The Newcastle upon Tyne Hospitals NHS Foundation Trust. Safeguarding Adults Policy and Guidelines

Transcription

1 The Newcastle upon Tyne Hospitals NHS Foundation Trust Safeguarding Adults Policy and Guidelines Version No.: 5.0 Effective From: 11 June 2015 Expiry Date: 11 June 2018 Date Ratified: 26 May 2015 Ratified By: Clinical Policy Group 1 Introduction The Newcastle upon Tyne Hospitals NHS Foundation Trust is committed to working in partnership with Newcastle Safeguarding Adults Board (NSAB) to help protect adults who are at risk from abuse, harm and neglect (adults at risk) and have in place systems and processes to support the NSAB's interagency policy and procedures. The Trust recognises that its first priority should always be to ensure the safety, wellbeing and protection of adults at risk in its care and that the responsibility of all staff working with patients is to act on any suspicion or evidence of abuse or neglect, and to report their concerns to their line manager and adult safeguarding team. The Newcastle upon Tyne Hospitals NHS Foundation Trust has a duty to participate fully in any Safeguarding Adults Reviews (SAR), Domestic Homicide Reviews (DHR) or Independent Management Review (IMR). SAR's, DHR s and IMR's are initiated by the Commissioning Safeguarding Adult Board. All SAR s are reviewed and signed off by the Newcastle Hospitals Executive Director Lead for Safeguarding (Nursing and Patient Services Director). The lead investigator will ensure potential evidence cannot be altered and is responsible for conducting an independent review and analysis of the case. On analysis of any SAR/DHR/IMR's, recommendations will be discussed at the Trust Safeguarding Committee and appropriate action taken. The Nursing and Patient Services Director in conjunction with safeguarding professionals will ensure recommendations are responded to by the Trust. 2 Policy Aim The aim of this policy is to provide staff with guidance on who might be adults at risk, indicators of abuse, harm and neglect and processes for responding to and reporting adult safeguarding cases. It clarifies the responsibilities of all Trust staff in relation to safeguarding adults and aims to ensure consistency of approach across Newcastle upon Tyne Hospitals NHS Foundation Trust. This policy and guidance is aligned with the NSAB interagency policy and procedures, and demonstrates commitment to working with other agencies to ensure that people within all services are appropriately safeguarded. This policy also provides information regarding the requirement for mandatory training and awareness raising requirements of the Trust to various staff groups. Page 1 of 27

2 It also describes staff roles and responsibility in the adult protection process (Appendix 1). This policy safeguards any adult who is 18 or over and has needs for care and support (whether or not those needs are being met) and is experiencing, or is at risk of abuse or neglect; and as a result of those needs is unable to protect him or herself against the abuse or neglect or risk of it 3 Background Every person has the right to live free from abuse and neglect. This right is underpinned by the duty on public agencies under the Human Rights Act (1998) to intervene proportionately to protect the rights of the citizens. However, whilst vast amounts of single and multi-agency work have been carried out over the last few years to safeguard children, adults at risk of abuse, harm and neglect have received significantly less attention. Until The Care Act (2014) no single piece of legislation which covered adult safeguarding. This policy reflects the legislative requirements outlined within the Care Act In March 2000, "No Secrets": guidance on developing and implementing multiagency policies and procedures to protect vulnerable adults from abuse was published by the Department of Health. This placed a requirement on all agencies to develop policies and procedures and local codes of practice. Following this, in Newcastle upon Tyne, a Safeguarding Adults Board (NSAB) was established which consists of representation from a range of statutory and voluntary agencies at a senior level. The Board's role is to ensure that protecting and safeguarding adults is a priority for everyone. This policy has been developed as a result of this work. In March 2011, the Department of Health published guidance material to support the No Secrets guidance, describing good practice safeguarding principles in relation to health. In April 2015 The Care Act (2014) is implemented, person centred, outcome focused and introducing more categories of potential harm. 4 Duties 4.1 The Trust Board and Directors The Trust Board and Directors have responsibility and overall accountability for ensuring that the Trust contribution to safeguarding and protecting the welfare of adults at risk of abuse, harm and neglect is discharged effectively. 4.2 The Nursing and Patient Services Director The Nursing and Patient Services Director, has delegated responsibility for ensuring that the health contribution to safeguarding and protecting the welfare of vulnerable adults is discharged effectively. Page 2 of 27

