ADULT SAFEGUARDING PROCEDURES

Transcription

1 Trafford Adult Safeguarding Board Working in partnership with agencies across Greater Manchester ADULT SAFEGUARDING PROCEDURES Trafford Adult Safeguarding Board APRIL 2012 EDITION If you don t do something, who will? 0

2 Trafford Adult Safeguarding Board Working in partnership with agencies across Greater Manchester PUBLISHED April 2012 REVIEW September 2012 Authors Cooling, J Corbett, L Goldstone, D Le-Straad, M Safeguarding Adults: If you don t do something, who will? 1

3 No single agency can deal with the abuse of vulnerable adults alone No Secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse Department of Health/Home Office, 2000 Trafford Adult Safeguarding Board We re working in partnership with agencies across Trafford and Greater Manchester 2

4 Acknowledgements Anne Barlow Trafford Council Satinderjit Bering - NHS Trafford Katie Christopherson Trafford NHS Provider Services Jane Curran - Greater Manchester Police Claire Heneghan Trafford NHS Provider Services Rachel Hind - Faversham Nursing Home Susan Mattinson Wyncourt Nursing Home Debbie Nash - Trafford Council Gilli Painter - Greater Manchester West Mental Health NHS Foundation Trust Nathan Percival - Greater Manchester Police Diane Robson Trafford NHS Provider Services Lesley Shaw University Hospital of South Manchester Dylan Southern New Care Limited Robert Templeton Social Care Institute for Excellence Julie Treadgold - Trafford Healthcare NHS Trust Nicola Walsh - NHS Trafford Sue Worsley Trafford NHS Provider Services The authors would like to acknowledge all of those who gave input, made comment and have supported the development of these procedures who may not have been listed, but whose contribution was valued and to whom we are grateful. 3

5 The purpose of this document This document provides a structure to enable all agencies to work in partnership adults, their carers and our local communities to: protect and empower those at risk from being harmed, abused, exploited or neglected respond sensitively and consistently to reported incidents of self-neglect and abuse where necessary, ensure that action is taken as quickly as possible put in place plans to protect and assist the adult at risk in the best way for them support carers who may themselves be vulnerable or at risk ensure regular monitoring is in place when concerns have been raised Underlying principles The following principles are the basis of this document and are subscribed to by all member agencies of the Trafford Adult Safeguarding Board: to actively work together within an inter-agency framework based on Department of Health and relevant best practice guidance. to actively promote the empowerment and well-being of those who are thought to be at risk through the services they commission or provide. to act in a way that supports the rights of the individual to lead an independent life based on self-determination and personal choice to recognise people who are unable to take their own decisions and/or protect themselves, their assets and bodily integrity to ensure the safety of the person thought to be at risk by integrating strategies, policies and services relevant to abuse within the framework of current legislation to ensure that when the right to an independent lifestyle and choice is at risk, the individual concerned receives appropriate help, including advice, protection and support from relevant agencies to ensure that the law and statutory requirement are known and used appropriately so that persons thought to be at risk of abuse receive the protection of the law and access to the judicial process. In applying these principles, agencies will balance the requirements of confidentiality with the consideration that, to protect persons thought to be at risk of abuse, it may be necessary to share information consistent with the Caldecott principles (see section 5 of the policy document) on confidentiality and information sharing. 4

6 Foreword These new procedures build upon the excellent work already undertaken to improve adult safeguarding in Trafford. They will support practitioners, from all agencies, to work in partnership with adults at risk where safeguarding issues arise. This continued partnership between public services and local people is crucial in identifying when people are at risk of harm, danger or abuse. Once identified, that partnership is a key element in keeping people safe as well as influencing and changing behaviours. Our new procedures place people who use our services at the centre of decision making in adult safeguarding, and support our multi-agency mission to ensure people who use services are consulted, listened to and supported to make their own decisions whenever possible. Where people are unable to make their own decisions, perhaps because of fluctuating mental capacity, we are committed to using metal capacity processes. Wherever possible, we are committed to engaging and working with people who know that person well to make decisions in their best interests. A continuous cycle of learning has been embedded within our new procedures, to ensure that lessons can be learned when things go wrong. This will support us in preventing those things occurring again. This is an organic set of documents, which will change and grow to reflect new research, guidance, best practice and the law. Ms. Helen McFarlane Chair, Trafford Adult Safeguarding Board Safeguarding Adults: If you don t do something, who will? 5

