EHAAT Safeguarding Leaflet
Introduction
Safeguarding is a term used in relation to the protection of vulnerable adults and children. The
tragic death of Victoria Climbié on the 25th February 2000 and the subsequent Inquiry
conducted by Lord Laming reminds everyone of us of the frailty of life when abused and the
ease whereby many individuals and agencies ignore warning signs.
The Laming Inquiry prompted the review of the Children Act 1989, and the recommendations
from the Laming report essentially informed and became the statute of the Children Act 2004.
As a result of the Children Act 2004 widespread changes have been implemented into the
whole arena of Safeguarding child and young people.
There is a statutory obligation for public bodies such as the ambulance service to have in place
policies and procedures to protect such members of the community and methods of reporting
where a person knows or suspects there is an issue with regards to safeguarding. Because
members of EHAAT staff and volunteers do come into contact at times with children and
vulnerable adults it is good practice to have in place similar policies and procedures.
General Principles
A considerable amount of legislation and guidance informs and directs the Charity in relation
to children and young adults. Whilst not receiving the same statutory backing (at present), the
principles and practices relating to children are applied equally to Vulnerable Adults.
A child is defined as anybody that has not yet reached their eighteenth birthday (Children Act
1989 and 2004).
A vulnerable adult is any person over the age of 18 who is, or may be in need of community
care services by reason of mental or other disability, age or illness; and who is or may be
unable to take care of him or herself, or unable to protect him or herself against significant
harm or exploitation (No Secrets 2000).
It is considered that Healthcare staff and those working in similar fields are key to recognising
both child and adult abuse. Research suggests that awareness of child and adult abuse has
previously been poor, approaches to dealing with the problem uncoordinated and many
problems underreported.
Abuse affects large numbers of people, presenting itself in many different ways and the extent
of the problem reflects the range of definitions available.
All Trusts are required to have in place Policies and Procedures to effectively respond to known
or suspected abuse in children, young people and adults. A copy of the East of England
Ambulance Service Trust Policy is available at both airbases. EHAAT has policies and
procedures for both vulnerable children and adults which are located on the shared drawer.
The subject also forms part of the mandatory IT based training for all staff.
The police and Social Services are the lead agencies coordinating the response to child and
adult abuse allegations. They have an important responsibility to work closely with other
agencies and organisations and undertake assessments and investigations.
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Everyone working for or on behalf of EHAAT have a specific duty to promote
Safeguarding and when faced with suspicion take responsibility to share concerns,
and when necessary report or refer suspected abuse.
EHAAT has a duty to ensure all staff working with the public for or on behalf of the
Charity has training and knowledge to support them in identifying and referring
cases of abuse.
General information on the types of abuse and their recognition.
Abuse
A single or repeated act or lack of appropriate action occurring within any relationship where
there is an expectation of trust which causes harm or distress to a person. Somebody may
abuse or neglect a child or young person by hurting them, or by failing to act to prevent
someone or something from hurting them. Children and young people may be abused in a
family or in an institutional or community setting, by those known to them or, more rarely, by
a stranger. They may be abused by an adult or adults, or another child, children or young
people.
Abuse falls into a number of categories. These are as follows;
-
Physical
Emotional
Sexual
Neglect
Financial or Material
Discrimination/Hate Crime
Migrant/Human Trafficking
Internet
Concealed Pregnancy
Forced Marriages
Domestic Violence
Common risk factors for abuse/maltreatment examples include:
-
Parental or Carer provider with drug or alcohol problems/abuse
Parental or Carer provider with mental health problems
Intra-familial violence or history of domestic violent offending
Previous child maltreatment in members of the family
Known maltreatment of animals by the Parent or Carer providers
Vulnerable and unsupported Parents or Carer providers
Pre-existing disability in the child/other family members
Lack of patience and/or understanding of vulnerable persons needs
High work loads for Care providers, stress levels high
Care provider taking advantage of vulnerable person
Care provider neglecting persons Human and Civil Rights
Care provider exerting power over vulnerable person to gain advantage and abuse
Abuse falls into different patterns
Long-term
an ongoing family situation leading to long term harm to an individual. This may
be in the persons own home or relatives home. Examples are domestic violence
between spouses or generations or misuse of benefits, poor/inappropriate
facilities and lack of care.
Opportunistic such as theft occurring because money has been left around; sexual abuse can
also be opportunistic.
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Serial
perpetrator seeks out and grooms vulnerable individuals, one after another, for
personal gain or exploitation. Sexual abuse usually falls into this pattern as do
some forms of financial abuse.