3 4.3 The Trust Adult Safeguarding team The Trust adult safeguarding team provides advice and expertise to fellow professionals and has a key role in promoting good professional practice through a variety of activities e.g. facilitating training and supervision, contributing to decisions made at strategy meetings and audit of safeguarding processes. This may include giving advice to partner agencies. 4.4 Directorate/Service Managers or Heads of Service Implementation of the Safeguarding Adult's Policy and associated procedures e.g. Mental Capacity Act (MCA) or Deprivation of Liberty (DoL) is the responsibility of Directorate/Service Managers or Heads of Service. Line mangers have a responsibility and a duty to ensure suspected or actual abuse is reported, using the reporting process outlined in this policy (Appendix 2) and in accordance with timescales set, as outlined in this policy (Appendix 3) or in special circumstances e.g. being removed from hospital by relatives, where the adult at risk of abuse, harm or neglect is in immediate danger or is suspected of being abused. 4.5 Medical staff, Registered Nurses, Midwives and Health Visitors All Medical staff, Registered Nurses, Midwives and Health Visitors are professionally accountable for the standard of care they provide to patients via the General Medical Council and Nursing and Midwifery Council, (GMC 2012, NMC, 2008) and for care delegated and subsequently provided by non registered staff. The relevant professional Codes of Conduct all place duties and responsibilities upon registrants in relation to adult safeguarding and are consistent with this policy. 4.6 All trust staff Every member of staff working with patients has a responsibility to act and a duty to report actual or suspected abuse, harm or neglect, or if they have a concern that there is a risk of harm, neglect or abuse may take place, to their line manager in the course of their work, in a timely manner. 5 Definition of Terms 5.1 Adult at risk of abuse, harm or neglect Abuse and neglect can take many forms. Professionals should not be constrained in their view of what constitutes abuse or neglect, and the circumstances of an individual case should always be considered 5.2 Abuse Abuse may be: A single act or repeated acts; Page 3 of 27

4 an opportunistic act or a form of serial abusing where the perpetrator seeks out and grooms individuals; an act of neglect or a failure to act; multiple in form (many situations involve more than one type of abuse);deliberate or the result of negligence or ignorance; Abuse may be: a crime. 5.3 For the purposes of this policy, abuse is categorised as follows: Discriminatory Including forms of harassment, bullying, slurs, isolation, neglect, denial of access to services or similar treatment; because of race, gender and gender identity, age, disability, religion or because someone is lesbian, gay, bisexual or transgender. This includes racism, sexism, ageism, homophobia or any other form of hate incident or crime. Domestic abuse or violence Including an incident or a pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse, by someone who is, or has been, an intimate partner or family member regardless of gender or sexual orientation. This includes psychological/emotional, physical, sexual, financial abuse; so called honour based violence, forced marriage or Female Genital Mutilation (FGM). Financial or material Including theft, fraud, internet scamming, exploitation, coercion in relation to an adult s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. Modern slavery Encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment. Neglect and acts of omission Including ignoring medical, emotional or physical care needs, failure to access appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. Organisational (sometimes referred to as institutional) Page 4 of 27

5 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 a person 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. Physical Including assault, hitting, slapping, pushing, burning, misuse of medication, restraint or inappropriate physical sanctions. Psychological (sometimes referred to as emotional) Including threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber-bullying, isolation or unreasonable and unjustified withdrawal of services or support networks. Sexual Including rape, indecent exposure, sexual assault, sexual acts, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts to which the adult has not consented or was pressured into consenting. It also includes sexual exploitation which is exploitative situations, contexts and relationships where the person receives something (e.g. food, accommodation, drugs, alcohol, mobile phones, cigarettes, gifts, money) or perceived friendship/relationship as a result of them performing, and/or another or others performing sexual acts. Self-neglect Includes a person neglecting to care for their personal hygiene, health or surroundings; or an inability to provide essential food, clothing, shelter or medical care necessary to maintain their physical and mental health, emotional wellbeing and general safety. It includes behaviour such as hoarding. 6 Local Arrangements 6.1 Responsibility of the alerter An "Alerter" is anyone who suspects that a patient or other adult at risk is being or has been abused, harmed or neglected. Trust managers should make themselves aware of the issue of safeguarding adults by familiarising themselves and their staff with Newcastle upon Tyne Hospitals NHS Foundation Trust Safeguarding Adults policy and guidelines, and Newcastle Safeguarding Adults Interagency Policy. Page 5 of 27