7 Trafford The NHS offer to Adult Safeguarding in Trafford encompasses: the prevention of harm, exploitation, neglect and abuse through the commissioning, provision and delivery of high quality NHS services; effective, proportionate responses to allegations of harm, exploitation, neglect and abuse that are in line with local multiagency procedures; Using learning from adult safeguarding to improve services to patients; Being an active and committed member of the multi-agency adult safeguarding partnership. The commissioning and delivery of high quality health care for patients is at the heart of the NHS in Trafford and across Greater Manchester. As the Senior Nurse responsible for Adult Safeguarding, I know that the NHS agencies serving Trafford are committed to offering support and protecting those who find themselves in the most vulnerable situations, whilst at the same time, supporting adults at risk to keep control of their lives, make well informed choices and make their own decisions, whenever this is possible. Staff, practitioners, managers and leaders of local health services have responsibilities for the safety and well-being of all of their patients and they have particular duties for those patients who are less able to protect themselves from harm, exploitation, neglect or abuse. Trafford s new Adult Safeguarding Procedures will support staff, practitioners, managers and leaders of local health services meet their responsibilities to those adults deemed to be at risk, they strengthen the multi-agency partnership that exists within Trafford, and across Greater Manchester, and are based on a solid evidence base. Mr. Michel Le-Straad Designated Nurse for Safeguarding & Vulnerable Adults for the Trafford Health Economy Safeguarding Adults: If you don t do something, who will? 6

8 GMP Trafford Division Greater Manchester Police in Trafford, and across Greater Manchester, are working closely with Local Authority Adult Social Services, NHS Commissioners and service providers, the Care Quality Commission and others to safeguard vulnerable adults from harm, exploitation and abuse, ensuring the safety and protection of the most vulnerable people in our communities. Working with partner agencies to target offenders and support victims are key aspects of our approach to dealing with vulnerable adults. This approach is supported through the implementation of local police public protection units, who will liaise with partner agencies, monitor investigations and provide advice. In recent years, several serious incidents have demonstrated the need for immediate action to ensure that vulnerable adults, who are at risk of abuse or who have been abused, receive care, protection and support. In particular, a range of public inquiries have identified that greater information sharing and multi-agency working may have placed organisations in a more positive position to safeguard adults concerned. These new Adult Safeguarding Procedures establish a tight framework through which Greater Manchester Police officers and staff will engage with partner agencies and where crimes have been committed, investigate, ensuring that all vulnerable adults are fully supported in accessing equal criminal justice opportunities. Whilst considering the continued health and social care needs of the victim. Mr. Mark Roberts Chief Superintendent and Divisional Commander Greater Manchester Police, Trafford Division Safeguarding Adults: If you don t do something, who will? 7

9 Communities & Well Being This new set of procedures for Adult Safeguarding provides a timely reminder of why safeguarding is so important. Local partnership arrangements provide a vital framework for responding to harm, exploitation, neglect or abuse of adults within our communities. We have long beaten the drum to promote adult safeguarding as everybody s business. These new procedures take that message to the next level, challenging people to consider if you don t do something, who will? The new Adult Safeguarding Panels will see carefully selected and screened lay members actively taking part in the decision making and appeals processes and much wider public participation in adult safeguarding will be driven forward by the Adult Safeguarding Board. When talking about adult safeguarding, it is crucial to remember that there are first class services delivered in Trafford by the Council, by the NHS, by Criminal Justice agencies, the Voluntary and Independent Sector and by colleagues in further and higher education. The vast majority of people who use services do so without issue or incident. However, where things do go wrong or where services identify that people are at risk of harm, exploitation, neglect or abuse we know that our multi-agency partnership arrangements are robust and that we are all committed to acting quickly, proportionately and safely to protect adults at risk. As the Assistant Director of Adult Social Care responsible for Safeguarding at Trafford Council, I know we are making a real difference to the lives of vulnerable adults in Trafford. Mr. David Hanley Director of Operations and Assistant Director of Adult Social Care, Trafford Council Safeguarding Adults: If you don t do something, who will? 8

10 CONTENTS 1. Definition of Adult at risk 2. Six National Principles for Adult Safeguarding 3. Safeguarding Adults: An Introduction Harm Abuse Domestic Abuse Domestic Homicide Review Honour Based Violence Hate Crime Mate Crime Human Trafficking Multi Agency Public Protection Arrangements (MAPPA) 4. Information for NHS, Social Care, Criminal Justice, Private, Independent, Voluntary sector and other agencies in Trafford Employment and Registration checks Human Resources functions Workforce Development Reporting and Recording Contractual Requirements 5. The Procedures: The Five Stages of Adult Safeguarding 7. Risk assessment and risk management 8. Table of the five stages, with outline timescales and responsibilities 9. Legal Framework and Guidance Consent "No Secrets": Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (2000) The Crime and Disorder Act 1998 Equality legislation Human Rights legislation Financial Exploitation Criminal Law Civil Law Public Law Mental Capacity Act 2005 Powers of Attorney Common Law Doctrine of Necessity Confidentiality Legal Framework 9

