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Safeguarding health and social care

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A Define the following types of abuse and identify the signs and/or symptoms associated with each type of abuse

The Department of Health has defined abuse as “Abuse is a violation of an individual’s human and civil rights by any person or persons” (No Secrets 2000). There are many different types of abuse and individual cases of abuse usually involve a different combination of these different types. (i) Physical abuse

Refers to hitting, slapping, scratching, pushing or rough handling of another person. It can also involve assault and battery either with the hand or another object. Restraining persons without out justifiable reason and misuse of medication are also forms of physical abuse. Inappropriate sanctions including deprivation of food, clothing, warmth and health care needs Some of the symptoms include a history of unexplained falls or minor injuries especially at different levels of healing. Unexplained bruising especially in well protected areas of the3 body,e.g. on the inside of thighs or upper arms. Burn marks of unusual type. A history of frequent changes of general practitioners or reluctance in the family, carer or friend towards a consultation. An accumulation of medicine which has been prescribed for a client but not administered. Malnutrition, ulcers, bed sores and being left in wet clothing. Lastly a reluctance to be left alone with the abuser. (ii) Sexual abuse

Sexual abuse involves sexual activity which a person (adult) has not consented to or been pressured into. All form of sexual activity with children is abuse as they are under the age of consent. Sexual activity which takes place when the adult is unaware or has the capacity to be aware of the consequences or risks involved. Rape, sexual assault and masturbation plus sexual harassment are further forms of sexual assault. Lastly there are forms of non-contact sexual abuse e.g. voyeurism and pornography Some of the signs and indicators of sexual abuse include unexplained changes in the behaviour, a tendency to withdraw and spend time in isolation. Reluctance to be left alone with the alleged abuser.

Expression of explicit sexual behaviour and/or language which is out of character. Irregular and distributed sleep patterns. Bruising or bleeding in the recital or genital areas. Sexually transmitted disease or pregnancy where the individual cannot give consent to. (iii) Psychological abuse

Psychological is a variety of behaviour that hurt or injure another person’s feelings or emotional state. They include emotional abuse, verbal abuse humiliation and ridicule. Threats of punishment, intimidation, blackmail or exclusion from services. Isolation or withdrawal from services or supportive networks and lastly deliberate denial of religious or cultural needs. Some of the indicators of this type of abuse include the inability of the person to sleep or tendency to spend long periods in bed. A loss of appetite or overeating at inappropriate times. The individual may display anxiety, confusion or a general air of resignation and become withdrawn. Other behavioural sign include fearfulness and signs of loss of self-esteem, in the other extreme uncooperative and aggressive behaviour.

(iv) Financial Abuse
The misuse or theft of money from an individual is an obvious form of financial abuse, but it can also include fraud and extortion of material assets, the misuse or misappropriation of property, possessions or benefits and exploitation or pressure in connection with wills, property or inheritance. Some of the signs of this form of abuse can include an unexplained inability to pay for household bills, withdrawal of large sums of money which cannot be explained. Also missing personal possessions and a disparity between the persons living conditions and their financial resources.

(v)Institutional abuse
Institutional abuse can include any of the different forms of abuse identified but is classed separately because the abuse is usually accepted or ignored by the organisation and the abuse occurs within the care setting. Institutional abuse is systematic of poor care standards inadequate staffing levels, poor training and skills. This can manifest itself in poor treatment programmes, for example overmedication, improper use of restraint, with holding food or drink, restriction of information an removal of persons right to self-determination.

(v) Self-neglect
Self-neglect is any failure of an adult to take care of themselves that causes or is reasonable to cause serious physical, mental or emotional harm or substantial damage to or loss of possessions. This self-neglect can be caused as a result of the adults choice of lifestyle or as a result of depression or poor health. Signs of self-neglect are typically the absence of food, clothing and other basic amenities, tattered or lack of clothing.

