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Wales Interim Policy and Procedures for the Protection of Vulnerable Adults from Abuse

The Interim Policy . Wales Policy and Procedures for the Protection of Vulnerable Adults from Abuse: is intended to guide the safeguarding work of all those concerned with the welfare of vulnerable adults employed in the statutory, third (voluntary) and private sectors, in health, social care, the p

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Wales Interim Policy and Procedures for the Protection of Vulnerable Adults from Abuse

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    1. Wales Interim Policy and Procedures for the Protection of Vulnerable Adults from Abuse An overview of the changes and expectations the new guidance will bring. POVA Co-ordinator

    2. The Interim Policy Wales Policy and Procedures for the Protection of Vulnerable Adults from Abuse: is intended to guide the safeguarding work of all those concerned with the welfare of vulnerable adults employed in the statutory, third (voluntary) and private sectors, in health, social care, the police and other services It is not expected that all health and social care workers involved in the care of vulnerable adults will read this long document In Safe Hands adhered to. However, the Revised document for in Safe Hands will affect the policy – changes to definition etc. Dyfed Powys Policy the most recently completed. Each region had different process and examples of good practice. These have all been brought together. Process clarified for Health and how this links with clinical governance. Each participant asked to edit completed their task in consultation with area co-oridnators, meaning the policy has been consulted as it has developed. In Safe Hands adhered to. However, the Revised document for in Safe Hands will affect the policy – changes to definition etc. Dyfed Powys Policy the most recently completed. Each region had different process and examples of good practice. These have all been brought together. Process clarified for Health and how this links with clinical governance. Each participant asked to edit completed their task in consultation with area co-oridnators, meaning the policy has been consulted as it has developed.

    3. Safeguarding in Wales Adult protection work has evolved rapidly since the Welsh Office issued the guidance document In Safe Hands in 2000 and continues to do so. It has been written in accordance with the current guidance and the Welsh Assembly plans to consult on proposals for future adult protection arrangements early in 2011, following upon its review of In Safe Hands. Revised Assembly guidance is expected in 2011 and there are also other potential changes to the context of Adult Protection. . As a result of the 106 learn lessons it was identified that an All Wales Policy was needed. The 106 recommendations have also been considered via myself as part of the policy. Minimal deviationsAs a result of the 106 learn lessons it was identified that an All Wales Policy was needed. The 106 recommendations have also been considered via myself as part of the policy. Minimal deviations

    4. Currently Stage 1 – The Alert Stage 2 – Written Referral – (within 24hrs of the Alert) Stage 3 – Strategy Discussion (within two working days of the alert) Stage 4 – Strategy Meeting (within 3 days of the referral) Stage 5 – Investigation Stage 6 – Case Conference( within 15 working days of the referral)

    5. Wales Interim Policy Stage 1-The alert Stage 2 - Referral (within 24hrs) Stage 3- Strategy discussion (within 48hrs) Stage 4 - Strategy Meeting (within 7 days of the referral) Stage 5 - Investigation. (Appropriate timescales agreed at Strategy Meeting) Stage 6 – Re-convened Strategy Meeting Stage 7 - Case Conference (Agreed date set at Strategy Meeting) Stage 8 - Implement actions (agreed timescales) Stage 9 - Review of an adult protection plan (within 6 weeks of the Case Conference) Stage 10 - Closure More emphasis placed on strategy discussion and the safeguarding action take at this point. Strategy Meeting target will now be more achievable and should ensure better attendance at meetings. Stage 6 – re-convened Strategy Meeting, for the purposes of receiving investigation as professionals, examining and evaluating findings from a purchaser and professional perspective, is further action required, has the TOR been adhered to, are there risk to other Vulnerable Adult, what actions are needed for the provider. More emphasis placed on strategy discussion and the safeguarding action take at this point. Strategy Meeting target will now be more achievable and should ensure better attendance at meetings. Stage 6 – re-convened Strategy Meeting, for the purposes of receiving investigation as professionals, examining and evaluating findings from a purchaser and professional perspective, is further action required, has the TOR been adhered to, are there risk to other Vulnerable Adult, what actions are needed for the provider.

