Presentation on theme: "Safeguarding adults is everybody’s business. If not you, then who?"— Presentation transcript:
Safeguarding adults is everybody’s business. If not you, then who?
Safeguarding 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
Do you know about these cases?
Scale of the problem In there were 1,522 safeguarding adults referrals in Buckinghamshire, 587 went to full assessment The majority of people have a GP Serious case reviews nationally and locally almost always demonstrate GP involvement A tiny number of alerts are made by GP practices
Legislation and guidance Civil LawCriminal LawRegulations/Guidance Mental Health Act 1983Offences against the person Act 1861 No Secrets 2000 Public Health Act 1984 Housing Act 1985 Theft Act 1968 PACE 1984 NHS & Community Care Act 1990Protection from Harassment Act 1997 Family Law Act 1996 Human Rights Act 1998 Data Protection Act 1998 Public Interest Disclosure Act 1998 Public Order Act 1986 Sexual Offences Act 2003 SI 2009/2023 Family Law Act 1996 forced marriages / relevant 3 rd party Domestic Violence Act 2004 (amendment 2012) Mental Health Act 1983s 127 Mental Capacity Act 2005Mental Capacity Act 2005 s.44 SI 2009/3112 CQC registration Safeguarding Vulnerable Groups Act 2006 Health & Social Care Act 2008 Equality Act 2010 Fraud Act 2006 Manslaughter (common law or corporate homicide Act 2007) SI 2010/781 HSC Act 08 regulated activities
Draft Care and Support Bill Most important piece of adult social care legislation in 60 years 40 statutes in one piece of legislation New safeguarding duties Adult Safeguarding Boards
Definitions 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 Harm Ill-treatment (includes sexual abuse and forms of ill-treatment that are not physical) impairment of, or an avoidable deterioration in, physical or mental health Impairment of physical, emotional, social or behavioral development Abuse “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”
This includes people who have: a mental health problem (including dementia or memory problems) a physical disability or illness drug and alcohol related problems a sensory impairment a learning disability an acquired brain injury frailty or a temporary illness
What Can Practices Do? Training and awareness Information for patients Asking questions Consider in reviews e.g. chronic disease Follow up non attenders e.g. Repeat prescriptions Carers policy Flag records of vulnerable adults Discuss concerns and significant events Contribute to meetings
Practice Checklist Safeguarding adults policy Safeguarding adults lead See the child behind the vulnerable adult Highlight records of vulnerable adults Information available for patients Regular training Significant events reviewed discussed Concerns shared with CCG Application of Mental Capacity Act to practice Minimum safety criteria for staff employment Complaints and whistle-blowing policy
How can you recognise abuse? There may be a perfectly reasonable rational explanation so ask some open questions Remember that the carer or accompanying person may be the abuser so may not always give a true reflection of events Check for corroboration from GP, community nurses or care home referral letter, ambulance notes etc Look at the social history, medical history, list of medication, risk assessments and observations When you have a fuller picture are you still worried?
Types of abuse Physical Sexual Psychological (or emotional) Neglect (or acts of omission) Financial Institutional Discriminatory or rights abuse (Domestic violence)
Physical Abuse Is 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.
Physical abuse causes injury, fear, intimidation and sometimes death
Physical Abuse - possible Indicators Delays in seeking medical attention. Shaped injuries Multiple old or new injuries Records of different visits for treatment Skin infections/Inconsistent or unexplained injuries (bruises, cuts, burns, blisters, scratches, fractures, sprains) ions Weight loss Medications withheld or omitted Fear/reluctance to be with someone Incontinence Changes in behaviour, mood or usual routine, (sleep patterns or eating habits).
Sexual Abuse Is 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.
Sexual abuse - possible Indicators Bruising to inner thighs, genital or anal areas Persistent and inappropriate sexual behaviour or pronounced overly affectionate behaviour STI or unexpected pregnancy Torn or blood stained clothing/bedding Love bites Obsessive behaviour/ Changed behaviour Difficulty sitting/standing Bulimia/Anorexia/Self Harm /Self neglect
Psychological abuse Is 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.
Psychological abuse – possible indicators Anxiety Low self esteem Difficulty communicating with vulnerable person or gaining access to visit Deference /submission to the perpetrator Sleep disturbance Confusion
Financial abuse Is 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.