11 An adult at risk is a person, aged 18 or older, who is, or maybe, unable to take care of him or herself or unable to protect him or herself against harm, abuse or exploitation. This is our locally adopted definition and the one which applies to these procedures 10

12 SIX NATIONAL PRINCIPLES FOR ADULT SAFEGUARDING Empowerment We give adults at risk relevant information about recognising harm, abuse and exploitation and the choices available to them to ensure their safety. We give adults at risk clear information about how to report harm, abuse and crime and provide any necessary support to do so. We consult the adult at risk before we take any action. Where an adult at risk lacks capacity to make a decision, we always act in his or her best interests. Protection Our local complaints, reporting arrangements for harm, abuse and suspected criminal offences and risk assessments work effectively. Our governance arrangements are open and transparent and communicated to our citizens. Prevention We can effectively identify and appropriately respond to signs of abuse and suspected criminal offences. We make staff aware, through setting standards and frameworks for appropriate training and guidance, how to recognise signs and take any appropriate action to prevent harm, abuse or exploitation occurring. In all our work, we consider how to make communities safer. Proportionality We discuss with the adult at risk and where appropriate with other relevant agencies the proportionality of possible responses to the risk of significant harm before we take a decision. Our arrangements support the use of professional judgment and the management of risk. Partnership We have effective, local information-sharing and multi-agency partnership arrangements in place and our staff understand these. We foster a one team approach that places the welfare of individuals above organisational boundaries and at the centre of our work. Accountability The roles of all agencies are clear, together with the lines of accountability. Staff understand what is expected of them and others. Agencies recognise their responsibilities to each other, act upon them and accept collective responsibility for safeguarding arrangements. 11

13 Safeguarding Adults: An Introduction All agencies and professionals should: Be alert to potential indicators of harm, abuse neglect and exploitation. Understand their role and responsibility to alert other agencies to adults they feel are at risk or who are suffering abuse in any form (stages 1 and 2 of the five stages). Share and assist in analysing information in order that a comprehensive risk assessment of the situation can be carried out. Contribute to whatever actions are needed to safeguard the person who is at risk. Harm is defined as: Ill treatment both physical and emotional; Impairment of physical or mental health; Avoidable deterioration in physical or mental health; Impairment of physical, emotional, social or behavioral development. The last two categories may be very important to an individual s ability to recover from an illness or have the best possible quality of life. (The Lord Chancellor s Department, 1997, Who Decides? pg 68). Abuse Any behaviour towards a person that deliberately or unknowingly causes him or her harm, endangers their life or violates their rights. Abuse may be physical, sexual, psychological, financial or through neglect. 1

14 An individual, a group or an organisation may perpetrate abuse. All abuse concerns the misuse of power; control and/or authority and can manifest itself as: Domestic Violence (Abuse), sexual assault or sexual harassment, Institutional abuse, Forced Marriages and, so called, Honour Based Violence. If the abuse is also a crime such as assault, racial harassment, rape or theft you should involve the police to prevent someone else from being abused immediately. Domestic abuse Within any relationship, there are ups and downs people say and do things to each other that are hurtful, however, there s a difference between a normal argument and abusive, fighting and threatening behaviour, this is domestic violence or abuse. Her Majesty s Government define Domestic Abuse as: Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality." This includes issues of concern to black and minority ethnic (BME) communities such as so called 'honour killings. Domestic Homicide Review Domestic homicide review means a review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or neglect by: (a) a person to whom he was related or with whom he was or had been in an intimate personal relationship, or (b) a member of the same household as himself, held with a view to identifying the lessons to be learnt from the death. It should be noted that an intimate personal relationship includes relationships between adults who are or have been intimate partners or family members, regardless of gender or sexuality Honour based violence So called Honour -Based Violence, honour crimes and honour killings embrace a variety of crimes of violence (mainly but not exclusively against women), including assault, imprisonment and murder where the person is being punished by their 2

