Adult Safeguarding: Legislative Framework, Roles, and Responsibilities

1. Councillors' briefing: Adult Safeguarding 2019 To cover: Legislative framework What’s changed Roles and responsibilities Local multi-agency policy and procedures Useful links Jane Elliott Tončić Strategic Safeguarding Lead (Adults)

2. What is adult safeguarding? • Adult safeguarding is concerned with: • protecting people’s right to live in safety, free from abuse and neglect • duties apply to adults with care and support needs who may not be able to protect themselves • organisationsworking together to prevent and deal with people facing the risk of or the actual experience of abuse or neglect. • Some of the high profile cases include the deaths of Stephen Hoskin and Gemma Hayter, and investigations into Winterbourne View and Mid Staffs hospitals (links provided)

3. Legislation • Unlike for Children’s Safeguarding, up until 2015 there had been no direct legislation • From April 2015, The Care Act 2014 put adult safeguarding on a firm legal footing and set out a new statutory framework to clarify the roles and responsibilities of local authorities and other organisations • It was revised later in 2015 and updated guidance was issued in February 2016

4. Local authority duties • Under the Care Act 2014, the local authority must: • make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect • set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the Police and the NHS (specifically the local Clinical Commissioning Group/s) • arrange, where appropriate, for an independent advocate to represent and support an adult who has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate adult to help them • cooperate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect. • Despite calls for them, it provides no powers for the LA to enter a person at risk’s accommodation without permission. This suggests that there are already sufficient powers under current legislation governing powers of the police and mental health practitioners

5. Local authorities’ roles and responsibilities • Safeguarding is now seen as a crucial aspect of local authority work. The Care Act 2014 states that the local authority is the lead agency with overall responsibility for safeguarding locally. • It also links to many local agendas and partnerships, including: • police and criminal justice • care quality • disability hate crime • community safety and cohesion • domestic abuse including forced marriage • support for carers

6. The role of Councillors • The LGA notes crucial roles for councillorsin examining: • how safeguarding is experienced by local people • how people were consulted and involved in developing policies and monitoring services • how they were involved in their own safeguarding plans and procedures. • Adult safeguarding policy and practice is moving rapidly into a new era where ensuring values such as preventing harm and promoting dignity, empowerment and choice form the basis of any practice and are taken as seriously as the numbers of safeguarding concerns and the results of enquiries into failures.

7. The role of Councillors • As community leaders championing the wellbeing of your constituents, you are in a position to raise awareness of adult safeguarding. You may become aware of individual cases of abuse or neglect through your work with constituents, and have a duty to report it. • Growing awareness of the prevalence of abuse makes it all the more urgent and necessary for councillors to take action locally to ensure that everyone, including professionals, the voluntary sector and the general public, are made aware of: • abuse and neglect of adults, how to recognise and report it • who is responsible for intervening • what people’s rights are to protection, support, choice and advocacy.

8. 6 principles of safeguarding adults Empowerment - Presumption of person led decisions and informed consent. Protection - Support and representation for those in greatest need. Prevention - It is better to take action before harm occurs. Proportionality – Proportionate and least intrusive response appropriate to the risk presented. Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. Accountability - Accountability and transparency in delivering safeguarding

9. What’s Changed – terminology and definitions • The term ‘vulnerable adult’ is no longer in use; the preferred term is now ‘adult at risk (of abuse or neglect)’. • Safeguarding duties apply where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) - • has needs for care and support (whether or not the authority is meeting any of those needs), and • is experiencing, or is at risk of, abuse or neglect, and • as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it • it must follow up any concerns about either actual or suspected abuse. It must make enquiries, or cause others to do so, regardless of whether it is providing any services.

