Safeguarding Adults
New resources
Care provider managers
9.30
Registration
10.00
Introductions and Housekeeping
10.05
Expectations of Provider managers – Jim Thomas Programme Head Skills for Care

Preventing abuse

Responding to concerns
10.15
Care Act changes to Safeguarding – revision of Pan London Safeguarding Adults Procedures
Mary Wynne – Safeguarding Adults Co-ordinator, RB Kensington and Chelsea
10.30
Questions
10.40
Table discussions with Safeguarding leads and commissioners

What are the provider manager’s challenges in meeting Safeguarding expectations?

How can they work with commissioners and safeguarding leads to meet expectations?
11.15
Break and networking
11. 40
Resources to help you meet CQC fundamental standards for a Safe service
• Table exercise identifying evidence opportunities for PIR completion and inspections
12.30
New Resources
12.40
Table discussion

How are you going to use the information and resources you have heard about today?

Feedback
12.50
Final Questions
1 pm
Lunch and networking
Jim Thomas
Programme Head
Workforce Innovation
CQC State of Care Report
First report since new inspection approach started
• Safety is one of five key lines of enquiry
• Services are rated on each of the five areas and also given
an overall rating.
• Services were generally performing well in the other four
areas
• The report cited safety as the greatest concern in the
sector, with a third of adult care services also rated
‘requires improvement’ in this area.
• State of Care report launched today | Care Quality
Commission
Safeguarding Adults and The Care Act 2014
Mary Wynne
Chair- London Safeguarding Adults Network
Three Boroughs
Professional Standards and Safeguarding Team
(RBKC, WCC,LBHF)
Oct 2015
What does the Care Act do?
The Act is built around people, it:
 ensures that people’s well-being, and the outcomes
which matter to them, will be at the heart of every
decision that is made;
 puts carers on the same footing as those they care for;
 creates a new focus on preventing and delaying needs
for care and support, rather than only intervening at
crisis point, and building on the strengths in the
community;
 embeds rights to choice ensuring a range of high
quality services are available locally.
Care Act 2014-guidance
 There is not a lot of detail in the Act. Much of this is
in the content of the Regulations and Statutory
Guidance (Safeguarding Chapter 14).
 Practice Guidance is now available from SCIE
 Practice Guidance
 Info Sharing Guide
 Powers of Entry Guidance
 SAB checklist
 SAR’s implementation support
The statutory guidance: chapter by chapter
Ch Topic
Ch Topic
1
Promoting wellbeing
12
Direct payments
2
Preventing, reducing or delaying needs
13
Review of care and support plans
3
Information and advice
14
Safeguarding
4
Market shaping and commissioning
15
Integration, cooperation and partnerships
5
Managing provider failure
16
Transition to adult care and support
6
Assessment and eligibility
17
Prisons and approved premises
7
Independent advocacy
18
Delegation of local authority functions
8
Charging and financial assessment
19
Ordinary residence
9
Deferred payment agreements
20
Continuity of care
10
Care and support planning
21
Cross-border placements
11
Personal budgets
22
Sight registers
23
Transition to the new legal framework
Areas with related regulations
The Care Act: reforming care and
support
Safeguarding and the Care Act Summary
• Make Safeguarding Adults Boards (SAB) statutory
• Make safeguarding enquiries a corporate duty for councils
• Make serious case reviews mandatory when certain triggering
situations have occurred and the parties believe that safeguarding
failures have had a part to play
• Place duties to co-operate over the supply of information on
relevant agencies
• Place a duty on councils to fund advocacy for assessment and
safeguarding for people who do not have anyone else to speak up
for them
Six key principles underpin adult safeguarding
work
 Empowerment
 Prevention
 Proportionality
 Protection
 Partnership
 Accountability
Promoting well-being
 Section 1
 Local authorities will have a general duty, when
undertaking adult social care functions with an
individual, to promote their well-being. This
includes “protection from abuse and neglect”.
Section 1: Duty to promote individual well-being
1. physical and mental health, emotional well-being and personal dignity
2. protection from abuse and neglect
3. control by the individual over day-to-day life (including over care and support,
or support, provided to the individual and the way in which it is provided)
4. participation in work, education, training or recreation
5. social and economic well-being
6. domestic, family and personal relationships
7. Suitability of living accommodation
8. the individual’s contribution to society
Section 1: must have regard to...
Assumption
that
the person is
the best judge
of
their well-being
Minimum
restrictions
The person’s
views, wishes
and
feelings
Individual
wellbeing
Protect
from abuse and
neglect
Balance with
well-being
of carers
Have regard to
all the adult’s
circumstances
Full
participation
in decision
making
Duty to assess needs for care and support
 Sections 9 and 11
 A local authority must assess a person’s needs for
care and support unless that person refuses an
assessment.
 But an assessment cannot be refused, and the
local authority must carry it out,
if the person lacks capacity to refuse and
carrying it out would be in their best interest,
or the adult is experiencing, or is at risk of,
abuse or neglect.
Care Act- shifts in language
 ‘Safeguarding
investigations’ become
‘safeguarding enquiries’
 ‘Safeguarding
concerns’
 ‘Serious
alerts’ are ‘safeguarding
Case Reviews’ become
‘Safeguarding Adult Reviews’
Categories of Abuse
Physical abuse – including assault, hitting, slapping, pushing, misuse of
medication, restraint or inappropriate physical sanctions.
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.
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
Categories of Abuse
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.
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
3 new categories of abuse
 Domestic violence – including psychological, physical,
sexual, financial, emotional abuse; so called ‘honour’ based
violence.
 Modern slavery – encompasses slavery, human
trafficking, forced labour and domestic servitude.
 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.
Safeguarding adults enquiry
 Section 42
 The local authority must make (or cause to be made) whatever
enquiries it thinks necessary to enable it to decide whether any action
should be taken and, if so, what and by whom where it has reasonable
cause to suspect that an adult in its area (whether or not ordinarily
resident there) has :
 needs for care and support (whether or not the local authority or
anybody else is meeting those needs)
 is experiencing, or is at risk of, abuse or neglect, and
 as a result of those needs is unable to protect himself or herself against
the abuse or neglect or the risk of it
Thresholds
There is a low test for triggering a safeguarding enquiry:

Claire Crawley, policy lead for safeguarding adults at the DH
described this recently as ‘the Care Act has no eligibility criteria for
safeguarding (other than the key 3 factors of care & support needs /
risk / unable to safeguard themselves)’.

The Act is clear that concerns relate to abuse, neglect, or the risk of
either of these. There is no test for ‘harm’ or ‘significant harm’

This may either
 Resolve the debates locally and nationally about thresholds
 Shift those debates from ‘what is the threshold for a safeguarding
investigation’ to ‘what safeguarding enquiry is appropriate to this
particular concern’.
Statutory Guidance
 Para 14.37.
 An enquiry could range from a conversation with the
individual who is the subject of the concern to a
much more formal multi-agency arrangement.
 The purpose of the enquiry is to decide whether or
not the LA or another organisation, or person, should
do something to protect them from any actual or risk
of abuse or neglect.
Who can carry out an enquiry?
 Although the LA is the lead agency for making enquiries, it may require
others to undertake them (cause enquiries to be made).
 The local authority retains the responsibility for ensuring that the enquiry is
referred to the right place and is acted upon.
 The specific circumstances will often determine who is the right person to
begin an enquiry e.g. GP, Fire Officer, social worker, a housing support
worker other health worker such as a community nurse. Police if its a crime
 The local authority, in its lead and coordinating role, should assure itself
that the enquiry satisfies its duty under section 42
 In this role if the local authority has asked someone else to make
enquiries, it is able to challenge the body making the enquiry if it considers
that the process and/or outcome is unsatisfactory.
Care Act Statutory Guidance
Highlights for Providers
LGA, ADASS DH Guide Aug 2015
Highlights
Supporting Staff
 Staff are clear about their responsibilities, know where to go locally
for help/advice and must have access to practical and legal
guidance
 There should be effective and well publicised ways of escalating
concerns where immediate line managers do not take action in a
response to a concern being raised.
 Agencies should support development of positive learning
environment
 Regular face to face supervision from skilled managers is essential
to enable staff to work confidently and competently in difficult and
sensitive situations
 Employers must ensure staff keep accurate records
 Staff should be made aware of their rights under employment law
and any disciplinary procedures
Highlights
Policies and Procedures
 In any organisation there should be adult safeguarding
policies and procedures which should reflect the
statutory guidance. Such policies should assist those
working with adults to develop swift and personalised
safeguarding responses and how to involve adults in the
decision making.
 Therefore be aware of the need for adult safeguarding
policies and procedures and the areas to cover;
benchmark against existing policies and procedures and
draw up new ones where required.
Decision Making Tree
Highlights
Culture- taking the ‘adversarial’ out of safeguarding
 Break down cultures that seek to scapegoat or blame
practitioners
 Commissioners of care or other professionals should
only use safeguarding procedures in a way that reflects
the 6 safeguarding principles not as a means of
intimidating providers or families
 Transparency, open- mindedness and timeliness are
important features of fair and effective safeguarding
enquiries
 Commissioners should encourage an open culture
working in partnership with providers to ensure the best
outcomes for the adult
Highlights
Quality versus Safeguarding?
 Need to clarify how responses to safeguarding concerns deriving from
poor quality and inadequacy of service provision including patient safety
should be responded to.
 Repeated instances of poor care may be an indication of more serious
problems and of what we now describe as organisational abuse. Important
that information is recorded and shared and emerging patterns identified.
 Agencies should implement robust risk management processes in order to
prevent concerns escalating to a crisis point and requiring intervention
under safeguarding procedures
 CQC and commissioners have alternative means of raising standards
including support for staff training, contract compliance and enforcement
powers.
Highlights
Information Sharing
 Early information sharing is the key to providing effective responses where there are
emerging concerns
 All orgs must have arrangements in place which set out clearly the processes and
principles for info sharing
 If a professional has concerns then they should share the information with the LA
and or the police if they suspect a crime has been committed.
 When an employer is aware of abuse or neglect in their org they are under a duty
