Safeguarding is everyones responsibility and has been put in place to prevent or minimise the potential for abuse occuring. It is also the process of protecting them from maltreatment, preventing impairment of service users health or development, and ensuring that vulnerable adults are living in environments consistent with the provision of safe and effective care. Prevention needs to take place in the context of person-centred support and personalisation, with individuals empowered to make choices and supported to manage risks.
Protection is the statutory responsibility in response to individual cases where risk of harm has been identified. .
Adult protection is defined as:-
Part of safeguarding and promoting welfare and refers to the responsbility to protectspecific service users who are suffering or likely to suffer significant harm.
Everyone involved in the care of vulnerable adults has a duty of care to safeguard them so that the need to protect them is reduced.
Prevention in safeguarding does not mean being over protective or putting risk assessments in place to cover every aspect of a persons daily living. One of the most effective ways to prevent abuse is by regular training and education of staff on abuse and how to recognise and respond to it.
Any concerns staff at Munhaven have that abuse may be, or has taken place, are reported to management and if need be MASH Norfolk and CQC. These concerns are always taken seriously and dealt with immediately. Understanding of signs and symptoms of abuse and application of safeguarding procedures are mandatory for all staff. Systems and processes to train and equip staff to protect vulnerable adults are necessary, and in place for all staff, including administrative and other non-clinical staff.
1.2 Evaluate the impact of policy developments on approaches to safeguarding vulnerable adults in own service setting
The publication of the paper “No Secrets” in 2000 was instrumental in forming the framework for Adult Safeguarding. It emphasisied how important it is for all agencies to work together and that all local authorities should take the lead on safeguarding vulnerable adults. This publication has helped to ensure that all relevant agencies are actively looking for signs of abuse and know how to respond accordingly, The “No Secrets” has also had a major impact on how vulnerable adults are protected, especially in residential settings. Munhaven has systems, policies and procedures in place to ensure that all staff have appropriate training on safeguarding, how to recognise and report abuse and whistle blowing. Pro-active management is necessary to ensure that all their staff understand the concept of safeguarding and that vulnerable adults are protected.
The Safeguarding training at Munhaven includes:-
Awareness that abuse can take place and their responsibility to report concerns.
Types of abuse and the signs to look out for.
How to report abuse and to whom.
1.3 Explain the legislative framework for safeguarding vulnerable adults
There are currently no Adult Protection legislation in the UK although the “No Secrets” document does offer guidance to help protect vulnerable adults at risk of abuse by developing multi-agency policies and procedures. The CQC also plays a role in ensuring abuse does not take place in care homes, and safeguarding concerns should be reported to them as part of a homes policies and procedures.
Other Acts which help to protect vulnerable adults are:-
(a) Mental Capacity Act (2005)
(b) Protection of Vulnerable Adults Scheme (Care Standards Act 2000) which aims to ensure that no one is permitted to work in the care sector if they have abused, neglected, harmed or placed a vulnerable adult at risk.
(c) The Sexual Offences Act (2003) makes it an offense for anyone providing care, assistance or services to an adult with learning disabilities or a mental diorder to engage in sexual activity even if the person has capacity to to consent. However, this does not apply if the sexual relationship pre-dates the relationship of care provider which is often the case with dementia.
(d) The Safeguarding Vulnerable Groups Act (SVGA) 2006 was passed to help avoid harm, or risk of harm, by preventing individuals who are deemed unsuitable to work with vulnerable adults or children from gaining access to them through their work. The Independent Safeguarding Authority was established as a result of this Act. (ref: www.scie.org.uk)
Below is a time line of important legislation/Guidance in regards to the protection of vulnerable adults: www.scie.org.uk/assets/elearning/ipiac/ipiac01/resource/text/…/keyPolicy.htm
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1998
White Paper Modernising Social Services – stressed the importance of improving the protection for adults needing care and support.
Speaking up for Justice – Report highlighted the treatment of vulnerable or intimidated witnesses in the criminal justice system and the need to obtain ‘best evidence’. This resulted in their eligibility for special support measures under Part 2 of the Youth Justice and Criminal Evidence Act 1999 supported by the Home Office Action for Justice and Achieving Best Evidence guidance.
