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Safeguarding adults at risk policy

Date: May 2024

Review date: March 2026

Version 5.0

Introduction

It is the responsibility of every NHS organisation and each member of their staff 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 safeguarding adults which are to

  • prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
  • 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 appropriately 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 understand their wishes and 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 safeguarding adult policies and procedure and their professional responsibilities
  • 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 any 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 professional to promote safeguarding adults 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); and regional, (London multi-agency adult Safeguarding policy & procedures, 2019), guidance and that 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 Policy Context

All safeguarding adults 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

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

Human Rights Act 1998

 

 

Describes the fundamental human rights which underpin safeguarding legislation
The Care Act 2014:

 

This sets out the duties and powers in law around safeguarding adult’s issues. It gives  Local Authorities the lead agency role in responding to safeguarding adults concerns, and Safeguarding Adults Boards (SAB) are the multi-agency strategic bodies for their area.

 

The Care and Support Statutory Guidance:

 

This gives detail about what must and should be done in relation to safeguarding adults issues. As statutory guidance, it must be followed unless circumstances mean that to do so would be harmful
The London Multi-Agency Adult Safeguarding Policy and Procedures:

 

 

This gives the framework adopted across London to create consistency for multi-agency responses to safeguarding adults concerns.
The Mental Capacity Act

 

This promotes and safeguards decision making within a legal framework.

It does this in two ways:

(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) 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. 14.13)

   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 safeguarding adults.  It requires that safeguarding adult 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

The Care Act requires safeguarding adults’ services to be provided for Adults at Risk defined in S42 of the Act as 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, Domestic abuse, Sexual abuse and exploitation, Psychological and emotional abuse, Financial and material abuse, Modern slavery, Neglect and acts of omission, Discriminatory violence & abuse, Organisational abuse, and  Self-neglect. 

Radicalisation is also considered a form of abuse.

See appendix A for more details

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 being raised. 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.

 

 

Chief Nursing Officer

 

The Chief Nursing Officer has day to day responsibility for ensuring that the Trust is operating within the procedures set out in this document. The Chief Nursing Officer will liaise specifically with the Safeguarding adults Lead and will provide the professional lead and expertise for the implementation of this procedure.
Chief People Officer

 

 

 

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 (OD, Culture and Engagement

 

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).
Safeguarding Adult Lead

 

The Safeguarding adults 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 safeguarding adults training. The lead will provide a quarterly update on Safeguarding adults issues to the Integrated Safeguarding group

 

The Safeguarding Adult Lead can 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, 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 to ensure that all agencies are 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.

 

All staff must undertake adult safeguarding training at a level appropriate to their role.

Education and Training

Awareness of these safeguarding policy and procedures 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, and in accordance with the Royal College of Nursing competency framework.

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

The Safeguarding Adults lead , Patient safety team and Complaints team will work closely together to ensure a consistent approach to enquiries.

Serious Incidents involving abuse of an adult may meet the criteria for reporting as Safeguarding as well as a Serious Incident. Such incidents may include:-

  • death or injury to a servicer user or adult identified at risk, where abuse or neglect is suspected to be a factor;
  • where a service user or adult identified at risk has suffered harm as a result of staff failing to follow agreed procedures or acceptable practice;

All complaints or concerns where there are safeguarding concerns will be sent to the Safeguarding Adults Lead for advice and guidance.

Recruitment and Disclosure and Barring Scheme checks

The Trust is required to comply with the Disclosure and Barring Scheme (DBS) which aims to ensure that unsuitable people do not work with service users on a paid or voluntary basis. The Trust has a statutory duty to refer to the DBS to make decisions regarding safe recruitment.

All Trust staff working with children and adults will undergo a DBS check on a regular basis, and are notified of this via HR.

All job descriptions contain a statement regarding staff responsibility for adhering to Trust policies on Safeguarding Adults and Safeguarding Children.

Process for Monitoring Compliance with this Policy

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

  • The Trust Integrated Safeguarding Group will monitor all safeguarding adults activity including the number of concerns being recorded and where/whether concerns are being reported to the relevant local authority.
  • The Integrated safeguarding Group and Quality & Safety Committee will monitor the uptake of safeguarding adults training as part of their continual monitoring of mandatory training, Compliance of this, will be reported to the People & Organisational Development committee.   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 Integrated Safeguarding group and to the Quality & Safety Committee containing information on 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 Lead.
  • The Adult Safeguarding Lead will be responsible for adding any specific safeguarding adults risks to the Operational Risk Register as they arise, and this Risk Register will be monitored through the Trust’s Risk Management
  • The Trust’s Safeguarding Team will undertake spot check audits of cases with safeguarding adults 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 Lead and an action plan will be developed and followed. Any action plan will be monitored by the Risk and Safety Sub-Committee.

References

The Care Act 2014 

Human Rights Act 1998

The Care and Support Statutory Guidance

The London Multi Agency Adult Safeguarding Policy and Procedure

Social Care Institute for excellence (SCIE) at-a-glance Adult Safeguarding types and indicators of abuse

Trust policies & procedures

Domestic abuse and sexual violence policy

Domestic abuse and sexual violence procedures

Admitting very important persons to Trust premises procedure

Managing allegations against staff and persons in positions of trust procedure

Sexual Safety of Patients Procedure

Freedom to Speak up Policy

Freedom to Speak up Procedure

Other resources

Whistleblowing helpline (to report Organisational Abuse/Neglect concern)

Voiceability: Advocacy in Camden

Care Quality Commission

Protecting Adult at Risk: Practice Resource

Forced Marriage

Camden Safeguarding Adults Review Framework

Domestic Violence Services/Resources in Camden

Safeguarding Resources and Services Links

Modern Slavery & Human Trafficking Guidance

Adult Safeguarding: Roles and Competencies for Health Care Staff RCN  2018