Presentation on theme: "Safeguarding adults is everybody’s business."— Presentation transcript:
1Safeguarding adults is everybody’s business. If not you, then who?
2Safeguarding Adults – BMA Toolkit Health professionalsShould be able to identify adults whose physical, psychological or social condition are likely to render them vulnerableShould be able to recognise signs of abuse and neglect, including institutional neglectNeed to familiarise themselves with local procedures and protocols for supporting and protecting vulnerable adults
4Scale of the problemIn there were 1,522 safeguarding adults referrals in Buckinghamshire, 587 went to full assessmentThe majority of people have a GPSerious case reviews nationally and locally almost always demonstrate GP involvementA tiny number of alerts are made by GP practices
5Legislation and guidance Civil LawCriminal LawRegulations/GuidanceMental Health Act 1983Offences against the person Act 1861No Secrets 2000Public Health Act 1984Housing Act 1985Theft Act 1968PACE 1984NHS & Community Care Act 1990Protection from Harassment Act 1997Family Law Act 1996Human Rights Act 1998Data Protection Act 1998Public Interest Disclosure Act 1998Public Order Act 1986 Sexual Offences Act 2003SI 2009/2023 Family Law Act 1996 forced marriages / relevant 3rd partyDomestic Violence Act 2004 (amendment 2012)Mental Health Act 1983s 127Mental Capacity Act 2005Mental Capacity Act 2005 s.44SI 2009/3112 CQC registrationSafeguarding Vulnerable Groups Act 2006Health & Social Care Act 2008Equality Act 2010Fraud Act 2006Manslaughter (common law or corporate homicide Act 2007)SI 2010/781 HSC Act 08 regulated activitiesLegislation and guidance
6Draft Care and Support Bill Most important piece of adult social care legislation in 60 years40 statutes in one piece of legislationNew safeguarding dutiesAdult Safeguarding Boards
7Definitions Vulnerable Adult “Anyone aged 18 or over who is or may be in need of care services by reason of mental or other disability, age or illness; and who is unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation”Significant HarmIll-treatment (includes sexual abuse and forms of ill-treatment that are not physical)impairment of, or an avoidable deterioration in, physical or mental healthImpairment of physical, emotional, social or behavioral developmentAbuse“A violation of an individual’s human and civil rights by any other person or persons”“A single or repeated act or lack of appropriate action occurring in a relationship where there is an expectation of trust which causes harm or distress”
8This includes people who have: a mental health problem(including dementia or memory problems)a physical disability or illnessdrug and alcohol related problemsa sensory impairmenta learning disabilityan acquired brain injuryfrailty or a temporary illness
9What Can Practices Do? Training and awareness Information for patients Asking questionsConsider in reviews e.g. chronic diseaseFollow up non attenders e.g. Repeat prescriptionsCarers policyFlag records of vulnerable adultsDiscuss concerns and significant eventsContribute to meetings
10Practice Checklist Safeguarding adults policy Safeguarding adults lead See the child behind the vulnerable adultHighlight records of vulnerable adultsInformation available for patientsRegular trainingSignificant events reviewed discussedConcerns shared with CCGApplication of Mental Capacity Act to practiceMinimum safety criteria for staff employmentComplaints and whistle-blowing policy
11How can you recognise abuse? There may be a perfectly reasonable rational explanation so ask some open questionsRemember that the carer or accompanying person may be the abuser so may not always give a true reflection of eventsCheck for corroboration from GP, community nurses or care home referral letter, ambulance notes etcLook at the social history, medical history, list of medication, risk assessments and observationsWhen you have a fuller picture are you still worried?
12Types of abuse Physical Sexual Psychological (or emotional) Neglect (or acts of omission)FinancialInstitutionalDiscriminatory or rights abuse(Domestic violence)
13Physical AbuseIs the non-accidental physical mistreatment of one person by another which may or may not result in physical injury. It can be the use of force that results in an unwanted change in a person’s physical state.Physical violence: Hitting, slapping, pushing, kicking, shaking, scalding, dragging, pinching hair-pulling.Rough or inappropriate handling: Careless/rough handling; force-feeding; inappropriate application of physical techniques such as manual handling, restraint or physical intervention; involuntary isolation or confinement.Medical Mistreatment: Misuse of medication; withholding of medication; inappropriate use of medical procedures, such as catheterisation.
