SAFEGUARDING ADULTS STRATEGY Originator: Corporate Nursing Date Approved: May 2009 Approved by: Safeguarding Committee Date for Review: May 2011
Contents Page 1. Introduction 3 1.1 Vision 3 1.2 Scope 3 1.3 Partnership arrangements 3 1.4 Roles and Responsibilities 4 2. Aims of the Strategy 4 2.1 Prevention of abuse 4 2.2 Education of staff 5 2.3 Evaluation of practices 5 3. Mental Capacity Act 2005 5 4. Deprivation of Liberty Safeguards 6 5. Independent Safeguarding Authority 7 6. References 7 7. Appendix 1: Adult Protection Plan 8 Appendix 2: Named leads 13 Appendix 3: Levels of Training 15 2
1. INTRODUCTION 1.1 Vision In Safe Hands (NAfW 2000) presented relevant public bodies with guidance on how to enact effective procedures to deal with the abuse of vulnerable adults. It defines abuse as a violation of an individual's human and civil rights by any other person or persons" (p14). The ABM University Health Board recognises that many of the people who access its services will be vulnerable whether that is as a direct result of the presenting problem or any other on-going issue resulting in vulnerability. The Health Board recognises that all people have a right to access the NHS without fear, discrimination or ill treatment and that it is the responsibility of all employees to safeguard patients from harm and/or exploitation. Additionally, the organisation supports the view that an adult at risk of abuse or neglect should be able to access public organisations for appropriate interventions which enable them to live a life free from violence and abuse. (ADSS 2005, p4). In recognition of the changing context, previous references to the protection of "vulnerable adults" and to "adult protection" work are now replaced by the new term: 'Safeguarding Adults'. This phrase means all work which enables an adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect. This definition specifically includes those people who are assessed as being able to purchase all or part of their community care services, as well as those who are eligible for community care services but whose need - in relation to safeguarding - is for access to mainstream services such as the police. 1.2 Scope of the Strategy This strategy applies to all staff employed by Abertawe Bro Morgannwg University Health Board and all independent contractors and providers (e.g GPs, opticians and dentists). 1.3 Partnership arrangements The Health Board will be a full and committed partner agency of the South Wales Adult Protection (SWAP) Forum. In addition, it will be a full and committed partner agency on the Area Adult Protection Committees 3
(AAPCs) within its geographical boundaries. As such, the organsiation will be a signatory to the Inter-Agency Policy and Procedures for Responding to Alleged Abuse and Inappropriate Care of Vulnerable Adults in South Wales (SWAP Forum 2004). A copy of this will be available in each work area or held by all line managers. 1.4 Roles and responsibilities All staff will be aware of their responsibilities in safeguarding vulnerable adults (see appendix 2). They will be able to achieve this through full compliance with the SWAP policy and procedures. Not all employees will work on a regular basis with vulnerable adults; whether they are patients, their families or their visitors. However, most will at some time and each of these employees is responsible for safeguarding such people who come into contact with staff. At all times due regard must be given to relevant organisation policy and procedures. 2. AIMS OF THE STRATEGY The aim of the strategy is to provide a meaningful plan of action to ensure that patients being cared for in the ABM University Health Board are protected from all forms of abuse and that care is delivered in a safe, caring and comfortable environment. The strategy has three interwoven strands; namely, 1. Prevention of abuse 2. Education of staff 3. Evaluation of practices (See Appendix 1) 2.1 Prevention of Abuse In Safe Hands (NAfW 2000) speaks of the need for the prevention of abuse being as important as good practice in the response to referrals of alleged abuse. The safeguarding agenda is a key priority and prevention of all forms of abuse is an integral part of the Trust s work and philosophy of care. Measures to promote prevention will include, amongst others Commitment to inter-agency working and co-ordination Encouragement of staff and volunteers to understand what constitutes abuse through awareness raising, education and easily accessible training programmes 4
Strategies, standards, policies and procedures that are clear, concise and encourage good practice Recording complaints and incidents in a timely, effective manner and responding to them positively Developing positive service cultures and the removal of unacceptable practices Whistle-blowing policy Employment and recruitment practices that are robust and effective These last two points are underpinned by the Safeguarding Vulnerable Groups Act 2006 (DfES 2006). This legislation demands that all those who have significant contact with members of vulnerable groups, either in the course of their employment or through unpaid/voluntary work, are registered and permitted members of the scheme monitored by the Independent Safeguarding Authority. 