1. Safeguarding Adults Level 2 Everybody’s Business Your Business

2. Aims & Objectives To enable you to apply knowledge of Safeguarding Adults Level 2 Human Rights Act 2000 Mental Capacity Act 2005 Deprivation Of Liberty 2009 Independent Mental Capacity Advocates Workshop Raising Awareness of Prevent Equality Act 2010

3. Human Rights in Context Equality & Diversity Safeguarding Adults Mental Capacity Act Independent Mental Capacity Advocates Deprivation of Liberty Prevent

4. Human Rights Act 1998 Expresses the European Convention of Human Rights in UK law Implemented in October 2000 Clarification through case law

5. Convention Rights Article 2 Right to life Article 3 Right not to be tortured or treated in an inhuman or degrading way. Article 4 Right to be free from slavery or forced labour. Article 5 Right to liberty Article 6 Right to a fair trial Article 7 Right not to be punished for something which wasn’t against the law.

6. Article 8 Right to respect for private and family home and correspondence. Article 9 Right to freedom of thought conscience and religion. Article 10 Right to freedom of expression. Article 11 Right to freedom of assembly and association. Article 12 Right to marry and found a family. Article 14 Right not to be discriminated against in relation to any of the rights contained in the European Convention.

7. Protocols of Articles Article 1 Protocol 1: Right to peaceful enjoyment of possessions. Article 2 Protocol 1: Right to Education Article 3 Protocol 1: Right to Free Elections Article 1 Protocol 13: Abolition of the Death Penalty

8. Article One “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood”. What does Equality & Diversity mean to you?

9. Discriminatory Abuse Can be direct or indirect discrimination. The Equality Act 2010 has nine Protected Characteristics: Age Disability Race Religion or Belief Sex Sexual Orientation Marriage & Civil Partnership Pregnancy & Maternity Gender Reassignment

10. Human Rights Act 2000 All UK Laws should be compatible with the rights in the Human Rights Act. The Mental Health Act 1983 was amended under the HRA. It is now for the ‘detaining authority’ to prove that detention of a patient for treatment for mental illness is justified under Article 5 (right to liberty) Previously, the onus was on the patient.

11. The Mental Capacity Act 2005 No decisions about me without me

12. 1.A person must be assumed to have Capacity unless it is proved otherwise 2.A person is not to be treated as unable to make a decision unless all practical steps to help them do so have been taken without success 3.An unwise decision does not in itself indicate a lack of capacity 4.An act or decision made on behalf of a person who lacks capacity must be made in their best interests 5.When a person lacks capacity any act or decision should aim to be the least restrictive option The 5 Principles of the MCA

13. A Person must be able to: Understand the information Retain the information Use or weigh the information Communicate the decision Failure on any one part indicates a lack of capacity to make the specific decision at that particular time Reasonable belief is sufficient Anyone can assess capacity

14. Level 1: Day to day decisions Activities of daily living, observations and simple diagnostic tests Level 2: More complex decisions Invasive procedures, complex diagnostic tests, treatments, self discharge Level 3: Significant decisions Serious medical treatment, long term accommodation changes Levels of Assessment

15. Defining Capacity ‘…a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or disturbance in the functioning of, the mind or brain.’

16. A decision made on the behalf of someone should always be in their BEST INTERESTS

17. Independent Mental Capacity Advocates - IMCA IMCAs referrals must be made when: A person has been assessed as lacking capacity to make a major decision about serious medical treatment or a longer- term accommodation move and they have no family or friends to consult with Referrals can be made by telephone on 0845 2799019 or referral forms are available on the RCHT intranet or the SEAP website: www.seap.org.uk/imca

18. Deprivation of Liberty Safeguards - DOLS If restrictions placed on patients are necessary, proportionate and the least restrictive option available the law can allow for the restrictions to be applied even if the result is that the person is being deprived of their liberty. In the vast majority of cases where this occurs there is no doubt that the deprivation of liberty is motivated by the patients best interests and safeguards them from harm.