(vii) Neglect by others
Neglect occurs when a health professional, carer or family member fails to provide the level of support or care that that person needs. This neglect can be deliberate or as a result of ignorance of required standards and practices. Again this neglect can result in the failure to meet the person’s physical, medical, nutritional, educational, emotional or social needs. Signs of this form of abuse include a deterioration of the person’s medical condition, hypothermia, unhygienic and hazardous environment, unexplained weight loss and withdrawal.

(b) Describe factors that may contribute to an individual being more vulnerable to abuse
(i)a setting or situation
In more recent years there has been a lot more emphasis placed on the prevention of abuse and part of this strategy includes the identification of who and why someone is more at risk than another. There are a variety of situations which will increase the likelihood of abuse. Institutional/service factors

Benbow (2008) indemnified common risks factors in cases of institutional abuse. They included, Low staffing levels and/or high use of agency staff
A geographically isolated service
A neglected physical environment
Weak management
Lack of practice leadership
Lack of policy awareness and training.
Family carers
Choi and Mayer (2000) identified that adult children are the most frequent abusers of older adults. Some of the risk factors they highlighted are Stress
Substance abuse
Mental illness of carer
Social isolation (those with less family support)
Living alone

(ii) Individual
It is widely acknowledged that those with learning disabilities are at risk from all types of abuse ( Bruder and Kroese 2005). Even within this broad group there are additional risk factors Those with poor social skills and judgement

Those with poor communication skills
Physical dependence (e.g. need for help with personal hygiene and intimate body care) Those with a lack of education about appropriate sexual behaviour Those with a lack of knowledge about how to defend against abuse Women with a psychiatric diagnosis are more at risk of sexual abuse

In general for older people a UK survey in 2000 of people aged 66 and over living at home found that the risk factors increased when Person was aged 85 and over
Suffering bad health
Suffering depression
Being female

Other studies in care institutions (de Hart2009) found those at increased risk where Quiet, disorientated and unable to communicate
Be isolated having few visitors
Non-compliant, demanding or to have difficult or challenging behaviour

2 Know how to respond to suspected or alleged abuse
(a) Explain and expand on the actions to take if there are suspicions that an individual is being abused or an individual alleges that they are being abused:

(i) Protect
A carers underlying duty should be to ensure that the individual is safe from abuse, feels comfortable and safe to report the abuse to you. This may involve removing the individual into an environment where that feel comfortable away from alleged abuser if necessary or to an area where confidentiality can be ensured. A carer should also consider the need for any emergency or medical action needed and the risk of repeated or escalating abuse. It is important to stay calm and listen carefully. Be sympathetic and reassure the individual that they have done the right thing by telling you and that you will inform the appropriate person. (ii) Report

All carers have a moral and professional duty to report any witnessed or suspected abuse to their line manager. Be aware of the reporting procedure of your organisation and follow it. If your line manager is in some way involved in the abuse, the procedures should indicate who exactly to report the incident to. In the case of institutional abuse within your organisation you should refer to the whistleblowing policies as it may involve reporting incident to the social worker or the police.

(iii) Preserve
It is important to realise the possibility that the alleged abuse could be a criminal offence. It is important not to destroy any physical or forensic evidence and to as far as possible leave the scene of the abuse undisturbed, with the exception of removing the victim of the abuse. You should not remove for example bedding, clothing and in the case of sexual abuse try to refrain the victim from removing forensic evidence by washing, again reassurance should be given.

