Outcome Focused Safeguarding in a Statutory Framework

The trouble with Adult Safeguarding Absence of Legislative Framework to define the Local Authorities duties and the responsibilities of others to safeguard adults. Lack of clarity between what constitutes poor practice, poor quality and examples of abuse and neglect. The lack of any evidence to consistently evidence what responses worked well and in what situations. Process driven responses concerned with who did it and at the expense of the individuals desired outcomes

Key Safeguarding duties Care Act 2014 The Local Authority has an overriding duty to ensure the wellbeing of the adult is at the heart of all interventions – prevention of abuse of neglect is a central aspect of well being. The S42 safeguarding duty (which cannot be delegated) to undertake an enquiry, or cause one to occur applies to an adult who: Has care and support needs (whether or not the Local Authority is meeting any of those needs); Is experiencing, or is at risk of, abuse and neglect; and As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

Key Safeguarding duties Care Act 2014 In its lead coordinating role the Local Authority should assure itself that any enquiry undertaken by itself, or any enquiry it has caused to occur satisfies its duty under S42 so as to determine what action is necessary to safeguard and protect the adult. This should include: Details of the concern / who raised it Views and wishes of the adult from the beginning and throughout Immediate actions agreed with the adult or representative Record of all actions and decisions including timeframes Who else was consulted Sign of from line manager and the relevant Local Authority Manager The desired outcomes of the individual will be a key requirement to ensure person centred safeguarding responses are effectively embedded.

Key Safeguarding duties Care Act 2014 S42 is not a substitute for: Providers responsibilities to provide safe and high quality care and support services Commissioners regularly assuring themselves of the safety and effectiveness of commissioned services CQC ensuring regulated providers comply with fundamental standards of care, or taking enforcement action The Local Authority has safeguarding responsibilities in respect of carers, but S42 will not generally apply.

Key Safeguarding duties Care Act 2014 The Care Act places a duty on all agencies to work together to prevent and respond to situation of abuse or neglect. If partners fail to supply relevant safeguarding information as part of this process the Safeguarding Adults Board will be asked to consider the use of its duty to request this information. The Mental Capacity Act places a duty on organisations to ensure people are supported to maintain independence, choice and control. The Local Authority must make arrangements for the provision of an independent advocate where it has determined the adult experiences substantial difficulties participating in the safeguarding process / safeguarding adults review.

What constitutes abuse and Neglect There is no general definition of abuse included in the Care Act 2014 Statutory guidance, so as not to limit thinking in this area. However, financial abuse is outlined in the Act. Common examples include Physical abuse Domestic abuse (new category and new definition) Sexual abuse Psychological abuse Financial or material abuse Modern Slavery (includes human trafficking) Discriminatory abuse Organisational abuse Neglect and acts of omission Self Neglect (new category)

Group exercise In you groups consider the new categories of Domestic Violence or Self Neglect and reflect on: Challenges with recognising and responding effectively? Any examples of how you currently support people in a positive manner?

Poor Care or Safeguarding The aim of all commissioners and providers of care and support service should be to deliver effective, high quality and safe support for everyone. When this does not happen safeguarding referrals increase due to concerns that people are at risk. There is evidence to support some issues are inappropriately raised as safeguarding - falls, pressures sores, wrongly administered medication, poor nutritional care, etc, all of which have the potential to cause harm (some will be legitimately raised as a safeguarding concern) The challenge is to differentiate between issues arising from poor care, poor quality and acts / omissions that need to be considered as a S42 safeguarding enquiry. To ensure appropriate actions are taken by providers, commissioners, safeguarding, the police, CQC.

Making Safeguarding Personal Outcome focused safeguarding requires a fundamental shift in custom and practice and is not “business as usual”. All agencies will need to evidence that the person’s wishes and feelings are central to the development of outcomes Outcomes should balance the need for safety with the person’s views on quality of life. This will require a robust risk enablement culture that supports individuals to meet their outcomes, whilst ensuring the statutory organisations are not unnecessarily exposed to risks associated with unsafe safeguarding adults practice.

Making Safeguarding Personal Taking a more creative approach to safeguarding situations is likely to lead to more sustainable and cost effective responses that enhance quality of life. It requires a range of responses that supports people to think through their desired outcomes and the purpose of the safeguarding intervention Person centred responses should consider how people will be supported to recover from their experience of abuse or neglect. Addressing this at the start, and throughout, the process will ensure a greater focus on the person at the centre, and make it easier to determine the difference that has been made.

Local Policies and Procedures West Midlands Procedures have been updated and are on Walsall’s Safeguarding Adults Board Website, which is accompanied by a detailed briefing note for staff. Safeguarding responses underpinned by three key distinct stages: Safeguarding concern Safeguarding enquiry Safeguarding plan

Raising a safeguarding concern Section 8 of the West Midlands Policy and Procedures outlines the expectations of Walsall Safeguarding Adults Board in respect of raising concerns If abuse or neglect occurs within a service such as a care home, home care agency, day care centre, etc the first responsibility to act lies with the employing agency. They must – undertake their own initial enquiry unless their is a compelling reason not to do so / raise a safeguarding concern with the Local Authority and CCG if they are the commissioners / inform CQC (as required) / and take immediate action to safeguard the adult. The persons well being, wishes and feelings must inform and underpin all actions of the provider responses.

