Principles of safeguarding and protection in health and social care
1. Know how to recognise signs of abuse
1.1. Define the following types of abuse:
• Physical abuse -deliberate use of force that results in bodily injury or pain. Includes hitting, biting, shaking, burning, inappropriate treatments, isolation or confinement and misuse of medication.
• Sexual abuse – involvement in sexual activity without consent. This may be direct (being forced to perform sex acts) or indirect (being forced to watch sexual activity in person or on the tv or internet). The person may not wish to consent, lack capacity, or they feel coerced because the abuser is in a position of trust, power or authority.
• Emotional/psychological abuse – any action that damages an individual’s mental wellbeing such as threats, humiliation, bullying, swearing, or other mental cruelty that results in distress. Includes the denial of basic human rights, such as choice, self-expression, privacy and dignity.
• Financial abuse – the theft or misuse of an individual’s money or personal possessions.
• Institutional abuse – mistreatment of an individual by the authorities or people within an institution. It occurs when the routines, systems and norms of an institution are seen as more important than the people they support.
• Self-neglect – when the individual fails to care for themselves and meet their own basic needs for food, warmth, rest, medical care and personal care. May be intentional (such as self-harm) or unintentional, due to physical or mental health issues.
• Neglect by others – failure to meet individuals needs for personal care, food warmth, rest, medical care, social stimulation, cultural or religious needs. This can be either acts or omission (not doing something) or commission (doing something on purpose).
1.2. Identify the signs and/or symptoms associated with each type of abuse
Physical abuse can occur in many forms these could be multiple or minor bruising of different areas, or marks from being slapped, scratched or bitten or pinched with inconsistent explanations. You need to look for fingerprint and teeth marks. Or it could be in the form of burns and scalds, including oddly shaped bruises or burns, such as shape of an iron, lighter or cigarette end. Or any broken bones or unexplained falls, you need to pay attention if an individual suddenly loses mobility when they were previously quite active it could be down to an unreported broken bone. You need to ask yourself why it was unreported and report your suspicions to your senior. Always keep an eye out for signs of malnourishment, sudden loss of weight, unhealthy skin and other signs of neglect. If an individual seems to drowsy or confused to regularly, it may be due to the fact that they have had too much pain relief or sedative, keep an eye out for misuse of medication. If an individual starts to cover themselves or make defensive gestures towards you or near another individual it may be a sign that the individual has been physically attacked previously.
Sexual abuse signs can be shown in the form of fear of physical contact from an individual. Any signs of bleeding, irritation, injury, sexual transmitted disease or infection around the genitals. Look out for foul smells or soreness. Any bruising in intimate places, bitemarks or scratches on breast or inner thigh. If any individual starts suddenly starts making inappropriate conversation of a sexual nature it may be because of sexual abuse. If an individual suddenly withdraws themselves from social contact or becomes distressed or starts crying or self-harming or neglecting themselves for unexplained reasons you must presume this may be because of sexual abuse.
If an individual is receiving emotional/ physiological abuse you may see signs of sadness, depression, no spontaneous laughter or smiles or uncontrollable crying. An individual may start to isolate themselves from people when previously they were more outgoing and start to have a low self-esteem or lack of confidence. An individual may start to exhibit fear or anxiety towards a certain member of staff and request not to be near that staff member. An individual may suddenly have a change in appetite or start refusing food or medication, or their sleeping patterns may change induced from nightmares or insomnia. The individual may become increasingly irritable and tense or may start seeking attention with their behaviour by either self-harm or self-abuse through misuse of drugs or alcohol.
An individual could be being financially abused if they have a sudden inability to pay bills when previously they were paying on time. Or if the individual is reluctant to spend money (even when money shouldn’t be a problem). If there is no food within the individuals house when previously it was okay. Unexplained outgoings on an account, or items going missing such as money, chequebooks, bank cards or valuable jewellery. There could be a risk of financial abuse if there a sudden interest in other people’s money or assets or changes in the terms of will.
