Safeguarding GP Target events welcome General introduction and feedback on where we are at: Pragmatic approach yes there are time limits yes we are all busy yes there is pressure to get the work done but! It needs to meet minimum requirements Hope this will be useful it will not tell you anything earth shattering that will change your whole world but it will fill in some gaps cause you to think about things and inform you of some recent and pending changes. There has been improvement since the initial audit but we are still seeing issues long time to outcome alerts long time to complete some interesting decision making GP Target events

Care Act 2014. What does it actually say about Safeguarding? S42 Enquiry by local authority (1)This section applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) (a) has needs for care and support (whether or not the authority is meeting any of those needs), AND (b) is experiencing, or is at risk of, abuse or neglect, AND (c) as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it. (2)The local authority must make (or cause to be made), whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case (whether under this part or otherwise) and, if so, what and by whom. In fact the Care Act says very little about how to undertake a safeguarding. If you think it might look like this meets these three criteria then do something about it Care and support needs do we really need to carry out an assessment? the care act states yes but then what’s an assessment and this is an on going process to gather information to inform decision making Is the individual able to protect – gives rise to issues of coercion and control substance abuse. In effect if in doubt refer, if in less doubt simply ask and make a referral to adult social care The most useful is Harm and Abuse someone causes harm or abuse. Duty of Care you’re a social worker so reasonably you need to do something to protect the vulnerable individual from the nasty individual

Safeguarding Other: Section 1(1) (of the care Act) placed a general duty on local authorities to promote the wellbeing of the individual when carrying out their social care functions. Section 1(2) lists a range of factors that local authorities must consider in relation to an individual's wellbeing, Mental Health, dignity etc. - if you think safeguarding is the best way to go to protect someone’s well being, then its safeguarding. Pays your money and you take your choice not often used usually takes place around carers, Could be used for lots of things BUT! Issues of Flood gates opening. Usual one is carers or others who might slip through the net.

Recent changes in Leeds to operational guidance The formal safeguarding process is no longer required to substantiate abuse. This is to ensure that the key purpose of safeguarding will be to identify, and if at all possible, meet an individuals desired outcomes and that identified risks, for all those at risk have been appropriately mitigated. This aligns with the stated aims of ensuring safeguarding meets personal outcomes and improves the quality and safety of services for the people of Leeds. The safeguarding process should identify, wherever possible, learning and how that learning is to be implemented to prevent re occurrence. But you can still state that something happened many families and individuals may want that acknowledgement and they shouldn’t be denied it just because we don’t want to make difficult decisions or have difficult conversations balance of probability it is more likely than not that it has occurred.

The actual process is; 1) Decide Does it meet safeguarding: with reasonable cause to believe a) Abuse or neglect (Self neglect). AND b) Likely to have care and support needs. AND c) Unable to protect themselves. 2) Decide How best to deal with the concerns/issues based on: Who’s at risk, so we can carry out urgent actions to make them safe. Any capacity issues, ability to take part in the process to support involvement. Desired outcomes, so we know what we are doing. 3) Sort it out, remove risk and achieve desired outcomes. What is the best way to address the concerns or risks for everyone at risk not just the alleged victim. So it meets safeguarding then do something about it section, because it was only reasonable cause to believe then it might not be safeguarding

Some key issues types of abuse, first graph all primary health (district nurses, YAS etc.) then just GP’s

Some key issues types of abuse, first graph all primary health (district nurses, YAS etc.) then just GP’s 16.13%

Some key issues types of abuse, first graph all primary health (district nurses, YAS etc.) then just GP’s

Neglect / Self neglect: Self neglect does ‘muddy the waters’ for safeguarding. One of the triggers for Sec 42 is Neglect or Abuse, but abuse and neglect is something usually perpetrated by a third person. Adults and Health interpretation is; if we receive a referral and the person is unknown we would triage and if appropriate offer a service, probably an assessment leading to services. If however the individual is known to not engage we would escalate to a safeguarding. Usually. The caveat is often the question of Mental Capacity, and there are no definitive answers. People can make unwise decisions we do not like or we find professionally difficult.

Not safeguarding, but what happened: Young person presented at a surgery with a series of mental health issues, anger management and anger control. Violent episodes, (assaults on others) having impact on individual life, potential fear for safety of mother. Did not meet requirements for care and support needs, nor abuse and neglect, and able to protect himself. The same applied to the mother. The individual was seen and was referred for Mental Health input.

Safeguarding Sec 42: Referral Potential DV: went into sec 42 and was managed after consultation with both individuals, separately as a risk management response. A range of complex issues were identified. Actions taken: Carers assessment was undertaken Tele-care provided Home adaptations were put in place. On going multi-agency risk management package put in place including referral to Multi-agency Best Practice Panel. There were concerns expressed but up to date the issues have been managed safely

Do these meet safeguarding? Does the information give reasonable cause to believe the individuals involved meet the three criteria;   Lady lives in a flat she has had no obvious previous contact with Adults and Health, there was no food in cupboards house in “poor” condition, the lady was unkempt, finds it difficult to get about. On a visit to a Care Home you witness staff acting in a way you consider abusive, you speak to the person and the individual states that they don’t want anything to be done cos the staff are alright really Young person comes to see you and tells you she is about to be taken to another country to be married to a man she does not know. Individual attends surgery appears to be malnourished and in very unkempt clothes the individual has full capacity and states nothing is wrong and they are fine thank you very much for asking bye.

Monitoring the process We are accountable for what we do and need to evidence what we do whether we like it or not!

Monitoring the process We are accountable for what we do and need to evidence what we do whether we like it or not!

Monitoring the process We are accountable for what we do and need to evidence what we do whether we like it or not!

 What can you as GP’s do Assess against the three criteria, but if in doubt refer. You can refer for Social Care support Log Concerns as coming from or on behalf of Dr NNNNNN GP and state the address of your surgery