(iv) Record and refer
At the first opportunity anyone suspecting abuse should make a note of the disclosure and date and sign your record. This report should as far aas possible Note what the person or people actually said using their words and phrases Describe the circumstances in which the disclosure came about Note the setting and anyone else who was there at the time

Separate factual information from your own opinions
Use a pen so that the report can be photocopied
Be aware that your report may be required later as part of a legal action or disciplinary action Be aware that you may have to make a more detailed referral report to another agency

(b) Identify ways to ensure that evidence of abuse is preserved

It is important as mentioned previously to ensure any forensic or physical evidence is preserved. Thais may involve Making sure clothing, bedding etc. are not removed or washed As few people as possible contaminate the scene of the abuse The victim refrain from washing so forensic evidence is preserved Any communication books detailing daily care that may make reference to previous incidents are not removed Any other physical evidence is not removed for example financial papers or medication That you write down as soon as possible what the victim has told you A list of other witnesses or persons present

If the scene of the abuse is in danger of being compromised photograph as much as possible

3 Identify the national and local context of safeguarding and protection from abuse

(a) Identify national policies and local systems that relate to safeguarding and protection from abuse. In 2000 the department of Health issued guidance (No Secrets) on development and implementation of multi-national policies to protect adults from abuse. From this framework within Northern Ireland more detailed policies embracing this right based, multi-disciplinary, inter-agency approach was detailed in safeguarding Vulnerable Adults 2006, the Regional Adult Protection Policy and Procedural Guidance 2006 and the associated Joint Protocol (revised 2009). This has resulted in the formation of the Northern Ireland Adult Safeguarding Partnership (NIASP) and 5 Local Adult Safeguarding Partnership (LASP’s), one for each of the Health and Social Care Trust areas.

The NIASP consists of a chair and 24 members from all those involved in providing, protecting and managing adult protection, including Health and Social Care Board, the Public Health Authority, Police Service for Northern Ireland, Probation Board for Northern Ireland, Social Security Agency, Northern Ireland Housing Executive and providers of sheltered housing, independent private sector providers of health and Social Care, the Patient and Client Council and other members form the voluntary, community and private sector groups. The LASP’s are made up of members from the main statuary, voluntary, community organisations and service providers with each Health and Social Care Trust area.

(b) Explain the roles of different agencies in safeguarding and protecting individuals from abuse In Northern Ireland the NIASP was set up to develop a strategic approach to safeguarding adults and within this the Health and Social Care and the criminal justice agencies have a lead role. In conjunction with the 5 LASP’s a 3-5 year strategic safeguarding Plan for Northern Ireland is agreed and implemented and together both organisation established and provide support for Adult safeguarding Forums. The NIASP also has overall responsibility for developing, reviewing operational policies and procedures for this integrated approach.

They also are responsible for raising awareness of abuse within Northern Ireland, implementing continual improvement and for conducting Serious Case Reviews. The LASP’s are responsible for the implementation of the NIASP guidance, operational policy and procedures in the Strategic Safeguarding Plan. They achieve this through work the different agencies both local and national, for example the Northern Ireland Social Care Council, PSNI and locally the Western Health Trust. This mixture of local and national multi –disciplinary, inter agency approach ensures a uniform co-ordinated approach to safe guarding venerable adult throughout the whole of Northern Ireland.

(c) Identify Reports into serious failures to protect individuals from above. As mention before national Safeguarding Boards have the responsibility to conduct Serious Case Reviews into circumstances where there has been a serious failure to protect vulnerable adults. This enables a multi-agency investigation and ensures that any recommendation are implemented across the board. In July 2012 the South Gloucester Safeguarding Adult Board conducted a serious case review into abuse at Winterbourne Hospital following a documentary expose. Following the conviction of 11 staff members the serious Case review report was published in July 2014.This report identified many failings both with in the hospital and within other agencies tasked with protection of adults, i.e. police, hospitals and social workers. Failure to have challenging policy and procedures

Inadequate training
Failure of management
Failure to spot a pattern of abuse
The report also published recommendations some of which have already been implemented.

On a local level the Northern Ireland Adult Safeguarding Partnership conducted a Serious Case Review published in March 2014 into Trevor Hamilton a high risk sex offender who whilst under supervision form prison in 2003 abducted and murdered a pensioner Mrs Attracta Harron. Again this was a multi-agency investigation but focused on the Police Service for Northern Ireland, the NI Probation Board and the Prison Service for NI. It identified major failings in how the sex offender was assessed and supervised. As a result many of the individual recommendations published in this report have been implemented, e.g. Multi Agency Procedures for the Assessment and Management of Sex Offenders Nov 2005.

