1. SAFEGUARDING ADULTS Level 2 for the London Borough of Camden

2. Jean Hanson Freelance consultant, auditor and trainer Associate of Skills for Care A former: – CQC national Service Inspector – Camden Council & local NHS Trusts manager – Associate of the Dept of Health.

3. CQC Registration ‘ Essential Standards of Quality and Safety’ How to identify and raise SA alerts Roles and responsibilities What not to do! Placing the adult at risk at the centre When an adult at risk refuses help Your input to the Safeguarding Adults Meetings The high importance of good quality recording Raising the profile of Safeguarding Adults.

4. Your role and duties The Adult Social Care Department of the Local Authority is always the lead agency. However: 1.Is your own service safe? (Whistle-blowing) 2.Do you know what to do if harm is suspected or reported to you? 3.Do your service users know that there is a ‘no tolerance of abuse and poor practice’ environment? Suggestion: appoint an internal lead for Safeguarding Adults and Children?

5. The London Safeguarding Adults Policy and Procedures Came into force in April 2011. Signed up to by: – all London councils – NHS London (all Trusts) – The Metropolitan Police – The London Ambulance Service – Social Care Institute for Excellence www.scie.org.uk/publications/reports/report39.pdf

6. Legislation? No single piece of legislation on Safeguarding Adults as yet. But we do have laws that help: - Mental Health Act 1983 (Guardianship) - Mental Capacity Act 2005 - Safeguarding Vulnerable Groups Act (Vetting & Barring Scheme) 2006 - Human Rights Act 1998 - NHS and Community Care Act 1990 - Criminal law (e.g. financial/ physical harm) - Civil law (e.g. injunctions)

7. Proposed specific legislation The Care and Support Act will: – Place Safeguarding Adults Multi-Agency Boards and formal Reviews on a statutory footing. – Set out an enhanced duty on all agencies to co- operate in adult safeguarding cases. (NB: The SA Board will be able to compel agencies to share information – Place a statutory duty on Local Authorities to investigate abuse.

8. Tougher penalties in recent years The Mental Capacity Act, Section 44 says: It is “a specific criminal offence to wilfully ill treat or neglect a person who lacks mental capacity”. An allegation of abuse about someone who lacks capacity will always trigger the Safeguarding Adults process.

9. SAFEGUARDING PRINCIPLES 1.Stopping abuse is everyone’s business 2.All care delivery must uphold dignity, respect and human rights 3.Suspected abuse to be reported and acted upon without delay 4.Never work alone in Safeguarding (eg, assess risk, make big decisions, visit dangerous situations)

10. Principles 2 5. Managers to ensure staff know what to do 6. Agencies to act together effectively and communicate well 7. The adult at risk should be fully involved 8. Assume they have Mental Capacity unless proven they don’t 9. Proportionate and least intrusive response.

11. What is ‘Safeguarding Adults’? It does not include all adults It isn’t about all kinds of harm and safety It is about protecting adults at risk from harm/exploitation caused by others Various forms of abuse: some abuse is a crime Includes deliberate acts or acts of omission

12. Who does it include? “…any person aged 18 years or over who: is, or appears to be, eligible for local authority/mental health services assistance by reason of mental ill health, physical or learning disability, illness or age related frailty; AND may be unable to take care of him/herself or unable to protect him/herself against significant harm or exploitation.” (No Secrets, DH 2000). NB: Can include some family Carers.

13. HATE CRIME against vulnerable people Crimes against people living with disabilities is called hate crime. Ms Fiona Pilkington killed herself and daughter in 2007 after years of serious harassment from local youths, as no-one had stopped it. Hate crimes and disability harassment can be frightening and damaging. You can prevent incidents from escalating to serious harm or from happening to someone else.