6 Where there is an adult at risk of, or is suspected of being a victim of abuse, harm or neglect this must be reported IMMEDIATELY to the appropriate line manager or any other senior manage in their absence. The safeguarding team needs to be advised of any alert using the Cause for Concern form which is available on the Trust Intranet/Info gadults/forms.aspx. This should be completed during the current shift and faxed to the adult safeguarding team. The adult safeguarding team is available to respond to concerns during office hours. If an immediate out of hours response is required the duty Social Worker must be contacted via the Newcastle City Council Social Work Emergency Duty Team (or Emergency Duty Team in the patients area of residence if the patient does not live in Newcastle). 6.2 Responsibility of the line manager, adult safeguarding named nurse and nurse specialist The Line Manager must, on being informed of a potential safeguarding incident: Ensure immediate safety of the alleged victim Ensure Cause for Concern form is completed and sent to the safeguarding adult team (team available for discussion during office hours) Refer on to Adult Services/ Adult Social Care Direct team via referral documentation (Safeguarding Adult Initial Enquiry Form) if required (advice available from adult safeguarding team) If a crime has been committed contact the police via usual process (999 if urgent, 101 if non urgent) Safeguarding nurse specialists liaise with Local Authority Adult Services regarding decision making in respect of the Safeguarding Alert as to whether the situation is to be managed via an initial strategy meeting, no further action or other procedures. There is a requirement that staff will share relevant information, participate in safeguarding meetings and be required to undertake actions and meet timescales agreed within the safeguarding meeting. In some circumstances staff will be required to write a report at any stage during the safeguarding process (See appendix 4 for report writing guidance). The level of detail will vary from agency to agency. Guidance is available from the adult safeguarding team. The report will be approved by the Nursing and Patient Services Page 6 of 27

7 Director or nominated deputy prior to submission. The findings will be shared within the Trust and any recommendations acted upon. 6.3 Service user and family involvement The Care Act (2014) recommends making safeguarding personal therefore where possible gaining consent for referrals and listening to and recording the views of patients and those involved in their care is important. Trust staff and patients including carer/s should be involved where appropriate in safeguarding procedures, their views considered and they may be invited to meetings as part of the investigation process. Staff participation in the investigation process and/or the safeguarding risk assessment should be treated as priority and support will be given as required from the Trust Adult Safeguarding Nurse Specialists. Staff will discuss their concerns with the patient/ and or their family/carer ensuring adequate provision is made to meet communication and advocacy needs and request permission to refer the concerns via the Safeguarding Adults Process. Should that patient/service user refuse intervention and is deemed to have the capacity to do so, the practitioner should document this discussion appropriately and seek further advice from the Safeguarding Team. Where safe to do so, staff should also discuss with the individual and their family/carer their views and desired outcomes of safeguarding procedures and document these within the clinical record or safeguarding referral. Should the patient/service user be assessed as not having capacity to make this decision at this particular time then a documented capacity assessment should be completed in line with the requirements of the Mental Capacity Act (2005) and a best interest decision made by the staff member on behalf of the patient (refer to the Trust Mental Capacity Policy for relevant documentation). In situations where there is immediate danger for the patient/significant others the safeguarding alert must be made immediately. 7. If the alleged abuser is an employee of the Trust If the alleged abuser is a member of Trust Staff, the appropriate line manager who received the original report of suspected/actual abuse should carry out the actions as set out above. In addition, the line manager will inform the Trust's Designated Page 7 of 27

8 Safeguarding Adults Manager (Senior Human Resources Manager) who will advise accordingly as per the Trust Policy Safeguarding Adults-Guidance on handling allegations/complaints of abuse made against employees. If the allegation of abuse perpetrated by the member of staff is upheld, the Trust's Disciplinary Procedure will be implemented which, may lead to the employment of such staff being terminated or other action taken. If the allegation is not upheld, it may be necessary for the Line Manager to implement supportive measures that could be required to improve the performance of staff through supervisory arrangements. Such arrangements will be formalised and included in a development plan. If the allegation is not upheld and there is no further action, no record will be placed on the staff member's personal file and the matter will be closed. 8. Support for Staff It is recognised that staff may find it difficult or stressful to be involved in reporting adult abuse. In such situations the appropriate line manager should assess the level of stress to the member of staff involved and offer advice and support, this may be through supervision or referral to Occupational Health or other services to help them through the difficult time. Human Resources advice is also available to line managers and individuals. If required adult safeguarding clinical supervision can be accessed via the adult safeguarding team. Staff should be followed up at regular intervals (at least monthly initially until no longer required), to ensure they have support and mentoring if needed and have recovered or are recovering from the experience. The adult safeguarding team will also ensure that appropriate feedback is given to staff who have raised concerns 9. Support of Service Users and Carers Patients and/or carers whose alleged abuse is being investigated may need support from the Trust. This may be ongoing during the safeguarding process. Staff will need to undertake actions and timescales as agreed in the safeguarding meetings. It will be the responsibility of supporting staff to ensure that patient/service user's and/or carers who are in receipt of health services have an appropriate care plan in place to identify the relevant support required to meet their needs. This should be carried out in partnership with the investigation team, taking care that evidence is not destroyed or invalidated during the investigation process. 10. Monitoring Periodically national and local safeguarding adult's guidance, as well as national inquiries may influence changes in policy and procedural guidance. The adult safeguarding team will monitor national/local policy and guidance and ensure this Policy reflects current requirements. Page 8 of 27