2.2 Education and development Training of staff and volunteers is an important element of the strategy (see appendix 3). The competencies needed by staff will differ depending on whether, for example, they are frontline staff or managers. All staff must be able to recognise abuse and neglect and know how to make effective reports. This is expanded upon in the Policy. There is to be a central record of everyone who has attended Vulnerable Adults training; this will be audited to plan and target training courses e.g. at particular staff groups. Other training programmes will be reviewed in partnership with relevant health professionals to ensure safeguarding issues are included where appropriate e.g. Dignity and Respect, Complaints, Nutrition, Tissue viability etc. 2.3 Evaluation of practices The strategy will be underpinned by a robust plan for audit of standards to ensure practices are safely maintained and continuously improved. All adult protection issues will be monitored and any changes approved by the and the Operational Group will review practice issues and aim to learn lessons from all cases. 3. MENTAL CAPACITY ACT (2005) The Mental Capacity Act created a new statutory service, the Independent Mental Capacity Advocate (IMCA) service. Its purpose is to help 5
vulnerable people who lack capacity and are facing important decisions made by the NHS and Local Authorities about serious medical treatment and changes of accommodation, for example, moving to a hospital or care home. Under the Mental Capacity Act 2005, NHS bodies have a duty to refer people who lack mental capacity and have no family or friends to support them to an IMCA when they are proposing to take a decision about serious medical treatment. These include cases of starting, stopping or withholding treatment, where there is a "fine balance" between likely benefits and risks. Early identification of the need for an IMCA and referral must be made to avoid delays in medical treatment or discharge from hospital. An exception to this is in situations where an urgent decision is needed. This decision must be recorded with the reason for the non-referral. An IMCA will still need to be instructed for any serious medical treatment that follows emergency treatment. 4. DEPRIVATION OF LIBERTY SAFEGUARDS The Deprivation of Liberty Safeguards (DOLS) are designed to protect service users who are in hospital and care homes registered under the Care Standards Act 2000. The procedures came into force in April 2009 and are a statutory obligation. The law will require a hospital or care home (a managing authority) to seek authorisation from a Local Authority or Health Board (a supervisory body) in order to deprive the liberty of someone with a mental disorder who lacks capacity to consent. This legislation will have an impact on the need for awareness and notification from care homes and hospitals to identify individuals for whom application should be made. They will apply to: people aged 18 and over; and suffer from a mental disorder; and lack the capacity to give consent to the arrangements made for their care or treatment in a care home or hospital, under public or private arrangements; and for whom a deprivation of liberty is considered, after an independent assessment, to be a necessary and proportionate response in their best interests to protect them from harm; and 6
detention under the Mental Health Act 1983 is not appropriate for the person at that time. If a person is at risk of deprivation of liberty because they are subject to frequent, cumulative and ongoing restriction or restraint, consideration should always be given to less restrictive alternatives. If this cannot be achieved, then an application for an authorisation under DOLS must be made. 5. INDEPENDENT SAFEGUARDING AUTHORITY (ISA) The ISA has been created to help prevent unsuitable people from working with children and vulnerable adults. The ISA works in partnership with the Criminal Records Bureau (CRB), it will gather relevant information on every person who wants to work or volunteer with vulnerable people. To ensure that the organisation is prepared for the implementation of the legislation in October 2009 all staff will be duly instructed to register with the ISA as advised by the Human Resources Department. 6. REFERENCES ADSS (2005) Safeguarding Adults. A National Framework of Standards for good practice and outcomes in adult protection work. Association of Directors of Social Services, London DfES (2006) Safeguarding Vulnerable Groups Act 2006. TSO, London NAfW (2000) In Safe Hands. Implementing Adult Protection Procedures in Wales. National Assembly for Wales, Cardiff SWAP Forum (2004) Inter-Agency Policy and Procedures for Responding to Alleged Abuse and Inappropriate Care of Vulnerable Adults in South Wales. South Wales Adult Protection Forum 7
Key Theme 1 Prevention of Abuse APPENDIX 1 Action Intended Outcome Lead Accountability Timescales Monitoring Continue multi-agency working to ensure that shared decision making processes are adhered to and there is a consistent approach to all alleged cases of abuse A Multi-agency approach to all adult protection issues Associate Nurse Director for Governance and Safeguarding Designated Lead Managers Immediate ongoing and i) ABM Safeguarding committee ii) Area Adult Protection Committees iii) South Wales Adult Protection Forum Develop a programme of events that will highlight current or topical issues with the focus on prevention. To inform staff, patients and the public on all types of abuse and ways to prevent or reduce the risks POVA co-ordinator June 2009 and 3-6 monthly thereafter Work in partnership with vulnerable groups including people with learning disabilities, mental illness and the elderly to develop ways to improve care delivery in acute and non-acute settings Develop and review standards, policies and guidelines that will improve patient care and staff All staff caring for vulnerable patients will be better informed of how to deliver care and will have a better understanding of individual s needs through the development of Health Passports and other initiatives To improve patient care, staff knowledge and understanding Associate Director Governance Safeguarding Designated Managers Nurse for and Lead Immediate ongoing Immediate ongoing and and Professional Advisory Group 8
