Adult safeguarding policy

Policy summary

1. Potential safeguarding concern
2. Ensure no harm/medical review of patient if required
3. Discuss with line manager/vulnerability unit
4. Complete adult safeguarding concern form (available on SharePoint)
5. Send concern form to vulnerability unit. If out of hours and urgent advice is required, please contact the EDT 01642 524552
6. Trust safeguarding team will forward all concerns to the local authority and log all events on InPhase
7. Local authority decides if the adult safeguarding concern meets the criteria under section 42 of the Care Act 014
8. Local authority safeguarding team will lead investigation and direct the trust with appropriate actions and outcomes
9. Lessons learnt are discussed as part of the trust safeguarding adults operational group and at the safeguarding council and signposted to each care group who are responsible for remedial actions

Policy title

Adult Safeguarding Policy

Reference and Version No

C46 Version 9

Author and Job Title

• Kathy Fitzwater Named Nurse Safeguarding Adults
• Executive Lead: Chief Nurse, Quality & Patient Safety

Validated By

Safeguarding Council

Ratified By

Patient Safety Council

Date Issued

October 2024

Date for Review

12 October 2027

Related Documents

• C50 Safeguarding children policy
• C53 Mental capacity/deprivation of liberty safeguards (DoLS) policy
• C81 Domestic abuse policy
• RM36 Freedom to speak up policy
• C40 Duty of candor policy
• HR74 Volunteers policy
• RM15 Incident reporting and investigation policy
• HR21 Supporting performance improvement policy
• HR19 Equal opportunities and diversity policy
• C61 Clinical supervision policy
• M48 Female genital mutilation

This Policy is Intended for

All staff groups

1. Introduction and purpose

1.1 Safeguarding is “everyone’s business”

The Care Act 2014 requires that Safeguarding Adults Boards assure themselves that local safeguarding arrangements are in place across their locality and that their partners act appropriately to help and protect adults from abuse and neglect.

Whilst protecting adults at risk of abuse or harm will always be the main priority of the TSAB, the Board also recognises the importance of raising awareness in order to prevent abuse and neglect and that partner’s share collective responsibility for ensuring that all efforts to keep people safe are effective and well-coordinated.

The purpose of this policy is to outline the principles and definitions that underpin safeguarding work and to describe the statutory duties set out under the Care Act 2014.

1.2 Think Family

All staff have a duty to consider the Think Family agenda which recognises and promotes the importance of a whole-family approach which is built on the principles of ‘Reaching out: think family’:

• No wrong door – contact with any service offers an open door into a system of joined-up support. This is based on more coordination between adult and children’s services.
• Looking at the whole family – services working with both adults and children take into account family circumstances and responsibilities. For example, an alcohol treatment service combines treatment with parenting classes while supervised childcare is provided for the children.
• Providing support tailored to need – working with families to agree a package of support best suited to their particular situation.
• Building on family strengths – practitioners work in partnerships with families recognising and promoting resilience and helping them to build their capabilities. For example, family group conferencing is used to empower a family to negotiate their own solution to a problem.

1.3 Trauma informed safeguarding practice

Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as harmful or life threatening. While unique to the individual, generally the experience of trauma can cause lasting adverse effects, limiting the ability to function and achieve mental, physical, social, emotional or spiritual well-being. Trauma can affect individuals, groups and communities.

Trauma-informed practice is an approach to health and care interventions which is grounded in the understanding that trauma exposure can impact an individual’s neurological, biological, psychological and social development. Trauma-informed practice aims to increase practitioners’ awareness of how trauma can negatively impact on individuals and communities, and their ability to feel safe or develop trusting relationships with health and care services and their staff.

It aims to improve the accessibility and quality of services by creating culturally sensitive, safe services that people trust and want to use. It seeks to prepare practitioners to work in collaboration and partnership with people and empower them to make choices about their health and wellbeing.

Trauma-informed practice acknowledges the need to see beyond an individual’s presenting behaviours and to ask, ‘What does this person need?’ rather than ‘What is wrong with this person?’

