Safeguarding

1. Safeguarding

2. Definition of safeguarding
“Safeguarding means protecting people's health, wellbeing and
human rights, and enabling them to live free from harm, abuse
and neglect. It's fundamental to high quality health and social
care.”
(Care Quality Commission, online, 2015)

3. Duties of health and social care
professionals
• While local authorities have overall responsibility for safeguarding
actions and leadership, all health and social care professionals have a
duty of care to protect people at risk of harm from others.
• For safeguarding children, this is enshrined in the Children Act 2004,
section 11, while section 10 of the Act requires cooperation with local
authorities at all levels of the organisation.
• For adults, the Care Act 2014 specifies the need for local authorities,
NHS and the police to work together to protect adults.
• While it can be difficult to know what to do and how to respond , you do
not do it alone. Asking for advice is important if you are unsure. Do not
hesitate, as the consequences could be life threatening if your concerns
are realised.

4. Duties (cont.)
Health and social care professionals have a duty to:
o recognise and identify potential abuse,
o where appropriate, speak to the child or adult about whom you
have concerns,
o raise concerns with your line manager/s; or seek advice from
social care or NSPCC for example,
o keep an accurate written record,
o report your concerns to the appropriate person,
e.g. social care duty team or police or both
o routinely communicate with other professionals
to ensure a multi-agency approach to safeguarding.

5. Safeguarding adults
• The term ‘safeguarding’ is often interpreted as meaning
safeguarding children and young people.
• However, adults need safeguarding too, often due
to their reduced ability to protect themselves
from harm.
• Adult safeguarding duties apply to an adult who has:
– “Care and support needs, and
– Is experiencing, or is at risk of, abuse or neglect, and
– Is unable to protect themselves because of their care and
support needs”.
(SCIE, online, 2015)

6. Safeguarding adults (cont.)
Importantly, an adult fitting these criteria includes:
“someone who misuses substances or alcohol
to the extent that it affects their ability to
manage day-to-day living.”
(SCIE, online, 2015)
Other needs include, but are not limited to, those relating to older age,
physical disability, learning disability, sensory impairment, mental
health needs including dementia, and long-term health conditions.
(SCIE, online, 2015)

7. Safeguarding children
• Safeguarding children is not only about child protection it is about
promoting their welfare.
• The Government policy document, Working Together to Safeguard
Children 2015 states safeguarding is:
o protecting children from maltreatment.
o preventing impairment of children’s health and development.
o ensuring that children grow up in circumstances consistent with the
provision of safe and effective care and.
o taking action to enable all children to have the best outcomes.
(Department for Education, 2015)

8. Reflective exercise
• Two resources, Impact on Children, and Impact on Family, Carers
and Parents have already identified how hard it can be for family
members living with a relative with substance problems.
• Sometimes such problematic use will raise safeguarding concerns
for adults and children in a number of ways.
• List three potential safeguarding issues when:
a. The vulnerable adult is using the substance.
b. The young person is using the substance.
c. When a carer/supporting friend/parent has problems with
substance use.

9. Reflective exercise: answers
• Adults – own use
– Decrease in their ability to judge others’ motivations.
– Potential decrease in their ability to navigate their physical
disabilities or mental health problems thereby lessening their
ability to avoid abuse or protect themselves.
– Potential for financial and emotional exploitation due to lessened
ability to make judgements.

10. Reflective exercise: answers
• Adults – someone else’s use
– Potential to neglect their caring duties.
– Potential for financial abuse if they are responsible for, or helping
out with, the person’s finances/budgeting.
– Potential exposure to stranger abuse if other
adults are invited into the house to use substances.

11. Reflective exercise: answers
• CYP – own use
– Exposure to high risk situations/people through the acquisition and
use of the substance, e.g. gangs/violence
– Physical and health-related harms; e.g. risks of overdose due to
potentially lower, age-related, tolerance levels.
– Inexperience in handling the effects of substance use.

12. Reflective exercise: answers
• CYP – someone else’s use
– Risk of neglect from parents/carers, e.g. money spent on
substances rather than food or clothes; loss of routines and
boundaries.
– Exposure to frequently co-existing issues, including
domestic violence and mental health problems.
– Risk of different types of abuse due to strangers or using friends
in the house, e.g. sexual or physical abuse.
– Watch Vicki Ellis, Advanced Practitioner for family service
SWIFT, provide an overview of safeguarding issues.