Institutional abuse can stem from rigid routines (such as mealtimes) or restricted visiting times or activities sessions provided when its suitable for the convenient for the staff. Institutional abuse can also happen when an individual’s religious or cultural needs are not met. It also happens when staff members restrict an individual’s access to food, fluids, toilets or baths (for example certain people only get to bath on certain days). It also happens when people set poor examples of professional standards of behaviour and don’t give individuals privacy and respect in turn taking away an individual’s dignity. It also happens when individuals have restricted access to social care or medication (if a patient has to wait for pain relief due to the convenience of the staff), or if the medication is misused such as giving an individual too much sedative to make the individual sleep for the benefit of the staff.
An individual is at risk of self-neglect if they are letting themselves live in unhygienic conditions (in the presence of vermin), or neglecting their personal hygiene or not exercising refusing to leave their rooms or won’t socialise with people. If individuals refuse to seek medical advice or take their prescribed medication this may also be a sign of self-neglect. If an individual begins to over eat or under eat or starts self-harming either by cutting, hitting or scratching themselves then refusing to get medical help these are sure signs of self-neglect.
Signs of neglect can come from withholding things from individuals such as medication, choices, rights, health and social care. Or by isolating the individual and discouraging active participation. Or failing to meet physical, emotional, cultural, social, intellectual, and social needs. Also, by not providing adequate shelter, warmth, food, fluids and safety. Neglect is also exposing an individual to risks, dangers and not following your Duty of Care.
1.3. Describe factors that may contribute to an individual being more vulnerable to abuse
Some factors that contribute to an individual being more vulnerable to abuse are age (young or old) as these individuals may lack the capacity for full understanding; isolation as lonely people are more likely to abused as people take advantage from the fact they want some human interaction; mental and emotional health issues e.g. dementia, depression or stress; communication problems e.g. speech or hearing impediments or learning disability; behavioural changes e.g. stroke or head injury; where violence is seen as normal in an environment or relationship because if people grow up in a violent environment they will expect it in every other area of their lives; culture or religion as people will always be prejudice against things they are uneducated on and financial factors.
2. Know how to respond to suspected or alleged abuse
2.1. Explain the actions to take if there are suspicions that an individual is being abused
If you suspect that an individual is being abused, it is important that you speak to the individual allowing them to open up to you, you should never be judgemental towards the individual. You must record all evidence of the suspected abuse sometimes it will be necessary to take photographs if you are suspecting physical abuse. You must also record all finding in an unbiased factual manner on the appropriate paperwork ensuring that it is signed and dated. You must also report your findings to a senior member of staff (sometimes several) but do not gossip with your colleagues about what you have found as this may hinder the investigation. Before you leave the individual, you suspect of being abused, you must firstly give them reassurance and ensure that they are safe before you do anything else. It may also be necessary to preserve evidence if you happen upon a seen where you believe that abuse has just taken place. You should never collude with other colleagues or jump to conclusions about the situation and never confront the person you think is responsible for the abuse.
2.2. Explain the actions to take if an individual alleges that they are being abused
If individual’s approach you to make an allegation about being abused you must always take it seriously, making sure that the individual feels heard and is not being judged. You must also explain to the individual that you need to report what they have told you so that steps can be taken to ensure the service user’s safety. You must report the incidence to your senior members of staff and record everything the individual has told you in the appropriate paperwork ensuring its signed and dated. You must give reassurance to the individual, making sure they know that something will be done about it and you must ensure that the individual is at no risk of abuse before you leave them. Always remember that you have a duty of care and responsibility to act on a service user’s behalf.
2.3. Identify ways to ensure that evidence of abuse is preserved
To ensure that all evidence is preserved from an abusive scene never move or remove anything from the scene, or clean or tidy the area. You shouldn’t touch anything within the scene, to avoid destroying fingerprints unless you need to make the area or the individual safe. Never allow access to anyone who isn’t involved with the investigation as they could tamper with evidence. You must preserve all clothing, bedding, footwear, and similar items and keep them safe and dry where necessary you may need to preserve items in a clean paper bag or unsealed envelope, or in a glass if the evidence is liquid. You need to make sure that all injuries are recorded, the state of the individual and the alleged abusers clothing needs to be taken into account and where possible it’s a good idea to get photographic evidence. You must also write a statement about the situation even describing the individual’s attitudes, which must be signed and dated.