It seeks to avoid re-traumatisation which is the re-experiencing of thoughts, feelings or sensations experienced at the time of a traumatic event or circumstance in a person’s past. Re-traumatisation is generally triggered by reminders of previous trauma which may or may not be potentially traumatic in themselves.

The purpose of trauma-informed practice is not to treat trauma-related difficulties, which is the role of trauma-specialist services and practitioners. Instead, it seeks to address the barriers that people affected by trauma can experience when accessing health and care services.

2. Definitions, background and scope

2.1 An adult in relation to adult safeguarding is a person over the age of 18.

This policy sets out the responsibilities of the Trust to protect adults from abuse or neglect. Safeguarding duties apply to any adult who:

• Has needs for care and support (whether or not the Local Authority is meeting any of those needs) and;
• Is experiencing, or at risk of, abuse or neglect; and
• As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

The adult experiencing, or at risk of abuse or neglect will be referred to the adult throughout this policy document.

2.2 This definition of adults at risk of abuse or neglect includes:

• Those who are at a greater risk of suffering abuse or neglect because of physical, mental, sensory, learning or cognitive illnesses or disabilities; and substance misuse or brain injury.
• Those who purchase their care through personal budgets.
• Those whose care is funded by Local Authorities and/or health services; and
• Those who fund their own care.
• Informal carers, family and friends who provide care on an unpaid basis.
• If an adult is at risk of abuse or is demonstrating any adult risky behaviours, then we need to consider if any children they are in regular contact with may be at risk. If you feel there are children who may be at risk refer to children’s safeguarding.

Appendix 1 provides a detailed list of, and example of, the categories of abuse. The Vulnerability Unit covers a wide range of subjects including but not exclusive to the following:

2.3 Domestic Abuse

The Domestic Abuse Bill 2021 defines Domestic Abuse as:

“Behaviour of a person (A) towards another person (B) is domestic abuse if:

• A and B are aged 16 or over and are personally connected to each other.
• The behaviour is abusive (consists of): physical or sexual abuse, violent or threatening behaviour; economic abuse; psychological, emotional or other abuse.
• It does not matter whether the behaviour consists of a single incident or a course of conduct.

People are personally connected if:

• They are, or have been, married to each other.
• They are, or have been, civil partners of each other.
• They have agreed to marry one another (whether or not the agreement has been terminated).
• They have entered into a civil partnership agreement (whether or not the agreement has been terminated).
• They are, or have been, in an intimate personal relationship with each other.
• They each have, or there has been a time when they each have had, a parental relationship in relation to the same child (see subsection 2).
• They are relatives.

2.4 Prevent

Prevent is one part of the government’s overall counter-terrorism strategy, CONTEST. The aim of Prevent is to:

• Tackle the ideological causes of terrorism
• intervene early to support people susceptible to radicalisation
• enable those who have already engaged in terrorism to disengage and rehabilitate

2.5 Forced Marriage

Forced Marriage (FM) – a marriage which one or both spouses do not (or, in the case of some adults with learning or physical disabilities, cannot) consent to, and where duress is involved. Duress can include physical, psychological, financial, sexual and emotional pressure (Forced Marriage Unit 2009). Duress and/or any other consequences of non-compliance are also defined as ‘honour based violence’.

2.6 Honour Based Violence (HBV)

HBV also called ‘honour crime’ or ‘violence committed in the name of honour’. The terms embrace a variety of practices, mainly but not exclusively perpetrated against women and girls, including assault, imprisonment and murder.

These practices are used to control behaviour within families to protect perceived cultural and religious beliefs and/or ‘honour’. Violence can occur when perpetrators believe that an individual has shamed the family and/or community by breaking their honour code (Crown Prosecution Service 2010).

HBV may be committed by male and/or females, often involves multiple perpetrators and is distinguished from other forms of abuse/violence as it is often committed with some degree of approval and/or collusion from family and/or community members.

