1. 1 Whose Business Is It?

2. 2 Housekeeping

3. 3 Ground Rules Share experiences and views Recognise the sensitive nature of the subject matter Listen and respect what others have to say Note differing views as these may add to your knowledge Promote anti-oppressive practice Respect confidentiality unless it is necessary to address a current concern about the safety/risks to a vulnerable adult, if you do, talk this through with the trainer or a relevant person on the course Explain any jargon

4. 4 Session 1 Introduction

5. 5 A National Perspective There were 136,000 safeguarding alerts reported by 121 councils in the 2011-12 reporting year, an increase of 44 per cent (41,000 alerts) compared to the previous reporting year The 121 councils who provided information on both alerts and referrals, 60 per cent of the total alerts reported met the safeguarding threshold and instigated a referral 62 per cent (66,000 referrals) related to individuals who were already known A total of 16,900 referrals were recorded as repeat referrals Health and Social Care Information Centre (2013), Final Report, Experimental Statistics March 2011-2012 https://nascis.ic.nhs.uk/

6. 6 A National Perspective cont… The most common type of alleged abuse is physical, which accounts for 29 per cent of the total types of abuse reported. This is followed by neglect, accounting for 26 per cent of the abuse reported 19 per cent of the instances reported were about financial abuse, 16 per cent were related to emotional or psychological abuse and sexual abuse accounted for 5 per cent. Institutional and discriminatory abuse accounted for 4 per cent and 1 per cent respectively of all types of abuse reported Health and Social Care Information Centre (2013), Final Report, Experimental Statistics March 2011-2012 https://nascis.ic.nhs.uk/

7. 7 A National Perspective cont… Referrals by client group: Physical disability 63,955 Mental health 32,580 Learning disability 26,570 Substance misuse 1, 750 Other vulnerable people 8,540 Health and Social Care Information Centre (2013), Final Report, Experimental Statistics March 2011-2012 https://nascis.ic.nhs.uk/

8. 8 Hampshire Figures 2012/13 Number of referrals: 2516 - an increase from 2145 in 2011/12 Overall referrals increased by a similar percentage in the 18-64 age group (17.4%) and the 65+ age group (17.2%). Mental health referrals rose to 18% from 13% in 2011/12 Most common types of abuse were neglect 34%, physical abuse 30%, followed by financial and material 17%, psychological 9%, sexual 5% Sources of referral: social care 38%, health care 17%, self/friend/relative/neighbour 9%, police 6%, housing 1% Location of abuse: residential or nursing home 46%, own home 33% Hampshire County Council 2012/13 Abuse of Vulnerable Adults (AVA) Initial Report, 10 th September 2013.

9. 9 Safeguarding Adults ‘Safeguarding Adults’ is a term used to mean all work which enables an adult to retain independence, wellbeing and choice and live a life that is free from abuse and neglect. The Association of Directors of Adult Social Services (ADASS), Safeguarding Adults October 2005 www.adass.org.uk

10. 10 Who Is In Need of Safeguarding Services? A Vulnerable adult is: ‘ ‘ A person aged 18 years or over, who is, or may be in need of community care services by reason of mental or other disability, age or illness’ AND Who ‘is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’. No Secrets 2000 para 2.3

11. 11 Who Is In Need of Safeguarding Services? cont… Adult at Risk: The Law Commission’s review of Adult Social Care Legislation (2011) proposes revised definition for consultation based on: Adults at risk should be those who appear to: (1)have health or social care needs; including carers (irrespective of whether or not those needs are being met by services); (2) be at risk of harm; and (3) be unable to safeguard themselves as a result of their health or social care needs. In addition, the statute should provide that the duty to investigate should apply only in cases where the Local Authority believes it necessary. The Law Commission (LAW COM No 326), 10 May 2011, Adult Social Care, p120

12. 12 Safeguarding Children The revised statutory guidance Working Together to Safeguard Children (2013), clarifies the core legal requirements, making it clearer what individuals and organisations should do to keep children safe and promote their welfare. It strengthens the focus away from processes and onto the needs of the child. Retrieved from: http://www.education.gov.uk/childrenandyoungpeople/safeguardingchildren/protection/a 00210235/consultation

13. 13 Government Policy Key Principles of Safeguarding 1. Empowerment - Presumption of person led decisions and consent 2. Protection -Support and representation for those in greatest need 3. Prevention – it is better to take action before harm occurs 4. Proportionality – Proportionate and least intrusive response appropriate to the risk presented 5. Partnerships - Local solutions through services working with their communities 6. Accountability - Accountability and transparency in delivering safeguarding Retrieved from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndG uidance/DH

