2. Whose Business Is It?

3. Ground Rules Share experiences and views
Recognise the sensitive nature of the subject matter
Listen and respect what others have to say
Note differing views as these may add to your knowledge
Promote anti-oppressive practice
Respect confidentiality unless it is necessary to address a current concern about the safety/risks to a vulnerable adult, if you do, talk this through with the trainer or a relevant person on the course
Explain any jargon

4. Session 1 Introduction

5. The Extent of Abuse – A National Perspective
As many as 342,000 older people were neglected and abused over the previous year by family and/or friends (UK study of abuse and neglect of older people: prevalence survey report, National Centre for Social Research 2007).
In the first 10 years that the AEA Helpline had been running, they have recorded 6,867 calls relating to10,528 incidents of abuse.
71% of those with mental health issues had been a victim of crime in the past two years, 22% had experienced physical assault, 41% experienced ongoing bullying,
27% experienced sexual harassment (with 10% experiencing sexual assault), with only 19% feeling safe at all times within their own home (MIND 2007).
Disabled people are four times more likely to be victims of crime compared to non- disabled people (British Council of Disabled People 2007).
Prevalence of abuse increased with a decline in health. The level of mistreatment was higher for people with a limiting long-term illness, a lower quality of life, and for those suffering from depression. (UK study of abuse and neglect of older people: prevalence survey report, National Centre for Social Research 2007). 5

6. The Extent of Abuse – A Local Perspective
Over the last year, there has been a rise in the total number of reported incidents of alleged abuse from 804 in 2008/09 to 1437 in 2009/10; an increase of 79%.
Hampshire has seen a 76.5% increase in cases of financial abuse.
Between 1st April 2005 and 31st March 2006 Hampshire Constabulary recorded 79 occurrences of disability hate crime and 374 occurrences of homophobic hate crime.
The Fire Service has reported that about 80% of fire deaths involve a vulnerable adult.
Self referrals and referrals from friends, relatives or neighbours of alleged victims have also increased from 156 in 2008/09 to197 in 2009/10 6

7. The Extent of Abuse – A Local Perspective continued….
585 reported incidents in the last 12 months were in respect of people not receiving a service commissioned by the County Council’s Adult Services (self-funders).
Referrals from partners account for 71% of reported safeguarding incidents with Health partners and the Police referring 19% and 8% of reported incidents respectively, with increased levels of reporting compared with previous years.
Work with Housing partners is beginning to impact on the numbers of reported incidents resulting from Housing (5 in 2008/09 and 15 in 2009/10).
Physical abuse, financial abuse, and neglect/acts of omission have been the most prevalent reported types of abuse over the last three years.
It is estimated that 56,000 women and girls have been a victim of domestic abuse in the last year in Hampshire. 7

8. ADSS Safeguarding Adults October 2005
‘Safeguarding Adults’ is a term used to mean all work which enables an adult to retain independence, wellbeing and choice and live a life that is free from abuse and neglect.
ADSS Safeguarding Adults October 2005

9. Safeguarding Services?
Who Is In Need of
Safeguarding Services?
‘‘A person aged 18 years or over, who is, or may be in need of community care services by reason of mental or other disability, age or illness’
AND
‘Who is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation’

10. Safeguarding Children
The government guidance Working Together (2006), places the responsibility for the safety and welfare of children with the local authority (WT section 2.9), but expects that all professionals who come into contact with children, parents and carers in the course of their work are aware of their responsibilities to safeguard and promote the welfare of children and young people (WT sections 2.52 to 2.73).

11. Rights and Responsibilities
Session 2
Rights and Responsibilities

12. What is the Mental Capacity Act 2005?
A statutory framework to empower and protect people who are not able to make their own decisions
Helps anyone over the age of 16, living in England and Wales, who lack capacity to make a decision for themselves
Puts the needs and wishes of a person who lacks capacity at the centre of any decision making process

13. What is the Mental Capacity Act 2005? cont...
Makes it clear who can take decisions, in which situations, and how they should go about this
Enables people to plan ahead for a time when they may lose capacity
Introduces new safeguards for people who lack capacity
A Code of Practice