2.7 Female Genital Mutilation (FGM)

Female Genital Mutilation (FGM) – the partial or total removal of the external female genitalia or other injury to the female genital organs whether for cultural reasons or other non-therapeutic reasons (Foreign & Commonwealth Office 2011). Previously referred to as ‘Female Circumcision’. FGM is illegal in the UK under the Female Genital Mutilation Act 2003

2.8 Hate Crime

Hate Crime is any offence which is perceived by the victim or any other person as being motivated by prejudice or hate, based on a person’s race, religious belief, sexual orientation, disability or transgender.

Hate crime can be physical violence and assault, verbal abuse, obscene calls or text, offensive mail, email or graffiti. It can be damage or rubbish, or offensive or dangerous substances post through letter box.

2.9 People with a Learning Disability

A learning disability is a reduced intellectual ability and difficulty with everyday activities, such as household tasks, socialising or managing money, which affects someone for their whole life. A learning disability differs from a learning difficulty in that it does not affect someone’s intellect.

People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.
Instead, a learning difficulty means that someone finds it more difficult to learn a specific thing, such as reading, writing or maths.

2.10 The Mental Capacity Act/Deprivation of Liberty Safeguards

The Mental Capacity Act 2005 came into effect April 2007. An addendum to the main Act, the Deprivation of Liberty Safeguards came into force from August 2008.

The Mental Capacity Act provides a statutory framework to empower and protect any adult over the age of 16 who may not be able to make their own decisions. The Mental Capacity Act assumes people have capacity unless it is established otherwise.

If it is considered that a patient may lack capacity, this should be appropriately assessed with reference to the test set out in the Mental Capacity Act. If following assessment, it is confirmed that a patient lacks capacity in relation to a particular decision, the MCA provides the legal framework to authorise treatment in a patient’s best interests.

This policy sets out what the test is to determine whether a patient lacks capacity and the factors which are relevant to determine what is in a patient’s best interest.

In some circumstances it will not be in a patient’s best interests to be allowed to leave hospital if they lack capacity. The Deprivation of Liberty Safeguards (DoLS) were established to provide a legal framework to protect adults and maintain a safe environment where they lack capacity to do so themselves. DoLS can only apply to individuals over the age of 18 years.

For more information, please refer to the Mental Capacity/Deprivation of Liberty Safeguard Policy C53.

2.11 Transitional Safeguarding

This term describes the need to safeguard adolescents and young adults fluidly across developmental stages which is built upon the best available evidence, learns from both children’s and adult safeguarding practice and which prepares young people for their adult lives.

It focuses on safeguarding young people, from adolescence into adulthood, recognising this period of transition will be experienced differently by young people at different times.

‘Young people’ refers to people aged from mid-teens to mid-twenties, though some flexibility is important as Transitional Safeguarding encourages a shift away from age-determined boundaries.

2.13 People in Positions of Trust (PiPoT)

The Care Act (2014) defines PiPoT as “people who work in paid or unpaid capacity, including celebrities and people undertaking charitable duties with adults with care and support needs” (see Statutory Guidance 14.120 to 14.132).

It is a requirement of the Care Act 2014 Statutory Guidance that SABs should establish and agree a framework and process for any organisation to respond to allegations against “anyone who works, (in either a paid or an unpaid capacity) with adults with care and support needs”.

3. Roles and responsibilities

3.1 Group Chief Executive

The Group Chief Executive has the ultimate responsibility for ensuring that the Trust contribution to safeguarding and promoting the welfare of adults are discharged effectively.

3.2 Group Chief Nurse, Quality & Patient Safety

The Group Chief Nurse, Quality and Patient Safety acts as the Executive Director for Safeguarding. This post holder provides professional advice and expertise to the Chief Executive and Board.

3.3 All Directors, Assistant Directors & Clinical Directors

All Directors, Assistant Directors and Clinical Directors should ensure the delivery of the Safeguarding Adults Policy and uphold the procedures and key documents referred to within it.

