Safeguarding Vulnerable Adults

Safeguarding is the protection of a vulnerable individual and the prevention of abuse and neglect against them. It means empowering an individual and giving them full support in order for them to maintain a happy life. It exists so that everyone has equal opportunities to access care and health providers in order for them to maintain a positive attitude and good health. Who is a vulnerable adult?

‘’A person who is 18 years or over, and who 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 themselves, or unable to protect themselves against significant harm or serious exploitation’’ (Caerphilly Country Borough Council , 2009)

Existing Legislation
Human Rights Act 1998- Came into force in the UK in October 2000 It is composed of sections that are protected by the European Convention on Human Rights. All public bodies have to carry out these rights. Individuals can take human rights cases into domestic courts. (Equality and Human Rights Commission, 2014) Mental Capacity Act 2005 amended 2007- Designed to protect people who cannot make decisions for themselves or lack the capacity to do so. Under this act it is presumed that a person can make their own decisions unless proven otherwise. (NHS, n.d.) NHS and Community Care Act 2008-regulation, direct, payments, Equalities Act 2010- Most significant piece of equality legalisation. Simplifies/strengthens law. Works based on age, disability, gender reassignment, marriage or civil partnership, race, religion or belief, sex, sexual orientation. This helps to prevent discriminatory abuse by making it illegal to discriminate against anyone with a protected characteristic. It also protects people from different types of discrimination for example third party discrimination and discrimination by association.

This means that if the correct policies and procedures are being followed in the health and social care setting discrimination should not take place due to consequences that could arise. If people are following the guidance of this act it means that staff members should be whistleblowing on their colleagues if they catch them abusing others, this will lead to them getting fired and therefore an overall decrease in the risk of abuse. (gov.uk, 2010) Domestic Violence Crimes and Victims Act 2004- the way in which instances of domestic violence are dealt with by the courts, together with measures to improve treatment of victims and people who have witness domestic crimes (Roger Bird, March 2005) SVG Act 2006 (Safeguarding Vulnerable Groups Act)- Controlling who should be working with vulnerable adults and children, Vetting and Barring scheme will deal with activities that are classified as ‘controlled’ (Independant Safeguarding Authority, 2006) Mental Health Act 2010- People can be detained, admitted and treated under different sections of this act. Allows people to have supervised treatment after a period of compulsory hospital treatment.

For people with a ‘mental disorder’ for example bipolar, depression, schizophrenia. (Rethink Mental Illness, n.d.) Rehabilitation of Offenders Act 1974- Anyone who is convicted of a criminal offence in which the sentence is below 2.5 years benefits from this act. Their conviction can become ‘spent’ as long as they are not convicted in their ‘rehabilitation period’. Exceptions if working with vulnerable people and children. (Safeguarding Matters, 2011) The Police Act 1997- When permitted it allows broader access to the criminal records of job applicants. (By the time they reach 30, a third of men have criminal records excluding monitoring offences) (Del Roy Fletcher, Alan Taylor, Stphen Hughes, Jonathan Breeze, 2001) Minimum Standards and the Care Home Regulations 2003- Sets out National Minimum Standards of which apply to all care homes, providing accommodation and nursing or personal care for older people. (Department of Health, 2002) This works well because this makes sure that all people in care are getting treated to the right standard which reduces the stress put on care givers, this then reduces the risk of abuse and neglect on service users.

This works with the National Care Standards Commission to make sure that all care homes meet a set of requirements otherwise they are not deemed as suitable. They do this by inspecting every registered service at least once every two year. This then means looking at what they can do to improve and reflect on strategies that can be put into place if abuse is occurring. Disability Discrimination Act 1995- Gives people with disabilities the rights in the areas of: employment, education, access to good, facilities and services, including larger private clubs and transport services, buying or renting land or property, including making it easier for people with disabilities to rent property and for tenants to make disability-related adaptions, functions of public bodies, for example issuing of licences. Promoting equal opportunities. (nidirect government services , 2013) DBS

The disclosure and barring service helps employers make safer recruitment decisions and prevent unsuitable people working with vulnerable adults and children, this replaces the CRB and ISA. Working Strategies

