Safeguarding Adults Annual Report







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Safeguarding Adults Annual Report 2014-15

Trust Board Part 1 Item: 10.1

29th July 2015 Enclosure: K4

Purpose of the Report:

The purpose of this annual report is to inform members of the Trust Board of the Safeguarding Adults activities within Kingston Hospital during the year 1st April 2014 to 31st March 2015, and priority areas for 2015/16

FOR: Information Assurance Discussion and input Decision/approval Sponsor (Executive Lead): Duncan Burton, Director of Nursing and

Patient Experience

Authors: Fergus Keegan, Deputy Director of Nursing

Sarah Loades, Older People Specialist Nurse Author Contact Details: Extension 3066

Financial/Resource Implications: Nil Risk Implications – Link to Assurance

Framework or Corporate Risk Register:


Legal / Regulatory / Reputation Implications:


Compliance with statutory requirements CQC Risk Profile

Quality Governance Implications:

Link to Relevant CQC Regulations Regulation 13 Safeguarding service users from abuse and improper treatment Fundamental standard (5) – safeguarding from abuse

Safe Domain – safeguarding arrangements: Staff understand their responsibilities and adhere to safeguarding policies and procedures

Link to Relevant Corporate Objective:

To comply with Care Quality Commission requirements to maintain license to practice

Impact on Patients and Carers:

To enable the Trust Board to assure patients and carers that there is a robust framework in place for the protection of adults at risk Document Previously Considered By: Executive Management Committee

(22nd July) Recommendation & Action required by the Trust Board :

Trust Board members are requested to note the report, the improvements made during 2014/15 and those scheduled for implementation during 2015/16



1. The arena for safeguarding has changed dramatically over the last 12-18 months as a result of a wide variety of national policy and legislation changes, best summarised in the principles highlighted below:

 Safeguarding duties have a legal effect in relation to all organisations, not just the Local Authority who retain their responsibility as the lead co-ordinating organisation.  Staff are required to act in a timely way to any concerns or suspicions that an adult

at risk is being or is at risk of being abused or neglected.

 Actions to protect the adult from abuse should always be given high priority by all organisations involved, and in consultation with the adult.

 Organisations working to safeguard adults at risk should make the dignity, safety and wellbeing of the individual a priority in their actions, respecting their wishes about any proposed actions wherever possible.

 Staff will understand their role and responsibilities in regard to this policy and procedure and their safeguarding duties under the Care Act 2014.

 Organisations may have their own internal operational procedures which relate to these multi-agency Safeguarding Adults policy and procedures

 Whistle blowing and a duty of candour should comply with the Public Interest Disclosure Act 1998 and the Care Act 2014. Staff should be made aware of their rights and obligations to both issues.

 Organisations will ensure that all staff and volunteers are familiar with policies relating to Safeguarding Adults, know how to recognise abuse and neglect and how to respond to it.

 Organisations will ensure that staff and volunteers will have access to training that is appropriate to their level of responsibility and will receive clinical and/ or management supervision that affords them the opportunity to reflect on their practice and the impact of their actions on the adult at risk and others.

2. The purpose of this annual report is to inform members of the Trust Board of the Safeguarding Adult activities in Kingston Hospital during 1st April 2014 to 30th March 2015. It aims to provide assurance against compliance with the local multi-agency guidelines for safeguarding adults, compliance with the Care Quality Commission Registration standards, Regulation 13 Safeguarding service users from abuse and improper treatment,, fundamental standard (5) – safeguarding from abuse, and Safe Domain – safeguarding arrangements.


3. The document “No Secrets” (Department of Health, 2000) signalled the intention of the Government to provide greater protection to patients. The report recognised there were concerns about the identification and reporting of crimes against adults at risk in care settings. It endorsed the proposals made by the Association of Directors of Social Services and others that a national policy should be developed for the protection of adults at risk. 4. In January 2011, NHS London launched the “Protecting Adults at Risk: London multiagency

policy and procedures to safeguard adults from abuse. The document represents the commitment of all organisations to Safeguarding Adults, harmonising the multi-agency approach which responds to, and safeguards, adults at risk across London. Partner


agencies include the Metropolitan Police, Local Authorities, volunteers and staff working in the public and private sector. The Local Authority (Royal Borough of Kingston) is the lead agency and holds the responsibility for coordinating the process. The Pan-London Policy has been under review during 2014/ 2015. This revised policy and procedure aims to represent the continuing commitment of organisations in London to work together to safeguard adults with care and support needs unable to protect themselves. One of the key functions of this revised policy and procedure will be to help agencies to achieve clarity and consistency across London in their approaches to safeguarding adults. The aim of this document is to ensure that it is aligned with the requirements of the Care Act 2014 and encapsulate national and regional initiatives.

5. On 19 March 2014, the Supreme Court handed down its judgment in the case of “P v Cheshire West and Chester Council and another” and “P and Q v Surrey County Council”. The Supreme Court (UK) has overturned case law and lowered the threshold for eligibility below that of the original regulations for Deprivation of Liberty Regulations. This has meant our focus in the last year has been towards ensuring that any decision to deprive someone of their liberty is made following defined processes and in consultation with specific authorities.

6. In October 2014, the Care and Support Statutory Guidance was issued by the Department of Health under the Care Act 2014. The Care Act represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support. The Act came into force from 1st April 2015 and delivers key elements of the Government’s response to the Francis Inquiry, increasing transparency and openness and helping drive up the quality of care across the system. The Care Act 2014, places the statutory responsibility on local authorities (in turn upon the Trust) to:

 Make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect which they cannot protect themselves from because of their care and support needs. An enquiry should establish whether any action needs to be taken to stop or prevent abuse or neglect, and if so, by whom.

 Set up a Safeguarding Adults Board (SAB) with core membership from the Local Authority, the Police and the NHS (specifically the local Clinical Commissioning Group/s) and the power to include other relevant bodies.

 SABs must arrange a Safeguarding Adults Review (SAR) when there are serious safeguarding concerns in order for all organisations to learn and make sustainable improvements.

 Co-operate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect. All partners should work more closely and share information.

7. The safeguarding duties have a legal affect in relation to organisations other than the Local Authority, on for example, the NHS and the Police. For the statutory partners these include, ‘Safeguarding Vulnerable People in the NHS Accountability and Assurance Framework’ (2015). All staff should familiarise themselves with their safeguarding roles and responsibilities in regard to these policies and procedures and their duties under the Care Act. The Care Act now describes six safeguarding principles:


Empowerment People are encouraged to make their own decisions and are provided with support and information.