Raising a safeguarding concern Some points to consider (please refer to Chapter 8 of West Midlands Procedures For further information) What immediate actions are needed to safeguard the person? Is it safe to speak to the person to gain their views and desire outcomes? How do I support the person to understand all the available options for responding to the concerns? Is anyone else at risk? Who do I need to inform about the concerns? Establishing the facts but not undertaking your own enquiries? What do I need to do if the issue involves a staff member, including my own manager? What do I do if I am concerned but the person does not want me to tell anyone?

Raising a safeguarding concern People with mental capacity can make decisions that others consider unwise or not in their best interests. This includes when a person decides to accept a situation you consider to be abusive or neglectful. People are free to make these decisions unless: The adult lacks the mental capacity to provide consent There is an impact on the persons vital interests There is an overdoing public interest due to others being at risk Staff are implicated A serious crime has occurred Coercion is involved

Objectives & Scope of a safeguarding adults enquiry Protect the adult from abuse and, or neglect in accordance with their views and wishes (or their advocate) about the level of risk. Providing individual with information about options for resolution Establish the facts Assess the level of risk, the impact on the individual and their needs for care and support, including how to meet their outcomes. The ability of the individual to safeguard themselves or the ability of their informal networks to increase the support they offer to safeguard the person (asset based).

Objectives & Scope of a safeguarding adults enquiry Make decisions about what follow up actions should take place with regards to the person or organisation causing harm The potential impact on important relationships and the potential that action could increase the risk of harm Risk of repeated / increasingly serious acts including risks to others (adults /children) Supporting the adult to identify and manage risks their own risks Enable the adult to achieve resolution and recovery

What happens after the enquiry? The Local Authority must consider if additional enquiries are needed The Local Authority must establish what action is necessary as a result of the enquiry If the Local believes no action is needed this will be end of the safeguarding process. If the Local Authority believes action must be taken it is under a duty to produce a safeguarding plan.

Safeguarding plans Where possible safeguarding plans must be agreed with the adult who is subject to the safeguarding concern This will ensure current and ongoing safety considerations are balanced with the individual’s views on quality of life, their rights and civil liberties The potential for undue influence will need to be considered, and if the adult is thought to be refusing intervention on the grounds of undue influence, action must be taken The Safeguarding plan should consider what action is acceptable to the adult

Safeguarding plans Steps being taken to assure current and future safety Provision of any support, treatment or therapy in response to the concern – including any modifications to the way in which services are provided How best to support the adult through any action they take to seek justice or redress Any ongoing risk management strategies Any action that needs to be taken in response to the person or organisation that has caused harm

The Role of the Designated Adult Safeguarding Manager The Care Act 2014 statutory guidance introduced the role of the designated safeguarding adults manager - LA, CCG and Police are required to have one in place. This individual will be operationally responsible for management oversight of complex investigations in their organisation and for ensuring any process involving staff members is managed in a timely and fair manner – commonly referred to as people in positions of trust When abuse or neglect occurs within professional relationships the codes of professional conduct and / or employment contracts should be followed to determine action to be taken – including referral to the professional regulatory body This role is subject to ongoing National engagement and consultation

When the Person alleged to be responsible for abuse and neglect is an adult with care and support needs When the alleged abuse is by an adult with care and support needs the Local Authority has a number of additional duties which includes: A duty to undertake a S9 needs assessment If the abuse or neglect is being considered under a criminal investigation the adult must be informed of their right to support from an appropriate adult. If the adult lacks mental capacity to understand the consequences of their actions they are entitled to support from an IMCA

Criminal investigations The Police and CPS should agree procedures with the Local Authority, NHS, CCG and other relevant partners This will ensure partners understand the primacy of any criminal investigations It will set out the Local Authorities general duty to promote an individuals well being during the criminal investigation It will also set out the actions that can be taken during a criminal investigation and following its conclusion As criminal investigations must satisfy the test of “beyond reasonable doubt” the Local Authority must consider if additional enquiries are required if the police investigation does not satisfy this burden of proof

Disciplinary action following safeguarding concerns If the safeguarding enquiry requires an organisation to undertake its own disciplinary process the burden of proof is generally on the “balance of probabilities” Criminal investigations which conclude without action being taken does not automatically mean that regulatory or disciplinary action should not be considered or taken The standard of proof for discretionary barring consideration by the DBS is usually the balance of probabilities. There remains a legal duty to make a safeguarding referral to the DBS if the person is dismissed, leaves during the disciplinary process, or is removed from their regulated role to one that includes non regulated activity, due to harm to an adult or child

Making this happen / Next steps What needs to be developed and implemented in order to support you to be compliant with the Care Act and Making Safeguarding Personal? What mechanisms currently exist / works well and can be used to evidence compliance with the Care Act 2014 and Making Safeguarding Personal? What support do staff need to embed an effective positive risk management culture?