Safeguarding Children and Vulnerable Adults for GP practices 2010

1. Safeguarding Children and Vulnerable Adults for GP practices2010

2. Background • Laming recommendations (2009) • Ensure all GP providers comply with child protection legislation • Ensure all GP’s have necessary skills and duties to carry out their duties (The Protection of Children in England : A progress report)

3. Further clarification of responsibilities • BMA letter to GP’s highlighting duty to maintain skills and competence in area of child protection (Nov 2009) • DH letter to all PCT Chief Executives outlining steps that PCT’s should take to support GP’s (Dec 2009) • CQC registration (requirement 2012)

4. Objectives On completion of the training, participants will: Be up to date with recognition and response and have a clear understanding of what to dowhen they have concerns about a child’s or vulnerable adult’s welfare Know where to access advice and guidance if concerned Be clear about their roles and responsibilitiesin respect of children in need and children who require safeguarding Know how to make a referral to Children’s/Adult’s Social Care Services Understand the statutory requirements governing consent, confidentiality and information sharing Know what safeguarding standards and processes require strengthening within General Practice.

5. WHAT IS SAFEGUARDING? Safeguarding and promoting the welfare of children is described as: • Protecting children from maltreatment • Preventing impairment of children’s health or development • Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care Working Together to Safeguard Children (DCSF 2010) • Remember continuum of need/early intervention

6. WHAT IS CHILD ABUSE? The term “child abuse” is used to describe a range of ways in which people, usually adults, harm children Disabled children are at greater risk of abuse

7. Race, ethnicity and culture Children from ALL cultures are subject to abuse and neglect. Cultural and religious factors should NOT be regarded as acceptable explanations for child abuse or neglect, and are not acceptable grounds for inaction when a child is at risk of significant harm.

8. Vulnerable adults-definitions • 18 or over • Who are, or may be in need of community care services because of learning/physical disability, older age or physical/mental illness. • Who are, or may be unable to take care of themselves, or unable to protect themselves from harm or exploitation by others.

9. Safeguarding adults • No statutory framework for safeguarding adults • No Secrets 2000 guidance • LA is lead agency –other statutory agencies invited to work in partnership • Similar process (referral/assessment/planning)

10. Lessons from Manchester SCR -remember • Neglect linked to adult issues e.g. domestic abuse/substance misuse/mental health) and need for early intervention*** • Missing health appointments (children and adults)*** • Take case histories into account • Child’s perspective/child focused • Need to strengthen significant contribution of GP’s***

11. 7 Golden rules for information sharing • Data Protection Act is not a barrier • Be open and honest • Seek advice • Share with consent if appropriate • Consider safety and well-being • Necessary, proportionate, relevant, accurate, timely and secure • Keep a record

12. Case Study • Single mum (26yrs) has been registered with practice for 3 yrs. She has 2 children aged 2yrs and 5yrs. Their father sees the children but does not live in family home. She is concerned that she is pregnant(10 weeks), not sure who the father is, and unsure what to do. She tells GP that she is feeling low and uses alcohol at night to help her relax. She says that she finds her 2 yr old son demanding and is sometimes afraid that she might hit him. • What do you consider are the risks? • What steps might you take? • Which other professionals could you speak to?

13. Children/adults Physical abuse Emotional abuse Neglect Sexual abuse Additional for adults Discriminatory Institutional Financial Domestic abuse Forced marriage Types of abuse

14. PHYSICAL ABUSE Burns Scalds Poisoning Shaking injuries Ligature marks Internal injuries Bruising on a baby Multiple bruises Bilateral black eyes Torn frenulum Bite marks Fractures “Actual or likely physical injury to a child, or failure to prevent physical injury or suffering to a child” Adults: Physical abuse includes hitting, slapping, pushing, kicking, squeezing, shaking, pinching, misuse of medication, undue restraint, force feeding.

15. NEGLECT Drug withdrawal in newborn Foetal Alcohol Syndrome Lack of stimulation Lack of supervision Failure to seek medical care Missed health appointments Failure to attend school or frequently late Unhygienic home conditions Neglected appearance Impaired growth Impaired development Voracious appetite Severe nappy rash / head lice Rampant dental caries Pot belly, thin hands, dry, sparse hair “The persistent failure to meet a child’s basic physical / psychological needs, likely to result in the serious impairment of health or development” For adults this Includes failure to access appropriate services for recognised needs, avoidance of required healthcare, ignoring physical care needs, withholding adequate nutrition, clothing or warmth, exposure to unacceptable risk, lack of action to provide/ensure adequate supervision.

