Guidance to assist in producing in

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Guidance to assist in producing in-house policy on adult
protection
b) Guidance intended to assist a range of agencies (including care home
owners) in drawing up an in house policy
Context:
A detailed multi agency policy and procedures to ensure the protection of
vulnerable adults from abuse was produced in early 2002 and revised in 2003
and in 2005 following wide consultation across agencies in all sectors in
Hampshire, Portsmouth and Southampton. This multi-agency document has
been produced as a result of mandatory guidance from the Department of
Health: “No secrets”: Guidance on developing and implementing multiagency policies and procedures to protect vulnerable adults from abuse (DoH
2000.) All agencies must refer to the multi agency policy and procedures for
detailed guidance when confronted with situations of abuse. It is available
from Social Services Headquarters in each of the three Authorities to whom it
applies and on their websites . However, in addition to this the Department of
Health has stipulated that:
“Provider agencies will produce for their staff a set of internal guidelines
which relate clearly to the multi-agency policy and which set out the
responsibilities of all staff to operate within it.
These will include guidance on:
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Identifying vulnerable adults who are particularly at risk
Recognising risk from different sources and in different situations and
recognising abusive behaviour from other service users, colleagues
and family members
Routes for making a referral and channels of communication within
and beyond the agency
Assurances of protection for whistle blowers
Working within best practice as specified in contracts
Working within and cooperating with regulatory mechanisms; and
Working within agreed operational guidelines to maintain best practice
in relation to:
o Challenging behaviour
o Personal and intimate care
o Control and restraint
o Sexuality
o Medication
o Handling of user’s money
o Risk assessment and risk management
Internal guidelines should also cover the rights of staff and how employees
will respond where abuse is alleged against them within either a criminal or
disciplinary context.”
“The starting point…must be that agencies have an organisational
framework within which all concerned at the operational level
understand the inter-agency policy and procedures, know their
own role and have access to comprehensive guidance.” “No Secrets”,
DoH, 2000
This mandatory guidance from the Department of Health further underlines
and is referred to within the requirements of the Care Standards Act, 2000,
the Care Homes Regulations 2001 and the National Minimum Standards.
The regulations and standards contain many references to the protection of
vulnerable adults including: a requirement that providers have robust
procedures for responding to suspicion or evidence of abuse or neglect; that
staff who may be unsuitable to work with vulnerable adults are referred for
consideration for inclusion on the protection of vulnerable adults list (POVA
List) kept by the Secretary of State (Part VII, Care Standards Act, 2000); to
check the POVA List when employing workers in registered settings; that
allegations and incidents of abuse are clearly recorded; that there are clear
policies around involvement with service users’ finances; that physical and
verbal aggression by service users is responded to appropriately. There are
also requirements within the regulations: to prevent harm and abuse; to notify
the National Care Standards Commission of “death, illness or other events.”
The latter would include incidents of actual or suspected abuse. The
standards also require staff to be trained in the prevention and management
of abuse.
Where the perpetrator is a member of staff, proprietor or manager the
disciplinary procedures must be implemented alongside the adult protection
procedures. The disciplinary procedure must not be operated in isolation from
adult protection considerations. (See section 4.2.1 multi-agency adult
protection policy) Within this, where abuse is alleged against a member of
staff a risk assessment must be undertaken immediately to assess the level of
risk to all service users posed by the suspected perpetrator of abuse. This
will include whether it is safe for them to continue in their role or any other role
within the service whilst the investigation is being undertaken. The
consideration of risk will be considered alongside employee rights. The safety
of vulnerable individuals will be paramount.
The above context along with the following information and guidance will
assist providers across a range of settings in producing the required internal
guidelines relating to adult protection. It is not prescriptive but is intended to
provide sufficient material to enable agencies in all sectors to adapt the
material to suit their own setting/requirements.
Who abuses and where can abuse occur?
The following are extracts from the Department of Health document “No
Secrets” referred to above and set the context of internal policy/guidelines:
“Vulnerable adults may be abused by a wide range of people including
relatives and family members, professional staff, paid care workers,
volunteers, other service users, neighbours, friends and associates, people
who deliberately exploit vulnerable people and strangers.”
“There is often particular concern when abuse is perpetrated by someone in a
position of power or authority who uses his or her position to the detriment of
the health, safety, welfare and general well-being of a vulnerable person.”