14. 14 Disclosure and Barring Service The DBS was established under the Protection of Freedoms Act 2012 which amends the Safeguarding Vulnerable Groups Act 2006 Merges the functions previously carried out by the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA) The primary role of the Disclosure and Barring Service (DBS) is to help employers make safer recruitment decisions A new test for regulated activity has been introduced

15. 15 Session 2 Rights and Responsibilities

16. 16 What is the Mental Capacity Act 2005? A statutory framework to empower and protect people who are not able to make their own decisions Helps anyone over the age of 16, living in England and Wales, who lack capacity to make a decision for themselves Puts the needs and wishes of a person who lacks capacity at the centre of any decision making process

17. 17 What is the Mental Capacity Act 2005? cont... Makes it clear who can take decisions, in which situations, and how they should go about this Enables people to plan ahead for a time when they may lose capacity Introduces new safeguards for people who lack capacity A Code of Practice

18. 18 Whose Work is Affected by the Mental Capacity Act? YOU ARE ALL LEGALLY REQUIRED TO HAVE REGARD TO THE CODE OF PRACTICE People working in a professional capacity People who are paid to care or support adults in any setting Anyone with a Lasting Power of Attorney Anyone who is a deputy appointed by the Court of Protection Anyone acting as an Independent Mental Capacity Advocate (IMCA) Anyone carrying out research with people who lack capacity Anyone being paid for acts for, or in relation to, a person who lacks capacity GENERALLY anyone who looks after or cares for someone who lacks capacity

19. Principles of The Act 1.Assume a person has capacity unless proved otherwise 2.Do not treat people as incapable of making a decision unless you have tried all practicable steps to help them 3.Do not treat someone as incapable of making a decision because their decision may seem unwise 4.Do things for, and take decisions for, people without capacity in their best interests 5.Before doing something to someone or making a decision on their behalf, consider whether you could achieve the outcome in a less restrictive way 19

20. 20 What is Mental Capacity? Mental capacity is the ability to make a decision, by: Understanding the information you are given Retaining the information long enough to enable you to make the decision Weighing up the information Communicating your decision

21. 21 Best Interests Checklist 1. Do whatever possible to encourage the person to take part 2. Identify the things that you think the person would want you to take into consideration 3. Take into account the person’s past wishes, values, religious and cultural beliefs and feelings 4. Do Not make assumptions about what someone wants because of their age, condition, race, culture or behaviour 5. Consider whether the decision has to be made now or could it wait until the person is more able to make it 6. Consult other people (if it is appropriate to do so) to get more information about the person’s wishes, feelings, beliefs and values. This may involve family, friends, anyone engaged in caring for the person There are full details in the MCA Code of Practice p65 and 66.

22. 22 The MCA and Safeguarding Adults Good practice in applying the principles of the MCA is also: Good Safeguarding Practice

23. 23 Deprivation of Liberty Safeguards (DOLS) DOLS were added to the MCA in 2008 to safeguard some of the most vulnerable people in our society, to ensure that any decision taken to deprive someone of their liberty is only made following defined processes and consultation. The safeguards apply to people aged 18 and over.

24. 24 Agency responsibilities ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response ‘No Secrets’ DH 2000 Adult Services have a responsibility, in partnership with other agencies, to co- ordinate safeguarding responses ‘No Secrets’ DH 2000

25. 25 All agencies Have the responsibility to: ALWAYS involve service users in decision making Promote the safety of service users Promote the awareness of abuse Assure staff and service users they will be listened to Ensure staff are aware of reporting procedures Take appropriate action where abuse is suspected Call emergency services where there is immediate danger Provide training Work alongside other professionals Keep records Commission/provide safe services

26. 26 Safeguarding Responses Should… Nothing about me without me Promote my independence Ascertain my views Keep me informed Support me in making informed choices Collaborate with others to promote my rights and keep me safe Enable me to improve my life chances Enable me to reduce my isolation Support me if I have been abused Enable me to develop new skills Protect me from significant harm Make decisions in my best interest if I lack capacity Provide me with advocacy Enable me to learn from experience Make use of opportunities

27. 27 Session 3 Recognising Abuse

28. 28 Defining Abuse Abuse is the violation of a person’s human and civil rights by any other person or persons Abuse is the harming of another individual usually by someone in a position of power, trust or authority over that individual The harm may be physical, psychological or emotional or may be directed at exploiting the vulnerability of the victim in more subtle ways The threat or use of punishment is also a form of Abuse Abuse may happen as a “one-off” or it may become a regular feature of a relationship Other people may be unaware that Abuse happening and for this reason it may be difficult to detect In many cases Abuse is also a criminal offence No Secrets DH (2000)