Public Interest Disclosure Act.
2000
Human Rights Act 1998 placed a positive duty upon ‘public bodies’ to act compatibly with the 1950 European Convention on Human Rights. This includes a duty to intervene proportionately to protect the rights of citizens. Article 2: ‘The right to life’, Article 3: ‘Freedom from torture’ (including humiliating and degrading treatment), Article 8: ‘Right to family life’ (one that sustains the individual)
No Secrets – guidance published by the Department of Health builds upon the Government’s respect for human rights and highlights the need to protect vulnerable adults through effective multi-agency teamwork.
National Care Standards Commission, now the Care Quality Commission (CQC) In Safe Hands: Implementing Adult Protection Procedures in Wales.
2003
Sexual Offences Act
Disability Discrimination Act
2005
Mental Capacity Act
Safeguarding Adults – National Framework of Standards was issued by the Association of Directors of Social Services (ADSS). The national framework is comprised of 11 sets of good practice standards in safeguarding adults. It makes a distinct shift in language from ‘vulnerable adult’ as used in No Secrets to ‘safeguarding adults’
1.4 Evaluate how serious case reviews or inquiries have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults
Below is the serious case review following the death of Steven Hoskin.
At the heart of the Serious Case Review were two uncomfortable and haunting realities. Firstly, Mr Hoskin was regarded by several agencies, not as a vulnerable adult to be protected from abuse and neglect, but as a perpetrator of antisocial behaviour. Mr Hoskin had been charged and convicted of assault and he was known to be verbally abusive when drinking. There were complaints from neighbours about noise, and wo emanating from his bedsit in St Austell. The fact that many agencies knew that Steven was a vulnerable adult with learning disabilities (including: Ocean Housing, the police, adult social care, the NHS and the Youth Service) was subjugated to their day to day experiences of responding to him. There were repeated complaints from neighbours and numerous calls to the police resulting in many visits to Steven’s bedsit. There were complaints to Steven’s landlord, Ocean Housing, including a petition from his neighbours about noise and nuisance problems in the days before his murder. There were several emergency calls to the ambulance service to attend the bedsit to care for Steven, and those later found guilty of his murder – with alcohol and violence often at the heart of the problems encountered when the ambulance crew arrived. Adult social care had “tagged” Steven’s file because of the assault he had perpetrated against his mother and they also understood Steven not only in terms of his vulnerability, but also in terms of the risk he posed to others.
The information below was taken from the following article : www.communitycare.co.uk
The body of Steven Hoskin was found at the bottom of a railway viaduct in St Austell, Cornwall, on 6 July 2006. Hoskin, who had learning disabilities, had suffered hours of abuse at the hands of a gang, two of whom – Darren Stewart, 29, and Sarah Bullock, 16 – were convicted of his murder, and one – Martin Pollard, 21 – of his manslaughter. In his final hours, the 38-year-old service user was forced to swallow a lethal dose of paracetamol, was hauled around his bedsit by a dog lead and burned with cigarettes. Then he was frogmarched to the viaduct from where he fell more than 30 metres to his death after Bullock kicked him in the face and stood on his hands.
A serious case review (SCR), published in December 2007, found that health, social care, housing and police had missed warning signals that ought to have invoked adult protection procedures. Since then statutory agencies in Cornwall have worked hard to meet the SCR’s recommendations.
Five years on, SCR chair Margaret Flynn says Cornwall “certainly has an edge in terms of engagement with emergency services”, compared with elsewhere.
She says that improving safeguarding requires explicit investment, and that some – though not all – authorities have considered the implications of the Hoskin case in detail.
What went wrong? In April 2005, Hoskin was allocated two hours of support each week by Cornwall Council adults’ services. But in the August he chose to cancel the service and by September his case was shut.
According to the SCR, Hoskin then “lost all control of his own life” when Stewart and his girlfriend, Bullock, moved into his bedsit and began to abuse him. The SCR added: “Steven’s ‘choice’ to terminate contact with adult social care was not investigated or explored with him, or other key agencies involved in his care, even though such choices may compound a person’s vulnerability; may be made on the basis of inadequate or inappropriate information; or result from the exercise of inappropriate coercion from third parties.”
