Safeguarding Adults - Portsmouth Hospitals NHS Trust

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... Adults Protection Policy ( Hampshire County Council), Whistle Blowing Policy .... bodily assault, bodily impairment and medical/healthcare maltreatment.

SAFEGUARDING ADULTS Practice and Procedure Guidance

|Version |6 | |Name of responsible (ratifying) |Older Persons and Vulnerable Adults | |committee |Committee | |Date ratified |07.10.2010 | |Document Manager (job title) |Lead Nurse – Vulnerable Adults | |Date issued |26.10.2010 | |Review date |October 2012 – extended to March 2013 to | | |correlate with awaited publication of Pan | | |Hampshire Document | |Electronic location |Corporate Clinical Guidelines | |Related Procedural Documents |Vulnerable Adults Protection Policy ( | | |Hampshire County Council), Whistle Blowing | | |Policy | |Key Words (to aid with searching) |Protection from Abuse; Adult; Vulnerable | | |Patients; Social Services Staff; support | | |systems; Inter-professional collaboration; | | |Mental health; Learning disabilities; | | |Patient safety; Vulnerable adults; | | |safeguarding; abuse |




For quick reference the guide below is a summary of actions required. This does not negate the need for the document author and others involved in the process to be aware of and follow the detail of this policy.

1. Portsmouth Hospitals Trust is a joint signatory to the ‘Vulnerable Adults Protection Policy’ (Hampshire County Council, 2008 available at

2. Safeguarding is everyone’s business. It is statutory guidance and we are required to follow it unless we can demonstrate why not.

3. Abuse can be physical, verbal or psychological, an act or omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial transaction to which he or she has not consented or cannot consent.

4. Some forms of abuse are criminal offences but not all.

5. If you are concerned that any patient you admit may have been subject to abuse including neglect prior to their admission, or they disclose information during their stay that leads to you suspect abuse you should:

a. Complete and Adverse Incident Form in line with Trust Policy b. If the patient has capacity seek consent to make an urgent referral to the hospital social care team – noting a potential safeguarding concern. c. If the patient does not have capacity a best interest assessment should be undertaken with a view to referral. d. Document in the patient’s notes the AIR number and cause of concern.

6. If any safeguarding concerns are expressed by a relative, carer of staff member related to care during a patient’s hospital stay, an adverse incident form must be completed and submitted to the risk department in line with local policy.

7. If any safeguarding concern is raised after discharge, the person raising the concern will contact the Safeguarding Adults in-box ([email protected]) and the Lead Nurse or delegated deputy will complete an AIR form and submit to the Risk Team.

8. Local authorities have overall authority for the investigation and management of safeguarding cases and PHT staffs are required to co- operate with the provision of timely, accurate responses to requests for information.

9. Further advice can be sought from the Nursing Directorate on ext 6428/6498 or Hampshire County Council on 0845 603 5638 (for Hampshire residents) and Portsmouth City Council on 02392 688615 (for Portsmouth City residents)

10. If you dismiss a member of staff or a volunteer because they have harmed a vulnerable adult, or you would have done so if they had not left, you must tell the Independent Safeguarding Authority.( Available at: )


“Vulnerable adults may be abused by a wide range of people including relatives and family members, professional staff, paid care workers, volunteers, other service users, neighbours, friends and associates, people who deliberately exploit vulnerable people and strangers.”

“There is often particular concern when abuse is perpetrated by someone in a position of power or authority who uses his or her position to the detriment of the health, safety, welfare and general well-being of a vulnerable person.”

“Abuse can take place in any context. It may occur when a vulnerable adult lives alone or with a relative, it may also occur within nursing, residential or day care settings, in hospitals, custodial situations, support services into people’s own homes, and other places previously assumed safe, or in public places.” “No Secrets”, DoH, 2000.

Portsmouth Hospitals Trust is a joint signatory to the ‘Vulnerable Adults Protection Policy’ (Hampshire County Council, 2008 available at ). The policy provides a comprehensive framework for the care and protection of adults. The principles that underpin the document are taken from the “No Secrets” guidance 2001 and encompass subsequent legislation, best available evidence and guidance.


