Safeguarding means: proactively seeking to involve the whole community in keeping the individual safe and promoting their welfare. Safeguarding is an important part of integrated working. When professionals work together in an integrated way, they put the individual at the centre of all activities to help identify their holistic needs earlier to improve their life outcomes. It is important to see safeguarding as part of a continuum, where prevention and early intervention can help children, vulnerable adults and families get back on track and avoid problems turning into a crisis. Protection is a central part of safeguarding and promoting welfare. It is the process of protecting an individual identified as either suffering or at risk of suffering significant harm as a result of abuse or neglect.
1.2 It is important to evaluate the processes that are in place to ensure that they are working to the good of the individuals. As new policies are brought in, then it is vital to ensure that, the service setting responds to these by updating their own paper work. The only way in which to evaluate as to whether the policies are working is by the feed back from staff and how they respond to situations, when policies are developed it is critical that staff are aware of the changes in the policies and that these policies are available to all staff and these changes are cascaded down. Lessons learned from safe guarding situations should be taken into account and used to strengthen the knowledge of all. 1.3 : The legislation and government policy framework relating to adult safeguarding is subject to considerable debate and change. But includes the following
Legal Powers to Intervene
Disclosure and Barring Service
Mental Capacity Act 2005
Mental Health Act 2007
Health and Social Care Act 2008
National Policy and Guidance
Registered Health and Social Care Providers
‘No Secrets’ sets out a code of practice for the protection of vulnerable adults.
It explains how commissioners and providers of health and social care services should work together to produce and implement local policies and procedures. They should collaborate with the public, voluntary and private sectors and they should also consult service users, their carers and representative groups. Local authority social services departments should co-ordinate the development of policies and procedures.
Serious case reviews “are not done to reinvestigate or to apportion blame”, but rather: 1. To establish whether there are lessons to be learnt from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults 2. To review the effectiveness of procedures (both multi-agency and those of individual organisations) 3. To inform and improve local inter-agency practice
4. To improve practice by acting on learning (developing best practice) 5. To prepare or commission an overview report which brings together and analyses the findings of the various reports from agencies in order to make recommendations for future action (ADASS, 2006). The purpose of any case review is to protect vulnerable adults, by drawing upon lessons to be learned from individual cases, making recommendations aimed at preventing similar tragedy by strengthening and improving multi-agency procedures and arrangements. Outcome 7 of CQC essential standards,” safeguarding people who use the service from abuse “ explains the regulations and expectations that a service provider must comply with.
The introduction of the No Secrets guidance (2000), which gives councils the responsibility for establishing and coordinating local multi-agency procedures for responding to allegations of abuse. It also introduced the principle that social services departments and their partners should set up adult protection committees, usually referred to as safeguarding adults partnership boards, to coordinate local safeguarding arrangements. The Putting People First concordat described a range of features that were viewed as central to system-wide transformation of care, including safeguarding.
• Joint (local council and PCT) strategic needs assessments to inform the local community strategy and an integrated approach to commissioning and market development. • Prevention, early intervention and enablement becoming the norm. • Universal information, advice and advocacy, irrespective of eligibility for public funds. • Common assessment – with greater emphasis on self-assessment. • Person-centred planning and self-directed support becoming mainstreamed, with personal budgets for everyone eligible for publicly-funded care and support and more people opting to arrange their own support with direct payments. • Adult social care to champion the needs and rights of disabled people and older adults, safeguarding and promoting dignity, supporting a collective voice through user-led organisations, enhancing social capital and developing the local workforce. Paper by department of health gateway reference 16702 outlines the government’s policy on safeguarding vulnerable adults.
1.5 Each county have their information on Safeguarding adults and these can be found on the appropriate websites for the county, which gives the information and guidance on Multi agency procedures. Below is an example from Surrey C.C. which outlines the referral procedures when dealing with a safeguarding alert, from agency level upwards. Prior to this, staff would report to their line manager, or in the case of serious concern, for instance where the person is in immediate danger they would report this to the police directly. Incident and accident report forms would need to be completed and the manager would be expected to take statements from the staff and notify the local authority.
The organisation should recognise that vulnerable adults have the right to take risks and should provide help and support to enable them to identify and manage potential and actual risks to themselves and others. It is important that the organisation has a policy of ‘positive risk-taking’ and avoids becoming totally risk averse. Risk averse cultures can stifle and constrain and could lead to inappropriate restriction to the individual’s rights. Life is never risk free. Some degree of risk-taking is an essential part of fostering independence. For instance, if you identify an activity or set of circumstances as potentially risky to a vulnerable adult or group of vulnerable adults, this needs to be offset against the benefits which the individual or group might draw from taking part in that activity. Risk-taking should be pursued in a context of promoting opportunities and safety, not poor practice.
