.Safeguarding Adults Level 1 Protecting adults from abuse and neglect.

Margaret Panting (1923 to 2001) 78yrs Steven Hoskin (1967- 2007) 40 years Steven (st austell)murdered by three people who befriended him – 27 attendances to hospital, GP’s, and minor injuries units. Failure to identify vulnerability, share information and assess decision making process. Suffered hours of abuse. Swallow lethal dose of paracetomol, was walk around on dogs lead, burnt with cigs. Police, health, housing, ASC all missed signs to help. 40 missed opportunities. Margaret Panting (Sheffield) – lived with daughter, son-iurdered. n-law, grandsons. 49 injuries on her body; Razor blade cuts to stomach and chest, fags burns, coroner unable to count the number of bruises on her body during autopsy. Cannot find photo of margaret. Adults need protecting from abuse and neglect.

Care Act 2014 From April 1st 2015. Protecting Adults will be Law. Section 14 of the Act No longer “vulnerable” adults definition. New trust safeguarding adults policy to guide you through the safeguarding part of the act

The safeguarding duties; apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or 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. Why is the word RISK significant? Answer; could be potentially lots of people (huge numbers requiring the safeguarding duty).

Safeguarding (2005) - umbrella term; Empowerment - Presumption of person led decisions and informed consent. Protection - Support and representation for those in greatest need. Prevention - It is better to take action before harm occurs. Proportionality – Proportionate and least intrusive response appropriate to the risk presented. Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability - Accountability and transparency in delivering safeguarding. Term safeguarding has been around since 2005. The DOH of health gave a definition for safeguarding in 2011; to include six principles. Empowerment - = these are adults we need to support them when they feel are vulnerable (in hospital). Empower them. If they have any disability making reasonable adjustments to empower them. To help maximise decision making etc. Protection from abuse – discuss further in next slides. Prevention – (everyday work in hospital) safe discharges, increases in packages of care, CARE – adhering to Trust values. Proportionality- ensuring the adult is at the centre of the admission/discharge. When potentials risks are identified we support the patient with the least intrusive option. Asking them what they want/ how can we reduce the risk together – please remember they are adults. Partnership – this is working with our multi-agency partners like the Council, health partners, housing, advocates. Accountability – to the patient, to out Trust and to the community.

10 Categories of Abuse Physical Abuse Neglect Discrimination Sexual abuse Financial abuse Psychological abuse Organisational abuse *Domestic Abuse *Modern Slavery *Self Neglect When we think about protection; we think about protecting the patient from the above areas. The star categories are new in the Care act.

Self- Neglect Definition: Self-neglect – this covers a wide range of behaviour; neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding that causes a risk of harm. Cases of severe self-neglect require management of the balance between protecting the adult from self-neglect against their right to self-determination is a serious challenge. It is not unusual for people to refuse a particular form of care due to lack of insight into the need for intervention. Examples may be: A person sends away a home care worker who is tasked to do cleaning or prepare a meal. A person is incontinent but is reluctant to wear pads. A person with diabetes refuses their insulin injection. All cases of self-neglect recognised in the acute hospital must be referred to Safeguarding Adults Team. If you identify anyone with signs of self-neglect please alert safeguarding adults team. These can be long and complex cases and need specialist input and referrals for a multi-agency approach.

Responding to a Disclosure; Ask the Adult what they want to happen? Follow the Trust’s safeguarding flowchart. Outcomes could be; Adult protection referral Increase in Package of care Referral to Domestic violence advocate Referral for GP or Community matron to follow up Referral to Adult social care for social worker. Patients can feel safe in hospital and WILL often disclose abuse and neglect. Ask the adult what they want (when possible); I have often seen cases where abuse has been suspected and reported to Council, but no-one has spoken to the adult; the principles are different to Child protection when the patient has capacity, they must be consulted on any referral about adult protection. When the patient doesn’t want a referral and you feel they are at risk please contact the safeguarding team for advice; out of hours contact the site cos. You can also ring social worker out of hours. The Trust flowchart will guide you decide what actions to take. Recognising abuse/neglect is sometimes difficult….Level 2 will help with this. 8 8 8