14. Whose Work is Affected by the Mental Capacity Act?
YOU ARE ALL LEGALLY REQUIRED TO HAVE REGARD TO THE CODE OF PRACTICE
People working in a professional capacity
People who are paid to care or support adults in any setting
Anyone with a Lasting Power of Attorney
Anyone who is a deputy appointed by the Court of Protection
Anyone acting as an Independent Mental Capacity Advocate (IMCA)
Anyone carrying out research with people who lack capacity
Anyone being paid for acts for, or in relation to, a person who lacks capacity
GENERALLY anyone who looks after or cares for someone who lacks capacity 14

15. Principles of The Act
Assume a person has capacity unless proved otherwise
Do not treat people as incapable of making a decision unless you have tried all practicable steps to help them
Do not treat someone as incapable of making a decision because their decision may seem unwise
Do things for, and take decisions for, people without capacity in their best interests
Before doing something to someone or making a decision on their behalf, consider whether you could achieve the outcome in a less restrictive way 15

16. What is Mental Capacity?
Mental capacity is the ability to make a
decision, by:
Understanding the information you are given
Retaining the information long enough to enable you to make the decision
Weighing up the information
Communicating your decision 16

17. The MCA and Safeguarding Adults
Good practice in applying the principles
of the MCA is also:
Good Safeguarding Practice 17

18. Agency responsibilities
ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response ‘No Secrets’ DH 2000
Adult Services have a responsibility, in partnership with other agencies, to co-ordinate safeguarding responses ‘No Secrets’ DH 2000

19. All agencies Have the responsibility to:
ALWAYS involve service users in decision making
Promote the safety of service users
Promote the awareness of abuse
Assure staff and service users they will be listened to
Ensure staff are aware of reporting procedures
Take appropriate action where abuse is suspected
Call emergency services where there is immediate danger
Provide training
Work alongside other professionals
Keep records
Commission/provide safe services

20. Session 3
Recognising Abuse

21. Defining Abuse No Secrets DH 2000
Abuse is the violation of a person’s human and civil rights by any other person or persons
Abuse is the harming of another individual usually by someone in a position of power, trust or authority over that individual.
The harm may be physical, psychological or emotional or may be directed at exploiting the vulnerability of the victim in more subtle ways
The threat or use of punishment is also a form of Abuse
Abuse may happen as a “one-off” or it may become a regular feature of a relationship
Other people may be unaware that Abuse happening and for this reason it may be difficult to detect.
In many cases Abuse is also a criminal offence
No Secrets DH 2000

22. Types of Abuse Physical Psychological/Emotional Financial Sexual
Neglect
Discriminatory

23. Indicators of Abuse
It is unlikely that any one indicator alone will conclusively prove abuse has taken place
People will often experience more than one type of abuse
Staff should be alert to patterns and clusters of indicators which may raise suspicions
It is vitally important to report any concern/s
Any report should be taken seriously
Many of the indicators will feature similar elements in a number of different types of abuse e.g. Institutional abuse

24. In the person’s own home In nursing, residential or day care services
Where Does Abuse Occur?
In the person’s own home
In the community
In nursing, residential or day care services
Hospitals
It can happen anywhere

25. Who Abuses? It can be any of us Relatives/Friends Other service users
Neighbours
Paid carers
Professionals
Strangers

26. Abuse Can Occur in Different Contexts
Domestic Abuse – between people where there is a relationship and living in the same household
Professional Abuse – by those who are acting in a professional capacity, e.g. Doctors, Therapists, Nurses, Social Workers etc.
Institutional Abuse – takes place within an institutional setting with evidence of….. see next slide……

27. Safeguarding Children
Children and young people may be abused in a family or in an institutional or community setting; by those known to them or, more rarely, by a stranger.
All abuse and neglect are forms of maltreatment – a person may abuse or neglect a child by
inflicting harm, or by failing to act to prevent harm.