    6. Changes – Stages 6 stages Often cases close without a Case Conference thus the Vulnerable Adult is not central to the process. Stages dictated by unachievable timescales that cannot be met. The use of different meetings not clear. Policy suggests that actions are set at meetings but no guidance to say that the case should remain open until they are complete. 10 stages Case Conferences and Vulnerable Adults attending are central to the process and necessary. Timescales changed to ensure they can be met. Type of meetings changed. Review meetings not necessarily needed. Current guidance highlights the need for a formal POVA review. This is not necessarily needed. POVA process to remain open until evidence suggests the actions have been complete. i.e – meeting with 48 hours. Now Strategy Meeting within 7 days. Strategy Meeting, Further Strategy Meeting, Case Conference, Case Conference Review, Further Case Conference etc – changed to Initial Strategy Meeting, Strategy Meeting 2, 3, 4, 5. Case Conference. What was the menaing on initial Strategy Meeting, further Strategy Meeting, final Strategy Meeting, Case Conference, Case Conference review, further Case Conference, further Case Conference review????i.e – meeting with 48 hours. Now Strategy Meeting within 7 days. Strategy Meeting, Further Strategy Meeting, Case Conference, Case Conference Review, Further Case Conference etc – changed to Initial Strategy Meeting, Strategy Meeting 2, 3, 4, 5. Case Conference. What was the menaing on initial Strategy Meeting, further Strategy Meeting, final Strategy Meeting, Case Conference, Case Conference review, further Case Conference, further Case Conference review????

    7. Additions Mental Capacity Act Mental Health Act 2007. Advocacy Escalating concerns One set of paperwork APC unified Regional Forums unified All Wales Serious Case Review guidance. More focus on prevention Thresholds Risk Assessment, prioritisation and response. MAPPA Roles clarified POVA roles clarified Glossary of Terms Child Protection Section updated to include the MCA, capacity and consent and making best interests decisions. IDVA – IMHA – AGE CONCERN – IDVA New reference to dealing with provider performance issues and escalating concerns – no more overarching meetings. Terms of reference written for adult protection forums and AAPC Guidance and policy on the criteria for Serious Case Reviews. Prevention section more comprehensive to prevent abuse. Thresholds vary through-out Wales, one guide for All Wales. South Wales guide used as well as Dyfed Powys policy used. Wayne’s tool for prioritisation – new assessment to evidence professional judgment. However, would you deal with 6, if they came in and you were alone. Defensible decisions. Further risk assessments being developed to evidence that the decisions made by DLM’s and risk assess from start to finish. MAPPA and MARAC Contracts, cssiw, police and health roles within the POVA process clearly defined and strengthened - what do we expect from you. Please look at! What is a DLM and what does the POVA coordinator do. Glossary of Terms created by All Wales POVA coordinators so that each word has a clear meaning. Removing the issues associated with interpretation. The links between CP and APSection updated to include the MCA, capacity and consent and making best interests decisions. IDVA – IMHA – AGE CONCERN – IDVA New reference to dealing with provider performance issues and escalating concerns – no more overarching meetings. Terms of reference written for adult protection forums and AAPC Guidance and policy on the criteria for Serious Case Reviews. Prevention section more comprehensive to prevent abuse. Thresholds vary through-out Wales, one guide for All Wales. South Wales guide used as well as Dyfed Powys policy used. Wayne’s tool for prioritisation – new assessment to evidence professional judgment. However, would you deal with 6, if they came in and you were alone. Defensible decisions. Further risk assessments being developed to evidence that the decisions made by DLM’s and risk assess from start to finish. MAPPA and MARAC Contracts, cssiw, police and health roles within the POVA process clearly defined and strengthened - what do we expect from you. Please look at! What is a DLM and what does the POVA coordinator do. Glossary of Terms created by All Wales POVA coordinators so that each word has a clear meaning. Removing the issues associated with interpretation. The links between CP and AP