Level 4 – Adult Protection (abuse and neglect) The Role of the Alerter/Referrer. RECOGNISE /RESPOND/REPORT If necessary call the police (abuse and neglect is a criminal offence). Ensure immediate safety of patient. Preserve forensic evidence Speak with your line manager – inform the patient – contact Trust’s safeguarding adults team. Hand write a report Sometimes difficult to recognise abuse; please listen to your instincts if something doesn’t feel right; contact the safeguarding adults team to discuss if at weekend your line manager or site co’s. It is important to discuss your concerns with the adult. If the adult has capacity to understand the concerns you must speak to them. Adult Protection must involve the adult and they must be at the centre of any referral to the Council to investigate Adult Protection. If the patient lacks capacity (and you are unable to seek permission for a referral) when possible please speak with family (but be cautious if they are the alleged perpetrator). 9 9

Organisational Abuse Mid Staffordshire hospital – public enquiry into the abuse at an acute general hospital. There was a failure; Focus on quality Failure to listen to patients Failure of the role of the regulator. In our safeguarding role we have 2 responsibilities. 1. Support the person if we there is abuse and neglect and 2. preventing harm to the patient from our own organisation. Robert Francis lead public enquiry into the abuse of patient at the acute hospital in mid staffs. Patient’s were drinking water from flowers vases. 10 10 10

Organisational Abuse continued Mid Staffordshire hospital – public enquiry of the abuse in the acute general hospital. Although, no specific reference to safeguarding; safeguards have been instigated to prevent another mid staffs. Francis emphasises the importance of Candour, Openness and Transparency for hospitals. Focus on listening to patients. CQC have improved their inspections, so there is focus on Quality. Raising Awareness in the Public Interest policy. Raising awareness in the public interest; if the inspections and candour are not working consider the raising awareness in public interest policy (on the document library. 11 11 11

Safeguarding Adult Named Nurse Zoe Cooper – 01872 252446 - Bleep 3048 Monday to Friday. Site coordinators offer out of office advice, along with your line managers.

Email. Learning.disabilities@cornwall.nhs.uk Learning Disabilities and Autism Acute Liaison Nurses for Learning Disabilities and / or Autism. Daniella Rubio-Mayer 07827 903729 Bleep 3054 Tristan Coombe 07827 903729 Bleep 3095 Jane Rees 07765 221848 Bleep 3053 All patients with a Learning Disability or Autism must be referred to the Team. They safeguard patients in hospital – thinking about the definition of safeguarding, the empower the patient by making reasonable adjustments to care. Appointments, easy read information, enhancing communication. Email. Learning.disabilities@cornwall.nhs.uk For Out of hours leave referrals on answer phone the clinical site co-ordinators.

Mental Health and Mental Capacity For support, advice and information with regards to patients with a diagnosed or suspected mental illness or concerns with regard to a patients mental capacity contact: Lerryn Hogg - Specialist Nurse for Mental Health and Wellbeing and Mental Capacity Via: Ext 2446 or Mobile 07789 876247 Lerryn.hogg@rcht.cornwall.nhs.uk Lerryn Hogg, specialist nurse for mental health and wellbeing – also trust lead for Mental Capacity. Based in the Safeguarding adults team and available 8 – 4, 4 days per week (not available on Wednesdays). When Lerryn is unavailable contact Zoe McLean, psychiatric liaison (for mental health concerns only) or the clinical site-coordinators. For deliberate self harm, mental health assessments or urgent mental health concerns contact the Psychiatric Liaison Team via: Bodmin Hospital Switchboard Ext 1300 For out of hours support contact the Clinical Site Co-ordinators via Switchboard.

Domestic Abuse Any incident or pattern of incidents of controlling coercive or threatening behaviour, violence or abuse between those ages 16 or over who are or have been intimate partners of family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse: Psychological Sexual Physical Financial Emotional

Independent Domestic Violence Advocate (IDVA) The IDVA is based at RCHT in the safeguarding adults team Anna Onslow - 07435 752497 Out of Hours leave a message or contact REACH on: 03007774777 IDVAs-Independent Domestic Violence Advocates- based on the Treliske Site working primarily in the Emergency Department and Maternity Services but happy to take referrals for patients and any staff member who may be subjected to Domestic Abuse There names are: Anna Onslow They are available and on-site 9am-5pm Monday to Friday & are contactable via their mobiles through RCHT Switchboard Out of hours messages can be left for either of their mobiles via switchboard and they will respond ASAP