Understanding the Legislation, Regulations and Policies that underpin the protection of Vulnerable Adults
1.1 Analyse the differences between the concept of safeguarding and the concept of protection in relation to vulnerable adults
Safeguarding was defined in the Children’s Act of 1989, and is most commonly applied to children and young people under the age of eighteen. Key aspects of legislation have recently been extended to include similar standards of protection to ‘vulnerable adults’. A vulnerable adult is defined as a person aged eighteen or over, who has either a dependency upon others in the performance of, or require assistance in the performance of basic functions:
•A severe impairment in the ability to communicate with others
•A reduced ability to protect themselves from assault
•A reduced ability to protect themselves from abuse
•A reduced ability to protect themselves from neglect
This can be as a result of learning or physical disability, or physical or mental illness, chronic or otherwise (including an addiction to drugs or alcohol) or a reduction in physical or mental illness.
In March 2000 the ‘No Secrets’ Department of Health guidance was issued under Section 7 of the Local Authority Social Act 1970.
It places a responsibility on Social Services to play a co-ordinating role in developing local policies and procedures for the protection of vulnerable adults from abuse. It states that other statutory agencies should work together ‘work together in partnership’ to ensure that appropriate policies, procedures and practices are in place and implemented locally. In 2005 the Association of Directors of Adult Social Services published ‘Safeguarding Adults’, a national framework of standards for good practice. This framework identified eleven standards of good practice standards which if implemented will lead to the development of consistent, high quality adult protection work. The Social Services recognised significant changes within the adult protection field, and moved the agenda from ‘vulnerable adults’ and ‘Adult Protection’ to the new term ‘Safeguarding Adults’, placing more of an emphasis on early intervention and prevention of abuse. This phase means that all work which enables an adult who is eligible for community care services, to retain independence, wellbeing and choice and to access their human rights to live a life that is free from abuse and neglect. The change in the name from POVA to SOVA focused on early intervention and prevention of abuse. ‘Vulnerable Adults’ became ‘Adults in need of Safeguarding’ to recognise a shift in service philosophy and practice since the launch of ‘No Secrets’ in 2000. The term ‘Vulnerable Adults’ can be disempowering, and can also suggest that the cause of the abuse is located with the victim rather than acts or omissions of others.
1.2 Evaluate the Impact of policy development on approaches to safeguarding vulnerable adults in own service setting
1.3 Explain the legislative framework for safeguarding vulnerable adults
Our work in the care system is governed by the legal system, and there are certain laws which impact our policies at Aspects . With respect to vulnerable adults in care the legal frame work provides only guide lines with respect to rights and service provision, but it does not specifically mention protection. Children are protected from abuse under the Children’s Act 1989.
The following laws provide guidance as to the rights and requirements for service provision but there was no mention of protection, until the Care Standards Act which was published in 2000. The acts set out the Protection of Vulnerable Adults (POVA), which was then implemented on a fazed basis from July 2004. The act has two fundamental aims:
•To protect vulnerable people from abuse and neglect
•Promote the high standards of quality in the care that people receive The aim is to ensure that children in care are protected from abuse and neglect, older people and people with a disability who rely on care services, get appropriate standards of care and protection they deserve. Private hospitals and clinics provide modern standards of healthcare and parents who use child minders or day-care services can be assured that their children are in safe hands. The General Social Care Council (GSCC) was set up under The Care Standards Act of 2000, alongside the National Care Standards Commission (NCSC) and the Social Services Inspectorate (SSI). NCSC and SSI merged in 2004 to become the Commission for Social Care Inspection (CSCI) which is now the Care Quality Commission (CQC).
The following laws have been developed over a number of years and occasionally come about as responses of cases being highlighted in the media: •National Assistance Act 1948
•Mental Health Act 1983
•Mental Health Bill 2004
•Mental Capacity act 2005
•Chronically Sick and Disabled Persons Act 1986
•Disability Discrimination Act 1995
•NHS Community Care Act 1990
•Safeguarding Vulnerable Groups Act 2006
•Adult Support and Protection Act (Scotland) 2007
This has led to an alarming number of changes in law overtime as a result of investigations into abuse in institutions and towards individuals. The government had to respond by changing the laws to address protection of adults through guidelines and policies documented. The year 2000, and a couple of years leading up to this date saw several publications from the government all seeking to address the issue of adult abuse.