3.4 Senior Clinical Matrons/Appropriate Clinical Leads

The Senior Clinical Matrons and Appropriate Clinical Leads will ensure that staff responds within Teeswide Safeguarding Adult Board Policy timescales to adult safeguarding enquiries, they will:

• Support staff to ensure that the Trust has the appropriate representatives attending the safeguarding meetings with professional reports
• To ensure implementation of the policy. Identify any training needs and action appropriately
• Ensure that lessons learnt are embedded into future practice
• Ensure, with support from the Adult Safeguarding Team that staff are supported through this process through clinical supervision
• Liaise with Human Resources as required
• Liaise with Police as required

3.5 The Vulnerability Unit

The Vulnerability Unit encompasses the Adult and Children Safeguarding Teams, the Learning Disability/Safeguarding Nurse advisor, the Specialist Dementia Nurse/Safeguarding Advisor, the Mental Capacity Act administration service and the Hospital Independent Domestic Violence Advisor.

The unit will act as the Trust single point of contact (SPOC), coordinating the adult safeguarding process by communicating documents required by the Local Authority such as a reports, assurance requirements or action plans.

The Senior Clinical Professional of the area concerned will quality check the report and investigation documents to ensure they answer the key issues identified in the safeguarding concern.

The Adult Safeguarding Team will offer guidance and support to each area to enable them to reach timescales by sharing practice guidance and communicate when and where meetings are, they will:

• Liaise with the Senior Clinical Professionals, Clinical Leads, Patient Safety, Human Resources, Police and relevant others to ensure that all are provided with the appropriate information in a supportive timely manner
• Communicate with the Trust Senior management team as required
• Coordinate on behalf of the Trust with all relevant external agencies concerning an adult safeguarding
• Liaise with Patient Experience Team, patients and/or families if appropriate
• The Vulnerability Unit will support the organisation in its governance role, by ensuring that adult safeguarding audits are undertaken.

The Vulnerability Unit are responsible for co-ordination the organisation’s internal reviews except when they have had personal involvement in the case, when it will be delegated to an appropriate professional to conduct the review. The Senior Clinical Professional will ensure that the resulting action plan is achieved and the lessons learned from the review are communicated to the appropriate personnel.

The Vulnerability Unit has a key role in promoting good professional practice within their organisation, and provides advice, supervision and expertise for fellow professionals.

3.6 All Staff, Volunteers & Students on Placement

North Tees and Hartlepool NHS Foundation Trust are committed to ensure that all staff, volunteers and students on placement have access to relevant information and possess the necessary information, knowledge and skills to enable them to fulfil their individual roles in relation to their adult safeguarding practice and responsibilities.

Volunteers will need to be managed accordingly and should be on Electronic Staff Records (ESR) and should have Training Needs Analysis (TNA) allocated to their role. The TNA will includes safeguarding training. Please refer to the Volunteers Policy HR74.
This includes but is not limited to:

• Recognising when an individual is at risk of abuse or is experiencing abuse or harm; either through what is happening or has happened or when something has not happened that should have.
• Recognising that abuse, harm or the likelihood of either can be a result of acts or omissions of appropriate interventions.
• Recognising that concerns can involve staff, volunteers, students on placements, carers, external staff, members of the public or family members.
• Recognising that harm can occur in any care setting.
• Acting in a timely manner to raise concerns and this includes recognising that if a crime has been committed that the Police are informed without delay.

Staff who provide services to adults and families and those staff who provide services to adults, whose behaviours may impact on their ability to care for vulnerable adults or children, must be able to identify adult safeguarding and welfare concerns and know what to do if they or others are concerned about a vulnerable adult.

Staff must be familiar with and have access to The Teeswide Adult Safeguarding Policy (link available on Adult Safeguarding SharePoint site), comply with The Mental Capacity Act (2005) and The Mental Health Act (1983).

It is identified that raising a safeguarding concern or being involved in the safeguarding process can be traumatic for staff. Vicarious trauma, sometimes called secondary traumatic stress, occurs when a person is exposed or has continuous exposure to the trauma of another indirectly, usually through hearing or seeing a first-hand account of it.

As a result, the person’s worldview may shift, and they may negatively impact their life and their work. Vicarious trauma is not the same as posttraumatic stress disorder (PTSD), which typically applies to those who experience trauma directly, but it may have similar symptoms.