16. SEXUAL ABUSE “Forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening” • Physical signs such as unexplained genital or rectal bleeding, recurrent UTI, STI • NOTE CHILDREN SHOULD ONLY BE EXAMINED BY DESIGNATED EXPERTS • Persistent and excessive masturbation • Sudden unexplained bedwetting or soiling • Precocious sexual knowledge or seductive behaviour • Pregnancy in underage girl especially where father’s identity is vague or secret • Symptoms of psychological distress, for example: • Introversion / depression • Eating disorders • Self-harming behaviour

17. Sexual abuse of adults • Includes sexual assault, rape or other sexual acts • Inappropriate touching • Coercion into viewing pornographic materials • Compelling, inciting or facilitating a person with impaired capacity for choice to engage in sexual acts without consent is an offence under the Sexual Offences Act 2003.

18. EMOTIONAL ABUSE Scapegoating Child may have to carry out tasks inappropriate to their age or development Overprotective and possessive behaviour of a parent Exposure to domestic abuse Frozen watchfulness Lack of comfort and love Lack of attachment Lack of praise/encouragement Lack of appropriate stimulation Lack of continuity of care Inconsistency of parenting Harsh discipline Negative comments “The persistent emotional ill treatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development” Psychological abuse of adults includes: threats of harm, abandonment, withdrawal from social contact/family networks, isolation, humiliation, shouting, bullying, name calling, intimidation, harassment or denial/withdrawal from required services.

19. Domestic abuse Domestic abuse Multi-agency group defines domestic abuse as: “Any incident of threatening behaviour, violence or abuse (physical, sexual, financial or emotional) between adults who are or who have been intimate partners or family members, regardless of gender or sexuality. This includes forced marriage.”

20. Impact for children • 90% children in same/next room during incident emotional abuse • Increasingly featured in Manchester SCR’s • Increased risk of physical abuse • Exposure to DA deemed to be emotional abuse

21. Resources available • Domestic Abuse Guidelines (intranet) • Women's Aid/Helpline/MARAC/IDVA and much more…. • Training available (will come to you!) • Lisa Ryder and Lisa Wisher –Specialist trainers for domestic abuse • Contact on 958- 4031

22. OTHER ISSUES TO BE AWARE OF Fabricated or Induced illness (prev.Munchausen's) “Home Alone” Domestic abuse and forced marriages (IDVA service) Female Genital Mutilation (prev. female circumcision) Child trafficking and private fostering Child Pornography Sexual Exploitation (prev.child prostitution) Guns and Gangs Peer abuse (abuse carried out by another child or young person)

23. WHAT DO I DO IF I SUSPECT A CHILD/ADULT IS BEING ABUSED?

24. Safeguarding Children Team Based at Rusholme HC Tel 0161 861 2250 Out of hours service (urgent matters only relating to children) 07811 462573 Adult Safeguarding Coordinators (also willing to offer training in your practice) Based at Claremont Resource Centre, Rolls Crescent, Hulme 0161 219 6830 Where to get advice?

25. HOW TO MAKE A REFERRAL Complete Multi-Agency Referral Form (copy in pack, intranet pages and MSCB website: www.manchesterscb.org.uk) Put in as much detail as possible and attach supporting evidence if you have it Contact Centre Tel Number 255-8250 Fax number is 255- 8266 Best practice to fax written referral within 24 hrs

26. Child Protection Clinic at Moss Side HC (Mon-Fri for children over 18 months) Sexual Assault Referral Centre (St Mary’s) (adults and children) Acute paediatric units for children aged under 18 months and out of hours. What happens next?

27. Safeguarding in General Practice – next steps • **Identify safeguarding lead for practice** • **Translate GP toolkit into practice (lead and policy)** • Support to General Practice (Safeguarding team/GP Steering group/e learning and targeted training) • Strengthen systems (ID and link vulnerable children/adults within families)

28. Next steps cont… • Develop a “Think Family “ approach (assess adults as potential parents/carers • **Develop an info sharing policy (draft toolkit) • Flagging system (Read codes)

29. Thank you!