The Human Rights Act 1998, aimed to protect adults from abuse, and within our job role we also have a responsibility to comply with this act. The act does not apply to those for private providers, and these services are not liable for prosecution under this act. The government is expected to review this situation soon.
The No Secrets 2000 government publication came about as a response to the ever increasing media coverage of adult abuse. The guidance insured that local authorities were responsible for developments of policies to protect the vulnerable individual through multi-agency working and set up safeguarding adults’ boards. In addition, The Care Standards Act of the same year set out the Protection of Vulnerable Adults (POVA) scheme to be rolled out on a fazed basis, being fully implemented by 2004. The White Paper Valuing People: A New Strategy for Learning Disability published in 2001 was a land mark for people with a learning disability, setting out ways in which services would be improved, highlighting 4 main principles: •Civil rights
Quality of Care for vulnerable adults were set to improve in a marked way because of the changes implemented in staff training, quality control, and the response by professional bodies to address codes of practice to bring them into line with National Minimum Standards.
It was the POVA scheme set out in The Care Standards Act 2000 and implemented in 2004 that went further to protect those in care from abuse by care providers. Central to POVA scheme is the POVA list of care workers who have harmed vulnerable adults in their care. It is vital within the recruitment of care workers to undertake checks through the Standard or Enhanced Disclosure Applications processed from the Criminal Records Bureau (CRB). This has now recently changed to Disclosure and Barring Service (DBS), which came into full force in October 2009. The Safeguarding Vulnerable Groups Act 2006 recognises that any adult receiving any form of health care is vulnerable although there is no formal definition of vulnerability, and some people receiving care may be at greater risk from harm than others. These risks need to be appropriately assessed and identified by health care professionals at first contact and continued throughout their care. The Independent Safeguarding Authorities (ISA) role is to help prevent unsuitable people from working with children and vulnerable adults. Referrals are made to the ISA regulatory body from the employer if they have concerns that a staff member has caused harm or poses future risk of harm to children or vulnerable adults.
The Mental Capacity Act 2005 (MCA) has been enforced since 2007 and applies to England and Wales. The primary purpose of the MCA is to promote and safeguard decision making within a legal framework. It does this in two ways:
•Empowering people to make decisions for themselves wherever possible by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision making process.
•By allowing people to plan ahead for a time in the future when they might lack capacity for any number of reasons.
1.4 Evaluate how serious case reviews or inquiries has influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults
The purpose of serious case reviews or inquiries is not to apportion blame, or to reinvestigate, but to establish whether there are lessons to be learnt from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults, and to learn from past experiences. It is also used to review the effectiveness of procedures and to improve future practice by acting on the learning. Case reviews are used to inform and improve local inter-agency practice and to improve multi-agency working. It can prepare or commission an overview report which brings together and analyses the finding of the various reports from agencies, in order to make recommendations for future action and to review safeguarding adults’ procedures.
Adult abuse pervades the lives of many people around the world, and the current definition of adult abuse used in Health and Social Care today states abuse:
‘May consist of a single or repeated act. It may be physical, verbal or psychological; it may be an act of neglect or failure to act; or it may occur when a vulnerable person is persuaded to enter into financial or sexual transaction to which he or she has not consented, or cannot give
consent’ (Department of Health, 2000).
Adult Abuse has received increasing recognition over the past 40 years at a national and international level. Initial abuse has been on the abuse of older adults, however, there is now an awareness of the vulnerability of other groups of adults to abuse, including those with learning difficulties and those with mental health problems.
There have been several high profile cases of abuse in recent years, resulting in serious case reviews which have influenced quality assurance, regulation and inspection relating to safeguarding of vulnerable adults. For example:
The Birchard Inquiry- following the case of Ian Huntley and the Soham murders, where two young girls were murdered. Published in 2004, it was in connection to how someone like Ian Huntley was able to work in a school, as a caretaker, and how this could be avoided in the future. Although the abuse that took place was involving children, the report had major effects on all areas of protection for both children and adult care. The Safeguarding Vulnerable Groups Act is a major element of a wide-ranging programme of work established across the government to address the systematic failures identified by the inquiry. It introduced the requirement for those who wish to work with children, or vulnerable adults to be registered. This would confirm that there is no known reason why an individual should not work with these clients. The main thing that came out of the Birchard report is the CRB Checks, now known as the DBS.
