SAFEGUARDING
ADULTS
Primary Care Teams
Basic Awareness Training
Safeguarding Vulnerable Adults –
BMA Toolkit
Health professionals
 Should be able to identify adults whose physical,
psychological or social condition are likely to
render them vulnerable
 Should be able to recognise signs of abuse and
neglect, including institutional neglect
 Need to familiarise themselves with local
procedures and protocols for supporting and
protecting vulnerable adults
Resources for Primary Care
Training plan
 Exemplar policy
 Checklist
 Contact details
 Alerts
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Scale of the problem
In 2010-11 there were 75,000
safeguarding adults referrals which met
the threshold for investigation in England
 The majority of people have a GP
 Serious case reviews almost always
demonstrate GP involvement
 A tiny number of alerts are made by GP
practices
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Examples
Steven Hoskin (Cornwall)
 Fiona Pilkington
 Winterbourne View
 Death by indifference report
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What do we mean by Safeguarding
Adults?
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‘ All the work which enables an adult who is or
may be eligible for community care services to
retain independence, well-being and choice, and
to access their human right to live a life that is
free from abuse and neglect’
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(Safeguarding Adults, ADASS,2005)
What do we mean by Vulnerable
Adult ?
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Aged over 18
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Who may need care services because of mental
health issues, physical or learning disability, age
or illness (elderly frail)
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Who cannot always protect themselves from
harm or exploitation
Factors Increasing Vulnerability
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Frail elderly
Mental health disorder including dementia and
personality disorders
Significant physical or sensory impairment
Learning disability
Severe physical illness
Unpaid carer who is under severe stress or is isolated
Homeless people
Living with someone with a drug or alcohol problem
Women as a result of isolating cultural factors
Categories of Abuse
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Physical
Sexual
Psychological
Financial
Neglect
Institutional
Discriminatory
Definition of Abuse
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Abuse is a violation of an individual’s human and
civil rights by any other person or persons” (No
Secrets 2000).
It may be intentional or unintentional
It may consist of a single act or repeated acts
It may cause harm temporarily or over a period
of time
May occur in any setting
People who behave abusively come from all
walks of life
It may be acts of omissions
Factors to Consider
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One off event or repeated?
The impact on victim and others
The impact on others e.g. children and families
Intent of alleged perpetrator
Illegality of alleged actions
Risk of repeat to this victim
Risk of repeat to other vulnerable adults or
children
The Jigsaw
Doreen
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Doreen – mother of a man with mental health
and alcohol problems
Discloses that he has hit her recently
What types of abuse are you concerned about?
What do you need to know?
What might be making her vulnerable?
What might protect her?
Responding to allegations or
concerns
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Ensure safety
Take seriously and remain calm
Preserve evidence
Avoid leading questions
Don’t confront alleged perpetrator
Keep records
Consider who else might have information
Seek advice
Examples of Legislation
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Human Rights Act 1998
Public Interest Disclosure Act 1998 (Whistle
Blowing)
Data Protection Act 1998
Youth and Criminal Evidence Act 1999
Sexual Offences Act 2003
Protection Of Vulnerable Adults (POVA) 2004
Mental Capacity Act 2005
Safeguarding Vulnerable Groups Act 2006
Health and Social Care Act 2008
Mental Capacity Act Principles
Presumption of capacity
 Maximise decision making ability
 Freedom to make unwise decisions
 Best interests
 Less restrictive alternative
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Assessing Mental Capacity (MCA1
form)
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2.
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Is there an impairment of, or disturbance
in the functioning of the individual’s mind
or brain?
Complete assessment
Understand information
Retain information
Weigh up information
Communicate their decision
Decision Making Flowchart
Stage 1. Is there a concern that harm has occurred or is likely to occur
and is the patient a vulnerable adult?
Stage 2. Does the concern relate to significant harm or serious risk of
harm?
Stage 3. Does the patient consent to safeguarding procedures? Does
the patient lack mental capacity for the decision? What is in their best
interests? Is there other justified and legal basis to act?
How to Refer
Local Adult Social Services
 Phone
 Follow up with multi-agency alert form
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Option of discussion and seeking advice
After referral
Initial information gathering and
safeguarding decision (within 24 hours)
 Strategy meeting or discussion (within 5-7
days)
 Allocate responsibilities and agree initial
protection plan
 Protection plan meeting (within 28 days)
 Review meetings and core group meetings
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Doreen
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What would you do?
What Makes It Difficult to Refer
Uncertainty as to what constitutes abuse
 Uncertainty as to what will happen
 Concern about impact on relationships
 Lack of consent
 Concerns regarding confidentiality
 Not having the whole picture
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Record Keeping
Document concerns and information in
medical records
 Document information received from other
agencies
 Document discussions and decision
making e.g. assessment of capacity
 Store case conference notes in medical
records
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Prevention
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Training and awareness
Patient information
Asking questions
Consider in reviews e.g. chronic disease
Follow up non attenders e.g. QOF, repeat prescriptions
Carers policy
Flag records of vulnerable adults
Discuss concerns and significant events
Contribute to meetings
Practice Checklist
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Safeguarding adults policy
Safeguarding adults lead
Highlight records of vulnerable adults
QOF exception reporting based on clinical decision
Patient information available
Regular training
Significant events discussed
Concerns shared within PHCT
Carers policy
Minimum safety criteria for staff employment
Complaints and whistle-blowing policy
Guidance
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“No Secrets” DOH Guidance on implementing
Multi-Agency Policy
Safeguarding Vulnerable Adults – a toolkit for
General Practitioners. British Medical
Association
Safeguarding Adults. The role of health service
practitioners
National Competence Framework for
Safeguarding Adults
Deciding Right (www.theclinicalnetwork.org)
Case Studies
What type of abuse?
 What makes them vulnerable?
 What would you do?
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