Level 2 Cer tificate in Understanding Dignity and Safeguarding in Adult Health and Social Care SAMPLE. Unit 1

Transcription

1 NCFE Level 2 Certificate in Understanding Dignity and Safeguarding in Adult Health and Social Care Unit 1 1

2 These learning resources and assessment questions have been approved and endorsed by ncfe as meeting the requirements of the Level 2 Certificate in Understanding Dignity and Safeguarding in Adult Health and Social Care. Disclaimer: This resource uses real life case studies where specifically stated and referenced. All other references to individuals, groups and companies contained within these resources are fictitious.

3 Unit 1: Understanding safeguarding in adult health and social care Welcome to unit one. This unit is split into five sections. These are: Section 1: The national and local context of safeguarding and protection from abuse Section 2: Recognising potential and actual abuse and harm Section 3: How to respond if abuse or harm is disclosed, suspected or alleged Section 4: Reducing the likelihood of abuse or harm Section 5: Information and support in relation to abuse or harm Introduction Whilst the rights of all individuals should be protected, adults who use health and social care services are amongst those most at risk of abuse or neglect. Health and social care workers must recognise situations which may lead to abuse and neglect, and the need for a person-centred approach which provides supportive and trusting relationships. For these reasons it is important for people working with adults in health and social care to develop an understanding of safeguarding. Q. What is safeguarding? A. Some adults may be unable to protect themselves from harm because of their disability, age or illness. They have a right to be supported to keep themselves safe, and for action to be taken if they are abused or neglected. This is known as safeguarding. 1

4 Section 1: The national and local context of safeguarding and protection from abuse This section will explore the following: Current legislation in relation to safeguarding National policies and local systems for safeguarding and protection from abuse Roles of different agencies in relation to safeguarding and protection from abuse Safeguarding concerns in adult health and social care. Current legislation in relation to safeguarding There is a wide range of legislation currently in place that relates to safeguarding. Here are some of the relevant laws; however, it is important to note that there is no single piece of legislation that covers all aspects of safeguarding at present. Mental Health Act 1983 (MHA) The Act states the circumstances in which a person can be detained. It also states what needs to happen if a person is detained. In England, the Care Quality Commission (CQC) is responsible for monitoring the way the Act is used and protecting the interests of patients. NHS and Community Care Act 1990 When local authorities carry out investigations or when they make enquiries in relation to safeguarding, they are carrying out their assessment duties under Section 47 of the NHS and Community Care Act Public Interest Disclosure Act 1998 This Act came into force in July The Act amends employment legislation so that employees are protected against dismissal and other adverse action if they make complaints or public disclosures whistleblowing about malpractice. 2

5 Human Rights Act 1998 The following key rights or Articles under the Act are particularly relevant in a safeguarding context: Article 2 Right to life Article 3 Prohibition of inhumane, degrading treatment and torture Article 5 Right to liberty Article 8 Right to respect for private and family life, home and correspondence. Data Protection Act 1998 The Act introduced protections for data held about individuals on electronic and paper databases, applied safeguards to data processing and allowed rights of access for those wishing to see information that is being held about them. Care Standards Act 2000 Standard 18 of the Act ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self-harm, inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policies. The Police Act 1997 (Enhanced Criminal Record Certificates) (Protection of Vulnerable Adults) Regulations 2002 The Regulations established the Criminal Records Bureau (CRB). This service enables organisations in the public, private and voluntary sectors to make safer recruitment decisions by identifying candidates who may be unsuitable for certain work, especially that involving children and vulnerable adults. Sexual Offences Act 2003 Part of the Act prohibits sexual abuse of vulnerable persons with a mental disorder. These include situations where: They are unable to refuse because of a lack of understanding They are threatened, deceived or offered inducements There is a breach of a relationship of care by a care worker. 3