The case of Margaret Panting (78 year old) who lived in a sheltered housing scheme in Sheffield highlights the failures of several services involved in her care. There were several instances where someone could have intervened, and raised the alarm. The Fire Service had been called out to property on ten separate occasions in as many years. The staff at the sheltered housing scheme had some concerns about her poor diet, confusion and lack of money, and had witnessed Margaret arguing with her grandchildren and her son in law. Margaret, had on one occasion reported to the staff at the sheltered housing scheme, that one of her grandchildren had hurt her arm, they were also seen by the staff, pestering Margaret for money. The psychiatric nurse and district nurse had also been out before Margaret was due to move in with her son in law and grandchildren, and she refused any support and help, and would not discuss the move. Margaret was found dead by the emergency services, just five weeks after moving in with her extended family. A post mortem examination revealed that there were 60 separate injuries including bruises, lacerations and burns. No injuries had been apparent on Margaret before the move.
Although Peter Biggin (son in law) and his sons were arrested on suspicion of murder, it could not be proved who was responsible for her injuries and no-one was prosecuted.
Now a new law- The Domestic Violence, Crime and Victims Bill, aims to protect vulnerable adults, including the elderly, from violence, abuse or neglect. And a new charge of ‘causing or allowing the death of a vulnerable adult’ will apply to relatives or cares who abuse old people. Even those who did not cause the injuries, but who ought to have been aware of the risks and failed to do anything about it can be prosecuted. The New Legislation was welcomed by the national charity, Action on Elder Abuse.
1.5 Explain the protocols and referral procedures when harm or abuse is alleged or suspected
All persons have the right to live their lives free from abuse and violence. This right is underpinned by the duty on public agencies, under The Human Rights Act (1998), to intervene proportionately to protect the rights of citizens.
The primary responsibility of the ‘Safeguarding Adults’ partnership is to enable all adults ‘Who is or may be eligible for community care services’ to access appropriate services if they need support to live a life free from abuse and neglect. The framework for enabling adults to access such support is referred to as the ‘Safeguarding Adults’ Procedures. They should ensure that those adults, who are or may be at risk of abuse or neglect, receive an assessment of that risk. Where they face a critical or substantial risk to their independence and wellbeing, community care services should be considered as part of a safeguarding plan. Where the assessment does not lead to community care services being provided or purchased, other appropriate services should be signposted. The procedure should be based on the presumption of mental capacity (Mental Capacity Act 2005) and on the consequent rights of such adults to make their own choices in relation to safety from abuse and neglect. For people who are eligible for community care services and who have mental capacity, Safeguarding Adults procedures should enable them to access mainstream services that will support them to live safer lives, as well as providing specific services to meet additional needs. For example, some adults have impairments which mean they need assistance to overcome current barriers to exiting services, in order to choose how to achieve a safer life.
The protocols and procedures for reporting abuse are laid out in Standard 6, 7, 8 and 9 of the Safeguarding Adults.
Standard 6: Makes provision for individual to access information about how to remain safe from abuse in an attempt to uphold human rights. It ensures that any organisation receiving reports that an adult may be experiencing abuse or neglect, responds in a positive and proactive manner, and lays down procedures and timings for that reporting. For example: •Alert- Immediate action to safeguard anyone at immediate risk
•Referral- Within the same working day
•Decision- By the end of the working day following the one that the safeguarding referral was made
•Safeguarding Assessment Strategy- Within five working days
•Safeguarding Assessment- Within four weeks of the safeguarding referral •Safeguarding Plan- Within four weeks of the safeguarding being completed
•Review- Within six months for first review and annually thereafter
Standard 7: Deals with the agencies involved in the situations of abuse and
highlights procedures for information sharing amongst multi- agencies.
Standard 8: Identifies the partner agency systems and the internal reporting procedures for all partner agencies, together with protocols for accurately recording information/facts, together with the actions taken as a result. This standard also highlights the need for each organisation to have a ‘whistle-blowing’ policy and procedure that is linked to that of safeguarding adults, and is disseminated to staff and volunteers.
