1. Safeguarding Vulnerable Adults - the national and local picture
Sue Darker
Assistant Director - Learning Disability and Mental Health
Hertfordshire County Council

2. Statutory Guidance and Legislation
No Secrets - Department of Health 2000
Vulnerable Groups Act
Mental Capacity Act
Deprivation of Liberty Safeguards

3. Statement of Government Policy on Adult Safeguarding
Empowerment - Presumption of person led decisions and informed consent.
Protection - Support and representation for those in greatest need.
Prevention - It is better to take action before harm occurs.
Proportionality – Proportionate and least intrusive response appropriate to the risk presented.

4. Statement of Government Policy on Adult Safeguarding (2)
Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse.
Accountability - Accountability and transparency in delivering safeguarding.

6. What does HSAB do?
Works together to safeguard and promote the welfare of vulnerable adults.
Works together to prevent abuse of vulnerable
adults
Ensures action is taken when individuals are harmed
Raises awareness of adult abuse
The most important thing that we do is to make sure that if you’ve been hurt there is help and support for you and that you’re treated with respect whoever you speak to.

7. Who are the HSAB?
Hertfordshire County Council (HCS / CS/ Fire and Rescue/Trading Standards)
NHS Hertfordshire
West Hertfordshire Hospitals NHS Trust
East & North Hertfordshire Hospitals Trust
Hertfordshire Partnership NHS Foundation Trust
Hertfordshire Community NHS Trust
Hertfordshire Constabulary
Hertfordshire Probation Service
POhWER
District Councils

8. HSAB structure
Chaired by Assistant Director Health and Community Services
Agencies represented at director level
Memorandum of Understanding
Quarterly meetings

9. Annual Business Plan

10. Safeguarding adults from abuse in Hertfordshire
Inter agency procedure which must be followed by all services in Hertfordshire who work with vulnerable adults.
Reporting and investigating abuse
Roles and Responsibilities
Serious concerns about providers
Serious case reviews
Good practice guidance

11. Hertfordshire policy
All agencies and individuals involved in safeguarding adults, including managers, professionals, volunteers and staff working in public, voluntary and private sector organisations must :-
work together to prevent and protect adults at risk from abuse
empower and support people to make their own choices
support adults and provide a service to adults at risk who are experiencing abuse, neglect and exploitation.

12. Procedures The procedures aim to make sure that:-
the needs and interests of adults at risk are always respected and upheld
the human rights of adults at risk are respected and upheld
a proportionate, timely, professional and ethical response is made to any adult at risk who may be experiencing abuse
all decisions and actions are taken in line with the Mental Capacity Act 2005.

13. Protection Once abuse has occurred how do we:-
work together to investigate actual or suspected abuse and neglect
and
secure the best outcome for the individual?

14. Hertfordshire Procedures Case Studies March 2012
Patricia Orme
Head of Adult Safeguarding
Health and Community Services

15. Head of Adult Safeguarding
work with managers and staff in social care to improve safeguarding practice
lead on the development of safeguarding policies and procedures
member of the Hertfordshire Safeguarding Adults Board

16. What action would you take?
John
John is a man in his fifties who has Asperger's syndrome. A young woman, Jane has befriended John. This friendship is important to John and he gives her money.
John’s home care worker reports that John has said he gives Jane and fifty pounds every week.
What action would you take?

17. What action would you take?
Caroline
Caroline is a resident at your nursing home. She has learning disabilities and has diabetes which requires two different types of insulin twice daily. The nurse administering this gave the wrong dosage. The nurse realised the error immediately and called an ambulance. Caroline was taken to hospital and was discharged the following day having suffered no harm.
What action would you take?

18. What action would you take?
Freya Jones
Mrs Jones has been a traveller from childhood. She was been admitted to a care home. She is frail and has diabetes. You are the manager of the care home and one of your staff Sam tells you that Freya has told him that the night care assistant, Josie “smacked” her and called her a ‘dirty gypsy’ because she had messed herself.
What action would you take?
C is correct
When allegations of possible or actual abuse are made against a member of staff it is important that the service provider contacts the investigating team before the allegations are investigated.  This is to ensure that an investigation by the employer does not compromise any possible police investigation. There should be discussion between the service provider and the investigating team about an immediate protection plan for the vulnerable adult. You would also inform the Care Quality Commission
Josie was suspended. A strategy meeting was held. The police and a social worker interviewed Freya but there was insufficient evidence to prosecute Josie for assault. The care home carried out a disciplinary investigation. Josie was dismissed and referred to the Independent Safeguarding Authority.
All providers and agencies should use their internal HR policies and procedures to investigate allegations of abuse against their staff

19. Sarah Roberts What do you do?
Mrs Roberts has Parkinson’s disease and needs daily assistance with personal care. Her care worker, Sue, also does a regular food shop for Mrs Roberts. Sue is admitted to hospital and a new care worker, Maddy, supports Mrs Roberts. After the second visit Mrs Roberts tells Maddy how pleased she is that her shopping bill has gone down so much since Maddy has been doing the shopping and she seems to be getting more for her money. Maddy tells you she is getting the same items from the same supermarket as Sue did.
What do you do?