Prevention Strategies are developed to prevent abuse and neglect that promotes resilience and self-determination.

Proportionate A proportionate and least intrusive response is made with people appropriate to the level of risk.

Protection People are offered ways to protect themselves, and there is a co-ordinated response to safeguarding concerns.

Partnerships Local solutions through services working together within their communities.

Accountable Accountability and transparency in delivering a safeguarding response.

8. From October 2014, following parliamentary approval, NHS providers are now required to comply with the duty of candour, meaning providers must be open and transparent with patients and carers about their care and treatment, including when it goes wrong. The duty was introduced as part of the fundamental standard requirements for all providers. It applies to all NHS Foundation Trusts.

9. In recent years, the publication of the Francis Inquiry and the Winterbourne View Inquiry have increased both the public awareness of safeguarding and the need for the health service to place greater emphasis on ensuring quality care is delivered at all times. In the last year, following the death of Jimmy Savile and subsequent allegations of his wrongdoing at NHS organisations, the Department of Health launched an inquiry into his activities across the NHS. In total, 44 reports have now been published following investigations triggered by this exercise. In February 2015, themes and lessons learnt from NHS investigations into matters relating to Jimmy Savile were published in the Lampard Report. 10. The Prevent Duty is effective as of 1st July 2015. The Prevent Duty provides definitions and

context regarding Prevent, details regarding monitoring and enforcement and sector specific guidance.

Key Issues:

11. There are a number of local factors in addition to the national context which have led to increased focus upon safeguarding matters over the last year and will continue to do so in the future, including:

 Growth in demand (with an increasing aged population/ greater awareness/ higher levels of scrutiny)

 Serious Case Reviews and increasing levels of activity arising from such issues as reported through the Saville/ Francis/ Winterbourne enquiries

 Deprivation of Liberty regulatory changes leading to a lower threshold for assessments and referrals to be made to the local authority (reflecting the wider national position).

12. In 2014/ 2015 the Trust has continued to manage the implications of the Supreme Court judgement in relation to Deprivation of Liberty, including the way in which the Trust deals with the risk and resource implications.


Recommendations & Action required by the Trust Board:

13. Trust Board members are requested to note the report, the improvements made during 2014/15 and those scheduled for implementation during 2015/16


Safeguarding Adults Annual Report:

April 2014 - March 2015

Report prepared by:

Fergus Keegan, Deputy Director of Nursing


Purpose of report:

1. The arena for safeguarding has changed dramatically over the last 12-18 months as a result of a wide variety of national policy and legislation changes, best summarised in the principles highlighted below:

 Safeguarding duties have a legal effect in relation to all organisations, not just the Local Authority who retain their responsibility as the lead co-ordinating organisation.  Staff are required to act in a timely way to any concerns or suspicions that an adult

at risk is being or is at risk of being abused or neglected.

 Actions to protect the adult from abuse should always be given high priority by all organisations involved, and in consultation with the adult.

 Organisations working to safeguard adults at risk should make the dignity, safety and wellbeing of the individual a priority in their actions, respecting their wishes about any proposed actions wherever possible.

 Staff will understand their role and responsibilities in regard to this policy and procedure and their safeguarding duties under the Care Act 2014.

 Organisations may have their own internal operational procedures which relate to these multi-agency Safeguarding Adults policy and procedures

 Whistle blowing and a duty of candour should comply with the Public Interest Disclosure Act 1998 and the Care Act 2014. Staff should be made aware of their rights and obligations to both issues.

 Organisations will ensure that all staff and volunteers are familiar with policies relating to Safeguarding Adults, know how to recognise abuse and neglect and how to respond to it.

 Organisations will ensure that staff and volunteers will have access to training that is appropriate to their level of responsibility and will receive clinical and/ or management supervision that affords them the opportunity to reflect on their practice and the impact of their actions on the adult at risk and others.

2. Safeguarding is defined as ‘protecting an adult’s right to live in safety, free from abuse and neglect.’ (Care Act, statutory guidance chapter 14) Safeguarding Adults is about preventing and responding to concerns of abuse, harm or neglect of adults. Professionals should work together in partnership with people so that they are:


 Safe and able to protect themselves from abuse and neglect  Treated fairly and with dignity and respect

 Protected when they need to be

 Able to easily get the support, protection and services that they need.

4. The purpose of this annual report is to inform members of the Trust Board of the Safeguarding Adult activities in Kingston Hospital during 1st April 2014 to 30th March 2015. It aims to provide assurance against compliance with the local multi-agency guidelines for safeguarding adults, compliance with the Care Quality Commission Registration standards, the Care Act and meets its duties to ensure that adults at risk remain safe and free from harm.



5. Adult Safeguarding must be seen as “everyone’s responsibility” across the whole of the organisation. Not only is there a commitment and a duty to safeguard adults at risk as stipulated in the Care Quality Commission Regulations but there is the overriding view that living a life free form harm and abuse is a fundamental right of every person.

6. The introduction of the Care Act 2014 puts adult safeguarding on a statutory footing for the first time as well as embracing the principle that the ‘person knows best’. It lays the foundation for change in the way that care and support is provided to people, encouraging greater self-determination, so people maintain independence and have real choice. There is an emphasis on working with people at risk of abuse and neglect to have greater control in their lives to both prevent it from happening, and to give meaningful options of dealing with it should it occur. For professionals, the Act provides clearer guidance and supports pathways to working in an integrated way, breaking down barriers between organisations. 7. This report highlights how the Trust manages allegations of abuse and neglect and how we

ensure that safeguarding is integral to everyday practice. Safeguarding Adults Structure (Governance):

The Trust Board

8. The Trust Board has a responsibility to ensure that there is an overall policy and procedure in place to protect adults at risk (appendix 1) under the ‘No secrets Guidance’ (DH 2000) and Section 3 of the Care Quality Commission Registration Requirements Regulations 2009 (CQC 2009).

9. The Trusts “Safeguarding Adults Policy and Procedure” was revised in January 2014 and ratified in February 2015. This policy provides guidance which enables staff to identify concerns, raise alerts and support the adult safeguarding process. It also provides information on implementation of the Prevent Strategy, DoL’s (Deprivation of Liberty Safeguards) FGM (Female Genital Mutilation) and pressure ulcers in relation to safeguarding. The purpose of this policy is also to inform employees of the types of abuse and alleged abuse that may occur against adult patients under the care of Kingston Hospital NHS Foundation Trust. It defines the Trust’s response to the management of allegations of abuse perpetrated by members of staff, and also describes what action Trust staff should take if they suspect an adult at risk is suffering, or has suffered, abuse perpetrated by another person outside the Trust.