“Abuse can take place in any context. It may occur when a vulnerable adult
lives alone or with a relative, it may also occur within nursing, residential or
day care settings, in hospitals, custodial situations, support services into
people’s own homes, and other places previously assumed safe, or in public
places.” “No Secrets”, DoH, 2000
Your response is crucial.
If you become aware of any situation which might be abusive to a
vulnerable adult acknowledge it and take action.
The protection of a vulnerable adult or more than one vulnerable adult
may well depend on your initial response.
Support for those who report abuse
All those making a complaint or allegation or expressing concern, whether
they be staff, service users, carers or members of the general public, should
be reassured that:
 They will be taken seriously
 Their comments will usually be treated confidentially but their concerns
may be shared if they or others are at significant risk
 If service users, they will be given immediate protection from the risk of
reprisals or intimidation
 If staff, they will be given support and afforded protection if necessary –
under the Public Interest Disclosure Act 1998:
they will be dealt with in a fair and equitable manner; and
they will be kept informed of action that has been taken and its outcome
“No Secrets”, DoH, 2000
Rights as well as responsibilities of workers and managers are outlined in
Section 1.4 of the multi-agency policy.
Public Concern at Work is a national organisation which provides legal advice
to individuals concerned about malpractice at work. The service is free and
strictly confidential. The telephone number is: 020 7404 6609 and is open
from 9am until 6:30pm.
Staff training is a key element in protecting vulnerable adults from abuse as
well as in supporting staff. The levels of training necessary for staff are
outlined in section 3.2 of the multi-agency policy. Organisations should
comply with the TOPPS requirements for Induction and Foundation training,
which includes issues of abuse. Training is also identified as a priority within
the National Minimum Standards and regulations.
Definitions to assist in the identification of abuse
A “vulnerable adult”…is a person “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.”
“Abuse may consist of a single act or repeated acts. It may be physical,
verbal or psychological, it may be an act of neglect or an omission to act, or it
may occur when a vulnerable person is persuaded to enter into a financial or
sexual transaction to which he or she has not consented, or cannot consent.
Abuse can occur in any relationship and may result in significant harm to, or
exploitation of, the person subjected to it.”
“No Secrets”, DoH, 2000
The local multi agency policy and procedure for adult protection endorses the
following definition of abuse offered by The Centre for Policy on Ageing
(1996). It gives further guidance on defining situations which must be dealt
with within this policy and procedural framework and as such should be used
alongside the definition given in “No Secrets”. It states:
“Abuse is the harming of another individual usually by someone who is in a
position of power, trust or authority over that individual. The harm may be
physical, psychological or emotional or it may be directed at exploiting the
vulnerability of the victim in more subtle ways (for example, through denying
access to people who can come to the aid of the victim, or through misuse or
misappropriation of his or her financial resources). The threat or use of
punishment is also a form of abuse. Abuse may happen as a “one-off”
occurrence or it may become a regular feature of a relationship. Other people
may be unaware that it is happening and for this reason it may be difficult to
detect. In many cases, it is a criminal offence.”
Centre for Policy on Ageing (1996)
“No Secrets” states: Consensus has emerged identifying the following main
different forms of abuse:
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Physical abuse
Including hitting, slapping, pushing, kicking, misuse of medication,
restraint, or inappropriate sanctions.
Sexual abuse
Including rape and sexual assault or sexual acts to which the vulnerable
adult has not consented, or could not consent or was pressured into
consenting.
Sexual abuse might also include exposure to pornographic materials,
being made to witness sexual acts and encompasses sexual harassment
and non-contact abuse.
NB. The Sexual Offences Act, 2003 has created a number of new
offences which can be committed by care workers in respect of a person
with a mental disorder. Sections 38 to 41 deal with the situation where a
care worker involves someone in their care, who has a mental disorder, in
sexual activity.
Psychological abuse
Including emotional abuse, threats of harm, controlling, intimidation,
coercion, harassment, verbal abuse, isolation or withdrawal from services
or supportive networks
Financial or material abuse
Including theft, fraud, exploitation, pressure in connection with wills,
property or inheritance or financial transactions, or the misuse or
misappropriation of property, possessions or benefits
Neglect and acts of omission
Including ignoring medical or physical care needs, failure to provide
access to appropriate health, social care or educational services, the
withholding of the necessities of life, such as medication, adequate
nutrition and heating
Discriminatory abuse
Including racist, sexist, that based on a person’s disability, and other
forms of harassment, slurs or similar treatment.