14Physical abuse causesinjury, fear, intimidationand sometimes death
15Physical Abuse - possible Indicators Delays in seeking medical attention.Shaped injuriesMultiple old or new injuriesRecords of different visits for treatmentSkin infections/Inconsistent or unexplained injuries (bruises, cuts, burns, blisters, scratches, fractures, sprains)ionsWeight lossMedications withheld or omittedFear/reluctance to be with someoneIncontinenceChanges in behaviour, mood or usual routine, (sleep patterns or eating habits).
16Sexual AbuseIs the direct or indirect involvement in any sexual activity to which a person does not give valid consent or cannot give valid consent.A person cannot give valid consent when they lack capacity to make a decision or if they are coerced into activity because the other person is in a position of authority, trust or power.Non-contact abuse:Indecent exposure, inappropriate looking, photography, harassment, serious teasing or innuendo, pornography.Contact Abuse:Rape or sexual assault, masturbation (of either or both persons), inappropriate touching of breast, genitals, anus, mouth.
17Sexual abuse - possible Indicators Bruising to inner thighs, genital or anal areasPersistent and inappropriate sexual behaviour or pronounced overly affectionate behaviourSTI or unexpected pregnancyTorn or blood stained clothing/beddingLove bitesObsessive behaviour/ Changed behaviourDifficulty sitting/standingBulimia/Anorexia/Self Harm /Self neglect
18Psychological abuseIs the use of threats, humiliation, bullying, other verbal conduct or any other form of mental cruelty that results in mental or physical distress.Emotional abuse is any act which negatively affects the emotional well being of a person or impairs their psychological development.
19Psychological abuse – possible indicators AnxietyLow self esteemDifficulty communicating with vulnerable person or gaining access to visitDeference /submission to the perpetratorSleep disturbanceConfusion
20Financial abuseIs the unauthorised and improper use of funds, property or any resources belonging to an individual.Unauthorised would include the coercion or misleading of an individual, or any lack of informed consent from the individual.
21Financial abusecan lead todeprivation,humiliation andstarvation
22Financial abuse – possible indicators Lack of basic necessities or inability to provide for basic needs (food, rent etc.)Inability to retain control over home lifestyle and/or apparently chaotic lifestyleDenying access to or controlling accountsRemoval of items without consentOverchargingTheft or “borrowing”Unexplained financial activityUnexplained interest in someone
23Neglect Poor personal hygiene or mouth care Malnutrition and / or dehydration and weight lossConstipationHypothermiaInappropriate and / or dirty clothingCategory 3 or 4 pressure ulcersUntreated or delay in seeking treatment for medical problems or falls resulting in injuryIncomplete or inconsistent records of care
24Neglect is degrading and undignified and can endanger life
25Institutional abuse Rituals and routines Confinements Stark environmentsLack of stimulationLack of consultationUse of restraintUse of power/control
26Discriminatory abuseIs the harassment, unfair treatment, exploitation or denial of mainstream opportunities and services to individuals because of their race, religion, culture, gender, age, sexuality or disability.Discrimination can be a motivating factor in other forms of abuse
27Discriminatory abuse – possible indicators Not providing food consistent with a person’s culture or beliefsUse of derogatory names or teasing about differencesLack of appropriate social contactsNot allowing attendance or observance of at religious festivalsLow self esteem, confidence or expressions of low self-worth
28Prevent Prevent is concerned with safeguarding individuals at risk of exposure to extreme ideologies, either throughpersonal contact or via the internetThese ideologies could be international terrorism, theextreme right or left wing, animal rights, environmentalprotest, the IRA etcThe Prevent team provide awareness sessions forprofessionals working with vulnerable young peopleand adults and can be delivered across the ThamesValley at your convenience
30Disclosure What should you do if someone discloses abuse to you? Be calm and do not show shock or disbeliefListen carefully to what is being saidDo not ask detailed or probing questions (investigator will do this)Ensure that any emergency action needed has been taken to ensure the person’s safetyDo not attempt to confront the alleged perpetratorDemonstrate a sympathetic approach by acknowledging regret and concern that what has been reported has happenedConfirm that the information will be treated seriouslyGive them information about the steps that will be takenInform them that they will receive feedback as to the result of the concerns they have raised and from whomGive the person contact details so that they can report any further issues or ask any questions that may ariseEnsure that an appropriate person within your organisation has been notified e.g. Line Manager, Safeguarding Adults Lead
31The safeguarding process - reporting Report the abuseIf in doubt then discuss concerns, better to over report than to say nothingLiaise with Bucks CC &/or Safeguarding LeadCQC?Fill out the SVAB or local alert formfax or as instructedConfirm receipt of faxIf member of staff or line manager suspected of being perpetrator refer direct to Senior ManagerCheck whistleblowing policy?Public Disclosure Act 1998
32The safeguarding process – communicating and helping Ensure persons safety and protectionInform police if criminal act suspectedProtect evidenceWork with adult social careReassureExplain processesConsent and information sharing
33Case One Harry is 78 yrs old and lives alone in a flat His daughter, Elaine, is very worried about him, he has always drank heavily but recently she feels he has worsened. She has seen bottles and rubbish strewn over the flat. Her dad looks very thin and observed injuries to his face she thinks are from falls. He refuses to let her take him to hospital, which was her planHis daughter, upset and anxious, calls Social Services who advise her to phone Harry’s GP Practice and discuss her concerns.What can the Practice do?
