Safeguarding Adults Your Responsibilities Categories of Abuse Your Role as Alerter Information Sharing The Mental Capacity Act Assessing Capacity ...
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Safeguarding Adults
Your Responsibilities
Categories of Abuse
Your Role as Alerter
Information Sharing
The Mental Capacity Act
Assessing Capacity Chart
Deprivation of Liberty
Pressure Ulcer Staging
Prevent
Capacity and Consent
Your Responsibilities
Safeguarding adults who is or may be unable to take
care of him or herself, or unable
All staff within health services have
to protect him or herself against
a responsibility for the safety and
significant harm or exploitation
wellbeing of patients and colleagues.
NB: Throughout this publication
Living a life that is free from
we have used the term ‘patient’
harm and abuse is a fundamental
to refer to patients and clients.
human right of every person
and an essential requirement
for health and well-being. Your responsibilities
when you have
Safeguarding adults is about the
safety and well-being of all patients
safeguarding concerns:
but providing additional measures • Assess the situation i.e. are
for those least able to protect emergency services required?
themselves from harm or abuse. • Ensure the safety and
wellbeing of the individual
Safeguarding adults is a fundamental
part of patient safety and wellbeing • Establish what the individual’s
and the outcomes expected of views and wishes are about the
the NHS. Safeguarding adults safeguarding issue and procedure
is also integral to complying • Maintain any evidence
with legislation, regulations and
• Follow internal procedures
delivering cost effective care.
for reporting incidents/risks
These cards should be used by • Remain calm and try not to
you as a guide should you have show any shock or disbelief
a safeguarding concern and
• Listen carefully and
should always be used alongside
demonstrate understanding
your organisations safeguarding
by acknowledging regret and
policy and procedures.
concern that this has happened
Definition of a vulnerable adult: • Inform the person that you are
required to share the information,
Aged 18 years or over;
explaining what information
Who may be in need of community
will be shared and why
care services by reason of mental or
other disability, age or illness; andYour Responsibilities
• Make a written record of what • Decisions are recorded,
the person has told you, using communicated and
their words or what you have thoroughly evaluated
seen as well as your actions • Policies and procedures
have been followed
Duty of care:
• Practitioners and managers
You have a duty of care to your
should seek to ascertain the
patients/service users, your
facts and are proactive
colleagues, your employer, yourself
and the public interest. Everyone You should always treat every
has a duty of care – it is not individual with dignity and
something that you can opt out of. respect to ensure that they feel
safe in services and empowered
The Health Professions Council to make choices and decisions.
standards state9
‘….a person who is capable of Ensure that significant others, i.e
giving their consent has the right family member, friend or advocate,
to refuse treatment. You must are involved to support the
respect this right. You must also individual where appropriate.
make sure they are fully aware However it is important to recognise
of the risk of refusing treatment, that though an individual with
particularly if you think there is a capacity has the right to refuse
significant or immediate risk to life.’ care for themselves, the duty of
Duty of care can be said to care extends to considering where
have reasonably been met others may be at risk and action
where an objective group of is needed to protect them.
professional considers. 10
You have a responsibility
• All reasonable steps
have been taken
to follow the 6
• Reliable assessment methods
safeguarding principles:
have been used Principle 1 – Empowerment -
Presumption of person led decisions
• Information has been collated
and consent
and thoroughly evaluated
Continued over...Your Responsibilities
Adults should be in control of their Principle 4 – Proportionality –
care and their consent is needed Proportionality and least
for decisions and actions designed intrusive response appropriate
to protect them. There must be to the risk presented
clear justification where action Responses to harm and abuse should
is taken without consent such as reflect the nature and seriousness
lack of capacity or other legal or of the concern. Responses must be
public interest justification. Where the least restrictive of the person’s
a person is not able to control the rights and take account of the
decision, they will still be included person’s age, culture, wishes, lifestyle
in decisions to the extent that and beliefs. Proportionality also
they are able. Decisions made relates to managing concerns in the
must respect the person’s age, most effective and efficient way.
culture, beliefs and lifestyle.
Principle 5 – Partnerships – Local
Principle 2 – Protection – Support solutions through services
and representation for those working with their communities
in greatest need Safeguarding adults will be
There is a duty to support all patients most effective where citizens,
to protect themselves. There is a services and communities work
positive obligation to take additional collaboratively to prevent, identify
measures for patients who may be and respond to harm and abuse.
less able to protect themselves.