What the SCR recommended: Any life-transforming decisions by a known vulnerable adult – such as discontinuing a support service – should result in assessments of a person’s decision-making capacity.
What has happened in Cornwall? Adult care staff must complete a risk assessment review before closing a case, overseen by a care manager. Cornwall Council has also introduced a quality assurance framework whereby a mixture of open and closed cases are selected monthly by line managers who examine them against four key measurements: whether safeguarding procedures were followed and recorded accurately; whether safeguarding actions were implemented; whether there is strong evidence of the service user’s voice in the process; and the outcomes for the individual and others.
“If someone says they don’t want a service, you need to look behind that,” says Jon Dunicliff, safeguarding adults co-ordinator for Cornwall’s independent safeguarding adults unit, which is accountable to the multi-agency safeguarding adults board.
“Choice is not a take-it-or-leave-it option. Even if they don’t want contact with social care, they will have contact with their GP, district nurse or their beat officer. That individual can be the best person to watch what’s happening, so it’s about using that range of multi-agency partners to stay aware of what’s going on in their life.”
What has happened nationally? David Congdon, head of campaigns and policy at Mencap, says: “There is a danger that a philosophy of choice – which is absolutely right – can be used as an excuse for inaction. With hard-pressed social services, if someone says they don’t want support it becomes convenient not to provide it. The starting point, but not the end result, is for the government to put safeguarding on a firm statutory basis.”
The body of Steven Hoskin was found at the bottom of a railway viaduct in St Austell, Cornwall, on 6 July 2006. Hoskin, who had learning disabilities, had suffered months of abuse from a gang, two of whom – Darren Stewart, 29, and Sarah Bullock, 16 – were convicted of his murder, and one – Martin Pollard, 21 – of his manslaughter. In his final hours, the 38-year-old was forced to swallow a lethal dose of paracetamol, was hauled around his bedsit by a dog lead and burned with cigarettes. Then he was frogmarched to the viaduct from where he fell more than 30 metres to his death after Bullock kicked him in the face and stood on his hands.
A serious case review (SCR), published in December 2007, found that health, social care, housing and police had missed warning signals that ought to have invoked adult protection procedures. Since then statutory agencies in Cornwall have worked hard to meet the SCR’s recommendations.
Five years on, SCR chair Margaret Flynn says Cornwall “certainly has an edge in terms of engagement with emergency services”, compared with elsewhere.
She says that improving safeguarding requires explicit investment, and that some – though not all – authorities have considered the implications of the Hoskin case in detail.
On whether there could be another death like Hoskin’s, Flynn admits “it is possible” but adds: “Some authorities have given a lot of thought to what it would have been like if he was resident in their authority and that’s more enlightened than thinking ‘thank god it didn’t happen here’.”
INFORMATION SHARING
What went wrong? Each agency focused on single issues within their own remits and did not connect them. The SCR said: “Each held a piece or pieces of a jigsaw puzzle without any sense of the picture they were creating, or indeed the timeframe within which the puzzle had to be completed.”
What the SCR recommended: A professional who comes into contact with a vulnerable adult should be able to determine immediately whether other agencies are involved and has a duty to share concerns.
What has happened in Cornwall? In March 2009 a trigger protocol was introduced. This amalgamates information from the flagging systems from the minor injury units (MIUs) and A&E and frequent calls from the same address to the ambulance service and the police on one database held by the primary care trust.
A monthly meeting discusses the 15 addresses that cause the most concern. Representatives from adult care, children’s services, the PCT, the safeguarding adults unit, the ambulance trust, police, the mental health trust and the fire brigade attend.
The PCT’s designated nurse for safeguarding adults, Chris Parish, who chairs the meeting, says: “Frequent-caller information is logged by address and we share that first rather than a person’s name. Darren Stewart was a frequent user of services and no one picked up that he and Hoskin were living at the same address.”
What has happened nationally? “There are some things that practitioners can’t share without checking them and, in the white noise of daily practice, it can be difficult to know who to check them with,” says Flynn. “But people are trying hard to share information.”
