Safeguarding adults at risk policy

Date: November 2021

Review date: November 2023

Version 4.0

Introduction

It’s the responsibility of every NHS funded organisation and each member of their staff teams to ensure the principles and duties of safeguarding adults are consistently and conscientiously applied, with the well-being of adults and children at the heart of all that is done.

Safeguarding adults from harm is a core duty of The Tavistock and Portman NHS Foundation Trust (‘The Trust’). The nature of services we provide mean it is likely that staff will have contact with adults at risk of abuse or neglect. This document provides guidance for staff to ensure the principles of safeguarding adults are embedded in all aspects of Trust practice.

The Trust is committed to the aims of adult safeguarding which are to

prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
stop abuse or neglect wherever possible
safeguard adults in a way that supports them in making choices and having control over their lives
promote an approach that concentrates on improving life for the adults concerned
raise awareness so that communities, alongside professionals, play their part in preventing abuse
identify and respond to abuse and neglect
provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult
address the causes of the abuse or neglect

To contribute to meeting these aims, we will

Manage our services in a way which minimises the risk of abuse occurring
Work with adults with care and support needs and other agencies to address any abuse that is taking place

To achieve these this, we will

Ensure all managers, employees (paid and unpaid) and students/trainees have access to and are familiar with this safeguarding adult policy and procedure and their responsibilities within it
Ensure concerns or allegations of abuse are always taken seriously
Ensure the Mental Capacity Act 2005 is used to inform any decision making on behalf of adults at risk who are unable to make particular decisions for themselves.
Ensure all staff receive training in relation to safeguarding adults at a level relevant to their role.
Ensure that people using our services, and where relevant their relatives and friends, have access to information about how to report concerns or allegations of abuse.
Ensure there is a named lead person to promote adult safeguarding awareness and practice within the organisation.

Scope

This policy applies to all staff at the Trust. It is supplementary to local, (Camden Safeguarding Adults Partnership Board); regional, (London multi-agency adult Safeguarding policy & procedures, 2019), and guidance from other Safeguarding Adults Boards in areas where the trust provides services) and national guidance.

This policy applies to all adults at risk aged 18 years and over with whom the Trust is concerned.

Legislative and policy context

All adult safeguarding activity aims to protect an adult’s right to live in safety, free from abuse and neglect.

It involves people & organisations working together to

prevent and stop risks and experience of abuse or neglect
promote adult’s wellbeing

Adult safeguarding work at The Tavistock and Portman NHS Foundation Trust (‘the trust’) takes place within the context of:

The Care Act 2014:

This sets out the duties and powers in law around adult safeguarding issues. It says the local authority is the lead agency on responding to adult safeguarding concerns and that Safeguarding Adults Boards (SAB) have the strategic lead for their area;

The Care and Support Statutory Guidance:

This gives detail about what must and should be done in relation to adult safeguarding issues. As it is statutory guidance, it must be followed unless there’s good reason not to

The London Multi-Agency Adult Safeguarding Policy and Procedures:

This gives the framework adopted across London to create consistency for multi-agency responses to adult safeguarding concerns.

The Mental Capacity Act

This promotes and safeguards decision making within a legal framework.

It does this in two ways:

I. (i) by empowering people to make decisions for themselves wherever possible, and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision-making process

II.

III. (ii) by allowing people to plan for a time in the future when they might lack the capacity to make specific decisions

Principles of adult safeguarding Care and support statutory guidance Ch 1413

Empowerment

Adults are encouraged to make their own decisions and are provided with support and information.

‘I am consulted about the outcomes I want from the safeguarding process and these directly inform what happens’

Prevention

Strategies are developed to prevent abuse and neglect that promotes resilience and self – determination.

‘I am provided with easily understood information about what abuse is, how to recognise the signs and what I can do to seek help’

Proportionality

A proportionate and least intrusive response is made balanced with the level of risk.

‘I am confident that the professionals will work in my interest and only get involved as much as needed.’

Protection

Adults are offered ways to protect themselves, and there is a coordinated response to adult safeguarding

‘I am provided with help and support to report abuse. I am supported to take part in the safeguarding process to the extent to which I want and to which I am able’

Partnerships

Local Solutions through services working together within their communities

‘I am confident that the information will be appropriately shared in a way that takes into account its personal and sensitive nature.

I am confident that agencies will work together to find the most effective responses for my own situation’

Accountability

Accountability and transparency in delivering a safeguarding response.

‘I am clear about the roles and responsibilities of all those involved in the solution to the problem’

Making safeguarding personal

Making safeguarding personal is the underpinning philosophy for adult safeguarding. It requires that adult safeguarding work should be person-led and outcome-focused. It should engage the person in a conversation about how best to respond to their situation in a way that enhances their involvement, choice and control as well as improving their quality of life, wellbeing and safety.