Institutional
poor standards of care, lack of positive responses to complex needs, rigid
routines, inadequate staffing, inadequate knowledge base within any service;
unacceptable treatments or programmes which include sanctions such as
withholding food, drink and medication, unnecessary and unauthorised use of
control and restraint and seclusion.
The following abuse explanations can be used for all vulnerable individuals unless specified in
the text.
Physical
May involve:
Bruising
Burns & Scalds
Hitting
Shaking
Drowning
Suffocating
Throwing
Poisoning
Slapping
Bites
Fractures
Consider when you are dealing with the patient, is the History consistent with the injuries I
can see. Could that really have caused what I see? If you ask again does/has the story
changed?
Fabricated Illness is a common form of Physical Abuse and can be difficult to spot in a pre
hospital setting.
Presentation (Signs & Symptoms) and common themes you may possibly see from the
incident are:
-
Induced cardiac arrhythmias
Haematuria (complaints about blood in the patient’s urine)
Food allergies
Unnecessary surgical procedures
Fictitious seizures and fits
Induced vomiting diarrhoea simulated Gastro Intestinal bleeding
Simulated cystic fibrosis/haemoptysis
Induced hypoglycaemia
Unconfirmed cases of Cancer where treatment has not yet been started
Patient may be incapacitated with no real diagnosis of injury or illness; they may have
a long history of tests and examinations. The care provider may want to talk for the
patient and not allow you to have a conversation with the person. They will want
attention drawn to them and may use many means to get that focus.
Emotional
Emotional abuse is when children, young person or vulnerable adult is not given love or
affection, appropriate levels of emotional support or is constantly threatened or humiliated.
Sarcasm, degrading punishments and ignoring a child, young person or vulnerable adult are
also forms of emotional abuse and undermine a child, young person or vulnerable adult’s
confidence and sense of self-worth. It may happen when a parent or care provider constantly
behaves in an uncaring or hostile way, perhaps by bullying, rejecting, frightening, or
threatened with harm and abandonment.
The vulnerable person may feel isolated or deprived of contact or consistently ignored, they
may be criticising, suffer name calling and constant inappropriate comment designed to bring
about low self worth/esteem or scape-goating them. A care provider may behave in an
inconsistent way all of the time so the vulnerable person never knows what reaction to expect.
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Some care providers can be very possessive or over protective towards a child, young person
or vulnerable adult. They may be constantly blamed unfairly for things that go wrong. They
may also be made to carry out tasks inappropriate to their age, physical ability, capability both
physically or mentally and/or not allowed to do ‘normal’ activities appropriate to the child’s
age or the vulnerable adults age or capability. This can give the care provider a sense of
power over the vulnerable person and the vulnerable person may then be ridiculed and live in
an oppressive environment.
It may also involve seeing or hearing the ill-treatment of another, for example domestic
abuse, bullying, causing the child, young person or vulnerable adult to frequently feel
frightened and/or in danger, or the exploitation or corruption of children, young people or
vulnerable adult. Some level of emotional abuse is involved in all types of
maltreatment/abuse, although it may occur alone. The long term effects of the care provider’s
behaviour can lead to mental health problems, drug/alcohol abuse and self harming.
Sexual
Sexual abuse involves forcing or enticing a child, young person or vulnerable adult to take part
in sexual activities, including prostitution, whether or not the child, young person or vulnerable
adult is aware of what is happening. The activities may involve physical contact, including
penetrative or non–penetrative acts. They may include non-contact activities, such as
involving them in looking at or producing sexual online images, watching sexual activities, or
encouraging children, young people or vulnerable adults to behave in sexually inappropriate
ways, rape or sexual assault, unwanted touching or being forced to touch another person in a
sexual manner, not having a choice about someone of the same sex to undertake intimate
personal care and being subject to sexual innuendoes and harassment.
Indications of this may be unwanted or concealed pregnancies; early pregnancies in young
girls, sexually transmitted infections are a small number of the associated problems. Sexual
assault and rape can occur in any relationship, being married/civil partnered does not make
unwanted sexual activity legal.
Neglect
Neglect is the persistent failure to meet a child, young person or vulnerable adult’s basic
physical and/or psychological needs over a period of time which is likely to result in serious
effects on their health or development. Neglect can also occur during pregnancy for example
as a result of substance misuse. Neglect may involve a parent or care provider failing to:
-
Provide adequate food, clothing and shelter (including exclusion from home or
abandonment)
Protect a from physical and emotional harm or danger
Ensure adequate supervision; (including the use of inadequate care-givers)
Ensure access to appropriate medial care or treatment.
