1. Safeguarding Adults Universal Level Training
July 2018 onwards

2. Aim
To raise the awareness of people working or volunteering with adults in regards to adult safeguarding and how to apply this to every day activities and working practice include competencies
The aims of adult safeguarding are to:
prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
stop abuse or neglect wherever possible
safeguard adults in a way that supports them in making choices and having control about how they want to live
promote an approach that concentrates on improving life for the adults concerned
raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect
provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult
address what has caused the abuse or neglect

3. HSAB Competencies 1-6
Understand what safeguarding is and your role in Adult Safeguarding Recognise an adult at risk, potentially in need of safeguarding and take action Understand the procedures involved to raise a concern Understand dignity and respect when working with individuals Have knowledge of policy, procedures and legislation that support Adult Safeguarding activity Have knowledge of action to take should a concern around a child or young person is being abused

4. Why safeguarding is important?
Watch this short video – in your groups discuss:
How much impact did abuse have on him?
Even many years on the impact can still be seen.
Video link:

5. What do you know about the dignity challenge?
You will all have seen the posters displayed in receptions, front desks, care offices. Below is an example of one of the statements.
Can you remember any other of the statements on the challenge?
This group activity will help establish what people know about this project launched in All health and care providers in Herefordshire should be aware of the national Dignity Challenge and be working to ensure their services reflect the 10 principles. In Herefordshire, we want to make sure that the public are also aware of the challenge so that they understand what a high quality service looks and feels like. High quality services respect people’s dignity and provide safe environments for care.
We are asking all health and care providers to display our Dignity Challenge poster in a public area and ensure everyone in receipt of their services has access to our Dignity Challenge leaflets. If you are in receipt of a health or care service and do not feel it meets all the elements of the Dignity Challenge you should raise it with the provider if you feel able to. They should have told you who you can talk to. If you feel they are not listening you should contact Healthwatch in Herefordshire on More information is available in the leaflet.

6. Dignity Challenge
Providers services should be displaying this poster to show they have signed up to this.
It is designed for service users to be able to measure service delivery being delivered and explains who to talk to if they have any problems

7. Raising Concern – this is your role
“A concern can be identified and reported by anyone, including the adult, a carer, family, friends, professionals or other members of the public “
Individual agencies should have internal procedures and guidance for responding to and reporting concerns.
West Midlands Multi-Agency Policy & Procedures 2015
This is used so that learners are aware of their role, it is relevant for them whether this is in relation to their work role or being part of the community in which they live. The procedures and Care Act support this.
Workers across a wide range of organisations need to be vigilant about adult safeguarding concerns in all walks of life including, amongst others in health and social care, welfare, policing, banking, fire and rescue services and trading standards; leisure services, faith groups, and housing. GPs, in particular, are often well-placed to notice changes in an adult that may indicate they are being abused or neglected. Findings from serious case reviews have sometimes stated that if professionals or other staff had acted upon their concerns or sought more information, then death or serious harm might have been prevented. The following example illustrates that someone who might not typically be thought of, in this case the neighbour, does in fact have an important role to play in identifying when an adult is at risk

8. Who does safeguarding apply to?
The adult safeguarding duties under the Care Act 2014 apply to an adult, aged 18 or over, who:
has needs for care and support (whether or not the local authority is meeting any of those needs) and;
is experiencing, or at risk of, abuse or neglect; and
as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
West Midlands Multiagency Policy & Procedures 2015
This definition replaces the ‘No secrets guidance’. Below is the definition of care and support from the Care Act:
The mixture of practical, financial and emotional support for adults who need extra help to
manage their lives and be independent – including older people, people with a disability or
long-term illness, people with mental health problems, and carers. Care and support includes
assessment of people’s needs, provision of services and the allocation of funds to enable
a person to purchase their own care and support. It could include care home, home care,
personal assistants, day services, or the provision of aids and adaptations.  (p497)
Although the wording is different, this is in line with the previous definition in ‘no secrets’.

