The Safeguarding and protection of vulnerable adults 1. Understand the legislation, regulations and policies that underpin the protection of vulnerable adults 1.1 Analyse the differences between the concept of safeguarding and the concept of protection in relation to vulnerable adults There is a difference between Safeguarding vulnerable adults/children and adult/child protection. Safeguarding is everybody’s responsibility, and includes measures to prevent or minimise the potential for abuse occurring.
Protection is considered a statutory responsibility in response to individual cases where risk of harm has been identified POVA or Protection of Vulnerable Adults was changed and implemented to SOVA or Safeguarding of Vulnerable Adults in 2007. This meant that the SOVA register was to replace the POVA and other individuals who are deemed unsuitable to work with children and vulnerable adults. 1.2 Evaluate the impact of policy developments on approaches to safeguarding vulnerable adults in own service setting (Our Health, our care, our say, Putting People First, No Secrets,
In Safe Hands, Vetting and Barring Scheme / Independent Safeguarding Authority, Local Safeguarding Adults Boards Policy developments not only influence Safeguarding policies and procedures within our services, they underpin them. City Care Partnership has worked in partnership to develop and adopt multi agency procedures and guidance relating to the safeguarding of vulnerable adults in line with local authority vulnerable adult policies.
Our Health, our care, our say is a White Paper published in 2006 and set a new direction for social care and community health services with four broad main goals. I’ve chosen to include the areas relating specifically to the development of safeguarding approaches. 1)Better prevention and early intervention for improved health, independence and well-being.
This included a shift in resources and in planning emphasis to prevention and early intervention, increased self-care and condition management among service users and more people who need care being supported to live in their own homes. 2)More choice and a stronger voice for individuals and communities. The people we support and their carers having more say over where, how and by whom their support is delivered, and better access to information that helps them make their own choices about this, individuals and their communities being able to influence the shape and delivery of local services and to trigger action to look at problems 3)Tackling inequalities and improving access to services.
More services being provided in the community through promoting emotional health and well-being and stronger services and support for people to help prevent physical and mental illness, ensuring that people are discharged from hospital with appropriate community support.
Our Health, our care, our say extensive public consultation exercise in which members of the public were asked about their priorities for health and social care. The White Paper was also shaped by views from those working in the health and social care sectors and those in receipt of support. Without discussing safeguarding explicitly, the white paper influenced other areas that indirectly impacted on the safeguarding of vulnerable adults.
Putting People First – A shared vision and commitment to the transformation of Adult Social Care was published by The Department of Health in 2007. Across Government, he shared ambition was to put people first through a radical reform of public services, enabling people to live their own lives as they wish, confident that services are of high quality, are safe and promote their own individual needs for independence, well-being and dignity. In Section 2.0 entitled ‘Values’, the paper discusses replacing paternalistic, reactive care of variable quality with a mainstream system focussed on prevention, early intervention, enablement, and high quality personally tailored services. In the future, people should have maximum choice, control and power over the support services they receive.
The Government outlined their aim to fulfil their responsibility to provide care and protection for those who through their illness or disability are genuinely unable to express needs and wants or exercise control. However, they made clear that the right to self-determination would be at the heart of a reformed system only constrained by the realities of finite resources and levels of protection, which should be responsible but not risk averse.
This section demonstrates a future vision for the safeguarding of vulnerable adults and discusses protection but also the importance of not being risk averse similar to what is outlined in the Human rights Act 1998 which discusses the right to independence which involves a degree of naturally occurring risk. Section 3 is entitled ‘A personalised Adult Social Care System’ and in subsection 3.3 it discusses ‘Systems which act on and minimise the risk of abuse and neglect of vulnerable adults, supported by a network of “champions”, including volunteers and professionals, promoting dignity in local care services.’.
This is yet more important policy and guidance which focuses on policy developments in relation to the Safeguarding of vulnerable adults. Although at City Care Partnership we haven’t adopted the system of champions, it’s something that could be given future consideration as we look to improve our own systems. We do have something similar in the form of an organisational Safeguarding lead however, a role fulfilled by the Director of Health & Social Care. No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse was published by the Department of Health in 2000. This was a key piece of policy which focused on the protection of vulnerable adults and focused on several key areas including:- 1)Wider definitions of abuse and who is at risk
2)Setting up an inter-agency framework – roles and responsibilities of those agencies, responsibilities of those at operational, supervisory and senior management levels, local authority level and Chief executive level 3)Developing inter-agency policy
4)Main elements of strategy including Training for staff and volunteers, theCommissioning of services and contract monitoring and Confidentiality v Secrecy 5)Procedures for responding in individual cases including the objectives of investigations, Management and co-ordination of the response to the allegation of adult abuse. Investigation, Record keeping and assessment. Responding to a person alleged to be responsible for abuse or poor practice, Staff discipline and criminal proceedings, Disciplinary procedures including the suspension from duty.