practices. These include clinical and non-clinical policies. Key theme 2: Education of Staff To ensure that introductory training on Adult Protection is provided for all staff on Induction To provide an overview and introduction into adult protection issues for all new starters POVA co-ordinator Ongoing Training Department To undertake a training needs analysis for the new organisation To ensure that training on Adult Protection is provided for all staff (appropriate to role). To establish training needs and work out the resources required to deliver on this To educate all staff about adult protection and to empower them to report cases of neglect or abuse. LHB leads DLMs POVA co-ordinator Social Services Coordinators January 2010 May 2009 and annually To liaise with Social Services Co-ordinators to ensure that sufficient LEVEL 3 training places are provided to meet the needs of the Trust To have DLM s fully trained to deal with POVA cases POVA co-ordinator Social Services Coordinators DLMs January 2010 Training Department 9
Provide training on the Mental Health Act, Mental Capacity Act and Deprivation of Liberty Safeguards for appropriate staff Incorporate adult protection issues into other relevant training provided by the Trust wherever there is risk of abuse / neglect occurring e.g. tissue viability, manual handling, infection control. Encourage staff to complete the POVA level 2 e-learning training programme To raise awareness and educate staff To raise awareness about the everyday adult protection risks associated with different aspects of care Larger number of educated staff Mental Capacity Act Co-ordinator DOLS Co-ordinator POVA Co-ordinator Lead trainers for different subjects POVA Co-ordinator Ongoing January 2010 Ongoing Training Department Training Department Training Department Key Theme 3 Evaluation of Practices To establish an Adult Protection database in the Trust for recording of all referrals (VA1s) and to record outcomes (VA4s) To have an up to date reliable system for recording all adult protection cases so that reports can be produced and lessons easily learnt POVA co-ordinator DLMs June 2009 Ensure that all staff carry out Full compliance with the DLM s Ongoing 10
their responsibilities in relation to record keeping and reporting Support the Safeguarding committee Establish an Operational Adult Safeguarding Group To report abusive staff to the Department of Health POVA list. South Wales inter- agency policy To monitor progress in adult protection and ratify changes made as a result of activity To review adult protection cases and ensure that practices changes as a result To protect the public and the Trust All staff Associate Nurse Director for Governance and Safeguarding Associate Nurse Director for Governance and Safeguarding DLMs Department Head Director of HR Ongoing Healthcare Governance Committee June 2009 Ongoing until October 12 th 2009 Ensure that all staff working with vulnerable people are registered with the Independent Safeguarding Authority. To report all staff proven to have abused patients to the Independent Safeguarding Authority and their professional regulatory body. To safeguard the public and comply with the legislation To protect the public and the Trust Director of HR Department Head Director of HR Department Head Director of HR As Directed by Department of Health From October 12 th 2009 11
Produce an annual adult protection report outlining the organisation s progress and outline plans for the next 12 months To ensure that the Health care Standards Self assessment is completed and that progress is noted year on year or reasons are identified for not doing so To account for all adult protection activity and report changes to practice To measure progress against HIW standards and other organsiations Annually Associate Director Governance Safeguarding Nurse for and Annually Healthcare Governance Committee 12
Named Leads APPENDIX 2 Executive Lead The Executive Nurse Director is identified as having executive responsibility and acts as the Organisation s Senior Co-ordinating Officer for the South Wales Adult Protection (SWAP) Forum. This person is responsible for ensuring that the Health Board discharges its responsibilities in respect of safeguarding vulnerable adults. Associate Nurse Director for Governance & Safeguarding The Associate Nurse Director for Governance and Safeguarding sets the strategic direction and ensures appropriate systems are in place for the delivery of Adult Protection across the Health Board in line with relevant National and Legislative requirements including the Healthcare Standards for Wales and National POVA Policy. He/she is accountable to the Board and is required to update members on all