(d) Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse. There are many places to obtain advice and support in understanding my own role in protecting individuals from abuse. Within my own organisation they have very detailed policies and procedures regarding abuse e.g. Financial Policy and Procedure, and these policies are available for all support workers at all times for consultation. In addition the support worker can refer back to the training he or she has completed e.g Management of challenging behaviour training by studio III, for additional information. Support worker can also contact a senior support worker or their manager if they require additional advice and this is actively encouraged within the organisation. There are also a number of useful websites,

4 Understand ways to reduce the likelihood of abuse

(a) Explain how the likelihood of abuse may be reduced by
(i) Working with person centred values- comment on each of the following Individuality
Everyone is unique and will have unique needs, unique personality, unique mental or physical ability, unique life experiences and unique morals or beliefs. It is important that the care package is tailored to suit each individual and their wishes, beliefs, morality, physical and mental needs are reflected. This will help to ensure that there is no unintentional abuse and no one size fits all approach. Rights

Active carer and support staff training and awareness of the legislative rights of individuals and embodiment of those rights into the organisations policies can go a long way to reduce the risk of abuse. These rights are protected in various legislation e.g. the Equality Act 2010, Human Rights Act 2000 and the Mental Capacity Act 2005. As important it is important that these rights are communicated to the individual and their families, this is usually part of a strategic approach from the national safeguarding boards Choice

The provision of accurate and easily digestible information to the individual regarding their human, financial, legislative and health and social care right can help them to make a more informed choice about their overall care package. On a more personal level enabling the individual to make daily decisions about their daily or weekly needs can give them a sense of ownership of their care package and help to ensure support worker do not infringe their basic human rights.

Under the Data Protection Act 1998 the individual privacy rights are protected under law. Ensuring that an individual’s personal details, including social care package, financial and medical records are kept private and only shared with those who have a need to know or with their consent is a fundamental requirement of any social care provider. All support workers need to be made aware of this plus the organisations policies and procedures to ensure they do not infringe on these rights.

Promoting independence in social care is paramount in ensuring that their individual needs, wishes and human rights are not infringed. Informing and supporting individuals independence is enshrined in the Human Right Act 2000 and the Mental Capacity Act 2005. This approach promotes well-being in individuals. Dignity and respect

Dignity and respect are the essential foundations for the involvement of people in their own care. Treating individuals with the dignity you would expect to be treated with and respecting the individual’s lifestyle choice, decisions, religion, sexual orientation and beliefs will ensure that all support and care given are centred around the person we are supporting. Although we have a duty of care to that individual it is important to remember that under the Mental Health Act 2005, that individual has the right to make that decision even if we do not agree with the decision or that decision may pose certain risks to that individual. Partnership

Working in partnership with other effectively is essential when using this holistic person centred approach. Not only will the support worker be working in partnership with the individual they are supporting, but also in partnership with their work colleagues, the individual’s family and other health and care professionals. The communication of information among everyone we work with in partnership will ensure that support plans are up to date, well informed, in the individual’s best interests and mistakes or errors in support are not repeated.

(ii) Encouraging active participation

Empowering individuals enables them to contribute and have an influence over the issues which affect the way they live. Active participation is a way of working that recognises an individual’s right to participate in the activities and relationships of everyday life as independently as possible. The individual is regarded as an active partner in their own care support rather than just a recipient. It doesn’t matter what kind of contribution they make, just being a part of something will give them a sense of belonging, a feeling of self-worth and independence.

