Safeguarding

SAFEGUARDING Types of abuse : * Physical abuse * Psychological/emotional abuse * Financial abuse * Neglect * Discrimination * Sexual abuse * Institutional abuse Physical abuse: This occurs when injuries are inflicted, or the health and development of the person is severely impaired. Examples: when a person is given too much medication causing drowsiness or someone hits/slaps another person. Psychological /emotional abuse: When there is a denial of a person’s basic right such as not being given choices, their opinion not being heard or they are not given any privacy . Where the person is over- protected and kept back ,not enabling someone live a normal life as possible and to be able to ‘ grow and develop’. Examples: When a person punished if they have been incontinent. When an adult with learning disabilities is not encouraged by their family to live independently because the family would lose the ‘disability living allowance’/other benefits etc. Financial abuse :People who are housebound,confused and/or have physical or mental disabilities are the most vulnerable and at risk.An example: someone cashes pension/benefits on behalf of a vulnerable adult and does not give it to the person it belongs to,but keeps it for their own use. Neglect :To pay too little or no attention to a person, to fail to take proper care of the person , to omit to do or be remiss about something .Neglect can also come under physical and phychological abuse. An example is where the person does not receive proper food and drink resulting in malnutrition or dehydration. Discrimination: Choices given to a person is not based on their ability or needs but made in relation to their race ,gender, disability, etc. Examples: An Asian women is not given any option about what she wants to wear , for example, sari, or any choices about the meal she has. Sexual abuse :This occurs when the person is involved in sexual activities to which they have not consented , or , if they are in a confused state and do not fully understand what is happening to them. Example : When a person is touch inappropriately, e. g. on the breast /legs, or has to watch pornography when they are unhappy about it etc. etc . Institutional:Servise users/patients being treated as a group not as individuals, for example, all service users/patient being toileted at the same time, all going to bed and getting up at the same time – no choices is being given re these times. Routines are rigid and inflexible . Everyday is exactly the same day as the previous day- there is no difference. They begin to become resigned to the situation that this is their lot and there is no light at the end of the tunnel. Indicators for the various types of abuse Physical Abuse : * If the explanation/story given is not consistent with the injuries * Different types or bruising and in various states of healing, often non-visible areas * Multiple bruising and fractures not consistent with a fall * Bruised eyes, slap-marks, kick marks etc * Burns, not consistent with scorching by direct heat * Over feeding * Use of equipment/furniture to restrict movement/mobility * Medication misuse –over or under use of medication * Laclk of personal care , such as inadequate/inappropriate clothing ,inadequate heating . Sexual abuse : * Touching with sexual intent anywhere on the body * Penetration of mouth , vulva or anus by a finger , penis or object * Looking at part of the body, sexual acts or other materials in a way * which is sexually arousing for the abuser * Leering, taking pornographic photographs * Signs of depression, stress * Clothing or underclothing is torn and or stained with blood * Pain ,bruising on inner thighs, bleeding in genital region * Severe upset or agitation when the person is being bathed, dressed, undressed or medically examined( or when these things are suggested). Psychological/emotional abuse: * Be alert to changes in behaviours such as becoming fearful/anxious- i.e. fearful af care giver and avoid looking at them, may flinch on approach, be defensive, stressed * Threats intimidation, humiliation ,bullying, shouting * Threats to put the person away * Few visitors ,phone calls ,or outings * Name calling, insulting, withholding affection * Inflicting punishment for being incontinent * Promises not kept * Locking the person in their own room/home Financial abuse: * Recent changes of deeds or title of house * Person lacks belongings or services, which they could clearly afford * Unusual/inappropriate bank account activity * Carer only interested in asking financial question and not about the care of the person * Person managing financial affairs is evasive or uncooperative. Discrimination abuse: * Where a person’s choices/needs are based on their race, gender, age, disability etc. and not on their ability. Other signs of discriminatory abuse may be similar to signs of other forms of abuse, e.g. physical or psychological abuse including: * Favouritism being shown to certain service users/patients * Threats, intimidation, shouting or bullying * Isolation/shunned/dismissed by other people * Unexplained fear or defensiveness * Emotional withdrawal/feelings of powerlessness and hope lesness * Deference, passivity, resignation * Unexplained attacks on the person, property or