aspects of safeguarding, both internal and external. The s role is to support the Associate Nurse Director for Governance & Safeguarding in setting the strategic direction and ensuring appropriate systems are in place for the delivery of Adult Protection. This is in line with relevant National and Legislative requirements including the Healthcare Standards for Wales and National POVA Policy. The will also manage, coordinate and set priorities for Adult Protection Service and liaise with other agencies through regular contact and attendance at the Area Adult Protection Committee (AAPC) meetings. The Head of POVA will advise on how national policy developments and primary legislation should be interpreted. Assistant The Assistant is responsible for acting in an advisory capacity to all staff, for maintaining good working relationships with other agencies, for supporting staff involved in difficult safeguarding vulnerable adult cases and for in-house training. The Assistant Head of POVA will deputise for the at AAPC meetings also help service the Protection of Vulnerable Adults (POVA) steering group. Named Lead Doctor 13
This person is the Executive Medical Director and is responsible for working with the Senior Co-ordinator and the other members of the to ensure the effective implementation of the safeguarding vulnerable adults policy and procedures within the Trust and to ensure best practice. They may also be asked to act as a Designated Lead Manager (DLM) under the safeguarding vulnerable adults policy. They are accountable to the Chief Executive. Designated Lead Managers These are the Heads and Assistant Heads of Nursing for each directorate. They are required to fulfil the role of DLM as stated in the SWAP policy; this includes organising and chairing strategy meetings, liaising with their counterpart DLMs in other agencies and keeping records of the referrals made in their directorates. DLMs are responsible also for ensuring that the appropriate documentation is completed. Having received a referral form (VA1), they will keep accurate records of discussions, meetings and actions (on form VA2) and record outcomes (on form VA4). The completed paperwork will be sent to Social Services for data collection purposes in order to record POVA activity within the organisation 14
Levels of Training APPENDIX 3 Level 1 This is part of the corporate induction programme that all new staff are required to attend. Level 2 This is the responsibility of the who arranges regular training sessions at various venues throughout the organisation. It will be deemed mandatory for those staff who meet the criteria of the target audience. There is also the option to complete this level through an e-learning pack that is available to everyone via the Trust intranet; the Assistant administers this. Level 3 Social Services, the Police and the run these sessions jointly. They are always multi-agency as required by the SWAP policy. Level 4 This level of training is delivered by the Police and is conducted only on an occasional basis. It is specific to those involved in interviewing vulnerable adults. Level 5 This is briefing for Board level staff and the is responsible for delivering this to the Executive Board. Exhibit 1 (see below) illustrates those staff who will be the target audiences for each level of training, along with the aims to be achieved. Exhibit 1: Levels of POVA Training (Taken from Inter-Agency Policy and Procedures for Responding to Alleged Abuse and Inappropriate Care of Vulnerable Adults in South Wales. SWAP Forum 2004) Level 1 Level 2 Targeting all individuals who may come into contact with vulnerable adults Targeting all staff who have Aimed at raising general awareness of the issues around vulnerable adults Aimed at raising general awareness of the issues around vulnerable adults, the potential 15
Level 3 Level 4 Level 5 direct and regular contact with vulnerable adults Targeting designated lead managers and staff who have a lead responsibility in the strategic process Targeting Police Officers, Social Workers and nominated Health professionals who are likely to become involved in investigation stage Chief Officers and Strategic Management Staff; Elected Members; AAPC Members and any other coopted professional and/or representative for abuse and to develop an understanding of their role and responsibilities in relation to POVA issues, including the completion of VA1 Referral form where appropriate Aimed at developing a broad understanding of: POVA procedures and the referral process Roles & responsibilities following receipt of referral or disclosure Gathering information Risk assessment Rules governing unilateral decision making Information sharing Strategic process when to hold a strategy discussion/meeting, roles and purpose of meeting Implications of capacity & consent Understanding Achieving Best Evidence Completion of VA2 and other VA documentation The areas to be covered include: Communication problems The roles of individuals at this stage in the process The implications of capacity and consent An outline of the Civil and Criminal Law as it will influence this stage of the procedures Achieving Best Evidence Interviewing Practice Understanding: Procedures and the roles and responsibilities of policy requirements and Inter-Agency working Complaints Review of Serious Cases Monitoring and Evaluation and Planning Prevalence Resources/Funding Training issues CSSIW Returns 16