Whose Business Is It?

Ground Rules Share experiences and views Recognise the sensitive nature of the subject matter Listen and respect what others have to say Note differing views as these may add to your knowledge Promote anti-oppressive practice Respect confidentiality unless it is necessary to address a current concern about the safety/risks to a vulnerable adult, if you do, talk this through with the trainer or a relevant person on the course Explain any jargon

Session 1 Introduction

The Extent of Abuse – A National Perspective As many as 342,000 older people were neglected and abused over the previous year by family and/or friends (UK study of abuse and neglect of older people: prevalence survey report, National Centre for Social Research 2007). In the first 10 years that the AEA Helpline had been running, they have recorded 6,867 calls relating to10,528 incidents of abuse. 71% of those with mental health issues had been a victim of crime in the past two years, 22% had experienced physical assault, 41% experienced ongoing bullying, 27% experienced sexual harassment (with 10% experiencing sexual assault), with only 19% feeling safe at all times within their own home (MIND 2007). Disabled people are four times more likely to be victims of crime compared to non- disabled people (British Council of Disabled People 2007). Prevalence of abuse increased with a decline in health. The level of mistreatment was higher for people with a limiting long-term illness, a lower quality of life, and for those suffering from depression. (UK study of abuse and neglect of older people: prevalence survey report, National Centre for Social Research 2007). 5

The Extent of Abuse – A Local Perspective Over the last year, there has been a rise in the total number of reported incidents of alleged abuse from 804 in 2008/09 to 1437 in 2009/10; an increase of 79%. Hampshire has seen a 76.5% increase in cases of financial abuse. Between 1st April 2005 and 31st March 2006 Hampshire Constabulary recorded 79 occurrences of disability hate crime and 374 occurrences of homophobic hate crime. The Fire Service has reported that about 80% of fire deaths involve a vulnerable adult. Self referrals and referrals from friends, relatives or neighbours of alleged victims have also increased from 156 in 2008/09 to197 in 2009/10 6

The Extent of Abuse – A Local Perspective continued…. 585 reported incidents in the last 12 months were in respect of people not receiving a service commissioned by the County Council’s Adult Services (self-funders). Referrals from partners account for 71% of reported safeguarding incidents with Health partners and the Police referring 19% and 8% of reported incidents respectively, with increased levels of reporting compared with previous years. Work with Housing partners is beginning to impact on the numbers of reported incidents resulting from Housing (5 in 2008/09 and 15 in 2009/10). Physical abuse, financial abuse, and neglect/acts of omission have been the most prevalent reported types of abuse over the last three years. It is estimated that 56,000 women and girls have been a victim of domestic abuse in the last year in Hampshire. 7

ADSS Safeguarding Adults October 2005 ‘Safeguarding Adults’ is a term used to mean all work which enables an adult to retain independence, wellbeing and choice and live a life that is free from abuse and neglect. ADSS Safeguarding Adults October 2005

Safeguarding Services? Who Is In Need of Safeguarding Services? ‘‘A person aged 18 years or over, who is, or may be in need of community care services by reason of mental or other disability, age or illness’ AND ‘Who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’

Safeguarding Children The government guidance Working Together (2006), places the responsibility for the safety and welfare of children with the local authority (WT section 2.9), but expects that all professionals who come into contact with children, parents and carers in the course of their work are aware of their responsibilities to safeguard and promote the welfare of children and young people (WT sections 2.52 to 2.73).

