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Protection of Vulnerable Adults
Multi Agency Procedures June 2008
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Safeguarding Adults Surrey Multiagency Procedures
2008
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This document is produced by Surrey Safeguarding Adults Board If you need more copies, it can be found on our website
http://www.surreycc.gov.uk/safeguardingadults
Safeguarding Adults Team Fairmount House Bull Hill LEATHERHEAD Surrey KT22 7AY Tel 01372 833520
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Foreword
Foreword
I am pleased to commend to you the revised procedures for the Surrey Safeguarding Adults Board. The procedures demonstrate the significance that the Board partners place on the importance of keeping up-to-date, ensuring practice is of the highest quality and ensuring that the Board develops its partnership working to protect some of the most vulnerable people in Surrey. There have been significant changes in many of the partner agencies and the procedures have been revised in part to reflect these changes. The procedures also reflect the changing role of the Board from Protection to Safeguarding along with new legislation in the form of the Mental Capacity Act and the Safeguarding Vulnerable Adults Group Act. The new procedures continue to emphasise the Government document “No Secrets” that encourages effective communication across all organizations. Our aim as a Safeguarding Board is to raise awareness of what constitutes abuse, how it can be identified and investigated and the strategies can be employed to prevent its occurrence.
Andy Roberts Strategic Director for Families Surrey County Council
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As part of their commitment, the following key agencies have signed up to the Surrey Multi-Agency Safeguarding Adults Procedures Signed of behalf of Surrey County Council Richard Shaw - Chief Executive
Signed on behalf of Surrey Police Jerry Kirkby, Temporary Assistant Chief Constable
Signed on behalf of the District and Boroughs Richard Woodward - Director of Community Services, Tandridge District Council.
Signed on behalf of Epsom and St Helier University Hospitals NHS Trust Samantha Jones - Chief Executive
Signed on behalf of Ashford and St Peter's Hospitals NHS Trust Paul Bentley - Acting Chief Executive
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Signed on behalf of Frimley Park Hospital NHS Foundation Trust Andrew Morris – Chief Executive
Signed on behalf of Royal Surrey County Hospital NHS Trust Nick Moberly – Chief Executive
Signed on behalf of Surrey and Sussex Healthcare NHS Trust Gail Wannell – Chief Executive
Signed on behalf of Surrey and Borders Partnership NHS Foundation Trust Fiona Edwards – Chief Executive
Signed on behalf of Surrey Primary Care Trust Chris Butler – Chief Executive
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Part A: Policy
A.1
Introduction............................................................................................... 11
A.1.2 A.1.3
Vulnerable adult definition and definition of abuse......................... 11
A.2 A.3 A.4
Context .......................................................................................... 12 Statement of principles............................................................................. 12 Prevention ................................................................................................ 14 What constitutes abuse? .......................................................................... 14
A.4.1 A.4.2 A.4.3 A.4.4 A.4.5 A.4.6 A.4.7 A.4.8 A.4.9
Physical abuse............................................................................... 15 Sexual abuse ................................................................................. 15 Neglect........................................................................................... 15 Psychological / emotional abuse.................................................... 15 Financial / material abuse .............................................................. 15 Abuse of individual rights / discriminatory abuse / racial abuse ..... 16 Professional abuse ........................................................................ 16 Institutional abuse .......................................................................... 16 Domestic Abuse............................................................................. 16
Part B: Procedures
B.1 B.2
Concern about a vulnerable adult - flowchart ........................................... 18 Safeguarding Adults Multi-agency process .............................................. 19
B.2.1 B.2.2 B.2.3 B.2.4 B.2.5 B.2.6 B.2.7
Safeguarding Adults Referral......................................................... 19 Record Keeping ............................................................................. 20 Monitoring and Report (Eforms)..................................................... 21 Safeguarding Adults planning meeting .......................................... 22 Suspected or actual abuse by a vulnerable adult .......................... 23 Safeguarding Adults Investigation ................................................. 24 Issues relating to capacity / consent / coercion consent and confidentiality/Informed consent/consent to treatment/consent to sexual activity/people unable to give consent................................................................................... 26 Safeguarding Adults conference.................................................... 31 Safeguarding Adults conference process ...................................... 34 Review of Safeguarding Adults conference ................................... 35
B.2.8 B.2.9 B.2.10
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B.2.11 B.2.12 B.2.13 B.2.14 B.2.15 B.2.16 B.2.17 B.2.18
Role of the Independent Chairperson ............................................ 35 Safeguarding Adults Senior Strategy Investigation ........................ 37 Psychotherapy and counselling ..................................................... 39 Vulnerable adults who make repeated or unfounded allegations... 39 Serious untoward incidents (SUI) .................................................. 40 Sex offenders and dangerous offenders ........................................ 40 Multi-agency protection panel arrangements (MAPPA) ................ 41 Multi Agency Risk Assessment Conference (MARAC) .................. 42
Part C: Roles and responsibilities
C.1
Referral Process....................................................................................... 43 C.1.1 Any individual becoming aware of potential abuse should take action to: ..................................................................... 44 C.1.2 The role of Adults Social Care or Integrated Teams (including Mental Health) .............................................................. 45 C.1.3 The role of the Police ..................................................................... 46 C.1.4 The role of the Surrey & Borders Partnership NHS Trust .............. 48 C.1.5 The role of the Acute NHS Trust.................................................... 49 C.1.6 The role Primary Care Trust .......................................................... 49 C.1.7 The role of the Districts and Boroughs........................................... 50 C.1.8 The role of the Emergency Duty Team .......................................... 50 C.1.9 The role of Emergency Services.................................................... 52 C.1.10 The role of Trading Standards ....................................................... 53 C.1.11 The role of Relatives and Carers ................................................... 53 C.1.12 The role of Voluntary Agencies/Independent/Private Providers..... 55 C.1.13 The role of Supporting People Team ............................................. 55 C.1.14 The role of Domestic Violence Service Outreach Providers and Refuge Providers .................................................................... 55 C.1.15 The role of the Advocate................................................................ 55 C.1.16 The role of the Independent Mental Capacity Advisor (IMCA) ....... 56 C.1.17 The role of the Crown Prosecution Service.................................... 57 C.1.18 The role of the Intermediary........................................................... 58 C.1.19 The role of the Appropriate Adult ................................................... 60 C.1.20 The role of the Interview Supporter................................................ 61 C.1.21 The role of the Interpreter .............................................................. 62 C.1.22 The role of the Surrey Coroner ...................................................... 63
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C.1.23 C.1.24 C.1.25
The role of the Commission for Social Care Inspection ............... 64 The role of the Health Care Commission ..................................... 66 The role of the Mental Health Act Commission ............................ 66
C.2
Vulnerable adults who may witness abuse or a crime............................. 67
Part D: Complaints and whistle-blowing
D.1 D.2 D.3 D.4
Staff concerns .......................................................................................... 68 Person alleged to be responsible ............................................................. 69 Staff discipline and criminal proceedings.................................................. 69 Protection of vulnerable adults (POVA) register ....................................... 71
Part E: Confidentiality
E.1
Confidentiality........................................................................................... 73
Part F: Surrey Safeguarding Adults Board
F.1
Surrey Safeguarding Adults Board ........................................................... 75 F.1.1 Terms of reference ........................................................................ 75 F.1.2 Membership of the Surrey Safeguarding Adults Board .................. 76 F.1.3 Reporting and accountability.......................................................... 77 Local Safeguarding Adults Groups........................................................... 77 F.2.1 Terms of reference ........................................................................ 77 F.2.2 Membership of the Local Safeguarding Adults Groups.................. 78 F.2.3 Key priorities .................................................................................. 78 Training Sub Group .................................................................................. 78 F.3.1 Terms of reference ........................................................................ 78 F.3.2 Membership of the Training Sub Group ......................................... 79 Communication and Publicity Group ........................................................ 79 F.4.1 Terms of reference ........................................................................ 79 F.4.2 Membership of the Communication and Publicity Group ............... 80 Serious Case Review Group .................................................................... 80 F.5.1 Purpose of serious case reviews ................................................... 80 F.5.2 Criteria for conducting a serious case review ................................ 80 Policy and Performance Group ................................................................ 81 F.6.1 Scope............................................................................................. 81
F.2
F.3
F.4
F.5
F.6
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F.7
Terms of Reference ....................................................................... 81 F.6.3 Membership of the Policy and Performance Group ....................... 81 Quality Assurance/Audit Group ................................................................ 82 F.7.1 Terms of Reference ....................................................................... 82 F.7.2 Membership of the Quality Assurance and Audit Group ................ 82
F.6.2
Part G: Practice guidance and reference
G.1
G.2 G.3
G.4
G.5 G.6 G.7 G.8 G.9
G.10 G.11 G.12 G.13 G.14 G.15 G.16 G.17 G.18 G.19
General indicators of abuse/thresholds for intervention ........................... 83 G.1.1 General indicators of abuse ........................................................... 83 G.1.2 Thresholds for intervention ............................................................ 87 Legal framework....................................................................................... 91 Mental Health Act 1983 ............................................................................ 91 G.3.1 Compulsory admission to hospital ................................................. 91 G.3.2 Guardianship ................................................................................. 92 G.3.3 Section 115: Entry and inspection ................................................. 92 G.3.4 Section 135: Application for a warrant to enter premises............... 92 G.3.5 Section 136: Place of safety .......................................................... 92 G.3.6 Section 127: Offences.................................................................... 93 G.3.7 Part VII of the Mental Health Act 1983: Protection of property and the court of protection ............................................... 93 Mental Capacity Act 2005......................................................................... 93 G.4.1 Deprivation of Liberty Safeguards.................................................. 95 The Official Solicitor ................................................................................. 95 National Health Service and Community Care Act 1990 .......................... 95 National Assistance Act 1948................................................................... 95 Human Rights Act 1998 .......................................................................... 96 Carers (Recognition and Services) Act 1995............................................ 96 G.9.1 The Carers and Disabled Children’s Act (2000) G.9.2 Carers Equal Opportunities Act 2004............................................. 97 The Care Standards Act 2000 .................................................................. 97 Safeguarding Vulnerable Adults Group Act .............................................. 98 The Sexual Offences Act 2003................................................................. 99 Family Law Act 1996 .............................................................................. 100 Protection from Harassment Act 1997.................................................... 101 Youth Justice and Criminal Evidence Act 1999 ...................................... 101 Crime and Disorder Act 1998 ................................................................. 101 The Fraud Act 2006................................................................................ 102 Domestic Violence Crime and Victim’s Act 2005.................................... 102 Corporate Manslaughter......................................................................... 103
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G.20 G.21 G.22 G.23 G.24 G.25
Race Relations Act 1976 (amended 2000)............................................. 104 Disability Discrimination Act 1995 .......................................................... 104 Sex Discrimination Act 1975................................................................... 104 The Public Interest Disclosure Act 1998................................................. 104 The Freedom of Information Act 2000.................................................... 104 The Data Protection Act 1998 ................................................................ 105
Part H: Contact addresses and telephone numbers
Emergency Duty Team, Contact Centre, Surrey Police (& Crimestoppers) .... 106
Part I: Helpful local and national organisations........................... 107 Part J: Relevant local and national guidance ............................... 110
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Part A: Policy
A.1
Introduction
This document is intended to provide an overall framework for best practice, and multiagency co-operation in all work relating to Safeguarding Adults in Surrey. Each agency has its own operational procedure to support this document. This policy document will be used when dealing with all vulnerable adults where abuse is suspected and/or reported. Some instances of abuse will constitute a criminal offence. In this respect vulnerable adults are entitled to the protection of the law in the same way as any other member of the public. In addition, statutory offences have been created which specifically protect those who may be incapacitated in various ways. Examples of actions which may constitute criminal offences are assault, whether physical or psychological, sexual assault and rape, theft, fraud or other forms of financial exploitation and certain forms of discrimination, whether on racial or gender grounds as well as wilful neglect or ill-treatment. Alleged criminal offences differ from all other non-criminal forms of abuse in that the responsibility for initiating action invariably rests with the state in the form of the police and the Crown Prosecution Service. Accordingly, when complaints about alleged abuse suggest that a criminal offence may have been committed, it is imperative that reference should be made to the police as a matter of urgency.’ (‘No Secrets’: Guidance on developing and implementing multi agency policies and procedures to protect vulnerable adults from abuse. March 2000) Criminal investigation by the police takes priority over all other lines of enquiry.
A.1.2
Vulnerable adult definition and definition of abuse
A vulnerable adult is a person aged 18 years or over 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 maybe unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation. (Who decides? 1997 Lord Chancellor’s Department and ‘No Secrets’ 2000) Whether or not a person is vulnerable in these cases will depend upon surrounding circumstances, environment and each case must be judged on its own merits Abuse is a violation of an individual’s human and civil rights by any other person or persons or organisation. 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 omission to act, or it may occur where a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent.
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A.1.3
Context
Abuse of vulnerable adults can occur in any setting or any situation and can be a complex area of work. Abuse may occur in domestic, institutional and public settings: • • • Domestic settings: including their own home, or another person's home. Institutional settings: including day care, residential care, nursing homes and hospitals. Public settings: including in the street, any public area or social or work environment.
Abuse of vulnerable adults occurs in all cultures, all religions and all levels of society. The abuser may be anyone, including a member of the family, friend, neighbour, partner, carer, stranger, care worker, manager, volunteer, another service user or any other person who comes into contact with the vulnerable adult.
A.2
Statement of principles
The following principles have been adopted by all agencies and professionals working together to protect vulnerable adults. 1. All vulnerable adults have a right to be protected and their decisions respected even if that decision involves risk. 2. The prime concern at all stages will be the interests and safety of the vulnerable adult. 3. The aim will be to give a professional service to support and minimise distress to any vulnerable adult. 4. Everyone will be treated sensitively at all stages of the investigation. 5. The importance of professionals working in partnership with the vulnerable adult and others involved, will be recognised throughout the process. 6. All services will be provided in a manner that respects the rights, dignity, privacy and beliefs of all the individuals concerned and does not discriminate on the basis of race, culture, religion, language, gender, disability, age or sexual orientation. 7. Adults who have been abused need the same care and sensitivity whoever the alleged abuser. 8. The responsibility to refer the vulnerable adult thought to be at risk rests with the person who has the concern. 9. All agencies receiving confidential information in the context of a vulnerable adult investigation will make decisions about sharing this information in appropriate circumstances.
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10. Procedures provide a framework to ensure that agencies work together for the protection of vulnerable adults. They are not a substitute for professional judgement and sensitivity. 11. Vulnerable adults have the right to have an independent advocate if they wish, at any stage in the process.
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A.3.
Prevention
Each agency / organisation has a duty to provide accessible information for users, carers, and the general public. Agencies / organisations must ensure that staff have an awareness of the possibility of abuse, that they have received training and that procedures are in place to deal with any disclosure of abuse. This would include, for example, an understanding of the type of situations where abuse is likely to occur, the analysis of risk and the importance of recording and sharing information. Safeguarding adults information should be provided to staff and managers through induction training; basic awareness training and multi agency safeguarding adults training. Agencies / organisations are also expected to have a clear ‘Code of Conduct’ in place for all staff, which sets out the standards of conduct expected of staff, especially in relation to personal and sexual relationships between people in a position of trust and vulnerable adults (See ‘Caring for Young People and the Vulnerable’ Home Office Guidance 1999). Internal guidelines should also cover the rights of staff, responsibilities of employers and policies to respond to violence and abuse directed at staff members. In order to prevent abuse, agencies / organisations 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 to operate within it. These will include guidance on: • • • • • • • • • •
•
identifying vulnerable adults who are particularly at risk routes for making a referral and channels of communication within and beyond the agency assurances of protection for whistleblowers (see Part D) working within agreed operational guidelines in relation to: challenging behaviour personal and intimate care physical interventions sexuality medication handling user’s money and risk assessment and management.
A.4
What constitutes abuse?
Abuse is a violation of an individual’s human and civil rights by any other person or persons. 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
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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. Abuse can be broadly defined under the following categories: see also G.1.1 for general indicators of abuse.
A.4.1
Physical abuse
The non-accidental infliction of physical force that results (or could result) in bodily injury, pain or impairment. Examples of behaviour: hitting, slapping, pushing, burning, physical restraint, harassment, enforced sedation, inappropriate use of medication, and catheterisation for management ease.
A.4.2
Sexual abuse
Direct or indirect involvement in sexual activity without capacity and/or consent. Examples of behaviour: Non-contact: looking, photography, indecent exposure, harassment, serious teasing or innuendo, pornography. Contact: coercion to touch, e.g. of breast, genitals, anus, mouth, masturbation of either self or others, penetration or attempted penetration of vagina, anus, mouth, with or by penis, fingers, and/or other objects.
A.4.3
Neglect
Ignoring or withholding physical or medical care needs. Examples of behaviour: failure to provide: appropriate food, shelter, heating, clothing, medical care, hygiene, personal care; inappropriate use of medication or over-medication.
A.4.4
Psychological / emotional abuse
Psychological abuse is that which impinges on the emotional health and development of individuals. It also presents with other forms of abuse. Examples of behaviour: shouting, swearing, insulting, ignoring, threats, intimidation, harassment, humiliation, depriving an individual of the right to choice and privacy.
A.4.5
Financial / material abuse
The unauthorised, fraudulent obtaining and improper use of funds, property or any resources of a vulnerable person. Examples of behaviour: misappropriating money, valuables or property, forcing changes to will, denying the vulnerable adult the right to access personal funds.
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A.4.6
Abuse of individual rights / discriminatory abuse / racial abuse
Abuse of individual rights is a violation of human and civil rights by any other person or persons. Discriminatory abuse consists of abusive or derisive attitudes or behaviour based on a person’s sex, sexuality, ethnic origin, race, culture, age, disability or any other discriminatory abuse - this includes Hate Crime. Forced Marriage It should be noted that forced marriage is an abuse of human rights and falls within the definition of adult abuse. The Foreign and Commonwealth Office has issued draft guidance entitled ‘Young people and vulnerable adults facing forced marriage – practice guidance for social workers’. There is also a website www.fco.gov.uk/forcedmarriage
A.4.7 Professional
abuse
Professional abuse is the misuse of therapeutic power and abuse of trust by professionals, the failure of professionals to act on suspected abuse/crimes, poor care practice or neglect in services, resource shortfalls or service pressures that lead to service failure and culpability as a result of poor management systems/structures. Examples of behaviour: entering into a sexual relationship with a patient/client, failure to refer disclosure of abuse, poor, ill-informed or outmoded care practice, failure to support vulnerable adult to access health care/treatment, denying vulnerable adults access to professional support and services such as advocacy, service design where groups of users living together are incompatible, punitive responses to challenging behaviours, failure to whistle-blow on issues when internal procedures to highlight issues are exhausted.
A.4.8 Institutional
abuse
Institutional abuse occurs when the lifestyles of individuals are sacrificed in favour of the rituals, routines and/or restrictive practices of the home or care setting. Examples of behaviour: lack of individualised care, inappropriate confinement or restrictions, sensory deprivation, inappropriate use of rules, custom and practice, no flexibility of bedtimes or waking times, dirty clothing or bed linen, lack of personal possessions or clothing, deprived environment or lack of stimulation, misuse of medical procedures
A.4.9
Domestic Abuse
Surrey uses the term domestic abuse to reflect the wide range of behaviours involved beyond physical violence but the term domestic abuse describes the same behaviours and is still widely used nationally.
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Although some agencies may also have their own definitions, (often nationally developed for their agency or service areas) the Home Office definition has been used within the Surrey strategy and is as follows Domestic abuse is: “Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality. An adult is defined as any person aged 18 years or over and family members are defined as mother, father, son, daughter, brother, sister and grandparents, whether directly related, in-laws of step-family.” The definition has been widened by the government to incorporate violence by family members as well as between adults who are or were intimate partners. It should also be noted that this could include a vulnerable person, adult or child, who is living in an environment where they are witnessing domestic abuse. All victims of domestic abuse should be treated with compassion and according to their own individual needs, without making assumptions or stereotyping. Resources will be directed, where necessary, towards the vulnerable person and those most at risk of repeat victimisation. People who meet the criteria of a vulnerable adult as defined in section A.1.2 of the Procedures and who are the subject to domestic abuse, must be initially referred through the safeguarding adults process. See also Section B.2.18 Multi Agency Risk Assessment Conference (MARAC)
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Part B: Procedures
B.1 Concern about a vulnerable adult - Flowchart
CONCERN ABOUT A VULNERABLE ADULT
Surrey County Council Contact Centre 08456 009 009
Police
Contact either
SCREENING/CONSULTATION
NO
Refer to another agency Review Care Plan Assessment of need No further action
Within 4 hours
YES
IS THIS POSSIBLE ABUSE?
Is this large scale, complex or allegations against SCC member of staff?
Within 3 working days
Convene Safeguarding Adult Planning Meeting Plan investigation Who takes the lead? Who supports the vulnerable adult?
YES NO
Convene Senior Strategy Meeting (at any time during process)
Investigation
Decision point/continue investigation
Safeguarding Adult Protection Conference
Within 15 working days of completion of the investigation
Decision point/convene conference
Review of Safeguarding Adult Protection Conference
Decision point/convene conference
Within 3 months
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B.2
Safeguarding Adults Multiagency Process
Adults Social Care or Integrated Health Teams (including Mental Health), will co-ordinate the response relating to any allegation within the Surrey boundary whether the vulnerable adult is an alleged victim or a perpetrator. This process is sequential, but can be concluded at any stage following an agreed multiagency decision that the safeguarding adults route is no longer appropriate There is an expectation that other local authorities would investigate on our behalf if a Surrey service user were resident in an out of county placement. Surrey, as the placing authority, would continue to have a duty of care to the alleged victim/perpetrator within the remit of the investigation. There is a reciprocal expectation that Surrey would investigate an allegation involving a service user placed within the Surrey boundary by another local authority.