In view of this, clinical supervision is recommended to all staff who are involved in the safeguarding process as per C61 Clinical Supervision Policy (sec 8.1) Staff must attend all applicable training as laid down in the Trust’s HR21 Supporting Performance Improvement Policy. Staff have a responsibility to ensure they read, understand and comply with these policies.

4. Policies and process

When raising a safeguarding adults concern, staff practice should adhere to the 6 principles of safeguarding adults, laid out within the Care Act 2014 Guidance (see appendix 2 for further details);

• Empowerment
• Prevention
• Proportionality
• Protection
• Partnership
• Accountability

All staff should follow the flowchart as shown in appendix 3 (copy also on SharePoint) when submitting an adult safeguarding concern form.

Decision Support Guidance is available on SharePoint and can be used to support staff when raising a concern to the Adult Safeguarding Team, or an alternative action of signposting to care management. Should a criminal act be suspected staff should have awareness of the Police Adults at Risk referral criteria, as police involvement at the earliest opportunity is vital to the preservation of forensic evidence (Adult-at-Risk-Police-Referral-Criteria-May-2020.pdf (tsab.org.uk) also available on the adult safeguarding section of SharePoint).

When a member of staff requires advice in respect of a possible adult safeguarding concern they should contact their Line Manager or the Adult Safeguarding team in the Vulnerability Unit. When a need for an adult safeguarding concern arises the form should be downloaded from the adult safeguarding section of SharePoint. Consent should be obtained from the adult, however there are circumstances where consent may be superseded. This can be discussed on a case by case basis with the Adult Safeguarding Team, or Local authority. Where capacity is lacking to consent to the concern being raised, this will be completed in the adults best interests as per C53 MCA/DoLS Policy. The wants and wishes of the outcome of safeguarding process should be obtained from the adult, as part of Making Safeguarding Personal (MSP). This will enable responses taken to be tailored to their wants where possible. The concern form will need to be completed with as much detail as possible and emailed securely to the Local Authority where the harm/incident occurred; a copy of the referral must be forwarded to the Trust Adult Safeguarding Team in the Vulnerability Unit: [email protected]

The Trust Adult Safeguarding team will complete an InPhase event and place an electronic flag on Trakcare for inpatients, to alert to the concern. If an investigation into an adult safeguarding concern progresses, any report produced and attendance to the strategy meeting are all coordinated by the Trust Adult Safeguarding Team in partnership with the relevant service, ward or department.

If the Local Authority investigates and the outcome is a Strategy meeting, it would be the responsibility of Care Groups (as identified and supported by the Adult Vulnerability Unit) to:

• Ensure the most appropriate staff member to attend the Strategy meeting
• Ensure a typed report is produced and submitted to Adult Safeguarding Team in advance of the strategy meeting

The Trust has an honorary contract in place with a Hospital Independent Domestic Violence Advisor (IDVA), funded via Harbour. The IDVA can provide support, signposting and advice for patients and staff on any aspect of domestic abuse (not just violent incidents). The IDVA is based within the Vulnerability Unit, and can be contacted through the Adult safeguarding team, or directly. Contact details are available on SharePoint. For further information, please refer to Domestic Abuse Policy C81.

NB. An incident of domestic abuse should not be regarded as ‘HBV’ purely because it occurs within the BME community.

The Trust adheres to HM Government Multi-agency practice guidelines: Handling cases of Forced Marriage which can be found on the Trust Adult Safeguarding SharePoint site.

Staff require sensitive training to recognise and respond to situations of Forced Marriage in accordance to the guidance. The Trust makes it explicit that both Forced marriage and HBV should be managed in accordance with the Trust Children’s Safeguarding Policy (C50) and Procedures as well as Adults. Concerns in respect of a child should be made via the Children’s Safeguarding team.

The Trust adheres to HM Government Multi-Agency Practice Guidelines: Female Genital Mutilation which can found on the Trust Adult Safeguarding SharePoint along with additional supportive information. Concerns in respect of this illegal act should be raised appropriately via Children’s or Adult Vulnerability Unit. All FGM cases within the Trust are to be clearly recorded in patient’s health care records. An InPhase event is to be initiated for mandatory monitoring purposes within the Trust, however all data will be anonymised (see FGM M48 Guideline).

