Safeguarding - adults and older people

Adult safeguarding is the term that describes the function of protecting adults from abuse or neglect. This is an important shared priority of many public services and a key responsibility of local authorities.

Safeguarding relates to the need to protect certain people who may be in vulnerable circumstances. These are adults in need of care and support who may be at risk of abuse or neglect, due to the actions (or lack of action) of another person.

In these cases it is critical that local services work together to identify people at risk, and put in place interventions to help prevent abuse or neglect, and to protect people.

Safeguarding is not just about protecting people who have been subject to abuse but also about preventing abuse and treating people with dignity and respect.

Figure 1: Safeguarding adults

Figure 1: Safeguarding adults

What do we know?

Abuse can happen anywhere. It may happen at happen at home, in a care home, hospital, day centre or in a public place. Anyone can be an abuser, but it is usually someone known to the person.

Abuse can take many forms and may include:

Physical abuse

Being hit or injured on purpose, restraining someone inappropriately. 

Emotional abuse

Intimidation, threats, humiliation, extortion, racial, verbal or psychological abuse.

Sexual abuse

Involvement in a sexual activity which is unwanted or not understood, unwanted sexual attention.

Neglect/deprivation

Not providing food, clothing, attention or care. Withholding of aids or equipment (continence, walking, hearing, glasses), putting someone at risk of infection, failure to provide access to appropriate health or social care.

Financial abuse

The theft or misuse of money, property or personal possessions. Pressure in connection with wills, property or inheritance.

Discriminatory abuse

Treating people differently or worse than you would want to be treated because they are older, more frail, confused or otherwise vulnerable. Self-inflicted injury may be a sign that abuse is taking place, for example because someone feels disturbed. 

Modern slavery

This 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.

Domestic violence

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

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.

Facts, figures, trends

During 2014/15, 461 alerts were made to the safeguarding team.

In 2014/15 issues of neglect made up 37% of all alerts. The second largest number of alerts related to physical abuse at 28%, followed by 19% for financial abuse, 16% emotional abuse. 6% sexual abuse, and 13% related to multiple types of abuse.

There are a number of factors that could explain the high proportion of neglect concerns. One significant factor is that we now have effective, consistent recording of pressure sores as ‘neglect’ and also that unavoidable pressure sores are being raised as safeguarding concerns where no evidenced abuse has occurred. This is evident within hospital practice but not so with community health services who have developed a risk form to determine whether pressure sores are avoidable or unavoidable.

Care homes have also become more consistent in identifying grade 3 and grade 4 pressure sores, whether they have been acquired in the care home itself or acquired prior to admission for example in hospital or whilst living independently.

National and local strategies (current best practices)

Berkshire Safeguarding Adults Policy and Good Practice Manual

The Berkshire Safeguarding Adults Policy and Procedures is a pan Berkshire policy that provides members of the public with a guide to identifying abuse and how to report it. It also provides health and social care practitioners with a wealth of guidance and knowledge regarding safeguarding processes, legislation relating to safeguarding and information regarding how and when to share information.

Slough Safeguarding Adults Strategy 2013 – 2016

A local strategy is key to supporting the aim to work with local people and with partners to ensure that adults who may be at risk are: able to live independently by being supported to manage risk, are able to protect themselves from abuse and neglect, are treated with dignity and respect and are properly supported by agencies when they need protection.

Since the publication of the Department of Health’s No Secrets guidance in 2000, work has been undertaken to promote an understanding and actions that “safeguarding is everybody’s business”. The development of this strategy marks a commitment for a shared vision and actions that will keep adults at risk safe and protected from abuse and neglect.

Leadership by the local authority and its partners is fundamental and it is important to be clear about the place of our Safeguarding Adults Partnership Board in supporting delivery of the wider safeguarding agenda. The strategy provides an overview of local safeguarding arrangements under the overarching umbrella of the Safeguarding Adults Partnership Board. 

The Care Act 2014

The Care Act 2014 represents the biggest change in Adult Social Care and for the first time Adult Safeguarding is embedded within the legislation. There is a whole chapter dedicated to Adult Safeguarding (chapter 14) within the Care Act Guidance. The Care Act makes changes to the following areas of Adult Safeguarding:-

  1. Safeguarding Adults Boards

    The Act requires local authorities to set up a Safeguarding Adults Board (SAB) in their area, giving these boards a clear basis in law for the first time.