B.2.1
Safeguarding Adults Referral
If an agency or individual has a safeguarding adults concern, this should initially be discussed with the Surrey Contact Centre (08456 009 009). Referrals are received by the Contact Centre or front line teams. Whoever receives the referral has a responsibility to ensure the details are taken and the referral is processed in accordance with Surrey County Council Procedure S I5 (see S.Net Forms and Procedures database) Where the alert relates to an allegation of abuse that has occurred within Surrey involving a service user funded by another Local Authority, it is the responsibility of Surrey (the host authority) to co-ordinate the Safeguarding arrangements under the Surrey Multiagency Safeguarding Procedures. The placing authority (i.e. the authority with funding/commissioning responsibility) will have a continuing duty of care to the vulnerable adult and will maintain their responsibility for the longer-term care needs of that individual. (Section 3.8 of 'No Secret's (DoH 2000) and LAC (93) 7 Ordinary Residence. Following referral, the first priority is to ensure the immediate safety of the vulnerable adults and the preservation of any evidence. A decision will be taken within 4-hours between Adults Social Care or Integrated Health Teams (including Mental Health), and the Police, as to who will lead the investigation, and to take whatever action may be necessary to safeguard the individual and/or others. At this stage there are four possible courses of action: a) Where it is felt that a criminal offence may have taken place, the Police will take the lead in the investigation or b) Where it is felt that no criminal offence has taken place, Adults Social Care or Integrated Health Teams (including Mental Health), will co-ordinate the investigation or
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c) Following discussion, it is not felt appropriate to pursue a Safeguarding Adults Investigation or d) Other actions determined e.g. review, complaint etc A decision on how to proceed will be made by the relevant Team Manager or equivalent and will be dependent on the Assessment of Seriousness. Reference should be made to the Thresholds of Intervention Protocol and Assessment of Seriousness in the decision making process (see SI 5 Forms and Procedures Database). Consideration must be given to how and when the vulnerable adult will be enabled to be part of the process. Where vulnerable adults are clearly able to make choices, they must be advised of the options available, and their wishes respected, unless, exceptionally, a statutory responsibility to intervene arises or there is a risk to others. If agencies are to enable people to experience both the opportunities and challenges of an ‘ordinary life’, some risk-taking is essential. In jointly determining appropriate action, every effort must be made to enable vulnerable adults to express their wishes in a way that is appropriate. Basic human and civil rights must be respected. Our values are underpinned by the principles set out in the Mental Capacity Act 2005 and Human Rights Act 1998. It should be noted that where an individual has capacity they must retain the right to make what maybe seen as eccentric or unwise decisions. Where an individual does not have capacity any action taken on their behalf should be the least restrictive of their basic rights and freedoms. If the referral/allegation is large scale or complex, or involves a member of Surrey County Council staff, a Safeguarding Adults Senior Strategy Meeting must be convened (see Part B.2.12)
B.2.2
Record keeping
Throughout the investigation detailed factual records must be kept, including the date, time and circumstances in which conversations or interviews are held. Wherever possible handwritten contemporaneous notes should be taken and retained as these may be required to be submitted in the future should any criminal prosecution take place or where in the case of a registered care service the authority decide to take legal action against a provider which may result in the cancellation of registration or prosecution. Whenever a complaint or allegation of abuse is made all agencies must keep clear and accurate records. Where a service provider is registered with the Commission for Social Care Inspection, records of incidents must be made available to the relevant officer. If the alleged abuser is a service user then information about his or her involvement in an safeguarding adults investigation, including the outcome of the investigation, should be included in the confidential section or ‘safeguarding adults’ section of his or her case records. It is recommended that all Surrey County Council case files, which contain safeguarding adults information, be retained for thirty years from the last point of contact with the service
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user, or ten years from the death of the service user, whichever is sooner. These records should be reviewed when the retention period comes to an end. Either they should be destroyed confidentially or they should have their retention period extended for a reasonable period if, on a case-by-case basis, there is still a need to keep a particular file. Partner agencies should follow their own guidelines regarding file retention. All safeguarding adults records must be compliant with the Human Rights Act 1998 and the Data Protection Act 1998. They are subject to Caldicott principles in the case of health and social care records and to the same confidentiality protocols as are operated by the agency, so far as reasonably practical. All agencies should identify arrangements, consistent with the principles of fairness, for making records available to those affected by and subject to investigation. Each agency should also identify procedures for incorporating, on receipt of a complaint or allegation, all relevant agency and service user records into a file to record all action taken. Requests for access to safeguarding adults documentation must be processed in accordance with the rights and exemptions to access detailed in the Freedom of Information Act 2000 and the Data Protection Act 1998. These requests should be handled in accordance with the agency’s procedures and always in consultation with the other agencies involved.
B.2.3
Monitoring and Reporting (E Monitoring Forms)
In order to collate accurate information on Safeguarding Adults referrals, an Eform should be submitted by front line operational staff at one of the following stages: • • • At the referral stage if there is no further action in relation to Safeguarding Adults; or After the Safeguarding Adults Planning Meeting if it is agreed that there will be no further action in relation to Safeguarding Adults; or After the Safeguarding Adults Conference when the outcomes will be recorded on the Eform
Eforms provide: • A monthly updated dataset which provides a record of all referrals back to 1st January 2006 and enables the Safeguarding Adults Team to search for key information to respond to queries from teams; and A Quarterly performance report detailing a series of graphs and data items which informs a variety of different stakeholders.
•
(Nb further detailed information on the process for Eforms can be found in Appendix 8 of the S I5 Procedures)
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B.2.4
Safeguarding Adults Planning Meeting
If a decision is made to convene a Safeguarding Adults Planning Meeting, this must be held within three working days of receipt of the referral. However, if this is not achieved, the reason why must be recorded. An investigation should not be delayed whilst waiting for a Safeguarding Adults Planning Meeting to be convened. Any interim action taken must be agreed by the relevant Team Manager or equivalent. The safety and well being of the individual is paramount. A Safeguarding Adults Planning Meeting between Adults Social Care or Integrated Health Teams (including Mental Health), and the Police can be held by telephone if urgent intervention/investigation is required, and recorded on the designated template. In either case, clear records of the meeting must be kept. At this stage, there must be clear delineation of responsibility and it should be clear about what can/cannot be said to the vulnerable adult involved. As the vulnerable adult may be isolated, it could be an appropriate time to involve an independent advocate at this early stage; the advocate should be appropriately skilled. The chairperson of this meeting will be a Team Manager or equivalent. They will be responsible for ensuring that a record of the meeting and its outcome is made and distributed (where appropriate) within 15 working days to all relevant agencies within the Caldicott principles. When an Safeguarding Adults Planning Meeting is convened, the Team Manager or equivalent within Adults Social Care or Integrated Health Teams (including Mental Health), will be responsible for: • • • • • • Setting the objectives of the meeting Ensuring appropriate representation Ensuring the meeting is held within the stated timescales (except in exceptional circumstances – in which case, clear reasons must be given and recorded) Ensuring an effective communication strategy is in place (e.g. referrers, employer, alleged perpetrator etc) Ensuring risks are identified and recorded Ensuring that the agreed actions are completed
Invitees – Consideration should be given to inviting the following representatives: • • • • • Care Manager/Social Worker/CSW or any other involved worker Care Co-ordinator Commission for Social Care Inspection Officer Health Care Commission/Mental Health Act Commission Police Representative
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• • • • • •
Health Representative (e.g. psychiatrist, community nurse, PCT representative) Legal Services Service Provider (e.g. residential home, day services, support services) Other Local Authority Service Users/Carers/Advocates Independent Mental Capacity Act Advocate (IMCA)
The alleged incident The meeting itself should consider: • • • • • • • • • • • •
B.2.5
Is there a need to investigate? (it may not always be appropriate, following the sharing of information, to proceed with the Safeguarding Adults process) Who is best to investigate the allegation of abuse and carry out any risk assessment? The time scale of the investigation The wishes of the vulnerable adult and the potential role for an advocate Any special needs of the vulnerable adult The needs of the vulnerable adult, such as the placement, or ongoing support The likelihood of media attention Who should be the key worker and liaise with the vulnerable adult? The safety and well-being of other vulnerable adults The timing and need for further Safeguarding Adults Meetings, including whether this meets the thresholds for a Safeguarding Adults Senior Strategy Meeting Consideration is given to any parallel proceedings (e.g. Regulatory Action, Health and Safety issues, Serious Untoward Incidents and Disciplinary Process) Where appropriate, a person should be nominated to appoint a joint investigator
Suspected or actual abuse by a vulnerable adult
It must be recognised that a vulnerable adult can be an offender as well as a victim. In this case, if a crime has been committed, it must not be assumed that the alleged perpetrator does not know the difference between right and wrong. Where there is an allegation made that a vulnerable adult may be, or is abusing others including the carer or care worker, the correct procedures, in relation to the victim/s, must be followed, including Child Protection and/or Domestic Abuse and/or Safeguarding Adults procedures, as appropriate. Investigators working with vulnerable adults as alleged offenders, should be of sufficient experience and have undertaken appropriate training. Where the abuse is so serious that it constitutes a criminal act, the Police must be consulted and will determine how the investigation is to proceed. The Police alone are
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responsible for interviewing the vulnerable adult who is a suspect, although it will be necessary in most cases for an Appropriate Adult to be present during the interview.
B.2.6 Safeguarding Adults Investigation
Where the vulnerable adult has the capacity to make decisions regarding their present and future circumstances, they should have the opportunity to discuss the possible options with a professional. The vulnerable adult’s wishes should be paramount, unless a legal responsibility to intervene exists. Where there are issues around capacity and potential legal proceedings, a formal assessment should be undertaken in accordance with the Mental Capacity Act 2005. An Independent Mental Capacity Advocate (IMCA), may also be considered at this stage. These actions will run alongside the investigation. (see C.1.16) Consideration should also be given at this stage to the potential role that could be played by family members, but this may not always be appropriate. If a vulnerable adult is deemed to lack capacity, then the responsibility to make a decision on behalf of that person rests with professionals acting in the best interests of the vulnerable adult following assessment and in accordance with the Mental Capacity Act. The purpose of the investigation and role of the investigator(s) The purpose of the investigation is to establish: • • • • • • Has abuse/crime occurred? The type of abuse and circumstances The risk to the vulnerable adult or others To take any immediate action to prevent further abuse if necessary The level of understanding of the risk by the vulnerable adult Where disciplinary action may be required on the part of the employer
The investigation into the circumstances of the vulnerable adult as the alleged perpetrator/offender will need to focus on; • • • The assessment of risk to other vulnerable adults or children (see Surrey Safeguarding Children Procedures) The abusive behaviour, including any pattern that may have developed The alleged perpetrator/offender as a vulnerable adult who might have been, or continues to be the subject of abuse him/herself
The role of the nominated investigator(s) is to: • • • Gather and preserve evidence Assemble background information Identify and liaise with other relevant agencies
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• • •
Interview the vulnerable adult if appropriate Carry out a risk assessment to assess present and future levels of risk, and the vulnerable adult’s ability to understand the risk Feedback to all relevant agencies regarding the progress of the investigation.
When the investigation is concluded, notify all relevant parties, including the initial referrer • • Make recommendations as to further action needed following investigation e.g. disciplinary, complaint If care staff are involved, agree who, if anyone, should interview them about the allegations that have been made. Under no circumstances should Families Directorate employees undertake staff interviews Where it is thought that no crime has been committed (following consultation with the Police) and where the employee has been directly employed e.g. via Direct Payments or via an Introduction Agency, the responsibility for the investigation lies with the service user and/or family as the employer.
•
Initial contact with the vulnerable adult The initial contact with the vulnerable adult by the nominated investigator will determine what course of action should be taken. The Investigator/s should gather and collate information and consider the following: • • The ability of the vulnerable adult to communicate Their means of communication - consideration should be given to how the vulnerable adult communicates, i.e. specific language, Makaton, Communication Board, or language other than English. This will reflect on the way questions are framed/language used and how sentences are constructed The degree of disability What the alleged incident was and where it occurred When the alleged incident occurred. This may be particularly significant when considering the collection of forensic evidence The perception of the vulnerable adult Any relevant background information Issues of capacity (i.e. the understanding of the vulnerable adult in relation to various decisions which are made during the course of the investigation) Informing the vulnerable adult about the process and what will happen next Recognition of the possible continuing emotional attachment a vulnerable adult as a victim may have for their abuser
• • • • • • • •
The same consideration needs to be taken into account when interviewing a vulnerable adult who is an alleged perpetrator.
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Issues relating to Mental Capacity/Consent/Coercion/Consent and Confidentiality/Informed Consent/Consent to Treatment/Consent to Sexual Activity/People unable to give Consent
B.2.7
Mental Capacity Mental Capacity is defined in the Mental Capacity Act 2005 (MCA) as the ability to make a decision. This includes the ability to make decisions which affect a person’s daily life or decisions that may have legal consequences – for them or others. Capacity can vary over time and according to circumstances. The MCA and the Code of Practice outlines the test to be used when assessing decision-making capacity. Mental Capacity can be assessed by anyone who may need to take an action or make a decision for someone who lacks the capacity to make that decision. Therefore in most circumstances it is not necessary to seek an independent opinion. In complex situations, e.g. borderline capacity or fluctuating capacity, where capacity is disputed or where there is a likelihood of legal proceedings a specialist (clinical) assessment may be required. Consent For consent to be valid the following factors need to be present: • • • • • Understanding what is proposed based on age, maturity, developmental level, functioning and experience Knowledge of society's standards for what is being proposed Awareness of potential consequences and alternatives Voluntary decision (i.e. without undue pressure or coercion – see below) Mental Capacity (see above)
Coercion It is important not to confuse mental incapacity to make a decision with decisions that are made subject to coercion or other pressures. The person who offends/abuses may use techniques like bribing, manipulation and emotional threats of secondary gains and losses, i.e. loss of love, friendship, etc. Some may use physical force, brutality or the threat of these regardless of victim resistance. For many vulnerable adults, valid consent may not have been given because of a number of barriers to consent that exist that may not directly link to mental incapacity. These include: • • • • the presence of a parental or familial relationship between the persons involved the presence of a custodial or care taking relationship between the persons involved the use of a weapon, threat of injury, or use of force by the first person the presence of a power imbalance between them, which precludes consent by the weaker person
The following questions may be used as a helpful guide in looking at a particular incident: • What is the nature of the relationship between the perpetrator and the victim?
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• • • • • • • •
How sophisticated is the activity; is the type of activity age-appropriate? How often and for how long did the activity take place? Has it become more frequent, severe or socially unacceptable? Is there overt aggression, coercion or bribery? What is the experience of the abused person? Have any of the individuals involved attempted to secure secrecy? How was the activity revealed; was it disclosed by either the victim or the perpetrator or was it discovered? Does the abuser appear to target a particular type of victim?
If during the course of an interview with the alleged perpetrator, under the Police and Criminal Evidence Act 1984 (PACE), they make an allegation of being a victim of abuse, the Police will make a referral to Adults Social Care or Integrated Health Teams (including Mental Health), and the normal Safeguarding procedures will be followed. The timing of the referral will depend on the circumstances. In such circumstances a second investigator from the appropriate agency will be appointed to investigate the alleged perpetrator as a victim. This is in order to avoid conflict of interest. All those involved with the provision of care for vulnerable adults in a twenty-four hour care setting must be alert to the possibility of abuse by other vulnerable adults. When another vulnerable adult, resident in the home, allegedly causes the abuse, it is necessary to apply the procedures to both the alleged abuser(s) and the victim(s). When the authority looking after both the abuser(s) and the victim(s) is also the investigating authority, it is considered vital that there should be an independent monitoring of the department's response to this type of complaint. Consent and Confidentiality Vulnerable adults have a right to be full participants in decisions being made about their lives as far as is practicable. Even if the person lacks the mental capacity to consent to the proposed protective measures, they should still be consulted and involved in the decisionmaking process as far as practicable. In these circumstances consideration should be given to appointing an Independent Mental Capacity Advocate (IMCA) under the MCA (refer to IMCA guidelines). Informed Consent The Mental Capacity Act 2005 is now the primary legislation that informs our professional understanding regarding mental capacity and the ability to give informed and valid consent in certain situations. The MCA is based on five key principles • • A person must be assumed to have capacity unless it is established that they lack capacity. A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success.
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• • •
A person is not to be treated as unable to make a decision merely because they make an unwise decision. An act done, or decision made, under the Act for or on behalf of a person who lacks capacity must be done, or made, in their best interests. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the persons rights and freedom of action.
These statutory principles aim to a) protect people who lack capacity and b) help them take part, as much as possible, in decisions that affect them. They aim to assist and support people who may lack capacity to make particular decisions, not to restrict or control their lives. Consent to treatment If a person has the mental capacity to consent to an examination or treatment any healthcare professional must be given that consent before carrying out any such examination or treatment. If there is doubt about the person’s mental capacity then a mental capacity assessment must be carried in accordance with the MCA Code of Practice. If the person lacks capacity then it is the responsibility of the person proposing the examination or treatment to carry out the mental capacity assessment and satisfy themselves that it is both necessary and in their best interests for the examination or treatment to be carried. Unless there is consent or a reasonable belief based on evidence that the person lacks capacity, that the action is in the persons best interests and that the action is the least restrictive option, the person carrying out the action can be accused of assault. Where the treatment is deemed to be ‘serious medical treatment’ as defined in the MCA Code of Practice and the person lacks capacity and there is no one else available or practicable to consult with, other than a paid carer, an IMCA must be appointed. In most cases health professionals cannot legally examine or treat a patient without his or her valid consent. Therefore the vulnerable adult has to: • • • • Have the capacity to give consent Be given appropriate information prior to giving that consent Give that consent to the particular treatment/examination proposed, and Give that consent voluntarily
Capacity to give consent This depends on the nature of the treatment/examination proposed as well as the ability of the vulnerable adult.
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Some people have the capacity to consent to some decisions and not to others. It should never be assumed that a person can take no decisions for themselves, just because they have been unable to take a particular decision in the past. Consent should not be confused with your assessment of the reasonableness of the decision. People are entitled to make a decision based on their own religious belief or value system, even if that decision is thought by others to be irrational, eccentric or will put them at risk. Compliance is not the same as consent. All relevant parties must use appropriate strategies to maximise the chance that persons will have the capacity to make decisions. This might include using specific communication strategies, providing information in more accessible form, or treating an underlying mental disorder to enable a person to regain capacity. The process carried out to assess a person’s capacity and the final decision taken must be recorded by the assessor/investigator/s. Vulnerable adult unable to give consent A person is unable to make a decision if they cannot: • • • • understand relevant information about the decision to be made retain the information in their mind use or weigh that information as part of the decision-making process or communicate their decision (by talking, using sign language or any other means)
In circumstances where the vulnerable adult is not able to give consent and a decision needs to be made on their behalf that decision made or action taken must be made or taken in their best interests. Best interests Best interest is not defined in the Mental Capacity Act but rather a framework/checklist is given to help decision-makers determine what is in a person's a best interest. In common law it has been defined as ‘Necessary to save life or prevent deterioration or ensure improvement in the patient's physical or mental health.’ however this definition refers primarily to medical treatment but the MCA and the concept of best interests extends to a wider range of welfare, health and financial decisions. In deciding whether to act or make a decision in the person’s best interests the following checklist should be considered: • • • • Working out what is in a persons best interests cannot be based simply on someone’s age, appearance, condition or behaviour All relevant circumstances should be considered when working out someone’s best interests Every effort should be made to encourage and enable the person who lacks capacity to take part in making the decision If there a chance that the person will regain the capacity to make a particular decision, then it may be possible to put off the decision until later if it is not urgent
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• •
Special considerations apply to decisions about life-sustaining treatment (see MCA Code of Practice) The persons past and present wishes, feelings, beliefs and values should be taken into account as well as the views of an attorney or court-appointed deputy*.
*NB. If a Lasting Power of Attorney (LPA) or an Enduring Power of Attorney (EPA) has been made and registered, or a deputy has been appointed under a court order, the attorney or deputy will be the decision-maker, for decisions within the scope of their authority. • Is the proposed action or decision the least restrictive option to achieve the desired outcome?
Consent to sexual activity Prior to the Sexual Offences Act 2003 there had been no statutory definition of consent in the context of sexual offences legislation. There is now a statutory definition set out in section 74 of the Act; “…. a person consents if he agrees by choice and has the freedom and capacity to make that choice.” There will be a presumption that consent is absent in the following circumstances: • • • • • Where at the time of the act, violence is used or threatened against the complainant or causes the complainant to fear that immediate violence would be used; Where at the time of the act, the complainant fears that violence will be used against another person Where the complainant was unlawfully detained at the time of the act Where the complainant was asleep or otherwise unconscious at the time of the act Where because of the complainant’s physical disability, the complainant would not have been able at the time to communicate to the defendant whether the complainant consented Where any person caused the complainant without the complainant’s consent, to take a substance capable of causing the complainant to be stupefied or overpowered at the time of the relevant act
•
What this means is that in the circumstances outlined above, there exists an evidential presumption that the victim had not consented and it will be for the Defendant to rebut the presumption by showing that he had reasonably believed that the complainant had consented. (For sexual offences under the Act see G12)
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People unable to give consent The Mental Capacity Act 2005 outlines the circumstances under which a third party can make a decision or take an action for on behalf of someone who lack the capacity to make a particular decision at a particular time. As long as the action or decision relates to the care or treatment of a person who lacks capacity to consent, the person making the decision or taking the action is protected from liability as long as they have applied the principles in the MCA Code of Practice and: • • •
B.2.8
they reasonably believe that the person lacks the capacity to make that particular decision at the time it needs to be made and the action or decision is in the persons best interests and the action or decision is the least restrictive alternative
Safeguarding Adults Conference
A Safeguarding Adults Conference will be called within 15 working days of the end of the investigation. An additional period of time may be requested where the investigation is particularly complex. Reasons for longer delays must be identified, recorded and the relevant senior manager informed. A review of the Safeguarding Adults Conference may be held if deemed appropriate by the participants. A Safeguarding Adults Conference is not a forum for a formal decision that a vulnerable adult has been abused, neither does the Safeguarding Adults Conference have a statutory role in law. • • • • The meeting provides an opportunity to exchange information and devise a safeguarding adults plan. The meeting does not form part of the investigation process, but is a method of pooling resources and information. The meeting is the prime forum for sharing information and concerns, analysing risk and recommending responsibility for action. The meeting will recognise the inter-agency nature of assessment and management of the abuse of vulnerable adults and where appropriate, a risk management plan will be put in place. The meeting provides the opportunity to focus on the inclusion of the vulnerable adult and/or their representative A separate Safeguarding Adults Conference should be held in respect of both the vulnerable adult and the alleged abuser if they are also a vulnerable adult.