Principle 6 – Accountability –
Principle 3 – Prevention Accountability and transparency
Prevention of harm or abuse in delivering safeguarding
is a primary goal. Prevention Services are accountable to
involves helping the person to patients, public and to their
reduce risks of harm and abuse governing bodies. Working in
that are unacceptable to them. partnerships also entails being
Prevention also involves reducing open and transparent with partner
risks of neglect and abuse agencies about how safeguarding
occurring within health services. responsibilities are being met.
(Ref: The role of Health Service
Practitioners DH 2011)Categories of Abuse
1. Categories of abuse Domestic violence and self
harm need to be considered
Physical, Psychological /
as possible indicators of abuse
Emotional, Sexual and Sexual
and/or contributory factors
Exploitation, Financial, Neglect,
Discriminatory, Institutional
2. Significant Harm
Physical: assault, rough handling, “Harm should be taken to include
unreasonable physical restraint not only ill treatment but also
Sexual and Sexual Exploitation: the impairment of, or avoidable
any non-consenting sexual deterioration in, physical or mental
act or behaviour health; and the impairment of
physical, intellectual, emotional,
Psychological/Emotional: bullying, social, or behavioural development”
intimidation, verbal attacks, or Law Commission 1995.
other behaviour that affects the
well-being of an individual 3. Whistle blowing
Neglect: a person’s well-being is Always act whenever abuse is
impaired and care needs not met suspected including when your
legitimate concern is not acted
Discrimination: psychological abuse
upon. Whistle blowers are given
that is racist, sexist or linked to a
protection under the Public
person’s sexuality, disability or age
Interest Disclosure Act 1998.
Financial: theft, fraud,
If in doubt contact your nominated
misappropriating funds i.e.
lead for adult safeguarding
when using a person’s money
for self gain or gratification
Institutional: Observed lack of
dignity and respect in the care
setting, rigid routine, processes/
tasks organised to meet staff needs,
disrespectful language and attitudesYour Role as Alerter
Your role as ‘Alerter’ in • Environmental factors eg.
signs of neglect, the reactions
the Safeguarding Process
and responses of other
• The ‘alerter’ raises a people with the patient
safeguarding concern within
• Does the patient have capacity
their own agency following
for the decision required?
own policy and procedures
• Are they able to give informed
• This concern may result from
consent or is action needed
something that you have
in their best interests?
seen, been told or heard
• Are there others at risk
• Make a referral to Safeguarding
e.g. children or other
Children where this is necessary
vulnerable adults?
Assessment • Is immediate protection required?
Your assessment should be • Has a crime been committed and
holistic and thorough considering should the Police be informed?
the patient’s emotional, social,
• Preserving any evidence
psychological and physical
presentation as well as the identified • Is any action that is being
clinical need. You need to be alert to: considered proportionate
• Inconsistencies in the to the risk identified?
history or explanation • What are the patient’s
• Skin integrity views/wishes?
• Hydration • Cultural differences or
religious beliefs
• Personal presentation e.g.
is the person unkempt • Are there valid reasons to act
even without the patient’s
• Delays or evidence of obstacles in
consent? E.g. where others are
seeking or receiving treatment
at risk; need to address a service
• Evidence of frequent attendances failure that may affect others
to health services or repeated
failure to attend (DNA)Information
Your Role as Sharing
Alerter
Golden rules: Holistic assessment • Is there any previous involvement/
support (consider statutory and
On admission: private providers and informal
carers) that needs re-engaging?
• Is the patient vulnerable as
defined under ‘No Secrets’? • Think about information sharing
when transferring patient
• Are there any existing alerts
relating to the patient? • Will they be safe on discharge?
• Is there any current agency • Is this the patient’s choice?
involvement. Consider both • Does there need to be a
statutory and private providers referral to Adult Social Care?
• What are the home circumstances? • Have community nurse
• Is the patient likely to require referrals been made?
more input on discharge? • Has the care package
• Who else lives in the household? been restarted?
• Skin integrity • Check for outcomes of any
Safeguarding referrals
• Nutritional state
including hydration • Does an alert need adding
to patient notes?
