ) will need to be completed and the situation escalated to the relevant matron, head of nursing and director of nursing. 11.0 Information sharing, Consent and Confidentiality In raising safeguarding adults concerns it is necessary to share information with others. Sharing of information is vital if adults are to be protected and receive the services they require. Often it is only when information from a number of sources has been shared that it becomes clear an adult is at risk of, or is suffering significant harm. Statutory and ethical codes concerned with confidentiality and data protection are not intended to prevent the sharing of information between different professionals. The Caldicott Committee Report on the review of patient-identifiable information. recognises that confidential information may need to be disclosed in the best interests of the individual and discusses in what circumstances this may be appropriate and what safeguards need to be observed. The principles can be summarised as: Information will only be shared on a need to know basis when it is in the interests of the adult; Confidentiality must not be confused with secrecy Informed consent should be obtained but, if this is not possible and other adults are at risk of abuse or neglect, it may be necessary to override the requirement; It is inappropriate for agencies to give assurances of absolute confidentiality in cases where there are concerns about abuse, particularly in those situations when other adults may be at risk. The Trust s information sharing will be consistent with the principles set out in the Caldicott Review (2013) ensuring that: Information should only be shared on a need to know basis so that informed decisions can be made to protect the adult. The duty to share information can be as important as the duty to protect confidentiality. Page 27 of 41
12.0 Audit / monitoring arrangements A monthly report detailing incidents reported both within the hospital and also the community will be provided to the Trust Safeguarding operational group. Safeguarding adults training data will be submitted quarterly to the Clinical commissioning group as part of the Trust performance framework and monthly to the safeguarding committee. Staff will also be monitored via individual supervision and professional development in order to ensure appropriate support is given. Monitoring of KSF s and Job Description through supervisions will also be the responsibility of Line Managers Adult Safeguarding is represented as outcome 7 of the Care Quality Commission (CQC) guidance, whereby in order to achieve compliance healthcare organizations must be able to provide evidence to justify the self-assessment All incidences of abuse or suspected abuse that occurs should in the first incident be reported to the Adult Safeguarding Unit. Incidents generated by staff must be notified to the Lead Nurse for safeguarding adults. Any significant findings will be reported back to the Lead Director and the Divisional Quality teams. The Trust Safeguarding Committee will oversee any deficiencies from the report and will escalate to the quality and safety committee by the chair of the Committee. This information will be reported quarterly to the quality and performance which is a group sub group of the Walsall adult safeguarding partnership board Monitoring Process Who Standards Monitored When How Presented to Monitored by Completion/Exception reported to Requirements Safeguarding Adults lead Incidents Report across the health economy and outcomes from investigations for quality assurance and trends analysis. Required paperwork completed appropriately Bi-monthly basis Case review Review of referrals. Participate in audits as agreed with commissioners and other agencies. Safeguarding operational group Safeguarding operational group Divisional Quality Teams/quality and safety committee. quarterly to the quality and performance which is a group Page 28 of 41
sub group of the Walsall adult safeguarding partnership board 13.0 Training Training requirements for each staff group are identified within the Trust Training Needs Analysis All staff joining the Trust will be given an awareness session on Adult Safeguarding during the Trust Induction day Clinical Staff will receive updates on the annual mandatory clinical update sessions other staff will be supported via the corporate update. Renewal of training is required every three years. An e-learning package available for level 1 and level 2 competency. All front line staff are to have access to the multi-agency full one day level 2 adult safeguarding awareness training facilitated by Walsall Council Further basic awareness training sessions and additional bespoke enhanced training is available annually, as part of rolling programme delivered by the Lead for Safeguarding Adults/Deputy or an external facilitator 14.0 Definitions Adult with support and care needs- A person over the age of 18 years who has a need for care and support, this could be an adult receiving a particular care and support service, or an adult who has such needs but are not receiving a service (for example, someone coming forward for an assessment). Abuse is defined within No Secrets as violation of an individual s human and civil