• •
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Objectives of the Safeguarding Adults Conference • To listen to and respect the wishes of the vulnerable adult, including acknowledging that person’s right to take risks (within the context of their capacity to make informed choices) To share and evaluate information gathered during the investigation. The information for consideration must include a chronology of key events from each agency To gather further information available to participants about the vulnerable adult and their circumstances To agree the level of risk to or from the vulnerable adult To agree safeguarding plans (where possible) for the safety and well-being and support of the vulnerable adult in the future. This will include the circumstances surrounding contact between the vulnerable adult and alleged perpetrator/s. To make recommendations to the authorities with legal powers about whether legal action needs to be taken To consider the legal context of any possible intervention To achieve a framework for inter-agency working and co-operation, including review Safeguarding Adults Conferences To clarify the roles and responsibilities of the various professionals involved To make arrangements for monitoring and reviewing the situation To agree future support for the vulnerable adult (see also Part B.2.13 Psychotherapy and Counselling)
•
• • •
• • • • • •
Attendees at Safeguarding Adults Conference All Safeguarding Adults Conferences will be chaired by an Independent Chair. The meeting will include those agencies who have information and can contribute to an understanding of the case. For the meeting to fulfil its purpose those professionals attending must have prepared full reports (written or verbal) for the meeting. The chairperson must be advised if this is not possible and the reasons. If it is not possible for the agency representative to be present at the meeting, a report must be submitted to the chair five working days prior to the meeting. The vulnerable adult, or their representative, has the right to attend the Conference and express their views and should be encouraged and enabled to do so. (This may include the attendance and support of an independent advocate or appropriate supporter, such as a carer). If the vulnerable adult chooses not to attend, they have the right to
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nominate an advocate or appropriate representative, such as a carer, to attend on their behalf. At the discretion of the chairperson, in discussion with the vulnerable adult and/or their representative, it may be deemed in the best interests that he/she only attends part of the meeting. The vulnerable adult or their representative may not attend part of the meeting if there is confidential third party information that needs to be shared amongst professionals. In the case of an independent advocate attending instead of the vulnerable adult, information that has been deemed not to be divulged to the client shall not be divulged to their representative. Where a vulnerable adult who is deemed to have capacity to make an informed decision does not wish to attend, their best interests must be addressed within the meeting forum and recorded within the notes. Their refusal to attend should not preclude the meeting from taking place and the attendance of an advocate on their behalf should be considered. The following should also be invited: • Care Manager/Social Worker/CSW or any involved worker • Police • An advocate/representative/supporter/interpreter as appropriate. • Independent Mental Health Act Advocate (IMCA) as appropriate Plus any of the following where they are involved: • • • • • • • • • • • • • • • • • • Commission for Social Care Inspection (where the service is registered or inspected) Health Care Commission Mental Health Act Commission Provider manager, if appropriate Representative from the Legal Services Proprietor of residential establishment and/or their representative Manager of day care services Housing Authority General Practitioner Psychiatrist Psychologist Emergency Duty Worker District Nurse/Community Nurse Health Visitor Therapists Probation Other Local Authority Any other responsible person who may be able to give relevant information appropriate to the situation.
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It may be appropriate to exclude one or more of the above for all or part of the meeting. The final decision rests with the chairperson who must discuss this with the relevant parties in advance. The number of people attending a Safeguarding Adults Conference should be limited to those who can contribute to the decision-making process.
B.2.9 Safeguarding
Adults Conference Process
The chairperson will be responsible for leading the process during the conference and the following format should be followed: 1. Identify name of subject, date of birth and address. 2. Participants will introduce themselves and state their role, agency and their contact with the vulnerable adult. 3. The independent chairperson will explain the reason for the meeting; give any apologies for attendance and emphasise the issues of confidentiality, equality and diversity. 4. From their report, the investigator/s will outline the details of the specifics of the allegation, level of risk, and actions taken to date or planned. These details to include events leading to the specific incident and any previous, relevant instances of abuse. 5. Introduce any other verbal report. 6. Introduce any other written report. 7. The vulnerable adult must be supported to express their views – the meeting will listen and respect those views and those given by their independent advocate or appropriate supporter. 8. A discussion will take place regarding the information provided by all parties. 9. The meeting will decide if the vulnerable adult is at risk. 10. A safeguarding adults plan should be agreed, identifying specific actions for each agency, as appropriate, with time scales. 11. Nominate an actions coordinator to liaise with the Independent Chair to ensure all recommendations are carried out 12. The vulnerable adult should be asked how they might wish to receive their copy of the notes; this may include their nominated person taking the notes to their home to read through or may require notes to be in an accessible format 13. Where the vulnerable adult has chosen not to attend or been unable to attend the conference for any other reason, a person must be nominated to inform the vulnerable adult of the outcome of the meeting. The nominated person must do all they can to ensure that the vulnerable adult understands the decisions/actions agreed and provide an opportunity for the vulnerable adult to make his/her wishes known. 14. Agree the arrangements to review/monitor the case. The chairperson will ensure that notes are sent out to all those invited to the meeting within 15 working days. Attendees will only receive the part of the notes relevant to the part of the meeting attended. Consideration should be given to the Caldicott guidance when notes are sent out, as far as reasonably practical. The outcome will be discussed in
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full with the vulnerable adult by a nominated person agreed at the meeting to ensure he/she is clear about the recommendations made. Where the vulnerable adult is able to make an informed choice and will not accept the recommendations of the meeting a full record of his/her comments must be made. Consideration will be given to the following: • Legal powers of intervention • Legal framework involved Where there is no legal power available to protect the vulnerable adult and they are deemed to be able to make an informed choice and choose to continue to live with the risk, either Adults Social Care or Integrated Health Teams (including Mental Health), or the Police must inform in writing the Surrey Safeguarding Adults Board (SSAB). Where a vulnerable adult does not have the mental capacity to make an informed choice as to whether to accept the outcome of the meeting consideration should be given to the following: • • Legal powers of intervention Legal framework involved
The civil rights of the vulnerable adult, as set out in the Human Rights Act, must not be infringed on the basis of not being able to make an informed choice and all efforts must be made to seek a reasonable outcome for the vulnerable adult.
B.2.10
Review of Safeguarding Adults Conference
All Safeguarding Adults Conferences will be followed up with a review within six months, unless it is deemed that a review should be held earlier or a further review is unnecessary. This will be recorded in the notes. This meeting will: • • Review the objectives set out in the safeguarding plan Note any significant changes in circumstances
• Modify the action plan in relation to new information if appropriate It is preferred that the same person should chair both the Safeguarding Adults Case Conference and any subsequent reviews.
B.2.11
Role of the Independent Chairperson
(or equivalent manager in Adults Social Care or Integrated Health Teams (including Mental Health) The chair is independent of the management of the case and acts in an impartial and objective way in conducting the conference and in reaching decisions and recommendations.
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The independent chairperson has an important role in the managing, planning and protection process and has the opportunity and responsibility for promoting an organisational culture which puts the needs of vulnerable adults first. The chair will also be instrumental in placing a high value on professional practice standards and the pursuit of positive outcomes for vulnerable adults. • • • The independent chairperson should not be directly involved with the investigation or the vulnerable adult. The independent chairperson is responsible for ensuring that the meeting is properly conducted and is accountable to the Surrey Safeguarding Adults Board. The independent chairperson will establish a culture of working co-operatively on a multi-agency basis. The independent chairperson will inform the forum of Surrey's equal opportunities and anti-discriminatory practice principles. Any statements made by attendees that are considered to be discriminatory will be challenged by or through the chair. The independent chairperson will establish, preferably through written reports and/or assessments, the structure of the meeting and remind attendees of its confidential nature. The independent chairperson will establish: 1. the precipitating incident 2. events leading up to the incident and action taken 3. any previous incidents or concerns The independent chairperson will ensure that the meeting comes to a decision as to whether the vulnerable adult is at risk. The independent chairperson will also make recommendations on inter-agency working and the dissemination of best practice.
•
•
• •
The independent chairperson will seek consensus on those decisions that the meeting can make. If agreement cannot be reached the chairperson has the final decision. Should the decision be against the majority view of the meeting it must be reported to the Surrey Safeguarding Adults Board (Part F.1). Any member of the meeting (including vulnerable adult, supporter/advocate, relatives and informal carers) may also register their dissent formally for the record and request that the matter is brought to the attention of the Safeguarding Adults Board as soon as possible, dependent on any perceived risks. At the discretion of the chairperson, people who did not attend the meeting, but who have a legitimate role in the safeguarding adults process, may also register their dissent, ideally in writing, to the chairperson within ten working days of the date of the meeting. All agencies need to agree that their role in any plan is immediately operable.
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B.2.12
Safeguarding Adults Senior Strategy Investigation
(Large scale or complex safeguarding adults cases – see also B.2.15 Serious Untoward Incidents) Safeguarding Adults Senior Strategy Investigations must be considered where: • • • • The allegation is complex, sensitive, political or high profile and therefore requires Senior Management involvement. Where one or more vulnerable adult/s may have been abused, typically, but not always, in an institutional setting. Where there is an allegation against a member of Surrey County Council Staff in order to prevent bias, as Surrey County Council lead this process Historical allegations, e.g. a number of vulnerable adults who disclose they were abused in care settings (as adults or as children).
Whilst the process of the investigation is being considered, other issues such as the removal of staff or relocation of residents must be discussed in order to maximise the gathering of evidence and minimise the distress caused to the vulnerable adult. If a situation arises that indicates the possibility of large-scale or complex abuse, it is the responsibility of the Team Manager or their equivalent to inform their manager of the details. In consultation with the Police and other investigating authorities, the senior manager will then decide whether or not a Safeguarding Adults Senior Strategy Meeting is indicated. An investigation should not be delayed whilst waiting to convene a Safeguarding Adults Senior Strategy Meeting. Safeguarding Adults Senior Strategy Meetings may be held either prior to the start of the investigation, during the investigation, or following the completion of the investigation. This decision must be made in consultation with and at the discretion of the senior manager involved. If, following the Safeguarding Adults Planning Meeting, a decision has been made to convene a Safeguarding Adults Senior Strategy Meeting, it is the responsibility of the relevant Service Manager/General Manager to: 1. Encourage all agencies to work together to achieve the best possible outcome. 2. Ensure any necessary action is taken to safeguard the vulnerable adult/s or any other person, which may include relocation or removal of staff, following careful consideration by the employer. 3. Ensure that disruption to any establishment is kept to a minimum subject to the requirements of the investigation and any necessary action. 4. Assess with the relevant agencies what resources may be required. Resources should be pooled if appropriate. 5. Give consideration to the consequent support/therapeutic work which may be needed by the vulnerable adult/s and their families following such investigations. 6. Make the necessary arrangements for convening the meeting, including invitations, venue and any secretarial support.
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Safeguarding Adults Senior Strategy Meeting should be chaired by a Service Manager/General Manger, or in specific circumstances, an Independent Chair The following people should be invited to all Safeguarding Adults Senior Strategy Meetings: • Service Manager/General Manager (Mental Health)/Independent Chair (Chair) • Senior Police Officer • Investigating Care Manager/Social Worker • Commission for Social Care Inspection Inspector • Health Care Commission, if appropriate • Mental Health Act Commission, if appropriate • Other Local Authority, if appropriate • Investigating Police Officer • Representative from County Council Legal Services • Appropriate senior managers from Health Services, PCT, Mental Health Trust • Where appropriate the manager of the establishment concerned • Independent person to provide independent oversight, where appropriate • HR where appropriate • Consideration should be given to any potential contributions that could be made by service users/carers. This could include inviting them to attend the Safeguarding Adults Senior Strategy Meeting, or by convening a separate meeting to discuss concerns. Care must be taken not to invite any person who may be subject to or involved in the allegation, i.e. line managers. In the case of investigations involving a Health Trust, the Trust Managers should be represented at any Safeguarding Adults Senior Strategy Meeting. It may be appropriate to consider inviting other professionals/agencies particularly if there are medical issues to be addressed or if other local authorities are involved. Such invitations should only be made after consultation with the chairperson. A Safeguarding Adults Senior Strategy Meeting should consider: • The most appropriate way to deal with the investigation • Extent and scope of the investigation, including timescales and general risk factors • Resource issues, e.g. number of investigators required, facilities for conducting interviews, gathering of forensic evidence and placements required if any vulnerable adult needs to be accommodated • Is the team likely to need a base away from the normal centre of operation? • Who should be notified of the investigation, by whom, and in what manner? • Who holds management responsibility if the investigation crosses boundaries?
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• The roles and involvement of other authorities who have placed vulnerable adults within Surrey • Requirements relating to confidentiality and access to records • Involvement of relatives • Appropriate interview plans • Other complex issues, such as sexually transmitted diseases • How to deal with media enquiries and notification of elected members County Council and District/Borough on a ‘need to know basis’ • Timescale for further Safeguarding Adults Senior Strategy Meetings • The risk to each vulnerable adult must be assessed and responses agreed. • The need, or the vulnerable adults wish for independent advocates • Support, consultation and supervision for staff In addition as a result of the abuse allegations there may be legal and/or criminal issues relating to the home’s ongoing registration with the Regulatory body, (Commission for Social Care Inspection), and in some exceptional cases an urgent closure of an establishment may be required to protect clients. In this instance the Senior Strategy Meeting must ensure that this legal imperative is not overlooked in the desire to conduct the investigation into the abuse allegations. (see Home Closure Protocol – see SI33 on Forms and Procedures Database).
B.2.13
Psychotherapy and counselling
Once an investigation has been completed and the Crown Prosecution Service has decided to proceed with legal action, then consideration should be given of how to support the service user. The primary duty of staff involved in the service user's care is to promote his or her health and welfare by providing any psychotherapy or counselling required, whether or not it relates to the specific incident. This primary duty must however, be balanced against the possible risk that the proposed psychotherapy or counselling might prejudice the legal proceedings. Before any such psychotherapy or counselling is started, the issues should be discussed with the service user's solicitor. (see also 'Provision of Therapy for Vulnerable or Intimidated Adult Witnesses Prior to a Criminal Trial' Practice Guidance - Home Office 2001)
B.2.14
Vulnerable adults who make repeated or unfounded allegations
Where a service user has made repeated allegations of abuse which have each been thoroughly investigated and found to be unsubstantiated, the service user’s multidisciplinary team together with the Care Manager/Social Worker can agree that making repeated allegations is part of the person’s normal repertoire of behaviour. This must lead to the development of a risk management plan and guidelines surrounding similar future allegations. All allegations must be dealt with and recorded as agreed in the risk management plan.
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B.2.15
Serious untoward incidents (SUI)
The County Council, PCT and NHS LD and MH Trust within Surrey have developed their own SUI policies, which are complementary to the Vulnerable Adults Procedure. These policies are developed in accordance with guidance issued by the Strategic Health Authority and the DOH. Where the Vulnerable Adult procedure is enacted the incident may be treated as a serious untoward incident. The SUI investigation process will be collaborative and complementary to the Safeguarding Adults Procedures. The agencies involved will agree at the initial Interagency Planning Meeting as to the joint reporting process and format to be used.
B.2.16
Sex offenders and dangerous offenders
Further to the Criminal Justice Act 2003 and guidance given by the Secretary of State, where there is clear evidence that a vulnerable adult may be an offender as defined by the Multi-Agency Protection Panel Arrangements (MAPPA), he/she must be referred to the Responsible Authorities (Police and the National Offender Management Service (NOMS) – formerly Prison and Probation Service). The legislation and guidance requires the Responsible Authorities to work closely together to manage the risks posed by dangerous offenders in the community. Offenders may fall into one of three categories: Category 1 - Registered Sex Offenders Convicted or cautioned since September 1997 of certain sexual offences. Offenders are required to register within three days of date of conviction, caution or release from prison. Category 2 - Violent and Other Sex Offenders Violent offenders who have received a sentence of 12 months or more including sex offenders who are not required to register (also applied to those detained under hospital/guardianship orders. Category 3 - Other Offenders Offenders who are not in Category 1 or 2 but because of the nature of the offences committed are considered to pose a risk of serious harm to the public: (i) it must be established that the person has a conviction for an offence which indicates that he is capable of causing serious harm to the public (ii) it must reasonably be considered that the offender may cause serious harm to the public
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Concerns about a vulnerable adult perpetrator/offender should be referred directly to one of the Responsible Authorities. There is a statutory duty for certain agencies to co-operate with the Responsible Authority. Currently they are: • Housing • Social Services • Local Education Authority • Youth Offending Teams • Department of Work and Pensions • Social Landlords • NHS Strategic Health Authority • NHS Hospital Trust • NHS Primary Care Trust
B.2.17
Multi-agency protection panel arrangements (MAPPA)
The Three MAPPA Levels In order that MAPPA can focus sharply on the ‘critical few’ in the assessment and management of risk, a three-level structure exists within each Area’s MAPPA: Level 1: involves a single agency, most commonly the probation service, managing the offender without the active or significant involvement of other agencies; Level 2: is used where the active involvement of more than one agency is required but where either the level of risk or the complexity of managing the risk is not so great as to require referral to Level 3; and, Level 3: referred to as the Multi-Agency Public Protection Panel (or MAPP). At this level senior representatives of relevant agencies are involved to co-ordinate the management of the very small number (the ‘critical few’) of high risk or difficult to manage MAPPA offenders. Cases that fall outside MAPPA In all cases where it is clear that there are significant concerns regarding the vulnerable adult's alleged abusive behaviour, a comprehensive risk assessment should be considered. Throughout this process it has to be recognised that the vulnerable adult has a right to choice. Every effort must be made to enable the vulnerable adult to understand the process and to take full part where possible. This may include the support of an independent advocate. Allegations of sexually inappropriate or abusive behaviour by a vulnerable adult can be extremely distressing for their family or carers. Typically family and/or carers may deny or minimise the behaviour. The importance of engaging with the family or carers at this early stage is crucial to ensure co-operation. Where the vulnerable adult is the potential/alleged abuser, the following should also be considered:
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• • • • • • • •
B.2.18
Degree to which responsibility for the behaviour has been accepted by the vulnerable adult The need to share relevant information with the wider community The level of risk/danger posed to themselves and others (including children where appropriate – refer back to MAPPA) The family background The family’s attitude to the concerns, including their level of co-operation The agreed intervention strategy Access to initial legal advice for the vulnerable adult Other forms of support the vulnerable adult may require
Multi Agency Risk Assessment Conference (MARAC)
MARAC is a multi-agency response to tackling Domestic Abuse (DA), which is Police led. In a single meeting, a Domestic Abuse MARAC combines up to date risk information with a comprehensive assessment of a victim’s needs and links those directly to the provision of appropriate services for all those involved in a case: victim, children and perpetrator. What are the aims of the MARAC? To share information to increase the safety, health and well being of victims – adults and their children; • To determine whether the perpetrator poses a significant risk to any particular individual and/or to the general community; also professional staff involved with DA cases; To jointly construct and implement a risk management plan that provides professional support to all those at risk and that reduces the risk of harm; To reduce repeat victimisation; To improve agency accountability; Improve support and safety for staff involved in high-risk DA cases; The responsibility to take appropriate actions rests with individual agencies; it is not transferred to the MARAC;
• • • • •
The role of the MARAC is to facilitate, monitor and evaluate effective information sharing to enable appropriate actions to be taken to increase public safety (See also Section A.4.9 Domestic Abuse)
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Part C: Roles and responsibilities
C.1
Referral Process
Who can refer Family members, carers, volunteers, paid care staff, professionals supporting or working with adults who are vulnerable, other service users and members of the general public can make referrals when they have a concern that a vulnerable adult may be abused, exploited or the victim of a crime. Anyone who knows or has a concern that a vulnerable adult has been abused and/or may be the victim of a criminal offence has a duty and responsibility to contact the Police or Adults Social Care or Integrated Health Teams (including Mental Health). People with concerns are also able to contact Crimestoppers (see Part H). What a referrer can expect All those making a complaint or allegation or expressing concern, whether they be staff, service users, carers or members of the general public, will 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 • Anyone who is perceived to be at risk will be given immediate protection from the risk of reprisals or intimidation • If staff, they have the right not to be subject to any detriment, or to be selected for dismissal or redundancy on the basis of having made a protected disclosure. Public Interest Disclosure Act 1998. (See Part D - Complaints and Whistle Blowing) • They will be dealt with in a fair and equitable manner • As far as it is possible, they will be kept informed of action that has been taken and its outcome Those reporting incidents or worries should follow the procedures for reporting and referral. Referrals can be made in writing or by telephone to Surrey Council Contact Centre or a local community team. The Surrey County Council Contact Centre provides the single point of access for all county council services through a variety of medium to raise a Safeguarding concern: Telephone: 08456 009 009 If telephoning you will be greeted by a welcome message and invited to press a number for Adults Social Care. Once you have pressed the appropriate number you will be put directly through to an Advisory Officer who will take details of your concerns. The Advisory Officer will pass any Safeguarding concerns immediately to the Contact Centre supervisor.
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It is the responsibility of the Supervisor to confirm the next steps with you, and ensure a safe and timely handover of any Safeguarding concerns to the appropriate social care team manager. It is the responsibility of the team manager to act upon any Safeguarding concerns within 4 hours. The Contact Centre has developed a memorandum of understanding with Surrey Police, Fire, Ambulance and Trading Standards, and have developed bespoke referral forms to promote the single point of access and facilitate good information sharing. When contacting the local community Adults Social Care or Integrated Health Teams (including Mental Health), ask to speak to the duty worker, not a clerk/receptionist and ensure that your concerns are passed on to an appropriate person. Make sure that you know the name of the person you are speaking to, report your incident, ask that you be kept informed of the outcome, make a record, report the date, time and name of the worker and follow up with a written referral to the named worker within three days. Advice and information regarding Safeguarding issues can be found on the Surrey County Council Web site on www.surreycc.gov.uk. The web pages do offer online enquiry forms, however it is not recommended that Safeguarding concerns are raised through this route.