NHS FAILINGS
What went wrong? Hoskin often used health services after he stopped his support service. The SCR said: “If primary and secondary healthcare personnel had been attuned to Steven’s learning disability, arguably his visits could have been regarded as ‘alerts’.”
What the SCR recommended:
Thresholds should be introduced to trigger safeguarding alerts based on vulnerable adults’ attendance of A&E or MIUs.
What has happened in Cornwall? NHS Cornwall and Isles of Scilly introduced an electronic system linking the county’s 11 MIUs to identify multiple attendances. Emails are sent automatically to a dedicated email address at the safeguarding children and adults team when the MIU nurse has concerns at the time of the consultation or someone comes in three or more times in one month, three or more times in three months, or six or more times in six months. Emails are checked daily.
“We ask the MIUs to send us a copy of the patient’s treatment card so we can scrutinise them and check whether everything is being done that should be,” says Chris Parish, the PCT’s designated nurse for safeguarding adults.
The team identifies patterns of attendance and areas of risk, and is responsible for ensuring action is taken.
The A;E department at Royal Cornwall Hospital in Truro introduced a similar flagging system, although it is not on the same computer system as the MIUs’.
“Their system checks whether someone has come in more than three times in any time period. When that happens, the clinician who sees them on their fourth visit is alerted,” says Parish.
What has happened nationally? Pete Morgan, chair of the Practitioners’ Alliance for Safeguarding Adults UK, says agencies are “getting better at having systems in place to pick concerns up”, and this goes beyond health.
“By involving agencies like housing they can pick up on low-level concerns which as individual incidents may not ring alarm bells but put them together and they should do,” he adds.
Despite significant additional resources being devoted to adult protection arrangements in Cornwall, there were a number of “missed opportunities” which, if followed up, may have prevented Steven’s murder. These missed opportunities include a failure to make adult protection alerts for Steven when there was a clear indication that it was appropriate to do.
1.5 Explain the protocols and referral procedures when harm or abuse is alleged or suspected
When harm or abuse is suspected or alleged at Munhaven the first thing staff must do is report their concerns to management. Management will then notify MASH (Norfolk) and CQC if relevant. In the case of alleged abuse staff are to obtain as much information as possible ensuring that all information is accurate, truthful, relevant and in the persons own words. This information is to be written down and dated/signed as a true account of what has taken place. This statement may, in the case of serious abuse, be used in a court of law.
Your responsibilities when you have safeguarding concerns:
• Assess the situation i.e. are emergency services required?
• Ensure the safety and wellbeing of the individual at all times
• Establish what the individual’s views and wishes are about the suspected abuse and the relevant safeguarding issue
• Maintain any evidence
• Follow Homes policies and procedures for reporting incidents/risks.
• Remain calm and try not to show any shock or disbelief. Listen carefully and demonstrate understanding by acknowledging concern that this has happened. Inform the person that you are required to share the information, explaining what information will be shared and why.
• Make a written record of what the person has told you, using their words, what you have seen and your actions.
Your role as ‘Alerter’ in the Safeguarding Process
The person who raises a safeguarding concern within their own workplace should follow their companies policy and procedures. This concern may result from something that you have seen, been told or heard. Make a Safeguarding Adult referral where this is necessary.
Assessment – Your assessment should be holistic and thorough considering the individuals emotional, social, psychological and physical presentation as well as any clinical medical and social needs.
You need to be alert to: The individuals views and wishes, Inconsistencies in the history or explanation of injury, skin integrity, hydration, personal presentation e.g. is the person unkempt etc, delays or evidence of reasons they are not seeking or receiving treatment, evidence of frequent attendances to the GP or repeated failure to attend appointments.
Other things to consider when abuse is susbected are :- Environmental factors such as signs of neglect, the reactions and responses of other people with the individual, does the person have capacity to make any decisions required, are they able to give informed consent or is action needed in their best interests, are there others at risk e.g. children or other vulnerable adults, Is immediate protection required, has a crime been committed and should the Police be informed, Is any action that is being considered proportionate to the risk identified, and are there valid reasons to act even without the individuals consent.