9 The safeguarding adults team and safeguarding committee will monitor this policy on behalf of the Trust in relation to effectiveness of its associated responsibilities and duties, and safeguarding procedures. Standard/ Process Issue Case Review Audit SAMA 1 Audit Threshold Audit Monitoring and Audit Method By Committee Frequency The case review audit will audit Safeguarding Safeguarding Monthly a random five patient files every Adult Team Operational month of patients who have Management been through the Safeguarding Group Adults process and whose case is now closed, to ensure that the NuTH Safeguarding Adults team are compliant with the Newcastle Safeguarding Adults Board Standards (NSABS). The SAMA1 audit will audit five cases every month to ensure that submitted SAMA1 s have been completed correctly and within the NSAB standards. NSAB have developed threshold guidance to provide a set standard across the Newcastle area, this guidance sets a base level for identifying and progressing safeguarding alerts. Safeguarding Adult Team Safeguarding Adult Team Safeguarding Operational Management Group Safeguarding Operational Management Group Monthly Twice per year January June Deprivation of Liberty Audit The threshold audit will therefore audit ten Cause for Concern (CFC) forms submitted to the NuTH Safeguarding Adult team to assess: 1) Was the threshold guidance followed? 2) The timescales for CFC to SAMA1 were met? 3) Were the submitted SAMA1 s based on the threshold guidance? The DoL audit will be conducted annually and will audit five DoL applications that NuTH have made. The audit will look at: 1) Was the NuTH DoL Standard Operating Safeguarding Adult Team Safeguarding Operational Management Group Annually June Page 9 of 27

10 Procedure followed? 2) Was the DoL ended correctly? 3) If conditions were attached to an authorisation were they followed? 4) Were timescales met? Mandatory Training Compliance Via Safeguarding Dashboard To meet training targets as agreed by NSAB Safeguarding Adult Team Safeguarding Operational Management Group 6 monthly Monitoring Safeguarding Activity Quality Assurance Via Safeguarding Dashboard Safeguarding Adult Team Safeguardin g Operational Management Group 3 times per year Annually August The Trust Safeguarding Group will review the information and identify areas for improvement, develop remedial action plans and monitor these through to completion. Internal Adult Safeguarding procedures are aligned with the Incident Management reporting (Datix) process. 11. Associated Procedures 11.1 PREVENT CONTEST is a four part UK Government Strategy for reducing the risk to the UK and its interests overseas from international terrorism made up of four work streams. One of these work streams is the PREVENT strategy which aims to stop people becoming terrorists or supporting terrorism. Health has been identified as a key strategic partner in supporting this strategy. It is about supporting and protecting people who might be susceptible to radicalisation. The overarching principle of PREVENT is to improve the health and wellbeing through the delivery of services, while safeguarding individuals who are at risk Any staff who have concerns in relation to those (patients or staff) who they think may be becoming radicalised or being involved in violent extremism should discuss this with the safeguarding team and follow the process for raising an alert when someone is considered to be a victim of or, potentially susceptible to, becoming radicalised into terrorist activity (Appendix 5 - flowchart on process to follow). Page 10 of 27

11 WRAP (Workshop to Raise Awareness of PREVENT) sessions are available for staff to raise awareness of the strategy Multi Agency Public Protection Arrangements/Meetings (MAPPA) These are statutory multi-agency meetings held to develop plans to reduce the risks posed to the public and/or specific individuals from sexual or violent offenders who have been assessed as posing a high risk of harm. Information is shared with the Trust via police to safeguarding leads in relation to individuals who pose a risk to patients and staff. This is cascaded to relevant staff on a need to know basis. Staff have a duty to share relevant information when requested to aid the development of safety plans that will protect those identified as being at risk from the offender Multi Agency Risk Assessment Conference (MARAC) MARAC is an intervention which combines risk assessment and a multi-agency approach to help very high risk victims of domestic abuse. Evidence suggests that this reduces repeat incidents even among those most at risk. Staff have a duty to share relevant information when requested to aid the development of safety plans Serious Incidents (SI) Some safeguarding concerns may be raised via incident reports and reported on the Datix system. Subsequently this may be subject to a SI investigation The Nursing and Patient Services Director will be responsible for ensuring that any safeguarding concerns raised initially as a SI are appropriately shared with the safeguarding team and a joint investigation will occur. Useful Contacts Safeguarding Adults Team Telephone: Mental Capacity Lead (NUTH) Telephone: Newcastle Adults Social Care Initial Response Team (Social Care Direct) Telephone: scd@newcastle.gov.uk Out of Hours Telephone: edt@newcaslte.gov.uk Page 11 of 27