Rights and Responsibilities Session 2 Rights and Responsibilities

What is the Mental Capacity Act 2005? A statutory framework to empower and protect people who are not able to make their own decisions Helps anyone over the age of 16, living in England and Wales, who lack capacity to make a decision for themselves Puts the needs and wishes of a person who lacks capacity at the centre of any decision making process

What is the Mental Capacity Act 2005? cont... Makes it clear who can take decisions, in which situations, and how they should go about this Enables people to plan ahead for a time when they may lose capacity Introduces new safeguards for people who lack capacity A Code of Practice

Whose Work is Affected by the Mental Capacity Act? YOU ARE ALL LEGALLY REQUIRED TO HAVE REGARD TO THE CODE OF PRACTICE People working in a professional capacity People who are paid to care or support adults in any setting Anyone with a Lasting Power of Attorney Anyone who is a deputy appointed by the Court of Protection Anyone acting as an Independent Mental Capacity Advocate (IMCA) Anyone carrying out research with people who lack capacity Anyone being paid for acts for, or in relation to, a person who lacks capacity GENERALLY anyone who looks after or cares for someone who lacks capacity 14

Principles of The Act Assume a person has capacity unless proved otherwise Do not treat people as incapable of making a decision unless you have tried all practicable steps to help them Do not treat someone as incapable of making a decision because their decision may seem unwise Do things for, and take decisions for, people without capacity in their best interests Before doing something to someone or making a decision on their behalf, consider whether you could achieve the outcome in a less restrictive way 15

What is Mental Capacity? Mental capacity is the ability to make a decision, by: Understanding the information you are given Retaining the information long enough to enable you to make the decision Weighing up the information Communicating your decision 16

The MCA and Safeguarding Adults Good practice in applying the principles of the MCA is also: Good Safeguarding Practice 17

Agency responsibilities ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response ‘No Secrets’ DH 2000 Adult Services have a responsibility, in partnership with other agencies, to co-ordinate safeguarding responses ‘No Secrets’ DH 2000

All agencies Have the responsibility to: ALWAYS involve service users in decision making Promote the safety of service users Promote the awareness of abuse Assure staff and service users they will be listened to Ensure staff are aware of reporting procedures Take appropriate action where abuse is suspected Call emergency services where there is immediate danger Provide training Work alongside other professionals Keep records Commission/provide safe services

Session 3 Recognising Abuse

Defining Abuse No Secrets DH 2000 Abuse is the violation of a person’s human and civil rights by any other person or persons Abuse is the harming of another individual usually by someone in a position of power, trust or authority over that individual. The harm may be physical, psychological or emotional or may be directed at exploiting the vulnerability of the victim in more subtle ways The threat or use of punishment is also a form of Abuse Abuse may happen as a “one-off” or it may become a regular feature of a relationship Other people may be unaware that Abuse happening and for this reason it may be difficult to detect. In many cases Abuse is also a criminal offence No Secrets DH 2000

Types of Abuse Physical Psychological/Emotional Financial Sexual Neglect Discriminatory

Indicators of Abuse It is unlikely that any one indicator alone will conclusively prove abuse has taken place People will often experience more than one type of abuse Staff should be alert to patterns and clusters of indicators which may raise suspicions It is vitally important to report any concern/s Any report should be taken seriously Many of the indicators will feature similar elements in a number of different types of abuse e.g. Institutional abuse

In the person’s own home In nursing, residential or day care services Where Does Abuse Occur? In the person’s own home In the community In nursing, residential or day care services Hospitals It can happen anywhere

Who Abuses? It can be any of us Relatives/Friends Other service users Neighbours Paid carers Professionals Strangers

Abuse Can Occur in Different Contexts Domestic Abuse – between people where there is a relationship and living in the same household Professional Abuse – by those who are acting in a professional capacity, e.g. Doctors, Therapists, Nurses, Social Workers etc. Institutional Abuse – takes place within an institutional setting with evidence of….. see next slide……

Safeguarding Children Children and young people may be abused in a family or in an institutional or community setting; by those known to them or, more rarely, by a stranger. All abuse and neglect are forms of maltreatment – a person may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm.