C.1.1
Any individual becoming aware of potential abuse should take action to:
• • • • Listen to what the vulnerable adult is saying Only ask questions if you are concerned the vulnerable adult is at immediate risk of harm Safeguard the vulnerable adult, alerting emergency services if necessary Record the words of the vulnerable adult and accepting the statements as fact, record the full details, including the time, date and location that disclosure was made. All written notes must be made as soon as practicable and kept Discuss and negotiate with the vulnerable adult as to who will be informed and why (see Section E Confidentiality) Do not promise the vulnerable adult that what has been disclosed/witnessed will be kept secret or confidential. Their right to confidentiality is not absolute and may be over-ridden where there is concern or evidence that the individual or others may be at risk of harm or that a serious crime may have occurred Ensure that actions are taken to preserve possible forensic evidence that may assist an investigation Do not confront the alleged abuser as this could place you at risk, give the alleged abuser an opportunity to destroy evidence, or intimidate vulnerable victims or witnesses
• •
• •
The initial conversation should be regarded as a source of evidence. It is therefore important to listen and not ask leading questions which may suggest or invite an anticipated or acceptable answer, and to record the concerns precisely, as expressed by the vulnerable adult and referrer. This initial conversation may become the basis for a formal interview at a later date.
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The appropriate authorities to respond to referrals regarding the possible abuse of a vulnerable adult will be Adults Social Care or Integrated Health Teams (including Mental Health), and the Police. If there are concerns, a referral should be made direct to Adults Social Care or Integrated Teams (including Mental Health), or to the Police if a criminal offence may have been committed. Line management responsibility should be clearly specified in each agency's own procedures for dealing with allegations of abuse. All organisations working with vulnerable adults should have appropriate procedures in place for the referral of concerns to be dealt with quickly and effectively. A vulnerable adult may be in need of protection from someone close to them, this can include staff and volunteers working in voluntary or independent sector organisations. Where the person making the referral is concerned about the possible involvement of staff or a volunteer, or there is delay in dealing with the referral within the organisation, they should make a direct referral to Adults Social Care or Integrated Teams (including Mental Health), or the Police as appropriate.
C.1.2
The role of Adults Social Care or Integrated Teams (including Mental Health)
Co-ordination The Local Authority Social Services Department (Adults Social Care or Integrated Teams (including Mental Health), has the lead responsibility for coordinating investigations into suspected abuse of vulnerable adults even though another agency may take a lead in conducting the investigation. This means that Adults Social Care or Integrated Teams (including Mental Health), will be responsible for liaison with other agencies and coordination of their respective contributions to the investigative process. They will also be responsible for convening, chairing and recording Safeguarding Adults Planning meetings and Safeguarding Adults Conferences where Safeguarding Protection Plans will be agreed and decisions made to continue or close down investigations. Assessment Adults Social Care or Integrated Teams (including Mental Health), are required to assess vulnerable adults and carers who are or may be in need of community care services and now have strengthened guidance in ‘Fair Access to Care Services’ which includes safeguarding adult issues as a criteria for access to services. Adults Social Care or Integrated Teams (including Mental Health), are also in the process of designing a format for ‘Single Assessment’ with Health colleagues, some of which may include the assessment of risk of abuse as a specific section. Care Management As representatives of social services departments, care managers and social workers have responsibility to regularly review and reassess services. This role will include actions necessary to protect the vulnerable adult from abuse. Following a safeguarding adults concern, care managers/social workers have the following responsibilities:
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Receive referrals, safeguarding adults concerns and alerts (see Part B.2.1) Safeguard the interests of the vulnerable adult. Working alongside the vulnerable adult, the care manager/social worker will ascertain the needs and wishes of the person in relation to the abuse. Keeping the person central to the decision-making process is vital. Care managers/social workers are only empowered to make decisions contrary to express wishes of the person in circumstances where other vulnerable people are at risk or where the person lacks the mental capacity to make informed decisions to protect themselves. Safeguard the vulnerable adult. After any immediate remedial action has been taken, care managers/social workers may consider providing increased care services, removal of the risk or the review of contract or placement arrangements in order to safeguard the person. Provision of additional care services. Following a multi-agency meeting, care managers/social workers will carry out a risk assessment and put in place the necessary review and monitoring arrangements in conjunction with the vulnerable adult. Removal of person alleged responsible. This may not fall to care managers/social workers alone and will often depend on close joint working with Police, housing, CSCI and health colleagues and providers to remove the alleged abuser. Action to ensure the safety of others. Care managers and social workers are empowered to share information where they believe other vulnerable adults may be at risk of abuse. If the alleged perpetrator is also a vulnerable adult, this may include a review of the person’s support needs or placement, again in conjunction with CSCI, health colleagues and/or providers where appropriate. Joint Interviewing. Care managers and social workers have been trained to work with Police colleagues to joint interview vulnerable victims and witnesses in relation to crime and abuse (Youth Justice and Criminal Evidence Act 1999). This brings together care management and police skills in order to best support the vulnerable victim in giving their best possible evidence. Emergency Duty Team. To coordinate an ‘Out of Hours’ emergency response to urgent safeguarding adults referrals and concerns Statutory Powers. Adults Social Care or Integrated Teams (including Mental Health), have few direct powers in relation to the protection of vulnerable adults. However, there are a number of pieces of legislation and guidance which can be used, sometimes in conjunction with local authority, CSCI, Police or health colleagues to prevent abuse or protect adults in circumstances where they are being abused or neglected. (See Part G).
C.1.3
The role of the police
Surrey Police Public Protection Investigation Units (PPIUs) have a number of specialist officers who will investigate crimes committed against vulnerable adults (VA Specialists). They also have a range of officers engaged in investigations related to public protection;
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child abuse, domestic abuse, risk management of sex and dangerous offenders, and missing persons. These officers are supervised by a Detective Sergeant. VA specialists will investigate allegations of crimes against vulnerable adults falling into the following categories:
• • • • •
Where a relationship of care existed between the suspect and the victim at the time of the alleged offence. Where the suspect and victim are members of the same family (this includes extended family e.g. grandparents, uncles, cousins etc). Where the suspect is a person living in or regularly visiting the household in which the victim lives e.g. a relative or home help, meals on wheels. Where the suspect is in a position of trust in relation to the victim. (position of trust here will include those who regularly supervise, train or care for a vulnerable adult). Where the victim attends, resides or is receiving treatment or therapy in a day care or residential setting (This will include nursing homes and hospitals).
In all other cases, the allegation will be investigated by an investigator from another department in Surrey Police. Where possible, the investigating officer will prioritise a safeguarding investigation if members of staff have been suspended. VA officers will investigate the following categories of abuse committed against the vulnerable adults listed above; where it is more likely than not that a crime has occurred:
• • • •
Physical; Sexual; Financial; Neglect (under S127 Mental Health Act 1983 or under any other enactment where criminal neglect is suspected).
Where the above crimes involve lengthy, complex investigations or serious offences, it will be a decision for the VA Sergeant as to whether particular aspects of the investigation should be referred to other departments for assistance. In such cases or in certain categories of crime, for example where the Major Crime Investigation Team lead an investigation, the VA specialist will have a responsibility for co-ordinating a multi-agency response and will ensure that the multi-agency procedures are followed. If the VA Sergeant becomes aware that an investigation that falls within the categories listed above is being undertaken by any other department, he or she should ensure that the multi-agency procedures are followed and act as a link between external agencies and the investigating department. Evidence gathering The Police will always be responsible for the gathering and preservation of evidence, but other agencies and individuals who have the crimes reported to them have an important role in ensuring that evidence is not lost. Gathering oral evidence may now be by way of a video-recorded interview which can be presented to the court as a witness’s evidence-inchief. The presentation of video evidence is just one of a number of ‘special measures’ provided for in the Youth Justice and Criminal Evidence Act (1999) to help vulnerable and intimidated witnesses give their evidence. It is important to remember that if it is suspected that a crime may have been committed there will be a ‘crime scene.’ The scene may
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contain valuable evidence that should be left in situ and preserved until the arrival of Police. Any response in gathering and preserving evidence should be proportional with the best interests of the adult. The need to preserve evidence following an assault should be balanced with the need to treat and care for the victim. Where the informed consent of the victim is not present (see Part B.2.7: Consent & Confidentiality) it will be necessary for the Police and Adults and Community Care to consider alternatives, such as the victim's own GP, following discussion with the investigating officer. Sexual assault Where an allegation of a sexual assault is reported to an individual it must be reported immediately to the Police in order to preserve any potential forensic evidence. It is important if at all possible, not to allow the victim to use the toilet, wash, wash bedding or have a drink until the Police have attended, in order that vital early evidence may be preserved. Evidence may be gathered from the clothing worn at the time of the offence. The victim should not change their clothing, if there is the slightest possibility that the clothing was worn at the time of the assault. Any clothing not worn by the victim, but believed to have been worn at the time of the assault, should be put to one side for the Police. The scene of the assault should be preserved as a crime scene. If it is clear where the assault took place and this is a room or premises, no one should be allowed in. If this is where the victim is, nothing should be touched or moved unless absolutely necessary. Physical assault When a vulnerable adult has been physically assaulted there may be physical evidence of the offence. Bruises, marks or other injuries may need to be examined and noted by a Police Forensic Medical Examiner (FME) for evidential purposes. Police should therefore be informed immediately and a trained Police photographer will photograph any injuries.
C.1.4
The role of the Surrey and Borders Partnership NHS Trust
The role of NHS Trusts is to work in cooperation and collaboration with other agencies to ensure the safety and well being of any person deemed to be a vulnerable adult. The Trust has a duty of care to protect a vulnerable adult from neglect and abuse by providing medical advice, guidance and other professional help that is within its overall remit in a timely, effective and appropriate manner and will ensure that safeguarding adults standards are included in commissioning arrangements. The Trust will ensure that its staff are suitably trained to recognise risk factors that potentially might lead to abuse, identify actual abuse situations and bring such situations promptly to the notice of the statutory agency.
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The Trust will participate in any investigation, as coordinated by the lead agency or those employed by other agencies, while ensuring the care necessary for the vulnerable adult is provided or maintained at an appropriate level while the investigation process is going on. The Trust recognises that the investigation could involve its staff as witnesses to various circumstances or possibly having to face allegations of being directly or indirectly involved in the perpetration of alleged abuse. The Trust will ensure the Memorandum of Understanding between the Police, NHS and the Health and Safety Executive to investigate NHS patient safety incidents involving unexpected death or serious untoward harm, is considered alongside the Surrey MultiAgency Safeguarding Procedures.
C.1.5. The
role of the Acute NHS Trust
The role of Acute NHS Trusts is to work in cooperation and collaboration with other agencies to ensure the safety and well being of any person deemed to be a vulnerable adult. The Trust has a duty of care to protect a vulnerable adult from neglect and abuse by providing medical advice, guidance and other professional help that is within its overall remit in a timely, effective and appropriate manner. The Trust will ensure that a senior member of the organisation is named as the lead for safeguarding vulnerable adults. The Trust will adhere to Surrey’s Safeguarding Adults policy or develop their own in line with this policy to advise staff of the procedures for recognising and reporting concerns about potentially abusive situations. The Trust will regularly monitor and review local policies and procedures relevant to safeguarding vulnerable adults and will ensure that safeguarding adults standards are included in all commissioning arrangements. The Trust will ensure that staff are suitably trained and competent to recognise risk factors that may lead to abuse, identify actual abuse situations and bring such situations promptly to the notice of the statutory agency. The Trust will promote working practices that minimise the risk of abuse and encourage staff to report their concerns. The Trust will adopt robust recruiting measures to minimise the risk of abuse to service users. Where staff and service users do report concerns about abusive situations, the Trust will support and advise these individuals. The Trust will participate in any investigation, as coordinated by the lead agency or those employed by other agencies, while ensuring the care necessary for the vulnerable adult is provided or maintained at an appropriate level while the investigation process is undertaken. The Trust recognises that the investigation could involve its staff as witnesses to various circumstances or possibly having to face allegations of being directly or indirectly involved in the perpetration of alleged abuse.
C.1.6 The
role of the Primary Care Trust
Surrey Primary Care Trust (Surrey PCT) is responsible for providing and commissioning services to meet the needs of people who live in Surrey.
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It employs nurses and allied professionals e.g. Physiotherapists to deliver services within a primary care setting such as a patient’s home or Community Hospital. Surrey PCT also commissions National Health Service care from other primary health care professionals e.g. General Practitioners (GPs), acute hospitals, Surrey and Borders Partnership NHS Trust, Opticians, Pharmacists and Dentists. Through partnership working with Surrey residents, Police, Adult Social Care, Education and the Voluntary Sector, Surrey PCT aims to provide a quality robust health care service With regard to safeguarding adults, through a process of collaboration and co-operation, Surrey PCT works with other agencies to ensure the safety and well being of any person deemed to be vulnerable. It has a duty of care to protect a vulnerable adult from neglect and abuse and to provide appropriate health care in a timely, effective and appropriate manner. To facilitate this all its employees are expected to access mandatory Safeguarding Adults training and update their knowledge. When a case of adult abuse is suspected Surrey PCT will participate fully in the investigation, as coordinated by the lead agency. Surrey PCT will ensure that Safeguarding Adults standards are included in all commissioning arrangements and reflected in any organisational change introduced as a result of a Creating a patient-led NHS: Delivering the NHS Improvement Plan.
C.1.7
The role of District and Borough Councils
The District and Borough Councils are an integral part of the multi agency process. District and Borough Councils have many staff whose duties involve working with the public including making home visits as part of their day-to-day duties. It is important therefore that appropriate arrangements are in place to raise staff awareness of the issues around safeguarding vulnerable adults. Staff will be in formed of the various conditions under which it is more likely that abuse may take place, what might indicate that abuse has taken place and what actions to take if they suspect that abuse is or has occurred. In this way local authority staff and volunteers are able to provide a valuable service for alerting statutory agencies to issues or concern regarding vulnerable adults and their families that come within the remit of local authority services. There is also the opportunity in some areas to use the Sanctuary Scheme (information is available from District and Borough Councils).
C.1.8 The
role of the Emergency Duty Team
The Emergency Duty Team (EDT) operates outside normal working hours from 5.00pm to 9.00am, Monday to Friday, and 24 hours at the weekends and on statutory holidays. EDT is a generic service covering the whole of Surrey. EDT staff attempt to react quickly to all referrals, prioritising safeguarding issues, and responding appropriately in relation to assessed risk. Response to an allegation or report of adult abuse or neglect:
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The normal procedures for responding to a referral apply to the EDT but investigations will only be started outside office hours where this is needed to immediately safeguard the vulnerable adult and/or preserve evidence. The key tasks are: • • • to record the facts and information concerning the alleged abuse; to establish whether the alleged victim or perpetrator are known to Services for Families; to ensure that the alleged victim and other vulnerable people or staff are safe;
• to ensure if necessary, the removal of the alleged victim or perpetrator; • to assess the need for immediate action, including medical attention or additional care services, and ensure that these are provided; • to contact the Police if a crime may have been committed and to ensure that any forensic evidence is not lost; • to pass all relevant information obtained to the appropriate Team the next working day. The EDT is not routinely responsible for the investigation of allegations of abuse. As repeated interviewing of victims should be avoided, the EDT should leave where possible, the initial interview to the investigating member of the appropriate Adult Team. The circumstances in which the EDT should interview the alleged victim are when: • the allegation of abuse is serious, i.e. impact, frequency, degree, context; • the referrer is not giving a clear picture of the circumstances; • the victim of abuse needs to be interviewed in order to ensure that she or he, or others are safe from further immediate abuse. The purpose of the interview (if required) is to: • establish the facts concerning the allegation of abuse; • investigate the need for any immediate action, i.e. medical attention, contact with the police, removal of the perpetrator; • clarify questions of consent and capacity to consent as appropriate; • provide information, comfort and reassurance to the victim. In addition it may be necessary to decide in conjunction with others and the victim of abuse whether and how other family members are informed. The EDT duty manager should be contacted for advice out of hours. The safeguarding adults service manager can also be contacted regarding serious or complicated referrals. Recording and communication with relevant Adult Teams: The EDT does not use the Safeguarding Adults Monitoring E Form. These should be completed by a member of the responsible Adult Team, on completion of any investigation. All information about the facts and circumstances of the alleged abuse, including details of the informants, should be recorded on an EDT referral form (not on SWIFT) and faxed or emailed to the appropriate Adult Team for the immediate attention of the duty manager on the first working day following the referral. A profile note should be created on SWIFT noting only the receipt of a safeguarding adults referral. A copy of any referral on a
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previously unknown service user is also sent to the Contact Centre for the creation of a database record. In cases where there is concern that problems may occur or continue out of normal working hours, an EDT Warning form should be sent to EDT giving enough information and contingency plans to ensure the case can be dealt with effectively for the victim in any crisis out of hours. Where appropriate, Safeguarding Adults Conference notes should be sent to EDT where they can be accessed out of hours. A Duty Advisory Officer for the EDT is available from 4.00 p.m. Monday to Friday to receive urgent information about cases that may be referred to EDT whilst they are on duty. Such information can however be emailed any time to ‘duty team emergency’ (Lotus Notes) or edt.ssd@surreycc.gov.uk (internet). See Section I for contact details of EDT
C.1.9
The role of the Emergency Services
Services for Families (Adults) have entered into and agreed a Memorandum of Understanding with the Surrey Emergency Services: Surrey Police, Surrey Fire and Rescue Service, South East Coast Ambulance Service and Surrey Trading Standards. Many of the people coming into contact with the Emergency Services and Trading Standards may be vulnerable adults due to age, ill health or disability. Officers working in these agencies may observe situations where further steps may be required to safeguard and protect the individual. The Memorandum of Understanding sets out the process to facilitate easy access for emergency services officers to refer for Safeguarding Services or Community Care Assessment, and also outlines circumstances in which it might be appropriate for Families Directorate staff to involve a particular agency within a safeguarding adults case. Criteria for such a referral is: • Where the person meets the criteria as defined by the definition of who is a vulnerable person, plus; • If the person appears to be confused or disorientated; • When the person would seem to need external support to stop the abuse or protect themselves from further abuse; • If there may be other vulnerable people at risk from the same perpetrator; • If the person appears to have little or no support from family, friends or neighbours; • Where the vulnerable adult maybe or is a potential/alleged victim and/or potential/alleged abuser.
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C.1.10 The
role of Trading Standards
It is the role of Surrey Trading Standards to investigate allegations of crime and disorder that fall within the legislation enforced by the department (not led on by Surrey Police). In relation to this procedure, interaction with vulnerable adults is most likely but not exclusively, to occur when criminal offences are being committed against them during incidents of doorstep crime and which often include evidence of financial abuse against the vulnerable person. All investigations which involve a vulnerable adult will be carried out sensitively and will involve at the earliest stages all and any relevant partners such as Adult Services Operational Teams, Safeguarding Adults, Surrey Police etc. The investigations will be carried out in a professional manner and in close liaison with the victims of crime and handled by a Trading Standards Officer. Where a criminal matter investigated may require a victim to give evidence to ensure the offender is brought to justice at court, all help and support will be given to them to eliminate the inconvenience and stress this may cause. In all cases, the officer in charge of the case will liaise with the Safeguarding Adults Team at the earliest point in the investigation to ensure that all procedures are followed allowing 'special measures' to be invoked.
C.1.11
The role of relatives and carers
Carers’ human rights as well as the people they care for should be upheld and the principle that carers have a right to a life beyond caring. If suitable preventative measures are in place to support the vulnerable adult and the carer, the chances of relationship breakdown and abuse occurring will be minimised. Suitable respite should be provided for both the vulnerable adult and the carer. This is enshrined in both the Carers and Equal Opportunities Act 2004 and Work and the Carers and Disabled Children’s Act (2000). Carers have a right to assessment and an evaluation of their needs even if the person who they care for refuses one. A carer is a family member, friend or neighbour who is unpaid and supports someone who has mental ill health and/or is learning disabled, and/or is physically disabled and/or whose health is impaired by illness or age. (Not to be confused with care worker who is someone who is employed and paid to provide personal/practical care to an individual) Relatives and carers will often have a close and trusting relationship with the vulnerable adult they care for or support. As a result they may witness abuse, have details of abuse disclosed to them, observe unexplained injuries, or see changes in behaviour that may suggest that something has occurred that has distressed the vulnerable adult. They need to be supported to express their concerns and make a referral as detailed in Part B.2.1. When something has occurred to the vulnerable adult they care for and support, it is natural that relatives and carers would wish to act on behalf of that vulnerable adult, be fully involved in any investigation that may occur, and support them to become survivors of what has happened. This however, may not be possible in a small number of situations as there may be a conflict of interest where:
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• The relative or carer may be a first witness to the alleged abuse or crime and involvement as an Appropriate Adult (see Part C.1.19) or Interview Supporter Part C.1.20) may compromise a criminal investigation meaning that a conviction in Court would not be secured. • The relative or carer may be the alleged perpetrator of abuse or crime and subject to investigation by Surrey Police or Surrey Adults Social Care or Integrated Teams (including Mental Health). • The relative or other recognised carer may be profoundly distressed or angry as a result of what may have occurred to the vulnerable adult they support and this may have a detrimental effect on the vulnerable adult affecting their ability to give evidence
The vulnerable adult is unable to express a view, or because of declining mental capacity is unable to make their own decisions, and relatives or carers seek to impose their own views as to what they think is best for the vulnerable adult. In this situation, Surrey Adults Social Care or Integrated Teams (Including Mental Health), may seek the involvement of an independent advocate (see Part C.1.15 Role of Advocate) to help support the vulnerable adult through the investigation. Managers and staff in services supporting vulnerable adults or family carers should: • Be open to the potential that a relative or carer may disclose abuse or an alleged crime. This may come in a form of a complaint, an enquiry or a specific referral • Reassure the relative or carer that the information will be treated with professional confidentiality, meaning that the concerns may need to be shared if the vulnerable adult or others are at significant risk (see Part E Confidentiality and B.2.7 Capacity to Consent). • Reassure the relative or carer that the risk to their vulnerable dependent, or themselves for disclosing the experience abuse/crime, will be given serious consideration and protection from reprisals, intimidation or further abuse will be a priority in referring the issue to Surrey Adults Social Care or Integrated Teams (Including Mental Health), or Surrey Police as appropriate. • Additionally, those investigating the alleged abuse or crime will: • Reassure relatives or carer that they will be informed of decisions made and actions that will occur • Reassure relatives or carer that they will sensitively seek to engage the vulnerable adult in the investigation process • Give clear explanations as to why the relatives or carer cannot fulfil given roles if there is a conflict of interest in supporting the vulnerable adult through a vulnerable adult investigation • Advise the relatives or carers not to approach the alleged abuser or question other service users about what they have seen or heard.