12 Newcastle Safeguarding Adults Board I.M.C.A. Service Your Voice Counts (YVC) The Old Bank, Swinburne Street, Gateshead, NE8 1AX Tel: Fax: Associated Policies This policy should be read in accordance with the following Trust policies, procedures and guidelines: Policy for responding to Incidents of Domestic Violence/Abuse Dignity and Respect at Work Policy Disciplinary Policy and Procedure Employees who are Victims of Domestic Violence Policy Whistleblowing Policy Management and Reporting of Accidents and Incidents: Operational Policy and Procedure Management of Violence and Aggression at Work Policy MAPPA Policy Mental Capacity Act (including the Deprivation of Liberty amendment) Policy Safeguarding Training Strategy Mandatory Training Policy Safeguarding Clinical Supervision for staff who work with vulnerable adults Clinical Supervision Policy (Non Medical) Deprivation of Liberty SoP Restraint Policy References Department of Health. (2000) No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse. Department of Health. (2010) Clinical Governance and Adult Safeguarding: An Integrated Process. Department of Health (2011) Safeguarding Adults: The Role of the Health Service Practitioner Department of Health (2011) Safeguarding Adults: The Role of Health Service Managers & their Boards Department of Health (2011) Safeguarding adults & the Role of Health Services: Analysis of the Impact on Equality Human Rights Act (1998) London. HMSO Mental Capacity Act (2005) London. HMSO Page 12 of 27

13 The Care Act (2014) Deprivation of Liberty Safeguards (2009) London HMSO Newcastle Safeguarding Adults Board Interagency Policy and Procedures Newcastle City Council Page 13 of 27

14 Appendix 1 Adult Safeguarding Training Strategy Level 1 For all staff both clinical and non-clinical on a 3 yearly basis. Level 2 Basic awareness of safeguarding which will include signs and indicators, recognition of abuse, categories of abuse, risk factors and what to do if you have a concern. Training includes awareness of protective characteristics that may increase an adult at risks vulnerability. This is available for new staff via staff induction. AND Breeze E-Iearning package on Trust intranet Learning Zone repeated every 3 years OR NSAB Multi agency face to face training. Basic awareness (3hrs) For all staff who hold a professional qualification on a 3 yearly basis. There is an expectation that staff will have completed level 1 Basic Awareness prior to attendance Increase understanding of responding to abuse including procedures that are followed in Newcastle, consent, confidentiality and capacity NSAB Multi-agency face to face training (3hrs). Sessions available within the trust Level 3 e-iearning package available For specific senior staff, e.g. Matrons who would be very closely involved in the safeguarding process, on a 3 yearly basis. Course includes how to participate effectively within a safeguarding adult strategy and protection plan meeting, the roles of others in safeguarding adults work and the role of the manager. NSAB Multi agency training Page 14 of 27

15 Multi-Agency Public Protection Arrangements (MAPPA) This is a half day course, provided by probation service to increase knowledge and understanding of the multi-agency public protection arrangements. This course is aimed at those staff who work with high risk offenders. This course would be suitable for frontline staff working within areas such as Accident and Emergency as well as Department managers, Matrons and sisters/charge nurses: Multi-Agency Risk Assessment Conference (MARAC) This is a one day course provided by the Domestic Violence Partnership, for staff who work with victims of domestic violence, and includes the MARAC process and risk assessment for victims of domestic violence (this is not mandatory). This course would be suitable for hospital/community midwives and staff working in emergency areas. PREVENT Awareness of the Governments Prevent Strategy is highlighted in level 1/2 safeguarding adults training. Workshop to raise awareness of prevent (WRAP) is available for key individuals and frontline staff. MCA and DOLs Training Awareness of Mental Capacity Act and Deprivation of Liberty safeguards is highlighted in level 1/2 safeguarding adults training. Bespoke training is delivered to relevant areas and professionals working with vulnerable adults to establish a working knowledge of assessment and application to practice. Multi-Agency training provided by Newcastle Safeguarding Adult Board. Access to Interagency training is important for staff as it facilitates joint working this can be provided face to face or as E learning package. Information on how to book training can be found on the Safeguarding website on the intranet. Level 1 Safeguarding Adults Basic Awareness All staff who come into contact with adults at risk Objectives Have an increased confidence in their understanding of their own values and attitudes in relation to adult abuse, harm or neglect Be aware of and have an understanding of Safeguarding Adults Be able to identify the different categories of abuse Be more familiar with the signs and indications of abuse Be clear about the roles and responsibilities of the alerter as defined within the procedures. Page 15 of 27