28. Institutional Abuse Routines and regimes
Lack of choice and consultation
Poor quality environment
The service revolves around the staff
Low staff morale
Lack of staff training
Lack of personal belongings
No evidence of effective policies and procedures

29. Session 4
Responding

30. Responding All allegations/disclosures must be treated seriously
The safety of the person is paramount
Stay calm, listen and reassure
Demonstrate a sensitive approach
Be aware of the possibility of the existence of forensic evidence
Explain the you are required to share that information with your manager but not with other staff or any other service users

31. Responding
Reassure the person that any further response will be taken sensitively and with their full involvement, whenever possible
Reassure the person that the service will take steps to support and where possible, protect them in the future
REPORT
MAKE A WRITTEN RECORD

32. IF IN DOUBT ALWAYS REPORT - in line with your organisation’s policy
Confidentiality
A person’s right to confidentiality is not absolute and may be overridden where there is evidence that sharing information is necessary in exceptional cases to prevent:
Serious crime
Danger to a person’s life
Danger to others
Danger to the community
Danger to the health of the person
IF IN DOUBT ALWAYS REPORT
- in line with your organisation’s policy

33. Session 5
Reporting

34. ‘No Secrets’ (2000)
ALL AGENCIES have a responsibility to report concerns in accordance with the policy to ensure the most effective response
ALL KINDS OF ABUSE HARM THE INDIVIDUAL – WE MUST NOT IGNORE IT

35. Enablers To Reporting
Service users awareness of what to expect from staff and the service
Knowing how to recognise indicators of abuse
Open organisational culture
Staff training
Staff support

36. Enablers To Reporting cont...
Accessible complaints procedures
Supervision and staff appraisal
Effective management role modelling of good practice
Good working relationships with professionals, families and carers

37. Barriers to Reporting Failure to recognise the abuse
Will not be believed
Fear of reprisals
Fear of ‘heavy handed’ responses
Breaching confidentiality
Not sure if concerns are valid
Lack of clarity about reporting procedures

38. Barriers To Reporting cont...
Impact on relationships with colleagues/service users/families
A workplace culture of non reporting
Increased tolerance levels (accepting certain behaviours)

39. Initial Action To Be Taken
All allegations should be treated seriously
The safety of the person is paramount
Call the Police if a crime has been committed
Stay calm, listen and reassure the person
Do not press the person for details
Do not make promises you cannot keep
Do not confront the alleged perpetrator
Do not dispose of possible evidence
Remember the limits of confidentiality
Make notes as soon as possible
Report concerns immediately
Follow procedures

40. Mapping the Alert In-house procedures
Within 24 hours:
Assess risk of further harm
Provide information and support
to adult at risk
Report concerns to Social
Services (in line with your local
safeguarding procedures)
Report to CQC (Regulation 18)
Consider internal disciplinary
action if the person alleged to
be causing the harm is an
employee
Record all actions and decision
making
Immediate Action:
Ensure safety of the
person
Call emergency
services
Support the person
Report to Line Manager
Record details
Preserve evidence

41. Child Protection Concerns
Be familiar with and follow your organisation’s procedures and protocols for promoting and safeguarding the welfare of children in your area, and know who to contact in your organisation to express concerns about a child’s welfare.

42. Session 6
Recording

43. Guidance for Making a Written Record
Make a note of date, time and setting
Make a note of anyone else who was there at the time
Record what was said using the person’s own words
Separate factual information from any opinions expressed
Use a pen or ballpoint with black ink if you can.

44. Guidance for Making a Written Record cont...
Make sure your writing is legible and do not use tippex and initial any changes
Date and sign your report
Remember that your report may be required as part of any legal action or disciplinary proceedings
Keep a copy for future reference which is filed securely.

45. Information To Be Given When Making a Referral
Your details
Details of the alleged victim
Details of alleged perpetrator (if known)
Details of any witnesses (if known)
Name and contact details of GP
Reasons for the concerns
Any relevant background information
Whether the person is aware of the referral
Action already taken.

46. Session 7
What Next?

47. What Do I Need To Know?
How to recognise abuse and where to report my concerns
Where to find my workplace Policy and Procedure and make sure I have read and understood it
That abuse is not an isolated problem, but a significant social concern
That abuse can be a crime
That anyone can potentially cause harm to a vulnerable adult, intentionally or unintentionally
The rights of the people I provide a service to
That I will be supported if I report a concern
My rights as an employee
What training I can expect to ensure I provide quality care
That Adult Services have a responsibility, in partnership with other agencies, to assess and respond

48. Prevention Acknowledge that it COULD happen here!
Report any concerns – in whatever way necessary to be heard
Do not tolerate poor practice
Be aware of possible indicators of abuse
Promote self advocacy and advocacy
Follow policies and procedures for intimate personal care, physical interventions and sexuality
Attend training when given the opportunity
Make use of supervision opportunities
Good record keeping
Use ‘Whistleblowing’ Procedure