pocessions * Low selfesteem. Institutional abuse: * Rigid care regimes ,i.e. everyone in bed and up morning at the same time * Lack of individual care plans * Staff opening service users/patient’s mail without permission * Not providing privacy * Not providing choices * Limited access to friends, independent visitors, advocates * Authoritative or disrespectful language or behaviour from staff * Entering service user’s/patient’s room without knocking. The public Interest Disclosure Act 1998 Support for alerters - The following information is extracted from the guidance to The Public Interest Disclosure Act 1998. People have in the past often been deterred from ‘whistle blowing’ about abuse or neglect by duties of confidentiality/and/or fear of the consequences of speaking out. The Public Interest Disclosure Act seeks to protect disclosure of the following: * Criminal offence(past, ongoing or prospective) * Failure to meet a legal obligation * A miscarriage of justice * Health and safety being endangered- risk of environmental OR deliberate concealment of any of the above. The act envisage that disclosure about such malpractice will generally be made in the first instance to the person’s employer, or another person or body who appears responsible for the malpractice, e.g. (relative of a resident reporting matters to managers of a home). The act envisages employers establishing procedures, so that the staff who have justified concerns about breaches of practice or the law can pass on these concerns to be investigated. Confidential alerters are only protected by the Act if they are acting in good faith and reasonably believe that their allegations are true. Staff making disclosures to people other than their employerare likely to be protected if : * they reasonably believe that they will be treated detrimentally for disclosing to the employer; or * they reasonably believe that the evidence will be destroyed or hidden if the employer is ‘tipped off ; or * the employer has been told, but has not taken appropriate action Disclosures to third parties has to be a reasonable step in all the circumstance including: * whom one tells(e.g. disclosure to a statutory inspectorate in preference to the press) * how serious the concern is and whether it is a continuing problem. * Whether the employer has a whistle-blowing procedure and if so, whether the employee has followed it. In addition, if the failure is ‘exceptionally serious’(a term not define in the act ), it may be justified to the whistle-blower to disclose to a third part in the first instance, rather than their employer. A disclosure made in accordance with the act’s expectations will mean that: * No confidentiality clause in an employment contract can be use to prevent one from disclosing relevant breaches of the law or practice. This means that confidentiality terms in employment contracts cannot be used by employers who are responsible for breaking a law, or for abuse or neglect or other malpractice. * Dismissal on grounds of disclosure within the term of the act is automatically unfair and can be challenged before the Employment Tribunal. Someone who is treated detrimentally at work because of making a disclosure which is protected by the act can claim compensation at the employment tribunal. The Do’s if someone discloses they have been abused * Do remain calm and try not to show any shock or disbelief. * Do take what you have been told seriously – even if the person is confused . * Do demonstrate an empathic approach by trying to think that it might feel like to be in their present position .you can never really know what it will feel like to that person but empathy is attempting to do that . * Do talk to the person some more without interrogating him/her. * Do say that they have done the right thing by sharing the information with you. * Do say that you are treating the information seriously. * Do say that the abuse is not their fault (if the information is being shared by the person who is being abused) * Do observe the person and take note of their body language. * Do remind the person about the bounds of confidentiality but explain that you are required to share the information only with your manager. * Do ascertains the facts – what has happened and when. * Do ask the person what he/she wants to do. * Do reassure the person , that any further investigation will be conducted sensitively and with their full involvement, wherever possible. * Do reassure the person that the service will take steps to support and where appropriate protect them in the future. The local and organisational system for safeguarding 1. Court protection This is an office of the supreme court and an application is normally made by the nearest relative but could also be made by the social worker , doctor, other relative , friend, etc. If the judge is satisfied after hearing medical evidence that a person is incapable by reason of mental disorder of managing of administering their property and affairs then the judge may ‘ with respect to the property and affairs of a patient, do or the secure the doing of all such thing as necessary or expedient (a) for the maintenance or other benefit of the patient , (b) for the benefit or other benefit of the patient’s family, (c) for making provisions for other persons or purposes for whom or which the patient might be expected to provide if he were not mentally disordered or (d) otherwise administering the patients affairs. Problems: * The court has control and the system is costly to administer ,confusing and remote.The costs are charged to the individual * Only applies to business and financial affairs * All or nothing. No partial control or control in consultation with the person. No sense pf progression towards independence. 