SAFEGUARDING ADULTS

1
SAFEGUARDING ADULTS

• Primary Care Teams
• Basic Awareness Training

2
Safeguarding Vulnerable Adults BMA Toolkit

• Health professionals
• Should be able to identify adults whose physical,
  psychological or social condition are likely to
  render them vulnerable
• Should be able to recognise signs of abuse and
  neglect, including institutional neglect
• Need to familiarise themselves with local
  procedures and protocols for supporting and
  protecting vulnerable adults

3
Resources for Primary Care

• Training plan
• Exemplar policy
• Checklist
• Contact details
• Alerts

4
Scale of the problem

• In 2010-11 there were 75,000 safeguarding adults
  referrals which met the threshold for
  investigation in England
• The majority of people have a GP
• Serious case reviews almost always demonstrate GP
  involvement
• A tiny number of alerts are made by GP practices

5
Examples

• Steven Hoskin (Cornwall)
• Fiona Pilkington
• Winterbourne View
• Death by indifference report

6
What do we mean by Safeguarding Adults?

• All the work which enables an adult who is or
  may be eligible for community care services to
  retain independence, well-being and choice, and
  to access their human right to live a life that
  is free from abuse and neglect
• (Safeguarding Adults, ADASS,2005)

7
What do we mean by Vulnerable Adult ?

• Aged over 18
• Who may need care services because of mental
  health issues, physical or learning disability,
  age or illness (elderly frail)
• Who cannot always protect themselves from harm or
  exploitation

8
Factors Increasing Vulnerability

• Frail elderly
• Mental health disorder including dementia and
  personality disorders
• Significant physical or sensory impairment
• Learning disability
• Severe physical illness
• Unpaid carer who is under severe stress or is
  isolated
• Homeless people
• Living with someone with a drug or alcohol
  problem
• Women as a result of isolating cultural factors

9
Categories of Abuse

• Physical
• Sexual
• Psychological
• Financial
• Neglect
• Institutional
• Discriminatory

10
Definition of Abuse

• Abuse is a violation of an individuals human and
  civil rights by any other person or persons (No
  Secrets 2000).
• It may be intentional or unintentional
• It may consist of a single act or repeated acts
• It may cause harm temporarily or over a period of
  time
• May occur in any setting
• People who behave abusively come from all walks
  of life
• It may be acts of omissions

11
Factors to Consider

1. One off event or repeated?
2. The impact on victim and others
3. The impact on others e.g. children and families
4. Intent of alleged perpetrator
5. Illegality of alleged actions
6. Risk of repeat to this victim
7. Risk of repeat to other vulnerable adults or
   children

12
The Jigsaw
13
Doreen

• Doreen mother of a man with mental health and
  alcohol problems
• Discloses that he has hit her recently
• What types of abuse are you concerned about?
• What do you need to know?
• What might be making her vulnerable?
• What might protect her?

14
Responding to allegations or concerns

• Ensure safety
• Take seriously and remain calm
• Preserve evidence
• Avoid leading questions
• Dont confront alleged perpetrator
• Keep records
• Consider who else might have information
• Seek advice

15
Examples of Legislation

• Human Rights Act 1998
• Public Interest Disclosure Act 1998 (Whistle
  Blowing)
• Data Protection Act 1998
• Youth and Criminal Evidence Act 1999
• Sexual Offences Act 2003
• Protection Of Vulnerable Adults (POVA) 2004
• Mental Capacity Act 2005
• Safeguarding Vulnerable Groups Act 2006
• Health and Social Care Act 2008

16
Mental Capacity Act Principles

• Presumption of capacity
• Maximise decision making ability
• Freedom to make unwise decisions
• Best interests
• Less restrictive alternative

17
Assessing Mental Capacity (MCA1 form)

• Is there an impairment of, or disturbance in the
  functioning of the individuals mind or brain?
• Complete assessment
• Understand information
• Retain information
• Weigh up information
• Communicate their decision

18
Decision Making Flowchart
19
How to Refer

• Local Adult Social Services
• Phone
• Follow up with multi-agency alert form
• Option of discussion and seeking advice

20
After referral

• Initial information gathering and safeguarding
  decision (within 24 hours)
• Strategy meeting or discussion (within 5-7 days)
• Allocate responsibilities and agree initial
  protection plan
• Protection plan meeting (within 28 days)
• Review meetings and core group meetings

21
Doreen

• What would you do?

22
What Makes It Difficult to Refer

• Uncertainty as to what constitutes abuse
• Uncertainty as to what will happen
• Concern about impact on relationships
• Lack of consent
• Concerns regarding confidentiality
• Not having the whole picture

23
Record Keeping

• Document concerns and information in medical
  records
• Document information received from other agencies
• Document discussions and decision making e.g.
  assessment of capacity
• Store case conference notes in medical records

24
Prevention

• Training and awareness
• Patient information
• Asking questions
• Consider in reviews e.g. chronic disease
• Follow up non attenders e.g. QOF, repeat
  prescriptions
• Carers policy
• Flag records of vulnerable adults
• Discuss concerns and significant events
• Contribute to meetings

25
Practice Checklist

• Safeguarding adults policy
• Safeguarding adults lead
• Highlight records of vulnerable adults
• QOF exception reporting based on clinical
  decision
• Patient information available
• Regular training
• Significant events discussed
• Concerns shared within PHCT
• Carers policy
• Minimum safety criteria for staff employment
• Complaints and whistle-blowing policy

26
Guidance

• No Secrets DOH Guidance on implementing
  Multi-Agency Policy
• Safeguarding Vulnerable Adults a toolkit for
  General Practitioners. British Medical
  Association
• Safeguarding Adults. The role of health service
  practitioners
• National Competence Framework for Safeguarding
  Adults
• Deciding Right (www.theclinicalnetwork.org)

27
Case Studies

• What type of abuse?
• What makes them vulnerable?
• What would you do?