10. When an individual becomes a patient, their vulnerability is increased; those at increased risk within the hospital setting include the elderly, confused, mentally ill, cognitively impaired, people with a learning disability, the dying, minority ethnic groups and non-English speaking people. Kingston Hospital NHS Foundation Trust is committed to providing a safe environment for its employees, volunteers and service users and recognises that it has a duty of care to adults at risk.

11. Timely and appropriate response to abusive situations, the prevention of abuse and respect for people’s human rights are central to all aspects of the services we provide. Moreover our service users should feel confident that they are listened to and that their views and


choices are respected. Employees must be aware of the sensitive and confidential nature of much of the information related during investigation of safeguarding concerns.

12. A London multi-agency protecting adults at risk report was produced by the Social Care Institute for Excellence (SCIE) in January 2011 entitled “London Multi-Agency Policy and Procedures to Safeguard Adults from Abuse”. This was adopted at the Trust in March 2011. This Policy has been in the process of being revised during 2014/ 2015. The revised edition aims to put the adult at risk at the centre of their own safeguarding arrangements (as specified in The Care Act 2014) by developing practice that listens and learns how professionals can share information, and support a one team approach to work together to improve the chances of protecting people in the way that they want to be safeguarded. All organisations have had the opportunity to contribute to this Policy and it is due for publication later in September 2015.

13. The Trust Board received an annual report for 2013/14 and receives appropriate updates through the Director of Nursing and Patient Experience regarding serious case reviews (SCR) or serious incidents requiring investigation (SIRI) as appropriate. Quarterly updates are also shared with commissioning colleagues at the Clinical Quality Review Group (CQRG). The Trust Board has a governance structure and the relevant posts are occupied by substantive staff.

Safeguarding Meetings - Safeguarding Adults and Learning Disabilities Steering Group

14. The purpose of the Safeguarding Adults and Learning Disabilities Group is to provide the leadership and direction that ensures safeguarding and learning disabilities issues are managed effectively and robustly in the Trust. In 2014/ 2015 the Steering Group has included a standing agenda item for DoL’s and MCA (Mental Capacity Act) updates and issues. Dr Duncan Gerry, Consultant Geriatrician, is a member of this group as the Trust’s MCA lead.

15. The group meets bi-monthly and is accountable to the Clinical Quality Improvement Committee (previously, the Patient Safety Committee) and the Clinical Quality Review Group (partnership with local commissioners). The steering group reports quarterly and the most recent report was submitted in March 2015.

16. The terms of reference for the group were reviewed in July 2014 and updated in May 2015.

The group’s main function is to provide the leadership and direction that ensures safeguarding and learning disabilities issues are managed effectively, and:

 To ensure reported allegations of abuse are investigated by an appropriate person(s)

 To ensure provision of reports as necessary to the Clinical Quality Improvement Committee, Trust Board, and Clinical Quality Review Group.

 To report annually to the Trust Board and Safeguarding Adults Partnership Board, and undertake an annual self–assessment on behalf of the Trust reported to NHS England (London)

 To ensure that there are appropriate training programmes in place to meet identified needs of staff.

 To ensure representation of the Trust at strategy planning meetings and case conferences.


 To ensure organisational learning from case reviews and consequent service improvements.

17. The group met on eight occasions and attendance was in accordance with the terms of reference of the group. It is particularly helpful to have consistent representation from Kingston Borough Safeguarding Team and Your Healthcare learning disability team. The group increases the frequency of the meeting to monthly as required, to ensure that it responds to the changing commissioning and provider environment and the increased awareness of adult safeguarding matters in Kingston. Medical representation has been consistent with a Medical Consultant member (with an interest in the Mental Capacity Act/ Deprivation of Liberty).

Executive Leadership

18. The Director of Nursing and Patient Experience as Trust Lead for Safeguarding is responsible for reporting to the Board on matters relating to leadership across the organisation, strategic safeguarding objectives and outcomes, and ensuring partnership working with other agencies.

19. The Deputy Director of Nursing is responsible for ensuring dissemination and implementation of the policy and procedure, thus ensuring that there is an effective safeguarding adult’s process in the Trust. The Safeguarding Adults Lead is also responsible for ensuring that there are systems in place to monitor the process for supporting staff involved in safeguarding adults, giving advice and support and ensuring that the correct procedure for investigation is followed.

Clinical Nurse Specialist for Older People (and Safeguarding Adults)

20. The Clinical Nurse Specialist for Older People is responsible for managing Safeguarding Adults issues/ incidents and assisting in investigations. The Clinical Nurse Specialist for Older People is the lead for communicating with the appropriate Community Care Services and Social Services, Boroughs connected to Kingston Hospital NHS Trust and attending Strategy Meetings and Case Conferences.

21. The Clinical Nurse Specialist for Older People is also responsible for providing training, expert advice and support to staff on safeguarding adults and reporting cases where abuse is suspected to the Safeguarding Adults Lead.

22. The Clinical Nurse Specialist for Older People attends Service Line Meetings to ensure that learning from events and incidents is embedded in the organisation.

Safeguarding Meetings - Safeguarding Adults Partnership Boards

23. The Safeguarding Adults Lead attends each of the quarterly Safeguarding Adults Partnership Board for both Kingston and Richmond. In the coming year, there are significant changes anticipated with the Care Act (2014) likely to broaden the range of people who can use the adult safeguarding service. At present, an adult at risk is anyone that is at significant risk of abuse and who is 18 years or more and “is or may be eligible for community care services”. This has meant that only people who were entitled to adult social care were able to use adult safeguarding. From the time the Act came into effect in 2015,


an adult at risk will be where a local authority has reasonable cause to suspect that an adult in its area (whether or not ordinarily resident there) and:

 has needs for care and support (whether or not the authority is meeting any of those needs),

 is experiencing, or is at risk of, abuse or neglect, and

 as a result of those needs is unable to protect him/herself against the abuse or neglect or the risk of it.

24. This will increase the volume and range of activity of the partnership board (the Trust has always raised alerts, irrespective of the patient’s home address and their receipt of care and support). The Care Act (2014) has also placed the Safeguarding Adults Partnership Board on a statutory footing with increased responsibilities.

25. There are three statutory members of the Safeguarding Adults Board (the word partnership has been dropped) – the local authority, the police and commissioners. The Trust will be a co-opted member to both the Kingston and Richmond Boards.

