Principles of safeguarding and protection

1. Know how to recognise signs of abuse

1.1 Define the following types of abuse:

According to the Oxford English Dictionary the term abuse can be generically described as to ‘Use or treat in such a way as to cause damage or harm’.

With that in mind, it can be easy to understand that vulnerable people, such as those in social care settings, the elderly, the young and the infirm, may be open to several types of abuse because of their dependence on others. However, it is important to note that anyone, of any age, gender, ethnicity, ability and social standing can be a victim of abuse.

• Physical Abuse

This type of abuse is causing harm to another through the medium of direct bodily contact. Such as hitting, biting, scratching, pushing, hair pulling, rough handling etc.
It can also mean making someone physically uncomfortable. For example, burning, scalding, illegal or forceful restraining, isolating, confining, over medicating (over sedation), force feeding, withholding both food and water etc.

• Sexual Abuse

Sexual abuse is where any sexual activity takes place whereby the victim does not consent or lacks the capacity to consent. Such as rape, attempted rape, sexual assault, inappropriate touching, inappropriate looking, inappropriate teasing and innuendo, harassment, non-consensual sexual acts involving mouth, anus and vagina, non-consensual masturbation (either by or to the victim). Further in the eyes of the law, even if the sexual act is wholly consensual, should one of the parties be below the age of consent, then that would constitute Statutory Rape, which in effect would be sexual abuse.

• Emotional/Psychological Abuse

‘Emotional, psychological and mental abuse are often closely linked terms that can be used interchangeably. The aim of the perpetrator of emotional abuse… is to reduce confidence and esteem in order to make their victim increasingly reliant on them. They use tactics such as intimidation, bullying, constant criticism and keeping someone isolated from family and friends in order to exert control. Emotional abuse… is often a means of controlling the victim by having a strong mental hold over them.’
Living Without Abuse. Emotional, Pschological and Mental Abuse (online).

Other examples of this abuse are (and are not limited to): name calling, leaving someone unattended when they need assistance, removal of communication aids, removal of mobility, not allowing someone to express their religious or cultural needs, cyber bullying, name calling and swearing, threats of abandonment and harm, withholding stimuli etc.

• Financial Abuse

Financial abuse covers any act whereby the perpetrator restricts, limits, or takes monies or assets from the victim surreptitiously or without consent. Examples include:

Theft of money or possessions.
Fraud, scamming, preventing a person from accessing their own money, benefits or assets.
Employees taking a loan from a person using the service.
Undue pressure, duress, threat or undue influence put on the person in connection with loans, wills, property, inheritance or financial transactions.
Arranging less care than is needed to save money to maximise inheritance.
Denying assistance to manage/monitor financial affairs.
Denying assistance to access benefits.
Misuse of personal allowance in a care home.
Misuse of benefits or direct payments in a family home.
Someone moving into a person’s home and living rent free without agreement or under duress.
False representation, using another person\’s bank account, cards or documents.
Exploitation of a person’s money or assets, e.g. unauthorised use of a car.
Misuse of a power of attorney, deputy, appointeeship or other legal authority.
Rogue trading – eg. unnecessary or overpriced property repairs and failure to carry out agreed repairs or poor workmanship
Social Care Institute for Excellence. Adult safeguarding: Types and indicators of abuse (online)

• Institutional Abuse

Institutional abuse is the maltreatment of a person (often children or older adults) from a system of power.
Powers, J. L.; A. Mooney; M. Nunno (1990).

This type of abuse is the systematic mistreatment of people who are living within a care setting, such as a care home, residential school, hospital etc. It is born out of poor and/or inadequate care and support. Where the operational needs of the organisation supersede the individual requirements and desires of the residents.

Examples of institutional abuse are rigid routines. No flexibility on bed or waking times. Discouraging visitors. Over sedation. Not allowing victims a choice in food and activities. Restricting personal clothing or possessions. Speaking to the victim in a patronising manner. Isolation. The use of un-prescribed medications and practices. Deprivation of living areas etc.
Run-down or overcrowded establishment. Authoritarian management or rigid regimes.
Lack of leadership and supervision. Insufficient staff or high turnover resulting in poor quality care. Abusive and disrespectful attitudes towards people using the service. Inappropriate use of restraints. Lack of respect for dignity and privacy. Failure to manage residents with abusive behaviour. Not providing adequate food and drink, or assistance with eating. Failure to provide care with dentures, spectacles or hearing aids. Not taking account of individuals’ cultural, religious or ethnic needs. Failure to respond to abuse appropriately. Interference with personal correspondence or communication. Failure to respond to complaints.

