Safeguarding children and adults Public health workshop Karen Rees Independent Safeguarding Consultant In some localities, the term ‘adults at risk’ is used instead of vulnerable adults – if that is the case in your area – please change title to reflect this

Aim The aim of today’s workshop is to develop your confidence, knowledge and skills to be able to deal professionally with a safeguarding issue should one arise in the course of your practice.

Learning objectives Summarise the background and policy surrounding the safeguarding of children and adults and the issues this raises for pharmacy professionals Convey the importance of pharmacy professionals increasing their awareness of abuse, neglect and child sexual exploitation (CSE) and developing ways of working with other health professionals to promote best practice to deal with situations involving suspected abuse, neglect or CSE

Learning objectives continued Highlight situations in which you are best placed to observe signs of abuse, neglect and CSE and the legal issues to consider when making a referral Identify sources of useful information and contacts for the development of local procedures for dealing with suspected abuse, neglect or CSE observed in the pharmacy setting Confidently make a referral to the appropriate local contacts should the need ever arise First we'll look at how we can recognise abuse.

Types of child abuse Physical, including female genital mutilation (FGM) Sexual abuse Emotional abuse Neglect Child sexual exploitation Physical abuse also includes fabricated and induced illness, as well as female genital mutilation. Healthcare professionals providing sexual health services should also be alert to the possibility of sexual exploitation. While physical and sexual abuse involve deliberate harm, emotional abuse and neglect may reflect the carer’s own health or social difficulties.

Significant harm Significant harm is any abuse or neglect, accident or injury attributable to lack of adequate parental care or control, that is sufficiently serious to adversely affect progress and enjoyment of life. There are no absolute criteria on which to rely when judging what constitutes significant harm. Sometimes a single violent episode may constitute significant harm but more often it is an accumulation of significant events, both acute and longstanding, which interrupt, damage or change development. Relates only to children- level is termed HARM for adults

Serious risk of immediate harm Where you have a reasonable belief that a child is at serious risk of immediate harm, you should act immediately to protect the interests of the child by making contact with the following: named or designated nurse/other local authority contact out-of-hours contact police. Remember only police can afford immediate protection

Update Legislation and Guidance Safeguarding Adults Care Act 2014- Section 42- 47 Care and Support Statutory Guidance Chapter 14 No Secrets (2000)

Adult Safeguarding Duty Applies to: Have need for care and support (whether or not the local authority is meeting those needs) Is experiencing or at risk of abuse or neglect Is unable to protect themselves from the risk of or the experience of abuse or neglect. Section 42 Care Act 2014

Abuse of adults- Post Care Act Physical abuse Domestic violence Sexual abuse Psychological abuse Financial or material abuse Modern slavery Discriminatory abuse Organisational abuse Neglect and acts of omission Self-neglect Institutional – may be deliberate or through ignorance, lack of training or understanding.

Information sharing ‘the amount of confidential information disclosed, and the number of people to whom it is disclosed, should be no more than is strictly necessary to meet public interest in protecting the health and well-being of a child’ ‘What do if you are worried a child is being abused’ Amend slide if other local guidance is used on information sharing.

Points to consider when sharing information Can the person be identified from the information? Is it confidential? Do you have consent? Do you have a statutory obligation or court order requiring you to share the information? Is there sufficient public interest to override the above: would they or others be at risk of significant harm if you did not share?

Confidentiality As a healthcare professional you have a responsibility to maintain patient confidentiality; however, you can breach this if you would be putting the victim or other vulnerable people at risk by not sharing information. Don’t let confidentiality issues put you off reporting – if you are sure you are acting in the best interests of the victim and they are at risk of significant harm, then you should be prepared to share confidential information.

Consent In a case of possible child abuse, you should seek parental consent to share information, unless they are the alleged perpetrator and therefore you would be putting the child at increased risk. In the case of adults, as long as they have mental capacity they can give consent to you sharing information. If they decide not to give consent the only time you can choose to share is if by not doing so you would be putting them or others at risk of significant harm. Now we are moving to consider the reporting of concern.

Local procedures Each clinical commissioning group (CCG) and NHS trust has a designated and/or named professional who has been trained to provide support and advice to any healthcare professional who has concerns about a child They are your first point of contact with any concern you may have

Local safeguarding contacts: Hereford The named professional for insert name CCG /NHS Trust is: Insert name and job title

Local safeguarding contacts Worcestershire Ellen Footman Head of Safeguarding, Designated Nurse for Safeguarding   01527 482919 Ext 32919    07885265970 ellen.footman@worcestershire.nhs.uk   David Lewis Designated Doctor for Safeguarding Children 01562 514608  david.lewis5@nhs.net Sue Griffiths, Named Professional Safeguarding Adults and Children 01527 482919 Ext 32919 07834172271 susan.griffiths@worcestershire.nhs.uk   susan.griffiths3@nhs.net Jez (Jeremy) Newell Adult Safeguarding Lead 01527 482919 Ext 32919  07730 029810  jeremy.newell@worcestershire.nhs.uk jeremynewell@nhs.net  The named professional for insert name CCG /NHS Trust is: Insert name and job title

Recording your concerns Listen and communicate in a way the victim can understand Do not ask leading questions Reassure, do not promise confidentiality Record as much factual information as you have Record all your concerns, actions and discussions Time for written report may be 24/48 hours.

Referral Discuss your concerns with a colleague or contact your local named professional for advice then decide whether to refer Seek agreement from the victim to refer or in the case of a child, their parents, unless this would put them at risk of significant harm If referring by phone, you must provide a written report within the locally agreed time

Referral Process and Documentation: Hereford https://www.herefordshire.gov.uk/health-and-social-care/adult-services/report-a-concern-about-adult-abuse Insert information on completion of local documentation here

Referral Process and Documentation: Hereford CHILDREN Insert information on completion of local documentation here Complete Multi Agency Referral Form (MARF) https://herefordshiresafeguardingboards.org.uk/herefordshire-safeguarding-children-board/for-professionals/multi-agency-referral-form-marf/

Referral Process and Documentation: WORCS ADULT Online Reporting https://ylyc.worcestershire.gov.uk/working-out-your-needs/raising-an-adult-safeguarding-concern/adult-safeguarding-professional-reporting-form/ Or via Access Centre if you can’t access the online form on 01905 768053 Insert information on completion of local documentation here

Referral Process and Documentation: WORCS CHILDREN Online Reporting Contact the Police on 999 if there is an immediate risk of danger Otherwise contact the Family Front Door on 01905 822 666 from Monday to Friday 8.30am to 5.00pm (until 4:30pm on a Friday) Out of office hours (5.00pm to 8.30am weekdays and all day weekends and bank holidays) contact the Emergency Duty team on 01905 768020 Then complete the Cause For Concern Notification, via the Professionals Portal (registration required). Insert information on completion of local documentation here http://www.worcestershire.gov.uk/info/20263/advice_information_and_guidance_for_professionals.html

In any case of suspected abuse DO NOT: Ignore your concerns Attempt to investigate suspicions or allegations of abuse Ask probing questions Discuss your concerns with the suspected/alleged perpetrator Assume someone else will recognise and report it

In summary Seek advice from your local safeguarding experts Follow local procedures and report your concerns appropriately Keep accurate records of your concerns and any actions you take

A final thought If you ever have cause for concern, doing nothing is not an option Never assume that someone else will recognise and report what you have seen or heard It takes many pieces of a jigsaw before you can see the full picture

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