Councillors' briefing: Adult Safeguarding 2016

1. Councillors' briefing: Adult Safeguarding 2016 To cover: Legislative framework What’s changed Roles of key agencies Local multi-agency policy and procedures Jane Elliott Tončić Adult Safeguarding Manager

2. What is adult safeguarding? Work aimed at preventing or stopping abuse and neglect of adults who are at risk of harm. Policy and practice around safeguarding adults has developed rapidly over the past 15 years as society has become more aware of abuse and neglect in institutions, people’s homes and in the community. Some of the high profile cases include the deaths of Stephen Hoskin and Gemma Hayter, and investigations into Winterbourne View and Mid Staffs hospitals (links provided)

3. 6 principles of safeguarding adults 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

4. How? Safeguarding of adults at risk takes place in communities through a number of different factors: Awareness raising and an absence of tolerance of abuse Health and social care services’ and police responses that are of decent quality Effective responses to allegations of harm Providing access to services, advocacy, justice and support Using learning from Safeguarding Adult Reviews (SARs, the new term for serious case reviews or SCRs) to improve services

5. Legislation • Unlike for Children’s Safeguarding, up until last year there had been no direct legislation. • Many organisations, including Action on Elder Abuse and the Association of Directors of Adult Social Services (ADASS), had for some time called for adult protection to be on a legislative footing, in order that it received equivalent priority • From April 1st 2015, the Care Act 2014 put adult safeguarding on such a legal footing, replacing the ‘No Secrets’ guidance of 2000 • The Care Act was revised later in 2015 and updated guidance issued in February 2016

6. What’s Changed - legislation • Under the Care Act 2014, the local authority must: • make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect • set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the Police and the NHS (specifically the local Clinical Commissioning Group/s) • arrange, where appropriate, for an independent advocate to represent and support an adult who has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate adult to help them • cooperate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect. • Despite calls to the contrary, it provides no powers for the LA to enter a person at risk’s accommodation without permission. This suggests that there are already sufficient powers under current legislation.

7. Related legislation • Criminal Justice & Courts Act 2015 (new offences involving ill treatment or wilful neglect by care providers under S 20/21) • Modern Slavery Act 2015 • Counter-Terrorism and Security Act 2015 • The Equality Act 2010 • The Mental Capacity Act 2007 (incl. powers of the Court of Protection) • Deprivation of Liberty Safeguards (amended the MCA 2005) • Mental Health Act 2007 • Domestic Violence, Crime and Victims Act 2004 • Youth Justice & Criminal Evidence Act 1999 • The Human Rights Act 1988

8. What’s Changed – terminology and definitions • The term ‘vulnerable adult’ is no longer in use; the preferred term is now ‘adult at risk (of abuse or neglect)’. • Where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) - • has needs for care and support (whether or not the authority is meeting any of those needs), • is experiencing, or is at risk of, abuse or neglect, and • as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it • it must follow up any concerns about either actual or suspected abuse. It must make enquiries, or cause others to do so, regardless of whether it is providing any services.

9. Categories of abuse • Domestic abuse – including violence, psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence, coercion or controlling behaviour • Sexual abuse – including inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, or sexual acts to which the adult has not consented or was pressured into consenting • Psychological abuse – including threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks • Financial or material abuse – including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits • Modern slavery – encompasses slavery, human trafficking, forced labour, domestic servitude and inhumane treatment

10. Categories of abuse • Discriminatory abuse – including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion • Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation • Neglect and acts of omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating • Self-neglect – this covers a wide range of behaviour; neglecting to care for one’s personal hygiene, health or surroundings, and includes behaviours such as hoarding

11. What’s changed - practice • Making Safeguarding Personal agenda - a major change in practice in a move away from the process-led, tick box culture to: • a person centered approach which aims to achieve the outcomes that people want • ‘no decision about me without me’ - the adult, their families and carers work together with agencies to find the right solutions to keep them safe and support them in making informed choices • practice that focuses on what the adult wants, and accounts for the possibility that individuals can change their mind on the outcomes they want throughout the course of the intervention • best practice guidance includes working with someone towards achievable results should their stated desired outcomes be unrealistic

12. Who is responsible? Adult safeguarding is everyone’s business. Any person may recognise and report abuse or neglect and everyone can play a part in building communities where abuse does not happen. However, specialist skills are required to make the relevant enquiries. Guidance calls for all agencies responsible for adult safeguarding to work effectively with each other; i.e. community healthcare providers, CCGs, Health and Wellbeing boards, Children’s and Adult Safeguarding Boards, and Community Safety Partnerships as set up by the Home Office to create links between Police, Local Authorities, Fire, Health and Probation Services, and Healthwatch.