The Role of advocates and decision making. 6)Getting the message across through rigorous recruitment practices, References, Volunteers, Internal guidelines for all staff and information for users, carers and the general public No Secrets was the single largest piece of advice and guidance to local agencies that had a responsibility to investigate and take action when a vulnerable adult is believed to be suffering abuse. It offered a structure and content for the development of local inter-agency policies, procedures and joint protocols which drew on good practice nationally and locally.
The Independent Safeguarding Authority’s (ISA) role is to help prevent unsuitable people from working with children and vulnerable adults. Referrals are made to the ISA when an employer or an organisation, for example, a regulatory body, has concerns that a person has caused harm or poses a future risk of harm to children or vulnerable adults. In these circumstances the employer or regulatory body must make a referral to the ISA. The range of organisations that is able to make referrals include -Regulated activity providers;
– Education and Library Boards
-Health and Social Care (HSC) bodies
-Keepers of Registers named in the legislation
– Supervisory authorities named in the legislation
Additionally the ISA can take referrals from members of the public. However as they do not have investigatory powers they will always advise any individual considering making such a referral to first contact the police and/or the relevant local authority’s children and adults safeguarding team or social services within a Health and Social Care Trust in Northern Ireland. The police and/or local authority will conduct an investigation. Following an assessment of the evidence, the information may then be sent as a referral to the ISA for consideration.
The safeguarding regulations introduced in October 2009 state that: -a person who is barred from working with children or vulnerable adults will be breaking the law if they work or volunteer, or try to work or volunteer with those groups -an organisation which knowingly employs someone who is barred to work with those groups will also be breaking the law -if your organisation works with children or vulnerable adults and you dismiss a member of staff or a volunteer because they have harmed a child or vulnerable adult, or you would have done so if they had not left, you must tell the Independent Safeguarding Authority
The Vetting and Barring Scheme
The ISA has a role in making independent barring decisions following
referrals from employers or through the Autobar process . Certain employers (those working in ‘regulated activity’) have a legal duty to refer people to the ISA (usually following their own disciplinary processes) when they have harmed a child or vulnerable adult, or there was a risk of harm. Anyone barred by the ISA cannot work or volunteer with the vulnerable group or groups from which they are barred. .The ISA’s legal responsibilities are to:
-To maintain a list of individuals barred from engaging in regulated activity with children; -To maintain a list of individuals barred from engaging in regulated activity with vulnerable adults; -To maintain both barred lists; and
– To reach decisions as to whether to remove an individual from a barred list. However, the registration element of the Vetting and Barring Scheme was halted as part of the Coalition Government’s review. Changes to the Scheme are being proposed through the Protection of Freedoms Act In terms of the ISA’s accountability, they are a Non-Departmental Public Body (NDPB) and have certain statutory responsibilities and their effectiveness and efficiency are closely scrutinised by government and stakeholders. For example, they will report annually to Parliament and all their operations – including decisions on barring – must be seen to be fair, open and transparent.
The ISA has had a huge impact since its implementation in the safeguarding of vulnerable adults through focusing specifically on preventing un suitable individuals from being able to gain employment in regulated activity with vulnerable adults and children. The ISA also ensures that those who are unsuitable are referred by their employers and therefore unable to gain future employment with vulnerable client groups. The Local Adult Safeguarding Boards (LSAB) were established in 2009. It is a multi – agency partnership which provides strategic leadership for the development of safeguarding policy and practice, consistent with national policy and best practice.
Membership includes representatives from Adult social care, health, housing, probation, police, fire, crown prosecution service and the third sector. The vision is to ensure that vulnerable adults living in local authorities feel safe and free from abuse and neglect. The Boards are based on the principles of prevention, protection, choice, self-determination, independence and recovery, and its mission is to ensure that Adult Safeguarding becomes everyone’s business.
In terms of their impact as a safeguarding measure, the boards provide an important forum for multi-agency working and allow all of those who should be involved in the safeguarding of societies more vulnerable demographics’ to meet and ensure a more co-ordinated approach. In evaluating all of the aforementioned policy developments on approaches to safeguarding vulnerable adults, I’d say that collectively they’ve improved the situation considerably.
Together, they include all relevant agencies, are underpinned by legislation and guidance from the government, include consideration of pre-employment, recruitment, training, roles and responsibilities of individuals and agencies and improve overall communication between different agencies and promote co-ordination of interagency working. 1.3 Explain the legislative framework for safeguarding vulnerable adults The legislative and policy framework for safeguarding vulnerable adults include:- 1)
The Human Rights Act (1998) – Outlines that everyone should be protected from abuse, regardless of age, disability, gender, sexual orientation, intellectual ability, race, ethnicity, ethnicity, religious beliefs or culture. It also states that all adults should have the right to live their lives free from violence fear and abuse. They should also have the right to be protected from harm and exploitation and the right to independence, which involves a degree of risk. 2)No Secrets (2000) – See above for an explanation of the legislation and what it includes but to summarise, it detailed a more co-ordinated approach from agencies, clarification on the roles and responsibilities of agencies and individuals, gave clear and wider definitions of abuse, discussed in more detail than ever Multi-disciplinary and interagency working and outlined aims for training, support and resources for staff. 3)Care Standards Act (2000) Implemented from July 2004 –
The Care Standards Act 2000 created a new regulatory framework for all currently regulated social care and independent health care services. It provided guidance on how service providers regulated under the Registered Homes Act 1984, The Children Act 1989 and the Nurses Agency Act 1957, would have their registration or licence transferred into registration with the National Care Standards Commission.
