1. Safeguarding children and vulnerable adults
Ann Marie Cresham & Julie Eaton
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 vulnerable adults and the issues this raises for pharmacy professionals
Convey the importance of pharmacy professionals increasing their awareness of abuse, neglect child sexual exploitation (CSE), criminal exploitation and developing ways of working with other health professionals to promote best practice to deal with situations involving suspected abuse, neglect or CSE
As part of the overall learning objectives the attendees should have an overview of their responsibilities regarding reporting Female Genital Mutilation – as part of harmful practices. Include information on Modern Slavery and Criminal Exploitation

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. Intercollegiate Document 2014 : Level 2 Staff Group Pharmacist
Knowledge: • Know about child maltreatment in its different forms (physical including Fabricated and induced illness, emotional and sexual abuse, and neglect) including child trafficking, FGM and radicalisation including prevalence and impact • Know about relevance of parental, family and carer factors such as domestic abuse, mental and physical ill-health, substance and alcohol misuse • Know what to do if there are concerns about child maltreatment, including local policies and procedures around who to contact, where to obtain further advice and support, and have awareness of the referral process • Know about the importance of sharing information (including the consequences of failing to do so) • Know what to do if they feel that their concerns are not being taken seriously or they experience any other barriers to referring a child/family • Know the risks associated with the internet and online social networking • Know what the term ‘Looked after child’ means
Level 2: All non-clinical and clinical staff who
have any contact with children, young people
and/or parents/carers
Competence at this level is about individuals knowing what to look for which may indicate possible harm
and knowing who to contact and seek advice from if they have concerns. It comprises of:
• Recognising potential indicators of child maltreatment – physical abuse including fabricated
and induced illness, emotional abuse, sexual abuse, and neglect including child trafficking and
Female Genital Mutilation (FGM)
• Understanding the potential impact of a parent/carers physical and mental health on the wellbeing
and development of a child or young person, including the impact of domestic violence
the risks associated with the internet and online social networking, an understanding of the
importance of children’s rights in the safeguarding/child protection context and the basic
knowledge of relevant legislation (Children Acts 1989, 2004 and of Sexual Offences Act 2003)
• Taking appropriate action if they have concerns, including appropriately reporting concerns
safely and seeking advice

6. Standards for Registered Pharmacists
All 5 principles refer to arrangements being made to safeguard the health, safety and wellbeing of patients and the public
1) Governance arrangements
1.8 Children and vulnerable adults are safeguarded
2) Staff empowered and competent
3) Environment and premises
4) Pharmaceutical services, including management of medicines and medical devices
5) Equipment and facilities
(General Pharmaceutical Council 2012)
Additional Slide

7. Practice requirements (NHS Standard Contracts– service conditions)
SC32 – Safeguarding
Safeguarding policies: updated “from time to time”
Provide evidence on request that safeguarding concerns raised through multiagency systems are being addressed
Have a safeguarding lead and a Prevent Lead
SC33 – Incident reporting as per NHS Serious Incident Framework
Additional Slide

8. Types of child abuse Physical abuse Sexual abuse
Emotional or psychological abuse
Neglect
Child sexual exploitation (CSE)
Female genital mutilation (FGM)
Fabricated or induced illness
Radicalisation
Institutional or organisational abuse
Modern slavery
Forced marriage
Physical abuse also includes fabricated and induced illness, as well as female genital mutilation.
Professionals should consider risk taking behaviour- self harm, suicidal intent. Ant-social behaviour and children ( primary school age) associating with older adolescent – be aware of Organised Gangs. Younger children are at the risk of being criminally exploited:- shop-lifting, running drugs, criminalised and fire-arms.
Healthcare professionals providing sexual health services should also be alert to the possibility of sexual exploitation –
New Definition of CSE
Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.
Give example of Pharmacist writing a note to a young adolescent girl when attending the pharmacy. The young person was a victim of CSE. The pharmacist had the presence of mind to ask her via the note if she was okay or did she need help. The girl (victim) had a mobile phone and the perpetrator (male) was sat in the care outside could hear any conversation between the pharmacist and victim. The girl wrote a written reply to the note saying she needed. The outcome of this was positive for the victim.
While physical and sexual abuse involve deliberate harm, emotional abuse and neglect may reflect the carer’s own health or social difficulties.
Modern Slavery – use example of young girl on flight with an adult male. The male would not allow the child out of his sight. His presentation was well dressed, clean and he spoke on behalf of the child. The child was in stark contrast :- malnourished, pale, clothing that was too big for her and her body language – withdrawn and would not make eye contact. The is raised concern with a cabin crew. One of Air Stewardesses wrote a note and left it in the toilet for the little girl when she needed the toilet. The girl replied to the Air Stewardess. The male was arrested when the flight arrived by police and border agencies. The girl was taken to a place of safety. She was being trafficked for domestic servitude and being brought in on a false passport. – Victoria Climbie
Institutional – may be deliberate or through ignorance, lack of training or understanding.