16 Level 2 Safeguarding Adults Responding to Abuse/Harm or Neglect Professionals who have a responsibility for receiving concerns, decision-making and informing statutory agencies. This may include: Social Workers, District Nurses, Police Officers, RGN's, RMN's, Ward Sisters, Probation Officers, GP's, Home Managers, Team Leaders, CPN's. Participants will have obtained prior knowledge and understanding of safeguarding adults by completing learning at Level One before attending Level Two training. Prior safeguarding learning will be tested at the start of the Level Two training to ensure that all participants have appropriate knowledge. Objectives: Understanding of safeguarding adults policy and procedures in Newcastle; What constitutes a safe environment and preventative strategies; Capacity, consent and confidentiality; Laws & guidance available regarding safeguarding adults Level 3a - Safeguarding Adults Risk Assessment and Management Plan (RAMP) Staff who have organisational or professional responsibility to safeguard adults at risk of harm, abuse or neglect particularly in the community, and who would partake in risk assessments and protection planning. This will include: Social Workers, Community Nurses, CPN's, Support Workers, Community Mental Health Workers, Team Leaders. Staff will be expected to have completed Level 2 training or have experience in safeguarding adults work prior to attending this course Objectives: The RAMP tool, how and when to use it; Patterns, severity and frequency of abuse; Risk assessment and risk management; Vulnerability factors and likelihood and level of harm; Working with the alleged victim and the alleged perpetrator; Their roles and responsibilities in respect of the safeguarding adults process and procedures; The importance of working together and information sharing to protect vulnerable adults living at home or in institutional settings; The legal framework, domestic violence and the Mental Capacity Act. Level 3b Safeguarding Adults - The Role of The Service Manager Managers of care homes, hospital wards, day resources, supported accommodation, domiciliary care services. All registered managers. Staff will be expected to have completed Level 2 training or have experience in safeguarding adults work prior to attending this course. Page 16 of 27

17 Objectives: The national and legal context of adult safeguarding; Roles and responsibilities in relation to the safeguarding adults process and procedures including the service manager's role; How to participate effectively within a safeguarding adult strategy and protection plan meeting; The roles of others in safeguarding adults work e.g. police, CQC, HSC; and the role of the manager. Other Related Multi-agency Training Information Gathering ~ Risk Management Mental Capacity Act Deprivation of Liberty Safeguard. Thematic workshops will also be available throughout the year all information will be advertised on the Safeguarding Adults website. Page 17 of 27

18 Appendix 2 Safeguarding Adults Cause For Concern Form (This form does not constitute a referral to Social Services) Discuss initially with your line manager and contact Safeguarding Adults Nurse Tel: or Dect: Please fax internally to or externally Security From an NHS NET account to tnu-tr.dolsafeguarding@nhs.net From an NUTH..NHS.UK account to safeguardingadults@nuth.nhs.uk Consider whether it is appropriate to place CFC in Patient s records. * Compulsory, must be completed Person completing this form * (Print) Role of the person completing this form Site (RVI, FH, CAV, Community) * Ward * Phone/contact details * Details of incident/suspected or actual abuse To be completed following discussion with Manager or organisation Safeguarding Lead Date of alleged incident/harm (if known) * Place where incident/harm took place * Details of alleged victim Name * Address GP address/ Tel No Date of Admission Patients Consultant * (If applicable) Ethnicity Safe telephone no Client group (please tick all that apply) Date of Discharge Tel No Preferred Language Previous Safeguarding issues? DOB Post Code MRN or NHS No* Gender Interpreter required? Yes No Unknown Physical disability, frailty and/or sensory impairment Mental Health Substance misuse (includes drug and alcohol) Learning disability Dementia Other vulnerable person Page 18 of 27

19 Safeguarding Team only Page 19 of 27

20 Details of alleged perpetrator (if known or applicable) Name Are they a vulnerable adult? Yes No Relationship to victim Alleged perpetrator s vulnerability (if applicable) If alleged perpetrator is a staff member, provide details. Description of alleged incident/alleged harm, detailing all people involved, including witnesses. (Use body map and/or separate continuation sheet if required) Type of abuse (please tick all that apply) Financial/material Physical Neglect or omission Psychological/emotional Sexual Discriminatory Radicalisation/extremism Modern Slavery If other please specify Organisational/ Institutional Self-Neglect Domestic Abuse/violence Other (i.e. suspicious death of a service user) Is the victim at risk of further abuse/neglect? (please tick) Yes No Unknown Other Information Do you think the adult at risk has mental capacity in relation to making decisions about their safety? If no, has a mental capacity assessment been undertaken? Yes No Has the adult(s) at risk given consent for this referral? Yes No Yes No If no, please confirm why you have not sought consent or are overriding their refusal to consent Public interest (risks to others) Risk of serious harm Suspected serious crime Adult at risk lacks capacity to provide consent (Best Interest decision made) Other please provide details Ability to consent is affected by threatening or coercive behaviour Seeking consent would increase risks to the adult or others Page 20 of 27

