1. 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

2. 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.

3. 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

4. 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.

5. 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.

6. 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

7. 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

8. Update Legislation and Guidance Safeguarding Adults
Care Act Section
Care and Support Statutory Guidance Chapter 14
No Secrets (2000)

9. 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

10. 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.

11. 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.

12. 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?

13. 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.

14. 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.

15. 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

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

17. Local safeguarding contacts Worcestershire
Ellen Footman
Head of Safeguarding, Designated Nurse for Safeguarding
   Ext 32919   
David Lewis
Designated Doctor for Safeguarding Children  
Sue Griffiths,
Named Professional Safeguarding Adults and Children
Ext
Jez (Jeremy) Newell
Adult Safeguarding Lead
Ext 32919 
The named professional for insert name CCG /NHS Trust is:
Insert name and job title

18. 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.

19. 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

20. Referral Process and Documentation: Hereford
Insert information on completion of local documentation here

21. Referral Process and Documentation: Hereford
CHILDREN
Insert information on completion of local documentation here
Complete Multi Agency Referral Form (MARF)

22. Referral Process and Documentation: WORCS
ADULT
Online Reporting
Or via Access Centre if you can’t access the online form on
Insert information on completion of local documentation here

23. 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 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
Then complete the Cause For Concern Notification, via the Professionals Portal (registration required).
Insert information on completion of local documentation here

24. 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

28. 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

29. 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

30. www.cppe.ac.uk info@cppe.ac.uk 0161 778 4000
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