15 family or their community. They are being punished for actually, or allegedly, undermining what the family or community believes to be the correct code of behaviour. In transgressing against this code of behaviour, the person shows that they have not been properly controlled to conform by their family and this is to the shame or dishonour of the family. Hate Crimes Hate Crimes which includes abuse or discrimination on the basis of any incident which may or may not constitute a criminal offence, which is perceived by the victim or other person as being motivated by prejudice or hate. The prejudice or hate can be based on any identifying factors including disability, race, religion, sexual orientation or transgender, race, colour, ethnic origin, nationality or national origins, religion, gender or gender identity, sexual orientation or disability. Policies and procedure Local Safeguarding Policy and Procedure Each organisation must have a local operational Safeguarding Adults Policy and Procedure in place that maps to this Borough Wide procedure. Your local policy and procedure should be reviewed annually and updated as required. Mate Crimes Vulnerable people being groomed by those who pretend to be their friends before being exploited by them financially, physically or sexually 'mate crime'. There is often drug or alcohol misuse in the life of the perpetrator of mate crime. Examples range from: Perpetrators routinely going to a vulnerable persons house and clearing their cupboards of food and alcohol People being persuaded to part with or having their benefits taken from them Being exploited sexually or coerced into prostitution Being physically harmed for the amusement of others Having their homes used as a place where for others to meet, gather, sleep, take drugs or hold parties to having their home taken over altogether by someone else Women can be sexually exploited by men who pretend to be their boyfriend In other cases, vulnerable adults may be asked to look after a package that contains drugs, guns or ammunition. Or they may go shoplifting with their new friends to support the friends drug or alcohol dependency, only to be caught by the police. 3

16 The vulnerable adult may not realise that what is happening is wrong. There can be feelings of, 'He's my friend, that's what friends do'. Many vulnerable adults have few friends and for some vulnerable people, having any friends is better than no friends at all. Mate crime centres around issues of self-belief and self-worth in the vulnerable person. Vulnerable people will often think it's all right for people to walk all over them, because that's what's happened to most of their lives and they perceive this behaviour to be usual. Human Trafficking Trafficking is the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation. Exploitation shall include, at a minimum, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs. United Nations definition of Human Trafficking. Trafficking in human beings is a serious crime, often committed within the framework of organised crime. It is a gross violation of a person s fundamental rights and is explicitly prohibited by the Human Rights Act, 1998 and the Charter of Fundamental Rights of the European Union. Human trafficking can be regarded as modern day slavery in that victims are controlled by traffickers with violence and intimidation for the purpose of exploitation for economic gains. The overwhelming majority of people trafficked are women and children. They form the most vulnerable group and estimates show that up to 4 million are trafficked each year worldwide for forced labour, domestic servitude, or sexual exploitation. Multi Agency Public Protection Arrangements (MAPPA) MAPPA is not a legal body or framework, but a set of arrangements for supervising offenders in the community. They are principally a structure by which the various agencies an offender comes into contact with can share information and thereby monitor risk factors after the person is released. 4

17 Which organisations are involved? Three agencies have a statutory responsibility to be involved with MAPPAs the Police, Probation Service and Prison Service. Other agencies including social services, the education authority, health services, jobcentres, housing authority, and home detention curfew providers, have a duty to cooperate. However, a MAPPA cannot force any of these organisations to do anything it would not normally do. It does not ensure that a housing authority will house someone they deem to be intentionally homeless, for example. Are the arrangements the same wherever you are IN Greater Manchester? Yes. They are statutory arrangements and therefore the same everywhere in the UK. Which offenders are subject to MAPPA? There are three categories of offenders who will be subject to MAPPA: 1. Registerable sexual offenders, regardless of the sentence they received (Category 1) 2. People convicted of a violent or other sexual offence (even if nobody was actually hurt), who are not registerable sexual offenders, with a 12 month or more prison sentence or hospital order, for a schedule 15 offence (Category 2) 3. Offenders who do not fall into either of the above categories, but are considered by the authorities to pose an on-going risk of serious harm to the public based on their past behaviour (Category 3). Do victims of crime get any say in MAPPA? The Probation Service has a responsibility to inform victims of a prisoner s release or consideration for parole, and will take their wishes into account. A victim living in close proximity who has asked for an exclusion zone may result in the prisoner not being allowed to live at home after release. The victim will not be told where the prisoner is. Exploitation by radicalisers who promote violence Individuals may be susceptible to exploitation into violent extremism by radicalisers. Violent extremists often use a persuasive rationale and charismatic individuals to attract people to their cause. The aim is to attract people to their reasoning, inspire new recruits and embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause. There are a number of factors that may make the individual susceptible to 5