    The Act says that the SAB must;

    • include the local authority, the NHS and the police, who should meet regularly to discuss and act upon local safeguarding issues
    • develop shared plans for safeguarding, working with local people to decide how best to protect adults in vulnerable situations
    • publish this safeguarding plan and report to the public annually on its progress, so that different organisations can make sure they are working together in the best way
  2. Safeguarding enquiries by local authorities
    • The Act also requires local authorities to make enquires, or ask others to make enquiries, when they think an adult with care and support needs may be at risk of abuse or neglect in their area and to find out what, if any, action may be needed. This applies whether or not the authority is actually providing any care and support services to that adult.
    • The enquiry may lead to a number of outcomes, depending on the circumstances, including to prosecution if abuse or neglect is proven. In other cases, the risk of abuse may be tackled, but the adult may have other care and support needs which require different services, and may lead to a needs assessment or review of an existing care and support plan.
  3. Safeguarding Adult Reviews
    • When there is any failure in safeguarding, the results can be severe and tragic and therefore demand a strong response.
    • The Act says that SABs must arrange a Safeguarding Adults Review in some circumstances – for instance, if an adult with care and support needs dies as a result of abuse or neglect and there is concern about how one of the members of the SAB acted.
    • The Reviews are about learning lessons for the future. They will make sure SABs get the full picture of what went wrong, so that all organisations involved can improve as a result.
  4. Independent advocacy
    • The local authority will arrange for an independent advocate to represent and support a person who is the subject of a Safeguarding Enquiry or a Safeguarding Adult Review, if they need help to understand and take part in the enquiry or review and to express their views, wishes, or feelings.
  5. Supply of information
    • The Act states that if an SAB requests information from an organisation or individual who is likely to have information which is relevant to SAB’s functions, they must share what they know with the SAB. This is so any problems can be tackled quickly, and lessons can be learnt to prevent them happening again in the future.
  6. Powers of access
    • What the Act does not do though is give local authorities any new powers to enter a person’s property. The Government did consult on whether there should be a specific power of entry. However, opinions were split on the issue and there was no strong evidence put forward in favour of a new law.
    • The Police already have a range of powers available to enter property if a person is at risk of harm, and local authorities have other powers which can be used in safeguarding situations. Separate guidance has been developed to help support practice in this area and can be found on the website of the Social Care Institute for Excellence (SCIE).

Making Safeguarding Personal

The MSP project was initiated by the LGA/ADASS in response to feedback from service users, stakeholders and practitioners. People felt that the focus of safeguarding work was on process and procedure. They wanted a focus on resolution, with more engagement and control.

Practitioners and safeguarding adult’s board members want to know what difference they’re making – but find it difficult to get this information from the national indicators – which currently measures inputs, processes and outputs. So, in 2009 the Improvement and Development Agency (IDeA, now LGA), SCIE, British Association of Social Workers (BASW) and Women’s Aid worked together to form a body of knowledge, to assist empowerment and support for people making difficult decisions.

The “Making Safeguarding Personal” project started in 2009 and has developed over the years with more and more local authorities engaging in the scheme. Slough Borough council joined in 2013 and has been developing its Safeguarding services in line with the ethos of the project to ensure that service users are fully engaged in the safeguarding process. The philosophy behind the project has been taken on board by the Care Act and is now integrated into Adult Safeguarding across the Country.

What is this telling us?

Whilst much has been achieved in raising awareness of adult safeguarding across Slough communities there is still much to do. We want to support Slough communities in indentifying and reporting abuse in all settings whether this is for people in their own homes, supported living, hospital or care homes. We intend to ensure Slough residents have accessible information which is easy to understand.

We need to work closely with the providers of services we commission to raise quality of care in care homes, domiciliary care agencies and supported living schemes. Treating people with dignity and respect is a cornerstone of safeguarding and helps prevent abuse from happening.

We also need to ensure that we are working in a person centered way with service users so that they remain central to the Safeguarding process. We also need to move to a more outcome focused way of working, so that we are making a real difference in people’s lives, in enabling them to help themselves to keep safe.

What are the key inequalities?

  • We need to ensure that ‘hard to reach’ communities are targeted for raising safeguarding awareness. There is a wide range of cultures within Slough and cultures may have a distrust of adult social care. Therefore we need to engage with community and faith leaders to develop ways of communicating the message regarding adult abuse.
  • We need to ensure victims of abuse are central to the safeguarding process that follows incidents of abuse and that we support and enable them to achieve the outcomes they want.

What are the unmet needs/service gaps?

  • National guidance states that ‘safeguarding is everybody’s business’ and with this in mind we need to ensure all staff working with vulnerable adults receive the appropriate levels of training specific to their roles and responsibilities.
  • This includes all front facing health and social care staff as well as other statutory partners within the emergency health services. Staff working in benefits, housing and environmental health and other council support services would also benefit from understanding the signs of abuse and how to report it.
  • Due to the new categories of abuse, in particular Modern Slavery these are new areas for Adult Social Care and it will be about working with other agencies and organisations to look at how to support vulnerable adults who are being abused in this way, as well as raising awareness around this issue.

Recommendations for consideration by other key organisations:

Safeguarding awareness is being embedded into all agencies and organisations who work with vulnerable adults. Whilst this is positive we need to ensure raising awareness and training is not an end in itself but is effective in preventing abuse and enabling vulnerable adults to be central in protecting themselves against abuse and influence safeguarding processes to ensure they are person centred and meaningful. 

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