(iii) Promoting choice and rights
Individuals have the same rights as when they were living independently. The individual should be allowed and supported to make their own choices. As a support worker it is up to us to provide individual’s with the information to make informed decisions. The level of care and support will depend on the level of the individual’s ability and the choices they want to make. Each individual has the right to say no. as a support worker the individual’s rights against your responsibilities, but it is important to remember they also have the right to take risks. Providing individuals with empowerment to make informed choices enable them to maintain their rights of choice, equality and opportunity.

(B) Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse

If a complaints procedure is clear and easily accessible abusers would be more likely to be challenged on their behaviour. Knowing this would make them less likely to abuse. It also helps vulnerable individuals to feel more protected and more empowered and therefore less likely to accept abuse. Support workers should be open, listen and explain this policy to individuals, the provision of information and advice helps to ensure that those who abuse vulnerable individuals are held accountable for their actions.

5 Know how to recognise and report unsafe practices

(a) Describe unsafe practices that may affect the well-being of individuals including, but not limited to: Poor working practice
A support worker should be aware through their training, and their organisations policies and procedures of the standard of care required and correct and safe working practices. Such poor working practices can manifest itself in a multitude of ways. There are some notable and well publicised examples of poor working practice. The whistle blowing documentary at Winterbourne Hospital exposed a number of poor working practices, including poor challenging behaviour working practices, no procedures, incorrect physical restraint practices, verbal, physical and emotional abuse. Some of these forms of poor practice may be very evident and easy to spot, for example physical threats such as hitting, verbal abuse or neglect.

Other forms of abuse or poor practice may be slightly harder to spot such as over medication but a fully trained support worker with reference to the medication sheets should be able to pick up over medication. As the social care agenda moves further away form more institutional setting and provides a more person centred approach there are a lot more emphasis on the more recent legislation, ( Care Act 2014, Equality Act 2010, Mental Act 2005) and their implications on working practices. It is the responsibility of the organisation to retrain and update their working practices to take account of new legislation. Restrictive practices such as locking doors to toilets in a care unit whist it may not appear on the surface to be poor practice is a breach of the individuals rights and now illegal under the Care Act2014, Equality Act 2014 and the Mental Act 2005. Similarly a working practice in which individuals are not given the choice or right to make their own decisions is illegal under this new legislation and broadly termed again as restrictive practice.

Resource difficulties
Unsafe practices with regard to resource difficulties can manifest themselves in many ways but usually entails a shortage of basic amenities essential for the correct level of care needed. A shortage of incontinent pads, wipes and other essential toilet accessories is an abuse of the duty of care to that individual. Likewise a shortage of bedding, mobility aids, inadequate diet, inadequate drinks, improper infection control, poor cleaning regime and heating of the premises are signs of resource difficulties and a failure of the duty of care. Operational difficulties

A high turnover or a shortage of staff, inadequately trained staff, poor communication between staff, inadequate accurate records, confusion over the prescribing and administration of medication and a failure to comply with the regulations are all signs of operational difficulties and poor operating practices.

(b) Explain the actions to take if unsafe practices have been identified. If a support worker suspects that there are unsafe practices they should report their concerns to their immediate manager. Most organisations have a documented procedure for this which can be either an informal (verbal report) or formal (a recorded and documented procedure). My organisation have a Challenging Bad Practice At Work (Whistleblowing) procedure which details the procedure, confidentiality, investigation and reporting back to the complainer. In addition this policy also specifies the details of the individual (Chief executive) to make the allegation to depending on the seriousness, sensitivity or who is suspected of the malpractice.

(c) Describe the actions to take if suspected abuse or unsafe practices have been reported but nothing has been done in response. If you are not satisfied with the outcome of a malpractice allegation you have made or if you feel unable to report and investigate the poor practice through your own organisational procedures you have the lawful right to make a protected disclosure or receive independent advice from other authorities. These could include

Regulation and Quality Improvement Authority
Northern Ireland Social Care Council
Health and Safety Executive
Public Concern at work (UK charity)
These organisations and how to contact them are widely available on the internet.

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