Partnership Working:

26. The Clinical Quality Review Group (with local commissioners) receives regular reports from the Trust regarding safeguarding adults.

27. The Kingston Learning Disability Parliament Partnership Board is also attended by members of the steering group and the Safeguarding Lead meets quarterly with the Learning Disability Parliament Health Group. The health group have supported the annual Patient Led Assessment of the Care Environment (PLACE) process and made valuable contributions to the assessment of the Trust.

28. The Safeguarding Adults and Mental Capacity Act Team at Kingston Borough Council needs to encompass a range of professional expertise if they are to be effective in coordinating the local partnership and identified the need for a nurse specialist. Two attempts to recruit a specialist nurse were unsuccessful. Kingston Hospital NHS Foundation Trust agreed to second a matron for three months at the beginning of 2014. She made a valuable contribution to a range of investigations as well as assisting developing individual practice. Concerns arising from pressure area care in the community setting were addressed and she developed practice guidance in collaboration with colleagues, which will form the basis of local of local practice. Based on this success, Kingston Clinical Commissioning Group are to fund a permanent post.

Serious Case Reviews:

29. A Serious Case Review (Adults) is undertaken by a Safeguarding Adults Partnership Board when a serious case of adult abuse takes place. The partnership board should undertake a serious case review (SCR) when an adult has died or been seriously injured and abuse or neglect is believed to be a factor. The purpose of an SCR is to establish whether there are lessons to be learned from the case, identify what those lessons are and how they will be acted upon to improve inter-agency working.

30. There have been no serious case reviews in the last year involving the Trust. The Trust contributed to two serious case reviews that were conducted in 2012/ 13. The actions to


deliver the recommendations were implemented and these actions continue to be periodically monitored at the Safeguarding Adults Partnership Board (Richmond). There are no outstanding actions for the Trust. An update will be provided to the Richmond team in August 2015.

31. The current policy for determining whether a Serious Case Review (SCR) is required is based on Association of Directors of Adult Social Services (ADASS) guidance. Work led by ADASS has sought to explore how “case reviews” could enable a stronger link with practice development. This trend was mirrored in the Munro Report which explored children’s safeguarding. The Care Act establishes a requirement for Safeguarding Adult Partnership Boards to conduct case reviews (as distinct from serious case reviews), which it anticipates will be published in the Kingston Borough annual report. This report will include reviews of interventions that have produced good outcomes. The Safeguarding Adults Board will be required to produce higher numbers of reviews at a lower threshold. Excluding interventions where a good outcome is achieved, approximately five cases are subject to review using a new method of enquiry. There have been no case reviews involving Kingston Hospital in the last year.

Compliance: Safeguarding Review (Care Quality Commission):

32. There have not been any inspections of safeguarding at the Trust since the last full report published in September 2013. The internal process for gathering evidence, reviewing and challenging the self-assessments against Outcome 7 requirements continues. The most recent assessment (conducted in June 2014) indicated an overall AMBER rating. The main areas of action were centred on updates of the Trust policies for Safeguarding and Mental Capacity. The Trust policies have been updated and ratified and monitoring of self-assessment now forms part of the Trust approach to CQC inspection preparation.

Compliance: Safeguarding Review (NHS London):

33. In previous years, the trust has undertaken Adult Safeguarding Self-Assessment Assurance Framework (SAAF) audits and shared these with local partners. NHS England (London) has confirmed that it will no longer publish a detailed London-wide overview report from the SAAF submissions; rather it will be left to local Clinical Commissioning Groups to address any performance issues identified. Kingston Clinical Commissioning Group as the lead commissioners has not yet indicated a time frame for this in 2015/ 16. It is expected that Safeguarding Adults Board reviews will be undertaken in the coming year based on the commissioner designed assessment framework.

Organisation Training Figures:

34. The Trust provides safeguarding adults training for every member of staff with a mandatory requirement for a three yearly update. The intention of the training is to:

 Raise awareness throughout the organisation.

 Embed the aspects of the multi-agency Safeguarding Adults Policy in the practice of staff.

 Ensure that every member of staff employed by the organisation has a basic awareness of the requirements and their responsibilities in relation to safeguarding adults at risk.


35. Training levels are monitored at the Safeguarding Adults and Learning Disability Steering Group and Executive Management Committee. Improvements in the overall corporate induction and mandatory training levels were achieved in response to mandatory training moving to a training booklet approach across the Trust (in addition to sessions delivered by the Clinical Nurse Specialist for Older People who delivers training to staff). The table below shows the delegate attendance on all training containing Safeguarding Adults modules recorded on the Trust data base from April 1st 2013 to 30th March 2015 for all new staff. We achieved 87% (new staff) at year-end against a target of 75%. For existing staff a training level of 69% was achieved (lower than the required threshold of 75%). The training includes raising awareness of the Mental Capacity Act and Deprivation of Liberty. Our own internal assessments and review of CQC inspections at other Trust has identified that in the coming year there needs to be a series of specific training sessions available to staff regarding Mental Capacity Act and Deprivation of Liberty. Dr Gerry, Consultant, is leading on the programme of training for medical staff.

A c t i v Reporting Activity:

36. Kingston Safeguarding Adults Partnership Board receives and monitors Key Performance Indicator data relating to the Borough. The Partnership Board performance framework is based on Safeguarding Standards and Performance (Local Government Agency & Association of Directors of Adult Social Services. April 2012). All alerts raised by the Trust and regarding the Trust are managed through the Kingston Safeguarding Adults Team (regardless of which borough the patient is from). The data below relates to all activities in the Royal Borough of Kingston and this allows the Trust to establish the activity in the Trust in the context of total volumes of referrals.

2011/12 2012/13 2013/14 2014/15

Alerts received 724 600 553 653

Number of repeat referrals 22 67 38 45

Number progressed to investigation 238 228 250 246

Substantiated – Fully 76 52 57 76

Substantiated – Partially 38 14 26 15

Inconclusive 50 33 30 20

Not Substantiated 57 54 41 53

Investigation Ceased at Individuals Request

- - 4 1

Open Cases – yet to be determined 7 25 140 157

2012/ 2013 2013/ 2014 2014/ 2015

Course Total Percentage Total Percentage Total Percentage (M) Corporate Induction: Day 1 74% 71% 87% (M) Mandatory Training: On-Line 64% 69% 69%


37. In previous years the most common form of abuse was neglect, however in 2014/15 physical abuse was the most highly reported on. Sexual abuse figures have marginally increased but traditionally cases are believed to be under reported, however this fits the national picture. There have been slight increases in emotional and financial abuse and reported incidents of discrimination are low, however it is likely that reported cases of discrimination are likely fielded by national government offices, and so traditionally this figure is reflected as low within local government reporting.