Failing to respond to a person’s needs or preventing someone else from meeting their
needs
Ignoring someone’s medical or physical care needs
Provide access to appropriate health, social care or educational services
Provide appropriate care/necessities of life such as medication, adequate hygiene,
nutrition or heating
Preventing someone from interacting with others
Provide an appropriate nutritional diet, providing poor meals allowing a child to over
eat of not have a balanced healthy diet
It may also include neglect of, or unresponsiveness to, a child or young person’s basic
emotional needs.
Financial or Material
This abuse is generally related to Safeguarding Adults. It can manifest in different ways from
opportunistic theft to institutional/family abuse over many years.
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Opportunistic financial abuse can be carried out both by low paid support staff, rogue triads
people and unpaid family members. Often with financial difficulties in their own personal lives,
making use of a vulnerable persons bank card, savings in a tin, or their weekly pension or
direct payments money. ‘Helping themselves to a little’ (often the perception of the person
doing it). This is theft and fraud – but can be hard to notice and prevent.
There is an increasing interest in and awareness of financial safeguarding. Police forces, social
care professionals and housing providers all state that financial abuse has greatly increased,
is difficult to deal with and that ‘financial safeguarding’ needed to be much better developed
and understood.
The government is doing a lot to increase choices for people, including people who might be
considered to be vulnerable due to their age, frailty, health condition, mental capacity,
disability or the situation they live or are cared for in. The government’s agenda has removed
barriers, opened up opportunities, encouraged responsibility for making health choices and
lifestyle choices, social care choices and financial choices. This has taken place at a time when
an increasing number of Safeguarding Adults and implementing multi-agency policies and
procedures to protect vulnerable adults from abuse. very elderly people are living not just
alone, but in isolation, without the protection of employment, friends, and social care workers.
The same applies to people with learning disabilities many of whom also increasingly live
without the support of families and friends. The increased choice means increased opportunity
for harm, particularly financial abuse but also other kinds of harm, such as ‘grooming’ of
people by individuals who set out to harm/manipulate vulnerable people.
Discrimination/Hate Crime
This category of abuse is on the whole within the vulnerable adult agenda. It has grown to be
such a huge problem within society the Police and Government have a focused agenda to deal
with all associated problems.
Hate crime is the targeting of individuals, groups and communities because of who they are. It
targets people because of elements which go to the core of their identities – their race, their
religious beliefs (or lack of them) their disability, sexual orientation or that they are
transgender. Hate crime is also a crime against the groups and communities to which these
people belong. Hate crime is a human rights issue, a threat to community cohesion and a
rejection of our shared values.
There is a spectrum of hate crime, which runs from abuse and harassment through to violent
extremism. Hate incidents and hate crimes are an everyday feature of the lives of some
people and occur in ordinary, everyday circumstances. For some, persistent harassment and
abuse may be an ongoing aspect of day-to-day existence. Other victims of hate crime may
experience a process of escalation in which insults, vandalism and minor crimes increase in
severity and intensity into more serious crimes of violence. Hate crime instils fear in victims,
groups and communities. It significantly impacts on the quality of people’s lives and leads
them to change their habits and lifestyle as they seek to avoid becoming victims, including
being forced to move home, changing the route to work, altering their daily routines and even
breaking off relationships or limiting meeting friends and relatives. Those who fear they will be
a target of hate crime even seek to hide their own identity, for example someone who is gay
may change their appearance and how they interact with people.
Discrimination and Hate crime can occur with individuals that work together, live or are related
to each other, familiar to the person as they live in the same community. There are also
occurrences of ‘one off’ opportunistic attacks of violence on individuals. ‘Happy slapping’
crimes within some teenage culture is classified as Hate crime.
Migrant/Human Trafficking
There are more people enslaved worldwide today than there were 200 years ago, the modern
day slave trade, is the fastest growing form of international crime with an estimated 600,000–
800,000 people trafficked across international borders each year. The number of people
trafficked internally is currently unknown. People are bought and sold into the sex industry,
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forced labour, domestic servitude and forced organ donation to name a few. This affects
children, young people and adults. Given promises of better prospects and living opportunities
by their abusers, they are exploited and held in poor conditions often suffering extreme
violence, harassments and threats. Often unable to speak English these individuals are unable
to speak out about their suffering.