2. Enduring power of Attorney Act 1985 Since the act came in a person with capacity may appoint an ‘attorney’ to manage his/her finances even after the person who has made the appointment loses mental capacity. You cannot apply for ‘enduring power of attorney if a person is confused and does not have the capacity to make the appointment . Problems: * The person has to have the capacity to make the appointment * Only applies to business and financial affairs * All or nothing . No partial control or control in consultation with the person 3. Lasting powers of attorney The Mental Capacity act 2005 has made provision for people to choose someone to manage not only their finances and property should they become incapable, but also to make health and welfare decisions on their behalf. They will be able to do this through a lasting power of attorney (LPA). LPAs replaced enduring power of Attorney in 2007 , when the mental capacity act came into force , although EPAs made before this time will still be valid . 4. Social Security Appointees . Under the social security (Claims and Payments ) Regulations 1987 if a person who is in receipt of or entitled to such benefit is ‘ unable to act ‘ then the secretary of state may appoint another person to act on that person’s behalf. The other person may then collect the benefits and use them for the benefit of the claimant. 5. Access to funds. Some pensions funds , insurance policies , building societies make provision in the contract for payments to be made to someone other than the customer, in the event of the customer lacking ‘ mental capacity’ when the payment fall due. 6. Guardianship (Mental Health Act 1993) A vulnerable adult can be received into guardianship by the local authority if they have a mental illness, severe mental impairment or mental impairment associated with ‘abnormally aggressive or seriously irresponsible conduct’. The Guardianship must be in the ‘interests or welfare of the adult or protection of other persons. There is a necessity to consult with the nearest relative. If the nearest relative is the perpetrator application can be made under the Mental Health Act 1983 to displace the nearest relative .The grounds being that they ‘are withholding their consent unreasonably’. There are three basic powers which the guardian can have : * To direct where the adult is to live * To require the adult to attend medical treatment, occupation , education or housing( this only requires the person to attend not to actual treatment of the adult) * To gain access to the adult at a place in which someone is living An application is made by the approved social worker or nearest relative. Two doctors must confirm that the person is suffering from one of four specified categories of mental disorder of a nature or degree which warrants reception into guardianship and it is necessary in the interests of the patient’s welfare or for the protection of others. The Guardian must be a local social services authority or person approved by the social services authority for the area in which the guardian lives. Patients must be over 16 of age. 7. The Declaratory Jurisdiction. In 1990in a case regarding the sterilization of a person with learning disabilities the Law Lords held that as English Law has no procedure whereby a substitute or proxy can be appointed to take medical decisions for an incompetent patient then the declaratory jurisdiction should be used to fill the gap. The declaratory jurisdiction is a right of thr High Court to declare whether a particular act would be unlawful or not. 8. Protective Powers The National Assistance Act 1948 allows social services to apply for a ‘ Removal Orders’ powers and arises in relation to people who are suffering from a grave chronic disease or are aged , infirm or physically incapacitated and are living in unsanitary conditions. It must be shown that they are unable to devote proper care and attention to themselves and are not receiving it from others. And to conclude is a list of Relevant statues and Bills Care Standard Act 2000 Carers and Disable Children Act 2000 Carer’s (Recognition and services) Act 1995 Chronically Sick and Disable Personals act 1970 Court of Protection derived from part VII of Mental Health Act 1983 Data Protection Act 1998 Declaratory Jurisdiction Disability Discrimination Act 1995 Disable Persons (Services, Consultation and Representation ) Act 1986 Enduring power of Attorney Act 1985 Guardianship (Mental Health Act ) 1983 Health act 1999 Health Services and Public Health Act 1968 Housing Act 1985 Housing Act 1996 Human rights Act 1998 Local Authority Social Services Act 1970 Mental Health Act 1983 National Assistance Act 1948 National Health Service and Community Care Act 1990 National Health Service Act 1977