Here at the trust, we will meet the aims of Making Safeguarding Personal by

Keeping the person at the heart of the process
Striving to understand the outcomes they want to achieve from the safeguarding work and supporting them to achieve these outcomes

Definitions

Who is an adult at risk

The Safeguarding Adults legislation applies to people who are aged 18 years or more, and

have needs for care and support (whether or not these are currently being met) and
are experiencing, or are at risk of, abuse or neglect, and
because of those needs are unable to protect themselves against the abuse or neglect or the risk of it.

This includes adults with physical, sensory and mental impairments and learning disabilities, whether present from birth or due to advancing age, illness or injury. Also included are people with a mental illness, dementia or other memory impairments, and people who misuse substances or alcohol (where this has led to impaired physical, cognitive or mental health).

See appendix A for more details

What is abuse

Abuse can take many forms and the circumstances of the individual should always be considered. It may consist of a single act or repeated acts. The following are examples of issues that would be considered as abuse or neglect:

Physical abuse	includes hitting, slapping, pushing, kicking, misuse of medication, unlawful or inappropriate restraint, or inappropriate physical sanctions
Domestic abuse	is an incident or 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. Domestic violence and abuse may include psychological, physical, sexual, financial, emotional abuse; as well as so called ‘honour’ based violence, forced marriage and female genital mutilation
Sexual abuse	includes rape and sexual assault or sexual acts to which the adult at risk has not consented, or could not consent or was pressured into consenting
Psychological abuse	includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal from services or supportive networks
Financial and material abuse	includes theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits
Modern slavery	includes human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhuman treatment
Neglect and acts of omission	includes ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating
Discriminatory abuse	includes abuse based on a person’s race, sex, gender, disability, faith, sexual orientation, or age; other forms of harassment, slurs or similar treatment or hate crime
Organisational abuse	Includes neglect and poor practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’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
Self-neglect	covers a wide range of behaviours, such as neglecting to care for one’s personal hygiene, health or surroundings and includes behaviours such as hoarding. A safeguarding response in relation to self-neglect may be appropriate where a person is declining assistance in relation to their care and support needs, and the impact of their decision, has or is likely to have a substantial impact on their overall individual wellbeing
Radicalisation	Radicalisation is comparable to other forms of exploitation, such as grooming and Child Sexual Exploitation. Prevent is part of the Government’s counter-terrorism strategy CONTEST and aims to provide support and re-direction to vulnerable individuals at risk of being groomed into terrorist activity before any crimes are committed. Vulnerable individuals are groomed directly or through social media to be persuaded of the legitimacy of a radical’s cause to inspire new recruits and have extreme views embedded.
From Care and support statutory guidance Ch14.17

Staff need to be aware of and be able to recognise these different types of abuse and the possible Indicators of Abuse. Seriousness of harm or the extent of the abuse is not always clear at the point of the concern. All reports of suspicions or concerns should be approached with an open mind and could give rise to action under Safeguarding Adults at Risk policy and procedures.

Key roles within the Tavistock and Portman NHS Foundation Trust

Chief Executive

The Chief Executive as accountable officer has overall responsibility for ensuring the implementation of effective safeguarding adults at risk procedures.

Medical Director

The Medical Director has day to day responsibility for ensuring that the Trust is operating within the procedures set out in this document. He will liaise specifically with the Adult Safeguarding lead and will provide the professional lead and expertise for the implementation of this procedure.

Director of Human Resources

The Director of Human Resources is responsible for:

Ensuring the Trust’s Recruitment and Retention Policies comply with relevant legislation and guidance relating to the safe employment of staff working with children and other vulnerable people. This includes ensuring enhanced Disclosure and Barring Service (DBS) checks are expedited in a timely manner for applicable staff, trainees, relevant students, honorary workers and volunteers.

Head of HR Operations

Ensuring that the Trust’s statutory and mandatory training programmes include safeguarding adults and safeguarding children training as defined by the training needs analysis (refer to the Staff Training Policy).

Adult Safeguarding Lead

The Adult Safeguarding Lead is a senior member of staff who has attended specialist training in the safeguarding of adults at risk. The lead will provide advice and training at trust and clinical induction and INSET and at other times as required, including advising the trust on the provision of level 1, 2 and 3 adult safeguarding training. The lead will provide a quarterly update on Adult Safeguarding issues to the Risk and Safety Sub Committee Lead

The adult safeguarding lead will act as the professional interface with other agencies, in conjunction with clinical staff, in the ongoing management of any cases where abuse is identified or suspected.

Clinician Responsible (case holder)

The responsible clinician or case holder for any person who is suspected of being at risk of abuse will have the overall responsibility for the management of the individual case and will ensure that appropriate liaison with members of the team, both internal to and external to the trust take place.