38. This year alerts have been raised regularly by hospital staff either to the Clinical Nurse Specialist or directly to Social Services. The majority are from Accident and Emergency and the Acute Assessment Unit where concerns have included various forms of alleged abuse, however the majority relate to neglect, self-neglect and community acquired pressure ulcers. Alerts have also been raised by other departments in the Trust including the Royal Eye Unit and Consultant Clinics.

39. The Borough Safeguarding teams are now scrutinising and triaging alerts with regard the “harm” that has occurred before formally progressing under Safeguarding. The majority of concerns raised, are progressed through social work care management.

40. The clinical nurse specialist will attend Strategy meetings and Case Conferences where appropriate, with the alerts raised by the Trust to support Safeguarding multi-agency working.

41. 31 alerts were raised by the Trust, out of a total of 653 alerts received by Kingston Council).This equates to less than 5% of the total safeguarding activities in the Borough. This matches the experience more widely, where 70-80% of abuse occurs in either the persons home or place or residence.

Alert Raised By KHFT 2012/13 Alert Raised By KHFT 2013/14 Alert Raised By KHFT 2013/14 Alert Raised Regarding KHFT 2012/13 Alert Raised Regarding KHFT 2013/14 Alert Raised Regarding KHFT 2014/2015 April 1 2 2 3 0 3 May 4 1 5 2 3 3 June 1 2 2 0 1 1 July 2 3 2 5 3 2 August 2 2 2 0 3 1 September 1 3 2 2 2 3 October 3 4 4 3 3 4 November 4 1 5 4 5 0 December 1 1 3 0 3 1 January 1 2 1 0 1 5 February 2 1 2 2 1 3 March 2 3 1 2 2 2 TOTAL 24 25 31 23 27 28

Alerts Raised Regarding the Trust:

42. Of the 28 alerts regarding the Trust, 21 alerts alleged neglect or acts of omission, 4 alleged physical abuse, 1 alleged psychological abuse, 1 alleged institutional abuse, and 1 a


combination of concerns. Outcomes of cases regarding treatment/ care at the Trust are as follows: Outcome 2012/13 2013/14 2014/15 Substantiated 8 3 5 Partially substantiated 2 2 0 Unsubstantiated 3 6 2 Inconclusive 3 2 0

No further action at Alert

4 4 5

No further action after Strategy Meeting

1 2 6

Awaiting further investigation / information

0 0 5

Awaiting Case Conference

0 0 5

43. 5 of the alerts regarding the Trust were substantiated (of the 76 in total for the Borough). These were:

 (1) Patient was discharged having developed a Stage 3 pressure ulcer while in hospital; patient was sent home without the appropriate equipment.

Action: Service line completed an RCA for the pressure ulcer and the Matron and Safeguarding CNS attended the Case Conference and actions and leanings were fed back to the Service line Governance meeting

 (2) Joint Safeguarding alert which included the Trust, the patient’s GP and Community Nurses. Patient’s warfarin dosages and appointments were not followed up by patient, due to the fact that cognitive impairment hadn’t been formally recognised

Action: Safeguarding CNS attended Case Conference and presented information from the Anti-Coagulation Department. Outcomes and learning fed back to the Haematology Department regarding improving multi-agency communication and carer involvement for patients with memory problems / dementia. Case shared with the Dementia and Delirium steering group.

 (3) Patient discharged after six weeks in hospital, having been diagnosed with a terminal condition. The previous care package was re-started on discharge without the patient’s functional needs being reassessed. Action: Service line Senior Nurse, Ward Sister and Therapy team attended Case Conference. Omissions in planning the discharge were recognised by the team and leaning presented to the Service Line Governance meeting.

 (4) Patient discharge back to residential home. On arrival back reported that patient had developed a large haematoma to her leg which was dressed in appropriately and a number of unexplained bruises. Patient had not had adequate mouth care and no discharge documentation was available.


Action: Service line matron completed a concise SI report. Areas of improvement and learning were identified. Matron attended the Case Conference and outcomes and learnings fed back to the Service line Governance meeting.

 (5) Elderly patient admitted to Accident and Emergency Department with a tibia fracture. Plaster cast was applied and recommendation was for non-weight bearing and discharge home. No referral to the occupational therapist or functional assessment was undertaken prior to discharge. Patient unable to manage at home even with family support therefore she was readmitted.

Action: Investigated by Accident and Emergency Matron and Safeguarding CNS and both attended Case Conference. It was identified that this patient should have had an occupational therapy assessment. Outcomes and findings shared at Accident and Emergency department Sister’s meeting and governance meetings. Safeguarding Activities Focus:

44. Pressure Ulcers: The overall focus on pressure ulcers continues, with additional focus on community acquired ulcers. A weekly report of patients with community acquired skin damage is sent to the Safeguarding CNS and the Tissue Viability Specialist Nurse. These patients are screened for any safeguarding concerns regarding how the pressure damage occurred.

 All patients deemed at risk of pressure damage should have a skin assessment completed within 6 hours of arrival to Accident and Emergency and if pressure damage is observed, this is recorded as community acquired

 Weekly reports with the outcome of this screening are sent to Your Healthcare and monthly reports to the other boroughs by the hospital risk team.

 All stage 3 and 4 pressure ulcers are automatically considered as possible safeguarding alerts and reported if neglect is identified or suspected.

45. Dementia Strategy: There are many reasons why people with dementia can be at risk of abuse. They might be abused by strangers or by people they know. Sometimes family or friends who are providing care to a person with dementia may also act abusively. This can be related to high levels of carer stress. It is important to acknowledge that a person with dementia can be vulnerable to abuse and staff are encouraged to be alert for signs of abuse. The three year Dementia Strategy 2014 - 17 was launched with progress being made through year one of the strategy. This included:

 Commencement of Memory lane café which is run jointly with Home Instead.

 Activities programme commenced with communal activities running weekly such as memory lane lunch club, art club, physical activities and reminiscence therapy in activities room and wards.

 Derwent ward identified as the first ward to be refurbished as a Dementia friendly ward.

 Environment working group set up with good involvement from carers and staff.  Introduction of finger food, new pictorial menus and a trail on the use of coloured

crockery to promote nutrition in patients with dementia.  Nursing Darzi fellow for Dementia.


