Implications for managers of new safeguarding policy

Irish health and social care staff must report all concerns of abuse of vulnerable persons, Pauline Levins, Principal Social Worker and Mary Griffin, Social Worker, HSE Safeguarding and Protection Team, Community Health Organisation Area 2 told a HMI West Regional meeting in Merlin Park Hospital, Galway. Maureen Browne reports.

Ms. Levins and Ms. Griffin were explaining the implications for managers and their staff of the new HSE safeguarding policy for older persons or persons with a disability, who as a result of physical, sensory or intellectual impairment, might be at risk of abuse.

The policy launched in December 2014, is not, to date, underpinned by legislation.

Ms. Levins and Ms. Griffin said safeguarding vulnerable persons was everyone’s business

“You must report all concerns, even if you are unsure. The safety of the people you support and care for must take priority over all other considerations. Environmental factors can create vulnerability. If supported, older people and persons with disabilities are more likely to speak out about concerns.” they said.

‘Nothing corrupts like loyalty and friendship’ and ‘what we permit we promote’

“It is important that service providers have a safeguarding policy statement in place and that they create and nurture open culture. It is also important to remember that ‘nothing corrupts like loyalty and friendship’ and ‘what we permit we promote’.

“We are in paradigm shift in Ireland at the moment, moving from the 19th century lunacy act to assisted decision making, from a situation where people did not have rights to a situation where they have many rights. The will and preference of the vulnerable adult must be considered and their capacity be assessed in terms of function not status. It is difficult for staff to make this shift.”

A Vulnerable Person is defined as an adult who may be restricted in capacity to guard himself or herself against harm or exploitation or to report such harm or exploitation.

The will and preference of the vulnerable adult must be considered and their capacity be assessed in terms of function not status.

Abuse is defined as any act, or failure to act, which resulted in a breach of a vulnerable person’s human rights, civil liberties, physical and mental integrity, dignity or general wellbeing, whether intended or through negligence. This included sexual relationships or financial transactions to which the person did not or could not validly consent, or which were deliberately exploitative.

They said that the abuse might be a single act or repeated. It could be one form or multiple forms of abuse. Lack of appropriate action could be abuse.

Abuse might be caused by deprivation of liberty, privacy, respect, dignity, freedom to choose, opportunities to realise potential, opportunities to live safely without fear of abuse or lack of respect for possessions.

Abuse could be physical, sexual, psychological, financial or material, neglect or acts of omission, discriminatory or institutional, e.g. rigid routines, poor standards of care

All statutory service providers and public funded non-statutory service providers (including for-profit organisations) with responsibility for the provision of health and social care services to vulnerable persons are covered by the policy. It applies to all staff and volunteers. It does not cover those with mental health issues or those in private nursing homes.

It applies across all service settings, including domestic, alternative family placements, residential care, respite services, day care and independent living (associated support services such as transport were also included). It also applies to all other relevant directly provided HSE services and to situations where formal health or social care services are not in place but where concerns have been raised.

Those who may potentially commit abuse include anyone who has contact with a vulnerable adult, this could include a family member or a professional, who may fail to act, engage in poor practice, misuse power.

Ms. Levins and Ms. Griffin said it widened the scope of the HSE Elder Abuse Policy 2012 to all vulnerable adults in social care. The scope of the policy was also widened, to provide for a designated offer to take notification, a preliminary screening process and a safeguarding plan, if required. Staff who had been working on the prevention of elder abuse were transferred to the new safeguarding and protection teams.

Service provider should have policies and procedures for recruitment, intimate and personal care, safe administration of medication, management of service users’ money, behaviour management and restraint, complaints, incident reporting, confidentiality and limits of confidentiality and bullying and harassment.

Ms. Levins and Ms. Griffin said the key policy messages of the new policy were:

  • Every effort must be made to promote the well being, security and safety of vulnerable adults consistent with their rights, mental capacity and personal choices
  • Presumption of capacity needed to be established if there was lack of capacity to guard a vulnerable person against harm or exploitation or to report such harm or exploitation
  • The importance of prevention strategies in services.
  • The importance of ongoing risk management.

“Vulnerable adults should have the right to live a life free from abuse, exploitation and neglect, be made aware of their rights and given information, advice and support, be supported in bringing a complaint, encouraged and be enabled to utilise protection from the law and legal process.

“They should be the people who decide the course of action whilst given all possible support, have alleged, suspected or confirmed cases of abuse investigated promptly and appropriately, receive support, education and counselling following abuse and opportunity to seek redress.

“Those who may potentially commit abuse include anyone who has contact with a vulnerable adult, this could include a family member or a professional, who may fail to act, engage in poor practice, misuse power. There is also peer abuse and stranger abuse.”

They said that if a concern or allegation arose, the vulnerable person should be provided with immediate protection, he or she should be listened to, reassured and supported, any evidence should be recorded and preserved and HIQA and the Safeguarding and Protection Team (SPT) should be notified within three working days.

The service manager was then responsible for ensuring that a preliminary screening took place.   This preliminary screening should take account of all relevant information which was readily available in order to establish if an abusive act could have occurred and If there were reasonable grounds for concern.

This process should be led by the designated officer or other person as determined by the service manager and completed, if possible, within three working days following the concern being raised.

A report on the preliminary screening should be given to the service manager with details of proposed actions/recommendations. The service manager would then decide on appropriate actions and prepare a written plan for each action.   The screening and the written plan should then be submitted to the Safeguarding Protection Team and any action after this must be agreed with the SPT.

Where the preliminary screening determined that additional information was required or reasonable grounds for concern existed a safeguarding plan must be developed and the outcome to be agreed with the safeguarding and protection team.

Responsibility to ensure the development of a safeguarding plan rested with the service manager.

If an abuse allegation was in respect of a staff member then the policy for managing allegations against staff needed to take place concurrently.

“Confidentiality underpins all we do and it can be difficult to manage our way through the parallel systems of trust in care, safeguarding, gardai, solicitors and FOI. We need to be clear on the person or agency to whom/which the information belongs, if it belongs to the service user and if so can she or meaningfully give consent.”

The role of the frontline staff is to promote the welfare of vulnerable persons in all interactions, be aware of policy and procedures, comply with policy and procedures, support an environment in which vulnerable persons were safeguarded from abuse or abusive practices through the implementation of preventative measures and strategies and avail of training and education.

They should be aware of signs and indicators of abuse, support vulnerable persons to report any type of abuse or abusive practice and ensure that any concerns or allegations of abuse were reported in accordance with the policy.

The role of the designated officer was to receive concerns or allegations of abuse re vulnerable persons, collate basic relevant information, ensure the appropriate manager was informed and collaboratively ensure necessary actions were identified, ensure all reporting obligations were met, support the manager and other personnel in addressing the issues arising, maintain appropriate records.   He or she should also consult with the Safeguarding and Protection Teams (S&PT) as required, carry out preliminary screenings, report findings to the service manager and submit

Preliminary screening report to the S&PT.

The role of service managers/line managers is to:

  • Receive concerns or allegations of abuse re vulnerable persons
  • Collate basic relevant information
  • Ensure the appropriate manager was informed and collaboratively ensure necessary actions are identified
  • Ensure all reporting obligations were met (internally to the service and externally to the statutory authorities)
  • Support the manager and other personnel in addressing the issues arising
  • Maintain appropriate records.
  • Consult with Safeguarding and Protection Teams (S&PT) as required
  • Carry out preliminary screenings
  • Report findings to service manager
  • Submit preliminary screening to the S&PT