13. Identifying concerns - adults
• Different types of abuse will manifest in different ways. For
example, physical abuse of adults may result in bruises or marks on
the body, it may also result in withdrawn behaviour in the presence
of the abuser.
• Sexual abuse may result in physical and psychological
manifestations, e.g. Poor sleep, fearfulness or difficulties walking or
sitting, blood or pain in genitals/rectum.
• The Social Care Institute for Excellence (SCIE 2013) has produced
a clear and helpful resource focussing on identifying the signs of
adult abuse. It can be found at:
http://www.scie.org.uk/publications/ataglance/69-adults-
safeguarding-types-and-indicators-of-abuse.asp

14. Identifying concerns - children
• Children might be scared to tell anyone about their abusive
experiences or they might fear they won’t be believed because the
abuser has told them so.
• As with adults, it is the observable signs and behaviours that can
provide clues as to whether a child is being abused.
• In this clip, Advanced Practitioner Vicki Ellis describes some of the
signs to be aware of.
• These can include being left home alone, being excessively violent
with other children, few friendships, and a lack of social skills (NSPCC,
online, 2015)
• Click on the NSPCC website for a list of the possible signs, symptoms
and effects of child abuse on children of different ages.

15. Assessment
• The law requires all health and social care staff to
respond to safeguarding concerns. Assessment,
even if this is limited to an initial assessment,
is part of all health and social care professionals’ roles.
• Full assessment will be conducted by, or under the leadership of,
social workers from the Local Authority.
• National policy dictates how they do this, and in what timeframe.
• For adult safeguarding concerns, there is guidance under the Care
Act 2014, for child safeguarding this falls under the Children Acts
1989 and 2004.

16. Assessing children’s needs
• In the following film clips, Vicki Ellis, Advanced Practitioner of the
SWIFT Family Service, offers advice on how to talk to children
about the impact of parental substance use on them, assessing
risk where parental substance use is problematic and finding out if
there is a non-substance using parent for support.
• Richard McVey, Service Manager of Aquarius, an alcohol, drugs
and gambling service, offers advice on routine questioning of
people about their substance use in a way which minimises their
defensiveness.

17. Children’s views
Children have said that they need:
 Vigilance: to have adults notice when things are troubling them.
 Understanding and action: to understand what is happening; to be
heard and understood; and to have that understanding acted upon.
 Stability: to be able to develop an on-going stable relationship of
trust with those helping them.
 Respect: to be treated with the expectation that they are competent
rather than not.

18. Children’s views (cont.)
 Information and engagement: to be informed about and involved in
procedures, decisions, concerns and plans.
 Explanation: to be informed of the outcome of assessments and
decisions and reasons when their views have not met with a positive
response.
 Support: to be provided with support in their own right as well as a
member of their family.
 Advocacy: to be provided with advocacy to assist them in putting
forward their views.
(Taken from: Working together to safeguard children, 2015:11)

19. Common Assessment Framework for
Health and Social Care Professionals
• While formal safeguarding assessments are conducted, or led by, the
local authority, the common assessment framework provides a tool for
all other professionals to assess children’s needs.
• There is currently no equivalent for adults’ needs.
• The Common Assessment Framework (CAF) is only for early
identification. It can help plan a child’s care and support.
• The CAF is not for use when a child may be at risk of harm or harmed
already. It comprises forms for completion, pre-assessment checklists
and other guidance documents.
• Go to your local authority website to access the CAF forms for your
area. Click on the following link for an example of CAF guidance and
forms:
http://greatermanchesterscb.proceduresonline.com/chapters/g_caf.ht
ml

20. Responding – Do’s
• While a formal safeguarding assessment is not a requirement of all
professionals, there is clear practice guidance on how to respond if you
have concerns or if someone has disclosed abuse to you.
• For all disclosures of abuse – from a child or adult - it is important to:
 Reassure the person that they were right to tell you.
 Reassure the person that you will take their disclosure seriously.
 Tell the person what your duties are having received a serious
disclosure, what happens to the information and what the
implications are for them.

21. Responding – Do’s (cont.)
 Reassure the person that the abuse is not their fault.
 Record what you were told, in writing, as soon as possible. Be
careful not to interpret or rephrase their words. Stay as close to their
words as possible.
 Where a colleague has also heard the disclosure, ask them to
countersign your record of a conversation or make a written record
of their own.
 Communicate across professional boundaries wherever necessary
to ensure a holistic and multi-agency approach to safeguarding.
(The lack of communication is repeatedly highlighted in serious case
reviews.)