Prevent Strategy:

46. CONTEST, the UK's Counter-terrorism strategy, aims to reduce the risk to the United Kingdom and its interests overseas from terrorism, so that people can go about their lives freely and with confidence. Counter Terrorism and Security Act. The Counter Terrorism and Security Act (CT Act) was passed into legislation in early 2015, with different elements of the Act becoming statutory duties at slightly differing times. The CT Act covers all aspects of the CONTEST strategy including Prevent, Prepare, Protect and Pursue. The new duties are explained in the following sections.

47. Prevent Duty - The Prevent Duty is effective as of 1st July 2015. The Prevent Duty provides definitions and context regarding Prevent, details regarding monitoring and enforcement and sector specific guidance. The authorities specified in the guidance are: Local Authorities, schools and registered childcare providers, further education colleges, independent providers that are eligible to receive public funding to deliver education, Sixth Form Colleges, private further education institutions that have at least 250 students, universities, NHS Trusts and Foundation Trusts, prisons and Youth Offending Institutions, under-18 secure estate, secure training centres, National Probation Service, Community Rehabilitation Companies and police forces including the British Transport Police.

48. The key responsibilities applicable to all specified authorities are:

 Leadership: develop mechanisms to understand the risk, ensure staff understand the risk and have capacity to deal with it, promote the duty and ensure staff implement the duty.

 Partnership: demonstrated partnership working particularly with Prevent Co-ordinators, Local Authorities and Police, via multi-agency forums already in place, such as the Community Safety Partnerships.

 Capabilities: ensure front line staff are trained to understand radicalisation and vulnerabilities, know the supports available and how people can access these supports.

49. The key responsibilities specific to health are:

 Partnership: Regional Safeguarding Forums should have oversight of compliance with the duty. Issues should be reported to the National Prevent sub board and Prevent leads should have networks in place for advice and support to make referrals to Channel. Contractual requirements should be bolstered by the statutory duty.

 Risk Assessment: all Trusts should have a Prevent lead (Trust Security Manager) who acts as a single point of contact for Prevent co-ordinators and are responsible for implementing Prevent within their organisation. To comply with the duty staff are expected to be able to recognise and refer people are risk.

 Staff Training: ensure staff are trained at the relevant competency for their role, the intercollegiate guidance Safeguarding Children and Young people: roles and competencies for health care staff and the NHS England Training and Competencies Framework provide guidance regarding the training requirements.  Monitoring and enforcement: the duty stated that Monitor, TDA and CQC as the

sector regulators will provide monitoring arrangements; however the robustness of these arrangements is being reviewed.


50. Healthcare professionals have a key role in PREVENT. PREVENT focuses on working with vulnerable individuals who may be at risk of being exploited by radicalisers and subsequently drawn into terrorist-related activity. PREVENT does not require staff to do anything in addition to their normal duties. What is important is that if they are concerned that a vulnerable individual is being exploited in this way, they can raise these concerns in accordance with the local procedures (through the Safeguarding Adults referral process). 51. Four key staff have been trained to deliver PREVENT training across the Trust and is now

part of the Safeguarding Adults element of on-line mandatory training in the Trust.

52. A Prevent Training and Competencies Framework had been developed to support NHS providers in meeting their contractual obligations in relation to the Prevent strategy. It is the role of the Clinical Commissioning Group to hold the providers to account on the NHS Standard Contract requirements. The Prevent Training and Competencies Framework works in conjunction with the ‘Safeguarding Children and Young people: roles and competences for health care staff. Intercollegiate Document’ (December 2013) in order to ensure a consistent approach within the children safeguarding agenda and develop some parity between the expectations to safeguard both children and adults at risk.

53. The framework aims to assist organisations in developing their training framework in relation to raising awareness of the Prevent strategy and in identifying staff groups requiring basic Prevent awareness training and Workshop to Raise Awareness of Prevent (WRAP or Health WRAP). It has been developed between October 2013 and April 2014 by NHS England Regional Prevent Coordinators and the Regional Prevent Forum Working Group in the South West, consisting of NHS Prevent Leads from both commissioning and provider organisations.

54. The Trust Prevent Lead will develop and implement the Trust training plan during 2015/ 16 and support the recently introduced quarterly data reporting to NHS England (London). Female Genital Mutilation:

55. Female genital mutilation (sometimes referred to as female circumcision) refers to procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. The practice is illegal in the UK. It has been estimated that over 20,000 girls under the age of 15 are at risk of female genital mutilation (FGM) in the UK each year, and that 66,000 women in the UK are living with the consequences of FGM. The true extent is however unknown due to the 'hidden' nature of the crime. The girls may be taken to their countries of origin so that FGM can be carried out during the summer holidays, allowing them time to 'heal' before they return to school. There are also worries that some girls may have FGM performed in the UK.

56. In March 2014 the Department of Health issued new guidance for Trusts when recording FGM in patient’s records. The purpose of the FGM Prevalence Dataset is to help provide a consistent approach in recording and capturing the prevalence of FGM, when this is identified by clinical staff, and subsequently returned to the Department of Health on a monthly basis.


57. When a patient is treated by an acute hospital, and FGM is identified, this should always be recorded in the patient clinical record, as part of the full clinical history. This is in accordance with the multi-agency guidelines.

58. The FGM information recorded by clinical staff is collated by the Trust in order to capture the relevant information for the FGM Prevalence Dataset. This is carried out by the Clinical Coding team at the Trust. To date there have not been any adult safeguarding referrals relating to FGM.

59. In the coming year, additional awareness training for staff in departments such as Accident and Emergency will be implemented to support the national focus and effort for future programmes of work. Awareness of FGM is increasing across the safeguarding partnership in the Borough and the Trust is developing a local policy which will link to the multi-agency approach to FGM.


60. Learning Disability: There is now well recognised international body of evidence indicating that people with learning disabilities have higher levels of health need than non-disabled population. There is increased risk of premature death, higher prevalence of certain conditions (such as epilepsy, dementia, sensory impairment) and atypical clinical presentation, greater exposure to wider determinants of health which disadvantage groups in society (such as low income, poor housing), and experiencing barriers to healthier lifestyles due to dependence on others to enable them to lead active lives.

61. For people with a learning disability admitted into acute care settings their general vulnerability and specific risks are well acknowledged NPSA (2004), Michaels (2008). MENCAP (2007), MENCAP (2012). Core themes include communication, diagnostic overshadowing leading to delayed or inappropriate treatment, assumptions about quality of life and resuscitation decisions, mental capacity act non-compliance, the role of family and paid carers. Solutions offered to reduce barriers to good care often focus on the importance of pre admission preparation and planning, (which is not possible in the case of emergency admission).