20. Identifying concerns What should you consider
What is the nature of the possible or actual abuse.
Is there a reasonable explanation.
Is medical attention or examination needed.
What are the current risks to the vulnerable adult.
Direct contact should be made with the police if:   
There is an immediate risk to life.
There is a serious injury.
A crime has been committed

21. Safeguarding alert/making a referral
Key actions to be taken
Immediate protection of the vulnerable adult
Record clear factual information
Contact the investigating team
Notify CQC
Notify commissioning team if the vulnerable adult is funded by another local authority

22. What happens next?
The team manager must decide whether a safeguarding investigation is needed within one working day of the alert.
A decision not to investigate might be made because there is sufficient information to indicate that:
the situation does not involve abuse, neglect or exploitation
the adult at risk is not an adult covered by these procedures
the adult at risk has the mental capacity to make an informed choice.
No other vulnerable adults are a risk or potentially at risk
The referrer should be informed of the outcome of the referral

23. Strategy discussion or meeting
If an investigation is needed a strategy discussion or meeting should be held within 3 or 10 working days depending on the seriousness of the incident. This is arranged by the investigating team.
A risk assessment and risk management plan must be completed once the decision to investigate is taken.

24. Strategy discussion or meeting
Purpose
agree a multi-agency plan to investigate the allegations
assess the risk to the person
put a protection plan in place
In most cases If the vulnerable adult lives in a care home, or attends a particular service, the care provider will be invited to the strategy meeting.
Discuss exceptions to this plus guidance given to our managers
Who do you invite/include in a strategy discussion/meeting?
How do you decide this?
How do you brief participants to get the best from them and achieve best outcomes
How do include the service user and/or their family

25. Investigation
In most cases the investigation will be lead by a member of the social care team who will carry out interviews with the alleged victim.
If the police are not investigating the allegation of abuse as a crime then the responsible person to carry out the interview will be decided at the safeguarding strategy meeting.
Where the alleged abuser is a member of staff (paid or a volunteer), this is likely to be the care provider.

26. Reconvened strategy meeting
Purpose
review the findings of the investigation
Decide whether the allegation is substantiated or unsubstantiated
review the protection plan
agree post investigation monitoring and support

27. Care provider involvement
Protection plan
Strategy meeting
Safeguarding investigation
Disciplinary investigation
Reconvened strategy meeting
Post investigation monitoring and support

28. Prevention - safeguarding challenges
The Social Care Institute for Excellence has published guidance which suggests that most safeguarding activity relating to care provision occurs as a result of poor practice and poor quality of service rather than malicious intent.
“The impact of poor practice and neglect can be just as significant as intentional abuse and yet it is arguably far easier to prevent “
The evidence underpinning this work was gathered from people using services, carers, commissioners, service providers, safeguarding leads and the Independent Safeguarding Authority (ISA). The impact of poor practice and neglect can be just as significant as intentional abuse and yet it is The evidence underpinning this work was gathered from people using services, carers, commissioners, service providers, safeguarding leads and the Independent Safeguarding Authority (ISA). It shows clearly that most safeguarding activity relating to care homes occurs as a result of poor practice and poor quality of service rather than malicious intent. The impact of poor practice and neglect can be just as significant as intentional abuse and yet it is arguably far easier to prevent.

29. Social Care Institute for Excellence
The guidance:-
identifies the issues that commonly lead to safeguarding referrals from care providers
sets out underlying causes
provides prevention checklists are provided to help providers reduce the occurrence of these issues

30. Common themes Maladministration of medication Pressure sores Falls
Rough treatment, being rushed, shouted at or ignored
Poor nutritional care
Lack of social inclusion
Institutionalised care
Physical abuse between residents
Financial abuse

31. Underlying causes Recruitment Staffing levels
Adherence to policy and procedure
Training
Choice of service
Record-keeping
Dehumanisation

32. Summary
As providers and commissioners of care we need to work together to prevent abuse occurring and to take prompt action to protect vulnerable adults if abuse takes place.