All Staff

All staff have a duty to recognise record and report suspected, alleged or actual harm or abuse or neglect involving an adult at risk. Staff should be aware of and follow Trust policy and local procedures.

Safeguarding adults at risk involves multi-agency working together to ensure that health and social care is appropriately coordinated, and individuals are protected from potential or actual harm or abuse. Clinical staff and teams should maintain close and effective links with all relevant statutory and voluntary agencies to collectively ensure that adults at risk are safeguarded.

Clinical staff should ensure that potential or actual safeguarding adult concerns and issues are raised, discussed and recorded within regular clinical supervision and /or team case reviews.

Education and training

Awareness of this safeguarding policy/procedure is covered within the induction programme of all new employees or volunteers and their understanding should be checked within supervision meetings.

All staff will receive training on safeguarding adults at a level commensurate with their roles.

The Trust has conducted a training needs analysis and details of training arrangements on adults at risk are contained in the Staff Training Procedure.

Process for monitoring compliance with this policy

The Trust will monitor compliance with this policy and procedure in the following way:

The Joint Trust Safeguarding Adults and Children Committee will monitor all adult safeguarding activity including the number of concerns being recorded and where/whether concerns are being reported to the relevant local authority.
The Staff Training and Development Committee will monitor the uptake of adult safeguarding training as part of their continual monitoring of mandatory training, Compliance of this, will be reported to the Organisational Development and People sub-committee of the Integrated Governance Committee (IGC). The group will refer training issues to the respective director for action as
The Trust Adult Safeguarding Lead will provide an annual report to the Risk and Safety sub-committee of the IGC arisen in respect of either safeguarding adults or the delivery and uptake of training in line with the requirements set out in the policy
The Adult Safeguarding Lead will review any incidents relating to Safeguarding and report concerns/ investigations/ lessons learned to the Patient Safety and Clinical Risk Lead;
The Adult Safeguarding Lead will be responsible for adding any specific adult safeguarding risks to the Operational Risk Register as they arise, and this Risk Register will be monitored through the Trust’s Risk Management Procedures;
The Trust’s Safeguarding Team will undertake spot check audits of cases with adult safeguarding concerns to ensure that the records show that all relevant procedures have been followed. If this audit raises concerns the relevant lead will make recommendations to the Patient Safety and Clinical Risk Lead and an action plan will be developed and followed. Any action plan will be monitored by the Risk and Safety Sub-Committee.

References

Other resources

Appendix A Care Act 2014 Grounds for a safeguarding enquiry

Care Act 2014 S42

Where a local authority has reasonable cause to suspect that an adult in its area:

(a) has needs for care and support (whether or not the authority is meeting any of those needs),

(b)is experiencing, or is at risk of, abuse or neglect, and

(c)as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.

The local authority must make (or cause to be made) whatever enquiries it thinks necessary…

Care & Support needs – [the Care and Support (Eligibility Criteria) Regulations 2014]

Needs which meet the eligibility criteria: adults who need care and support

2.—(1) An adult’s needs meet the eligibility criteria if—

(a) the adult’s needs arise from or are related to a physical or mental impairment or illness;

(b) as a result of the adult’s needs the adult is unable to achieve two or more of the outcomes specified in paragraph (2); and

(2) The specified outcomes are—

(a) managing and maintaining nutrition;

(b) maintaining personal hygiene;

(d) being appropriately clothed;

(e) being able to make use of the adult’s home safely;

(f) maintaining a habitable home environment;

(g) developing and maintaining family or other personal relationships;

(h) accessing and engaging in work, training, education or volunteering;

(i) making use of necessary facilities or services in the local community including public

transport, and recreational facilities or services; and

(j) carrying out any caring responsibilities the adult has for a child.

(3) For the purposes of this regulation an adult is to be regarded as being unable to achieve an

outcome if the adult—

(a) is unable to achieve it without assistance;

(b) is able to achieve it without assistance but doing so causes the adult significant pain,

distress or anxiety;

(c) is able to achieve it without assistance but doing so endangers or is likely to endanger the health or safety of the adult, or of others; or

(d) is able to achieve it without assistance but takes significantly longer than would normally be expected.

Definition of wellbeing – (Care and support statutory guidance Ch. 1.5)

‘Wellbeing’ is a broad concept, and it is described as relating to the following areas in particular:

personal dignity (including treatment of the individual with respect)
physical and mental health and emotional wellbeing
protection from abuse and neglect
control by the individual over day-to-day life (including over care and support provided and the way it is provided)
participation in work, education, training or recreation
social and economic wellbeing
domestic, family and personal
suitability of living accommodation
the individual’s contribution to society