9. Abuse of adults In addition, abuse of adults can include:
Financial abuse
Discriminatory abuse
Domestic abuse
Honour-based violence (HBV)
Self neglect

10. 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.
Local authorities have overarching responsibility and duty of care to for safeguard and promote the welfare of all children and young people in their area. This includes statutory functions under the 1989 and 2004 Children Acts which make this clear. This includes specific duties in relation to children in need and children suffering, or likely to suffer, significant harm, regardless of where they are found, under sections 17 (Child in Need) and 47 (child at risk ) of the Children Act 1989.

11. 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.

13. 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.

14. Seven golden rules for information sharing
Be open& Honest
Seek Advice
Data Protection Act .
Consider
safety & well-being
Share with consent
If possible
proportionate,
relevant,
accurate,
timely and secure
Information Sharing
 You should explain to children, young people and families at the outset, openly and honestly, what and how information will, or could be shared and why, and seek their agreement. The exception to this is where to do so would put that child, young person or others at increased risk of significant harm or an adult at risk of serious harm, or if it would undermine the prevention, detection or prosecution of a serious crime including where seeking consent might lead to interference with any potential investigation. Risk of Sexual Abuse
Consider the safety and welfare of a child or young person when making decisions on whether to share information about them. Where there is concern that the child may be suffering or is at risk of suffering significant harm, the child’s safety and welfare must be the overriding consideration.
You should, where possible, respect the wishes of children, young people or families who do not consent to share confidential information. You may still share information, if in your judgment on the facts of the case; there is sufficient need in the public interest to override that lack of consent.
You should seek advice where you are in doubt, especially where your doubt relates to a concern about possible significant harm to a child or serious harm to others.
You should ensure that the information you share is accurate and up-to-date, necessary or the purpose for which you are sharing it, shared only with those people who need to see it, and shared securely.
You should always record the reasons for your decision – whether it is to share information or not.
Keep a record

15. 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?

16. 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.

17. 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.

18. 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

19. Liverpool & Sefton LSCB Safeguarding Procedures
Additional Slide

20. Children Social Care contact details
St Helens – Tel: Out of Hours: Warrington – Tel: Out of Hours: Wigan - Tel: Out of Hours: Manchester - Tel: Lancashire- Tel:
Halton (covering Widnes & Runcorn): Tel: Out of Hours: Knowsley – Tel: Out of Hours: Out of Hours: Liverpool - Tel: / 3029
The named professional for insert name CCG /NHS Trust is:
Insert name and job title

21. Liverpool Careline
If you are a professional with an urgent child protection concern and need to tell us about it, please make an immediate referral by calling Careline on You will then be asked to follow up your call by submitting an online Multi-Agency Referral Form (MARF) using the button below. You will receive an automated acknowledgement once the MARF has been successfully submitted which will include a unique reference number.
Additional Slide
Children at risk
Report a child at risk
If you are a member of the public and have a concern about a child please contact Careline on or Merseyside Police on or 999 in an emergency.
You should report your concerns if you feel that:
A child needs protection – if a child is suffering harm, neglect or abuse, we can investigate and act to protect them.
A family is under stress – we can offer support and advice and help families access support from other services.
A child is seriously ill or disabled – we can arrange an assessment of the child’s and families needs and provide support.

22. Sefton MASH
Sefton Multi-Agency Safeguarding Hub is the front-door for Children Social Care: Monday – Thursday : & Friday Out of Hours - Emergency Duty Team on
Additional Slide
For all general enquiries please continue to call  between 8am and 6pm.
If you would like to have a consultation with a social worker prior to making a referral through to Children’s Social Care call the MASH Team on
Once you have determined that a referral is required, please complete the online Child Referral Form. Upon completion, this form is automatically submitted. It should be noted that the form may time out, to prevent you losing information and to prepare you for what information is required see the ”Child Referral Form - Example". If, after referring to this example, you still require further assistance you can speak to a MASH Contact Officer on the following numbers /2533/4200/3596.
For urgent advice/response outside of office hours (from 5.30pm Mon to Thurs, 4pm Friday and weekends) contact the emergency duty team on If you think a child is in immediate danger then call for police assistance

23. Pan Merseyside Child Sexual Exploitation Procedures
Additional Slide

24. Pan Merseyside CSE Strategy
Pan Merseyside CSE Procedures are currently under review.
Additional Slide

25. Local safeguarding adults contact
The named professional for insert name CCG /NHS Trust is:
Insert name and job title

26. 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.

27. Referral
Discuss your concerns with a colleague or contact your local named nurse 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

28. 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

29. Next steps in the process
Once you have made the decision to refer, your concerns will be investigated and will result in one of the following outcomes: Adults, depending on the local authority you may receive notification that your concern is being looked into and information in relation to the outcome.
Insert local information here

30. Local sources of support
NSPCC
Action on Elder Abuse
LCH
  Safeguarding Adults Duty Line 9am pm
Children's Safeguarding Duty Line
Add as appropriate
Mention national support groups too if recommended locally, eg,
NSPCC
Action on Elder Abuse

31. 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

32. 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

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