•
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C.1.12
The role of voluntary agencies / independent and private providers of care
A wide range of organisations and agencies provide support and/or care to vulnerable adults. Managers and staff in those organisations and agencies have a responsibility to bring those adults in need of protection to the attention of the Adults Social Care or Integrated Health Teams (including Mental Health) and/or the Police. All organisations and agencies providing support and/or care to adults must have their own supporting safeguarding adults procedures in place.
C.1.13
The role of the Supporting People Team
Supporting People is a Government scheme that started in April 2003. It aims to support people in their own homes so that they can live more independent lives. Surrey has a Supporting People Team who pay providers for the support services that they offer. The team also monitors services provided. One important aspect of the service review is the Quality Assurance Framework (or QAF). Providers must demonstrate (amongst other things) that, "Service users have the right to be protected from abuse and this right is safeguarded". If the providers do not meet the minimum standards prescribed, in terms of their procedures and practices, then the provider's contract will not be renewed. The Supporting People Team requires that all its providers sign up to the Surrey Multi-Agency Safeguarding Adults Procedures and, in cooperation with the County's Safeguarding Adult Coordinators, offers training sessions to its providers. It is a condition of the Supporting People contract that services are safeguarding compliant.
The role of domestic abuse service outreach providers and refuge providers
C.1.14
There are a number of specialist domestic abuse outreach and refuge service providers within Surrey. In addition, the various Surrey Victim Support Schemes and CAB schemes also offer support to those experiencing domestic abuse as part of their wider service provision. Surrey Domestic Abuse Helpline (01483 776822), provides a 24-hour telephone service offering a listening service as well as information and signposting to other services. The Domestic Abuse Outreach Services offer a locally based service again offering a listening ear, specialist information and access to more specialist services. They aim to provide service users with appropriate support and information to enable them to make safe decisions about their future.
C.1.15
The role of the advocate
Independent advocate An independent advocate is a paid worker or volunteer from an advocacy service that is independent from statutory services. An independent advocate is someone who: • Will listen to the person;
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• Will ensure the person has sufficient, appropriate and timely information; • Will support the person to make a decision or come to a view, by explaining the options available and exploring the possible consequences of each of the options; • Will support the person to express their views; • Where a person lacks capacity, will promote and represent the best interests of the person. (non-directed advocacy) An advocate will strive to ensure that a person can contribute to decisions that affect their lives and will represent the person’s own views even when the advocate does not share them.
C.1.16 The
role of the Independent Mental Capacity Advocate (IMCA)
From 2nd April 2007 the Mental Capacity Act 2005 created an Independent Mental Capacity Advocate (IMCA) who will represent and support a person who lacks capacity when there is no other appropriate person (other than paid staff) to do so, and where there is a decision to be made in relation to: • • • Serious medical treatment provided by the NHS A move into long-term care of more than 28 days in a hospital or 8 weeks in a care home When a long-term move (8 weeks or more) to different accommodation is being considered, for example to a different hospital or care home
For any decision-maker in the Local Authority or the NHS there is a duty to instruct the IMCA before making a decision and acting upon that decision. Under the Mental Capacity Act, an NHS body or Local Authority may request the services of an IMCA where a safeguarding allegation has been made. Whilst there is no requirement that an IMCA be appointed in each case, it would be unlawful for the Local Authority or the NHS not to consider the exercise of this power to instruct an IMCA for safeguarding adult purposes. (Reference SSAB Policy and Procedure for requesting an IMCA in relation to Safeguarding Adults). Consideration of the involvement of an IMCA within safeguarding adults will equally apply to a vulnerable adult who may have been abused or neglected or to a vulnerable adult who is the alleged abuser provided that person lacks capacity in relation to the matter in question. The request for an IMCA within safeguarding adults is considered against the following criteria: • Where the person lacks the mental capacity to consent to or comply with the potential or proposed safeguarding plan AND • Where there are no family, friends or other unpaid persons able and willing to represent the interests of the vulnerable adult OR
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• • •
Where the family, friends or other unpaid persons do not appear to be acting in the best interests of the vulnerable person OR Where there is a conflict of interest between the vulnerable adult and their family, friends or other unpaid persons who purport to be representing their interests OR Where there is a dispute between the decision maker and the family, friends or other unpaid person as to what safeguarding measures would be in the best interests of the vulnerable person AND, in every case Where it has been assessed that it would be of particular benefit to the person for the IMCA to be appointed.
• •
Services should consider early in their management of a case where there is an allegation of abuse whether to involve an advocate. An advocate is likely to be more effective the earlier s/he gets to know the person. A person’s advocate should be invited to ‘safeguarding adults’ conferences if the person agrees. In most cases the advocate will be present to support the person at the conference, but there may be occasions that the person wishes the advocate to speak on their behalf or even to attend the conference in their place. In the latter circumstances the advocate has a duty to accurately express the views of the absent person at the conference and to report back to the person on what has taken place.
C.1.17 The
role of Crown Prosecution Service (CPS)
The Crown Prosecution Service is the Government Department responsible for prosecuting criminal cases investigated by the police in England and Wales. As the principal prosecuting authority in England and Wales, it is responsible for: • Advising the police on cases for possible prosecution. • Reviewing cases submitted by the police. • Where the decision is to prosecute, determine the charge in all but minor cases. • Preparing cases for court. • Presentation of cases at court. A vulnerable or intimidated witness will be eligible for special measures under sections 16 to 33 of the Youth Justice and Criminal Evidence Act 1999. These range from giving evidence in chief by way of video or DVD to the use of screens. Once eligibility is established, prosecutors will have to consider whether or not any measure would be likely to improve the quality of the evidence given, and if so, which measure would be most appropriate. It is then for the court to consider whether a direction should be made, having regard to all the circumstances. When considering whether to apply for a special measure; confirm the views of the witness as to the measure to be applied for; inform the witness of the measure that the court has directed; or explain to the witness why it is not appropriate to apply for a special measure prosecutors may hold a meeting with the witness.
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Consideration should always be given to the use of appropriate bail conditions if there is a fear of attack, intimidation or harassment. In court there is provision for witnesses not to have to give their name and address in open court, and to give evidence from behind a screen. The CPS will make the appropriate application to the court. Where a statement is made by a person who is unfit to attend court through fear, the police should notify the prosecutor. Consideration can then be given as to whether to make an application under the provisions of Section 23 Criminal Justice Act 1988. The CPS must be alive to the concerns and fears of all of those involved in the prosecution process. Witnesses will be given as much notice as possible of the date and time they are required to attend court. Priority will be accorded to preparing and listing cases involving child witnesses and those at risk of being intimidated. People with special needs may include: • • • • • • • • Children and young persons The elderly and disabled; Victims of sexual or serious abuse; Victims of domestic violence; Victims of racially motivated crime; Witnesses who may have been intimidated; Witnesses from abroad; Professional and expert witnesses.
C.1.18 The
role of the Intermediary
An Intermediary is accessed via the police and is someone who can help a vulnerable witness understand questions that they are asked and who can communicate their responses. They can help witnesses at each stage of the criminal justice process, from police investigation and interviews, through pre-trial preparations to court. They perform an important function helping vulnerable witnesses gain equal access to justice. As well as improving access to justice for vulnerable people, intermediaries also help criminal justice practitioners. Intermediaries can: • • • Improve decision making by providing practical information about a witness’s needs; Make investigative interviews and court testimony more productive; and Improve the prospect that a case will have a positive outcome in court
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All witnesses who are considered ‘vulnerable’ can get help from an Intermediary. Under section 16 of the Youth Justice and Criminal Evidence Act 1999. Under S16 of the Youth Justice and Criminal Evidence Act 1999, a vulnerable witness is someone: • Less than 17 years old; or
Whose evidence would be diminished in quality because they have a: • • • mental disorder (within the meaning of the Mental Health Act 1983); or a learning disability (significant impairment of intelligence and social functioning); or physical disability or physical disorder
Intermediaries have a range of responsibilities that help both vulnerable witnesses and criminal justice practitioners at every stage from investigation to trial. They can carry out an initial assessment of a witness’s communication needs. At this stage they will not discuss the case in any way. This assessment is for the Intermediary to: • • • evaluate the abilities and needs of the witness evaluate whether they have the necessary skills to act as the intermediary for that witness; and
establish rapport with the witness so that their assistance enables the witness to give their best evidence. They can provide advice that can help achieve more productive interviews and get the best evidence at trial. For they can advise on: • • • how a witness communicates their levels of understanding, and how it would be best to question them to get the best evidence.
Advice on questioning could include: • • • • types of questions to avoid what question formulation is likely to get the most accurate response; how long the witness will take to answer a question; or when they will require a break in questioning
Intermediaries can also directly assist in the communication process, helping a witness understand questions during an investigative interview or testimony at trial and helping them communicate their answers. They can also help out in pre-trial preparation such as court familiarisation visits by the witness. Intermediaries are independent and do not pursue their own line of questioning – they are not an investigator, an advocate, an appropriate adult or a supporter. Their duty is to the court and to justice.
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C.1.19
The role of the appropriate adult
(for vulnerable people facing criminal charges and not witnesses) Code C of the Police and Criminal Evidence Act 1984 Codes of Practice (as amended), deals with persons of all ages in police custody and concerns their detention, treatment and questioning by Police Officers. When is an appropriate adult required? If an officer has any suspicion or is told in good faith that a person of any age may be mentally disordered or otherwise mentally vulnerable, in the absence of clear evidence to dispel that suspicion, the person shall be treated as such. Two new categories are defined and lay down the criteria as to whether an appropriate adult needs to be present in an interview with the Police: ‘Mentally Vulnerable’ applies to any detainee who, because of their mental state or capacity, may not understand the significance of what is said of questions or of their replies. When the custody officer has any doubt about the mental state or capacity of a detainee, that detainee should be treated as mentally vulnerable and an appropriate adult called. ‘Mental Disorder’ is defined in the Mental Health Act 1983 S1(2) as ‘mental illness, arrested or incomplete development of mind, psychopathic disorder and any other disorder or disability of the mind’. (Note: This definition will be amended following implementation of the Mental Health Act 2007). If a person appears to be blind, seriously visually impaired, deaf, unable to read or speak or has difficulty orally because of a speech impairment, they shall be treated as vulnerable for the purposes of this Code in the absence of clear evidence to the contrary. Definition of an appropriate adult The Police and Criminal Evidence Act 1984 defines an appropriate adult as: • A relative or guardian or some other person responsible for their care or custody; or • Someone who has experience in dealing with such people, such as an approved social worker as defined by the Mental Health Act 1983, or specialist social worker, but not a Police Officer or someone employed by the Police; or • Failing either of the above some other responsible adult aged eighteen or over who is not a Police Officer or employed by the Police. Factors in selecting the appropriate adult It is important when deciding upon an appropriate adult that the vulnerable adult is given some choice. It is vital that the vulnerable adult has confidence in that adult. In the majority of cases the appropriate adult will be the relative or carer. The relative or carer however cannot be used in the following circumstances:
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• If the relative or carer is suspected of involvement in the offence being alleged • If the relative or carer is the victim or a witness to the offence being alleged • If the relative or carer is suffering from a mental illness at that time or has a learning disability In the case of the mentally ill or those with a learning disability, it may in certain circumstances be more satisfactory for all concerned if the appropriate adult is someone who has experience or training in their care rather than a relative lacking such qualifications. If the person themselves prefers a relative to a better qualified stranger or objects to a particular person as the appropriate adult, their wishes should if practicable be respected. The appropriate adult must be independent This independence may be problematic for example, when asking a social worker to act as appropriate adult, if that particular social worker is looking at disciplinary issues within their own organisation. Clearly they may have a conflict of interest. If this is the case then another social worker must be used to act as the appropriate adult. For the same reason an appropriate adult should not act as an interpreter or supporter. Victim support volunteers can be used as appropriate adults but should only be used as a last resort. This is because the role of the voluntary support worker is to support the victim throughout the investigation and in appropriate cases at court. Difficulties may arise in that defence solicitors could accuse the volunteer of coaching. If it is necessary to use a victim support scheme (VSS) volunteer as an appropriate adult, the officer in charge of the investigation should liaise with the VSS co-ordinator to ensure that a different volunteer is used thereafter to support the vulnerable adult through the investigative process. This must be done in consultation with the vulnerable adult and the reasons for changing the volunteer explained. In cases of difficulty and out of office hours the Adults Social Care or Integrated Teams (including Mental Health)//Emergency Duty Team may be contacted.
C.1.20
The role of the interview supporter
An interview supporter is someone provided to assist a vulnerable witness when providing evidence as opposed to someone who is being interviewed as a suspect. Support and preparation during the investigative process helps the vulnerable adult to produce better evidence as well as reduce the trauma and distress from participating in the criminal justice process. High stress levels may reduce the witness’s ability to participate and respond to questioning or effectively recall events in order to assist the fact-finding process. In addition, the witness may also be coming to terms with severe personal difficulties and trauma. Preparation and support prior to, during and beyond the interview process can help to alleviate many of these problems. Learning disabled children and adults may have problems with memory, vocabulary, level of understanding and suggestibility to leading questions. The interviewee may also be sensitive to imputations of their own guilt or responsibility for the alleged actions of the accused. Learning disabled people may be acquiescent, or compliant to the demands of those in positions of power and authority. This is particularly relevant where a Police
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Officer and/or social worker are the interviewers. It is therefore essential that the witness is supported properly through the process. Who should be an interview supporter? This will depend largely on the needs of the witness and the availability of someone who has a particular understanding of these needs. Consideration should also be given to the wishes and the gender, ethnic, racial or cultural background of the adult. It is important when deciding upon an interview supporter that the adult is given some choice in the matter and that he/she has confidence in that person. The victim may already have a named contact person from either a voluntary or statutory agency, who can act as a supporter. The following persons should not be used as interview supporters: • A person who is suspected of involvement in the offence • A person who is a victim or witness to the alleged offence • A person who has a learning disability or mental disorder • A person against whom the victim has a grievance or • Where there is a conflict of interests • The supporter is not independent of the investigation team Purpose of the interview supporter The purpose of the interview supporter is to: • Advise the person being interviewed about the process • Observe whether or not the interview is being conducted properly and fairly • Facilitate communication with the person being interviewed • They are not present to act as legal advisors The interview supporter should be made aware of their responsibilities towards the victim before the commencement of the interview by the interview team.
C.1.21
The role of the interpreter
When dealing with vulnerable adults it may be necessary to engage the services of an interpreter. An interpreter is a person who translates from one language to another. Their role is: • To facilitate communication and understanding of what is being said • To be impartial and neutral • Bound by the rules of confidentiality • To be there for both parties equally to enable understanding between them • To interpret and not influence the communication – just to relay it • To ensure material is presented in a logical way, so it can be understood
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• May use symbols, photos etc, to help the person follow the flow of communication The interpreter does not have the same role as an appropriate adult whose function is to safeguard the rights of the vulnerable adult. Translate in this context not only means translating from a language other than spoken English into English. It also means translating sign language or any other form of communication used by the vulnerable adult. A professional interpreter will not try and influence the communication, but only act to relay what is said. The interpreter must whenever possible, use the words of the investigator to tell the vulnerable adult what is being asked, and use the 'words' of the vulnerable adult to tell the investigator what is being communicated. Interpreters must not translate what they think is being said. In the case of signing, the interpreter ensures that he/she is signing the right meaning of the words. Signing is about meaning, not the specific words being used. The investigator can help by offering alternative ways of saying the same thing, if the original terms and frames of reference are not clearly understood by the vulnerable adult. In this way the roles of the interpreter and investigator do not become confused. The investigator must make the interpreter aware of their respective roles and responsibilities prior to the interview. The interpreter may become a witness in cases of alleged criminal offences and be asked to produce a statement in the language of the vulnerable adult, as their exhibit. Should the case go to Court it may therefore be necessary to secure the use of a second interpreter. In order for this process to be effective, wherever possible, it will always be the primary goal to use a trained/skilled interpreter.
C.1.22
The role of the Surrey Coroner
The Coroner is an independent judicial officer who is responsible for carrying out enquiries into deaths. The criteria is laid down by the Coroners’ Act 1988 which provides that when a Coroner is informed that the body of a person is lying within their district and that there is reasonable cause to suspect that the deceased had died a violent or unnatural death or had died a sudden death of which the cause is unknown then whether the cause of death arose within the district or not, the Coroner shall as soon as practical hold an inquest into the death. If the death is reported to the Coroner then a number of separate parallel enquiries will normally be instigated: 1. by a pathologist who will make an examination of the body and 2. by the Police (see above) 3. through their own office of the doctors and others who may have some responsibility or knowledge of the medical condition, care and circumstances of the deceased and of the death of the deceased. When all these strands of information have been collected and assessed the inquest will then be convened at which evidence will be heard directed towards finding factual
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answers to four important limited questions namely, who the deceased person was, how, where and when the death came about. If the death has arisen because of some criminal action or gross negligence amounting to a crime, the inquest may be adjourned for the criminal proceedings to take place. Those called to an inquest to give evidence will be expected to answer all questions put to them and of which they have knowledge.
C.1.23 The
role of the Commission for Social Care Inspection
The Commission for Social Care Inspection (CSCI) is the official regulator for adult social care in England. CSCI regulates and inspects residential care, Nurses Agencies, Domiciliary Care and Adult Placement Schemes for adults. Residential Care includes care homes that provide nursing care. In addition, CSCI inspects and reports on councils who provide and commission these services. CSCI does not regulate childrens services. The responsibility for the regulation of childrens services transferred to OfSTED on 1st April 2007. In February 2007, CSCI issued "Safeguarding Adults - Protocol and Guidance". Please see the following link for more information and access to the document in full: http://www.csci.org.uk/professional/care_providers/all_services/guidance/safeguarding_ad ults_protocol.aspx This protocol demonstrates CSCI's commitment to working with other agencies to ensure that people within regulated services are appropriately safeguarded. It replaces the December 2003 NCSC adult protection protocol and has been formally agreed with the Association of Directors of Adult Social Services (ADASS) and Association of Chief Police Officers (ACPO). The protocol has the support of the Department of Health. This is a national protocol and all local CSCI offices will work within this protocol when engaging with Social Services and other agencies. BASIS AND BOUNDARY OF CSCI ROLE WITHIN SAFEGUARDING ADULTS PROCEDURES CSCI’s function in response to safeguarding adults concerns is primarily as a regulator, contributing knowledge of the service, regulations and standards to the multi-agency assessment. CSCI will work in partnership with other agencies to ensure that concerns or allegations of abuse are appropriately referred to and investigated by the most appropriate agency. Whilst working in partnership with other agencies, CSCI will not suspend its own statutory enforcement responsibilities pending the outcome of another (e.g. criminal) process where to do so would run counter to the safety and well-being of the people who use the service. Where a safeguarding alert suggests breaches of regulations or lack of fitness of registered persons, we will consider what regulatory action is needed by the commission and undertake that work in partnership with other agencies.
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Where the local council has accepted a safeguarding referral about a regulated service from a source other than CSCI the local council will inform the relevant CSCI local office. Where it is suspected that abuse may have occurred in a regulated setting, service staff must report this to their line manager, and the registered person must ensure that this is referred to the local social services according to current procedures and policy. In addition, the registered person must notify CSCI that this has happened. CSCI is NOT a lead agency in investigating safeguarding matters. This role is rightly carried out by one or more of the following, after due consideration of the circumstances, by the Safeguarding Assessment panel: Police Social Services Healthcare Organisations Healthcare Commission in respect of NHS patients in certain cases The Registered Provider CSCI ATTENDANCE AT SAFEGUARDING ASSESSMENT STRATEGIES (STRATEGY MEETINGS) CSCI should always be made aware of any Safeguarding Adults concern within a regulated service. However, it is not necessary or appropriate for CSCI to attend all Safeguarding assessment strategies (strategy meetings). Broadly speaking, CSCI presence at such meetings will be based on the following criteria: 1. One or more registered people are directly implicated 2. Urgent or complex regulatory action is indicated 3. If any form of enforcement action has commenced or is under consideration in relation to the service involved. Where CSCI is not actively present at such meetings, they will nevertheless ensure that appropriate information about the service is shared with the Safeguarding Manager in order to inform the assessment strategy. Whether or not CSCI staff attend the Safeguarding Assessment strategy meeting, CSCI must be supplied with copies of the notes and agreed strategies formally by the chair of the meeting. CONTACT DETAILS Email: enquiries.southeast@csci.gsi.gov.uk Tel: 01622 724 950 Fax: 01622 724 980 These contact details should be used by all agencies and professionals in Surrey who need to contact CSCI in respect of Safeguarding Matters. All registered services should have these contact details available for staff, service users and the public.
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C.1.24
The role of the Health Care Commission
The Health Care Commission exists to promote improvements in the quality of healthcare and public health in England and Wales. It is responsible for registering and inspecting individuals and organisations that provide healthcare services and will carry out investigations into allegations of serious service failings, particularly when there are concerns for the safety of patients. These include: • • • • • NHS organisations, including foundation hospitals and ambulance service Primary Care Trusts Services for people with learning disabilities and mental health problems, and substance misuse services Independent healthcare services such as private hospitals, independent clinics, hospices and private doctors School health services
There is a named representative from the Health Care Commission who sits on the Surrey Safeguarding Board and an informal threshold has been agreed with the Safeguarding Adults Team to alert the Health Care Commission to any serious safeguarding concerns. The longer-term strategy is to merge the Health Care Commission and the Commission for Social Care Inspection and it is anticipated that formal guidance will then be produced outlining their role in Safeguarding Adults.
C.1.25 The
role of the Mental Health Act Commission
The Mental Health Act Commission was established in 1983 and consists of some 100 members (Commissioners), including laypersons, lawyers, doctors, nurses, social workers, psychologists and other specialists. Its functions are: • • • • • • • To keep under review the operation of the Mental Health Act 1983 in respect of patients liable to be detained under the Act. To visit and interview, in private, patients detained under the Act in hospitals and mental nursing homes. To investigate complaints which fall within the Commission's remit. To review decisions to withhold the mail of patients detained in the High Security Hospitals. To appoint medical practitioners and others to give second opinions in cases where this is required by the Act. To publish and lay before Parliament a report every 2 years. To monitor the implementation of the Code of Practice and propose amendments to Ministers.