62. In Richmond and Kingston from April 2014 to April 2015, 99 out of 102 learning disability admissions were urgent. Therefore a person with a learning disability who is urgently admitted faces additional risk compared to a person with a learning disability admitted in planned way for elective procedures. The Richmond Specialist Health Team has been working collaboratively with Kingston Hospital to mitigate this additional risk and function as a reasonable adjustment under the Equality Duty (2010).

63. Admissions 2014 / 2015: Since April 2014, Richmond Specialist Health Care Team has been tracking hospital admissions. In tracking admissions we are able to provide specialist support and advice and ensure any necessary reasonable adjustments are made. It also enables us to identify any recurrent themes in terms of admissions and any issues / barriers identified and learning is used to achieve real change by embedding national and best practice guidance and local innovation into existing practice and procedures.

64. The team are notified of admissions through a number of routes, direct contact with the team, the duty learning disability social worker or from A&E, or ward staff. It has become


apparent that people with learning disabilities tend to have more extended length of stay than the general population but data on length of stay was not captured in 2014 as part of this audit. This information is now being collected from 1st April 2015. Of the 102 admissions, five people had more than one admission during this period, these were people with complex health needs and a number of co-morbidities, two of those were referred to the Community Matron and the Richmond Specialist Health Team have been working in partnership with them to avoid hospital admissions were possible. The majority of admissions are unplanned (rather than planned) and the primary diagnosis is highlighted below:

65. Kingston Hospital: Your Healthcare CIC Richmond Specialist Health Team have worked closely with Kingston hospital since 2006 following the death of a patient with learning disabilities on one of their wards, this was also one of the cases highlighted in Death by Indifference, MENCAP (2007). This included the development of the joint protocol for collaborative working between Kingston Hospital and Learning Disability Services. The protocol is due to be reviewed in 2015 but following a meeting with the Deputy Director of Nursing (Kingston Hospital) it was agreed that a restructure of the document to separate best practice guidance from the joint working protocol would be more effective in raising awareness of the needs of people with learning disabilities to hospital staff and carers. 66. In early 2014, one of the specialist learning disability nurses from the Richmond Specialist

Health Team became the LD Lead for Kingston Hospital, her role was to represent learning disability services at the hospitals learning disability and safeguarding steering group, act as a point of contact and reference for hospital and learning disability staff, provide learning disability awareness training sessions to the medical and nursing staff. Over the past twelve months the role has evolved and a work stream developed.

67. Recent innovations include:

 Kingston Hospital have offered honorary contracts to three of the specialist learning disability nurses, giving access to the hospitals IT, email and CRS (Clinical Records Service)












other, 29%

Emergency Admissions


 The three specialist learning disability nurses have formed a learning disability liaison team, Your Healthcare have provided a dedicated mobile phone for hospital liaison and this is held by one of the learning disability liaison nurses from 9 -5pm, Monday to Friday. Kingston Hospital have also provided access to a desk and PC in the Medical Office.

 A bespoke emergency and inpatient care pathway was developed for a patient whose complex and very specific care and support needs made him very vulnerable in hospital. The pathway was signed off by senior members of the medical and nursing team at the hospital, the patient’s parents and the learning disability lead nurse. Due to the success of this initiative there are plans to offer a similar pathway to the most complex and vulnerable learning disability patients.

68. Conclusion: Having a dedicated learning disability lead and point of contact for the hospitals has enabled a more consistent, proactive collaborative approach in meeting the needs of people with learning disabilities. Medical and Nursing staff are contacting the learning disability team earlier meaning that admissions are tracked, learning disability healthcare professionals are more involved in multidisciplinary, best interests and discharge planning meetings, ensuring that interventions are timely, more person centred and any reasonable adjustments made.

69. Following the audit, a number of recommendations have been identified which the Trust is progressing with the Richmond Specialist Health Team:

 Joint hospital protocol to be reviewed as agreed. Currently it is a comprehensive document which would benefit from being divided in two parts, a concise joint working protocol and best practice guidance

 A learning disability resource page to be developed on the Trust intranet  Data to be collected on length of stay

 A learning disability nurse triage checklist for acute admissions to be developed to ensure consistency of approach and information

 Bespoke emergency and inpatient care pathways to be offered to all learning disability patients with complex needs who have very specific support and care requirements that mean they are at greater risk in an acute setting.

 The learning disability nurses would like to offer skill sharing shifts to all wards and departments, to share skills, information and best practice, hospital staff will also be offered the opportunity to spend time with the specialist health teams.


70. The following Safeguarding Policies and Guidelines are currently up to date:  Domestic Violence and Abuse Policy

 Domestic Abuse Guidelines - Accident & Emergency and Maternity  Safeguarding Adults Policy & Procedure

 Safeguarding Girls at Risk of Female Genital Mutilation (FGM)

 The Mental Capacity Act (2005) Policy & Procedure Incorporating the Deprivation of Liberty Safeguards


71. The current Kingston Local Safeguarding Protocol (Adults) is being revised and the Borough will publish in due course. It is expected that this will reflect the wider London procedures due for completion in September.

72. The Trust Restraint Policy is overdue for review and a revised and updated policy is currently being drafted in the Trust and is planned for ratification in September 2015 along with an associated communication and training programme.

Deprivation of Liberty:

73. Deprivation of Liberty Safeguards (DOLS) has not been without its challenges during 2014/ 2015 for the Trust as a result of the changes in national law and the threshold for referrals. The local picture reflects the wider national pressures in this arena. In April 2014, the new Cheshire West guidelines identified the “acid test” for making an application to deprive a patient of their liberty:

 Where a resident is in care and is deemed to lack capacity to make decisions about their care

 Where that person is not free to leave the care home, nursing home or hospital, (unsupervised)

 Where that person is under continuous supervision and control (to such an extent that they would be prevented from leaving if they attempted to).

74. The safeguarding CNS and lead doctor undertook an audit of Kennet and Blyth Ward with assistance from Royal Borough of Kingston Supervisory Body and this identified that due to the high numbers of patients – the volume of patients with dementia attending the Trust - with either cognitive impairment or a dementia diagnosis that approximately 50% of these patients could essentially be appropriate for a DOLS application.