21 What does the adult at risk (or their representative) say they want to happen as a result of the safeguarding adult s enquiry (desired outcomes)? Were the Police called or involved in any way? Yes No Are there any other Agencies involved? (If yes please name) Yes No Are there any risks to others (Carer. Co-dependents, Children)? * If yes Please provide details (also include who this information has been shared with e.g. Police, Children s Social Care, etc): Yes Unknown No Page 21 of 27

22 Safeguarding Adults Team - Body Map Patient name.. Site DoB. Ward Signed.. (Person completing form) Date. Page 22 of 27

23 Appendix 3 Procedural Flowchart EVENT Concern/Suspicion/Disclosure/Allegation/Discovery of Abuse of an Adult at risk REPORT Inform Line Manager within 24 hours Complete cause for concern form Forward To Safeguarding Nurse Specialist Decision No Decision made as to whether Safeguarding Adult procedures are appropriate Follow alternative Trust Policies and Procedures e.g Disciplinary Procedures Complete and send Safeguarding Alert form to relevant local Safeguarding Team Local Authority) Consider referral to Police if crime has been committed Safeguarding Process initiated by Safeguarding Team. Local investigation process agreed at initial Strategy/Discussion Ongoing Safeguarding Procedures as per Multi-Agency Policy Page 23 of 27

24 Newcastle Safeguarding Adults Board Safeguarding Adults Report Appendix 4 It would be useful if all professionals could use this format in the preparation of reports to safeguarding adults meetings. The level of detail will vary from agency to agency. It would be helpful if this report could be typed. Please bring enough copies for attendees. Please make arrangements with the Chair of the Safeguarding Adults meeting if you wish to send the report in advance. This report should not be ed unless there is a secure available with sender and recipient. The contents of this document are restricted and should only be reproduced or shared with the agreement of the report author. You are responsible for the safe storage and disposal of this document. 1. Report author Including name, role and agency 2. Date, time and venue of safeguarding adults meeting 3. Details of vulnerable adult (and alleged perpetrator where known) A pen picture of the adult at risk and his or her circumstances, including an assessment relating to consent or mental capacity or other legal issues. Please also detail the social networks of the vulnerable adult. If you are involved with the alleged perpetrator/perpetrating organisation please provide details as above. If the alleged perpetrator is a paid worker or volunteer, please provide details of their recruitment, employment history and disciplinary record. 4. Details of the initial alert or alleged abuse Please outline this alert and any other previous related allegations. If you are involved with the alleged perpetrator/perpetrating organisation please include any previous allegations. 5. Details of your professional involvement In relation to the alleged victim and/or alleged perpetrator/perpetrating organisation. 6. Your assessment of the seriousness of the alleged abuse Considering: extent of the abusive acts; whether abuse was a one-off or has happened before; impact on the victim and others; intent of the alleged perpetrator; illegality of the abuse; risk of abuse being repeated. 7. Recommendations about future actions and risk Identify what risks you feel there are to the vulnerable adult and/or others in relation to the concern and what actions could be taken to manage those risks. Page 24 of 27

25 8. Your opinion and conclusions Do you feel the concerns are: substantiated; partly substantiated; not determined/inconclusive; unsubstantiated? Do you feel that safeguarding adults procedures should continue? Page 25 of 27

26 Appendix 5 PREVENT - Escalating Concerns Flowchart Identify potential PREVENT issue in adult/child patient/staff Health Care Worker discusses with Line Manager Line Manager Referral to Safeguarding Team/Senior Human Resources if staff related Local Police PREVENT Lead Assessment and Risk Assessment process by police decision to proceed Yes/No Decision Outcome Support for Patient/Staff Page 26 of 27

27 The Newcastle upon Tyne Hospitals NHS Foundation Trust Equality Analysis Form A This form must be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. PART 1 1. Assessment Date: 1 st April Name of policy / strategy / service: Adult Safeguarding Policy and Guidelines 3. Name and designation of Author: Val Murray Named Nurse Adult Safeguarding 4. Names & Designations of those involved in the impact analysis screening process: Lesley Sinclair Adult Safeguarding Specialist Nurse 5. Is this a: Policy x Strategy Service

28 Is this: New Revised x Who is affected: Employees x Service Users x Wider Community x 6. What are the main aims, objectives of the policy, strategy, or service and the intended outcomes? (These can be cut and pasted from your policy) The policy and guidelines are designed to ensure that all trust staff understand their responsibilities when they have concerns about the safety or welfare of an adult at risk and the actions which need to be taken. Guidance is also provided to support staff in undertaking their role in specific areas of adult safeguarding 7. Does this policy, strategy, or service have any equality implications? Yes X No