• Personal presentation
• Person’s communication Communication
and behaviour
• Consider use of communication
• Are any reasonable aids/language line if required
adjustments required to involve the patient
• Treat the person with • Take account of individual
dignity and respect differences
• Listen carefully, remain calm and
Before discharge:
try not to show shock or disbelief
• Where is the patient
• Acknowledge what is being said
being discharged to?
• Don’t transfer problems
Continued over...Your Role as Alerter
• Do not ask probing or leading Recording
questions which may affect
• You are accountable for
credibility of evidence
your actions or omissions
• Be open and honest and do
• Make a legible, factual, timely
not promise to keep a secret
and accurate record of what you
• Seek consent to share information did and why, to demonstrate
if patient has capacity and transparent, defensible
if this does not place you or decision making e.g. capacity
them at increased risk assessment made, best interest
• You may share information decision, any restraint which
without consent if it is in the was required which must be
public interest in order to prevent proportionate to the situation
a crime or protect others from
harm (follow own organisation’s
policy and procedures)
Reporting
• Report concern following
your safeguarding adult
policy and procedures
• Make clear and concise referral
so that person reading the form
understands the key issues
• Do not delay unnecessarily
• Concern about a colleague
should be raised through
your organisations Managing
Allegations against staff or
Whistle blowing policy
Remember that you are accountable
for what you do or choose not to do.Information Sharing
Information sharing 3. Seek advice if you are
in any doubt, without
Where there are safeguarding
disclosing the identity of the
concerns staff have a duty to
person where possible
share information. It is important
to remember that in most serious 4. Share with consent where
case reviews, lack of information appropriate and, where possible,
sharing can be a significant respect the wishes of those
contributor when things go wrong. who do not consent to share
confidential information. You may
Information should be shared
still share information without
with consent wherever possible. A
consent if, in your judgment, that
person’s right to confidentiality is
lack of consent can be overridden
not absolute and may be overridden
in the public interest. You will
where there is evidence that
need to base your judgment
sharing information is necessary
on the facts of the case
to support an investigation or in
best interests e.g. in the interests of 5. Consider safety and well-being:
public safety, police investigation, Base your information sharing
implications for regulated service. decisions on considerations of
the safety and well-being of
1. Remember that the Data
the person and others who may
Protection Act is not a barrier to
be affected by their actions
sharing information but provides
a framework to ensure that 6. Necessary, proportionate, relevant,
personal information about living accurate, timely and secure: Ensure
persons is shared appropriately that the information you share
is necessary for the purpose for
2. Be open and honest with the
which you are sharing it, is shared
person (and/or their family where
only with those people who
appropriate) from the outset
need to have it, is accurate and
about why, what, how and
up-to-date, is shared in a timely
with whom information will, or
fashion, and is shared securely
could be shared, and seek their
agreement, unless it is unsafe
or inappropriate to do so
Continued over...Information Sharing
7. Keep a record of your decision Sharing data when
and the reasons for it – whether
someone lacks
it is to share information or not. If
you decide to share, then record mental capacity
what you have shared, with • Can the patient give consent
whom and for what purpose to disclosure of information?
Any information disclosed should be: • You have a responsibility
to explore approaches to
• clear regarding the nature help them understand
of the problem and purpose
• In some instances the individual
of sharing information
will not have the capacity to
• based on fact, not assumption consent to disclosure of personal
• restricted to those with a information relating to them.
legitimate need to know Where this is the case any
disclosure of information needs
• relevant to specific incident
to be considered against the
• strictly limited to the needs of conditions set out in the Data
the situation at that time Protection Act and Best interests
• recorded in writing with
reasons statedThe Mental Capacity Act
The Mental Capacity If Yes:
Act (MCA) 2005 • Stage 2: Is the person able to:
• Understand the decision
5 Principles Which Underpin
they need to make and why
The Mental Capacity Act: they need to make it?
In order to protect those who • Understand, retain, use
lack capacity and to enable them and weigh information
to take part, as much as possible relevant to the decision?
in decisions that affect them, the
following statutory principles apply: • Understand the consequences
of making, or not making,
• You must always assume a this decision?
person has capacity unless • Communicate their decision by any
it is proved otherwise means (i.e. speech, sign language)?