POVA: Protection of Vulnerable Adults
Applies to anyone working in are, people who provide care and people on placements. List of care workers who are abused.  Aims are to: ensure that the department holds the information it needs to support the decisions it has made, ensure that the record reliably included all the information which was actually used in or crated by the decision making process, ensure the information is not retained for longer than is necessary. An allegation may have been raised that may have hurt or placed an adult at risk- social services have a duty to look into this concern. This is done through the process of POVA (Dignity and Safety Team- Social Care Policy Division, 2010) Happens in the local community, social services will respond, if it happens in primary care the NHS Trust will respond. When an allegation is made there will be information that may be needed to be shared with people such as the police but other than this the information is only shared with the people involved in the situation.

If a concern is raised: Strategy discussion takes place where the issue of concern is discussed with relevant people. The police or social care worker may be asked to carry out the investigation. Care givers may be asked to give view of situation; this could be an interview with the police, your employer or staff from another agency who are involved in using POVA procedures. (Caerphilly Country Borough Council , 2009) Procedure for raising a protection of vulnerable adults alert: Requires: full name of individual, date of birth, last known address, National Insurance Number, conformation that the individual occupied a care position, full details of misconduct, details of investigations and conclusions, details of action taken, information if police were involved Providers must check POVA list before offering any individual employment in care. They must cease to employ that individual if they are found on the POVA list. (Community Lives, n.d.) Care Home Regulations:

Set of requirements that provide and manager care homes
Care homes must meet these requirements in order to be registered as suitable Care should be carried out
The National Care Standards Commission established under the Care Standards Act 2000, response to recommendations of the Royal Commission on Long Term Care in 1999 In April 2004 body replaced by two organisations, Commission for Social Care Inspection and Commission for Healthcare Audit and Inspection April 2009 replaced by Care Quality Commission which is exclusively responsible for monitoring health and social care in England. National Minimum Standards replaced with Compliance Guidance Criteria by 2010 (The Care Directrory , n.d.) CQC

Independent regulator of health and adult social services in England Make sure care provided by hospitals, dentists, ambulances, care homes and home care agencies are meeting guidelines Protect interests of vulnerable people including rights of people restricted under Mental Health Act Register health and adult social care services across England and inspect them to check standards are being met During inspections we ask people about experiences of care, take to carers and check that the right systems, standards and procedures are being followed. Make sure standards are being met by:

Issuing a warning notice
Restricting services that care provider can offer
Issue a fixed penalty notice
Suspend the care provider’s registration
Prosecute the care provider.
Mental Health Act Commissioners make sure that the powers under Mental Health Act are used properly. Visit patients detained to find out about their experiences. Finally they publish any statistics and findings about care homes and other health providers on their website. (Care Quality Commission, n.d.) National Service Framework

These apply to health, social services and other organisations They implement good practice so that the risk of abuse is minimalized They Cover:
-Mental Health
-Older people
-Long term conditions
The NSF for older people ensures that they are treated with respect, prevents unnecessary hospital admissions and supports early discharge, reduces long term illness by providing specialist care and tries to promote healthy lifestyles and independence for those in older age. Staff must have confidence in working with older people so that their behaviour does not lead to a situation that looks like discriminatory practice. Staff should be fully involved

All members of the local health and social care community should use communication skills to work with carers and elderly people (Health, 2001)
Decision making processes and forums:
Everyone understands what is happening and there are monthly meetings that encourage the sharing of ideas so that the best standards and conditions can be put in place for each individual service user. Organisational Policies Training

Clear guidelines about expected behaviour, service users know what is acceptable and when to recognise that they are being abused. Training for staff is provided as soon as possible so the best care can be provided. Whistle Blowing

When a member of staff whistle blows it means they have witnessed another member of staff abusing a service user. This is protected by The Public Interest Disclosure Act 1998 which ensures that staff does not suffer from any negative consequences on raising concern or complaining. Working Procedures:

Assessment of needs
Care planning
Person-centred planning
Written and oral communications
Information shared between professionals so everyone has a clear understanding of a particular situation Anti-discriminatory Practice
Procedures for Protection:
Advocacy
Lines of reporting
Confidentiality
Actions to take in event of disclosure
Rights of service users
Recording and reporting requirement
Actions to take if abuse is suspected.
Reducing the Risk of Abuse:
Family life and community’s prevention:
-Safer community’s strategies
-‘Stay safe’ initiative
-Care Plans
-Vigilant neighbourhoods
Multi-agency working

This is partnership working between the service users and the professionals and organisations i.e the doctor and the patient. This joint working encourages the sharing of information and a working partnership. There are many benefits to multi-agency working including: earlier identification of any issues, improved achievement, more expertise on a particular experience and better quality services. But alongside these benefits come many disadvantages such as: it is hard to always identify the people who need to be involved, it is a very time consuming process and sometimes it can be hard to persuade people to become part of the collaboration. If senior members of staff are involved in multi-agency working it can increase their work load dramatically, this means that they are met with demanding workloads which can then lead to mental illness.

It is noted that the lack of time is the main reason that multi-agency working does not always take place. Decision making groups: This is where different agencies meet in order for them to discuss the situation and to make strategic decisions on what to do next. This can be time consuming and brings together education, social services, health services and other things such as the police. This would be needed if a child was being abused because they would need to consult social services if a child was at risk in their own home, education services such as teachers to talk about any specific changes to the child’s regular pattern and health care in the extent of the abuse. (Atkinson, 2002)

Case Study: Victoria Climbe
April-June 1999- When Victoria arrived from the Ivory Coast to live with her aunt she is given the name Ann due to the name on her fake passport, her aunt takes a job as a hospital cleaner. Some weeks into living in the UK Victoria and her aunt got on the bus together, this led to them meeting Carl Manning (the bus driver) for the first time. July 1999- Victoria and her aunt move into Carl Manning’s house, within days Victoria would be suffering abuse. 14 July 1999- Victoria makes her first visit to the Middlesex Hospital after suspicions of non-accidental injuries. The doctor accepts her aunt’s story that the wounds were caused by her scratching at scabies sores. Doctors alert child protection and Lisa Arthurworrey and PC Karen Jones are assigned to the case. They cancel a home visit scheduled for 4th August after hearing the story. 24 July 1999- Victoria is taken to North Middlesex Hospital’s causality department with scalding’s on her face.

Her aunt tells the social worker and police woman that she poured hot water over Victoria to stop her scratching her scalp and that she caused the injuries herself using utensils. 6 August 1999- The story is accepted by child protection and Victoria is discharged from hospital. October 1999- Evidence reveals that from October 1999 to the January, Carl Manning is forcing Victoria to sleep in a bin liner in the bath every night. 1 November 1999- Aunt tells social workers that Carl has sexually assaulted Victoria but withdraws this accusation the next day. PC Jones is asked to investigate the situation but no further action is taken. 24 February 2000- Victoria s rushed to hospital suffering with malnutrition and hypothermia, she is transferred to the Intensive Care Ward 25 February- Victoria is declared dead.

(Anon., 2003)
If multi-agency procedures had gone through correctly then when the doctors informed social services they should have took further action. If suspicions had arisen it should have been essential that child protection agencies should have gone to the home and spent more time investigating. The situation should have been investigated further when her aunt claimed that Carl Manning had sexually abused her despite withdrawing her statement. The police should have investigated to see what caused her to make an accusation. The only people who followed mutli-agency procedures were health services who informed child protection services. If they had done their job correctly Victoria Climbie would not have died. Supportive relationships in reducing the risk of abuse

Patient Empowerment
Provision of aids, for example if they need an interpreter or assistance with eating and drinking they have the correct equipment. For example if a service user is deaf and requires an interpreter giving them one will allow them to feel as though they are more in charge of their own care. It will also help to make sure they are getting the best possible experience which means they will be happy. If a happy atmosphere is created then the risk of abuse will be reduced as care givers will feel less stressed due to them having a lighter work load. Minimising the impact of disability, making sure that the service users does not feel like they are a burden. Maximise decision making: including people using the system into decisions about their own health and service. Disempowerment can lead to frustration and isolation of the service user. If a service giver a forcing a service user to do something due to them being under stress due to not having enough support it could lead to the service user being distressed.

