1. Supporting and Protecting Adults From Harm A&E briefing

2. Aims of the session The briefing will enable staff to:  Recognise harm in an A&E/Unscheduled Care setting  Identify related legislation and its implications  Know the reporting process

3. What does the Adult Support and Protection (Scotland) Act 2007 do? The Act introduced adult protection duties and powers, including: Councils duty to inquire and investigate Duty to co-operate

4. When you think of an Adult at risk...

5. ?

6. Who is an Adult At Risk? The three point test: Adults (over the age of 16) who – a) are unable to safeguard their own well-being, property, rights or other interests; b) are at risk of harm; and c)because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected. Need to satisfy all 3 parts to apply Think of it in terms of “ does this person depend on others for their needs”

7. Sarah 18 years old. Lives at home with her Mum, Dad and brother. ? Mild learning disability She arrives at A&E, ‘burns’ on the tops of her legs, can’t get an appt with her own GP. Examination ? Urine burns. No story given as to what has happened. Decision to treat and discharge home She comments that she’s going to be cold tonight and doesn’t like the rain as she can’t sleep.

8. Duties of Cooperation The ASP Act sets out statutory duties of co-operation for certain public bodies and their office-holders: Councils; NHS services; the Police; the Care Commission; the Mental Welfare Commission; and the Public Guardian. Members and staff of all of these bodies are subject to statutory duties to:  Report the facts and circumstances to the local Council when they know or believe that someone is an adult at risk and that action is needed to protect that adult from harm;  Co-operate with the Council and each other to enable or assist the council making inquiries.

9. David 50 years of age. Has a terminal diagnosis. Admitted via Ambulance at weekend – stomach pains Decision to admit for observation Tells Nurse that his cousin is his carer and she ‘looks after me’. Jokes that she might not for long though as she was angry at him for buying a new tv, bed and bedroom carpet and that ‘there would be nothing left for the funeral’ and ‘her inheritance’.

10. Links to Professional Guidance NMC - You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support. NMC - You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising General Medical Council. All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely. The Public Interest Disclosure Act 1998The Public Interest Disclosure Act 1998 protects individuals making disclosures that ‘tend to show’ that the health or safety of a person is or may be endangered. These are ‘protected disclosures’.

11. Links to Professional Guidance Health and Care Professions Council’s standards of conduct, performance and ethics. You must act in the best interests of service users. You are personally responsible for making sure that you promote and protect the best interests of your service users. You must respect and take account of these factors when providing care or a service, and must not abuse the relationship you have with a service user. You should take appropriate action to protect the rights of children and vulnerable adults if you believe they are at risk, including following national and local policies. You must protect service users if you believe that any situation puts them in danger. This includes the conduct, performance or health of a colleague. The safety of service users must come before any personal or professional loyalties at all times.

12. Mary 60 year old grandmother. Sold her house to move in with her son, daughter in law and two teenage grandchildren. Family report that she can’t be left on her own and doesn’t manage to look after herself. Ambulance called by family as Mary was feeling unwell and was distressed. SAS reported to A&E Nurse that when they arrived to collect Mary, they noticed that the rest of the house was comfortable and warm whereas her bedroom was noticeably colder and untidy. There are some concerns re personal hygiene. Mary herself showed some agitation around the Daughter in law in particular.

13. Role of NHS Staff Will report all cases where an adult is considered at risk of harm to the Council and agree how to proceed with the investigation. This includes instances where the allegation is made against a NHS employee (Section 5) Will co-operate with the Council making inquiries and with each other where that would assist the Council. Information and records regarding the adult will be provided when requested under the Act. (Section 10) A doctor, nurse or midwife may conduct a medical examination during a visit or part of an Assessment Order (Section 9) It is an offence to prevent or obstruct any person from acting under the Act and to refuse without reasonable excuse to provide information. (Section 49, 50)

14. Things to look out for: Unable/prevented from reporting Dependent on others for care Family pressure to control patient Delayed treatment Physical signs of abuse / neglect Collateral history concerns Financial abuse

15. George George lives in a care home. His only son, Brian, lives in England. He phones regularly but can only visit a few times a year. George is brought to A&E by ambulance, having fallen. A care assistant comes with him but can only give basic information about what happened. George is malnourished, complains of having a sore mouth, appears dehydrated. The care assistant doesn’t think that he eats very much of what’s given to him and tells the Nurse in A&E that he can be ‘difficult’. On examination, there are a number of sore, red patches on his skin and some bruising around his upper arms. George does not know how he got these or what happened to make him fall.

16. If you believe or know someone is an adult at risk and in need of protection …. Recognise Respond - Is the person in immediate danger/in need of urgent medical assistance Report - To your relevant Adult Protection Network; Consider calling the police; Enter on Datix

17. What does Social Work do when they receive your ASP Referral? Your referral is sent to the appropriate Social Work Team and they begin an inquiry into the adults circumstances No Further Action required ASP Investigation Care Management Approach May be because for example: Appropriate supports are already in place The adult declines the support (and is not being coerced etc.) No on-going risk of harm is identified Additional supports or resources introduced into care plan to manage issues – Decision taken that further work under ASP would not benefit the adult ASP Case Conference Multi agency Protection Plan – taking into account the wishes of the adult ASP Protection Orders (used only when necessary) Assessment Order Removal Order Banning Order

18. Add here - Additional Local information

19. ANY QUESTIONS Summary