The Care Standards Act 2000 was passed on 20 July 2000. The Act aimed to extend the regulation of social care and followed on from two white papers published by the Government in 1998 and 1999 entitled “Modernising Social Services and Building for the Future”. Care services in the housing sector ranged from residential care homes and nursing homes to domiciliary care. Up until now this range of care services has been regulated under the Registered Homes Act 1984. The 1984 Act was passed to protect the welfare of vulnerable adults in residential care in the private sector. The current arrangements under the 1984 Act were considered unsatisfactory.
There was a lack of consistency in the way the regulations were applied and there were some forms of supported housing, which were not being regulated, which they ought to have been. The aim of the Care Standards Act 2000 was to make sure that the care of vulnerable people, in different types of supported housing was properly regulated, to improve care standards and introduce consistency in the regulation of services provided.
The main changes introduced by the Act were – For the first time local authorities would have to be regulated and meet the same care standards as independent sector providers. -The Act introduced a new, independent regulatory body for social care known as the National Care Standards Commission.
The NCSC monitored care homes on a national basis and they were no longer be regulated by local inspectorate units. -The Government had the power to introduce minimum care standards -The Act established a general social care council for England and a care council for Wales and the councils registered social care workers, regulated the training of social workers and raised standards in social care through codes of conduct and practice. -Domiciliary care agencies became registrable. Any organisation arranging for people in their homes to receive personal care had been registered. 4)Safeguarding Adults (2005)
5)Mental Capacity Act (2005) – The Mental Capacity Act 2005 for England and Wales received Royal Assent on 7 April 2005 and came into force in 2007. The Act generally only affected people aged 16 or over and provides a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.
For example, people with dementia, learning disabilities, mental health problems, stroke or head injuries who may lack capacity to make certain decisions. It makes it clear who can take decisions in which situations and how they should go about this. It enables people to plan ahead for a time when they may lack capacity. The Act covers major decisions about someone’s property and affairs, healthcare treatment and where the person lives, as well as everyday decisions about personal care (such as what someone eats), where the person lacks capacity to make the decisions themselves.
The whole Act is underpinned by a set of five key principles set out in Section 1 of the Act: -A presumption of capacity – every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; -Individuals being supported to make their own decisions – a person must be given all practicable help before anyone treats them as not being able to make their own decisions; -Unwise decisions – just because an individual makes what might be seen as an unwise decision, they should not be treated as lacking capacity to make that decision. -Best interests – an act done or decision made under the Act for or on behalf of a person who lacks capacity must be done in their best interests; and -Least restrictive option – anything done for or on behalf of a person who lacks capacity should be the least restrictive of their basic rights and freedoms.
6)Deprivation of Liberty Safeguards (DoLS) added to MCA 2005 through Mental Health Act (2007). The Mental Capacity Act Deprivation of Liberty safeguards. The Mental Capacity Act Deprivation of Liberty safeguards (formerly known as the Bournewood safeguards) were introduced into the Mental Capacity Act 2005 through the Mental Health Act 2007 (which received Royal Assent in July 2007). The MCA DOL safeguards apply to anyone:- – Aged 18 and over
– Who suffers from a mental disorder or disability of the mind – such as dementia or a profound learning disability – Who lacks the capacity to give informed consent to the arrangements made for their care and / or treatment and – For whom deprivation of liberty (within the meaning of Article 5 of the ECHR) is considered after an independent assessment to be necessary in their best interests to protect them from harm.
There is an emphasis on continual learning and training for support staff and the empowerment of the people we support to report concerns and feel safe to do so. As I have already discussed, the training available to both support staff and managers is effective and meets the regulatory standards of the CQC. We endeavour to continually review and update safeguarding systems, procedures and training in accordance with changes to government and local authority guidance also 4.3 Challenge ineffective practice in the promotion of the safeguarding of vulnerable adults/
Recommend proposals for improvements in systems and procedures in own service settings I believe that the training and support we offer our support staff is excellent and not only meets standards, but is also very effective. An area where I believe we could improve the systems we have in place is with on-going support and training for middle and senior managers whose responsibilities are wide ranging. As an organisation, we don’t currently offer safeguarding training for managers although it is included in their QCF qualification and opportunities occasionally become available for individuals to attend local authority training days although these are quite sporadic and places are always limited.
I’m currently working on developing a ‘Safeguarding for managers’ training and will deliver this to all managers and apprentice managers in September 2012. I’m working with the Safeguarding lead for the organisation and will liaise with the local authority trainer. Another area I would like to develop is the awareness and involvement of the people we support around our safeguarding procedures. As discussed we currently have some literature available for when an individual purchases our service but there is no refresher of this knowledge and therefore I’m going to look at developing a service user consultation group where we review and develop relevant policies for the people we support.