9. Definition of Care & Support
Could be:
A care service
Home care, Personal Assistant,
Residential or Nursing Care
Respite Care
Support service – to meet their individual needs
Aids, adaptations
Voluntary services -
Financial support

10. Aims of safeguarding
To prevent and reduce risk of abuse or neglect to adult with care and support needs
To safeguarding adults in a way that supports them making choices and have control over how they choose to live
To promote an outcome approach to safeguarding so adults have the best experience possible
To raise public awareness so that communities can play their part in preventing, identifying and respond to abuse and neglect
Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances

11. Legislation Care Act 2014 Mental Capacity Act 2005
Public Interest Disclosure Act 1998 ‘Whistle Blowing Act’
Human Rights Act 1998
Children's Act 1989
Disclosure and Barring Service
Equalities Act 2010
Serious Crime Act 2015
14.21 A new offence of coercive and controlling behaviour in intimate and familial relationships was introduced into the Serious Crime Act The offence will impose a maximum 5 years imprisonment, a fine or both.
14.22 The offence closes a gap in the law around patterns of coercive and controlling behaviour during a relationship between intimate partners, former partners who still live together, or family members, sending a clear message that it is wrong to violate the trust of those closest to you, providing better protection to victims experiencing continuous abuse and allowing for earlier identification, intervention and prevention.

12. What is making Safeguarding Personal?
Working with the individual
Improving quality of life, wellbeing
& safety
Giving people greater choice & control
Making safeguarding more effective from the perspective of the person being safeguarded
Viewing the person as the expert on their own life
Talking and listening to what people want to happen
Making safeguarding personal
14.14 In addition to these 6 key principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised;
14.15 Making safeguarding personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Nevertheless, there are key issues that local authorities and their partners should consider
Gathering information to understand how MSP helps improve people’s lives

13. No decision about me without me
NHS Initiative
“Shared decision-making is a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences. “

14. What is abuse and neglect?
Abuse and neglect can take many forms and circumstances of the individuals case should be taken into consideration
Abuse and neglect maybe deliberate or the result of negligence or ignorance
Incidents of abuse maybe one off.
14.18 Incidents of abuse may be one-off or multiple, and affect one person or more. Professionals and others should look beyond single incidents or individuals to identify patterns of harm, just as the CCG, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what we now describe as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.
14.19 Patterns of abuse vary and include:
serial abuse, in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse
long-term abuse, in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse
opportunistic abuse, such as theft occurring because money or jewellery has been left lying around

15. Emotional / Psychological Exploitation / Modern Day Slavery
Types of Abuse
Abuse
Emotional / Psychological
Financial / Material
Physical
Exploitation / Modern Day Slavery
Self Neglect
Neglect
Discriminatory
Institutional
Sexual
Domestic Abuse
Physical abuse including:
assault
hitting
slapping
pushing
misuse of medication
restraint
inappropriate physical sanctions
Domestic violence including:
psychological
physical
sexual
financial
emotional abuse
so called ‘honour’ based violence
Sexual abuse including:
rape
indecent exposure
sexual harassment
inappropriate looking or touching
sexual teasing or innuendo
sexual photography
subjection to pornography or witnessing sexual acts
sexual assault
sexual acts to which the adult has not consented or was pressured into consenting
Psychological abuse including:
threats of harm or abandonment
deprivation of contact
humiliation
blaming
controlling
intimidation
coercion
harassment
verbal abuse
cyber bullying
isolation
unreasonable and unjustified withdrawal of services or supportive networks
Financial or material abuse including:
theft
fraud
internet scamming
coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions
the misuse or misappropriation of property, possessions or benefits
Modern slavery encompasses:
slavery
human trafficking
forced labour and domestic servitude.
traffickers and slave masters using whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment
Read Modern slavery: how the UK is leading the fight for further information.
Discriminatory abuse including forms of:
slurs or similar treatment:
because of race
gender and gender identity
age
disability
sexual orientation
religion
Read Discrimination: your rights for further information.
Organisational abuse
Including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.
Neglect and acts of omission including:
ignoring medical
emotional or physical care needs
failure to provide access to appropriate health, care and support or educational services
the withholding of the necessities of life, such as medication, adequate nutrition and heating
Self-neglect
This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding. It should be noted that self-neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.
14.18 Incidents of abuse may be one-off or multiple, and affect one person or more. Professionals and others should look beyond single incidents or individuals to identify patterns of harm, just as the CCG, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what we now describe as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared.
14.19 Patterns of abuse vary and include:
serial abuse, in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse
long-term abuse, in the context of an ongoing family relationship such as domestic violence between spouses or generations or persistent psychological abuse
opportunistic abuse, such as theft occurring because money or jewellery has been left lying around
Domestic abuse
14.20 The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to:
emotional