Care environment:
Identify patients who are at a greater risk, if they need assistance, have higher communication needs, respecting their dignity and privacy. Which wards/service users present a greater risk

How are carers identified
How use of restriction and restrain is governed (Manson, n.d.) How can abuse be prevented?
Communication – Support with families and regular contact Working Together- Right personality, share giving responsibilities to relieve stress, learn about community sources that are available. For example if a care giver is caring for someone with a demanding and difficult disease such as dementia it is better for them to share the responsibilities with their co-workers. Stress is defined as the way you feel when you are under a lot of pressure, when you are stressed you are more likely to become ill-mannered, indecisive and frustrated, this could then lead to neglecting or abusing a service user as you may not be able to deal with the pressure. (Mental Health Foundation, n.d.) Taking Care of You- Regular time for yourself, including breaks between long shifts and support groups if work gets too much. Strengthen Relationships- Keeping in touch with family members, trying to maintain any old traditions within the care setting. (BC, January 2014) Person Centred Care: To ensure older people are treated as individuals and receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social service boundaries. Listen to old people

Respect Dignity
Recognise Individual Differences and specific needs
Enable older people to make informed choices
Involve and support carers whenever necessary
(Health, 2001)

References
Anon., 2003. Timeline: Victoria Climbie. [Online]
Available at: news.bbc.co.uk/1/hi/uk/2062590.stm
[Accessed 21 11 2014].
Atkinson, M. W. A. S. A. D. P. K. K., 2002. mult-agency working: a detailed sutdy. [Online] Available at: www.nfer.ac.uk/publications/CSSO2/CSSO2.pdg
[Accessed 21 11 2014].
BC, H. L., January 2014. Elder Abuse Prevention Series. Number 93b , s.l.: Health Link BC . Caerphilly Country Borough Council , 2009. Protection of Vulnerable Adults. [Online] Available at: caerphilly.gov.uk/pd/Health_SocialCare/Pova_Staff_Allegations.pdf Care
Quality Commission, n.d. What We Do. [Online]

Available at: www.cqc.org.uk/content/what-we-do
[Accessed 3 September 2014].
Community Lives, n.d. Protection of Vulnerable Adults Scheme: Summary of Procedures. [Online] Available at: www.communitylives.co.uk/consortium/making_the_consortium_better/documents/Appendix5-SummaryofPOVAprocedures.pdf Del Roy Fletcher, Alan Taylor, Stphen Hughes, Jonathan Breeze, 2001. Recruiting and Employing Offenders: The Impact of the Police Act, s.l.: Josepth Rowntree Foundation. Department of Health, 2002. Care Homes for Older People: National Minimum Standards , London: TSO . Dignity and Safety Team- Social Care Policy Division, 2010. Protection of Vulnerable Adults Scheme Record Retention and Disposal Policy. [Online] Available at: http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215956/dh_121571.pdf Equality and Human Rights Commission, 2014. The Human Rights Act. [Online] Available at: www.equalityhumanrights.com/your-rights/human-rights/what-are-human-rights/human-rights-act [Accessed 7 May 2014].

gov.uk, 2010. Equality Act 2010. [Online]
Available at: www.leglistation.gov.uk/ukpga/2010/15/introduction Health, A. M. S. o. S. f., 2001. National Service Framework for Older People, s.l.: Department of Health. Independant Safeguarding Authority, 2006. The Safeguarding Vulnerable Groups Act 2006. [Online] Available at: www.coventry.gov.uk/download/downloads/id/6383/safeguarding_vulnerable_groups_act_2006_factsheet Manson, S., n.d. Safeguarding Adults and the NHS, s.l.: Department of Health. Mental Health Foundation, n.d. Stress. [Online]

Available at: www.mentalhealth.org.uk/help-information/mental-health-a-z/S/stress [Accessed 21 11 2014].
NHS, n.d. Mental Capacity Act. [Online]
Available at: www.nhs.uk/CarersDirect/moneyandlegal/legal/Pages/MentalCapacityAct.aspx