Standard 9: Identifies a checklist for effective procedures detailing the stages that should be followed.
Good Practice for receivers of alerts and referrals should respond by: •Reassure the person
•Remaining calm and not showing shock or disbelief
•Listening carefully to what is being said
•Not asking detailed or probing questions
•Demonstrating a sympathetic approach by acknowledging regret and concern that what has been reported has happened •Ensuring that any emergency action needed has been taken •Inform them that they will receive feedback as to the result of the concerns they have raised and from whom •Giving the person contact details so that they can report any further issues or ask any questions that may arise
Be able to lead service provision that protects vulnerable adults
2.1 Promote service provision that supports vulnerable adults to assess risks and make informed choices
Safeguarding vulnerable adults involves a range of measures to protect patients in the most vulnerable circumstances. The Government has published a series of policies and reports focused on achieving good outcomes in safeguarding vulnerable adults from abuse and other types of exploitations, whilst helping individuals to maintain control over their lives, and to make informed choices without coercion. The Statement of Government Policy on Adults Safeguarding published in May 2011, sets out the government’s vision for improving vulnerable adults safeguarding services. It is based on achieving local service provision and outcome-focused practice. The statement sets out six principles for benchmarking Adult Safeguarding: •Empowerment
Furthermore, in March 2011 the Department of Health published a series of safeguarding guidelines titled Safeguarding Adults: The Role of Health Services. These documents provide best practice principles for preventing and responding to neglect and abuse and focusing on patients in the most vulnerable situations.
The choices available to an individual will depend on the eligibility criteria for each service, but it is important that the individual is supported to access information about the options that are open to them. The most relevant aspect of Mental Capacity is that of understanding and making decisions about safety from abuse and neglect. Making this decision includes having information about what is taking place, the harm that it may cause, and the options available to stop abuse and neglect, or to reduce harm. Everyone has the right to follow a course of action that others judge to be unwise or eccentric, including one which may lead to them being abused. Where the person chooses to live with risk of abuse the safeguarding plan should include access to services that help to minimise the risk. All actions should be taken with the individuals consent without embarking on their choices and decisions. Actions must ensure that when individuals with Mental Capacity make decisions to remain in abusive situations, they do so without intimidations, and with an understanding of the risks involved and have access to appropriate services if they should change their mind. In all decision making processes, Human Rights must be considered paramount.
2.2 Provide information to others on;
•Indicators of abuse
•Measures that can be taken to avoid abuse taking place
•Steps that need to be taken in the case of suspected or alleged abuse
Types and indicators of abuse are;
•Physical abuse-hitting, slapping, pushing and assault
•Sexual abuse-sexual activity which an adult client cannot or has not consented to or has been pressured into
•Psychological abuse-emotional abuse, verbal abuse, humiliation and ridicule
•Financial abuse-misuse or theft of money, fraud and extortion of material assets
•Neglect and acts of omission-ignoring medical or physical care needs, failure to give prescribed medication, failure to access care or equipment for functional independence
•Discriminatory abuse- demonstrated on any grounds including sex, race, colour, language, culture, religion, politics or sexual orientation
Multiple forms of abuse may occur in an ongoing relationship or an abusive service setting to one person or to more than one person at a time. This makes it important for me as a manager to look beyond single incidents or breaches in standards, to underlying dynamics and patterns of harm. Any or all of the above types of abuse may be perpetrated as a result of deliberate intent and targeting of vulnerable people, negligence or ignorance. Most instances of abuse will constitute a criminal offence which may lead to criminal proceedings.
There are measures that can be taken to avoid abuse from taking place. As a manager my responsibility is to develop structures where it is possible to deliver the best possible care, encourage a culture and ethos which is hostile to any sort of abuse, produce and regularly revise policies and procedures to combat abuse, operate personnel policies which identify, appropriately deal with and if necessary exclude from practice potential or actual abusers. It is also my responsibility to provide training for staff in all aspects of abuse and protection, investigate any evidence of abuse efficiently and sympathetically, improve procedures if any investigation or review reveals deficiencies and collaborate with other external agencies in combating abuse and improving the protection of our service users. I can also prevent abuse from occurring by introducing steps to prevent abuse from occurring and which includes setting out and making widely known the procedures for responding to suspicions or evidence of abuse, operating personnel policies which ensure that all potential staff are rigorously checked by taking up references and clearance through DBS. Also by incorporating material relevant to abuse into staff training at all levels, maintaining vigilance concerning the possibility of abuse of service users from whatever source. Also by helping service users as far as possible to avoid or control situations or relationships which would make them vulnerable to abuse.
