Local authorities have the lead role in coordinating the multi-agency approach to safeguard adults who are experiencing, or at risk of abuse or neglect. This includes the coordination of the application of these policy and procedures, coordination of activity between organisations, review of practice, facilitation of joint training, dissemination of information and monitoring and review of progress within the local authority area.
In addition to this strategic coordinating role, the local authority adult social care department, joint health and social care teams and mental health teams also have responsibility for coordinating the action taken by organisations in response to concerns that an adult is experiencing or at risk of abuse or neglect; including:
Additional agencies the local authority must consider also cooperate with are:
The local authority should:
The lead councillor / assistant mayor for safeguarding adults has a responsibility to make sure that the director of adult social services and the SAB are effectively discharging their responsibilities in relation to adults.
The director of adult social care has specific responsibilities under statutory guidance issued by the Department of Health (DH). Within adult social care, the director has a responsibility to:
Every member of the community deserves protection from exploitation and abuse by those entrusted with their care and the people they should be able to rely on to keep them safe. The police take any crime against an adult seriously, and will investigate it thoroughly, professionally and empathetically. The police work very closely with partner agencies to ensure effective information sharing, risk assessment and decision making takes place every time an incident of abuse is reported.
The police will hold people causing abuse accountable for their actions. Where criminal proceedings are deemed inappropriate the police will work closely with partners to identify the most suitable course of action.
The police will work in effective partnership with other agencies to safeguard adults.
Where a criminal offence appears to have been committed, the police will be the lead investigating agency and will direct investigations in line with legal and other procedural protocols. A police investigation will be initiated at the outset and a comprehensive initial risk assessment undertaken.
It is the responsibility of the police to secure and preserve evidence. The police will interview the alleged victim, the alleged person causing harm and any witnesses. Where the police are the lead investigating agency they will work closely with the local authority and other partner agencies in line with the Safeguarding Adults policy and procedures to ensure that the identified risks are acted on and a risk management or protection plan is agreed at an early stage.
There are now special measures that can be put into place to help vulnerable people through the court process. These measures have allowed many people who may once have been denied access to the criminal justice system the opportunity to give their evidence in court. The police will discuss these special measures with victims at the earliest stage possible in the investigation.
Some adults can be abused by strangers and the role of the police is to work in partnership with key agencies where a potential crime has been committed and on the development of a protection plan.
The National Health Service (NHS) has a commitment and a duty to safeguard. In order to achieve this, health organisations need to:
NHS providers must work collaboratively with other statutory, voluntary and charitable organisations to ensure the safety and wellbeing of any person deemed to be vulnerable. The primary aim is to prevent abuse where possible but, if this fails robust procedures must be in place for the effective management and investigation of incidents of abuse.
The DH has published three guidance documents concerning the statutory duties relating to safeguard adults:
Health commissioners must ensure that adult safeguarding standards are included in all commissioning arrangements and are reflected in organisational change to meet the needs of people who live in their local health area. Liberating the NHS states that GP clinical commissioning groups have a duty to promote equalities and work in SABs with local authorities in relation to health and social care, early years, public health, safeguarding and the wellbeing of the local population.
The provision of high quality, safe services continues to be a key priority for the NHS and remains an organising principle for current NHS reform. The NHS has a duty of care to protect adults from neglect and abuse and to provide appropriate health care in a timely, effective and appropriate manner. Government reform maintains that health providers will be held to account by patients, the public, their commissioners and regulators. Managers of health services and their boards play an essential role in safeguarding patients in the most vulnerable situations.
Safeguarding must be integrated with NHS clinical governance arrangements, with greater openness and transparency about clinical incidents, both in terms of clear reporting, shared learning and improved SAB working. Non-executive directors and lay members of trusts also have a vital role to play in promoting the safeguarding agenda. They have the opportunity to provide independent scrutiny and hold services to account.
Six basic measures will help managers and their health boards comply with legislation and achieve good outcomes at a local level.
Health care staff often work with patients who, for a range of reasons, may find it difficult to protect themselves from neglect, harm or abuse, and all staff have a duty towards such people. These duties stem from a common law duty of care and from professional codes of practice. In addition, their employers have an explicit duty under the Regulated Activity Regulations. A number of guidelines have been developed with the aim of assisting managers / practitioners in this role to:
It is essential for health care organisations to have systems and processes in place in order to review and benchmark their safeguarding adults arrangements and to provide assurance and accountability for the organisation and its commissioners, partners and patients. Safeguarding adults activity in health care should not be measured in isolation; it is fundamental that assurance processes support multi-agency safeguarding adults objectives.
The assurance framework and outcomes tools developed in local organisations should draw on existing standards and inspection frameworks. Services must be accountable to patients for the quality of care, shared decision making should become the norm and patient safety must always be put above all else.
GPs have a significant role in safeguarding adults. This includes:
The CCGs should make sure that effective training and reporting systems are in place to support GPs and GP practices in this work.