18 exploitation by violent extremists. None of these factors should be considered in isolation but in conjunction with the particular circumstances of the individual: identity or personal crisis, particular personal circumstances, unemployment or underemployment and criminality. All of these may contribute to alienation from UK values and a decision to cause harm to symbols of the community or the state. The Home Office leads on the anti-terrorism strategy, CONTEST, and PREVENT is part of the overall CONTEST strategy, aiming to stop people becoming terrorists or supporting violent extremism. Local safeguarding structures have a role to play for those eligible for adult protection. Abuse by another adult at risk Where the person causing the harm is also an adult at risk, the safety of the person who may have been abused is paramount. Organisations may also have responsibilities towards the person causing the harm, and certainly will have if they are both in a care setting or have contact because they attend the same place (for example, a day centre). The person causing the harm may themselves be eligible to receive an assessment. In this situation it is important that the needs of the adult at risk who is the alleged victim are addressed separately from the needs of the person causing the harm. It will be necessary to reassess the adult allegedly causing the harm. This could involve a network meeting where the following could be addressed: the extent to which the person causing the harm is able to understand his/her actions the extent to which the abuse or neglect reflects the needs of the person causing the harm the likelihood that the person causing the harm will further abuse the victim or others. The same principles and responsibilities to report a crime apply. The appropriate community mental health team (CMHT) would be involved if the person alleged to have caused the abuse appears to have a mental illness or is showing signs of mental disturbance. Allegations against carers who are relatives or friends There is a clear difference between unintentional harm caused inadvertently by a carer and a deliberate act of either harm or omission, in which case the same principles and responsibilities for reporting to the police apply. 6

19 In cases where unintentional harm has occurred this may be due to lack of knowledge or due to the fact that the carer s own physical or mental needs make them unable to care adequately for the adult at risk. The carer may also be an adult at risk. In this situation the aim of Safeguarding Adults work will be to support the carer to provide support and to help make changes in their behaviour in order to decrease the risk of further harm to the person they are caring for. A carer s assessment should take into account the following factors: whether the adult for whom they care has a learning disability, mental health problems or a chronic progressive disabling illness that creates caring needs which exceed the carer s ability to meet them the emotional and/or social isolation of the carer and the adult at risk minimal or no communication between the adult at risk and the carer either through choice, mental incapacity or poor relationship whether the carer is not in receipt of any practical and/or emotional support from other family members or professionals financial difficulties whether the carer has a lasting power of attorney or appointeeship a personal or family history of violent behaviour, alcoholism, substance misuse or mental illness the physical and mental health and well-being of the carer. Abuse of trust A relationship of trust is one in which one person is in a position of power or influence over the other person because of their work or the nature of their activity. There is a particular concern when abuse is caused by the actions or omissions of someone who is in a position of power or authority and who uses their position to the detriment of the health and well-being of a person at risk, who in many cases could be dependent on their care. There is always a power imbalance in a relationship of trust. Where the person who is alleged to have caused harm is in a position of trust with the adult at risk, they may be deterred from making a complaint or taking action out of a sense of loyalty, fear, of abandonment or other repercussions. Where the person who is alleged to have caused the abuse or neglect has a relationship of trust with the adult at risk because they are a member of staff, a paid employee, a paid carer, a volunteer or a manager or proprietor of an establishment, the 7

20 organisation will invoke its disciplinary procedures as well as taking action under the Safeguarding Adults policy and procedures. If a crime is suspected, reporting to the police should always be considered, and referral must be made to the Independent Safeguarding Authority (ISA) if they have been found to have harmed or put at risk of harm an adult at risk. If the person who is alleged to have caused the abuse is a member of a recognised professional group the organisation will act under the relevant code of conduct for the profession as well as taking action under this policy and procedures. Where the person alleged to have caused the abuse or neglect is a volunteer or a member of a community group, adult social care services will work with the relevant group to take action under this policy and procedures. Where the person alleged to have caused the abuse is a neighbour, a member of the public, a stranger or a person who deliberately targets vulnerable people, in many cases the policy and procedures will be used to ensure that the adult at risk receives the services and support that they may need. In all cases regard should be given to issues of consent, confidentiality and information sharing. Abuse by children If a child or children is/are causing harm to an adult at risk, this should be dealt with under the Safeguarding Adults policy and procedures, but will also need to involve the local authority children s services. Child protection The Children Act 1989 provides the legislative framework for agencies to take decisions on behalf of children and to take action to protect them from abuse and neglect. Everyone must be aware that in situations where there is a concern that an adult at risk is or could be being abused or neglected and there are children in the same household, they too could be at risk. Reference should be made to the Trafford child protection procedure, the local Safeguarding Children Board, inter-agency guidelines and internal protocols dealing with cross-boundary working if there are concerns about abuse or neglect of children and young people under the age of 18. Referral must be made to the relevant children and families department and the multi-agency safeguarding children policy and procedures. Transitions (care leavers) Robust joint working arrangements between children s and adult services need to be put in place to ensure that the medical, psychosocial and vocational needs of children leaving care are addressed as they move to adulthood. The care needs of the young person should be at the forefront of any support 8