34Case TwoPatricia has Dementia, she is in a nursing home and she experiences periods of agitation and confusion that make her management difficult. Patricia refuses to take the Trazodone that has been prescribed so staff ask you to write it up as a covert medication which they will put in to her drink.What are the issues?
35Summary of MCA Principles Presumption of capacity.Unwise decision making.Practicable steps.Best interest.Least restrictive option
36What is Capacity?Mental Capacity is the ability to make a decision e.g.Daily life decisions.Serious or significant decisionsDecisions that may have legal consequences.These decisions must be viewed asTime specificDecision specific
37Decisions that cannot be made DivorceMarriageVotingSexual relationsAdoption
38New Power - Ill treatment or neglect. For those who have care of someone who lacks or is believed to lack capacityAlso if they have LPA, EPA or are COP deputyIf found guilty of willful neglect or ill treatment liable to be imprisoned or fined or bothS.44 Mental capacity Act 2005
39Two Stage Test of Capacity Does the person have an impairment of or a disturbance in the function of their mind or brain?Proceed to stage 2 only if YES to this question.Stage 2Does the impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?A person is deemed unable to make a decision if once given the relevant information they cannotUnderstand itRetain itUse or weigh itCommunicate their decision(p44 MCA Code of Practice)
40Arriving at a decision re capacity Identify the Decision Maker:“The person who is most appropriate to make a particular decision or has the specific authority to make the decisionReasonable belief ( on the balance of probability)Acts or decisions must be made in the person’s best interestsUse a Best Interest checklistEvidence how the decision was arrived at.Record your decision, including date and time
42Example Checklist Is the person likely to regain capacity? Yes/No If yes, is this likely to be in time to make the decision in question? Yes/NoHave all practicable steps been taken to encourage the person to participate in the decision? Yes/NoIf Yes then briefly describe how….……………………………………………………………………………………………………………………………………………………………………………………………Have any statements or wishes of the person been taken in to account? Yes/NoIf practicable and appropriate, have the following views been taken in to account:Anyone named by the person to be consulted? Yes/No/Not ApplicableAnyone engaged in caring for the person? Yes/No/Not ApplicableAny Court Appointed Deputy? Yes/No/Not ApplicableThe Attorney under any Lasting Power of Attorney? Yes/No/Not ApplicableAnyone interested in the welfare of the person? Yes/No/Not applicableIf Yes, name the person consulted………………………………IMCA if no close personsHow is this the least restrictive/harmful option?
43Best InterestsFollowing Best Interests assessment where no consensus can be reached, the Court of Protection must be approached to resolve the issue
44Case StudySelima is a 75 year old lady in a residential care home. She has dementia and she suffers periods of acute confusion and agitation, she also suffers from Asthma. It is October time and Selima is due a Flu vaccination which she refused.What are the issues?What information do you need and from where?What needs to be documented?Who is the decision maker?
45Case Study TwoSarah has complex learning and physical disabilities. She has never been sexually active, at her Annual Health Check should she have a Cervical Smear Test?Issues?Documentation?
46Contact details Adult Social Care Teams Out of hours 0800 9997677 central access team adult social careSVAB Team at County Hall, AylesburyDuty DeskCarelinePolice 101/999
47Discussion and support Tania AtchesonSafeguarding Lead CCG’sVikki GraySafeguarding Manager CCG’sSarah PadyJoint Mental Capacity Act Coordinator
48Thank you Key message from today? Email presentation Change to practice?Further study/training?presentationVisitCollect a Mental Capacity Act card as you leave