75. Since this audit the Trust has reviewed its response to the acid test and the current guidance is for DOLS authorisations to be sought if there is any concern about deprivation of liberty but specifically if any form of restraint is being used i.e. safety mittens, drug sedation, 1:1 nursing care, application of falls alarms. This has resulted in a significant increase in applications as illustrated in the table below:

Borough 2013/2014 2014/2015 Kingston 4 26 Richmond 2 18 Wandsworth 0 4 Surrey 1 4 Merton 0 2 Sutton 0 1 Total 7 55


76. The DOLS process requires increased scrutiny and understanding of the MCA framework (the understanding of how to formally complete a MCA assessment has to be present when making a DOLS application and this must be formally documented). Training has been undertaken throughout the year updating the Service Lines. Dr Duncan Gerry has updated the Surgical, Orthopaedic, Medical and ITU Teams on the MCA and DOLS.

77. Originally there were 32 forms attached to each application however these have been reviewed and revised in 2014 by ADASS and there are now 13 forms. Obviously this results in a significant administrative burden on the Trust but it is unavoidable in order to comply with the new procedures. In each individual case the CQC is notified of the application of a DOLS request.

78. If a patient dies under a DOLS authorisation, this is deemed as being “death in custody”. Therefore the case has to formally be discussed with the Coroner and an inquest considered. Guidelines and forms for doing this have been made available. The CNS has provided training to the Mortuary staff liaises with them regarding any deaths.

Saville Review:

79. The investigation reports in relation to Jimmy Savile’s association with 28 NHS trusts were published recently. Two of the main reports related to Savile’s association with Leeds Royal Infirmary and Broadmoor. Following the publication of the reports, Jeremy Hunt, Secretary of State for Health, accepted the recommendations and asked NHS England, CQC, Monitor and the NHS Trust Development Authority, along with all NHS organisations, to carry out a review of safeguarding procedures within the NHS.

80. Kingston Hospital NHS Foundation Trust has taken action to consider the recommendations (summarised from all of the investigations undertaken in the Lampard Review) and has assessed its current processes for adequacy and has made changes where necessary. The Trust has made changes to the current safeguarding, security and other policies in light of the recommendations.

81. Monitor was provided with assurance that the Trust has made changes where required to meet the recommendations (see appendix 2 for the full list of recommendations).

82. The areas where further progress is required are as follows:

 Internal Audit of Adult Safeguarding to take place during Q2 of 15/16

 All NHS hospital trusts should undertake DBS checks (including, where applicable, enhanced DBS and barring list checks) on their staff and volunteers every three years. Currently the Trust performs this every 5 years and the Director of Workforce has made a proposal to the Executive Management Committee to move to compliance by December 2015.

Learning Disability:

83. People with learning disabilities have a right to the same level of health care as that provided to the general population. This care should be flexible and responsive and any diagnosis or treatment must take account of specific needs associated with the person’s learning disability.


84. The Trust Board should provide assurance that the approach taken in their regulatory frameworks and performance monitoring regimes provides effective assurance that the Trust is meeting its statutory and regulatory requirements in relation to the provision of services to people with learning disabilities. This is delivered through compliance with meeting the six requirements regarding access to healthcare for people with a learning disability (based on recommendations set out in ‘Healthcare for all’ (DH, 2008):

 Does the NHS foundation trust have a mechanism in place to identify and flag patients with learning disabilities and protocols that ensure that pathways of care are reasonably adjusted to meet the health needs of these patients?

 Does the NHS foundation trust provide readily available and comprehensible information to patients with learning disabilities about the following criteria:

- treatment options - complaints procedures - appointments?

 Does the NHS foundation trust have protocols in place to provide suitable support for family carers who support patients with learning disabilities?

 Does the NHS foundation trust have protocols in place to routinely include training on providing healthcare to patients with learning disabilities for all staff?

 Does the NHS foundation trust have protocols in place to encourage representation of people with learning disabilities and their family carers?

 Does the NHS foundation trust have protocols in place to regularly audit its practices for patients with learning disabilities and to demonstrate the findings in routine public reports?

85. As part of a national review undertaken by Monitor, the Trust discussed the compliance and evidence to support each of the six elements with Monitor and provided assurance that these are in place.

Objectives for 2015/ 2016:

86. The following recommendations will be incorporated to inform the 2015/ 2016 work programmes as required:

 Ensure Safeguarding Adults Guidelines/ Policies training is provided for all appropriate staff groups

 To monitor training closely to ensure compliance and in particular to improve PREVENT and DoLs training

 Enhance and strengthen Mental Capacity Act training for all staff

 Ratification and implementation of the Restraint Policy once finalised in September  Continue to manage the implications of the Supreme Court judgement in relation to

Deprivation of Liberty, including the way in which the Trust deals with the risk and resource implications


87. This annual report for 2014/ 15 demonstrates that the Trust has in place mechanisms to safeguard adults at risk and to investigate and learn from concerns raised about the Trust through safeguarding processes.


88. As part of the Trust annual internal audit programme, the Trust has commissioned KPMG to undertake an audit of adult safeguarding in 2015/ 16 and will act upon any findings reported.


Appendix 1: Types of abuse and abusive behaviours

The Care Act Statutory guidance does not provide a general definition of what constitutes abuse or neglect. The statutory guidance identifies specific types of abuse, but also emphasises that organisations should not limit their view of what constitutes abuse or neglect, as they can take many forms and the circumstances of the individual case should always be considered; although the criteria in section 2.2 needs to be met before the issue is considered as a safeguarding concern. The list below illustrates types of abuse and abusive behaviours which in themselves may constitute abuse. It is not an exhaustive list or made in any particular order.

Physical abuse – assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions

Sexual abuse – rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

Psychological abuse - emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.

Financial or material abuse – theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. Organisational abuse – neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation. (Procedures - Provider Concerns)

Neglect and acts of omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating

Restraint - Unlawful or inappropriate use of restraint or physical interventions and/or deprivation of liberty is physical abuse. There is a distinction to be drawn between restraint, restriction and deprivation of liberty. In extreme circumstances unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where a person’s freedom of movement is restricted, whether they are resisting or not. Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.

Human trafficking - is actively being used by Serious and Organised Crime Groups to make considerable amounts of money. This problem has a global reach covering a wide number of countries. It is run like a business with the supply of people and services to a customer, all for the purpose of making a profit. Traffickers exploit the social, cultural or financial vulnerability of the victim and place huge financial and ethical obligations on them. They control almost every aspect of the victim’s life, with little regard for the victim’s welfare and health. The Organised Crime Groups will continue to be involved in the trafficking of people, whilst there is still a supply of victims, a demand for the services they provide and a lack of information and intelligence on the groups and their activities.





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