This element of safeguarding should be considered alongside The Trust Policy for Safeguarding Children C50 which refers to the Governments statutory guidance “Working Together to Safeguard Children” (2023). Staff require sensitive training to recognise and respond in accordance with the guidance.

Hate Crime should be reported through the most appropriate channel whether this is the police or the Trust Vulnerability Unit. Across Tees we are committed to ensuring smooth transitions for young people into adulthood. Transitional safeguarding is ‘an approach to safeguarding adolescents and young adults fluidly across developmental stages which builds on the best available evidence, learns from both children’s and adult safeguarding practice and which prepares young people for their adult lives”.

Every child has a right to protection from harm and every group or organisation that works, volunteers or comes into contact with children has a responsibility to keep them safe. Children and young people who are deaf or have a disability are at an increased risk of being abused compared with their peers. They are also less likely to receive the protection and support they need when they have been abused.

Every support should be provided to children with learning disabilities and autism to enable them to communicate their needs. Significant learning has been required where these needs and wishes have been ignored resulting in child deaths and poorer outcomes for children with protected characteristics.

Disadvantage has also been highlighted in their transition between adult and children health services resulting in deterioration of health outcomes. Consideration should be given by staff to age of maturity rather than chronological age (i.e. turning 18) as a mark of how children with significant additional needs with cope moving into adult health care services. Adaption of adult health care services may be required to scaffold the transition.
The Trust employs a specialist nurse advisor who can support the needs of an adult with a learning disability in hospital. The specialist nurse works within the Vulnerability Unit and can be contacted on the same office telephone number.

The Trust operates a clear zero tolerance approach to any abuse. Where an allegation of abuse is made against a member of Trust staff, students or volunteers the relevant TSAB Policy must be followed alongside the Freedom to Speak up Policy (RM36).

HR should be informed if the safeguarding concerns relate to workforce or management of the Trust’s workforce after discernment from the appropriate Senior Clinical Professional or the Clinical Lead for the area/department, this includes if the member of staff is employed by NHS Professionals (NHSP). This could be in respect of an employee who is under investigation for an act of omission or co-omission and would involve close working with the Care Group leads. A referral to the Disclosure and Barring Service (DBS), or Local Authority Designated Officer (LADO) may be made by HR if required.

Healthcare professionals have a key role in Prevent. Mandatory training for all staff is accessed via ESR. Training is required to be updated 3-yearly. Prevent focuses on working with vulnerable individuals who may be at risk of being exploited by radicalisers and subsequently drawn into terrorist related activity. If staff are concerned that a vulnerable individual is being exploited in this way, they can raise these concerns via the Channel referral process managed by the Adult Safeguarding Team. All Channel referrals are processed in the Trust via the Adult Safeguarding Team.

5. Review and revision

Three yearly review or on legislative or procedural changes.

6. Monitoring

The Trust Safeguarding Adults meeting meets a minimum of four times per year and consider the activity report which is prepared on a quarterly basis. An analysis of this report includes all aspects of adult safeguarding concern activity and identifies key lessons learnt. Lessons learned are shared by the appropriate Care Group as a learning platform, and then with the Safeguarding Council The following processes will be monitored for compliance as outlined in the table below.

Where monitoring identifies deficiencies an action plan will be produced. Adult safeguarding training compliance is monitored within care groups via Yellowfin. The Named Nurse Safeguarding Adults closely monitors training and if compliance falls below set target, Care Groups will be informed by the Safeguarding Trainers. Care groups will provide remedial action plans to the Adult Safeguarding Operational Group. Exceptions will be escalated to the Safeguarding Council.

The Trust undertakes a bi-annual audit of 20 sets of case notes which have had a safeguarding concern submitted, which tests compliance with the Policy and these are then presented to the Trust Adult Safeguarding Operational Group, with exceptions escalated to the Safeguarding Council.

Event Reporting:

This policy will be monitored primarily through exception reporting via InPhase Event reporting system as and when an event occurs. This will be monitored by the Adult Safeguarding Team, and shared via the Adult Safeguarding Operational Group.