In a culture of positive risk-taking, risk assessment should involve everyone affected – vulnerable adults and carers, advocates, staff and volunteers and, where they are involved, health and social care staff.
Physical abuse: indicators
A history of unexplained falls or minor injuries especially at different stages of healing Unexplained bruising in well-protected areas of body, e.g. on the inside of thighs or upper arms etc. Unexplained bruising or injuries of any sort
Burn marks of unusual type, e.g. burns caused by cigarettes and rope burns etc. A history of frequent changes of general practitioners or reluctance in the family, carer or friend towards a general practitioner consultation Accumulation of medicine which has been prescribed for a client but not administered Malnutrition, ulcers, bed sores and being left in wet clothing Sexual abuse: indicators
Unexplained changes in the demeanour and behaviour of the vulnerable adult Tendency to withdraw and spend time in isolation. expression of explicit sexual behaviour and/or language by the vulnerable adult which is out of character Irregular and disturbed sleep pattern
Bruising or bleeding in the rectal or genital areas
Torn or stained underclothing especially with blood or semen Sexually transmitted disease or pregnancy where the individual cannot give consent to sexual acts.
Psychological abuse: indicators
Inability of the vulnerable person to sleep or tendency to spend long periods in bed
Loss of appetite or overeating at inappropriate times
Anxiety, confusion or general resignation
Tendency towards social withdrawal and isolation
Fearfulness and signs of loss of self-esteem
Uncharacteristic manipulative, uncooperative and aggressive behaviour
Financial abuse: indicators
Unexplained inability to pay for household shopping or bills etc.
Withdrawal of large sums of money which cannot be explained
Missing personal possessions
Disparity between the person’s living conditions and their financial resources
Unusual and extraordinary interest and involvement in the vulnerable adult’s assets
Neglect and acts of omission: indicators
Inadequate heating, lighting, food or fluids
Failure by carer to give prescribed medication or obtain appropriate medical care
Carer’s reluctant to accept contact from health or social care professionals
Refusal to arrange access for visitors
Poor physical condition in the vulnerable person e.g. ulcers, bed sores
Apparently unexplained weight loss
Unkempt clothing and appearance
Inappropriate or inadequate clothing, or nightclothes worn during the day Sensory deprivation – lack of access to glasses, hearing aids etc.
Absence of appropriate privacy and dignity
Absence of method of calling for assistance
Discriminatory abuse: indicators
Tendency to withdrawal and isolation
Fearfulness and anxiety
Being refused access to services or being excluded inappropriately
Loss of self-esteem
Resistance or refusal to access services that are required to meet need
Expressions of anger or frustration
Measures that can be taken to avoid abuse taking place can be as follows:
1. Identifying people at risk of abuse
2. Public awareness
3. Information, advice and advocacy
4. Training and education
5. Policies and procedures
6. Community links
7. Regulation and legislation
8. Inter-agency collaboration
9. Empowerment and choice
Measures that can be taken to avoid the risk of abuse, is the implementation of robust policies, which need to be monitored and evaluated on a regular basis. Risk assessments should be in place and information should be shared with other professionals involved in the care of the vulnerable adult. Where there is doubt or concerns in respect of an individual, then it is important that these are acted upon with immediate effect and that a multi agency strategy meeting is held, so that a risk assessment may be put together to prevent the service user coming to harm. Reporting and record keeping is essential in such cases as is the sharing of information. 3. Recently in Surrey the first quality assurance,multi agency risk management meeting was held, this was a meeting following a safeguarding incident which took place in July last year. It looked at how the different agencies had worked together to safe guard a vulnerable adult from suspected abuse.
Agencies involved , were social care team, police, service provider, housing , g.p’s and specialist nurses. During the period of time prior to this meeting there had been safeguarding meetings on a 6 weekly basis, multi agency risk assessments had been drawn up and had been discussed at length by all of those involved, each member taking part had deadlines to meet on actions raised. When circumstances changed, so did the risk assessments, and always covered were the “ what if “ scenarios. It was felt from this meeting that everything had been done to protect the service user and that all agencies had worked well together ( I was a participant at this meeting )
All vulnerable adults where possible should contribute to decisions made in respect of the care that they receive. Families and professionals involved in the care of a vulnerable adult, should also contribute to the initial risk assessment which are done and subsequent ones when there are changes. It will become apparent whether systems and procedures put in place are working, with constant recording and reporting back from staff involved in the care of the individual. There may be times, when there needs to be a review of the care plans, or changes to it due to changes within the environment, the service user themselves or their circumstances.
This does not always mean that all of those involved get it right all of the time, personally I have been involved in a unsafe hospital discharge, where I challenged the procedures that were in place. Following that there was a senior strategy meeting and it was discussed how we could all move forward together to prevent the type of situation occurring again. The key to getting things right is discussion and not apportioning blame to others, looking at how services can be improved, then implementing them and monitoring them. Feedback is essential from all involved.