Institutional Abuse Routines and regimes Lack of choice and consultation Poor quality environment The service revolves around the staff Low staff morale Lack of staff training Lack of personal belongings No evidence of effective policies and procedures

Session 4 Responding

Responding All allegations/disclosures must be treated seriously The safety of the person is paramount Stay calm, listen and reassure Demonstrate a sensitive approach Be aware of the possibility of the existence of forensic evidence Explain the you are required to share that information with your manager but not with other staff or any other service users

Responding Reassure the person that any further response will be taken sensitively and with their full involvement, whenever possible Reassure the person that the service will take steps to support and where possible, protect them in the future REPORT MAKE A WRITTEN RECORD

IF IN DOUBT ALWAYS REPORT - in line with your organisation’s policy Confidentiality A person’s right to confidentiality is not absolute and may be overridden where there is evidence that sharing information is necessary in exceptional cases to prevent: Serious crime Danger to a person’s life Danger to others Danger to the community Danger to the health of the person IF IN DOUBT ALWAYS REPORT - in line with your organisation’s policy

Session 5 Reporting

‘No Secrets’ (2000) ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response ALL KINDS OF ABUSE HARM THE INDIVIDUAL – WE MUST NOT IGNORE IT

Enablers To Reporting Service users awareness of what to expect from staff and the service Knowing how to recognise indicators of abuse Open organisational culture Staff training Staff support

Enablers To Reporting cont... Accessible complaints procedures Supervision and staff appraisal Effective management role modelling of good practice Good working relationships with professionals, families and carers

Barriers to Reporting Failure to recognise the abuse Will not be believed Fear of reprisals Fear of ‘heavy handed’ responses Breaching confidentiality Not sure if concerns are valid Lack of clarity about reporting procedures

Barriers To Reporting cont... Impact on relationships with colleagues/service users/families A workplace culture of non reporting Increased tolerance levels (accepting certain behaviours)

Initial Action To Be Taken All allegations should be treated seriously The safety of the person is paramount Call the Police if a crime has been committed Stay calm, listen and reassure the person Do not press the person for details Do not make promises you cannot keep Do not confront the alleged perpetrator Do not dispose of possible evidence Remember the limits of confidentiality Make notes as soon as possible Report concerns immediately Follow procedures

Mapping the Alert In-house procedures Within 24 hours: Assess risk of further harm Provide information and support to adult at risk Report concerns to Social Services (in line with your local safeguarding procedures) Report to CQC (Regulation 18) Consider internal disciplinary action if the person alleged to be causing the harm is an employee Record all actions and decision making Immediate Action: Ensure safety of the person Call emergency services Support the person Report to Line Manager Record details Preserve evidence

Child Protection Concerns Be familiar with and follow your organisation’s procedures and protocols for promoting and safeguarding the welfare of children in your area, and know who to contact in your organisation to express concerns about a child’s welfare.

Session 6 Recording

Guidance for Making a Written Record Make a note of date, time and setting Make a note of anyone else who was there at the time Record what was said using the person’s own words Separate factual information from any opinions expressed Use a pen or ballpoint with black ink if you can.

Guidance for Making a Written Record cont... Make sure your writing is legible and do not use tippex and initial any changes Date and sign your report Remember that your report may be required as part of any legal action or disciplinary proceedings Keep a copy for future reference which is filed securely.

Information To Be Given When Making a Referral Your details Details of the alleged victim Details of alleged perpetrator (if known) Details of any witnesses (if known) Name and contact details of GP Reasons for the concerns Any relevant background information Whether the person is aware of the referral Action already taken.

Session 7 What Next?

What Do I Need To Know? How to recognise abuse and where to report my concerns Where to find my workplace Policy and Procedure and make sure I have read and understood it That abuse is not an isolated problem, but a significant social concern That abuse can be a crime That anyone can potentially cause harm to a vulnerable adult, intentionally or unintentionally The rights of the people I provide a service to That I will be supported if I report a concern My rights as an employee What training I can expect to ensure I provide quality care That Adult Services have a responsibility, in partnership with other agencies, to assess and respond

Prevention Acknowledge that it COULD happen here! Report any concerns – in whatever way necessary to be heard Do not tolerate poor practice Be aware of possible indicators of abuse Promote self advocacy and advocacy Follow policies and procedures for intimate personal care, physical interventions and sexuality Attend training when given the opportunity Make use of supervision opportunities Good record keeping Use ‘Whistleblowing’ Procedure