These definitions from “No Secrets” are expanded upon in the local multiagency policy and procedures relating to adult protection.
Prevention of Abuse
In section 7 of “No Secrets”, the Department of Health outlines a number of
suggestions which will be effective in contributing to the prevention of abuse.
These include:
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Rigorous recruitment practices (including volunteers). This now includes
reference to the POVA (Protection of vulnerable Adults) List as set out in
Part VII of the Care Standards Act, 2000. See section 10.2 of local Multi
agency adult protection procedures (July 2005) for information.
Internal guidelines for staff
Training
Information for users, carers and the general public
Attention to issues relating to protection of vulnerable adults in Direct
Payments arrangements
Commissioning of services and contract monitoring
Further information/guidance on these issues is given in section 3 of the multiagency policy.
The issue of prevention by empowerment of vulnerable individuals is also
outlined in section 3.5 of the multi-agency policy. Empowering individuals
with knowledge and understanding so that they will be aware of what is
appropriate or inappropriate behaviour towards them is an important aspect of
prevention of abuse. Empowering individuals with knowledge and information
as to their rights is also important and will include a well-publicised and userfriendly complaints procedure.
Intervention in situations of suspected abuse
The individual who suspects abuse/hears a disclosure or allegation will
need to bear in mind the following:`
 In situations of immediate danger take urgent action by calling the relevant
emergency services (eg Police, ambulance, GP)
 Log your concerns and any information given to you or witnessed by you.
Do not ask leading questions (see guidance sect. 10.9, multi agency
policy)
 Remember that it is not necessary or advisable for you to seek evidence
or proof at this stage. This is for a formal adult protection investigation to
carry out. By supporting the vulnerable adult and carefully gathering any
readily available information and logging it at this stage, you will lay the
foundations for an effective formal investigation.
 Understand the need not to contaminate (and indeed to preserve)
evidence if a crime may have been committed.
 Report concerns and information to the appropriate manager or
supervisor. If this is not possible refer directly to Social Services
Dept/Police/ Commission for Social Care Inspection
 Understand that the Police must be contacted if a crime may have been
committed.
 Remember to have regard to your own safety. Leave the situation if it is
not safe for you.
 Listen to the vulnerable adult, offer necessary support and reassurance.
Record what is said and what is observed, recording accurately and in
detail the nature of allegations as well as your own actions/response, who
was present at the time and the times and dates.
 Issues of confidentiality must be clarified early on. For example where
staff or volunteers working for an organisation are dealing with an initial
concern/allegation it must be made clear that they will at least have to
discuss the information/concerns with their supervisor/manager (see
section 10.7, multi-agency policy)
 Where a vulnerable adult expresses a wish for concerns not to be pursued
then this should be respected wherever possible. However, decisions
about whether to respect the service user’s wishes must have regard to
the level of risk to the individual and/or others and their capacity to
understand the decision in question and to make decisions relating to it. In
some circumstances the vulnerable adult’s wishes may be overridden in
favour of considerations of safety.
 Decisions to override the vulnerable adult’s wish not to proceed with an
investigation or not to allow referral to another agency such as the Police
or Social Services Department will where possible be the product of
discussion with appropriate line manager/supervisor within your
organisation. These decisions will be clearly recorded.
“The first priority should always be to ensure the safety a nd protection of
vulnerable adults. To this end it is the responsibility of all staff to act on
any suspicion or evidence of abuse or neglect (see the Public Interest
Disclosure Act 1998) and to pass on their concerns to a responsible
person/agency.” “No Secrets”, DoH, 2000
Discussion and decision-making with line manager/supervisor
Concerns about suspected abuse of a vulnerable adult must where possible
be reported to a line manager/supervisor as soon as possible.
A discussion will take place to decide whether the situation falls within the
remit of the multi agency policy/procedure and to evaluate the seriousness of
the situation. This will inform a decision as to whether to report the situation
to the Police/Social Services/CSCI/others. This decision will be taken
alongside a decisions as to whether internal disciplinary action is required.