22. Responding – Don’ts
Some responses will not help and can give the wrong message, however
inadvertently. Do not:
 Interrupt or stop the person who is talking freely – they need to be heard
and you may be the first person they have told.
 Ask them lots of questions or for more detail – unless you are in a
specialist role to do that.
 Promise to keep anything confidential or secret. You can reassure that
you’ll only tell people who need to know, like your manager.
 Investigate any further yourself or follow up with alleged perpetrators etc.
 Be judgemental or doubt their disclosure or imply they should have
stopped it.

23. Crisis response
• In some situations a crisis response may be needed. This may include
calling the police and/or reporting your concerns urgently to social care
services. In the following clip, Addictions Consultant, Trevor McCarthy,
describes when a crisis response is needed.
• For suspected abuse or neglect in a care home, day centre or hospital,
the employer has the duty to act by:
– Informing the local authority.
– Taking action to protect the adult concerned from further harm, e.g.
removing staff from their posts.
– Conducting their own internal investigation.
• For child safeguarding concerns, the local authority has to be informed.
• Watch Vicki Ellis describe how you should proceed in this situation.

24. Who to refer to
• All health and social care organisations will have safeguarding
policies and procedures in place.
• The first thing to do is to check your own organisation’s procedures
and ensure you are following them.
• The following organisations are likely to be among the key contacts
for safeguarding referrals:
o Local Authority – children’s or adults’ social care duty team.
o Police – for criminal offences.
o Department for Work and Pensions and Office of the Public
Guardian – financial abuse by someone with authority to manage
an adult’s money.
o Care Quality Commission and/or Clinical Commissioning Group.

25. Referral and follow up
• The Safeguarding process is a multi-agency and multi-disciplinary
task involving different professionals in a range of agencies fulfilling
different roles.
• Services must be careful not to ‘close the door’
once the referral has been made - ongoing
support is needed, both directly to the person
and to the referred service which may require
further information on the individual/s you have referred.
• It is possible for referrals to fail or for people not to meet criteria.
Referring organisations must remain involved until they are satisfied
that their concerns have been addressed and it is safe and
appropriate to withdraw services.
• Done well, safeguarding interventions have hugely positive decisions
on people’s lives and confidence.

26. References and resources
• Care Quality Commission et al. (undated) Safeguarding adults: roles and
responsibilities in health and social care services. Available online at:
http://www.pasauk.org.uk/upload/public/featurebox/Safeguarding%20Adults.%20Role
s%20and%20responsibilities%20in%20health%20and%20care%20services.pdf
• Department for Education (2014) Working together to safeguard children (2015) is
available online at: https://www.gov.uk/government/publications/working-together-to-
safeguard-children--2 Versions of this document are available for young people and
younger children too with links from this document.
• Department of Health (2014) Care and Support Statutory Guidance. Issued under the
Care Act 2014 (Department of Health 2014).
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/366104
/43380_23902777_Care_Act_Book.pdf
• NSPCC (2015) ‘Signs, symptoms and effects of child abuse and neglect What to look
out for, the effects of abuse and support for adults abused as children.’ Available
online at: http://www.nspcc.org.uk/preventing-abuse/signs-symptoms-effects/

27. References and resources (cont.)
• Royal College of Nursing (2015)’Safeguarding Adults.’ Available online at:
https://www2.rcn.org.uk/__data/assets/pdf_file/0017/630206/RCNguidance_safeguar
ding_adults_WEB.pdf
• Royal College of Nursing (2014) ‘Safeguarding children and young people: roles and
competences for health care staff.’ 3rd edition. Available online at:
http://www.rcpch.ac.uk/sites/default/files/page/Safeguarding Children - Roles and
Competences for Healthcare Staff 02 0 (3)_0.pdf
• Royal College of Nursing (2014) Safeguarding children and young people – every
nurse’s responsibility. RCN guidance for nursing staff. Available online
at: https://www.rcn.org.uk/-/media/royal-college-of-
nursing/documents/publications/2014/april/pub-004542.pdf.
• SCIE’s (2013) ‘Safeguarding e-learning’ resource – including information and film
clips of professionals and users of services and case scenarios.
http://www.scie.org.uk/publications/elearning/adultsafeguarding/index.asp