The most classic case of our time of Migrant abuse was Victoria Climbė, she was given the
opportunity to have better prospects, but was systematically abused from the time she left
Africa. The numbers of Migrant children has increased in recent years they are of increased
vulnerability. They may be being moved illegally or against their will often on an undisclosed
pretext.
They are children first; do not lose sight of that. They face legal and cultural complexities.
Migrant children can have a high degree of vulnerability. Avoid interrogating the child.
Internet
This is growing problem with vulnerable groups of people; it can lead to bullying, harassment,
death threats, suicide pacts, mental health problems, self harming and eating disorders.
The internet is a place for perpetrators to prowl for children, young adults or vulnerable adults.
They will often watch chat rooms making them unsafe for children, young people and
vulnerable adults. They will often encourage individuals to discuss personal information. Some
perpetrators often access as many as 10 chat rooms at any one time. Girls can often be more
at risk of abuse over the internet than boys as they are more willing to discuss emotional
issues. Abusers very adept at manipulating their contacts and often will be disguised as
someone the child may be familiar to.
Chat rooms are only one aspect of the problem, the ever increasing growth of inappropriate
web sites teaching vulnerable people how to be anorexic, commit suicide to name a few.
The moving of inappropriate images of children and young adults is big business and is
watched very closely by the government in the UK. There are no criminally obscene content
hosted in the UK and if found the perpetrators are prosecuted.
Concealed Pregnancy
There is no national agreed definition of what constitutes a concealed pregnancy but a study
carried out by The Crisis Pregnancy Agency (CPA) revealed that the main reasons for
concealing or denying a pregnancy are fear of the social stigma of becoming pregnant in
unconventional circumstances and fear of the family’s reaction. The report “Concealed
Pregnancy, A case Study in an Irish Setting” looked at 51 women who concealed their
pregnancies between July 2003 and December 2004. The most striking aspect of the study
was that the sample of women used included women of all ages, and of all social backgrounds,
both married and single, and the report noted that “Denial and concealment of pregnancy
places a very heavy emotional toll on women.”
The report categorised concealment under four headings:
Conscious Denial:
When the woman recognises that she is pregnant but denies this to herself and others. Her
denial is a coping strategy invoked because the reality of the pregnancy is unimaginable and
threatening to her.
Concealment of Pregnancy:
When a woman acknowledges the pregnancy to herself but hides it from others, because
external stressors make it difficult for her to reveal the pregnancy or because she wants to
retain control over the outcome. A third group are not aware of being pregnant because
significant unusual features in the pregnancy cause her to deny it or makes diagnosis difficult.
A Crisis Pregnancy:
Defined as a “pregnancy which is neither planned nor desired by the woman concerned”, and
which represents a personal crisis for her.
Late Booker:
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Reasons are mixed but may include the woman who wants a baby against the wishes of
others, or to serve a purpose known only to herself.
Un-booked women presenting in labour must be regarded as high risk as their medical,
obstetric and antenatal histories will not be known. As such, they should be taken to the
nearest Hospital without exception, either before or after the birth.
There are also concerns in relation to the age of the mother. The Sexual Offences Act 2003
note that sexual activity with a child under the age of 13 is not acceptable and that regardless
of the circumstances, children of this age can never legally give their consent and penetrative
sex with a child under the age of 13 is classed as rape regardless of the age of the
perpetrator/s and must be referred to Social Care/Police as a child protection issue. Sexual
activity with a child under 16 is also an offence, but where the child is between 13 and 16
consideration must be given to discussion with other agencies.
Remember the child is at risk at all times during the pregnancy through to the birth. If you are
aware the mother has not yet engaged with Maternity services you need to ensure this is
highlighted to Social Care, where ever possible ensure the Mother is taken to the Hospital.
Forced Marriages
A marriage must be entered into with the full and free consent of both people. Everyone
involved should feel that they have a choice. An arranged marriage is not the same as a forced
marriage. In an arranged marriage, the families take a leading role in choosing the marriage
partner. The marriage is entered into freely by both people. However, in some cases, one or
both people are ‘forced’ into a marriage their families want.
A forced marriage is a marriage conducted without the valid consent of both people, where
pressure or abuse is used. You might be put under both physical pressure (when someone
threatens to or actually does hurt you), or emotional pressure (for example, when someone
makes you feel like you’re bringing shame on your family) to get married. In some cases
people may be taken abroad without knowing that they are to be married. When they arrive in
the country their passports may be taken by their family to try and stop them from returning
home.
Forced marriage is an abuse of human rights, and a form of domestic violence and child
abuse, children as young as 7/8 can be victims of Forced Marriage.