By identifying actual or possible abuse, as a manager I aim to identify any instances of actual or possible abuse involving our service users by all possible means including; fostering an open and trusting communication structure within day care and residences so that staff, service users and others feel able to discuss their concerns with someone authorised to take action, ensuring that all staff and residents know whom they may turn to for advice and action if they become aware or suspect that abuse is occurring. Also by encouraging staff to recognise that a commitment to the highest possible standards of care must when necessary overrule loyalty to colleagues individually or corporately and by making it clear to staff that not to report incidents or suspicions of abuse is itself abusive and may lead to disciplinary or criminal proceedings.
2.3 Identify the policies and procedures in own work setting that contribute towards safeguarding and the prevention of abuse
I have attached Aspects Safeguarding policy and procedure; please refer to policy. The first steps to take are to report all suspicions or allegations within 1 hour and make a record of incident during the shift. A safeguarding adult’s strategy discussion will then take place within 4 hours. Then an initial visit takes place to the vulnerable adult within 12 hours of the strategy discussion. There is then a safeguarding adult’s strategy meeting held within 48 hours of the strategy discussion. A request for the information for the strategy meeting can also be requested giving 24 hours notice. A distribution of adult protection plan is put in place within 8 hours and a safeguarding investigation plan is also put in place as soon as practicable following a decision. Disciplinary procedures are also put into action as soon as practicable following a decision and criminal procedures are determined by the criminal investigation process. Safeguarding adults planning and monitoring meeting is usually held within 5 days and a review/closure meeting then takes place usually within 3 months of the strategy meeting. If for any reason there is a disagreement about closure as a manager I should refer my concerns to the safeguarding manager within 2 days.
2.4 Monitor the implementation of policies and procedures that aim to safeguard vulnerable adults and prevent abuse from occurring
It is important that effective monitoring and recording systems are in place to ensure Aspects policies and procedures are effective in safeguarding individuals and also preventing abuse from occurring. I am required to review and monitor the policy and procedures at Aspects on a regular basis to ensure they are still effective in safeguarding vulnerable adults from abuse. I am responsible for my own area of monitoring the implementation within Aspects . This includes areas such as staff training, staff DBS checks and managing the risks associated with safeguarding adults as well as keeping up to date and accurate records of any disclosures that may have taken place.
2.5 Provide feedback to other on practice that supports the protection of vulnerable adults
Once I have monitored the implementation of polices and procedures, it is important that any findings, chances or recommendations which are established or needed are then conveyed to all staff through staff meetings and staff training and notices.
Learning outcome 3; Be able to manage inter-agency, joint or integrated working in order to protect vulnerable adults
3.1 Follow agreed protocols for working in partnership with other organisations
The ‘No Secrets’ document requires that local agencies collaborate and work together within overall framework of DH guidance on joint working. The lead agency with responsibility for co-ordination such activity is the local social services authority but all agencies designate a lead officer. With the development of the safeguarding adult board, local social services authority are made up of various agencies including the police, the NHS and also members of the local community. The National Minimum standards outline how the partnership should work. To achieve effective inter-agency working, agencies consider that there are merits in establishing a multi-agency management committee (adult protection), which is a standing committee of lead officers. Such a body will have a clearly defined remit and lines of accountability and it will identify agreed objectives and priorities for its work. Such committees will determine policy, co-ordinate activity between agencies, facilitate joint training and monitor and review progress.
3.2 Review the effectiveness of systems and procedures for working in partnership with other organisations
It is very important for me as a manager to work alongside other agencies and have joint and integrated working in order to protect vulnerable adults. This joint working will be based on set and agreed protocols. A protocol is simply a method for accomplishing something. In practice, protocols refer to a standard form of conduct or etiquette or simply a set of rules. The purpose of these rules is to ensure the effective communication between all parties without conflict or misinterpretation. In order to review the effectiveness of these protocols or systems and procedures it is important that I am able to measure how well the partnership is working against set targets, reviewing objectives and checking progress made. I need to evaluate the performance of my own organisation and also that of the other organisations I work with.