21 planning and require a coordinated multi-agency approach. Assessments of care needs at this stage should include issues of safeguarding and risk. Care planning needs to ensure that the young adult s safety is not put at risk through delays in providing the services they need to maintain their independence and well-being and choice. Good practice includes: having policies and procedures which support effective transition processes shifting the general view of risk as a potential danger for a child, to one of potential opportunity but acknowledging potential risks for an adult managing risks as a phased process with awareness of the psychological and emotional issues managing family expectations (being clear about the level of support and resources available) taking time to get to know the young person and their family, especially if they have communication difficulties acknowledging the rights of adults to take more responsibility for their decisions. 9

22 Information for NHS, Social Care, Criminal Justice, Private, Independent, Voluntary sector and other agencies in Trafford All care agencies, care homes, health centres, hospitals, further education colleges and other agencies and organisations in Trafford should: Have an identified and nominated lead responsible for Safeguarding Adults. Ensure that the Board of Directors, Board of Trustees, Executive Management Team, Locality Management Team or other senior Management Group are provided with quarterly updates with regard to Adult safeguarding, including the number of alerts made, the training needs analysis and the number of staff that have attended workforce development sessions. Ensure that the Directors, Board or Senior Management Team for each organisation/service/company are aware of and execute their responsibilities for Adult Safeguarding. Be alert to potential indicators of abuse and neglect at an institutional level. Understand their responsibility to alert statutory agencies to adults they feel are at risk or who are suffering abuse, harm or neglect in any form. Share and assist in analysing information in order that a comprehensive assessment of the situation can be carried out. Contribute to whatever actions are needed to safeguard the person who is at risk, including the suspension of staff members. 10

23 Media Interest and management There may be occasions when safeguarding allegations or concerns attract media attention. In ensuring we maintain our 'one' team approach due consideration must be given to the impact of media interest on ongoing investigations. The strategy meeting/discussion may need to consider if there is a need to notify responsible departments/persons within their organisation of potential media interest. Before any member of staff may give a comment or interview to the media, they must liaise with their own agency Communications Lead and seek guidance. Each Communications Team will liaise with those of other agencies involved. It is the responsibility of the relevant corporate Communications Teams of the agencies involved to draft and agree joint (or singular) holding statements, press releases or other communications that may be necessary. Employment and Registration checks All agencies and organisations must be compliant with the Independent Safeguarding Authority standards for pre-employment checks including the Criminal Records Bureau. Agencies and organisations should not attempt to circumvent the safeguards put in place by ensuring robust pre-employment screening is undertaken to protect vulnerable people to expedite the commencement of employment. Where staff are professionally registered, the agency or organisation is expected to verify with the appropriate professional body the status of the individuals registration. Copies of CRB, Identity and Registration Documents, and the associated company paperwork, must be available to interested parties and access provided on a need to know basis. A minimum of two references should be taken up, and be deemed satisfactory, before employment commences. References should be provided on the company's pre-printed questionnaire and a company stamp from the person providing the reference applied. Alternatively, references should be provided on the Notepaper of the agency or organisation the person works for and their Company Stamp applied. Human Resources functions All agencies and organisation should have robust Human Resources procedures in place for the management of staff and situations where an Adult Safeguarding concern has been raised or an allegation of abuse has been made. All agencies should have robust procedures in place for HR investigations and hearings. All HR investigations in the independent sector, must be undertaken by the sector. The NHS 11

24 and Local Authority are unable to support the HR investigation process, apart from to provide expert opinion. Where, on the balance of probability, an employee is deemed to have placed an adult at risk, has harmed a an adult at risk or an allegation of abuse has been found, each agency and organisation must have a robust system in place for dismissal and referral to the Vetting and Barring Scheme operated by the Independent Safeguarding Authority. Workforce Development As part of the organisations workforce development plan, each organisation should develop a robust training and workforce development strategy in place for adult safeguarding that applies to all employees, at every level of the organisation, which links the Trafford Adult Safeguarding Board Workforce Development Framework. An annual training needs analysis should be completed by each organisation/service/company. Reporting and Recording All organisations and agencies should have robust recording and reporting mechanisms in place regarding Adult Safeguarding, reflected in their local policy and procedure. Appropriate notification forms are to be completed and forwarded to the appropriate statutory bodies in a timely manner or in the timescales designated by the statutory body. A defined, legible audit trail must be available to support and assist investigators and others who may have a legitimate need to review documentation for example NHS Commissioners. Contractual Requirements Each organisation commissioned by Trafford Council or NHS Trafford will be obliged to meet minimum standards with regard to Adult Safeguarding, Workforce Development relating to Adult Safeguarding and the reduction of harm in their organisations. This is monitored through regular contract review meetings. 12