Financial abuse can lead to deprivation, humiliation and starvation
Financial 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 lifestyle Denying access to or controlling accounts Removal of items without consent Overcharging Theft or “borrowing” Unexplained financial activity Unexplained interest in someone
Neglect Poor personal hygiene or mouth care Malnutrition and / or dehydration and weight loss Constipation Hypothermia Inappropriate and / or dirty clothing Category 3 or 4 pressure ulcers Untreated or delay in seeking treatment for medical problems or falls resulting in injury Incomplete or inconsistent records of care
Neglect is degrading and undignified and can endanger life
Institutional abuse Rituals and routines Confinements Stark environments Lack of stimulation Lack of consultation Use of restraint Use of power/control
Discriminatory abuse Is 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
Discriminatory abuse – possible indicators Not providing food consistent with a person’s culture or beliefs Use of derogatory names or teasing about differences Lack of appropriate social contacts Not allowing attendance or observance of at religious festivals Low self esteem, confidence or expressions of low self-worth
Prevent Prevent is concerned with safeguarding individuals at risk of exposure to extreme ideologies, either through personal contact or via the internet These ideologies could be international terrorism, the extreme right or left wing, animal rights, environmental protest, the IRA etc The Prevent team provide awareness sessions for professionals working with vulnerable young people and adults and can be delivered across the Thames Valley at your convenience
Disclosure What should you do if someone discloses abuse to you? Be calm and do not show shock or disbelief Listen carefully to what is being said Do not ask detailed or probing questions (investigator will do this) Ensure that any emergency action needed has been taken to ensure the person’s safety Do not attempt to confront the alleged perpetrator Demonstrate a sympathetic approach by acknowledging regret and concern that what has been reported has happened Confirm that the information will be treated seriously Give them information about the steps that will be taken Inform them that they will receive feedback as to the result of the concerns they have raised and from whom Give the person contact details so that they can report any further issues or ask any questions that may arise Ensure that an appropriate person within your organisation has been notified e.g. Line Manager, Safeguarding Adults Lead
The safeguarding process - reporting Report the abuse –If in doubt then discuss concerns, better to over report than to say nothing –Liaise with Bucks CC &/or Safeguarding Lead –CQC? Fill out the SVAB or local alert form –fax or as instructed –Confirm receipt of fax If member of staff or line manager suspected of being perpetrator refer direct to Senior Manager –Check whistleblowing policy? –Public Disclosure Act 1998
The safeguarding process – communicating and helping Ensure persons safety and protection –Inform police if criminal act suspected –Protect evidence –Work with adult social care Reassure Explain processes Consent and information sharing
Case 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 plan His 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?
Case Two Patricia 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?
Summary of MCA Principles Presumption of capacity. Unwise decision making. Practicable steps. Best interest. Least restrictive option
What is Capacity? Mental Capacity is the ability to make a decision e.g. Daily life decisions. Serious or significant decisions Decisions that may have legal consequences. These decisions must be viewed as Time specific Decision specific
Decisions that cannot be made Divorce Marriage Voting Sexual relations Adoption
New Power - Ill treatment or neglect. For those who have care of someone who lacks or is believed to lack capacity Also if they have LPA, EPA or are COP deputy If found guilty of willful neglect or ill treatment liable to be imprisoned or fined or both S.44 Mental capacity Act 2005
Two Stage Test of Capacity Stage 1 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 2 Does 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 cannot Understand it Retain it Use or weigh it Communicate their decision (p44 MCA Code of Practice)
Arriving 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 decision Reasonable belief ( on the balance of probability) Acts or decisions must be made in the person’s best interests Use a Best Interest checklist Evidence how the decision was arrived at. Record your decision, including date and time
Example 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/No Have all practicable steps been taken to encourage the person to participate in the decision? Yes/No If Yes then briefly describe how….……………………………………………………………………………………………………………………… …………………………………………………………………… Have any statements or wishes of the person been taken in to account? Yes/No If practicable and appropriate, have the following views been taken in to account: Anyone named by the person to be consulted? Yes/No/Not Applicable Anyone engaged in caring for the person? Yes/No/Not Applicable Any Court Appointed Deputy? Yes/No/Not Applicable The Attorney under any Lasting Power of Attorney? Yes/No/Not Applicable Anyone interested in the welfare of the person? Yes/No/Not applicable If Yes, name the person consulted……………………………… IMCA if no close persons How is this the least restrictive/harmful option?
Best Interests Following Best Interests assessment where no consensus can be reached, the Court of Protection must be approached to resolve the issue
Case Study Selima 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?
Case Study Two Sarah 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?
Adult Social Care Teams Out of hours central access team adult social care SVAB Team at County Hall, Aylesbury Duty Desk Careline Police 101/999 Contact details
Discussion and support Tania Atcheson Safeguarding Lead CCG’s Vikki Gray Safeguarding Manager CCG’s Sarah Pady Joint Mental Capacity Act Coordinator
Thank you Key message from today? Change to practice? Further study/training? presentation Visit Collect a Mental Capacity Act card as you leave