10. Categories of abuse • Domestic abuse – including violence, psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence, coercion or controlling behaviour • Sexual abuse – including inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, or sexual acts to which the adult has not consented or was pressured into consenting • Psychological abuse – including threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks • Financial or material abuse – including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits

11. Categories of abuse • Discriminatory abuse – including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion • Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation • Neglect and acts of omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating. • New criminal offences involving ill treatment or wilful neglect by care providers under S 20/21 Criminal Justice & Courts Act 2015

12. Categories of abuse • Self-neglect: • covers a wide range of behaviour, including neglecting to care for one’s personal hygiene, health or surroundings, and hoarding disorders • often notified to us as a result of community concerns/complaints • presents a range of challenges to frontline workers who have to balance the capacitated person’s right to self determination with our duty of care • New multi-agency policy and practice guidance developed in response to local and national case reviews: http://plysab.proceduresonline.com/chapters/p_risk_man_self.html

13. Categories of abuse • Modern slavery: • encompasses slavery, human trafficking, forced labour, domestic servitude and inhumane treatment • Operation Triage 2016, National Crime Agency weeks of action • All council staff have been made aware of recent Home Office guidance specifically developed for public sector staff • Several awareness raising sessions have been delivered across sectors and agencies • Public information on our website: • https://www.plymouth.gov.uk/crimeandantisocialbehaviour/modernslavery • Safer Plymouth have developed the local multi-agency guidance: • https://www.plymouth.gov.uk/sites/default/files/TacklingModernSlaveryHumanTrafficking.pdf

14. What’s changed - practice • Making Safeguarding Personal agenda - a major change in practice in a move away from the process-led, tick box culture to: • a person centered approach which aims to achieve the outcomes that people want • ‘no decision about me without me’ - the adult, their families and carers work together with agencies to find the right solutions to keep them safe and support them in making informed choices • practice that focuses on what the adult wants, and accounts for the possibility that individuals can change their mind on the outcomes they want throughout the course of the intervention • best practice guidance includes working with someone towards achievable results should their stated desired outcomes be unrealistic

15. Who is responsible? Adult safeguarding is everyone’s business. Any person may recognise and report abuse or neglect and everyone can play a part in building communities where abuse does not happen. However, specialist skills are required to make the relevant enquiries. Key organisations include: • Councils • NHS organisations • Police and criminal justice agencies • CQC and other regulatory bodies • Providers of care • Voluntary and community sector agencies • Safeguarding Adults Boards • Health & Wellbeing Boards

16. Harm and Abuse Anyone can be at risk of harm, people may be harmed at home, in their communities, in a care home, at hospital, in college, at work or in community centres. People who harm adults at risk largely fall into four main categories: • Paid staff members or support workers • Family members, partners or carers • Friends, neighbours and members of the community • People who deliberately exploit adults they perceive as vulnerable to abuse; • While a lot of attention is paid, for example, to targeted fraud or internet scams perpetrated by complete strangers, it is far more likely that the person responsible for abuse is known to the adult and is in a position of trust and power.

17. SAC (Safeguarding Adults Collection)Annual government requirement • Collected by the Health and Social Care Information Centre; records details about safeguarding activity for adults aged 18 and over in England. • includes demographic information about the adults at risk and details of the incidents that have been alleged • designed to strengthen the information held nationally and locally on the incidence of abuse, supporting local authorities to reduce incidents of abuse and neglect, and to respond appropriately when incidents occur • more focused on the outcomes of safeguarding activity, supporting local authorities to identify areas for improvement, and enabling the sharing of learning and expertise between councils

18. Raising a safeguarding concern • If you have witnessed or received a concern about possible abuse or neglect of an adult at risk, this can be reported to the PCC Contact Centre by ringing 668000 to raise a safeguarding concern • However, following the recent revision of the PCC website, Adult Care & Health was moved to the front page and contains an online referral form for professionals, enabling us to capture information accurately and feedback to the referrer: https://www.plymouth.gov.uk/adultcareandhealth/reportadultabuseorneglect • Information will be sent to the Retained Function team as a referral, who will gather information and hold a strategy discussion/meeting with key agencies • Priority will be to ensure that an immediate protection plan is in place for the adult at risk. Consent is required to share individuals’ information and/or that regarding their circumstances

19. Multi-agency policy and procedures manual • Public access is gained from our main PCC website: http://www.plymouth.gov.uk/homepage/socialcareandhealth/adultsocialcare/adultsafeguardingboard.htm • or the policy can be accessed direct: http://plysab.proceduresonline.com • It is arranged in clear ‘chapters’, and is regularly updated on legislation and guidance • There is a facility to register for update alerts by email.