3. Understand the national and local context of safeguarding and protection from abuse
3.1. Identify national policies and local systems that relate to safeguarding and protection from abuse
The national policies and systems that relate to the safeguarding and protection from abuse, can be distinguished to be Care Quality Commission (CQC), Housing organisations, Court of Protection, Crown Prosecution Service (CPS), The Deprivation of Liberty Safeguards (DOLS), The Coroner, Safeguarding Vulnerable Groups Act(2006) which led to the creation of The Independent Safeguarding Authority (ISA), No Secrets (Adult Protection), The Office of the Public Guardian (OPG), The Mental Capacity Act (2005), The Human Rights Act (1998), Care Home Policy and a range of laws enabling abusers to be prosecuted these include: Offences Against the Person Act (2003) which relates to physical abuse, Sexual Offences Act (2003) which relates to sexual abuse, Protection from Harassment Act (1997) which relates to physiological abuse and the National Assistance Act (1948) which relates to neglect.
3.2. Explain the roles of different agencies in safeguarding and protecting individuals from abuse
Care Quality Commission (CQC) – must always be made aware of any safeguarding adult concerns within a regulated service. If the concern is reported to the local authority CQC must be notified by the local authority and also by the regulated service, as is their duty. CQC is the health and social care regulator for England. Its aim is to ensure high quality care for everyone in hospital, in a care home and at home. CQC monitors, inspects and regulate services to make sure that they meet fundamental standards of quality and safety and they publish what they find, with performance ratings to help people choose care. Any care setting that doesn’t pass the basic care standards CQC has the authority to shut them down.
Local Council Authority- are there to make changes to the health care system as a whole, they keep an eye on governing bodies such as CQC. They make changes to funding and how processes are made to keep health care setting up to a high standard.
Court of Protection- Deals with decisions and orders that affect people who lack capacity. The court will decide whether an individual has the capacity to make decisions for themselves. the court will then make declarations, orders and decisions on an individual’s health, finances and welfare matters for individuals who lack the capacity to do so themselves. the court will also appoint deputies and power of attorneys to make decisions on behalf of the individual’s who lack capacity. The court or protection also has the power to remove deputies and attorneys who fail to perform their duties sufficiently.
Housing Organisations – Staff from Housing Organisations are in a position where they are able to identify tenants who are at risk of abuse, neglect and exploitation. In addition to recognising the risk of abuse of the adults whom they provide accommodation and in many cases care, staff of housing organisations have an important part to play in establishing protection plans for these individuals.
Coroners – Are independent judicial officers who are responsible for investigating violent, unnatural deaths or sudden deaths of unknown cause, which must be reported to them. The Coroner may have specific questions arising from the death of an adult at risk.
The Deprivation of Liberty Safeguards (DOLS) – Provide legal protection for those vulnerable people who are or may become, deprived of their liberty. Safeguards exist to provide a proper legal process and suitable protection in those circumstances where deprivation of liberty appears to be unavoidable, in the person’s best interest.
3.3. Identify reports into serious failures to protect individuals from abuse
There is a report about Michael Gilbert who was held captive by members of the Watt family in Luton for 10 years and was regularly beaten, stabbed, tortured, treated like a slave and had his benefits money stolen. Until in may 2009, when his headless, dismembered body was found in the
Blue Lagoon at Arlesey in Bedfordshire. Mr Gilbert had been murdered four months earlier by the Watt family. Mr Gilbert was no stranger to the authorities, spending his youth ‘in care’ jumping between care, foster homes and hostels, coming into frequent contact with the police, social workers and medical professionals.