• You must take all practicable • Failure on one point will
steps to enable people to determine lack of capacity
make their own decisions
• You must not assume incapacity How To Act In Someone’s
simply because someone Best Interests:
makes an unwise decision
• Do not make assumptions
• Always act, or decide, for about capacity based on age,
a person without capacity appearance or medical condition
in their best interests
• Encourage the person to
• Carefully consider actions to participate as fully as possible
ensure the least restrictive
• Consider whether the person will
option is taken
in the future have capacity in
relation to the matter in question
Assessment Of Capacity:
• Consider the person’s past
Follow the 2 stage test for capacity:
and present beliefs, values,
• Stage 1: Does the person have an wishes and feelings
impairment of the mind or brain
(temporary or permanent)?
Continued over...The Mental Capacity Act
• Take into account the views of Where To Find Guidance
others – i.e. carers, relatives,
The full text of the Act and the
friends, advocates
Code of Practice is available on
• Consider the least website address: www.dca.gov.
restrictive options uk/legal-policy/mental-capacity.
• Best Interests checklist will
NB there may not always be time
be available as part of local
in emergency situations for all
policy and procedure
investigation and consultation,
What Else Do You and there should be no liability
for acting in the reasonable belief
Need To Consider? that someone lacks capacity, and
MCA Code of Practice: Professionals what you do is reasonably believed
and carers must have regard to to be in their best interests (MCA
the Code and record reasons s5). This can include restraint if
for assessing capacity or best need be, if it is proportionate and
interests. If anyone decides to necessary to prevent harm (MCA
depart from the Code they must s6), and even “a deprivation of
record their reasons for doing so. liberty”, if this is necessary for
“life sustaining treatment or a
LPAs & ADs: Is there a valid/current
vital act”, while a Court Order is
Lasting Power of Attorney or an
sought if need be (MCA s4B).
Advance Decision in place?
IMCAs: The Mental Capacity Act sets
up a new service, the Independent
Mental Capacity Advocate (IMCA),
to help vulnerable people who lack
capacity and are facing important
decisions including serious healthcare
treatment decisions and who have
no one else to speak for them.Assessing Capacity Chart
Continued over...Assessing Capacity Chart
Best Interests
If the patient is not able to consent
or refuse treatment, there is a duty to
make a best interest decision about
whether to treat the patient.
You must:
• involve the person who lacks capacity
• have regard for past and present wishes
and feelings, especially written statements
• consult with others who are
involved in the person’s care
• there can be no discriminationDeprivation of Liberty Safeguards
Deprivation of Liberty Who does it apply to?
Safeguards The safeguards ONLY apply to
people who lack capacity to consent
What is it? to care/treatment they receive:
The Deprivation of Liberty AND are over 18 years of age AND
Safeguards 2009 (DoLS) are an receive care in a hospital or a care
amendment to the Mental Capacity home setting AND the care they
Act 2005. They provide a legal receive deprives them of their
framework to protect those (over liberty AND they are not detained
18 years) who lack the capacity under the Mental Health Act.
to consent to the arrangements
If a person is being deprived of
for their treatment or care, for
their liberty and they are not in a
example by reason of Dementia,
care home or hospital, their care
Learning disability or Brain Injury
can only be authorised through
and where levels of restriction or
the Court of Protection.
restraint used in delivering that
care for the purpose of protection
from risk/harm are so extensive as to
potentially be depriving the person
of their liberty. Deprivation of Liberty
Safeguards goes beyond the actions
permitted under section 5 of the
Mental Capacity Act (MCA) 2005.
Continued over...Deprivation of Liberty Safeguards
What you need to know What to do
• Sometimes deprivation of liberty • If you are worried about a patient
(DoL) is required to provide care/ in your care who you think might
treatment and protect people be being deprived of their liberty,
from harm, BUT every effort consider ways in which you can
should be made to prevent minimise restrictions. Please refer
DoL by making provision to to your local DoLs procedures
avoid placing restrictions, if DoL • Discuss the case with your
cannot be avoided it should be Adult Safeguarding Lead
for no longer than is necessary
• “ In a community setting you can
• There is a legal duty on the contact your Local Authority DoLS
hospital or care home, if the team who will be able to assist
Safeguards apply, to request the
It is important to act quickly
PCT or local authority to authorise
to comply with legislation.
to deprive someone of their liberty
for a limited period of time
• A major part of preventing
DoL is minimizing any restraint.