13. Harm and Abuse Anyone can be at risk of harm, people may be harmed at home, in their communities, in a care home, at hospital, in college, at work or in community centres. People who harm adults at risk largely fall into four main categories: • Paid staff members or support workers • Family members, partners or carers • Friends, neighbours and members of the community • People who deliberately exploit adults they perceive as vulnerable to abuse; • While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power.

14. Roles of Key Agencies • Councils - to ensure that they set up a Safeguarding Adults Board, commission services that safeguard individual’s dignity and rights, and respond appropriately to concerns about harm or abuse • Health and social care agencies – to identify abuse, play an important part in monitoring and supporting adults at risk, and participate in the local multi-agency arrangements • Clinical Commissioning Group - to commission and provide independent oversight of services that are safe and that safeguard individual’s dignity and rights, and to work with partner agencies. • Police and Criminal Justice System - to join the multi-agency process, investigate where crime is suspected, and to play a key role in promoting community safety

15. Roles of key agencies • Care Quality Commission: to register and monitor compliance against essential regulated standards of quality and safety • Providers: to ensure they provide quality services that uphold individual’s dignity and rights, and adhere to safe recruitment guidance • Safeguarding Adults Board: meets quarterly to co-ordinate the delivery of adult safeguarding across agencies • Health and Wellbeing Board: to build strong and effective partnerships, which improve the commissioning and delivery of services across NHS and local government, leading in turn to improved health and wellbeing for local people.

16. The role of Councillors As community leaders championing the wellbeing of your constituents, you are in a position to raise awareness of adult safeguarding. You may become aware of individual cases of abuse through your work with constituents, and have a duty to report it. NB: we are not always able to feedback detail unless we have the consent of the person or their representative, but usually can report that the concern has been explored and a summary of the outcome. Councillors, as part of governance, can ask council executives and partner agencies to account for the safety of adults within their area. Councils’ Lead Members for Adults Services have a role to promote wellbeing, prevent social exclusion and protect adults at risk

17. The role of Councillors • Safeguarding is now seen as a crucial aspect of local authority work. • Crucial roles for councillors in examining how safeguarding is experienced by local people, and how they were involved in their own safeguarding plans and procedures • Growing awareness of the prevalence of abuse makes it all the more urgent and necessary for councillors to take action locally to ensure that everyone, including professionals, the voluntary sector and the general public, are made aware of: • abuse and neglect of adults, how to recognise and report it • who is responsible for intervening • what people’s rights are to protection, support, choice and advocacy.

18. SAC (Safeguarding Adults Collection)National government requirement • records details about safeguarding activity for adults aged 18 and over in England. • includes demographic information about the adults at risk and details of the incidents that have been alleged • Collected by the Health and Social Care Information Centre • designed to strengthen the information held nationally and locally on the incidence of abuse, supporting local authorities to reduce incidents of abuse and neglect, and to respond appropriately when incidents occur • more focused on the outcomes of safeguarding activity, supporting local authorities to identify areas for improvement, and enabling the sharing of learning and expertise between councils

19. Statistics 1 April 2015 - 31 March 2016 • 1810 adult safeguarding concerns received • 609 did not meet the criteria for an enquiry and were signposted to other actions i.e. social care or OT assessment/review, risk management meetings, referral to another service • 1201 went onto Section 42 enquiry, of which • 464 were people aged 18-64 • 737 over 65 • 669 Female • 501 Male • 31 were anonymous concerns relating to whole service