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If a Commissioner believes that there may be abuse of a vulnerable adult, they should notify their Regional Director immediately, who will in turn notify the local authority. (In exceptional circumstances when the Regional Director is not available, the Commissioner should notify the Local Authority Safeguarding Adults Co-ordinator direct). This does NOT solely relate to suspicion of abuse of detained patients. If during the course of a visit a Commissioner has concern about an informal patient, the MHAC has a duty to inform the Local Authority of these concerns
C.2
Vulnerable adults who may witness abuse or a crime
Vulnerable adults may witness a crime or acts of abuse or have knowledge of abuse that has been disclosed to them by a friend or someone else they know. They need to be supported to express their concerns and make a referral as detailed in Part B.2.1. Adults Social Care or Integrated Teams (including Mental Health), managers and staff should: • • • • Be open to the potential that any vulnerable adult may witness a crime or abuse and report what they have seen. Do not under-react or dismiss an allegation of crime or abuse because the allegation is being made by a vulnerable adult Reassure the vulnerable person that their disclosure is accepted as truth and that the information they share will be taken seriously Reassure the vulnerable person that the information will be treated confidentially, while informing them that their concerns will need to be shared if the person being reported or others are at risk Reassure the vulnerable person that they will be informed of what is happening Advise the vulnerable person not to approach the alleged abuser or discuss with or question other people about what they have seen and heard Record what the vulnerable person has said and any comments/questions made by any staff members in line with the multi-agency safeguarding adults policy and procedures. This record will be shared with the agencies undertaking any investigation of the alleged crime and/or abuse and is a potential source of evidence to the Police and may also form the basis for a formal interview at a later date with the vulnerable person reporting the allegation. Consideration will be given to giving the vulnerable person a written copy of the allegation they have made, however staff need to be mindful of any possible security issues relating to the keeping of such a document in the person’s home.
• • •
•
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Part D: Complaints and whistle-blowing
D.1 Staff
concerns
All agencies whether, statutory, voluntary or private have their own procedures to enable staff to express their concerns. Some may describe these as ‘whistle-blowing’ procedures or codes of conduct/practice. All procedures should make plain the moral obligation, right and duty of staff to inform their employer of: • • • • Issues regarding malpractice, negligence, suspected criminal activity and unprofessional behaviour Any situation where the service user is being abused or their rights and dignity are being or have been disregarded or over-ruled Where decisions are taken which are not in their interests and put them at risk of abuse, exploitation, oppression or discrimination Matters of concern about social care, health care, or practice issues concerned with the delivery of care to service users and/or carers which are detrimental to their interests Circumstances to do with employment environment, employment conditions or employer practices that place colleagues at risk.
• •
Not to be subjected to any detriment by any act, or any deliberate failure to act by his employer done on the ground that the employee has made a ‘protected’ disclosure, as defined under the act Managers must ensure that staff concerns are dealt with promptly, thoroughly and fairly. In most circumstances staff are able and willing to inform their managers of any concerns regarding a vulnerable adult. However there are occasionally exceptional circumstances where this may not be possible. For example: where they have concerns involving their manager or where previous notification of serious concerns to their manager have not been actioned. In this instance it is important that they are able to bring the matter to the attention of others, including Adults Social Care or Integrated Teams (including Mental Health), the Police or Crimestoppers. All agencies must be aware of the legal responsibilities placed on employers by the provisions of the Public Interest Disclosure Act 1998 which provides workers who make disclosures in relation to the activities of their employer with specific employment rights. These include the rights of a worker:
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D.2 Person
alleged to be responsible
When a complaint or allegation has been made against a member of staff, he or she should be made aware, by their employer, of his or her rights under employment legislation and internal disciplinary procedures. In criminal law the Crown or other prosecuting authority has to prove guilt, and the defendant is presumed innocent until proved guilty. Alleged perpetrators who are also vulnerable adults themselves, in that they may have learning disabilities or mental health problems and are unable to understand the significance of questions put to them or their replies, should be assured of their right to the support of an ‘appropriate’ adult (see part C.1.10) whilst they are being questioned by the police under the Police and Criminal Evidence Act 1984 (PACE).
D.3 Staff
discipline and criminal proceedings
As a matter of course allegations of criminal behaviour should be reported to the police, and agencies should agree procedures to cover the following situations: • • • • • Action pending the outcome of the police and the employer’s investigations Action following a decision to prosecute an individual Action following a decision not to prosecute Action pending trial; and Responses to both acquittal and conviction
Employers who are also service providers or service commissioners have not only a duty to the victim of abuse but also a responsibility to take action in relation to the employee when allegations of abuse are made against him/her. Employers should ensure that their disciplinary procedures are compatible with the responsibility to protect vulnerable adults. Following any such allegation, the police investigation should take priority over any disciplinary or complaints procedure, in order to safeguard the integrity of the investigation. However, this must be done in a timely manner and the Police, in consultation with other lead agencies, should advise when it may be appropriate for any other process to commence i.e. disciplinary or complaint procedures. With regard to abuse, neglect and misconduct within a professional relationship, some perpetrators will be governed by codes of professional conduct and/or employment contracts which will determine the action that can be taken against them. Where appropriate, employers should report workers to the statutory and other bodies responsible for professional regulation. Managing Potential Risk In order to manage any potential risk, the employer should consider suspension, or alternative work arrangements pending the outcome of the employer’s investigation. Decisions not to suspend or arrange alternative work arrangements for an employee
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and/or not to inform the police, must be fully documented and endorsed separately by an independent senior officer from within the investigating agency. Close co-operation should be achieved between the employer and the investigator including the commitment to share relevant information where possible. Appropriate independent support should be made available to staff who are suspended or subject to alternative work arrangements. Staff also have the right to the support of their Union or professional body. In any case of a proved complaint or allegation, particularly where this involves professional malpractice, the lead agency should ensure that relevant agencies/professional bodies are appropriately informed (the 1999 Home Office document Caring for Young People and the Vulnerable offers guidance for preventing abuse of trust). Consideration should also be given to placing the staff members name on the temporary POVA register – see D.4. (Nb in October 2008 the POVA, POCA and List 99 will be amalgamated and known as the Safeguarding Vulnerable Groups Act 2006, which provides the legal framework for the new Vetting and Barring Scheme – see G.11) The Government has introduced a statutory workforce ban mechanism for people found to be unsuitable to work with vulnerable adults (Protection of vulnerable adults register POVA). The Care Standards Act 2000 sets out the basis of the mechanism, which closely mirrors that in the Protection of Children Act 1999. In this system ‘vulnerability’ of adults is defined in relation to those services where adults are inherently at risk of harm. This new mechanism complements the General Social Care Council (GSCC) and adds significant new safeguards for vulnerable people. If the abuse has occurred within a regulated service, once the safety of the service users has been established and any immediate investigation is completed, the appropriate regulatory body should establish the need for any enforcement action. If a member of staff is alleged to have abused a service user and has been temporarily removed from their substantive post, the procedure will be as follows: • • It should be explained to the member of staff that an allegation of abuse has been made against them In line with the agencies procedures, the member of staff should be advised that they are being temporarily removed from their substantive post and the reason should be confirmed in writing either notifying of the intention to hold a disciplinary hearing or confirming the continuing temporary removal from the substantive post of the person and the reasons The member of staff should be advised that an investigation is being carried out under the Surrey Multi-Agency Procedures and the member of staff should have a copy of the Procedure made available to them The member of staff should be given any relevant information about sources of help, support and advice, e.g. Staff Helpline The member of staff should be informed that there may be a police investigation into the allegation and that in this case they should seek legal advice
•
• •
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•
The member of staff should be advised to contact their Union representative for support and a contact number should be provided
Sharing of information relating to an investigation Surrey Police and Adults Social Care or Integrated Teams (including Mental Health), owe a duty of confidentiality to all people who are interviewed as part of an investigation and each agency is bound by its own protocols for disclosure of that confidential information. There is an implied undertaking in taking statements from any party that the material will only be used for the purpose for which it is obtained. In order to disclose this type of material for the purposes of a disciplinary or complaint investigation, the agency concerned must first have written authority from the individuals concerned. This can be obtained in two ways. Firstly, at the time of making the statement, or secondly by written consent after the conclusion of the investigation or trial. The police may consider releasing witness statements providing they have received permission to do so. Surrey Police and Adults Social Care or Integrated Teams (including Mental Health), have agreed that it will be a matter for the police officer leading the investigation, or the team manager (Adults Social Care or Integrated Teams (including Mental Health),) to decide when is the most appropriate time to raise with a party the possibility that another agency might have an interest in the statement or records of the investigation. In practice it is often clear from the outset whether it is likely that disciplinary matters may be associated with the investigation. It is therefore recommended that this issue is given consideration at the first Safeguarding Adults Planning Meeting or Safeguarding Adults Senior Strategy Meeting. (See Information Sharing Guidance on SCC website).
D.4 Protection
of vulnerable adults (POVA) register
Provision for the Protection of Vulnerable Adults (POVA), is set out in Part VII of the Care Standards Act 2000. The scheme created a list of people, held by the Secretary of State who are considered unsuitable to work with vulnerable adults in England and Wales because their conduct has harmed, or placed at risk of harm, a vulnerable adult in their care. Care homeowners; domiciliary care agencies and employment agencies which supply care workers are required to request checks against the POVA list as part of a range of rigorous pre-employment checks, including disclosures from the Criminal Records Bureau (CRB). Requests for such checks must be made to the CRB. Enhanced CRB checks will automatically include checks against the POVA Register. Care providers and suppliers of care workers are also required to refer workers to the Secretary of State for possible inclusion on the POVA list where, in their view, the individual has been guilty of misconduct which harmed or placed at risk of harm, a vulnerable adult. People who know they are confirmed on the list but seek employment in care positions will face criminal charges including possible imprisonment.
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The POVA list runs alongside the Protection of Children Act (POCA) scheme which has been in force since 2000 and contains similar provisions in relation to childcare organisations. POVA Helpline Number – 01325 391328 See http://www.dh.gov.uk/en/SocialCare/Deliveringadultsocialcare/Vulnerableadults/index.htm (nb in October 2008 the POVA, POCA and List 99 will be amalgamated and known as the Safeguarding Vulnerable Groups Act 2006, which provides the legal framework for the new Vetting and Barring Scheme – see G.11)
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Part E: Confidentiality
E.1
Confidentiality
Adults Social Care or Integrated Health Teams (including Mental Health) professionals, health professionals and professionals in allied services have a common law duty of confidentiality. They also have a duty to process personal information in line with the Data Protection Act 1998. Health and social care staff must also comply with the Caldicott principles. These are a set of requirements that ensure information regarding social care service users is treated with sensitivity to maintain its confidentiality. Information that has been provided in confidence and personal information should not usually be used or shared without consent from the subject and source of that information. The above rule applies in almost all circumstances, but there are occasions where exceptions may apply. Where there is a perceived need to disclose personal / confidential information to another person or agency, it is necessary to consider carefully whether this is lawful in line with the common law and the Data Protection Act. The reasons for disclosing personal / confidential information should always be recorded, and legal advice must be sought whenever there is doubt about a decision to disclose. Personal information and records All personal and medical records, any information therein and any information about a person known to health care and allied services must be regarded as confidential under the key principles on confidentiality. Consent to disclosure Where it is possible and appropriate to approach the subject of personal information, their consent must be obtained before their personal / confidential information is shared. Similarly, where information has been provided in confidence from someone other than the subject of the information, it may also be necessary to obtain consent from the source of that information before it can be shared. Where consent for disclosure cannot be obtained The following circumstances may arise where it may not be possible or appropriate to obtain consent to share: • • • • the subject cannot be contacted within a reasonable timeframe* the subject does not have sufficient capacity contacting the subject may e.g. jeopardise a criminal investigation or put someone in unacceptable risk the subject has refused to give their consent
* the period of time considered reasonable will differ on a case-by-case basis depending on the urgency with which the information needs to be shared.
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Personal / confidential information may be shared without obtaining consent in exceptional circumstances where it is necessary for the information to be shared. Examples of what may override the duty of confidentiality include: • • The power of the Courts The power of certain Tribunals
• A legislative requirement e.g. statutory assessment under the Mental Health Act 1983 To prevent: • Serious crime • Danger to a person’s life • Danger to other people • Danger to the community • Serious threat to others, including staff • Serious infringement of the law • Breach of a legal obligation to supply the information • The health of the person • Public health concerns This list, whilst comprehensive, is not exhaustive. Consultation with colleagues and / or legal advice should be sought whenever disclosure of personal / confidential information without consent is being considered, and the reasons should be recorded. Confidentiality guidance The following can be consulted for further guidance on handling confidential and personal information: • • • • • ‘Confidentiality: NHS Code of Practice’, November 2003 (update expected in 2007/8) ‘HSC 2000/009. Data Protection Act 1998: protection and use of patient information’, March 2000 ‘Data Protection Act 1998: Guidance to Social Services’, March 2000 (Section 6) ‘No Secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse’, March 2000 (Section 5.5 and 5.6) The Information Commissioner’s Officer website www.ico.gov.uk
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Part F: Surrey Safeguarding Adults Board
F.1
Surrey Safeguarding Adults Board
Surrey Safeguarding Adults Board
Safeguarding Adults Team
Training Sub Group Quality Assurance and Audit Group
Serious Case Review Panel
Communication and Publicity Group Policy and Procedures Group
Local Safeguarding Adults Group (SW)
Local Safeguarding Adults Group (NW)
Local Safeguarding Adults Group (SE)
F.1.1
Terms of reference
Policy statement Surrey Safeguarding Adults Board’s policy is to work with users, carers and other agencies to protect vulnerable adults from abuse, in line with the agreed procedures. Adults who are vulnerable will be treated in a way which respects their individuality and does not undermine their dignity or their human or civil rights. The decisions of all vulnerable adults will be respected unless there is a legal responsibility to intervene or where there is a risk to others. The terms of reference for the Board are: • To oversee the implementation and working of the Safeguarding Adults procedures, including publication, distribution and administration of the document
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• •
The management of inter-agency organisational relationships to support and promote the implementation of the procedures To make links with other areas of policy and good practice guidance, including, contracting, care management and child protection within the statutory, voluntary and independent sectors To oversee the training strategy, and to maintain a strategic overview of Safeguarding Adults training To identify sources of funding required to implement the training and development needs associated with the procedures and to monitor the use of these resources To oversee the development of information systems which support the gathering of information necessary to carry out the evaluation of policy and practice To regularly review the monitoring and reporting of safeguarding adults concerns and investigations and to undertake a full review annually To make recommendations for revisions and changes necessary to the procedures, identified as a result of the monitoring process The promotion of multi-agency working in Safeguarding Adults, through formal events or information campaigns to ensure a wider professional and public understanding of adult abuse To support and advise operational managers working with abuse, through the local groups and sub groups To agree and maintain links with relevant corporate management groups Manage and support the work of the sub groups
• • • • • •
• • •
F.1.2
Membership of the Surrey Safeguarding Adults Board
Senior managers from each of the statutory agencies in Surrey who have regular contact with vulnerable adults from: • • • • • • • • • • • • Families Directorate Surrey Primary Care Trust Acute Trust Surrey Police Surrey County Council Adults and Community Care (Chair) Commission for Social Care Inspection Surrey Probation Service Legal Services Local Safeguarding Adults Management Group Chairs Learning Disability/Mental Health NHS Trust(s) District and Boroughs Surrey Ambulance
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• Surrey Fire Service • Service User • Carer representative Meetings take place bi-monthly
F.1.3
Reporting and accountability
The Surrey Safeguarding Adults Board (SSAB) is constituted under “No Secrets” March 2000, Section 7 Guidance. The SSAB manages the work of the local groups and the subgroups. Chairs of the above group will be members of the SSAB and provide annual reports to the SSAB as part of the business planning process. The SSAB will set the key priorities of the sub groups, against the annual business plan. The annual business plan will reflect: • • •
F.2
National requirements/guidance Relevant performance indicators Identified local needs.
Local Safeguarding Adult Groups Terms of reference
Implementation of the multi-agency policy and procedures Consultation and communication on safeguarding adults issues with local provider organisations, service user groups, carer groups and voluntary organisations To report to, and receive advice from the SSAB on matters of policy and professional practice Monitoring and evaluation of practice issues Maintaining links with other local safeguarding adults groups and sub groups Implement case review and recommendations (The group will preserve the confidentiality of information discussed at the meeting in relation to clients) To ensure the provision of professional advice to those involved in safeguarding adults work To contribute to the revision of policy and procedures To identify local training needs and feed to the Training Sub Group
F.2.1
• • • • • • • • •
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• • • •
F.2.2
Identify local priorities and areas in need of development to SSAB – for inclusion in local and county wide strategic planning Dissemination of information Local publicity/community awareness raising (contribute to the Safeguarding Adults Awareness Week) Contributing to preventative strategies.
Membership of Local Safeguarding Adults Groups
Families Directorate Safeguarding Adults Independent Chair District and Borough Councils Carers Representative Surrey Police Primary Care Trusts Mental Health/Learning Disability Trusts Acute Trusts Service Users Voluntary & Independent Sector
• • • • • • • • • •
F.2.3
Key priorities
Service user engagement/centrality in the safeguarding adults process Raising the profile and awareness of safeguarding adults locally Bedding safeguarding adults into other strategic protocols.
• • •
F.3
Training Sub Group Terms of reference
F.3.1
To implement and oversee a county wide multi-agency training strategy for the protection of vulnerable adults, including awareness raising; joint investigation training and training for managers: • • • • To produce an annual work plan based on the above strategy To consult and communicate with all partner agencies To communicate and maintain links with the wider reference group To identify appropriate funding from each agency and develop a multi-agency training strategy
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• •
F.3.2
To ensure appropriate links between each agency and multi-agency training To produce an annual report to the Safeguarding Adults Board
Membership of the Training Sub Group
NHS Trusts Primary Care Trust (PCT) District and Boroughs Families Directorate Surrey Police Voluntary sector and service users Independent Sector Advocacy Trading Standards Commission for Social Care Inspection
• • • • • • • • • •
F.4
Communication and Publicity Group of reference
F.4.1 Terms
• • • • • • • • • • • •
To facilitate the provision of a robust and high quality communication To effectively publicise the safeguarding adults agenda throughout Surrey To report to and receive advice from the Surrey Safeguarding Adults Board on matters relating to communication and publicity To evaluate and regularly audit the effectiveness of communication and publicity material relating to the safeguarding adults agenda To maintain strong links with the Local Safeguarding Adults Groups (S.A.G.s) and the training subgroup To contribute on the revision of policy and procedures, ensuring that these are clearly presented to service users and professionals To ensure that publicity material is available in different mediums and is accessible to all partner and user groups To raise the profile locally of the safeguarding adults’ agenda To consult and communicate with all partner agencies, including users and carers To produce a clear communications strategy which informs communication and the consultation process with partner agencies, pertaining to safeguarding adults To seek, identify and effectively use the funding available to support the publication of the safeguarding adults agenda To provide a 3 year action plan with a realistic timescale
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F.4.2
Membership of the Communication and Publicity Group
Primary Care Trusts District/Boroughs (Councils) Safeguarding Adults Support Service Surrey Police Service users Voluntary and independent sector Acute Trust Ambulance Service Worship
• • • • • • • • •
F.5
Serious Case Review Group Purpose of serious case reviews
F.5.1
The purpose of having a Serious Case Review is neither to re-investigate nor to apportion blame. It is to:
•
Establish whether there are lessons to be learned from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults. Establish what those lessons are, how they will be acted upon and what is expected to change as a result. From second point above, to inform and improve inter-agency working. Prepare or commission an overview report which brings together and analyses the findings of the various reports from agencies in order to make recommendations for future action
•
• •
F.5.2
Criteria for conducting a serious case review
The Surrey Safeguarding Adults Board (SSAB) has the lead responsibility for conducting a serious case review. The SSAB should consider conducting a serious case review when: • a vulnerable adult dies (including death by suicide), and abuse or neglect is known or suspected to be a factor in their death. In such circumstances the Surrey Safeguarding Adults Board should always conduct a review into the involvement of agencies and professionals associated with the vulnerable adult.
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•
A vulnerable adult has sustained a potentially life-threatening injury through abuse or neglect, serious sexual abuse, or sustained serious and permanent impairment of health or development through abuse or neglect, and the case gives rise to concern about the way in which local professionals and services work together to protect vulnerable people. Serious abuse takes place in an institution or when multiple abusers are involved.
•
*Consideration should always be given to referring cases to the Local Safeguarding Adults Group for review in the first instance.
F.6
Policy and Performance Group
F.6.1 Scope
To identify, review and disseminate key policies/issues from key documents, legislation, research etc that impact on Safeguarding Adults for more than one organisation in Surrey.
F.6.2 Terms • • • • • •
of Reference
To identify and keep a master list of all key documents and legislation related to Safeguarding Adults and prioritise those to be considered by the committee. To review the identified documents and produce a summary of the issues related to Safeguarding Adults To present the identified documents and summary to the Safeguarding Adults Board for decisions re implementation To regularly review and update the multi-agency procedures To receive reports from the local Safeguarding Adults Groups re the need for further guidance, and develop appropriate guidance To link with the Training and Communication and Publicity Groups re issues raised
F.6.3 • • • • • • • •
Membership of the Policy and Performance Group
Surrey Primary Care Trust Surrey Police Commission for Social Care Inspection NHS Trusts Families Directorate Surrey County Council – Legal Services Surrey Care Homes Association District and Borough Councils
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F.7 Quality F.7.1
Assurance/Audit Group
Terms of Reference
To achieve high standards in relation to safeguarding adults and promote the welfare of vulnerable adults, not just through co-ordinating but also by evaluation and continuous improvement. To compile complete and accurate relevant statistical information across the partner agencies to inform good practice and make recommendations. To undertake specific audits in relation to identified safeguarding issues or concerns To ask individual organisations to take responsibility under an agreed framework of benchmarks or indicators for responding to specific concerns raised by quality assurance issues or resulting from an audit. To develop a self evaluation audit tool for partner agencies To co ordinate a multi agency approach to reviewing individual safeguarding adults cases, identifying the quality of practice and lessons to be learned. To help organisations to develop new procedures by spreading best practice and by bringing together expertise in different bodies and by supporting capacity building and training. To ensure recommendations from Serious Case Reviews and completed audits are followed up and implemented effectively. To work with the Safeguarding Adults Policy and Performance group around the implementation of recommendations arising from new national legislation and from local and national policies, procedures and reports. To feedback outcomes to the Safeguarding Adults Board and to front line practitioners/managers as appropriate.