Around 85% of those cases involve women, 15% of cases involve men, there are many more
cases – involving both men and women – that don’t get reported.
Domestic Violence
Domestic Violence accounts for 14% of all violent incidents. It has more repeat victims than
any other crime: repeat victimisation accounts for 66% of all incidents of domestic violence
and 21% of victims have been victimised three or more times. Raising awareness of domestic
violence with a wide range of practitioners and providing appropriate training and tools is key
to early identification and intervention. New materials have been launched for schools and for
young people to raise awareness of forced marriage.
Research was commissioned to look at the prevalence of, and responses to, forced marriage
affecting children and young people. Work also began on developing guidance on sex and
relationships education as part of the Personal, Social, Health Education and the Government
invested in the expansion of parent support advisors to support families across a range of
issues including domestic violence. Work continued across Government to review, update and
promote employee domestic violence policies. Some themes of Domestic Violence are:
Control
Physical assault
Past violent behaviour
Divide and rule
Psychological abuse
Higher risk of repetition
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Targeted hitting
25% of all police work
EHAAT Safeguarding Leaflet
Domestic Violence victims live with a constant fear from their partner be that a male of
female. This can often lead to long term mental health problems, self harming, drug and
alcohol problems and suicide attempts. Often if the situation is left and the violence escalates
it can lead to homicide at the hands of the violent partner.
Who Harms Children
- Parent / Carer Provider
- Friends
- Siblings
- Strangers
Confidentiality
REMEMBER.
• Make accurate clinical observations.
• Listen to what the child, young adult of vulnerable person has to say.
• The needs of the vulnerable person are paramount
How serious do things have to be before we intervene?
Significant harm is the trigger for any intervention. The Law Commission advises that harm
should be taken to include not only ill treatment (including sexual abuse and forms of ill
treatment which are not physical) but also the impairment of or avoidable deterioration in
physical or mental health; and the impairment of physical, intellectual, emotional, social or
behavioural development.
Why we must act on any abuse
Sharing sensitive information is a difficult area for many people who care for others. Some
circumstances over-ride the duty of confidence and the wishes of the victim. The Public
Interest Disclosure Act (1998) supports all workers’ rights to disclose evidence under a range
of important circumstances. It is important not to promise confidentiality when
someone discloses information about possible abuse and you might want to have a form
of words ready for such an eventuality, for instance: “I can’t promise to keep what you’re
telling me to myself because of the risk to you or others.”
EHAAT Staff Responsibilities (Clinicians please refer to SOP’s)
When you are working on behalf of EHAAT and you become aware of or suspect there may be
safeguarding issue
-
-
Ensure you have informed EHAAT Safeguarding Lead (currently Operations Director) of
all you have seen, heard, felt, been told and witnessed as soon as practicable.
When giving the description to EHAAT Safeguarding Lead you use the same words the
patient/person used to tell you, as some language used can be misleading or
misinterpreted.
Ensure the EHAAT Safeguarding Lead has taken the information and is clear about what
you have said.
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Safeguarding Team Contact Details
1st point of contact
Cliff Gale 07889 397257
cliff@ehaat.uk.com
2nd point of contact
Jane Gurney 07971 243065
jane@ehaat.uk.com
Anneliese Hillyer-Thake, Safeguarding Lead for Beds, Herts and Essex
anneliese.hillyer-thake@eastamb.nhs.uk or mobile 07917 657192
(above is the link with EEAST)
Relevant EHAAT Policies & Procedures :
Protection of Vulnerable Adults Policy
Safeguarding Adults Procedure
Safeguarding Children Policy
Safeguarding Children Procedure
Useful Links:
www.everychildmatters.gov.uk
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrensServices/ChildrenServicesInfo
rmation/fs/en
www.victoria-climbie-inquiry.org.uk
www.care.org.uk/Group/humantrafficking
www.doh.gov.uk you can use this web page for many different types of information you will find No
Secrets on here and some aspect of the rewrite.
www.dcsf.gov.uk
www.bedfordshirelscb.org.uk
www.hertsdirect.org/caresupport/childfam/childprotection/acpc
www.cambslscb.org.uk
www.southend.gov.uk/search
for LSCB
www.peterborough.gov.uk/children_and_families/peterborough_safeguarding.aspx
www.lscb.norfolk.gov.uk
www.suffolk.gov.uk/CareAndHealth/ChildrenAndFamilies/SuffolkSafeguardingChildrenBoard
www.thurrock-community.org.uk/lsp/safeguard
www.escb.co.uk
www.direct.gov.uk
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