20. Multi-agency online policy and procedures manual:

21. Adult safeguarding training • We deliver several courses in conjunction with Plymouth Safeguarding Adults Board (PSAB) including: • Adult Safeguarding (AS) training: aimed at staff across the city who may have contact with adults at risk • AS Enquiry training: aimed at staff who undertake safeguarding enquiries • Managers training: aimed at managers of provider services or other agencies who are responsible for staff awareness and internal processes • All training is multi-agency and reflects learning from Safeguarding Adult Reviews, current legislation and guidance • Further details: http://www.plymouth.gov.uk/homepage/socialcareandhealth/adultsocialcare/adultsafeguardingboard/asbprofessionals/asbadultprotectiontraining.htm • Email: adultsafeguardingtraining@plymouth.gov.uk • Tel: 01752 306360

22. Related legislation • Criminal Justice & Courts Act 2015 (new offences involving ill treatment or wilful neglect by care providers under S 20/21) • Modern Slavery Act 2015 • Counter-Terrorism and Security Act 2015 • The Equality Act 2010 • The Mental Capacity Act 2007 (incl. powers of the Court of Protection) • Deprivation of Liberty Safeguards (amended the MCA 2005) • Mental Health Act 2007 • Domestic Violence, Crime and Victims Act 2004 • The Human Rights Act 1988

23. Useful information • Revised Care and Support Statutory Guidance issued under the Care Act 2014, Dept. of Health: https://www.gov.uk/guidance/care-and-support-statutory-guidance/safeguarding • PCC Adult Safeguarding leaflet – can be downloaded and printed: http://web.plymouth.gov.uk/asc_safeguarding_leaflet_2018.pdf • SCIE adult safeguarding resources: http://www.scie.org.uk/adults/safeguarding/ • LGA Councillors’ Briefing (2015): http://www.local.gov.uk/documents/10180/11493/Councillors+briefing+Safeguarding+Adults+2015.pdf/318d4089-6707-4628-9159-a6c97714cf5e • ADASS/LGA Safeguarding Consolidated List of Resources (2015): http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/7521881/ARTICLE

24. Useful information • Modern Slavery : • https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328096/Modern_slavery_booklet_v12_WEB__2_.pdf • https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/652536/6.3920_HO_Modern_Slavery_Awareness_Booklet_web.pdf • Self neglect and adult safeguarding: http://www.scie.org.uk/publications/reports/report46.pdf • Think Jessica - campaign to protect elderly and vulnerable people from 'scams' and exploitation http://www.thinkjessica.com • Prevent Strategy (2011) : part of the government's counter- terrorism strategy, aimed at preventing radicalisation of vulnerable people: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/97976/prevent-strategy-review.pdf • Centre for Policy on Ageing: Financial Abuse of Older People http://www.cpa.org.uk/information/reviews/financialabuse240408%5B1%5D.pdf

25. Serious Case Reviews, Safeguarding Adults Reviews and Reports • Cornwall County Council (2007) The Murder of Stephen HoskinSCR: • MENCAP (2007) Death by Indifference: • Warwickshire County Council (2011) The Murder of Gemma Hayter SCR • DoH (2012) Transforming Care: a national response to Winterbourne View hospital • Francis Inquiry (2013) report on failings at Mid Staffordshire Hospital • Plymouth Safeguarding Adults Board (2017) SCR ‘V’: http://web.plymouth.gov.uk/serious_case_review_v_2017.pdf • Plymouth Safeguarding Adults Board (2017) SAR ‘RM’: • http://web.plymouth.gov.uk/safeguarding_adult_review_ruth_mitchell.pdf