    8. Additions Definitions and categories of abuse remain the same as In Safe Hands Vulnerable Adult on Vulnerable Adult abuse explored further Vulnerable Adults attending Strategy Meetings. ISA More guidance on domestic violence Deprivation of Liberty Forced Marriage Data collection Keeping families and others informed. Responsibilities to alleged perpetrators. SEW definitions do not match working definitions in In Safe Hands, slight changes. The In Safe Hands definitions will be used. Vulnerable Adult on Vulnerable Adult – more emphasis placed on Care Management Case Conferences. However, thresholds apply and historical abuse has been ignored and tolerated. This should no longer be allowed. Deprivation of Liberty included and how this links with POVA. Specific guidance on data collection and the need for health to share this consistently with local authorities. POVA list no longer exists. Reference made to the need to refer to the ISA. Nothing about us without us. Mencap/Peoples’ First. Consideration to a Vulnerable Adult attending the Strategy Meeting. Two part required. Need to consider! Keeping families, perpetrators involved and update. Stressful times – complaints about this. SEW definitions do not match working definitions in In Safe Hands, slight changes. The In Safe Hands definitions will be used. Vulnerable Adult on Vulnerable Adult – more emphasis placed on Care Management Case Conferences. However, thresholds apply and historical abuse has been ignored and tolerated. This should no longer be allowed. Deprivation of Liberty included and how this links with POVA. Specific guidance on data collection and the need for health to share this consistently with local authorities. POVA list no longer exists. Reference made to the need to refer to the ISA. Nothing about us without us. Mencap/Peoples’ First. Consideration to a Vulnerable Adult attending the Strategy Meeting. Two part required. Need to consider! Keeping families, perpetrators involved and update. Stressful times – complaints about this.

    9. Non-Criminal Investigations Best practice promotes: Statutory Agency should lead on all investigations. Not the care manager and should not go on to be care manager. Ideally not providers Health and Social Services to chair/investigate in certain complex cases for independence. Managing Non-Criminal Investigation Tool Tool to be implemented across Wales Tool to be implemented across Wales

    10. Criminal Investigations Police Decision Forms Achieving Best Evidence. Promoting successful prosecutions. Criminal Investigations Intermediaries Strategy discussion with Public Protection Unit Supervisor. This section re-written by DCI Alan Green Support for the Vulnerable Adult through the CJS, advocacy, victim support etc. Rank not specified as previous. However, policy suggests it is someone with the PPU with supervisory responsibilities. This section re-written by DCI Alan Green Support for the Vulnerable Adult through the CJS, advocacy, victim support etc. Rank not specified as previous. However, policy suggests it is someone with the PPU with supervisory responsibilities.

    11. Health – One system for all Clinical Governance versus POVA –thresholds differed. Critical incident policy/ Root cause analysis – Investigation process. Non-criminal investigation tool to be followed for POVA investigations Complaints / POVA screening. Role of Health Boards We all need to be working to one set of thresholds. Critical incident/root cause analysis referred to but at any point if POVA issues arise a POVa must be raised, and the non-criminal investigation tool used. Same report whether the abuse happened in hospital or the community. Example of big complaints its all dealt with as one as opposed to picking out the POVA concerns and those following POVA process. Accepting the referral process slightly different due to the nature of organisation. We all need to be working to one set of thresholds. Critical incident/root cause analysis referred to but at any point if POVA issues arise a POVa must be raised, and the non-criminal investigation tool used. Same report whether the abuse happened in hospital or the community. Example of big complaints its all dealt with as one as opposed to picking out the POVA concerns and those following POVA process. Accepting the referral process slightly different due to the nature of organisation.

    12. Key Messages

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