25 The Procedures 1. Five stages of safeguarding in Trafford 11. The five key stages of the Safeguarding Adults process in Trafford are: Stage One: Identifying harm, abuse, neglect or exploitation Stage Two: Making a referral Stage Three: Strategy discussion or meeting Stage Four: Investigation Phase Stage Five: Adult Safeguarding Panel Hearing The protection plan and review The Appeals process Closing the safeguarding process 1.2 During these stages, key considerations are: deciding whether a mental capacity assessment is needed to clarify issues of consent; the need for the person at risk to be represented by an advocate, including an IMCA; supporting and enabling the adult at risk to achieve outcomes that they see as the best for them, where possible; assessing and addressing risk; taking action to protect and support the adult; taking appropriate action for the person causing harm; taking appropriate action with a service and/or its management if they have been culpable, ineffective or negligent; 13

26 identifying any lessons to be learnt for the future, including recommendations for any changes to the organisation and service delivery Table 2.1 summarises what is involved in the five key stages. If, at any stage, a Safeguarding Adults Manager (SAM) feels that the issue is no longer appropriate for the Safeguarding Adults process, the case can be closed down using Stage Five of the process. The Safeguarding Adults Manager has a responsibility to ensure that the person who made the referral is responded to and to reassure them that appropriate action is or has been taken. The SAM will make the decision as to when, not if, this response should be made It is important that this process runs to time; however, the interests of the adult at risk are paramount, and divergence from the timescales may be justified on grounds of good practice where: adherence to the timescales would jeopardise achieving the outcome that the adult at risk wants; it would not serve the interests of the person at risk; the complexity of the investigation is such that a longer timescale is unavoidable. there are other relevant and acceptable reasons that require a longer timescale which are unavoidable Reasons for divergence from timescales must be recorded. Where this divergence concerns the strategy meeting, investigation or Panel Hearing, the agreement of the co-ordinating Safeguarding Adults Manager must be sought and an alternative timescale agreed to avoid the process becoming open ended Other processes, including disciplinary investigations in most cases, can continue alongside the Safeguarding Adults process, but must not delay it. 2. Risk assessment and management 2.1 Risk assessment and risk management are central to the Safeguarding Adults process. 2.2 A risk assessment must be undertaken when an adult safeguarding referral is raised. This will clarify the degree of risk to the adult at risk, other adults and/or children. 14

27 Risk must be constantly re-evaluated throughout the process to ensure adults at risk and all others involved are appropriately protected. 2.3 Risk assessment is integral to the whole process of safeguarding and is specifically concerned with the identification of specific risks to a person covered by the Adult Safeguarding procedures. 2.4 Any risk assessment will determine: what the actual risks are the harm that has been caused, the level of severity of the harm, and the views and wishes of the adult at risk; the person s ability to protect themselves; who or what is causing the harm; factors that contribute to the risk, for example, personal, environmental, relationships, resulting in an increase or decrease to the risk; the risk of future harm from the same source. 2.5 The risk assessment should also take into account wider risk factors, such as the risk of fire in the person s home. 2.6 Organisations will have a range of risk assessment tools in paper and IT formats to assist staff in risk assessment, it is these local tools that must be utilised. 2.7 The Adult Safeguarding protection plan is the risk management plan that is put in place aimed at removing or minimising risk to the person, and others who may be affected if it is not possible to remove the risk altogether. It will need to be monitored, reviewed and amended/revised as circumstances arise and develop. A formal risk assessment can take place at any point. However, the most likely point at which a formal assessment will take place is after the strategy discussion or meeting. 2.9 The risk assessment should: establish the facts of the harm, abuse or neglect and inform the protection plan assess what service provision may be needed by the adult at risk and/or, where indicated, their carer 15

28 gain information to help inform decisions about what legal powers may be relevant to a protection plan ensure that forensic and other evidence is collected and preserved, and relevant files and documents are secured, using the appropriate powers of partner organisations where necessary ensure that any other assessments required are carried out establish if there is a need to protect other adults at risk and find out what is needed to protect them identify the person causing the harm, if their identity is known and establish where they are; find out if the person causing the harm is also a service user decide if domestic violence is indicated and the need for referral to a MARAC identify people causing harm who should be referred to MAPPA identify whether a child (under 18 years) is at risk. 16

29 THE FIVE STAGES STAGE ACTIVITY RESPONSIBILITY TIMESCALE Stage One Responsibilities when identifying harm, abuse, neglect or exploitation Act to protect adult at risk Take any immediate action to identify and address risk Deal with immediate needs Report to line manager Everyone with a duty of care Immediately, if Emergency or within same working day (this should be within four hours) Stage one Decisions Consider reporting to the police, if a crime do not wait for the PPIU to respond, if a crime has been committed dial 999 in an emergency or 101 for non-emergency police needed response Record! Update care plan to reflect the protective factors you have but in place. This will be your interim protection plan. Take any immediate management action to identify and address the risk All suspicions, disclosures or witnessed incidents of abuse MUST be reported on a Safeguarding Adults referral form Does the adult at risk have capacity to agree to an investigation? Do you have any reason to doubt the adult at risks capacity to agree to an investigation? If so, you must formally assess capacity and if they lack capacity at the time it is done, complete the best interest process. Does the adult at risk want the issue investigated? If no, be clear about this on the referral, but also be clear with the adult at risk that we may still investigate if it is considered in the wider public interest to do so. Referrer Referring manager Safeguarding Adults lead Other Member of staff if appropriate Immediately or within 24 hours If NHS employee, complete an incident form. 17