If any deviation from the policy occurs, an event is created using the following categories:

InPhase

7. References

This policy has been developed within the context of the law and guidance that seeks to protect adults including:

• Care Act 2014 (legislation.gov.uk) accessed 18.08.2024
• Care and support statutory guidance – GOV.UK (www.gov.uk) accessed 18.08.2024
• Mental Capacity Act 2005 (legislation.gov.uk) (including Deprivation of Liberty Safeguards) accessed 18.08.2024
• Human Rights Act 1998 (legislation.gov.uk) accessed 18.08.2024
• Equality Act 2010 (legislation.gov.uk) accessed 18.08.2024
• Mental Health Act 1983 (legislation.gov.uk) accessed 18.08.2024
• Code of practice: Mental Health Act 1983 – GOV.UK (www.gov.uk) accessed 18.08.2024
• Adult-at-Risk-Police-Referral-Criteria-May-2020.pdf (tsab.org.uk) accessed 18.08.2024
• TSAB-Information-Sharing-Agreement-v6.pdf accessed 18.08.2024
• Tees Safeguarding Adults and Children Joint Working Protocol v1 – Accessible Version (tsab.org.uk)accessed 18.08.2024
• Fact Sheet on Trauma Informed Practice (tsab.org.uk) accessed 18.08.2024
• Vulnerabilities: applying All Our Health – GOV.UK (www.gov.uk) accessed 18.08.2024
• NHSE elfh Hub (e-lfh.org.uk) accessed 18.08.2024
• Bridging the gap: Transitional Safeguarding and the role of social work with adults (publishing.service.gov.uk) accessed 18.08.2024
• What is a learning disability? | Mencap accessed 18.08.2024
• Working together to safeguard children 2023: statutory guidance (publishing.service.gov.uk) accessed 18.08.2024
• Safeguarding Deaf and disabled children and young people | NSPCC Learning accessed 18.08.2024

8. Policy revisions change control

The table below identifies the areas where this policy has been reviewed; where these are minor changes staff should ensure that they take this opportunity to refresh knowledge of the whole policy and their responsibilities in relation to this and not just focus on the minor changes.

Policy ref: C46

Version number: V9

Description of revisions made: Fully reviewed policy

Appendix 1 – Types of abuse and neglect

Physical abuse

Including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

Financial or material abuse

Including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Sexual abuse

Including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

Psychological abuse

Including 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 of services or supportive networks.

Modern slavery

Encompasses slavery, human trafficking, forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.

Discriminatory abuse

Including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion.

Organisational abuse

Including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in 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.

Neglect and acts of omission

Including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating

Self-neglect

This covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.

Domestic violence

Including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence.

Appendix 2 – Principles of Safeguarding Adults

Six Key Principles Underpin All Safeguarding Adult Work:

The Department of Health Care and Support Statutory Guidance issued under the Care Act 2014, describes six principles that underpin all safeguarding adult work which applies to all sectors and settings. This includes: care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider Local Authority functions and the criminal justice system.

These principles should always inform the ways in which professionals and other staff work with adults.

Empowerment

People being supported and encouraged to make their own decisions and informed consent. “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

Prevention

It is better to take action before harm occurs. “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionally

The least intrusive response appropriate to the risk presented. “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”

Protection

Support and representation for those in greatest need. “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.”

Partnership

Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”

Accountability

Accountability and transparency in delivering safeguarding. “I understand the role of everyone involved in my life and so do they.”

Appendix 3 – Raising a safeguarding concern

1. Raising a safeguarding concern
2. Ensure no further harm/medical review of patient if required
3. Discuss with Line Manager/Vulnerability Unit. Document outcomes/actions in patient records
4. Complete Adult Safeguarding Concern form (available on Sharepoint)
5. Send concern form to Vulnerability Unit. If out of hours and urgent advice is required, please contact the EDT 01642 524552
6. Trust Safeguarding Team will forward all concerns to the Local Authority and log all events on InPhase
7. Local Authority decides if the adult safeguarding concern meets the criteria under Section 42 of the Care Act 2014
8. Local Authority Safeguarding Team will lead the investigation and direct the Trust with appropriate actions and outcomes
9. Lessons learnt are discussed as part of the Trust Safeguarding Adults Operational Group and at the Safeguarding Council and signposted to each Care Group who are responsible for remedial actions

Consider, if appropriate, to refer to Independent Mental Capacity Advocate (IMCA). Guidance on this can be obtained via SharePoint or adult safeguarding team.