to correct this and protect the adult from harm ASAP and inform the LA, CQC and
CCG where the latter is the commissioner.
 If someone knows that abuse or neglect is happening they must act upon this
knowledge not wait to be asked for information.
Highlights
Making Enquiries
 The employers should investigate any concern unless there is compelling
reason why it is inappropriate or unsafe to do this e.g. conflict of interest,
performance of the provider in undertaking past investigations or serious
multiple concerns or a matter requiring a police investigation.
 If the LA decides that another org should make the enquiry then the LA
should be clear about timescales, the need to know the outcomes and
what action will follow if this is not done.
 The LA should assure itself that the enquiry satisfies its duty under s42..In
this role if the LA has caused an enquiry to be made it is able to challenge
the agency if it considers the process or outcome unsatisfactory.
 Where a crime is suspected....then the police must lead the criminal
investigation.
Highlights
HR Processes
 Employers should ensure that their disciplinary
procedures are compatible with the responsibility to
protect adults at risk of abuse or neglect.
 When criminal procedures are concluded without
action being taken this does not automatically mean
that regulatory or disciplinary procedures should
cease or not be considered.
Highlights
Criminal Investigations
 The Police and Crown Prosecution Service (CPS) should
agree procedures with the LA, care providers, housing
providers, and the NHS/CCG to cover the following
situations:
 action pending the outcome of the police and the
employer’s investigations;
 action following a decision to prosecute an individual;
 action following a decision not to prosecute;
 action pending trial; and
 responses to both acquittal and conviction.
Highlights
 Cooperating Sections 6 and 7
 Section 6 creates a general duty to cooperate and section 7 a specific duty
on individual cases when requested by a LA.
 Section 6- LA’s must cooperate with each of their relevant partners and
those partners must cooperate with the LA e.g. NHSE, CCG’s, NHS Trusts,
DWP, Police, Probation and Prisons
 Section 7-LA’s must also cooperate with such other agencies as it
considers appropriate e.g. GP’s, dentists, pharmacists, housing, health and
care providers
 The request must be complied with unless it is “incompatible with its own
duties” or “would otherwise have an adverse effect on the exercise of its
functions”. Written reasons must be given for a decision not to comply with
a request.
Highlights
Mental Capacity Act 2005/Making Safeguarding
Personal
 Professionals and staff need to understand and
always work in line with the MCA 2005.
 They will need considerable guidance and support
from their employers if they are to help adults
manage risk in ways that put them in control of
decision making
Making Safeguarding Personal 2014
Making Safeguarding Personal
 Making Safeguarding Personal is a shift in culture
and practice.
 It is about having conversations with people about
how we might respond in safeguarding situations in
a way that enhances involvement, choice and control
as well as improving quality of life, wellbeing and
safety.
 It is about seeing people as experts in their own lives
and working alongside them.
Undue Influence?
 If the adult has the capacity to make decisions in this area of their
life and declines assistance, this can limit the intervention that
organisations can make. The focus should therefore be, on harm
reduction.
 It should not however limit the action that may be required to protect
others who are at risk of harm.
 The potential for ‘undue influence’ will need to be considered if
relevant. If the adult is thought to be refusing intervention on the
grounds of duress then action must be taken.
 In order to make sound decisions, the adult’s emotional, physical,
intellectual and mental capacity in relation to self-determination and
consent and any intimidation, misuse of authority or undue influence
will have to be assessed
SAB-supply of information
Section 45
 A SAB may request a person to supply information to it or
to another person. The person who receives the request
must provide the information provided if:
•the request is made in order to enable or assist the SAB
to do its job;
•the request is made of a person who is likely to have
relevant information
SARs
 Section 44
 The purpose of Safeguarding Adults Reviews (Serious Case
Reviews) is to identify the lessons to be learnt from a case, and
applying those lessons to future cases.
 SABs may arrange for a review for any case, but must arrange
them where there is reasonable cause for concern about how
the SAB, members of it or other persons with relevant functions
worked together to safeguard the adult and either