Where the line manager/supervisor may be the perpetrator of the abuse (or
where no such person is available), a direct referral to Social Services and/or
the Police/ Commission for Social Care Inspection must be made.
Deciding whether to refer on to another agency (eg Police; Social
Services, Commission for Social Care Inspection)
This decision, as to whether to refer elsewhere, is crucial and should make
reference to:
 The wishes of the vulnerable adult
 The mental capacity of the vulnerable adult (see guidance, sect 10.11,
multi-agency policy and procedures)
 Known indicators of abuse
 Definitions of abuse
 Level of risk to this individual
 Level of risk to others (public interest considerations)
Decisions as to whether to inform others will be concerned with:
 The individual’s right to self-determination
 The seriousness of the abuse
 The pervasiveness of the abuse
 The effect of the abuse on the individual in question, and on other
vulnerable adults
 The ability of others (eg Police, Social Services) to make a positive
contribution to the situation
 Whether a criminal offence has been committed or whether there are other
statutory obligations to refer on (eg to Commission for Social Care
Inspection )
 The need for others to know (eg to protect others who may not be involved
in the immediate situation)
Responsible sharing of information in the public interest is supported by:
The Public Interest Disclosure Act, Data Protection Act, Crime and
Disorder Act(see guidance, section 10.7, multi-agency policy and
procedures)
Consideration of issues of mental capacity and consent:
The consent of the vulnerable adult to refer on must be obtained except
where
 The vulnerable adult lacks the mental capacity to make a decision
regarding informing others and a risk assessment indicates that referral
would be in their best interests
 There are public interest considerations (others may be at risk)
 A crime has been committed
Further guidance on the issue of consent and capacity can be found in section
10.11 of the multi-agency policy and procedures. The issue of sharing
information with other agencies/confidentiality is covered in section 10.7 of the
multi-agency policy.
Who to refer/report concerns to:
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Relevant local Social Services team, depending on age/any mental health
problems/any learning disability/any physical disability and also on area in
which the vulnerable adult lives. Social Services Departments have the
lead responsibility for coordinating all investigations into suspected abuse
of vulnerable adults
Relevant hospital Social Services team if vulnerable adult is in hospital
Emergency Social Services duty team, if urgent and outside normal office
hours
Community Mental Health Team (CMHT) where the vulnerable adult has
an ongoing mental health need
Commission for Social Care Inspection (CSCI) where there are issues
relating to standards and regulations in care homes and domiciliary care
agencies (later on it is anticipated that day care settings will also be
registered with CSCI). See specifically Regulation 37, Care Homes
Regulations 2002, which includes a requirement for the Registered Person
to give notice to the Commission without delay of the occurrence of any
serious injury to a service user and /or of any event in the care home
which adversely affects the well-being or safety of any service user. It also
refers to any theft, burglary or accident in the care home or allegation of
misconduct by the registered person or any person who works at the care
home. (Refer directly to regulation 37 in the Care Homes Regulation 2002
as this is not a full quotation of that regulation).
Hospital Trusts/ Primary Care Trusts where there is a complaint of abuse
by a member of staff.
The Police
 if there is an emergency where delay in contacting emergency services
may result in serious harm to the vulnerable adult
 if the abuse may constitute a crime
(See section 4.2, multi-agency policy and procedures.)
Information which will be required when you make a referral:
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Details of alleged victim (name ,address, tel no, date of birth/age, gender,
ethnic background (including principle language spoken), details of any
disability (including any communication needs)
Details of GP
Whether the individual is aware of and has consented to the referral being
made
The mental capacity of the individual (are there any concerns/doubts about
this?)
This will be required along with any available information on the following:
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Details of any other professional involved
Details of carers and any significant family members, neighbours, friends
Details about the nature of the vulnerable adult’s home/accommodation
Reasons for concerns and therefore this referral
Details of how these concerns came to light
Details of alleged abuse including information about suspicions, specific
information
Details of any arrangements which have already been made for the
protection of the vulnerable adult/any immediate action taken
Details of anyone else to whom this referral has also been made
(Commission for Social Care Inspection, Police, Primary Care Trust,
Hospital Trust etc..)
Details of the alleged perpetrator and whether they too are a vulnerable
adult
Details of any other background information or context of concerns
An impression of how serious the situation might be
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