30 Do CQC need to be informed? Stage Two Making a referral Refer to Community Screening Team Report to the police, if a crime Complete a Domestic Abuse referral and DASH form if Domestic Abuse (these forms can be found by clicking here) Complete a TARGet referral if the person meets the criteria (this can be found by clicking here) Adult at risk (carer, friend, relative) Manager Safeguarding Adults lead. Other professional Any staff in emergency Notify CQC if necessary Stage two Decisions Stage Three Strategy discussion or meeting Stage three Decision Stage Four Investigation Gather initial information Clarify facts Evaluate risk Decide if Safeguarding Adults procedures apply Agree interim protection plan (Police investigation may have begun) Decide if a strategy meeting or discussion is needed Evaluate risk Decide if investigation needed Agree investigation plan If not Safeguarding Adults agree appropriate action If not Safeguarding Adults close process at this point Conduct investigation Re-evaluate risk Collate evidence and share SAM and relevant partner organisations SAM and relevant partner organisations Adult at risk as appropriate SAM and relevant partner organisations Adult at risk as appropriate Coordinated by SAM with relevant partner organizations Within 24 hours of referral The same day\ or within five working days from receipt of the Safeguarding Adults referral Within 25 working days from receipt of referral Investigation report must be with SAM by day 25. with involved organizations 18

31 Produce and distribute Investigation report Stage Five Adult Safeguarding Panel Hearing Receive investigation evidence Receive any other reports or accounts submitted to the Panel hearing Evaluate risk Coordinated by SAM Three Panel members Adult at risk/family/ Advocate Within five working days from receipt of investigation report (or as agreed at strategy discussion or meeting) Formulate protection plan Investigating Officer Close Safeguarding Adults Process Other relevant parties The protection plan and Review Closing the Safeguarding Adults process Stage five decisions Keep under review Review the protection plan Evaluate risk Complete Safeguarding Adults process Sign off Safeguarding Adults process Review process continues Decide if a referral to a serious case review is required Dissemination of lessons Learnt Process may also be closed pending outcome of prosecution Agree outcome Substantiated, Partially Substantiated, Not Substantiated. Agree review date if needed Make recommendations for lessons learned Provide information about appeals process Coordinated by SAM with relevant, supporting agencies Adult at risk/family/ advocate Signed off by SAM Within three months of Panel Hearing or as agreed at Panel Hearing. On agreement with adult at risk and other organizations 19

32 LEGAL FRAMEWORK AND GUIDANCE 20

33 Legal Framework Her Majesty s Government is expected to introduce additional amendments to the statutory framework for the safeguarding of adults at risk. However in contrast to the regime concerned with children at risk, there is at present no clear statutory framework providing duties and responsibilities in relation to the protection of adults generally. The Mental Capacity Act 2005 improves the position in relation to persons who lack or may lack capacity but it is still necessary in individual cases to consider innovatively a range of Local Authority, NHS and other public service functions, and the criminal, private civil and common law to provide the necessary safeguards. In some cases the ability of public services to act may be limited but they may nevertheless be provided to assist adults at risk to access appropriate advice and representation to pursue their own remedies. As the legal powers are found in a range of acts, regulations and case law all of which are subject to frequent amendment and development, providing a list of statutory provisions is unlikely to be helpful and it is important when professional concerns arise that legal advice is sought on the appropriate response to the individual circumstances of a case. It is intended that the government website Legislation will provide details of all statutory provisions currently in force in their amended form. "No Secrets": Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (2000) This guidance was issued by the Secretary of State for Health exercising the powers under section seven of the Local Authority Social Services Act It must therefore be followed by local Social Services Authorities unless there are exceptional reasons why it should not be followed. New statutory powers are not created but social services functions including liaison and co-operative relationships, joint funding, commissioning and provision of services with other agencies must be carried out so far as they can in accordance with the guidance, the focus of which is to provide protection from abuse, neglect and exploitation for vulnerable adults. "There can be no secrets and no hiding place when it comes to exposing the abuse of vulnerable adults". All NHS, Local Authority or Criminal Justice commissioned services being delivered for the benefit of adults must include the emphasis required by the guidance. 21