Patient Advice and Liaison Services (PALS) / Patient Information and Liaison service (PILS), along with complaints departments provided by acute, specialist and community NHS health trusts, have been established to provide confidential advice and support to patients, families and carers, including confidential assistance in resolving problems and concerns. PALS acts as a focal point for feedback from patients to inform service developments and as such can act as an early warning system.
PALS staff should be in a position to recognise that a concern raised by a patient, carer or friend could indicate that a person is at risk of abuse or neglect. They are then able to raise this concern within their own health organisation in line with its safeguarding / complaints policy. This policy will in turn ensure that appropriate action is taken.
Service users often feel they do not have a strong enough voice to change aspects of their health or social care. Local Involvement Networks (LINks) are part of a wider process to help people have a stronger local voice. The role of LINks is to:
Overseen by the Care Quality Commission (CQC), Healthwatch is the ‘consumer champion’, operating at both local and national levels.
There are a number of ways in which ambulance staff may receive information or make observations which suggest that an adult has been abused or is at risk of harm. Ambulance staff will often be the first professionals on the scene and their actions and recording of information may be crucial to subsequent enquiries.
Ambulance staff will not investigate suspicions and, if there is someone else present, will not reveal their concerns. If the patient is conveyed to hospital, ambulance staff will inform a senior member of the accident & emergency (A&E) team (or of the nursing staff if the patient is taken to another department) of their concerns about possible abuse. They will complete a patient report form and give a copy to hospital staff. Ambulance staff should also follow local procedures for contacting the local authority.
Fire Service personnel visit people in their homes when carrying out home fire safety visits. In cases where they have a concern about an adult they will inform their line manager who will then take appropriate action, which may involve referral to another agency.
The Fire Service has officers who are trained to recognise and report concerns that an adult may be at risk of harm, in line with the local safeguarding adults procedure.
The CQC regulates and inspects health and social care services including domiciliary services, and protects the rights of people detained under the Mental Health Act (MHA) 1983. It has a role in identifying situations that give rise to concern that a person using a regulated service is or has been at risk of harm, or may receive an allegation or complaint about a service that could indicate potential risk of harm to an individual or individuals. The CQC should make a safeguarding referral when appropriate to the safeguarding contact point.
The CQC will be directly involved with the safeguarding adults process where:
The Court of Protection deals with decisions and orders affecting people who lack capacity. The Court can make major decisions about health and welfare, as well as property and financial affairs. The Court has powers to:
The Court of Protection has far reaching powers which include but not limited to the above.
Local authority housing services are responsible under homeless legislation to assist people who are:
There is a duty on housing authorities to ensure that advice and information about homelessness, and preventing homelessness, is available to everyone in their district free of charge. Authorities are also required to assist individuals and families who are homeless or threatened with homelessness and who apply for help. Authorities should not wait until homelessness is likely or is imminent before providing advice and assistance. There is an emphasis on the need for joint working between housing authorities, social services and other statutory, voluntary and private sector partners in tackling homelessness more effectively to safeguard adults.
The Crown Prosecution Service (CPS) is the principal public prosecuting authority for England and Wales and is headed by the Director of Public Prosecutions. The CPS has produced a policy on prosecuting crimes against older people which is equally applicable to adults who may also be vulnerable witnesses.
Support is available within the judicial system for those at risk to enable them to bring cases to court and to give the best evidence. If a person has been the victim of abuse that is also a crime, their support needs can be identified by the police, the CPS and others who have contact with the adult. Witness Care Units exist in all judicial areas and are run jointly by the CPS and the police.
The CPS has a key role to play in making sure that special measures are put in place to support vulnerable or intimidated witnesses. Special measures are available in both Crown and the Magistrates’ courts. They include the use of screens, trained intermediaries to help with communication and arrangements for evidence and cross examination to be given by video link.
Coroners are independent judicial officers who are responsible for investigating violent, unnatural deaths, sudden deaths of unknown cause and deaths in custody, which must be reported to them. The coroner may have specific questions arising from the death of an adult. These are likely to fall within one of the following categories:
In the above situations the local SAB should give serious consideration to instigating a Safeguarding Adult Review where an adult is involved, and the review procedure should be agreed with the coroner.
The Probation Service protects the public by working with offenders to reduce reoffending and harm. It works jointly with other public and voluntary services to identify, assess and manage the risk in the community of offenders who have the potential to do harm. Probation officers use the Offender Assessment System (OASys) to assess risk and identify factors that have contributed to offending. The Probation Service also has a remit to be involved with victims of serious sexual and other violent crimes.
The Probation Service shares information and works with SABs from other agencies including local authorities and health services, and contributes to local MAPPA procedures to help reduce the reoffending behaviour of sexual and violent offenders, so as to protect the public and previous victims from serious harm.
Although the focus of the Probation Service is on those who cause harm, it is also in a position to identify offenders who are themselves at risk from abuse and to take steps to reduce this risk in line with the principles of this policy and procedure.
Commissioners of services should set out clear expectations for provider agencies and monitor compliance. Commissioners have a responsibility to:
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