Restraint must be appropriate,
proportionate and in the
patient’s best interestsPressure Ulcer Staging
Stage 1:
Non-blanching erythema
of intact skin.
Stage 1
Stage 2:
Partial thickness skin loss
involving epidermis, dermis or
Stage 2 both. Superficial and presents
as blister or abrasion.
Stage 3:
Full thickness skin loss
involving damage / necrosis
of subcutaneous tissue may
extend to underlying fascia.
Stage 3
Stage 4:
Extensive destruction, tissue necrosis,
damage to muscle, bone, supporting
structures +/- full thickness skin loss.
If patient has pressure ulcers ask
Stage 4
yourself – could this be neglect?
NB: Some areas of health use a slightly different categorisation based on
European GuidelinesPrevent
The Governments counter- • Address the grievances which
terrorism strategy is called radicalisers are exploiting
CONTEST and it is divided up The health service has been
into four priority objectives: identified as a key partner
Pursue – stop terrorist attacks in preventing vulnerable
people being radicalised.
Prepare – where we cannot stop
an attack, mitigate its impact The key message is that all
staff must escalate a concern
Protect – strengthen overall and have confidence that each
protection against terrorist attacks issue will be taken seriously,
handled appropriately and
PREVENT – stop people
that, where necessary, specialist
becoming terrorists and
advice will be available.
supporting violent extremism
Contracts of employment,
PREVENT is a strategy that seeks
professional codes of conduct and
to stop people becoming terrorists
safeguarding frameworks such as
and supporting violent extremism.
No Secrets and Every Child Matters
There are numerous government
require all healthcare staff to
departments and local partners
exercise a duty of care to patients
involved in the strategy, and
and, where necessary, take action for
one of the main organisations
safeguarding and crime prevention.
involved are health care services.
If you have a concern discuss
The specific PREVENT objectives that
it with your safeguarding lead
relate to healthcare services are to:
and they will advise and identify
• Support individuals who are local referral pathways.
vulnerable to recruitment, or
have already been recruited
by violent extremists
• Disrupt those who promote
violent terrorism and support
the places where they operateCapacity and Consent
Capacity and Consent • Family/carers or others
may be seeking to override
It is OK to ask questions or ask for
the views of others
further guidance/reassurance if:
• If You disagree with the decision
• It is not clear who has made/ or have concern that the MCA and/
is making the assessment of or Policy is not being followed
capacity or best interests
It is NOT ok to DO NOTHING.
• There is a relevant
assessment of capacity
and this is documented
• The assessment is specific
to the relevant decision
and time - Eg - “John lacks
capacity” [for what, when?]
might raise concern
• All reasonable and
appropriate steps have
been taken to empower/
maximise capacity
• Regular review has
been provided for
• An appropriate range of
disciplines have been involved
• Family and carers have been
involved appropriately
It is your responsibility to make sure you know how
to contact your local Safeguarding Adults LeadMy Notes & Contacts:
Resources
For the resources listed below, visit: More resources:
http://www.dh.gov.uk/en/ Association of Directors of Adult
Publicationsandstatistics/Publications/ Social Services – Safeguarding Adults
PublicationsPolicyAndGuidance/ Key Documents
DH_124882 www.adass.org.uk
• Clinical Governance and Adult Adult Safeguarding Resources and
Safeguarding: An integrated Reports from Social Care Institute
process. February 2010 for Excellence:
http://www.scie.org.uk/adults/
• Safeguarding Adults: The Role
safeguarding/index.asp
of Health Service Managers and
their Boards DH March 2011 Adult Safeguarding
• Safeguarding Adults: The Role Community of Practice:
of Health Service Practitioners http://www.communities.idea.gov.uk/
DH March 2011 comm/landing-home.do?id=2962596
• Safeguarding adults: The Role of NHS
Commissioners DH March 2011 East Midlands Adult Safeguarding
Community of Practice:
• Safeguarding Adults Self
http://www.communities.idea.gov.uk/
Assessment and Assurance
comm/landing-home.do?id=5053750
Framework DH March 2011
• Safeguarding Adults and the Mental capacity Act 2005 in
Role of Health Services: Analysis primary care E-learning toolkit
of the Impact on Equality www.mcahealth.net
• Statement of Government Policy on
Adult Safeguarding DH May 2011Copyright © 2012
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