6 Mental Capacity Act 2005 (MCA) The question of a person s mental capacity to make decisions about their own welfare may be crucial in determining whether other people have a duty, and the power, to intervene and provide care and treatment, or protection, of the person s finances. Safeguarding Vulnerable Groups Act 2006 The principles of the Act are as follows: Unsuitable persons should be barred from working with children or vulnerable adults Employers should have a straightforward means of checking that a person is not barred from working with children or vulnerable adults Suitability checks should not be one-offs they should be an element of ongoing assessment of suitability to catch those who commit crimes following a suitability check. NHS Act 2006 Public bodies have general duties under the NHS Act 2006 to provide medical and related services. Safeguarding issues could arise from the failure to provide appropriate, timely services to a vulnerable adult. Mental Health Act 2007 The Act introduced the Deprivation of Liberty or Bournewood safeguards. These protect against illegitimate deprivation of liberty for people who lack the capacity to consent to arrangements made for their care that would deprive them of liberty. The Health and Social Care Act 2008 This Act helps to ensure that people are protected within the health sector. It requires all health and social care services to be registered with the Care Quality Commission. Once registered, the Care Quality Commission is responsible for inspecting adult health and social care services to ensure people within the service are protected. Regulations have been made under the Act to specify what is required of health and social care providers. Some of these refer explicitly to the need to protect users of services from abuse or undue restraint. Others cover care issues relating to dignity, nutrition, infection control, and adequate staffing. Lapses in such matters, particularly where they are systematic, can lead to serious safeguarding issues, including institutional abuse. 4

7 The Equality Act 2010 The Act prohibits discrimination on the grounds of what are called protected characteristics for example, age, disability, religion or belief. The Act prohibits not only direct discrimination, but also indirect discrimination, harassment and victimisation. National policies and local systems for safeguarding and protection from abuse Safeguarding Adults is the formal term used to describe a range of activities aimed at preventing and responding to harm and abuse of vulnerable adults who are at risk of harm. It involves people in official roles in health and social care services and the police, but family carers are also important to all aspects of safeguarding from helping their relatives stay safe, to responding when they have been harmed. Q. What is a vulnerable adult? A. A vulnerable adult is a person 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. Source: No Secrets, Dept of Health (2000). 5

8 National policies Current national policy relating to safeguarding and protection from abuse is set out in the following documents: No Secrets, Dept of Health (2000) The No Secrets guidance encouraged the development of multi-agency working to promote an effective and coordinated approach to safeguarding in each local authority area. This guidance still forms the basis for current government policy in relation to safeguarding. Adult Social Care Outcomes Framework (ASCOF) The ASCOF has been developed with local government. It focusses on people s quality of life and their experiences of care, and aims to track progress and strengthen transparency both locally and nationally in the delivery of adult social care. Statement of government policy on adult safeguarding The Department of Health (2011) sets out six key safeguarding principles: 1. Empowerment: a presumption of person-led decisions and informed consent 2. Protection: support and representation for those in greatest need 3. Prevention: it is better to take action before harm occurs 4. Proportionality: a proportionate, and the least intrusive, response appropriate to the risk presented 5. Partnership: local solutions achieved via services working with their communities communities have a part to play in preventing, detecting and reporting neglect and abuse 6. Accountability: accountability and transparency in delivering safeguarding. 6

9 Local systems Local systems may include: Multi-agency adult protection arrangements for the locality Local organisational policies and procedures. Multi-agency adult protection arrangements Multi-agency partnerships are arrangements whereby different organisations agree to work together to provide the care and protection of vulnerable adults. They work at a local level to develop policies and procedures which safeguard adults by promoting good practice through the following systems: Local Safeguarding Adults procedures Safeguarding Adults Board Safeguarding Adults Team These procedures are based on No Secrets and guidance issued by the Association of Directors of Adult Social Services. These procedures represent a shared approach to safeguarding adults across all health and social care agencies in a local authority area. However, the responsibility for coordinating safeguarding lies with the local authority social services. In each local authority there is a Safeguarding Adults Board. This is the forum for agreeing how different agencies, services and professional groups will cooperate to safeguard adults at risk in their area. Family carers should also be represented on the Board. The Safeguarding Adults Board: Makes sure multi-agency procedures are put into practice Audits and reviews practice at regular intervals Guides the actions of anyone involved in safeguarding adults at risk Makes decisions about when serious case reviews are held. Every local authority will have a Safeguarding Adults Team, which is made up of people with appropriate qualifications and training in safeguarding adults in the local authority area. These teams offer information, advice and training to care staff and anyone who has concerns that an adult at risk has been harmed. The team will also coordinate the response once a concern has been raised. 7