In 1997, Michael Gilbert was 15 and ‘in care.’ He remained under the guidance of the Luton Leaving Care Team until his 21st birthday. At the time of his death Mr Gilbert was not deemed to be eligible for Adult Social Care services. In 1998, Mr Gilbert met James Watt in a children’s home where they became close and Mr Gilbert felt almost adopted into the Watt family. Had the care staff been doing there jobs efficiently then Mr Gilbert should have been discouraged from having interactions with Mr Watt as Mr Gilbert himself had expressed desire to be kept away from Mr Watt it is not known whether the help was given. As Mr Watt had a very long list of offenses even then where he had exhibited violent behaviour, some of a sexually abusive nature, where he had assaulted his family members on various occasions and later even assaulted a police officer. Mr Gilbert’s own delinquent behaviour increased from the proximity of Mr Watt. Mr Gilbert was considered to be vulnerable and naïve man who was easily exploited.
Mr Gilbert’s avoidance of the police (he believed that they would not do anything); his rejection of assistance for injuries; and difficulties with money management (he had rent arrears). Although Mr Gilbert’s support needs were urgent and complex, the professional interventions he experienced were unpromising in terms of nurturing his entrance into responsible adulthood.
In 2002, the police were informed by Mr Gilbert and his mother that Mr Gilbert had been kidnapped by the Watt Family. On two occasions Mr Gilbert’s mother had previously reported that her son had been assaulted by James Watt. It is significant that when Mr Gilbert told his mother about the abduction and assault and his fear of Mr Watt and his family he was too scared to report it to the police. It is unclear whether this was because Mr Gilbert was scared of the police and/ or the consequences for him and his family. Mr Gilbert’s wish to be accompanied by his mother, as an appropriate adult, suggests apprehension on Mr Gilbert’s part. But wasn’t the only incidence with the police where by Mr Gilbert requested to have an appropriate adult with him, suggesting that Mr Gilbert felt apprehensive making reports and later declined to give a full statement as it would be ‘worse for him in the long run’. This shows us that Mr Gilbert maybe lack the capacity to make the correct decisions for his health and the care system essentially failed him as he wasn’t able to deal with the adult world in the correct manner more support should have been given to Mr Gilbert earlier on as they would have then been able to spot Mr Gilbert declining mental health. Mr Gilbert had reported to a doctor that he had been hearing voices for over two years, this information should have been passed onto the correct channels as it would have meant that he could have more support which he evidentially needed to make informed decisions about his welfare. On several occasions in interviews with police Mr Gilbert requested to leave through a side door as he was terrified for his wellbeing from getting attacked by Mr Watt, Mr Gilbert again chose not to make a statement for fear of his own safety. Surely there was something that the police could have done then to stop this individual from receiving further harm from Mr Watt but the police chose to leave it as Mr Gilbert did not want to make a statement and simply let him slip out of the building from a side door.
There were several circumstances whereby Mr Gilbert’s life could have been changed had the correct information been passed in the correct channels, had the individual had more support or more continued support from the correct channels Mr Gilbert could potentially be alive today. There were repeated failings in the system and a complete lack of information sharing that caused this man’s death. Which is why it is incredibly important to keep clear logs and all relevant information up to date.
3.4. Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse
There are many ways to access information on safeguarding and protecting individuals from abuse such as having regular up to date training, supervisions and team meetings, where you can access information from your management team. National policies and procedures and your care settings personal policies and procedures should be kept in paper copy within your care setting, so it can be referred to at any time, these will also be in line with national policies and procedures. You can also refer to GSCC codes of practise as they are the national standards of professional conduct and practise required of social care workers as they go about their daily work.
Further sources of information of where to seek advice:
A Guide to the Police – Available from Voice UK. Telephone 08451228695 www.voiceuk.org.uk A leaflet to explain to people with learning disabilities the role of the police and how they support vulnerable adults and witnesses.
Abuse in Care? – A practical guide to protecting people with learning disabilities from abuse in residential services.