19. When is a patient deprived of their liberty? Situation and individual specific Restraint Possible Deprivation of Liberty Doors locked but able to go out Doors Doors locked but unable to go out Regular escorted leave Leave No leave or very limited leave Some control exercised Control Extensive control re: care and movement Compromise re: discharge Discharge Carers discharge request refused Periodic restraint Restraint Restrained regularly for prolonged periods Visitors attend during visiting hours Visitors Contact with visitors is severely limited Some choice and control re: lifestyle Lifestyle Limited control over lifestyle *The above is not an exhaustive list Degree vs. Intensity

20. Making a DOLS application

21. Prevent Part of CONTEST, the Governments counter-terrorism strategy. Pursue: to stop terrorist attacks Prevent: to stop people becoming terrorists or supporting violent extremism Protect: to strengthen our overall protection against terrorist attack Prepare: where we cannot stop an attack, to mitigate its impact

22. Nicky Reilly attempted to detonate an improvised explosive device at a restaurant in Exeter in May 2008 Known to have mental health issues and learning difficulties and had regular contact with health and social services Was radicalised through contact with people on the internet Andrew Ibrahim was arrested in Bristol in April 2008 charged with terrorist offences and convicted in July 2009 Had previously sought medical help for injuries to his hands during trials with explosives Had shown his drug counsellor violent footage that he had downloaded onto his mobile phone Developed a "mind-set of martyrdom" after accessing extremist material on the internet Is it possible to recognise signs and intervene to prevent people being drawn into terrorist activity?

23. LUNCH 30mins

24. Human Rights in Context Equality & Diversity Safeguarding Adults Mental Capacity Act Independent Mental Capacity Advocates Deprivation of Liberty Prevent

25. Transferring Learning into Practice

26. Effort Workload Lack of support Low Motivation No time to reflect No resources Workplace culture Time pressures Learning Practice

27. Definition of a vulnerable adult A “vulnerable adult”, is a person 18 years of age or older. 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 Is unable to protect him or herself against significant harm or exploitation. Safeguarding of Vulnerable Adults Policy and Procedures 4.1

28. Please identify 7 Categories of Abuse DVD

29. Definition of Abuse ‘ A violation of an individual’s human and civil rights by an act, or a failure to act, on the part of another person or persons. Abuse may consist of a single or repeated act of neglect or failure to act or it may occur when a vulnerable person is persuaded. 4.4

30. A key act of omission Failure to take action in your role as an alerter when you suspect a person in your care has been or is being abused Recognise abuse Respond Record Report

31. Examples of acts of omission Inadequate assessment & planning of an individuals needs The neglect of an individual's personal care needs Failure to give pain relief Not communicating with and ignoring patients & / or their relatives/carers Too hasty discharge from hospital

32. Safeguarding Adults is everyone's responsibility Can you account for your own practice, and do you challenge and hold others to account when required to do so? How effective is your practice in relation to safeguarding vulnerable adults in your care?

33. 33 The Role of the Alerter You are not: Being asked to prove that information is true You are: Being asked to report and record your concerns or disclosures made to you.

34. 34 Responding to a Disclosure Don’t: Do not be judgmental (eg ‘Why didn’t you try to stop them?) Do not break confidentiality agreed between the person disclosing the information, yourself and your line manager Do not gossip with other staff members or service users about the information shared with you (ie: ‘It’s awful, you’ll never guess what I’ve just been told.)

35. 35 The Role of the Alerter If necessary call the police/ambulance Ensure safety Preserve forensic evidence Contact your line manager – inform the patient ( out of hours bleep 2634) Hand write a report Follow RCHT’s Alert flowchart

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38. 38 Safeguarding Adults Multi-Agency Process Information gather– checks made with all agencies involved Strategy Process / enquiries, risk assessment, interviews Case Conference Protection Plan Review Initial concern Co-ordinating Manager ASCW ALERT