rights by any other person or persons Abuse may consist of a single act or repeated acts. Abuse can occur in any relationship and may result in significant harm or exploitation of the person subjected. Abuse maybe deliberate or caused by poor standards or care, lack of knowledge, understanding or training, and may involve more than one type of abuse. Abuse can happen anywhere i.e. own home, care home hospital work setting or other places within the community. Concerns may also arise through the person placing themselves at risk due to their own lack of care or risky behavior. Care and support- The mixture of practical, financial and emotional support for adults who need extra help to manage their lives and be independent including older people, people with a disability or long-term illness, people with mental health problems, and carers. Care and support includes assessment of people s needs, provision of services and the allocation of funds to enable a person to purchase their own care and support. It could include care home, home care, personal assistants, day services, or the provision of aids and adaptations. Disclosure and Barring Service (DBS). The DBS will carry out the Criminal records Bureaus and Independent safeguarding authority functions; will not represent a change to the services it just means that they will be provided by one organisation rather than two. Page 29 of 41
Domestic Abuse-Domestic abuse is defined as any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members regardless of gender or sexuality Deprivation of Liberty Safeguards (DOLS) are there to prevent arbitrary decisions that deprive vulnerable people of lack mental capacity of their liberty, by giving them rights of appeal, representatives and for authorized deprivation to be monitored and reviewed. Mental capacity -is the ability to make a decision and is decision and time specific. For a person to be deemed as lacking capacity for a particular decision they must 1) have an impairment of or disturbance in the functioning of their mind or brain and 2) that impairment or disturbance must make the person unable to make the particular decision (MCA 2005 2-stage test appendix 6 for forms) Self-neglect, where the individual has capacity and where there is no allegation that someone else is abusing them, is not classed as abuse and should follow the usual management processes. The Alerter- The Alerter can be anyone including the alleged victim, their families, carers, health workers or any professional involved in the care or provision or service. Page 30 of 41
15.0 References Care and support statutory Guidance issued under the Care Act 2014 Department of Health (2014) Care Quality Commission-Guidance about compliance with essential standards of quality and safety (2010) Health and Social Care Act 2012 Information for Local Areas on the change to the Definition of Domestic Violence and Abuse (2013) Home office Mental Capacity Act 2005 and Code of Practice and Deprivation of Liberty safeguards Safeguarding Vulnerable People in the Reformed NHS-Accountability and Assurance Framework (2013) NHS Commissioning Board Walsall Multi Agency Adult safeguarding procedures http://cms.walsall.gov.uk/index/health_and_social_care/social_care-2/adult_safeguarding.htm 16.0 Related Polices: Page 31 of 41
Walsall Multi Agency Adult Safeguarding Policyhttp://cms.walsall.gov.uk/index/health_and_social_care/social_care- 2/adult_safeguarding.htm Consent policy Disciplinary procedure policy Deprivation of Liberty Safeguards (DOL s) operational policy Dignity Policy Incident policy for reporting and investigating adverse incidences and near misses Induction policy Incident Reporting policy Mandatory training policy Mental Capacity Policy NHS Employment Standards Vetting & Barring Policy Raising Concerns at work (Whistle Blowing) Policy Recruitment and Selection Policy Safeguarding Children Policy Care after Death Policy Appendix 1 Page 32 of 41
Adult Safeguarding Concern Form (Version 1) Details of Person Person s Name (including Title and other names used) Person s Address Telephone Number Date of Birth Gender Ethnicity First Language Interpreter required Communication needs/preferred method of contact (This relates to ensuring that the person at risk can be contacted in a safe and confidential manner. Is the person known to Social Care? GP Details (Name/Address/Telephone Number) NHS Number (if known) Primary Support Reason (if known) Known Health Conditions/Long Term medical conditions. Is the person known to Social Care? Is the adult with care and support needs a carer for another adult with care and support needs or a child? Are additional arrangements required Would the person like a carer s assessment? Details of Concern Date of Alleged Concern Date Form completed Date Concern passed to the Local Authority Details of person raising the Safeguarding Concern (Name, Address, Telephone number) Organisation Name Organisation Address and Contact Page 33 of 41