20. Statistics • Location of abuse: • 480 Care Home • 617 Own Home • 27 Hospital • 17 Service in the community (i.e. day centre) • 60 Other (i.e. other people’s homes, public places) • Types of abuse: • 358 Physical • 70 Sexual • 235 Emotional • 278 Financial • 545 Neglect • 57 Discriminatory • 96 Institutional

21. Raising a safeguarding concern If you have witnessed or received a concern about possible abuse or neglect of an adult at risk, report this to the PCC Contact Centre by ringing 668000 to raise a safeguarding concern This information will be sent to the Retained Function team as a referral, who will gather information and hold a strategy discussion/meeting with key agencies Priority will be to ensure that an immediate protection plan is in place for the adult at risk. Consent is required to share individuals’ information and/or that regarding their circumstances

22. Multi-agency policy and procedures manual • Following our revision of our Adult Safeguarding policy, we commissioned its digitalisation, in line with Children's Services’ arrangements, and the new version went live in November 2013 • Public access is gained from our main PCC website: http://www.plymouth.gov.uk/homepage/socialcareandhealth/adultsocialcare/adultsafeguardingboard.htm or the policy can be accessed direct: http://plysab.proceduresonline.com • It is arranged in clear ‘chapters’, and is regularly updated on legislation and guidance. There is a facility to register for update alerts by email.

23. Multi-agency online policy and procedures manual:

24. Adult safeguarding training • We deliver several courses in conjunction with Plymouth Safeguarding Adults Board (PSAB) including: • Level 1 Adult Safeguarding (AS) training: aimed at staff across the city who have contact with adults at risk • Level 2 AS Enquiry training: aimed at staff who undertake safeguarding enquiries • AS Registered Managers training: aimed at managers of provider services • All training is multi-agency and reflects learning from Safeguarding Adult Reviews, current legislation and guidance • Further details: http://www.plymouth.gov.uk/homepage/socialcareandhealth/adultsocialcare/adultsafeguardingboard/asbprofessionals/asbadultprotectiontraining.htm • Email: ascadultprotection@plymouth.gov.uk • Tel: 01752 306360

25. Useful information • Revised Care and Support Statutory Guidance issued under the Care Act 2014, Dept. of Health: https://www.gov.uk/guidance/care-and-support-statutory-guidance/safeguarding • PCC Adult Safeguarding leaflet – can be downloaded and printed: http://www.plymouth.gov.uk/safeguarding_adults_leaflet.pdf • SCIE adult safeguarding resources: http://www.scie.org.uk/adults/safeguarding/ • LGA Councillors’ Briefing (2015): http://www.local.gov.uk/documents/10180/11493/Councillors+briefing+Safeguarding+Adults+2015.pdf/318d4089-6707-4628-9159-a6c97714cf5e • ADASS/LGA Safeguarding Consolidated List of Resources (2015): http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/7521881/ARTICLE • RiPfA(2015) Safeguarding in light of the Care Act: Leaders' Briefing (to be included in Members’ Toolkit)

26. Useful information • Modern Slavery: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328096/Modern_slavery_booklet_v12_WEB__2_.pdf • Self neglect and adult safeguarding: http://www.scie.org.uk/publications/reports/report46.pdf • Think Jessica - campaign to protect elderly and vulnerable people from 'scams' and exploitation http://www.thinkjessica.com • Prevent Strategy (2011) : part of the government's counter- terrorism strategy, aimed at preventing radicalisation of vulnerable people: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97976/prevent-strategy-review.pdf • Centre for Policy on Ageing: Financial Abuse of Older People http://www.cpa.org.uk/information/reviews/financialabuse240408%5B1%5D.pdf

27. Serious Case Reviews and reports • DoH (2012) Transforming Care: a national response to Winterbourne View hospital • Francis Inquiry (2013) report on failings at Mid Staffordshire Hospital • Cornwall County Council (2007) The Murder of Stephen Hoskin SCR • Warwickshire County Council (2011) The Murder of Gemma Hayter SCR • MENCAP (2007) Death by Indifference

28. Councillors' briefing:Adult Safeguarding 2016 Thank you for listening. Any further questions?