•
• • •
• • •
• •
•
F.7.2 Membership
of the Quality Assurance and Audit Group
• • • • • • • •
Families Directorate (Chair) Safeguarding Adults Team Surrey Police Acute Trust PCT Surrey and Borders Trust Team Managers from OP/PD, MH and LD Users and Carers
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Part G: Practice guidance and reference
G.1
General indicators of abuse/thresholds for intervention General indicators of abuse
G.1.1
Where abuse has occurred one or more of the following signs or indicators may have been, or may be present, for example: • Seeking shelter or protection • Unexplained reactions towards particular individuals or settings • Frequent or regular visits to the general practitioner or the accident and emergency department, or hospital admissions • Frequent or irrational refusal to accept investigations or treatments for routine difficulties • Unexplained change in material circumstances • Inconsistency of explanation regarding the area of possible concern • Carer/care worker or third party always wishing to be present at interviews • Anorexia/bulimia or eating disorders • Panic attacks, withdrawal of verbal communication, regressive behaviour • Disturbed sleep patterns • Absconding/wandering • Dislike of being touched and flinching on being touched • Obsessive or challenging behaviour • Self harm • Withdrawal • History of domestic violence • History of drug and/or alcohol abuse None of the previously mentioned indicators, or indeed those given below, definitively suggests abuse. However suspicions should be heightened if one or a combination of factors exist. Signs of possible physical abuse:
• • • • • • • •
Bruising Fractures Sprains or dislocations Lacerations Burns – including friction burns and scalds Drowsiness, confusion due to over-sedation Pressure sores Welt marks
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• • •
Symmetrical grip marks/bruising caused by finger tips Malnutrition
Cowering and flinching In addition to these physical signs, suspicions should be heightened by the following: • Injuries not consistent with information given by the vulnerable adult, carer or care worker • Injuries in locations where accidental injury is implausible/unlikely • The vulnerable adult is unable to explain repeated unexplained injuries • Injuries inconsistent with known lifestyle/habits • Failure or unexplained delays in seeking treatment • Use of furniture and other equipment to restrict movement • Carer, care worker or third party defensive in explanation As with the indicators for sexual abuse, none of these definitively suggests abuse and care should be taken to investigate each case and the surrounding circumstances thoroughly. Signs of possible sexual abuse:
• • • • • • •
Repeated urinary infections Incontinence/bed wetting Sexually transmitted diseases Bruising/bleeding/soreness/cuts/in genital or breast area Pregnancy Depression/stress
Deliberate self-harm In addition to physical signs, suspicions should be heightened by the following: • Increase in sexualised behaviour, e.g. excessive masturbation • Inappropriate sexual behaviour/language • Excessive washing • Inappropriate dressing • Self-neglect, poor self-image • Panic attacks Signs of possible neglect:
• • • • • •
Poor hygiene – smell of urine / faeces Dehydration Weight loss or malnutrition Hypothermia – or abnormal body temperature Inappropriate clothing Failure to respond to prescribed medication raising suspicion medication withheld
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• • •
Infections Pressure sores
Failure to protect, e.g. lack of safety equipment, such as stair guard In addition to these physical signs, suspicions should be heightened by the following: • Deliberate deprivation of social contact • Sensory deprivation e.g. not allowed to have hearing aid, glasses or other aids to daily living • Deliberate withholding of medical care/treatment • Deliberate withholding of an adequate environment, e.g. light, heat, space, privacy or food Signs of possible psychological or emotional abuse:
• • • • • • • • • •
Sudden changes in behaviour Sleep disturbance Low self esteem Punitive approach to bodily functions on incontinence Anxiety/unease/silence Fear Depression Deterioration in ability to exercise choice Irrational fears Onset of phobias
In addition to the previously mentioned signs, suspicions should be heightened by the following: • Excessive deference to carer, care worker or third party • Over-protection • Violation of civil liberties Signs of possible financial / material abuse: • • • • • • • • Unexplained loss of funds/sudden large withdrawals from bank accounts, etc. Inability to pay bills Marked change in lifestyle/standard of living Basic needs not being met Theft of property Misuse of benefits Recent acquaintances expressing sudden or disproportionate affection for a person with money or property Person managing financial affairs is evasive or unco-operative
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• •
Power of Attorney obtained when a person believed to be unable comprehend Intimidation and extortion
Signs of abuse of rights (discriminatory and institutional):
• • • • • • • •
Submission to prescriptive routines Lack of choice Lack of privacy and dignity Lack of personal belongings Use of punishment – withholding food, drink Poorly trained and unskilled staff Needs not being met by available staff levels Unacceptable ‘treatments’ or programmes which include sanctions or punishment such as withholding of food and drink, seclusion, unnecessary and unauthorised use of control and restraint or over-medication Lack of disabled access
•
In addition to the previously mention signs, suspicions should also be heightened by repeated instances of care which fall below current evidence and research based practice. Signs possible professional abuse:
• • • • •
Entering into a sexual relationship with patient/client Failure to refer disclosure of abuse Poor, ill-informed or outmoded care practice Failure to support vulnerable to access healthcare/treatment Denying vulnerable adults access to professional support and services such as advocacy, service design where groups of users living together are incompatible Punitive responses to challenging behaviours Failure to whistle blow on issues when internal procedures to highlight issue are exhausted.
• •
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G.1.2
Thresholds of intervention
PRESENTING INFORMATION RESPONSE
Issues to be considered as part of the assessment of seriousness and decision making process
ACTION & OUTCOMES
Level 1 Intervention by Service Providers
‘One-off’ isolated incident – some of the factors to consider within the assessment of seriousness and decision making process are: • Has there been a previous history of similar incidents recorded for the vulnerable adult?
•
Service Provider to report initial concerns to appropriate Team/Agency (Social Care Team, Learning Disability Team, Community Mental Health Team, Commission for Social Care Inspection) for assessment of seriousness /intent By agreement, identified Action taken by Service Provider to address ‘presenting concerns’. Outcomes of subsequent actions taken reported to the appropriate Team by the Service Provider. May lead to alterations in the way service is provided to a vulnerable adult and/or alterations to the way staff or other resources are deployed in the delivery of health and social care Managed level of risk to vulnerable adult or other vulnerable people is identified
• • Has there been a previous history of similar incidents recorded for the service provider? • • Has there been previous history of abuse by the person alleged responsible? • • • Is this a pattern of abuse? Is there a clear criminal offence described in the referral? Is there a clear intent to harm or exploit the vulnerable person?
•
•
MAY OR MAY NOT REQUIRE A Safeguarding Adults Planning Meeting – The decision must be recorded on the E-Monitoring Form
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• Level 2 •
The physical, psychological or emotional well-being of the vulnerable adult may be being adversely affected The concerns reflect difficulties and tension in the way current health and social care services are provided to the vulnerable adult (e.g. Some perceived inadequacy in the services being provided) The concerns reflect difficulties and tensions within the network of informal support provided to the vulnerable adult (e.g. some perceived difficulties between the vulnerable adult and family/friends)
• •
Consideration of discussion with Police - Vulnerable Person’s Unit The ‘needs’ of the vulnerable adult and/or alleged perpetrator of abuse are formally assessed or reviewed by a member of the appropriate team (e.g. Social Care Team etc) or by any other appropriate agency/Team/Provider/Professional Adjustments may be made to the way health and social care services are provided to the vulnerable adult and/or alleged perpetrator to ensure that the presenting concerns have been addressed and risk managed
Intervention by the appropriate Team (Social Care Team, Learning Disability Team, Community Mental Health Team, Commission for Social Care Inspection) to assess or review the needs of the vulnerable adult and/or the alleged perpetrator within the context of the presenting concern(s)
•
•
•
Concerns have occurred in the past, but at lengthy and infrequent intervals
•
Vulnerable adult should be empowered to contribute and express their views using appropriate support if necessary Current and future risks of harm or exploitation are significantly reduced or eradicated by changes to a ‘Health and Social care plan’ or adjustments with more informal support networks or personal relationships LIKELY TO LEAD TO A SAFEGUARDING ADULTS PLANNING MEETING BEING HELD where a decision will be made as to whether this should follow the safeguarding adults process or be signposted for other actions e.g. Risk Management, Complaint, Re-assessment of needs, Adjustment to care package, Review, Disciplinary etc.
•
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Level 3 Safeguarding Adults Enquiry Undertaken
•
The physical, psychological or emotional well-being of the adult has been adversely affected by the alleged incident A criminal offence may have been committed There is a breach of regulations provided by the Care Standards Act 2000 Breach of Professional Codes of Conduct There is an actual or potential risk of harm or exploitation to other vulnerable people There is a deliberate intent to exploit or harm a vulnerable adult There is a breach in an implied or actual ‘duty of care’ between vulnerable adults and the person alleged responsible The referral forms parts of a pattern of abuse either against a particular individual or by a health or social care service
•
Interagency (Safeguarding Adults Planning Meeting) held to agree an ‘Investigation Plan’ Investigation Plan implemented with further planning/strategy discussions/meetings if appropriate Evaluation of Investigation activity and evidence obtained Determine if abuse has taken place Case conference to agree a ‘Safeguarding Plan’ Chaired by an Independent Chair from the Safeguarding Adults Team to consider further actions, legal intervention, level of risk, protection plan Monitoring of Safeguarding Plan Review of Safeguarding Plan WILL LEAD TO SAFEGUARDING ADULTS CONFERENCE
• •
•
•
• •
• •
•
• • •
•
•
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Level 4 Complex safeguarding adults enquiry undertaken with multiple service user/victims
• • •
Institutional abuse Number of people adversely affected A number of criminal offences may have been committed Multiple breach of Care Standards Act 2000 Potential high profile due to seriousness/complexity
•
Notify Senior Manager to determine need for Safeguarding Adults Senior Strategy Meeting Allocate resources to undertake, and coordinate, the investigation (requiring senior management support) Strategy discussion/meeting held to agree an ‘Investigation Plan’ Safeguarding Plan implemented with further strategy discussions/meeting if appropriate Evaluation of Investigation activity and evidence obtained Determine if abuse has taken place Safeguarding Adults Senior Strategy Meeting, chaired by an appropriate senior manager, to agree a ‘Safeguarding Plan’ that prevents or reduces the risk of further abuse Monitoring of Safeguarding Plan Review of Safeguarding Plan WILL LEAD TO SAFEGUARDING ADULTS INVESTIGATION
•
•
• •
•
•
• •
• • •
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G.2
Legal Framework
It is not always possible to take legal action to address the many forms of exploitation and abuse to which vulnerable adults may fall victim particularly where a vulnerable has capacity to act to protect themselves or to seek redress but does not wish to do so. Even where a civil wrong or criminal offence may have been committed, there may be significant difficulties hampering or preventing the presentation of sufficient evidence to meet the required standard of proof, namely: • • Proof 'on balance of probabilities' in civil cases that the incident or conduct alleged did, or did not, take place
Proof 'beyond reasonable doubt' in criminal matters that the incident or conduct alleged did, or did not, take place What follows below is a summary of the legal processes that may be available to assist in protecting vulnerable adults. It must be stressed that the legal framework for protecting vulnerable adults is potentially complex and expert help will often be needed: in cases where there is any doubt about the legal position legal advice should be sought.
G.3
Mental Health Act 1983
The Act deals with the care and treatment of mentally disordered people. Part II of the act deals with the circumstances in which people suffering from mental disorder can be taken to or kept in hospital in order to for them to be assessed and/or to receive medical treatment for their condition. It is a complex piece of legislation which attempts to balance the civil liberties of people who may be suffering from mental disorder with the necessity to protect the individuals themselves and/or the safety and protection of others. Consultant psychiatrists and general practitioners have key roles, and the Act also gives specific legal duties and powers to social workers trained in the mental health field called ‘approved social workers’, employed by the local social services authority.
G.3.1
Compulsory admission to hospital
Section 2 of the Act gives authority to detain a person in hospital for up to twenty-eight days for assessment (although treatment may also be given in that period). Section 3 of the Act gives authority to detain a person in hospital for treatment (further assessment may be undertaken during this period). The patient is initially detained for a period of six months but this may be extended in appropriate circumstances. It should be stressed that the purpose of admission to hospital is for assessment and/ or treatment, not to remove a patient from an unsatisfactory home environment. Mental disorder must be of a nature or degree to warrant detention and it has to be the case that the patient ought to be detained in the interests of their own health or safety or with a view to the protection of other persons. (See ‘nearest relative’ in next section, G.3.2.)
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G.3.2
Guardianship
The Mental Health Act enables a person (the guardian) to be appointed to supervise mentally disordered people in particular circumstances. The powers of the guardian include directing where the person subject to guardianship should live. Nearest relative In addition to the duties of the approved social worker, the Act gives rights to the mentally disordered person's ‘nearest relative’ to act on behalf of and safeguard their civil rights when compulsory admission to hospital or detention in hospital, or guardianship is being considered. The nearest relative has a specific legal definition in the Mental Health Act .
G.3.3
Section 115: Entry and inspection
An approved social worker can at all reasonable times, after producing appropriate identification, enter and inspect any premises (other than a hospital) in the local authority's area where a mentally disordered person is living if they have reasonable cause to believe that the patient is not under proper care. Refusal to allow access is an offence. This power could be used to investigate a suspicion of abuse before considering what other action might be taken. If access cannot be gained a warrant under Section 135 (see below) could be sought.
G.3.4
Section 135: Application for a warrant to enter premises
This section enables an approved social worker to apply to a court for a warrant authorising the police to enter premises where there is reasonable cause to suspect that a person believed to be suffering from mental disorder has been, or is being ill-treated, neglected or kept otherwise than under proper control, or is living alone and is unable to care for themselves. The police constable, accompanied by a social worker and doctor can enter the premises (either by force or by invitation) and, if appropriate with a view to making arrangements for their health and care, remove the patient to a place of safety, i.e. local authority Part III accommodation or a hostel, a hospital, police station, nursing or residential home or other suitable place. The power to hold in a place of safety does not in itself authorise any treatment to be given but the patient can be kept in the place of safety for up to seventy-two hours with the purpose that it should be investigated whether other intervention such as hospital treatment or guardianship would be appropriate.
G.3.5
Section 136: Place of safety
The police have power to remove to a place of safety for up to seventy-two hours any person who is found in a public place and appears to the police to be suffering from a mental disorder and to be in immediate need of care and control. Again, this is for the purpose of organising a thorough assessment of the person's needs. The police would immediately contact a psychiatrist and an approved social worker.
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G.3.6
Section 127: Offences
It is an offence under Section 127 of the Act for an officer or member of staff of a care home or hospital or a hospital manager to ill-treat or wilfully to neglect a mentally disordered patient whether this is a person receiving treatment as an in-patient or as an out-patient or who is under their guardianship or otherwise in their custody or care (whether by virtue of any legal or moral obligation or otherwise). The Director of Public Prosecutions must agree to a prosecution being brought. The wide definition of custody or care and the application to all mentally disordered patients should mean that the police could consider taking action against any relative or friend abusing a mentally disordered adult although it is not yet settled in law that such a prosecution would be successful. The accused must have intended ill treatment or neglect, i.e. known or been reckless as to the consequences of their actions. Mental Capacity Act 2005 section 44 introduced a new criminal offence of ill-treatment or wilful neglect
Part VII- Mental Capacity Act 2005: Protection of Property and the Court of Protection
G.3.7
With effect from 1st October 2007, the MCA introduces two new bodies to look after the interests of person who lack decision specific capacity: the Court of Protection and the Office of the Public Guardian. A “Public Guardian” has also been appointed for this purpose. Further to sections 15 and 16, the Court of Protection has to power to: • • • • • decide whether a person has the capacity to make the specific decision set out in the courts declaration make financial and welfare decisions for persons who lack capacity appoint deputies to make decisions for persons who lack capacity decide whether a lasting Power of Attorney or old Enduring Power of Attorney is valid remove deputies or attorneys who fail to carry out their duties
G.4
Mental Capacity Act 2005
Capacity
Capacity is now addressed by the Mental Capacity Act 2005 (“the Act “) A person must be assumed to have capacity unless it is established that s/he lacks capacity; section 1(2). This is a fundamental principal of the Act which applies for the purposes of the Act.
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A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success; section 1(3) A person is not to be treated as unable to make a decision merely because s/he makes an unwise decision; section 1(4). Lack of capacity is also defined by the Act at section 2(1) “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for her/himself in relation to the matter because of an impairment of, or disturbance in the functioning of, the mind or brain”. It does not matter whether the impairment or disturbance is permanent or temporary; section 2(2). A lack of capacity cannot be established merely by reference to a person’s age or appearance or a condition of his (hers), or an aspect of his/her behaviour, which might lead others to make unjustified assumptions about his/her capacity; section 2(3) A person is unable to make a decision for him/herself if s/he is unable to understand the information relevant to the decision, to retain that information, to use or weigh that information as part of the process of making the decision, or to communicate his/her decision; section 3 An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his/her best interests; section 1(5) In determining for the purposes of the Act what is in a person’s best interests, the person making the determination must not make it purely on the basis of the person’s age or appearance to a conditions of his (hers) or an aspect of his/her behaviour, which might lead others to make unjustified assumptions about what might be in his best interests; section 4(1). The person making the determination must consider all the relevant circumstances and, in particular, take the following steps. S/he must consider whether it is likely that the person will at some time have capacity in relation to the matter in question, and if it appears likely that s/he will, when is that likely to be; section 4(3). S/he must so far as reasonably practicable, permit and encourage the person to participate, or to improve her/his ability to participate, as fully as possible in any act done for him/her and any decision affecting him/her; section 4(4). S/he must consider, so far as is reasonably ascertainable the persons past and present wishes and feelings (and, in particular, any relevant written statement made by him when s/he had capacity), the beliefs and values that would be likely to influence her/his decision if s/he had capacity, and the other factors that s/he would be likely to consider if s/he were able to do so; section 4(6). There is a duty for the person making the determination to take into account the views of certain specified persons; section 4(7).
G.4.1
Deprivation of Liberty Safeguards
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The Mental Capacity Act 2005 has now been amended to introduce new safeguards in respect of the deprivation of liberty of hospital and care home residents who lack capacity to consent to their placements. The amendments, which will be implemented in April 2009, will introduce a regime that requires local authorities or hospital management to assess and, if appropriate, authorise the deprivation of liberty of a person in that place following specified assessments if satisfied that certain criteria are met. The person whose liberty is in question must be assessed as to age, health, mental capacity, and best interests. They must also satisfy the eligibility requirement and for health issues, a requirement that they have not made a valid advance decision concerning treatment.
G.5
The Official Solicitor
Where a person lacks capacity to conduct proceedings in the civil courts or give instructions to a legal representative; they will need to be represented by someone acting on their behalf. This may be a relative or friend. (The legal term for somebody acting on behalf of another person is ‘litigation friend’). However, the Official Solicitor can also act in this capacity and can represent a person to defend an action (for example because they are being evicted from their home or facing a civil claim for debt), or bring an action (for example to expel someone else from their home). The Official Solicitor may also be involved in proceedings in the new Court of Protection particularly where the Court is considering making decisions regarding the individual’s personal circumstances.
G.6
National Health Service and Community Care Act 1990
Section 47 - Where it appears to a local authority that any person for whom they may provide or arrange for the provision of community care services may be in need of any such services, the authority: (a) shall carry out an assessment of his needs for those services; and (b) having regard to the results of that assessment, shall then decide whether his needs call for the provision by them of any such services.
G.7
National Assistance Act 1948
Section 47 of the Act applies to persons who are suffering from grave chronic disease or are aged, infirm or physically incapacitated and are living in unsanitary conditions and are unable to devote to themselves, and are not receiving from other persons, proper care and attention. It is not limited to person who lack decision making capacity. An application may be made to the Magistrate’s Court by the district council for the area supported by a certificate from the medical officer of health and the Court may order removal from the place where the person is living if this is necessary in their interests or for preventing injury to the health of, or serious nuisance to, other persons. Any action can only be taken under this provision if it is compliant with the individual’s human rights under Article 2, 5 and 8 of the European Convention and the Human Rights
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Act 1998. This is now rarely used as there is widespread concern that use of this provision will be tantamount to a deprivation of liberty in breach of Art 5.
G.8
Human Rights Act 1998 and European Convention on Human Rights
Following the implementation of the Human Rights Act 1998 in 2000, local authorities and health authorities can be directly challenged on action or inaction which leads to a breach of an individual’s human rights. The Articles of the European Convention which are likely to be most relevant in safeguarding adults can be summarised as follows: Article 2 Article 3 Article 5 Article 6 Article 8 Right to life Prohibition of torture, inhuman or degrading treatment The right not to be deprived of liberty, save in accordance with the law The right to a fair and public hearing within a reasonable time for the determination of civil rights and obligations The right to respect for private and family life, home and correspondence. A public authority may only interfere with the exercise of this right in accordance with the law and so far as is necessary in the interests of inter alia public safety and for the prevention of disorder or crime, or for the protection of health and morals
Individuals are entitled to enjoy the rights and freedoms set out in the Act without discrimination
G.9
Carers (Recognition and Services) Act 1995
Carers (but not care workers or volunteers) are entitled to an assessment if they are providing or intending to provide regular and substantial care to a disabled, ill or elderly person. The local authority must then include the results of this assessment when making decisions about the services that they may provide to the disabled person (service user). This may include services to enable the carer to continue to care. A carer’s assessment is an important opportunity to enable the carer to discuss his own needs.