Appendix 4 – Making safeguarding personal

What is Making Safeguarding Personal?

Making Safeguarding Personal (MSP) is an initiative which aims to develop a person-centred and outcomes focus to safeguarding work in supporting people to improve or resolve their circumstances.MSP is applicable to all agencies working with adults in relation to safeguarding, including those at the initial stages of a Safeguarding Concern being identified.

This guidance is designed to provide advice on how best to engage with adults, and work in a committed, multi-agency partnership approach to the subject.
What MSP Seeks to Achieve:

1. A personalised approach enabling safeguarding to be done with and not to people, using practical methods defined by the adults’ individual needs rather than those of an organisation
2. The outcomes an adult want, by determining these at the beginning of working with them, and ascertaining if those outcomes were realised at the end.
3. Improvement to people’s circumstances rather than on ‘investigation and conclusion’
4. Utilisation of person-centred practice rather than ‘putting people through a process’
5. Good outcomes for people by working with them in a timely way, rather than one constrained by timescales.
6. Improved practice by supporting a range of methods for staff learning and development
7. Learning through sharing good practice.
8. Further development of recording systems in order to understand what works well
9. Broader cultural change and commitment within organisations, to enable practitioners, families, teams and the Board to know what difference has been made.

Evaluation of Safeguarding Enquiries and MSP

The effective evaluation of Safeguarding Enquiries is a crucial part of MSP and fundamental to the principles of improving and learning through sharing good practice.

Appendix 5 – Trauma informed practice

Key principles of trauma-informed practice

There are 6 principles of trauma-informed practice: safety, trust, choice, collaboration, empowerment and cultural consideration.

Safety

The physical, psychological and emotional safety of service users and staff is prioritised, by:

• people knowing they are safe or asking what they need to feel safe
• there being reasonable freedom from threat or harm
• attempting to prevent re-traumatisation
• putting policies, practices and safeguarding arrangements in place

Trustworthiness

Transparency exists in an organisation’s policies and procedures, with the objective of building trust among staff, service users and the wider community, by:

• the organisation and staff explaining what they are doing and why
• the organisation and staff doing what they say they will do
• expectations being made clear and the organisation and staff not overpromising

Choice

Service users are supported in shared decision-making, choice and goal setting to determine the plan of action they need to heal and move forward, by:

• ensuring service users and staff have a voice in the decision-making process of the organisation and its services
• listening to the needs and wishes of service users and staff
• explaining choices clearly and transparently
• acknowledging that people who have experienced or are experiencing trauma may feel a lack of safety or control over the course of their life which can cause difficulties in developing trusting relationships

Collaboration

The value of staff and service user experience is recognised in overcoming challenges and improving the system as a whole, by:

• using formal and informal peer support and mutual self-help
• the organisation asking service users and staff what they need and collaboratively considering how these needs can be met
• focussing on working alongside and actively involving service users in the delivery of services

Empowerment

Efforts are made to share power and give service users and staff a strong voice in decision-making, at both individual and organisational level, by:

• validating feelings and concerns of staff and service users
• listening to what a person wants and needs
• supporting people to make decisions and take action
• acknowledging that people who have experienced or are experiencing trauma may feel powerless to control what happens to them, isolated by their experiences and have feelings of low self-worth

Cultural consideration

Move past cultural stereotypes and biases based on, for example, gender, sexual orientation, age, religion, disability, geography, race or ethnicity by:

• offering access to gender responsive services
• leveraging the healing value of traditional cultural connections
• incorporating policies, protocols and processes that are responsive to the needs of individuals served