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
Read the slide as it is –
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
Please get staff to complete an attendance list

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
The ASP Act introduces new adult protection duties and powers, the most important of for NHS Staff was the Councils duty to inquire and investigate when there were concerns about an adult. Just like in child protection the local authority, or rather the social work department, has the lead in carrying out investigations – these can be anonymous, from members of the public or from different agencies like NHS ……. Each of the local authorities have contact points for people to voice their concerns. More of which later. NHS Staff do have a duty to co-operate – more of which in a minute. 3 3

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
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”
This is the definition of what we used to refer to as Vulnerable Adults
An ‘adult ’ means an individual aged sixteen years or over.
All adults could be considered potentially vulnerable from time to time but this legislation focus’ on those who for reason of ill health, disability, frailty or special circumstances depend on others to provide and promote their well-being and/or protection.
These are the patients we are concerned about.
All three parts a,b and c should be met. You have some patients who, for example had a stroke who are well able to protect themselves however there will be others who are unable to safeguard themselves from harm.
The legislation uses the word harm rather than abuse – it essentially we mean the same thing.
Think about the people you care for – are they adults at risk – ASK the group what they think. (Hopefully most of the group will acknowledge that some of the patients they support are adults at risk)

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.
This is a really important slide – What it means is that if ANY member of NHS staff knows or believe that someone is an adult at risk and that action is needed to protect that adult from harm then they should report this to the council.
A straight forward example would be a woman with severe dementia tells you her carer in the nursing home grabbed her and this is how she broken her wrist.
Where it gets more complicated is where the person says do not tell. If this happens we have to be very clear that, as NHS staff we have a statutory duty to tell. Just like in child protection if we know or believe someone is an adult at risk and they are in need of protection from harm then we have to tell the council. Often patients will recognise that by telling you you will have to do something about it.. You are also covered by the Data Protection Act as you are sharing information in relation to the prevention or detection of a crime.
You will also see that the NHS has a duty to assist or enable inquiries – this may well also be about giving the council information, e.g. giving health records are part of an investigation. 8

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 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’. 10

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. 11

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)
We have a summary of the all the roles of NHS staff. We have already spoken about a duty to report. This would also include if there was an allegation against a member of staff. For example if I was accused of hitting a patient, who was thought to be an adult at risk, then this would have to be reported to the council because this was an example of an adult at risk of harm who was unable to protect themselves against me.

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
If you were ever to find yourself in the position of having concerns about an adult at risk you should firstly assess whether he/she is in immediate danger, or in need of urgent medical attention. Consideration should be given to their capacity. It must be remembered that it is everyone’s duty to ensure an adult’s safety wherever possible. Staff should not undertake to question the adult further. Take immediate action to safeguard, i.e. go to hospital, call GP or take to a Safe Place, e.g. A&E.
You should then tell your line manager who will then contact the appropriate adult protection network – each of the councils have a contact point which is called the adult protection network. They will then tell you what you need to do next.
If you or your line manager believes that a crime has also been committed then the police should also be contacted. Unless it is an emergency you should contact the police.
The Adult protection team will tell you if you have to complete an adult protection recording sheet. This is a simply form – a bit like a referral form and is available on the adult protection website.
A datix form should also be completed. There is now a section on the Datix form specifically for adult protection concerns.

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
ASP Case Conference
Multi agency Protection Plan – taking into account the wishes of the adult
Additional supports or resources introduced into care plan to manage issues – Decision taken that further work under ASP would not benefit the adult
ASP Protection Orders
(used only when necessary)
Assessment Order
Removal Order
Banning Order

18. Add here - Additional Local information
Use this slide to include local contacts, websites, address, telephone numbers

19. Summary
ANY QUESTIONS
Please leave an opportunity for any questions.