• the adult has died, and the SAB knows or suspects that the
death resulted from abuse or neglect, or
• the adult is still alive, and the SAB knows or suspects that the
adult has experienced serious abuse or neglect
The DASM- changes expected
 Statutory guidance states that each statutory member of the SAB should have a
Designated Adult Safeguarding Manager (DASM). That is: the local authority, the
CCG and the police.
 The DASM is responsible for the management and oversight of individual complex
cases and coordination where allegations are made or concerns raised about a
person, whether an employee, volunteer or student, paid or unpaid.
 The DASMs to work with care and support providers and other service providers
e.g. housing and NHS trusts to ensure that referral of individual employees to the
DBS and, or, Regulatory Bodies (e.g. CQC, HCPC, GMC, NMC) are made promptly
and appropriately and that any supporting evidence required is made available.
 The revised statutory guidance expected soon will have changes on the role of the
DASM
Statutory duty of candour for health and adult social
care providers
 New Care Quality Commission registration requirements
introduces a duty of candour under the Health & Social Care
Act 2008 (Regulated Activities) Regulations 2014.
 Since Nov 2014, NHS providers are required to comply with
the duty of candour. Meaning they must be open and
transparent with service users about their care and treatment,
including when it goes wrong.
 The duty was introduced as part of the fundamental standard
requirements for all providers. It applies to all NHS trusts,
foundation trusts and special health authorities
 From April 2015 it now applies to all other providers.
New offences of ill-treatment or wilful neglect
 In Nov 2013, the Govt accepted the recommendation of
the National Advisory Group on the Safety of Patients in
England that a new statutory criminal offence of illtreatment or wilful neglect should be created.
 The Criminal Justice and Courts Act 2015 establishes 2
offences which came into effect from 13 April 2015
 Section 20: Ill-treatment or wilful neglect: care worker
offence
 Section 21: Ill-treatment or wilful neglect: care provider
offence
Table discussion
Introducing - Safeguarding Leads
Jenny Moran - Bromley
Denise Roach -RBKC
Andrew Hill – Kingston
Jackie Bennett – Hillingdon
Rachel Adelson-Kettle – Islington
Seamus Doherty – Harrow
Sophie Shah – Ealing
Nicole Booty - Havering
Table discussion
Introducing Commissioners
Sue Newton – Islington
Helen Shewa – Southwark
Andy Loxton - Southwark
Carole Ferguson – Camden
Jason McCulloch – Greenwich
Barbara Disney – Tower Hamlets
Table discussion
Meeting Care Act expectations
• What are the provider manager’s challenges in
meeting Safeguarding expectations? Write on
Post it notes
• How can you work with commissioners and
safeguarding leads to meet expectations?
• Group Post -it notes on flip chart paper
• Record suggested ways to work together on flip
chart paper
Care Quality Commission
- Is the service Safe?
CQC – Is the service Safe?
The new approach
CQC seminar – Is the service Safe?
Provider Handbook & Appendices
CQC seminar
5 Key Questions:
CQC – Is the service Safe?
BY SAFE WE MEAN THAT PEOPLE ARE PROTECTED FROM ABUSE AND
AVOIDABLE HARM
How are people protected from bullying, harassment, avoidable harm and
abuse that may breach their human rights?
How are risks to individuals and the service managed so that people are
protected and their freedom is supported and respected?
How does the service make sure that there are sufficient numbers of
suitable staff to keep people safe and meet their needs?
How are people’s medicines managed so that they receive them safely?
How well are people protected by the prevention and control of infection?
(not mandatory)
Table exercise
Meeting CQC “Safe” standard
Identifying evidence opportunities for PIR
completion and inspections
Have a go at filling it in!
CQC – Is the service Safe?
Care Improvement works
http://www.careimprovementworks.org.uk
CQC – Is the service Safe?
Rachel Reid
rachel.reid@skillsforcare.org.uk
07770507812
Website : www.skillsforcare.org.uk
New Resources
Jim Thomas
• A guide to adult safeguarding for
social care service providers
• Safeguarding Route Planner
Table discussion
How will you use what you have heard about today?
Feedback on how you can use the information
and resources we have talked about today
Write on Post-its and put on flip chart
Registered Managers
Registered Managers networks
If you are interested in joining a network or
would like to start one!
Contact your Skills for Care Locality Manager
Locality Managers
London
North West – Donna.Bunce@skillsforcare.org.uk
North Central – Voyta.Camek@skillsforcare.org.uk
North East – Ali.Rusbridge@skillsforcare.org.uk
South East – Linda.MacEachen@skillsforcare.org.uk
South West – Laura.Anthony@skillsforcare.org.uk
Thank you