G.9.1
The Carers and Disabled Children’s Act (2000)
One of the key aspects of this Act is that if the person that is cared for refuses an assessment the Carers can still request and receive one. Carers (but not care workers or volunteers) aged 16 years and over providing or intending to provide regular and substantial care for an adult may be assessed, whether or not the person they care for chooses to be assessed. The assessment is of their ability to provide and to continue to provide care. A "carer's service" may be provided to help the carer carry out their caring role; it may take the form of physical help or other forms of support, including
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direct payments. It may also take the form of a service delivered to the person cared for, unless of an intimate nature. The Act also gives local authorities the power to issue Carer Break Vouchers to enable carers to take a break. These may be issued as a result of a carer’s assessment undertaken under either Act. Work and Families Act 2006 Became law in April 2007. Carers have a right to request flexible working. From altering arrival and leaving times with their employer to getting emergency paid leave. Carers that would be eligible for this right are: An adult who they are married to, or their partner or civil partner: Someone who is a close relative (including parent, parent –in-law, child, siblings, uncles, aunts, grandparents and step relatives Someone who falls into neither category but lives at the same address.
G.9.2
Carers Equal Opportunities Act 2004
The Carers Equal Opportunities Act came into force on 1st April 2005. Clause 1 of the ACT means that Local Authorities have a legal duty to inform Carers of their right to a separate assessment of their needs- A Carers Assessment. For parent Carers of children with disabilities it may be undertaken as part of a Children’s Act Assessment. Clause 2 amends earlier Carer legislation by ensuring that when a Carers assessment is being completed it must take into account if the Carer works or wishes to work. Leisure opportunities for Carers must also be taken into consideration when the assessment is carried out. Clause 3 states that the Local authority can request cooperation in ensuring that Carers issues are addressed in planning processes. This is particularly significant in relation to cross agency cooperation and liaison. A potential Carer may also ask for an assessment if they are going to provide substantial and regular care in the near future if for example, when someone is about to be discharged from hospital who is likely to need care when they return home.
G.10 The
Care Standards Act 2000
The Act provides a comprehensive scheme for registration and inspection of all types of care provided in both residential and domiciliary care settings by the Commission for Social Care Inspection (CSCI). CSCI also has powers of refusal and cancellation of registration
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G.11
Safeguarding Vulnerable Adults Group Act
The Safeguarding Vulnerable Groups Act 2006 provides the legal framework for the new Vetting and Barring Scheme. Background The Safeguarding Vulnerable Groups Act is a major element of a wide-ranging and ambitious programme of work established across government to address the systemic failures identified by the Bichard inquiry into the Soham murders. The Act was created in response to recommendation 19 of the Bichard Inquiry Report, which states: “new arrangements should be introduced requiring those who wish to work with children, or vulnerable adults, to be registered. The register would confirm that there is no known reason why an individual should not work with these clients.” In March 2005 Sir Michael Bichard endorsed DfES and DH’s proposal to implement Recommendation 19 through the development of a central scheme whereby unsuitable people would be barred from working with children and/or vulnerable adults. The full text of the Safeguarding Vulnerable Groups Act and its Explanatory Notes is available on the Office of Public Sector Information website, www.opsi.gov.uk. The future of Vetting and Barring The Safeguarding Vulnerable Groups Act provides the legal framework for the new Vetting and Barring Scheme. The new Vetting and Barring Scheme is due to be introduced in a phased roll-out from autumn 2008. In the meantime, the DfES, DH and Home Office are drafting the Regulations and Guidance that will underpin the scheme and help prepare for its launch. Provisions under the Safeguarding Vulnerable Groups Act In summary, the Act includes the following provisions:
• • • • • • •
Coverage of the scheme defined in terms of regulated and controlled activities* Two barred lists with four routes to inclusion on one or both of the barred lists An Independent Barring Board The referral of relevant information A right of appeal to the Care Standards Tribunal A series of new criminal offences to enforce the scheme The Act and the new Vetting and Barring Scheme will not distinguish between paid and unpaid (voluntary) work as this does not have any bearing on the potential for abuse.
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Improvements under the new Vetting and Barring Scheme When the new Vetting and Barring Scheme is phased in from autumn 2008, it will reform current vetting and barring practices through the following improvements: • The Integration of lists – The Protection of Children Act (POCA) list, Protection of Vulnerable Adults (POVA) list, List 99 and the Disqualification Order Regime will be replaced by the new Vetting and Barring Scheme. There will be a single list of those barred from working with children and a separate, but aligned, list of those barred from working with vulnerable adults. • Pre-employment vetting - The scheme will ensure that those who are known to present a risk of harm to children and/or vulnerable adults are prevented from entering the relevant workforce in the first place. • Independent and consistent decision making - A new Independent Barring Board will be set up to take all discretionary decisions on who should be placed on the barred lists both prior to an individual’s employment and, if necessary, following a referral into the scheme. • The introduction of continuous monitoring - When relevant new information becomes known about an individual who is already in the workforce and being monitored by the scheme, the Independent Barring Board will if necessary review the original decision not to bar. Where they have registered, the employer will be notified if a person’s status in the Vetting and Barring Scheme has changed. • Workforce coverage – The scope of the new scheme will be wider than the current arrangements. For example, in relation to vulnerable adults this is a significant step forward from the existing POVA scheme, which applies in regulated social care settings only. • A reduction in bureaucracy - Once people have joined the new scheme, subsequent employers will be able to check their status in the scheme on-line, free of charge. • Wide range of sources of information - As with the current arrangements, certain organisations will be under a duty to refer relevant information about individuals to the Independent Barring Board. Under the new scheme, other employers and service providers will also have the opportunity to refer information For further information go to www.everychildmatters.gov.uk
G.12
The Sexual Offences Act 2003
Offences Against Mentally Disordered Persons
Three groups of offences: (1) Offences against persons with a mental disorder impeding choice • ss30 –33 • causing/inciting person with mental disorder to engage in sexual activity
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• • •
engaging in sexual activity in presence of person with mental disorder causing person with mental disorder to watch sexual activity and because of mental disorder/reasons relating to it, the victim is unable to refuse.
‘Mental Disorder’ = mental illness, arrested or incomplete development of the mind, psychopathic disorder and any other disorder of the mind – importantly this will include a learning disability ‘Inability to Refuse’ = (i) absence of capacity to choose or (ii) inability to communicate (2) Inducement, threat or deception to a person with a mental disorder • ss34 -37 • inducement/threat/deception to procure sexual activity with person with mental disorder • difference between these and previous offences is that there is no need to prove mentally disordered person was unable to refuse. • need to prove victim’s agreement was procured by threat/inducement/deception by the defendant. (3) Offences by care workers against persons with a mental disorder • ss38 -41 • offences deal with care workers who involve persons with a mental disorder in sexual activity • offences mirror the offences relating to an abuse of trust in respect of a child (ss16 19) • there is no need to prove victim did not have capacity to consent • neither is there a need to show the care worker exerted any undue influence • it is presumed that the care worker knew the victim had a mental disorder unless he/she can provide evidence to rebut this presumption ‘Care worker’ = wide interpretation – where the mentally disordered person is accommodated and cared for in a care home/community home/voluntary home, children’s home or their own home, and the care worker has functions to perform in the home in the course of employment which bring him/her in to regular face-to-face contact with them.
G.13
Family Law Act 1996
This Act seeks to protect individuals from domestic violence.
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Sections 33 to 41 of the Act deal with occupation orders A court may make such an order enforcing, or restricting the respective rights of spouses, co-habitees and various other categories of people in a family relationship in respect of their occupation of a property. Where the court decides to make an occupation order, the type of order may range from regulating who can live in the residence to actually ousting an individual from a property. Section 42 of the Act deals with non-molestation orders. A court may make such an order to prohibit any person falling within a category of persons/relatives prescribed in the Act from molesting another person in the same household.
G.14
Protection from Harassment Act 1997
This Act creates both criminal and civil remedies for persons who are victims of harassment through another person's ‘course of conduct.’ A course of conduct must involve conduct on at least two occasions and ‘conduct’ includes speech. ‘Harassment’ under the Act includes alarming a person that violence will be used against them, or causing them distress.
G.15
Youth Justice and Criminal Evidence Act 1999
The Youth Justice and Criminal Act 1999 provides new measures to make it easier for vulnerable witnesses to give evidence in the criminal courts. The court can allow special measures for eligible witnesses, i.e. if the court considers that the quality of evidence given by the witness could be improved because the witness: • • • suffers from a mental disorder within the meaning of the Mental Health Act 1983 otherwise has a significant impairment of intelligence and social functioning the witness has a physical disability or is suffering from a physical disorder
The possible special measures are set out in Section 23-30 of the Act. They include provision for screens, video recording of evidence in chief, pre-recorded cross-examination and examination through an intermediary or with the use of communication aids. A party will apply for special measures in respect of eligible witnesses. If special measures would improve the quality of the witnesses evidence, i.e. improve its completeness, coherence and accuracy, then special measures may be used. The court must balance on the one hand the potential to improve the quality of the evidence with the risk of inhibiting the testing of evidence by the defendant.
G.16
Crime and Disorder Act 1998
Section 115 establishes the power to disclose information, which is central to the Act’s partnership approach. The Police have an important and general power at common law to disclose information for the prevention, detection and reduction of crime. However, some other public bodies which collect information may not previously have had power to disclose it to the Police and others. This section therefore puts beyond doubt the power of any organisation to disclose information to Police authorities, local authorities, probation
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committees, health authorities, or to persons acting on their behalf, so long as such disclosure is necessary or expedient for the purposes of this Act. These bodies also have the power to use this information.
G.17
The Fraud Act 2006
The Act provides for a general offence of fraud with three ways of committing it, which are by false representation, by failing to disclose information and by abuse of position. It creates new offences of obtaining services dishonestly and of possessing, making and supplying articles for use in frauds. It also contains a new offence of fraudulent trading applicable to non-corporate traders. The effect of the new legislation is to move the law to criminalise the conduct of the fraudster rather than to look at the consequence of the fraudster's activities. Section 4 of the Act may be of particular interest to those investigating financial abuse of vulnerable adults. It makes it an offence to commit a fraud by dishonestly abusing one's position. It applies in situations where the defendant has been put in a privileged position, and by virtue of this position is expected to safeguard another's financial interests or not act against those interests. The term "abuse" is not limited by a definition, because it is intended to cover a wide range of conduct. Moreover subsection (2) makes clear that the offence can be committed by omission as well as by positive action. For example, an employee who fails to take up the chance of a crucial contract in order that an associate or rival company can take it up instead at the expense of the employer, commits an offence under this section. An example covered by this section is where a person who is employed to care for an elderly or disabled person has access to that person's bank account and abuses his position by transferring funds to invest in a high-risk business venture of his own. It may also apply to the misuse of a lasting or enduring power of attorney.
G.18
The Domestic Violence Crime and Victim’s Act 2005
The Act is intended to introduce reform to the civil and criminal law in these areas by criminalising the breach of non-molestation orders under the Family Law Act 1996; by extending the availability of restraining orders under the Protection from Harassment Act 1997; and by making common assault an arrestable offence. There is also a provision included on a new offence of causing or allowing the death of a child or vulnerable adult following on from the Law Commission proposals in their report published in September 2003 "Children: their non-accidental death or serious injury (criminal trials)" No 282, together with their earlier Consultative Report No 279 and the report by the National Society for the Protection of Children "Which of you did it?", published in autumn 2003. These reports contain a detailed analysis of the problems encountered in the law at present. However, the new offence is designed to protect vulnerable adults as well as children and the approach taken to its formulation is also different in other ways.
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Section 5: Causing or allowing the death of a child or vulnerable adult: the offence 25. Subsection (1) sets out the circumstances under which a person is guilty of an offence of causing or allowing the death of a child or a vulnerable adult. It limits the offence to where the victim has died of an unlawful act, so it will not apply where the death was an accident, or where for example a child may have suffered a cot death. The offence only applies to members of the household who had frequent contact with the victim, and could therefore be reasonably expected both to be aware of any risk to the victim, and to have a duty to protect him from harm. 26. The household member must have failed to take reasonable steps to protect the victim. What will constitute "reasonable steps" will depend on the circumstances of the person and their relationship to the victim. 27. The victim must also have been at significant risk of serious physical harm. The risk is likely to be demonstrated by a history of violence towards the vulnerable person, or towards others in the household. The offence will not apply if the victim died of a single blow when there was no previous history of abuse, nor any reason to suspect a risk. Where there is no reason to suspect the victim is at risk, other members of the household cannot reasonably be expected to have taken steps to prevent the abuse. They will therefore not be guilty of the new offence, even where it is clear that one of them is guilty of a homicide offence. 28. The effect of subsection (2) is that where, for example, there are two defendants and it is established that one must have caused the death and the other must have failed to take reasonable steps to prevent it, the prosecution does not have to prove which is which. 29. Subsection (3) provides that only those who are 16 or over may be guilty of the offence, unless they are the mother or father of the victim. Members of the household under 16 will not have a duty of care or be expected to take steps to prevent a victim coming to harm. In particular, a child under 16 will have no duty to prevent their parents from harming a sibling. The parents of a child will be expected to take reasonable steps to protect their child even if they themselves are under 16. 30. Subsection (4)(a) provides that a person who visits the household frequently and for long periods can be regarded as a member of the household for these purposes. This will apply whatever the formal relationship of the person to the victim. Subsection (4)(b) covers situations where the victim might have lived in different households at different times. Only the members of the household where the victim suffered fatal harm could be guilty of the offence. 31. Subsection (5) makes it clear that a defendant can be charged with failing to take reasonable steps to protect the victim, even where the victim died as a result of the act of person who lacks criminal responsibility. There is a safeguard to ensure that a person who lacks criminal responsibility cannot be charged with the criminal act of causing the death by virtue of the definition in this section if he could not otherwise be charged with an offence.
G.19
Corporate Manslaughter
The Corporate Manslaughter and Corporate Homicide Act 2007 introduces a new offence. From 6th April 2008, companies and other organisations will be prosecuted where there has
103
been a gross failing in the management of health and safety causing death. An organisation that is found guilty will be liable to a fine, a remedial order and a publicity order. This is a change to the present law where organisations can only by convicted of manslaughter if a single individual at the very top of the organisation is personally guilty.
G.20
Race Relations Act 1976 (amended 2000)
The Race Relations Act 1976 makes it unlawful to discriminate again a person, directly or indirectly on racial grounds in: employment, education, housing, and in the provision of goods, facilities and services. The Race Relation (Amendment) Act 2000 extends the requirements under the 1976 Act to all functions. The new Act gives public authorities a new statutory duty to promote race equality. The aim is to help public authorities to provide fair and accessible services, and to improve equal opportunities in employment
G.21
Disability Discrimination Act 1995
The Disability Discrimination Act 1995 (DDA 1995) is a UK parliamentary act of 1995, which makes it unlawful to discriminate against people in respect of their disabilities in relation to employment, the provision of goods and services, education and transport. It is a civil rights law.
G.22
Sex Discrimination Act 1975
This Act applies to women and men of any age, including children, and makes discrimination on the grounds of sex or marriage unlawful. However, it is not unlawful to discriminate against someone because they are not married. Victimisation, because someone has tried to exercise his or her rights under this Act, is also unlawful.
G.23
The Public Interest Disclosure Act 1998
Came into force on 2nd July 1999. It mainly takes the form of amendments to the Employment Rights Act 1996. It is designed to protect workers from detrimental treatment or victimisation from their employer if, in the public interest, they “blow the whistle” on wrongdoing.
G.24
The Freedom of Information Act 2000
The Freedom of Information Act 2000 grants a right of access to any information held by public authorities, unless there are valid legal reasons why this information should not be disclosed. It is intended to promote a culture of openness and to facilitate a better public
104
understanding of how public authorities carry out their duties, the reasoning behind their decisions, and how public money is spent. The Freedom of Information Act 2000 does not interfere with the public authority’s obligation to protect personal or confidential data, nor does it inhibit an individual’s right to access their own personal information, as prescribed under the Data Protection Act 1998.
G.25
The Data Protection Act 1998
The Data Protection Act 1998 requires organisations to ensure that personal data is processed (i.e. obtained, held, used, disclosed and destroyed) in accordance with eight Data Protection principles, unless exemptions apply. It also grants individuals a right of access to their own personal information, unless exemptions apply. • • • • • • • • • The eight data protection principles are as follows: Processed fairly and lawfully Processed for specified purposes Adequate, relevant and not excessive Accurate and kept up-to-date Not kept for longer than is necessary Processed in accordance with the rights of data subjects Protected by appropriate security (practical and organisational) Not transferred outside the EEA without adequate protection
105
Part H: Contact numbers and addresses for Emergency Duty Team, Surrey Contact Centre and Surrey Police Surrey Contact Centre 08456 009 009 or Email: contact.centre@surreycc.gov.uk
Emergency Duty Team (Out of Hours Service)
PO Box 473, Guildford Surrey GU4 7ZL Telephone: 01483 517898 Fax: 01483 517895 Minicom: 01483 517844 Email: edt.ssd@surreycc.gov.uk
Surrey Police
Main switchboard number is 0845 125 2222 ~ call then ask for relevant public protection unit.
In the event of an emergency situation then please dial 999 Crimestoppers: Freephone 0800 555111
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Part I: Helpful local and national organisations
Local Organisations Action for Carers (Surrey)
Countywide will signpost to local carers support schemes in each borough of the county.
Telephone Number/EMail 01483 302748
Websites
www.actionforcarers.org.uk
Age Concern Surrey
Guildford Banstead Epsom/ Ewell 01483 503414 01737 352156 01372 732456
www.acsurrey.org.uk
Carers Support Projects across Surrey Citizens Advice Bureaux Local telephone numbers in directory
www.carersnet.org.uk
www.citizensadvice.org.uk
DisCASS
01483 860551 E Mail: info@discass.org Domestic Abuse Helpline (24- 01483 776822 hour confidential service) Takes calls from anyone affected by domestic abuse
www.discass.org
Headway Surrey Independent Mental Capacity Advocate Providers
Helpline 01483 454433 Just Advocacy 01483 527759 West Surrey: Boroughs of Waverley, Guildford, Surrey Heath, Woking, Runnymede and Spelthorne Email
imca.surrey@justadvocacy.org.uk
www.headwaysurrey.org www.justadvocacy.org.uk
Kingston Advocacy Group (KAG) Office: 0208 549 1028 Dedicated mobile: 07825 549191 East Surrey: Boroughs of Elmbridge, Epsom & Ewell, Mole Valley, Reigate & Banstead and Tandridge
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PHAB (Surrey) South West Surrey Partnership Board Surrey Coalition of Disabled People (formerley SUN) Surrey Alcohol and Drug Advisory Service (SADAS) National Organisations Action on Elder Abuse Astral House 1268 London Road London SW16 4ER Ann Craft Trust ACT Centre for Social Work University of Nottingham University Park Nottingham NG7 2RD BILD (British Institute of Learning Disabilities Carers UK 32-36 Loman Street, Southwark, London SE1 0££ Disability Law Service 39-45 Cavell Street London E1 2BP MENCAP PAVA (National) PAVA PO BOX 127 RYDE PO33 9AE Pavilion Publishing Richmond House Richmond Road Brighton East Sussex BN2 3RL
01306 730929 01483 517254 01483 456558 E Mail:
info@surreycoalition.org.uk
www.lifetrain.org.uk
01483 590150 Email :
info@sadas.org.uk
www.sadas.org.uk
Telephone Number/EMail 020 8765 7000 Helpline: 080 880 88141 0115 951 5400 Email:
ann-craft-trust@nottingham.ac.uk
Websites
www.elderabuse.org.uk
www.anncrafttrust.org
01562 723 010 E Mail:
enquiries@bild.org.uk
www.bild.org.uk
0207 490 8818 Carersline (helpline) 0808 808 7777
Weds/Thurs 10-12 & 2-4pm
www.carersuk.org
0207 791 9800 Email:
advice@dls.org.uk
www.dls.org.uk
020 7454 0454 E Mail:
information@mencap.org.uk
www.mencap.org.uk
www.pavauk.org.uk
01273 623222 Telephone customer services: 0870 890 1080 Email
info@pavpub.com
www.pavpub.com
Princess Royal Trust for Carers
0844 800 4361
www.carers.org
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Unit 14 Bourne Court Southend Road, Woodford Green Essex IG8 8HD
Rape Crisis (helpline) Respond 3rd Floor 24-32 Stephenson Way London NW1 2HD
020 7837 1600 020 7383 0700 Helpline: 0808 808 0700
www.rapecrisis.co.uk www.respond.org.uk
Samaritans Victim Support National Helpline) Voice Wyvern House Railway Terrace Derby, DE1 2RU
08457 90 90 90 0845 30 30 900 Email
supportline@victimsupport.org.uk
www.samaritans.org www.victimsupport.com
01332 345346 HELPLINE 0845 122 8695 Email:
voice@voiceuk.org.uk
www.voiceuk.org.uk
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Part J: Relevant local and national guidance
Action on Elder Abuse (AEA) ‘UK Study of Abuse and Neglect of Older People – Prevalence Survey Report’ Association of Directors of Social Services (2005) ‘Safeguarding Adults – a National framework of standards for good practice and outcomes in adult protection work’ Commission for Social Care Inspection ‘Safeguarding Adults Protocol and Guidance Department of Health (1997) ‘The Caldicott Committee: Report on the review of patient identifiable information’ Department of Health NHS Exec (1998) ‘Revised framework for reporting and managing serious untoward incidents’ Department of Health (2000) ‘No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse’ Department of Health (May 2003) ‘What To Do If You’re Worried A Child Is Being Abused’ Department of Health (November 2003) The NHS Confidentiality Code of Practice. Confidentiality: NHS Code of Practice Department of Health (2004) ‘Memorandum of Understanding – Investigating patient safety incidents (patient death or serious untoward harm)’ Department of Health (2005) ‘Independence, Well-being and Choice’ Department of Health (2007) ‘Valuing People Now: From Progress to Transformation’ Foreign and Commonwealth Office ‘Young People and vulnerable adults facing forced marriage – practice guidance for social workers’ www.fco.gov.uk/forcedmarriage Government Green Paper ‘Every Child Matters’ Home Office 'Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses, and Using Special Measures'
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Home Office ‘Keep Safe – a Guide to personal safety’ Surrey Safeguarding Children Board Procedures ‘Manual that lays out the principles and standards agreed between all partner agencies for safeguarding children, in the context of the Framework for the Assessment of Children in Need and whilst recognising that children need to be made safe from harm alongside meeting their other needs’ Surrey Safeguarding Children Board www.surreycc.gov.uk/safeguarding Valuing People Now ‘From Progress to Transformation (2007)’
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