The Trust recognises its responsibility to ensure that effective and safe working systems are in place for staff working with adults and their relatives and carers. This guideline provides details for staff of Portsmouth Hospitals NHS Trust on the recognition of signs of abuse and Trust specific arrangements for the alerting to and management of suspected and confirmed safeguarding issues.


This guideline applies to all staff of Portsmouth Hospitals NHS Trust, including bank, agency and locum

‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’


VULNERABLE ADULT: The term “vulnerable adult” is defined by the Law Commission as a person who: is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation".

SIGNIFICANT HARM: 'Harm' should be taken to include not only ill-treatment (including sexual abuse and forms of ill-treatment which are not physical), but also 'the impairment of, or an avoidable deterioration in, physical or mental health; and the impairment of physical, intellectual, emotional, social or behavioral development'. These latter categories may be very important to an individual's ability to recover from an illness or have the best possible quality of life".

ABUSE “Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it”.

PHYSICAL ABUSE Resulting from acts of commission or omission on the part of others and causing pain, injury or impairment including hitting, slapping, pushing, kicking, and misuse of medication, restraint, or inappropriate sanctions includes bodily assault, bodily impairment and medical/healthcare maltreatment.

SEXUAL ABUSE Including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting. Sexual abuse might also include exposure to pornographic materials, being made to witness sexual acts and encompasses sexual harassment and non-contact abuse.

PSYCHOLOGICAL/EMOTIONAL ABUSE This includes: emotional abuse, threats of harm, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks. It might also include the following, in addition to this definition from “No Secrets”: playing on someone’s emotions to make them afraid, uneasy or unnecessarily dependent. This might include bullying, shouting, threats of harm or abandonment, intimidation, persistent ignoring, isolation or withdrawal from social contact or supportive networks, emotional blackmail, undermining, ridiculing, coercion, verbal or racial abuse, deprivation of contact, blaming or controlling.

NEGLECT/ACTS OF OMISSION AND POOR PROFESSIONAL PRACTICE This includes: ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating.

FINANCIAL OR MATERIAL ABUSE This includes: theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

DISCRIMINATORY ABUSE: This includes: racist, sexist, or that based on a person’s disability, and other forms of harassment, slurs or similar treatment.


Chief Executive

The Chief Executive has overall responsibility for ensuring the Trust has appropriate safeguarding processes are in place but delegates this responsibility to the Chief Nurse

Director of Nursing The Director of Nursing has responsibility for ensuring that appropriate safeguarding processes are in place, including compliance with all legal, statutory and good practice requirements and delegates that authority to the Lead Nurse.

Lead Nurse The Lead Nurse has responsibility for • The day to day, operational implementation of this policy and for being the focus of advice and support for Trust staff. • Facilitating the completion and reporting of the required audits and feedback on the results to the Vulnerable Adults and Older Persons Committee; to provide assurance on the Trust’s Safeguarding process or to ensure appropriate action plan are developed to address any highlighted deficiencies. • Ensuring any risks identified by the audits or review of legislation and guidance are escalated to the Risk Assurance Committee for discussion and potential inclusion on the Trust Risk Register.

Clinical Service Centre – Safeguarding Operational Leads The CSC Operational Leads have responsibility for: • Acting as first point of contact for your CSC with regard issues related to safeguarding • Providing first line advice based on local policy ( and information folder) to CSC staff • Supporting wards/departments undertaking/subject to safeguarding investigations • Acing as communication conduit to and from Lead Nurse • Actively contributing to monthly Safeguarding Operational Group ensuring information is effectively communicated to the CSC • With Heads of Nursing monitoring safeguarding training compliance, and support implementation of action plans to ensure 75% of all CSC staff have undertaken training.

Clinical Leaders (all professions) Clinical Leaders are responsible for ensuring that all of their staff are aware of this policy and know how to report suspected abuse is reported to Adult Social Care.

All Managers Managers are responsible for ensuring staff involved in the process of reporting suspected abuse are supported in line with the local policy for supporting staff. If a member of staff is dismissed due to harm to a vulnerable adult, the Independent Safeguarding Authority must be made aware. For further information contact your Human Resources Advisor or access

All staff are responsible for: • Knowing how to recognised abuse. • Immediately reporting suspected abuse

Trust Board

The Board is responsible for setting the strategic context in which organisational policies are developed and for the formal review and approval of Corporate Policies. The Board may designate approval authority to a committee: in this case the Vulnerable Adults and Older Persons Committee.