14. What can make an adult ‘at risk’? Protective factorsRisk factors Good communication High self-esteem Good mental health Self-directing own care Good relationships Active circle of friends Access to community/ activities/ information Communication difficulties Ill-health (physical or mental) or disabilities History of abuse Being dependent on others Stigma Isolation

15. Possible signs and symptoms NEW and/or UNEXPLAINED:  abrasions/bruises/fractures  destruction of physical environment  sleep disturbance  disinhibition with sexualised behaviour  physical and/or emotional dependence  verbal abuse and/or aggression towards the carer  depression/withdrawal/changes in usual behaviour  obsessive behaviour  wandering/absconding  self harm.

16. What do adults at risk say? “We want to: be listened to and properly heard be in control of the safeguarding decision- making, but be supported too have a range of choices keep a balance between being safe and still having good quality of life/key relationships”. The national No Secrets Consultation 2009

17. The role of the Alerter YOU MUST: make an immediate evaluation of the risks ensure the person is in no immediate danger dial 999 for an ambulance or Police, if an emergency not disturb evidence or the scene of a crime ensure other vulnerable people are not at immediate risk make a record of the above information make the alert / get advice asap.

18. YOUR role 2  Alert the LBC Access and Support Team immediately: Tel: 0207 974 4000 (select option 1 for Adult Social Care) Email: adultsocialcare@camden.gov.uk  complete any of the tasks not done by another colleague, if necessary  ensure appropriate support if alleged perpetrator of harm is a vulnerable adult.

19. What will the Access Team want to know? How and when did this concern come to light? When and where did the alleged abuse occur? What are the details of the alleged abuse? What impact has this had on the adult at risk? What is the adult at risk saying about it? Are there details of any witnesses? Is there potential risks to visitors? What’s missing?

20. YOUR role 3  caution, suspend or transfer your staff if alleged abusers, if appropriate  think about the adult at risk’s Mental Capacity to make related decisions, if appropriate  contact Children’s Services if necessary  ensure all of this work is properly recorded!

21. Should we raise an Alert or not? Did everyone read and make their decisions about the three cases?

22. What is a ‘proportionate’ response? When deciding, we take into account the: the level of the person’s ability to protect themselves or not nature and seriousness of the abuse length of time it’s been going on/repetition/increasing seriousness impact on the adult at risk the illegality of the abusive act.

23. What not to do! 1 Please don’t: ×avoid or delay taking protective action ×make promises guaranteeing full confidentiality ×discuss it with the person alleged to have caused harm or their associates ×assess serious risks / make difficult decisions alone

24. What not to do! 2 Please don’t: ×forget to consider if others may be at risk ×forget to involve and communicate with the adult at risk ×be judgemental or jump to conclusions ×avoid or delay asking for advice or help, if you need it.

25. People who refuse help 1 “I don’t want you to take this any further” Try to get consent to share info from the adult at risk, preferably written Reassure, support, persuade, influence and negotiate with the adult at risk Ensure that they are not being intimidated or forced into dropping the allegations Establish if they have Mental Capacity for this decision Offer other supports to ‘help refusers’ (eg, an advocate, Domestic Violence Outreach Unit, another visit from your staff or other agency)

26. Help refusers 2 Can an adult at risk stop you making the Alert? (and stop the subsequent Safeguarding processes) Yes, if they have full Mental Capacity to make decisions about their own welfare UNLESS…..

27. Alerting without their consent You can IF you are ‘acting in the public interest’:-  A crime is suspected or has been committed  The adult is at risk of serious harm  Other adults at risk or children may be harmed by the same perpetrator  The abuse has occurred in a place with a responsibility to provide care  The person alleged to be causing the harm is:  paid staff  a volunteer.

28. What are the differences between Safeguarding Adults and Children? 1. Adults have the right to make their own decisions about all aspects of life unless they:  lack the mental capacity to do so  are detained under Mental Health Acts  detained in prison system. 2. Financial abuse is not such as big issue. 3. The law and national guidance are not so well- developed or funded.

29. Other important tasks for you Contributing reports to the Strategy Meeting and/or Case Conference (your manager) Attending those meetings, if requested to (but don’t be a ‘passenger’ - always go well prepared!) Helping the SA leads with investigation, on request – may include the Police Q: if the Police are involved from the start, do you still raise a Safeguarding Alert or not?