29. 29 Types of Abuse Physical Psychological/Emotional Financial or Material Sexual Neglect and Acts of Omission Discriminatory

30. Context in which abuse might take place Institutional abuse Domestic abuse Abuse of trust Hate crime Mate crime Honour based violence Forced marriage Female genital mutilation Human trafficking Exploitation by radicalisers who promote violence Carers at risk of harm; carers who cause harm Safeguarding concerns between persons at risk Prisons Personal budgets, direct payments and self-directed care 30

31. 31 Who Abuses? It can be any of us Relatives/Friends Other service users Neighbours Paid carers Professionals Strangers

32. 32 Where Does Abuse Occur? In the person’s own home In the community In nursing, residential or day care services Hospitals Prisons It can happen anywhere

33. 33 Indicators of Abuse It is unlikely that any one indicator alone will conclusively prove abuse has taken place People will often experience more than one type of abuse Staff should be alert to patterns and clusters of indicators which may raise suspicions It is vitally important to report any concern/s Any report should be taken seriously Many of the indicators will feature similar elements in a number of different types of abuse e.g. Institutional abuse

34. 34 Hate Crimes and Incidents A Hate Incident is defined as: Any incident, which may or may not constitute a criminal offence, which is perceived by the victim or any other person, as being motivated by prejudice or hate A Hate Crime is defined as: Any hate incident, which constitutes a criminal offence, perceived by the victim or any other person, as being motivated by prejudice or hate

35. 35 Mate Crime Mate Crime is a newly recognised form of abuse which presents a risk to adults who may be vulnerable to being manipulated and exploited. Often the exploitation is financial but it can also be sexual, physical or emotional; the exploitation may be a crime.

36. 36 Institutional Abuse Routines and regimes Lack of choice and consultation Poor quality environment The service revolves around the staff Low staff morale Lack of staff training Lack of personal belongings No evidence of effective policies and procedures

37. 37 Abuse of Children Children and young people may be abused in a family or in an institutional or community setting; by those known to them or, more rarely, by a stranger All abuse and neglect are forms of maltreatment – a person may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm

38. 38 Session 4 Responding

39. 39 Responding All allegations/disclosures must be treated seriously The safety of the person is paramount Stay calm, listen and reassure Demonstrate a sensitive approach Be aware of the possibility of the existence of forensic evidence Explain the you are required to share that information with your manager but not with other staff or any other service users

40. 40 Responding cont… Reassure the person that any further response will be taken sensitively and with their full involvement, whenever possible Reassure the person that the service will take steps to support and where possible, protect them in the future REPORT MAKE A WRITTEN RECORD

41. 41 Session 5 Reporting

42. 42 ‘No Secrets’ (2000) ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response ALL KINDS OF ABUSE HARM THE INDIVIDUAL – WE MUST NOT IGNORE IT

43. 43 Confidentiality A person’s right to confidentiality is not absolute and may be overridden where there is evidence that sharing information is necessary in exceptional cases to prevent: Serious crime Danger to a person’s life Danger to others Danger to the community Danger to the health of the person IF IN DOUBT ALWAYS REPORT - in line with your organisation’s policy

44. 44 Enablers To Reporting Service users awareness of what to expect from staff and the service Knowing how to recognise indicators of abuse Open organisational culture Staff training Staff support

45. 45 Enablers To Reporting cont... Accessible complaints procedures Supervision and staff appraisal Effective management role modelling of good practice Good working relationships with professionals, families and carers

46. 46 Barriers to Reporting Failure to recognise the abuse Will not be believed Fear of reprisals Fear of ‘heavy handed’ responses Breaching confidentiality Not sure if concerns are valid Lack of clarity about reporting procedures

47. 47 Barriers To Reporting cont... Impact on relationships with colleagues/service users/families A workplace culture of non reporting Increased tolerance levels (accepting certain behaviours)

48. 48 Whistleblowing There are times when staff feel that their concerns about abuse have not been taken seriously, or when they have felt that they risk being victimised in the workplace if they report their concerns; or where staff genuinely feel that the manager is the abuser or is condoning abuse All agencies whether, statutory, voluntary or private should have their own procedures to enable staff to express their concerns outside of their organisation/line-management

49. 49 Children’s Safeguarding Concerns Be familiar with and follow your organisation’s procedures and protocols for promoting and safeguarding the welfare of children in your area, and know who to contact in your organisation to express concerns about a child’s welfare.