2.3 Identify the policies and procedures in own worksetting that contribute towards safeguarding and the prevention of abuse
At Munhaven we have policies and procedures in place to ensure that staff we employ have gone through relevant checks to ensure that they are deemed safe to work with the vulnerable adults in our home. Communication –All staff are told why procedures are needed and answer any questions they may have.
Training and awareness – for all staff at the initial stage and then on a continuous basis for updating. (Specific training for those with lead or named responsibility for adult protection.)
Induction – all new workers are informed of the safeguarding procedures and their responsibilities are included in their induction before they start to have contact with vulnerable adults.
Monitoring and supervision – of the use and application of the policies and procedures. Staff also need to be asked about safeguarding issues and awareness when discussing their progress and review of their work.
Recording and information sharing – are these accurate and within the guidelines of NorseCare policies and procedures. Do staff need support or additional training in recording and sharing information with each other and other agencies?
Recruitment and vetting – do all the recruitment processes take safeguarding into account? We know that all new staff are subject to a satisfactory DBS but is this enough to ensure that they will not harm our residents?
Managing allegations or incidents within Munhaven – after an allegation or suspicion about an adult protection concern has been investigated, there are likely to be strong feelings from staff, families and residents and possibly within the wider community, which will need to be addressed.
4.2 Evaluate the effectiveness of systems and procedures to protect vulnerable adults in own service setting
At Munhaven each resident has their own individual well-designed care plan/risk assessment file, which states how the individuals assessed needs can be met and any risks managed. These careplans are person centred and demonstrate that:
• The care plan is resident focused and takes into account the resident’s preferences and requests;
•The plan has been developed according to the resident’s needs, including his or her preferences and wishes, care and maintenance of health, lifestyle and wellbeing;
• The plan has been devised and developed in conjunction with the resident and other interested parties;
• Individualised procedures for managing the resident’s needs and risks in everyday life (especially for those residents who have specific needs or the potential to be aggressive, abusive or cause harm) have been established.
• There is appropriate and adequate liaison with relevant professionals to develop and agree the care plans and the means of monitoring these.
All those involved in supporting the resident are working towards the same goals. The resident’s care regimes are established and maintained, according to assessed need, and the resident’s health, lifestyle and wellbeing is safeguarded, taking into account his or her individual needs. Support workers receive training to provide for the resident’s needs and to reduce any perceived risks.
• Each care plan ensures that all those working with the resident develop the skills to be able to provide high class person centred care based on the wishes/preferences of the individual.
• I have been involved in inducting and training support workers and monitoring their work during workplace supervisions to demonstrate that the resident’s needs and the guidelines of care are being met. There are systems in place to ensure the support workers receive sufficient information and appropriate training in order to provide the appropriate resident’s care.
• The staff, by working together as a team and following the individuals care plans, are able to provide opportunities for the resident to establish a structured and purposeful lifestyle. These activities also take into account preferences and abilities, leisure pursuits and social events. These ensure that they comply with the relevant legislation relating to the provision of care to people in residential care.
4.4 Recommend proposals for improvements in systems and procedures in own service setting
For me, it is vitally important that when working with adults with additional needs, such as dementia that we ensure that the environment they are in provides them with the best outcomes and opportunities in life. Adults who have additional needs, have many experiences within their lives where they need support from certain services. Therefore to provide this support it is extremely important that all disciplines work together in an efficient and harmonious way, as this will be providing each individual with the best services which will benefit the resident and their family. Having looked at how vital and dependant these services are for adults with additional needs, it is easy for me to see how these services work together and what their role involves. When certain services work together this is also known as ‘multi disciplinary working.’ The term ‘multi disciplinary working’ is taken from the term ‘team work.’ Team work is essential in assessing and supporting a residents abilities and needs, because it would be impossible for one service to provide all of the services needed for that individual. Professionals from all different services come together,as a team, to support the changing needs of an adult with dementia or other additional needs.. Families and loved ones are also considered as valuable members to ‘multi disciplinary working’ and are usually invited to attend meetings that involve the residents welfare and wellbeing.
See also 2.3.