Details Does the referrer wish to remain anonymous? Note: this cannot be guaranteed Police Involved (Referred to the Police?) YES NO YES NO Details: Details (including crime number): Funding Authority Self Funding YES NO Details of Professionals Involved Name & Designation Contact details Nature of involvement Any Reason to doubt the person s capacity to understand the presenting risks? Is the person supported by an IMCA/IMHA/Advocate YES NO YES If YES, or don t know has a Mental Capacity Assessment been completed? Outcome of Mental Capacity Assessment If NO, does a referral need to be made? YES YES NO NO NO If YES, Please provide details: Is the person aware of the concern? Have they agreed to the concern being raised? Details of alleged abuse Is this suspected or witnessed abuse Has a Referral been made or required MARAC/MAPPA/Prevent/Vulnerability forum. Does the information identify that a child is at risk? Date of Referral to Children Services Details: Page 34 of 41
Information of alleged source of risk Are they a person or organisation? Location? Organisation Name Organisation Address and Contact Details Source of possible risk (relationship to individual) Is this person the main carer No Don t Know If other please state: Do they live with the adult with care and support needs? Do they have EPA/LPA or deputyship? Not Known None of the Above Are there potential others at risk of harm? YES NO If YES, what actions have been agreed: Is the person alleged to have caused harm also a vulnerable adult? If, are duties for this person being considered : No E.g. S9 Needs Assessment, appropriate adult, IMCA. Consideration needed as to when it is not appropriate to speak to the adult i.e. This will put the person at more risk and / or increase the risk of impact on criminal investigations. Are they aware the concern has been raised? No Nature of alleged abuse Physical Domestic Abuse Sexual Psychological Financial/Material Modern Slavery Discriminatory Organisational Neglect/Acts of Omission Self Neglect Other inc Forced Marriage FGM Hate/Mate Crime Page 35 of 41
Has a risk assessment been completed YES NO HBV Radicalisation Child Sexual Exploitation Risk Outcome: Adults Views & Desired Outcomes Does the Adult want safeguarding enquires to be made? Views of the Adult and/or Representative/s YES NO Desired Outcomes of the Adult and/or Representative/s Actions Agreed with Vulnerable Adult or Representative Name and designation of person completeing this form Contact Details Date/Time ADULT SAFEGUARDING REPORTING PROCEDURE Appendix 2 Page 36 of 41
EVERYONES BUISNESS- ADULT SAFEGUARDING MANAGING A SAFEGUARDING CONCERN DO YOU HAVE A CONCERN REGARDING A VULNERABLE ADULT? Help and Advice Contact: In Hours Lead Nurse for Safeguarding Adults Bleep - 8128 (9-5 Mon- Fri) Integrated discharge team (social Tel Ext - 6439 care) Patient Safety team- Tel Ext - 7354 or 7481 Out of hours Adult safeguarding unit Tel - 0300 555 2922 Matron Emergency social services department On-site manager / night manager Bleep - 6111 Tel - 0300 555 2922 initialintake@walsall.gov.uk Making an Adult Safeguarding Referral Unexplained Injury/ Inconsistent History When an individual has injuries where the explanation given doesn t match the injury, no explanation has been given or concern regarding the type, location and severity of bruising the consultant/ Other Professional must decide if a referral to the police is warranted- Taking into account the patient ability to consent and mental capacity Safeguarding Referral Complete WSS220 Adult safeguarding initial assessment form (section 1 only) and fax to social services department (Ring department to confirm fax number). Retain copy for patients medical records. Confirm fax received by a follow up telephone call Forward a copy of form to lead nurse for older adults to review Incident Reporting If alleged abuse has occurred within the hospital please complete clinical incident form as per Adult safeguarding Policy. Notify on site manager / Night manager / matron of incident. Maintaining Safety If the patient is with acute care and requires supervision to maintain their safety and protect from further harm, the level of supervision must be agreed with safeguarding lead, ward staff, matron Communication and Documentation In the event of a police investigation safeguarding lead, ward staff and the social worker will agree the process of communication and document in patients records. In the event of an individual dying in hospital and a safeguarding concern has been raised, medical staff will need to consult with the coroner prior to the issue of the death certificate. Discharge / transfer of care Consider the safeguarding alert as part of the patients discharge process and check progress with social services before the individual is discharged. Please inform Safeguarding lead of any patient in your area who is admitted into hospital with an existing safeguarding concern. Page 37 of 41
Appendix 3 Risk Origin: Division: Monitoring Body: Lead Director: CQC Regulation: Likelihood Consequence Risk Score Initial Current Key Controls Risk Added Date Last Reviewed Risk Closed Residual Risk April May June July August September October November December January February March Status - Action Plan Due Action Progress to date Date completed Page 38 of 41
Appendix 4 Access to Safeguarding Webpage Log on to http://themanor.xwalsall.nhs.uk/ Hover over Directorate at top of page, Hover over Corporate, and then click on Adult Safeguarding (as below) Page 39 of 41