Vulnerable Adults and Older Persons Committee

The purpose of the Committee is to:

• Provide an overview of the clinical care provided to vulnerable and older people in Portsmouth Hospitals NHS Trust. • Focus on the quality agenda in older persons nursing. It will take into account national best practice guidelines, including National Service Frameworks and associated improvement strategies, NICE guidance and NPSA guidance. • Consider the implications arising out of national reports and enquiries, including the National Confidential Enquiries and will consider any outcomes of the national audit programme coordinated by the Healthcare Quality Improvement Board. • Ensure links with the work of the Clinical Advisory Group of the South Central SHA, outputs from the Quality Observatory and the National Quality Board.

Risk Assurance Committee (RAC) The purpose of the Risk Assurance Committee is to promote effective risk management and to establish and maintain an assurance framework and a risk register through which the Board can monitor the arrangements in place to achieve a satisfactory level of internal control, safety and quality.


Portsmouth Hospitals NHS Trust serves patients from both Portsmouth City and Hampshire. The processes for raising concerns are the same for both areas but the contact details different so please do note a patient’s address prior to reporting a concern.

Who can raise a concern?

Safeguarding concerns may be raised by any member of hospital staff, social care team members, a patient themselves or a relative and/or carer. All those making a complaint or allegation or expressing concern, whether they be staff, service users, carers or members of the general public, should be reassured that:

• They will be taken seriously • Their comments will usually be treated confidentially but their concerns may be shared if they or others are at significant risk • If service users, they will be given immediate protection from the risk of reprisals or intimidation • If staff, they will be given support and afforded protection if necessary – under the Public Interest Disclosure Act 1998: • They will be dealt with in a fair and equitable manner; and

• They will be kept informed of action that has been taken and its outcome

The Trust is committed to supporting staff who report situations of concern. Local guidance can be found at:

What would cause a member of staff to raise a concern?

There are a number of different reasons for staff members to be concerned about an individual person’s vulnerability. For example, physical signs, such as unaccounted for bruises and marks may suggest physical abuse. The presence of wounds that are not healing or pressure ulcers, may suggest neglect. Patients may disclose information in an environment where they feel supported and able to share information previously they have kept secret.

A concern may be raised (but not exclusively) by: • Members of PHT staff who has admitted a patient and on examination or discussion with the patient signs of abuse have been identified. • A non-PHT member of staff (community/primary care, adult social care, domiciliary agency) who has concerns regarding the patient’s situation prior to admission. • A friend or relative of the patient on admission. • A member of adult social care related to care provided during a patient’s hospital stay. • A member of adult social care, community/primary care, domiciliary agency, relative, carer or friend who has concerns related to a patient’s discharge.

Urgent/additional advice is available from:

Hampshire County Council on 0845 603 5638 and Portsmouth City Council on 02392 688615

What information will I need to provide when completing an AIR form?

• Details of alleged victim • The mental capacity of the individual (are there any concerns/doubts about this?) • Reasons for concerns • Details of how these concerns came to light • Details of alleged abuse including information about suspicions, specific information • Details of any arrangements which have already been made for the protection of the vulnerable adult/any immediate action taken • Details of anyone else to whom this referral has also been made (Care Quality Commission, Police, Primary Care Trust, Hospital Trust etc..) • Details of the alleged perpetrator and whether they too are a vulnerable adult • Details of any other background information or context of concerns • An impression of how serious the situation might be


Safeguarding forms part of the Trust’s Core Essential Skills and Training requirements for clinical staff, as identified by the Training Needs Analysis and, as such is included in mandatory Corporate Induction and annual update training for all staff. Whilst Corporate Induction is classroom delivered on commencement of employment, staff are able to access and complete the Essential Update Training, which must be undertaken every three years, in a variety of ways, including:

• E-learning packages. • Essential Training MOTs (where key competencies are tested, without the need to undertake full refresher training). • Centrally provided Instructor-led courses and workshops. • Department/locally delivered update training