10 Look at the following case study example. Case Study: Safeguarding Adults Board, York The Safeguarding Adults Board exists to serve the City of York s population of vulnerable adults, and has been in existence since November It has a strong focus on partnership working, and, through this partnership approach, hopes to ensure that vulnerable adults are able to live their life free from violence, whilst maintaining their independence and well-being. Key partners include: City of York Council NHS Vale of York Clinical Commissioning Group (CCG) North Yorkshire Police Healthwatch York Leeds and York Partnership Foundation Trust NHS England, Yorkshire and Humber Team Independent Care Group York and North Yorkshire Probation Trust Partnership Commissioning Unit Stockton Hall York CVS The Retreat York District Hospitals NHS Foundation Trust. A Activity 1: Research Find out about the Safeguarding Adults Board and Team in your own local area. You can do this by entering Safeguarding Adults Board [the name of your locality] into an internet search engine, by contacting your local authority, or by visiting your local library. 8

11 Local organisational policies and procedures All organisations and employers that have contact with or responsibility for vulnerable adults must have policies and procedures in place to prevent abuse, harm and neglect. Use the next activity to see an example of local procedures in detail. A Activity 2: Swindon and Wiltshire Local Authority Use the link below to download the document Policy and Procedures for Safeguarding Adults at Risk in Swindon and Wiltshire (March 2013). Make notes in the space below. 9

12 Roles of different agencies in relation to safeguarding and protection from abuse Specific roles The following table shows some specific roles of different agencies in safeguarding and protecting individuals from abuse. Specific roles or investigations Assessment of need for health and social care provision for service users and carers Complaint regarding failure of service including neglect of provision of care and failure to protect one service user from the actions of another Breach of service regulations relevant to the service Breach of contract to provide care Fitness of a registered provider or manager Breach of terms of employment or disciplinary procedures Breach of professional code of conduct Unresolved serious complaint in a health setting Lack of proper administration of a complaint by a local authority or public health body Breach of health and safety legislation Inappropriate decisions about the care and well-being of an adult without mental capacity that are not in his or her best interests Misuse of Enduring Power of Attorney or Lasting Power of Attorney or Deputyship Misuse of appointeeship or agency status in dealing with Department of Work and Pensions (DWP) administered benefits Breach of rights of person detained under the Mental Health Act Criminal acts including: assault, theft, fraud, hate crime and domestic violence, bogus officials, wilful neglect 10 Local authority social services Service provider manager, proprietor or complaints department Care Quality Commission (CQC) Service commissioner CQC Employer Professional regulatory body CQC Local Government Ombudsman or Health Ombudsman Health and Safety Executive (HSE) Court of Protection Office of the Public Guardian (OPG) Department of Work and Pensions (DWP) CQC Police Agency responsible

13 A Activity 3: Agencies Use the internet or your local library to find out more about the roles of the following agencies that are involved in safeguarding and protecting individuals from abuse. i) Care Quality Commission: ii) Local authority social services: iii) Court of protection: You can use your notes to help with the assessment at the end of this section. 11

14 General roles Agencies involved in safeguarding have general roles in implementing the following six principles set out in the Statement of government policy on adult safeguarding, Department of Health (2011): Principles Empowerment Protection Prevention Proportionality Partnership Accountability Roles of agencies Give people relevant information about recognising abuse and the choices available to them to ensure their safety. Give clear information about how to report abuse and crime, and any necessary support in doing so. Consult people before taking any action. Where someone lacks capacity to make a decision, always act in his or her best interests. Devise local reporting arrangements for abuse and suspected criminal offences, along with risk assessment. Effectively identify and appropriately respond to signs of abuse and suspected criminal offences. Make staff aware, through provision of appropriate training and guidance, of how to recognise signs and take any appropriate action to prevent abuse from occurring. Discuss with the individual and where appropriate with partner agencies the proportionality of possible responses to the risk of significant harm before taking a decision. Have effective local information-sharing and multiagency partnership arrangements in place and make sure that staff understand these. Foster a one team approach that places the welfare of individuals above organisational boundaries. Ensure that the roles of all agencies are clear, together with the lines of accountability, and that staff understand what is expected of them and others. Ensure that agencies recognise their responsibilities to each other, act upon them and accept collective responsibility for safeguarding arrangements. 12