29 If No, state reasons and the information used to make this decision, please refer to paragraph 2.3 of the Equality Analysis Guidance before providing reasons: 8. Summary of evidence related to protected characteristics Protected Characteristic Evidence i.e. What evidence do you have that the Trust is meeting the needs of people in various protected Groups related to this policy/service/strategy please refer to the Equality Evidence (available via the intranet Click A-Z; E for Equality and Diversity. Summary on front page and more detailed information in resources section) Does evidence/engagement highlight areas of direct or indirect discrimination? If yes describe steps to be taken to address (by whom, completion date and review date) Does the evidence highlight any areas to advance equal opportunities or foster good relations. If yes what steps will be taken? (by whom, completion date and review date) Race / Ethnic origin (including gypsies and travellers) Interpreter policy FGM and Honour Based Violence, Radicalisation and Forced Marriage are incorporated into the policy Use of professional interpreters is associated with improved quality of clinical care and outcomes, use of services, patient satisfaction and reduction in communication errors. Lack of interpreting was found to produce adverse effects for patients, practitioners, providers, public health teams, commissioners and communities. Identifying and meeting communication and cultural needs is considered in training Not meeting communication needs

30 could cause direct discrimination. Differences in cultural understanding of safeguarding can create misunderstandings. Sex (male/ female) Integral through the policy that the needs of men and women are assessed individually Abuse of men may often more hidden. Identifying and meeting needs of men and women is considered in training Religion and Belief Chaplaincy Team available for advice and support Religious practices support families but they can become abusive. For example patients who lack capacity being persuaded to go into care of homes related to a specific religion Identifying and meeting religious needs is considered in training Consideration to be given to ensure that religion and belief practices do not impact on the safety and well-being of the adult at risk Sexual orientation including lesbian, gay and bisexual people Good links with 3 rd sector organisations supporting LGB people LGB adults at risk may be also at risk of bullying and harassment because of their sexual orientation. Adults at risk who are also LGB may not be supported within their family group or in their care setting. Identifying and meeting the needs of LGB people is considered in training

31 Age The Policy applies to adults 18 or over The Policy identifies the need for the adult at risk to be at the centre of their care and to be asked what they hope to achieve Older people may be more vulnerable to abuse. This is incorporated into training and is highlighted in the policy The Policy identifies the need to work in partnership with adults at risk and their families/carers Disability learning difficulties, physical disability, sensory impairment and mental health. Consider the needs of carers in this section The policy identifies that adults with disabilities are more at risk :The Care Act (2014) identifies adults with disabilities as requiring careful assessment, their needs should be assessed and monitored Impact of the needs of carers in relation to their ability and needs to provide safe care are considered and addressed within the policy Potential inequalities are addressed in the policy Identifying and meeting the needs of disabled people is considered in training There is an electric training package for staff that includes Mental Capacity Act Training, Learning Disability and Safeguarding Adults (level 2) There is a Mental Capacity Act 2005 (including the Deprivation of Liberty Amendment 2009) Policy within the Trust There is also support for people with learning disability within the Trust through the work of the Learning Disability Nurse Specialists

32 Re- Gender assignment Good links with 3 rd sector organisations supporting Trans people Existing evidence suggests that trans people experience, and are badly affected by, transphobia, in a wide range of forms. This includes bullying and discriminatory treatment, harassment and physical/sexual assault and rejection from families, work colleagues and friends. Identifying and meeting the needs of Trans people is considered in training Adults at risk who are also Trans may not be supported within their family group or in their care setting. Marriage and Civil Partnership The Policy references Forced Marriage and Honour based Violence affecting adults at risk. Potential inequalities are addressed in the policy and training Honour Based Violence and Forced marriage are included in training Honour Based Violence and Forced marriage are included in training Maternity / Pregnancy When adults at risk attend Maternity/are pregnant the appropriate Safeguarding Team should be notified Pregnant and nursing mothers are at more risk if they are in an abusive relationship. Identifying and meeting the needs of pregnant and nursing mothers is considered in training The needs of the adult and their unborn child should be assessed and monitored. Are the above incorporated into the policy?

33 9. Are there any gaps in the evidence outlined above. If yes how will these be rectified? No 10. Engagement has taken place with people who have protected characteristics and will continue through the Equality Delivery System and the Equality Diversity and Human Rights Group. Please note you may require further engagement in respect of any significant changes to policies, new developments and or changes to service delivery. In such circumstances please contact the Equality and Diversity Lead or the Involvement and Equalities Officer. Do you require further engagement Yes xno 11. Could the policy, strategy or service have a negative impact on human rights? (E.g. the right to respect for private and family life, the right to a fair hearing and the right to education? No. Abuse is an issue relating to human rights not to be tortured or treated in a degrading way. The policy seeks to prevent this type of treatment. PART 2 Signature of Author

34 Print name Val Murray Date of completion 28 th April 2015 (If any reader of this procedural document identifies a potential discriminatory impact that has not been identified, please refer to the Policy Author identified above, together with any suggestions for action required to avoid/reduce the impact.)