• Self Neglect

Definitions of self-neglect:

‘Whilst there is currently no standard definition of self-neglect… research has suggested that there are three recognised
forms of self-neglect which include:
• Lack of self-care – this may involve neglecting personal hygiene, nutrition and
hydration or health…
• Lack of care of one’s environment – this may result in unpleasant or dirty
home conditions and an increased level of risk in the domestic environment
such as health and safety and fire risks associated with hoarding…
• Refusal of services that could alleviate these issues – this may include the
refusal of care services, treatment, assessments or intervention, which could
potentially improve self-care or care of one’s environment.’
Self-Neglect Guidance. North of Tyne. (2016)

Self-neglect, may at times be rather subjective. For what seems acceptable to one person, may not be to another. Freedom of choice is another cause for concern. So varying factors need to be considered. Such as the mental and physical health issues of the individual concerned.

• Neglect by Others

Vulnerable people rely on others, and so, they may be at risk of neglect. Neglect by others is where they are not receiving the care or attention that they require, in order to lead a healthy, fulfilled life.

Examples of neglect by others would be: Failure to provide access to food, shelter, clothing, heating, stimulation and activity, personal or medical care. Providing care in a way that the person dislikes. Failure to administer medication as prescribed. Refusal of access to visitors. Not taking account of individuals’ cultural, religious or ethnic needs. Not taking account of educational, social and recreational needs. Ignoring or isolating the person. Preventing the person from making their own decisions. Preventing access to glasses, hearing aids, dentures, etc. Failure to ensure privacy and dignity.

It is important to recognise the difference between active and passive neglect. Active neglect is premeditated, it is born out of frustration, anger, manipulation. Passive neglect is a product of ignorance, lack of experience and/or inability. Passive neglect is not malicious. And so, requires extra support and education provision to the care giver, in order to facilitate the needs of the vulnerable care receiver. In fact, it may be argued, that allowing an incompetent person to provide care to another, can be seen as inherent neglect by the authorities. Measures must be taken to ensure that all care givers are qualified, monitored and able.

One recurring undercurrent that is evident in abuse in the Health and Social Care Sector is that the types of abuse can overlap. There is no clear-cut divide, and an individual may fall victim to several definitions of abuse simultaneously. Consequently, it is important to recognise the symptoms of abuse. So that when there is cause for concern, the issues can be highlighted and addressed as effectively and quickly as possible.

1.2 Identify the signs and/or symptoms associated with each type of abuse
Signs of abuse can vary and are multiple, depending on the catagorisation of abuse and the setting. Following are examples for each of the afore-mentioned.

Physical Abuse
No explanation for injuries or absence of uniformity with the account of what happened. Injuries do not tally with the person’s lifestyle. Bruising, cuts, welts, burns and/or marks on the body or loss of hair in clumps. Repeated injuries. Unexplained falls. Downcast or changed behaviour in the presence of a specific person. Signs of malnutrition. Failure to pursue medical treatment, or frequent changes of GP.

Sexual Abuse
Bruising, predominately to the thighs, bottoms, upper arms and neck. ripped, blemished or blood stained underclothing. Bleeding, pain or itching in the genital area. atypical effort in walking or sitting. Foreign bodies in genital or rectal openings. Infections, unexplained genital discharge, or sexually transmitted diseases. Pregnancy in a woman who is unable to consent to sexual intercourse. Unexplained incontinence. Self-harming. Poor concentration, withdrawal, sleep disturbance. Excessive fear/apprehension of, or withdrawal from relationships. Fear of receiving help with personal care. Reluctance to be alone with a specific person.

Emotional/Psychological Abuse
Withdrawal or change in the psychological state of the person. Insomnia. Low self-esteem. Uncooperative and aggressive behaviour. A change of appetite, weight loss/gain. Signs of distress: tearfulness, anger.

Financial Abuse
Missing personal possessions. Unexplained lack of money or lack of ability to sustain lifestyle. Unexplained withdrawal of funds from accounts. Power of attorney or lasting power of attorney (LPA) being obtained after the person has ceased to have mental capacity. Failure to register an LPA after the person has ceased to have mental capacity to manage their finances, so that it appears that they are continuing to do so. The person allocated to manage financial affairs is evasive or uncooperative. The family or others show unusual interest in the assets of the person. Signs of financial hardship in cases where the person’s financial affairs are being managed by a court appointed deputy, attorney or LPA. Recent changes in deeds or title to property. Rent arrears and eviction notices. A lack of clear financial accounts held by a care home or service. Failure to provide receipts for shopping or other financial transactions carried out on behalf of the person. Disparity between the person’s living conditions and their financial resources, e.g. Insufficient food in the house. Unnecessary property repairs.