Abuse in Bad – Action against Abuse. Recognising and preventing abuse of people with learning disabilities.
Blowing the Whistle – on abuse of adults with learning disabilities. Reports on research findings about whistle blowing, and offers information about the experiences of whistle blowers and suggestions with regard to the development of whistle blowing policies.
Facing the Possibility – supporting managers in preventing handling abuse allegations against staff. Information for service managers about appropriate responses when staff members are alleged to have carried out abuse.
4. Understand ways to reduce the likelihood of abuse
4.1. Explain how the likelihood of abuse may be reduced by:
• working with person centred values – To work in a person-centred approach you must work in partnership with the service user, respecting their rights and unique circumstances. You must make any reasonable adjustments to maintain a service user’s independence and provide support to help them understand and make informed decisions about their care and treatment options, including the extent to which they may wish to manage these options themselves. You must make sure that you take into account people’s capacity and ability to consent, and that either the service user, or a person lawfully acting on their behalf, must be involved in the planning, management and review of their care and treatment. In doing this, you pay attention to a person’s right for independence, choice and to be included and valued. You must also respect a service user’s dignity by covering the individual and making sure that curtains are drawn during personal care and that all information that the service user shares with you remains private. If you are working in this person-centred approach then the likely hood of any individuals receiving abuse within you care setting is reduced incredibly, as institutional abuse stems from and individual not being able to do want they want, and having to do what the staff want because it’s convenient for them. In this circumstance an individual’s feelings are not considered. This also reduces the risk of physiological abuse from staff members as individuals can make their own choices and can’t be bullied into doing things by staff members if they do not wish to.
• encouraging active participation – When you encourage individuals to actively participate you build up an individual’s confidence. It will help the individual to create a network of friends whom the individual will feel supported by. Then the individual can gain trust in others so that they have the confidence to speak up about any abuse they have experienced or are experiencing and other individual’s have the ability to report this information onwards and stop the abuse all together.
• promoting choice and rights – When you promote peoples right and choices you are discouraging all forms of abuse (apart from self-neglect) as in general all individuals want to make choices to help themselves and by promoting these rights and choices no abuse should happen to these individuals as no one chooses to be abused in any manner. When person’s choices are heard, people know that they can share anything and that the information will be taken seriously, this will reduce the likelihood of abuse taking place.
4.2. Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse
Complaints are good way of considering how well the services are provided, it also helps us to identify if there are any weaknesses e.g. potential for abuse and neglect. A complaints procedure should be simple to follow because it encourages people to raise their concerns and it indicates that the organisation will respond to those concerns rather than ignoring them. If it’s too difficult to make a complaint the abuse is likely to continue. If it’s easy to make a complaint the abuse is likely to be dealt with sooner. On bigger scale complaints the government bring changes in their policies according to people demand.
5. Know how to recognise and report unsafe practices
5.1. Describe unsafe practices that may affect the well-being of individuals
Staff shortages – Staff are too tired to do their job correctly. Staff cut corners due to lack of time. Agency staff not knowing service users correct needs
Lack of training – Inexperienced staff having to act up in a senior role. Staff not trained in their role correctly.
Lack of correct equipment – Personal protective equipment unavailable and equipment either broken, such a as baths or hoists, being broken or unavailable
5.2. Explain the actions to take if unsafe practices have been identified
All unsafe practices need to be reported to my immediate supervisor so the person can be retrained or the condition remedied to prevent further damage.
5.3. Describe the action to take if suspected abuse or unsafe practices have been reported but nothing has been done in response
After I have reported the incident I still have a duty of care to my patient. If I feel that my patient is still at risk then speak with my line manager regarding my concerns. If I feel my line manager is not taking appropriate action, or I suspect my line manager of abusing a patient then most company policies would state that I would need to contact the Care Quality Commission or else organisations, as part of the process for reporting abuse is to contact the local care standards inspectorate, the person you reported this abuse to should have done this and if they have not, this in itself may be considered abuse (neglect) if it should be the case that abuse or dangerous practice is being carried out.