15 Safeguarding concerns in adult health and social care There are a number of safeguarding concerns in adult health and social care including: Falls Some people who are frail or have mobility problems may be at greater risk of falls. The consequences of falls can be very costly for both the individual in terms of their health, well-being and mobility and for adult health and social care services. Following a fall, the individual may require more intensive services for longer and, in some cases, may never return to previous levels of mobility. Nutrition Poor nutritional care in care homes and hospitals has been frequently highlighted in recent years. Between 19 and 30 per cent of all people admitted to hospitals, care homes or mental health units are at risk of malnutrition. The consequences of malnutrition and dehydration can be very costly both for the individual, in terms of their health and well-being, and for services, as people may become ill and require more intervention for longer. A Falls Nutrition Maladministration of medication Pressure area care Social exclusion Institutionalised care Rough or rushed treatment Abuse between individuals Challenging behaviour. Activity 4: Nutrition concerns in adult health and social care Use the link below to watch a short video about nutrition. If you need help using the internet seek advice from your tutor. 13

16 Maladministration of medication There have been cases of medication being mismanaged intentionally, such as the misuse of drugs by staff. There are also concerns about the misuse of sedatives to control challenging behaviour. Where this is suspected or alleged it should be referred through safeguarding procedures. In care homes, incidents occur where a resident is accidentally given the wrong medication, given too much or too little, or given it at the wrong time. Most errors do not result in significant harm but mistakes can lead to serious, and in some cases, fatal consequences. Pressure area care Many people who are frail and have restricted mobility are at risk of developing pressure sores sometimes called bed sores or ulcers. Pressure sores start with skin discolouration, but if left untreated, can become very deep and infected. In the worst cases they can be life-threatening. With management and care, pressure sores can be avoided in most cases. Social exclusion People in residential care and their relatives often complain of a lack of stimulation, activity, opportunities for social interaction, including sexual relationships, and community participation. The results of inactivity and social isolation can be experienced as harmful and abusive by individuals, and can have a negative effect on mental health and general well-being. Institutionalised care Institutionalised care is a safeguarding concern when the routines and regimes of an institution result in poor or inadequate standards of care and poor practice, which denies or restricts people s dignity, privacy, choice and independence for example, people being forced to eat or go to bed at a particular time can be experienced as abuse. Rough or rushed treatment People receiving care support often feel they are being roughly treated, rushed or ignored. People can experience such treatment as abuse. Unexplained bruising is a common reason for safeguarding concerns and rough handling may be the cause. Abuse between individuals Care homes often have to deal with altercations and abuse between residents, some of which entail physical attacks. This could be the result of tensions between people living in close proximity, and may also be caused or exacerbated by misunderstandings due to dementia, learning disabilities, or mental health problems. Challenging behaviour Challenging behaviour is another issue of concern in adult health and social care. Use the next activity to learn more. 14

17 A Activity 5: Concerns about challenging behaviour Use the link below to find information about challenging behaviour in the document At a glance 37: Challenging behaviour: a guide for family carers on getting the right support for adults. Make notes in the space provided. If you need help using the internet seek advice from your tutor. You can use your notes to help with the assessment at the end of this section. Key Fact There are a range of safeguarding concerns that affect people with disabilities, dementia, learning difficulties and other vulnerable adults using care services. 15

18 Let s Summarise! Take a few moments to answer the following questions to help you summarise what you have learnt in this section. This will help you answer the questions in your assessment booklet. 1. What is meant by the term safeguarding? 2. What is a vulnerable adult? 3. What systems do local authorities have to set up in order to provide safeguarding of vulnerable adults? 4. Identify two examples of safeguarding concerns in adult health and social care. i) ii) Check your answers by looking back over this section. CONGRATULATIONS, YOU HAVE NOW COMPLETED SECTION 1. PLEASE NOW GO TO YOUR ASSESSMENT BOOKLET AND ANSWER QUESTIONS Q1 TO Q4. 16