1. Shaping healthcare … for you and your family Philip Tremewan, Designated Nurse for Safeguarding Adults Guildford & Waverley CCG Safeguarding Adults & Mental Capacity

2. Shaping healthcare … for you and your family Introduction Several incidents have demonstrated the need to ensure that people at risk of abuse receive protection and support. Multi agency safeguarding policies underpinned by the Human Rights Act 1998

3. Shaping healthcare … for you and your family Aims To ensure all staff know that they have a responsibility to safeguard. To develop an awareness of and ability to act on concerns about the safety and welfare of those people

4. Shaping healthcare … for you and your family Learning Outcomes To identify those at risk To recognise that this is everyone’s responsibility To identify the categories and indicators of abuse To state how to respond quickly and effectively to concerns.

5. Shaping healthcare … for you and your family Defining who is at risk Which adults are vulnerable? a person ‘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/herself or unable to protect him/herself against significant harm or exploitation Lord Chancellor (1997)

6. Shaping healthcare … for you and your family What constitutes abuse? The term ‘abuse’ can be subject to wide interpretation – it can also result in harm Abuse defined as ‘…violation of an individual’s human and civil rights by any other person or persons’ No Secrets (2000)

7. Shaping healthcare … for you and your family Main forms of abuse Physical abuse Sexual abuse Psychological abuse Financial or material abuse Neglect and acts of omission Institutional abuse Discriminatory abuse Criminal investigation by the police takes priority over all other lines of enquiry

8. Shaping healthcare … for you and your family Patterns of abuse Hate/Mate Crime – PREVENT Agenda Domestic abuse Opportunistic Institutional abuse through ritualistic practice Unauthorised use of control and restraint Poor organisational guidance on anti- discriminatory practice

9. Shaping healthcare … for you and your family For help and advice contact: Adult Social care 0300 200 1005

10. Shaping healthcare … for you and your family How are concerns reported? Discuss with your other colleagues or CCG Leads Seek advice from a Social Worker or contact the local Social Services Helpdesk Complete Safeguarding Adults Alert Form Submit to your Surrey CC Keep an internal record

11. Shaping healthcare … for you and your family Confidentiality Information is shared may need to know basis. When it is in the best interests of the patient Confidentiality must not be confused with secrecy Informed consent must be sought except if it is likely to increase the risk of harm to the patient Decisions about who needs to know what, should be made on a case-by-case basis In certain circumstances it will be necessary to exchange or disclose personal information which will need to be in accordance with the data protection act

12. Shaping healthcare … for you and your family Mental Capacity Act 2005 The Mental Capacity Act provides a framework to empower and protect people who may lack capacity to make some decisions for themselves The Mental Capacity Act makes clear who can take decisions in which situations, and how they should go about this Anyone who works with or cares for an adult who lacks capacity must comply with the MCA when making decisions or acting for that person.

13. Shaping healthcare … for you and your family The five key principles in the Act are: 1.Every adult has the right to make his or her own decisions and must be assumed to have capacity to make them unless it is proved otherwise. 2.A person must be given all practicable help before anyone treats them as not being able to make their own decisions. 3.Just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. 4.Anything done or any decision made on behalf of a person who lacks capacity must be done in their best interests. 5.Anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.

14. Shaping healthcare … for you and your family First stage test of Mental Capacity A person lacks capacity in relation to matter if, at the time they are unable to make a decision for themselves in relation to the matter because of an impairment or in the functioning of the mind or brain The impairment can be temporary, permanent or fluctuating Capacity assessments are decision specific Lacking capacity for one decision does not mean the person lacks capacity for another decision No impairment = no assessment for capacity

15. Shaping healthcare … for you and your family Second stage test of Mental Capacity A person is unable to make a decision for him/herself if s/he is unable: 1.To understand the information relevant to the decision 2.To Retain that information 3.To use or weigh that information as part of that process of making that decision 4.To communicate their decision

16. Shaping healthcare … for you and your family Practical Support in Capacitated Decision Making Provide relevant information that can be understood Provide information on options Don’t rush the process – one decision at a time Consult with anyone who might have an interest in the person’s welfare Take into account the effects of current treatment on functioning

17. Shaping healthcare … for you and your family Remember Safeguarding procedures were developed to protect vulnerable members of society Patients in our care can be vulnerable Seek advice and report if you have any doubt Good practice should be evidenced