Institutional Abuse
Lack of flexibility and choice for people using the service. Inadequate staffing levels. People being hungry or dehydrated. Poor standards of care. Lack of personal clothing and possessions and communal use of personal items. Lack of adequate procedures. Poor record-keeping and missing documents. Absence of visitors. Few social, recreational and educational activities. Public discussion of personal matters. Unnecessary exposure during bathing or using the toilet. Absence of individual care plans. Lack of management overview and support.

Self Neglect
Very poor personal hygiene. Unkempt appearance. Lack of essential food, clothing or shelter. Malnutrition and/or dehydration. Living in squalid or unsanitary conditions. Neglecting household maintenance. Hoarding. Collecting a large number of animals in inappropriate conditions. Non-compliance with health or care services. Inability or unwillingness to take medication or treat illness or injury.

Neglect from Others
Poor environment – dirty or unhygienic. Poor physical condition and/or personal hygiene. Pressure sores or ulcers. Malnutrition or unexplained weight loss. Untreated injuries and medical problems. Inconsistent or reluctant contact with medical and social care organisations. Accumulation of untaken medication. Uncharacteristic failure to engage in social interaction. Inappropriate or inadequate clothing.

1.3 Describe factors that may contribute to an individual being more vulnerable to abuse
There are many factors that contribute to a person being vulnerable to abuse. A person suffering from abuse may be less aware of their rights, may be socially isolated, may need help with personal care and daily living.
They may live in poor housing. They may need more care than their carer can give. They may have difficulty understanding requests or actions. They may not know how to complain
Further, a vulnerable person may not be able to express themselves clearly, may have limited sex education and/or may have to share a home with people they have not chosen to be with.
They may receive support from several different carers. There may be a history of substance misuse. They may be in a relationship of unequal power, such as a domineering spouse or partner. They may be in unsuitable housing with no aids or adaptations specific to their needs. They may have limited life experiences and so not recognise risky situations.

2. Know how to respond to suspected or alleged abuse
Indications of a person experiencing abuse, may be difficult to recognise. However, certain red flags such as changes in personality and behaviour may facilitate the suspicion of abuse.
For example you may see signs of self harm, deteriorating health, lack of finances, unexplained marks, like bruising. You may also notice changes in appearance and personality, such as being withdrawn, angry, clingy and/or scared.

2.1 Explain the actions to take if there are suspicions that an individual is being abused.
If a Community Care worker suspects abuse of a vulnerable person, they should reassure the individual, tell the individual that it is necessary to report the incident/s. Take a record of their words and take evidence, where possible (for example, dates and times), and report directly to their line manager. It is important to follow company policy and procedure, and make a signed and dated written statement of all concerns.

If the person in question is unable to communicate effectively (dementia, confusion, mental health issues etc), it is essential to record all suspicions, take evidence, where appropriate (for example photographs), and inform the line manager immediately. It is of paramount importance to ensure that any reporting is followed up. Ask if it was investigated. Alternatively report any concerns on insufficient action taken, to the Care Quality Council.

2.2 Explain the actions to take if an individual alleges that they are being abused.
It is important to report the alleged abuse to the appropriate person, i.e. your line manager. Record the facts on appropriate paperwork; listen and do not judge. Reassure the individual, and take every allegation seriously. Always date the paperwork and have it signed by any witnesses, if any. Take photographs of evidence if possible. Speak clearly and precise and avoid any leading questions.

2.3 Identify ways to ensure that evidence of abuse is preserved.
Always record the facts immediately Report evidence immediately to your line manager. Do not tamper with any evidence. Try to ensure that no one else enters the premises or alleged scene of crime until the police arrive. If possible, try and ensure that the alleged perpetrator does not have any contact with the victim. Record any physical signs or injuries, including size, shape, colour etc. Always remember to sign and date your notes and any other records you have made.

3.1 Identify national policies and local systems that relate to safeguarding and protection from abuse.
Safeguarding is everyone’s responsibility and all staff who, during the course of their employment have direct or indirect contact with children and families and vulnerable adults, or who have access to information about them, have a responsibility to safeguard and promote the welfare of children and vulnerable adults.

There is a duty on organisations to make appropriate arrangements to safeguard and promote the welfare of children and vulnerable adults. Also government guidance makes it clear that it is a shared responsibility, and depends upon effective joint working between agencies and professionals that have different roles and expertise.

The statutory inquiry into the death of Victoria Climbié and the first joint Chief Inspectors report on safeguarding children highlighted the lack of priority status given to safeguarding. The government response to these findings included the Green Paper Every Child Matters and the provisions in the Children Act 2004. Section 11 of the Children Act 2004 places a duty on all agencies to make arrangements to safeguard and promote the welfare of children. The Health and Social Care Act 2008 also places statutory duties on organisations and individuals.
Safeguarding and promoting the welfare of children, young people and vulnerable adults is not just the province of those working directly with these groups of people.