Periodic audits of individual adult protection case records will enable strengths and weaknesses in current practice to be indentified. Standardised recordings and monitoring systems are agreed across agencies to assist such information gathering. Accurate and consistent monitoring of vulnerable adult data will increasingly enable agencies across the region to base their policy and practice on sound and relevant evident, highlighting trends in the planning process.
Learning outcome 4; Be able to monitor and evaluate the systems, processes and practice that safeguards vulnerable adults
4.1 Support the participation of vulnerable adults in a review of systems and procedures
Person centred practice reduces the risk of abuse by empowering the individual, ensuring they are central to the support they receive and are involved in the decision making. Because of this it is important to also involve and support the vulnerable adult to participate in the review of the systems and procedures in place, to help in their protection. As a manager I encourage this by supplying written guides, by talking to people, by holding regular service users meetings and assessment and review meetings. The ‘valuing peoples white paper advises that individuals should be allowed to make their own choices and decisions, even if this sometimes involves risks. Standard 11 of the ‘Safeguarding adults’ national framework states;
‘The partnership explicitly includes service users as key partners in all aspects of the work. This includes building service user participation into its; membership-monitoring, development and implementation of its work-training strategy and planning and implementation of their individual safeguarding assessment and plans.’
Aspects service users are made aware of their rights and their rights to complain and the procedure’s we have in place when they are taken on to our service. Monthly service user meetings are held at Aspects to give service users the opportunities to highlight any concerns they may have and put their points of views across. Please find attached minutes from a service user meeting which clearly states if service users have any concerns in regards to their support they have the opportunity to highlight their concerns. Once a complaint has been made the appropriate steps are taken to ensure the complaint is dealt with in the correct manner. The manager writes a letter of receipt of the complaint whether it was made verbally, or at a service user meeting or via post. The acknowledgment letter is usually sent within 7 days. Then the complaint is investigated and all staff members if any involved are also investigated. Once this stage has taken place as a manager I write a letter of my findings and apologise to the service user and make the relevant changes if required. The directors of Aspects also have the chance to put in their input on the complaint and feedback to me as the manager if they are not happy with the way the complaint was dealt with.
4.2 Evaluate the effectiveness of systems and procedures to protect vulnerable adults in own service setting
Periodic audits of individual adult protection case records enable strengths and weaknesses in current practice to be identified. Accurate and consistent monitoring of vulnerable adult data will enables me to base Aspects Care policy and practice on sound and relevant evident, highlighting trends and assisting in the planning process. By monitoring and auditing the individual’s complaints procedure and by listening to members of staff I am able to determine and evaluate if the systems and procedures in Aspects Care setting are effective in protecting vulnerable adults.
4.3 Challenge ineffective practice in the promotion of the safeguarding of vulnerable adults
Ineffective practice means not producing an intended effect, inadequate or incompetent. In my role as a manager it is part of my duty to seek out, rectify and also when necessary to report ineffective practices. This could include staff using unsafe practices such as not following appropriate risk assessments or Aspects Care policies and procedures, not abating consent before assisting an individual with their support etc. As a manager I am diplomatic when challenging staff. Is their ineffectiveness due to lack of knowledge or training or is because of an overload of duties? Whatever the issue, as a manager I address this. I will consider the seriousness of the situation. Is it a complaint, a concern or an alert? In more serious situations I need to take the matter further and ‘whistleblower’ or report my concerns to the CQC. I will require following Aspects Care policy and procedures for reporting abuse.
4.4 Recommend proposals for improvements in systems and procedures in own service setting In my personal view I feel that Aspects policy and procedures in regards to Safeguarding and complaints are efficient therefore I feel that I do not need to make any recommendations although if I felt that I did need to make recommendations to our policies and procedures then the factors I will need to consider are as follows;
•To establish whether there are lessons to be learned from the case about the way in which professionals and agencies work together to safeguard service users
•To establish what those lessons are, how they will be acted upon and what is expected to change as a result
•To improve interagency working and better safeguard vulnerable adults Although when a serious case review happens policies and procedures are changed to ensure the same circumstances do not get repeated.