50. 50 Session 6 Recording

51. 51 Guidance for Making a Written Record Make a note of date, time and setting Make a note of anyone else who was there at the time Record what was said using the person’s own words Separate factual information from any opinions expressed Use a pen or ballpoint with black ink if you can

52. 52 Guidance for Making a Written Record cont... Make sure your writing is legible and do not use tippex and initial any changes Date and sign your report Remember that your report may be required as part of any legal action or disciplinary proceedings Keep a copy for future reference which is filed securely

53. 53 Session 7 What Next?

54. 54 Information To Be Given When Making a Referral Your details Details of the alleged victim Details of alleged perpetrator (if known) Details of any witnesses (if known) Name and contact details of GP Reasons for the concerns Any relevant background information Whether the person is aware of the referral Action already taken

55. 55 Safeguarding Children Referral Processes Hampshire During office hours (8.30am – 5:00pm) - you should contact Children's Services: 0845 603 5620 At all other times you should contact the Out-of-hours Service: 0845 600 4555 Professional Line: 01329 225379 Details are found on the Hampshire County Council website.Hampshire County Council website Portsmouth Portsmouth residents and practitioners should contact the Child and Family Enquiries (CAFE) service for advice if they are unsure whether or how to refer a child or family they are worried about. Email: CAF.Enquiries@portsmouthcc.gov.uk or phone 0845 671 0271CAF.Enquiries@portsmouthcc.gov.uk Detail are found on the Portsmouth City Council website.Portsmouth City Council website Isle of Wight The Referral and Assessment Team is the central team that handles all initialReferral and Assessment Team enquiries to Children and Family Services. The team operates a duty system based at the Children’s Service Centre, Atkinson Drive, Newport (Telephone: 01983 525790).

56. 56 Safeguarding Adults Referral Processes Referral to Adult Services as the Co-ordinating Agency: Refer to the Adult Services Contact Centre - Professional Line: 01329 225378 The Patient/Service User can self-refer to Adult Services Contact Centre – Hantsdirect Public Line: 0845 603 5630 or 01329 225398 Out of Hours Service: 0845 600 4555 Your referral will be screened by the contact centre and passed to our social work teams who will assess the Safeguarding concern raised. Consultation/Advice only: A Safeguarding Co-ordinator is available daily 08.30-17.00 for specialist advice and the Professional Line for consultation/advice only: 01962 847214. You can e-mail a safeguarding co-ordinator for specialist advice to our Adult Safeguarding Unit shared inbox: Adult.safeguarding.unit@hants.gov.uk Visit our safeguarding website at: http://www3.hants.gov.uk/protection-from-abuse.htm

57. 57 Safeguarding Adults/ Domestic Abuse Central Referral Unit (CRU) Hampshire Constabulary’s Central Referral Unit will receive and grade all referrals to ensure that the right level and consistency of response is given to agencies. Referrals can be sent by email or phone; the unit is open 7.30am - 8pm Monday to Friday and 8am - 4pm Saturday and Sunday. Outside of these times, if it is an emergency, the police can be contacted via 999 or via 101 for issues that require a less urgent response. The Central Referral Unit contact details are as follows: E-mail: cru@hampshire.pnn-police.police.uk Phone: 02380 745399 Fax: 02380 745298

58. 58 What Do I Need To Know? How to recognise abuse and where to report my concerns Where to find my workplace Policy and Procedure and make sure I have read and understood it That abuse is not an isolated problem, but a significant social concern That abuse can be a crime That anyone can potentially cause harm to a vulnerable adult, intentionally or unintentionally The rights of the people I provide a service to That I will be supported if I report a concern My rights as an employee What training I can expect to ensure I provide quality care That Adult Services have a responsibility, in partnership with other agencies, to assess and respond

59. 59 Prevention Acknowledge that it COULD happen here! Report any concerns – in whatever way necessary to be heard Do not tolerate poor practice Be aware of possible indicators of abuse Promote self advocacy and advocacy Follow policies and procedures for intimate personal care, physical interventions and sexuality Attend training when given the opportunity Make use of supervision opportunities Good record keeping Use ‘Whistleblowing’ Procedure

60. 60 Safeguarding Outcomes People have: Been listened to Taken seriously Learnt new skills More money Greater independence Received improved care Better relationships Better trained staff Been kept physically safe Been safer in their community Been safer in their services New assessments/care packages Seen prosecutions (criminal and civil) Seen action taken against staff (Human Resources /DBS) Seen action taken by regulators (CQC)

61. 61 What Have I Learnt? Stop Start Keep

62. 62 ‘Safeguarding News’ Visit the new Making Connections’ website at www.making-connections.co.uk for more information Making Connections (IOW) Ltd. 2013 Practice Guidance Research News Updates Documents Useful Links