Safeguarding Adults Level 1 and Level 2 Training

1. Wanda Palmer Head of Quality and Safeguarding NHS Camden Clinical Commissioning Group 16th July 2015 Safeguarding Adults Level 1 and Level 2 Training Working with the people of Camden to achieve the best health for all

2. Aims of the session 8 By the end of this session, participants will: 1. Be able to define safeguarding and the key principles 2. Identify Categories of abuse 3. Know how to recognise and respond to suspected abuse 4. Understand the basics of the Mental Capacity Act 5. Be aware of the ‘PREVENT’ agenda and key principles 6. Have completed a case study discussion 7. Considered implications in practice – such as the practice ‘checklist’ 8. Have had the opportunity to ask questions……..

3. Defining Safeguarding The safeguarding duties apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect

4. Safeguarding Principles Six key principles underpin all adult safeguarding work: 1. Empowerment – People being supported and encouraged to make their own decisions and informed consent 2. Prevention – It is better to take action before harm occurs 3. Proportionality – The least intrusive response appropriate to the risk presented 4. Protection – Support and representation for those in greatest need 5. Partnership – Local solutions through services working with their communities 6. Accountability – Accountability and transparency in delivering safeguarding

5. Categories of Abuse Physical Domestic violence Sexual Psychological Financial/ material Modern slavery Discriminatory Organisational Neglect/ acts of omission Self-neglect

6. Identifying Abuse There are a number of factors which may indicate abuse. The list is not exhaustive and clinical judgement is key. Missed appointments or a reluctance to submit to examinations Bruising or unexplained injury Changes in a persons mood or interactions Fear of another person, or allowing another person to speak for them Self harm or increased risk taking behaviours Lowered self esteem Poor nutrition may indicate someone is not able to purchase food Poor personal hygiene Pressure ulcers A direct or indirect disclosure Fear of going home Money or possessions going missing Inappropriate comments Behaviour of other people

7. Responding to Suspected Abuse - Disclosure Be calm and do not show shock or disbelief Listen carefully to what is being said Do not ask detailed or probing questions at the initial stage Ensure that any emergency action needed has been taken to ensure the person’s safety Do not attempt to confront the alleged perpetrator Demonstrate a sympathetic approach by acknowledging regret and concern that what has been reported has happened Confirm that the information will be treated seriously Give them information about the steps that will be taken Inform them that they will receive feedback as to the result of the concerns they have raised Give the person contact details so that they can report any further issues or ask any questions that may arise Ensure that an appropriate person within your organisation has been notified

8. Reporting Suspected Abuse Explain to the patient what your concerns are and what you intend to do. If the abuse is putting a patient’s immediate safety at risk, please call 999 straight away. For all other concerns that a patient is being abused or may be at risk of harm speak with the Camden Local Authority team on 020 7974 4000 You can also use one of the following options to report specific concerns of abuse or neglect: If you suspect the abuse may be a crime, please contact Camden Police Community Safety Unit on 020 8733 6443 If you are worried about potential abuse in a care home or hospital or other regulated setting you can report your concerns to the CQC. Health and social care staff who are worried about contacting Camden Council or the CQC directly about organisational abuse concerns, can pass on their suspicions by contacting the 08000 824 725

9. Mental Capacity Act 2005 The MCA exists to protect the rights of people who may not be able to make their own decisions due to factors which impair their mental state – this may be stroke, head injury, learning disability, mental illness, intoxication etc. There are 5 key principles: A presumption of mental capacity The right for individuals to be supported to make their own decisions The individual retains the right to make “eccentric or unwise” choices All decisions should be made in the person’s best interest Using the least restrictive intervention

10. Assessing Capacity The Act makes use of a ‘functional’ test of capacity, adapted from the common law, which focuses on the decision-making process itself. First it must be established that the person being assessed has ‘an impairment of, or a disturbance in the functioning of, themindor brain’ which may affect their ability to make the decision in question. Under the Act, a person is regarded as being unable to make a decision if, at the time the decision needs to be made, he or she is unable: To understand the information relevant to the decision To retain the information relevant to the decision To use or weigh the information; or To communicate the decision (by any means).

11. Prevent Strategy – Reducing Risk of Radicalisation and Terrorism Working with the people of Camden to achieve the best health for all 1. Prevent strategy aims to stop people becoming terrorists or supporting terrorism. The health sector is involved in Objective 2 and 3: To prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support. To work with sectors and institutions where there are risks of radicalisation that we need to address. 2.  Prevent is part of existing safeguarding responsibilities for the health sector, not an additional job. 3.  Healthcare workers have the opportunity to refer vulnerable individuals for support in a pre-criminal space by: a)  Recognising  vulnerable adults, children and young people who may be at risk of radicalisation; b) Working in partnership to reduce risk and protect the individual and c) Providing adequate and necessary support as part of a proportionate multi-agency response to any concerns.

12. Working with the people of Camden to achieve the best health for all 4. Vulnerability factors Radicalisation is a process, not one off event. There is no single profile of a terrorist – there is no checklist to measure someone against. This is not about race, religion or ethnicity - the programme is to prevent the exploitation of susceptible people.

14. Working with the people of Camden to achieve the best health for all 5. Recognise, Understand and Share Concerns You could reduce the risk of someone being exploited by radicalisers and subsequently drawn into terrorist-related activity. 6. Report any Prevent related concerns to: Wanda Palmer, Head of Quality and Safeguarding (incl. Prevent Lead) Tel: 02036882049 wandapalmer@nhs.net or safeguarding.camdenccg@nhs.net 7. Further guidance available Prevent in WRAP and Safeguarding training via Head of Quality and Safeguarding (as above) Search ‘Building Partnerships, Staying Safe’ Department of Health guidance for staff and organisations https://www.gov.uk/government/publications/building-partnerships-staying-safe-guidance-for-healthcare-organisations https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215253/dh_131912.pdf

15. Case Study Working with the people of Camden to achieve the best health for all Harry is 78 yrs old and lives alone in a flat His daughter, Elaine, is very worried about him, he has always been a heavy drinker but recently she feels he has worsened. She has seen bottles and rubbish strewn over the flat. Her dad looks very thin and she has observed injuries to his face she thinks are from falls. He refuses to let her take him to hospital, which was her plan. His daughter, upset and anxious, calls Social Services who advise her to phone Harry’s GP Practice and discuss her concerns. What are the safeguarding concerns and risks? What can the Practice do?

16. What Can Practices Do? Training and awareness Information for patients Asking questions Consider in reviews e.g. chronic disease Follow up non attenders e.g. Repeat prescriptions Carers policy Flag records of vulnerable adults Discuss concerns and significant events Contribute to meetings

17. Practice Checklist Safeguarding adults policy Safeguarding adults lead See the child behind the vulnerable adult Highlight records of vulnerable adults Information available for patients Regular training Significant events reviewed discussed Concerns shared with CCG Application of Mental Capacity Act to practice Minimum safety criteria for staff employment Complaints and whistle-blowing policy

18. Final Thoughts…. It is not your responsibility to decide whether an adult at risk is being abused It is your responsibility to report abuse of an adult at risk if you have any concerns Safeguarding adults from abuse is everyone’s business Please do not ignore your concerns and let the abuse of an adult at risk continue Don’t forget to apply the MCA principles