The uptake of training is tracked by the use of the Essential Training Needs Tracker and monitored through the Clinical Service Centre structure


Commission for Health Improvement. (2003). Investigation into Matters Arising from Care on Rowan Ward, Manchester Mental Health and Social Care Trust. London: Crown Copyright. Available at: Commission for Social Care Inspection. (2008). Safeguarding Adults - A Study of the Effectiveness of Arrangements to Safeguard Adults from Abuse. CSCI. Available at: Department of Health. (2000). No secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Vulnerable Adults from Abuse. London: Department of Health. Available at: Department of Health. (2000). Care Standards Act (2000). London: The Stationery Office. Available at: Department of Health. (2001). National Service Framework for Older People. London: Department of Health. Available at: Department of Health. (2002). No Secrets: The Protection of Vulnerable Adults - Findings from an Analysis of Local Codes of Practice. London: Department of Health. Available at: Department of Health. (2004). Standards for Better Health C2 - Safety. London: Department of Health. Available at: Department of Health. (2004). The Government’s Response to the Recommendations and Conclusions of the Health Select Committee’s Inquiry into Elder Abuse. London: Department of Health. Available at: Department of Health. (2005). Responding to Domestic Abuse:  a Handbook for Health Professionals. London: Department of Health. Available at: Kings College, University of London and the Social Care Workforce Research Unit. (2005). Protection of Vulnerable Adults (POVA) Referrals - the First 100. London: Department of Health. Available at:


Essential Skills Training Policy

Pre-employment and employment checks Policy

Wellbeing and Stress Policy

Whistle blowing Policy


Monitoring of compliance with this guidance will be undertaken at two levels: one at a corporate level related to corporate function and response and at a clinical service centrel level related to Key Performance Indicators |Indicator |Measure |Frequency|Responsible| | | | |Officer | |75% of all clinical staff will have |Report from |Annually |Lead Nurse | |completed the essential skills |Learning and | | | |training.[1] |Development | | | | |Department | | | |75% of clinical staff sampled will be |Audit ( sample of|Annually |Matrons | |aware of where to seek advice external|10 staff per | | | |to the Trust with regard safeguarding |speciality) | | | |issues. | | | | |75% of clinical staff sampled will be |Audit ( sample of|Annually |Matrons | |aware of where to seek advice within |10 staff per | | | |the Trust with regard safeguarding |speciality) | | | |issues | | | | |The Trust will provide representation |Audit of |Annually |Lead Nurse | |at 75% of all strategy (planning) |statutory records| | | |meetings at the request of relevant |from city and | | | |local authorities. |county councils. | | | |The Trust will comply with the |Audit of |Annually |Lead Nurse | |recommendations from strategy |statutory records| | | |(planning) meetings. In the unlikely |from city and | | | |event that compliance is not possible |county councils. | | | |or feasible an exception report will | | | | |be provided. | | | |

• The Lead Nurse will ensure that: o The results of the above audits are reported to the Vulnerable Adults and Older Persons Committee, to ensure any required action plans are developed, with target dates for implementation, to address any identified issues o Information, including outcomes of audits and associated action plans is provided to the Vulnerable Adults and Older Persons Committee to support development of the annual report to the Clinical Standards and Quality Board o Any identified risks associated with Safeguarding Adults are presented to the Risk Assurance Committee for consideration of entry onto the Trust Risk Register. The Risk Assurance Committee will then monitor the progress of actions against the stated risks.

• The Vulnerable Adults and Older Persons Committee, through the chair, will ensure that: o The action plans are disseminated to the Clinical Leaders to ensure implementation o Monitoring implementation of the action plans o An annual report is provided to the Clinical Standards and Quality Committee o Regular feedback is provided to the Divisional Governance Committees, to support the Trust’s processes for Safeguarding Adults

• The Chair of the Risk Assurance Committee will ensure that should it appear that the timescales for implementation of the actions to mitigate the identified risks are not going to be achieved, that the Lead Nurse: Safeguarding Adults is invited to the next Committee meeting to provide an update

----------------------- [1]Implicit in this standard is that staff will be have an understanding of the types of abuse, individual and organisational responsibilities and how to raise a concern due to the assessment nature of the training,

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