16. Activity in Groups Your role in prevention, what do you do?
What might you see, hear or observe?

17. Potential signs- Adults*
Defending the alleged perpetrator – making excuses for them Background shouting – obviously being influenced/ coached regarding responses Being unable to talk directly to the individual concerned (being spoken for) Obvious untruths – stories not matching injuries A disclosure Weight gain / loss Change in condition – smelling, dirty clothes, unwell
Changes in behaviour e.g. tone of voice, whispering, aggressive, withdrawn, emotional, expression of fear, worry and anger. Lengthy silences Changes of habits – shopping, visits, trips, eating, not eating, way of dressing Difficulty in talking due to another’s presence Unexplained injuries, bruising in unusual places
Delete ones not relevant and include ones that may be more relevant to your workforce. Complete the Hint / Tips
Highlight the concern that not everyone does display an outward sign of something being wrong

18. Who might be the person of concern?
Anyone!
Professional status does not mean that a person is incapable of abusing
Deliberately target vulnerable people
Family, friends, siblings.
Steven Hoskin Video
VIDEO LINK:
14.33 Anyone can perpetrate abuse or neglect, including:
spouses/partners
other family members
neighbours
friends
acquaintances
local residents
people who deliberately exploit adults they perceive as vulnerable to abuse
paid staff or professionals and volunteers
strangers
14.34 While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power. Read the report on Abuse of Vulnerable Adults in England for more information.

19. Why does abuse happen? What led to this abuse happening?
Could this happen in Hereford / your setting?

20. Preserving evidence & Responding to an immediate danger
Ensure the safety and well being of the adult
Keep records, documents safe
Preserve any evidence at the scene such as clothing, containers, and the actual location
Ensure the location not disturbed until police arrive
Refer to Good practice in preserving evidence document

21. Responding to a disclosure
Listen very carefully; use your active listening skills
Don’t dismiss their concerns. Reassure them that you will deal with the allegation discreetly and will take it seriously
Don’t confront the person of concern
If the person is in immediate danger call the police or ambulance.
Explain to them that that you will pass it on
Report the concern to your * responsible person / line manager / supervisor straight away using the victims own words.
If you can’t go through your manager consult your whistle blowing policy on how to report. This will tell you who to contact
Write an account of what you have been told for future reference.
* delete as required to suit your own organisation internal procedures.

22. Writing a report Why should you report abuse? To stop the abuse
Ensure that those involved get support
To stop risk to others
Adult may be unable to report themselves
We have a duty of care to report abuse. If you don’t you are part of the abuse.

23. If you have a concern Raising Concern – this is your role
Reporting a concern, disclosure or allegation
Recognising signs & signals of adult abuse
Responding to disclosures
14.68 It is important that all partners are clear where responsibility lies where abuse or neglect is carried out by employees or in a regulated setting, such as a care home, hospital, or college. The first responsibility to act must be with the employing organisation as provider of the service. However, social workers or counsellors may need to be involved in order to support the adult to recover.

24. How to I raise a concern?
Talk to the *responsible person / supervisor / line manager – follow your internal procedures
Used the MCA Checklist, Threshold document,
Contact social work teams
Call Advice and Referrals Team on (out of hours )
Fax:
* Delete as required to suit your service

25. You will be asked What happened? Who is the adult?
Who is the person of concern?
What actions have been taken to keep the adult safe?
Are they still at risk?
Is the adult aware of the concern being raised?

26. What happens when a concern becomes an enquiry?
Work with the individual to establish their preferred outcome
Immediate action to protect the adult that is outcome focused
Full investigation to establish facts
Consent to act
May be single or multi-agency, you may be asked to attend meeting or give further information
Police lead where there is criminality
Allocation of named worker

27. Where to go for further advice

28. Family approach
Adult services focus on adults but we regularly come into contact with children as part of that work
What contact do you have?
Still not sure – check Levels of Need.
Please remember that pregnant adults who are at risk will need to be referred to Children teams as well as the unborn child is also at risk.

29. Concerned about a child or young person

30. Any questions? Summary:
Abuse can occur in any setting and anyone can be a person of concern
Don’t assume that someone else will report abuse - you have a duty to report if you witness or suspect abuse and never ignore a hunch.