39. Lead Safeguarding Nurse - Zoe Mclean 07825904386 or Bleep 3048

40. Email. Learning.disabilities@cornwall.nhs.uk For Out of hours leave referrals on answer phone the clinical site co- ordinators. All patients with a Learning Disability or Autism must be referred to the Acute Liaison Nurses for Learning Disabilities Daniella Rubio-Mayer 07827 903729 Bleep 3054 Tristan Coombe 07827 903729 Bleep 3095 Jane Rees 07765 221848 Bleep 3053 Learning Disabilities

41. 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. 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 Via: Ext 2446 or Mobile 07789 876247 Lerryn.hogg@rcht.cornwall.nhs.uk Lerryn.hogg@rcht.cornwall.nhs.uk Mental Health and Wellbeing

42. Independent Domestic Violence Advocates - IDVAs There are two IDVAs based at RCHT in the safeguarding adults team Anna Onslow - 07435 752497 Susie Brown - 07435 752498 Out of Hours leave a message or contact Twelves Company on: 08458 121212

43. Physical Abuse Scenario Peter arrived in emergency department with bruises after a stay in a care home for respite. The home reported to the ambulance crew that while he had been at the home.. staff had described him as ‘aggressive and disruptive’. The patient is elderly and had been known previously to mental health services, he doesn’t have any relatives and has been throwing himself on the floor. He has not been communicating since he arrived at hospital, other than grabbing at staff. What would you do?

44. Recognise, Record and Respond Get doctor to look at bruises and body map them. If the doctor feels that these may have been caused other than normal knocks and bruises… speak to you manager or safeguarding nurse and make an alert. In the case above the Co-ordinating manager from ASCW asked for medical photography to take pictures and they ensured patient was discharged to alternative accommodation when he was fit for discharge.

45. Physical Abuse This is an easier form of abuse to spot as there will be physical signs. Speak to Peter, ask about the bruise or fractures, ask questions, document your questions and answers, discuss your concerns with a senior member of staff. If the Peter cannot answer your questions…alarm bells need to start ringing very loud. Do not forget the body map diagram in the safeguarding policy, please use it. If you feel the assault maybe of domestic nature, speak with you Domestic Violent advocates or line manager. They can support you and the patient with advice.

46. Sexual Abuse Scenario 18 year old Sally was waiting for surgery for an ectopic pregnancy this had been her 6th miscarriage in the last 9 months. Sally disclosed about sexual violence from her boyfriend to nursing staff; Sally said she was scared of her boyfriend and the boyfriend was trying to encourage her to self- discharge. What do you do?

47. Is the patient a vulnerable adult? Yes at present…Sally is in hospital waiting for potentially life threatening treatment, however, will she be vulnerable after she leaves hospital? She may not be… Consider the patient’s immediate safety. Speak to the patient, ask what they want to happen. Speak to the safeguarding nurse for vulnerable adults for advice. Speak to the patient about referring to the Trust’s Independent Domestic Violence Advocates. Datix

48. Outcome The IDVA did a risk assessment with the patient, and helped find her a place of safety after she was discharged. Sally was referred to the MARAC group while supported her after discharge. The patient refused to see her boyfriend, and was moved to another ward where he couldn’t find her, and her details were removed from the visible bed board.

49. DVD’s How many of the seven types of abuse can you recognise? Which of the 16 Human Rights were breached? What ‘protected characteristics’ under the equality and diversity act did you identify.

50. 50 Possible barriers to reporting If abuser is a friend If you are new member of staff If it is your manager Fear of reprisals Fear of the stigma of reporting Fear of losing job If it is the majority of the team What if I’m not believed? I can’t prove it

51. 51 Raising a concern (Whistle blowing) procedure If you raise a genuine concern under this policy, you will: not be at risk of dismissal demotion pay reduction failure to renew a contract failure to gain potential promotion or other detrimental action. Provided you are acting in good faith, it does not matter if you are mistaken.

52. 52 http://intra.cornwall.nhs.uk/DocumentsLibrary/Roy alCornwallHospitalsTrust/NursingMidwiferyAHP/S afeguardingVulnerableAdults.pdf How to access RCHT safeguarding Adults policy and procedures

53. IF YOU SEE SOMETHING, SAY SOMETHING Presentation by Jacqui Blackwell