(Revised April 2018)

Contents

  1. Purpose and Scope
  2. Safeguarding - Who is at Risk?
  3. Safeguarding Adults at Risk – What To Do?
  4. Safeguarding Adults at Risk – What To Do Flowchart
  5. Consent and Information Sharing
  6. Preserving Evidence
  7. Reporting and Recording
  8. Managing Allegations Against Staff
  9. Safer Recruitment
  10. Victim Support

 

Annex A – Legal Context

Annex B – Factsheet

 

1.Purpose and Scope

1.1 If we know or suspect that an adult at risk is being abused, we have a duty to do something about it and ensure our work is properly recorded. It is essential that the adult at risk is involved in all decisions and is supported to make their own choices. The assumption is that the adult at risk has the mental capacity to make informed decisions about their lives unless it is established that they lack capacity to make safeguarding decisions - those decisions will then be made in their best interests (Mental Capacity Act (MCA 2005 & MCA – Code of Practice), or belief, sex or sexual orientation. Services offered to the adult at risk need to be appropriate to their needs.

 

1.2Safeguarding is everybody’s business. Safeguarding is the responsibility of everyone including statutory, independent and voluntary agencies as well as every citizen. We have a duty to work together to prevent and minimise abuse. We need to ensure, that services we provide/offer need to be appropriate to the adult at risk. They should not discriminate due to age, gender, race, reassignment, disability, marriage & civil partnership, religion or belief, sex or sexual orientation. Services offered to the adult at risk need to be appropriate to their needs.

 

1.3Making Safeguarding personal is a shift in culture and practice. We can now respond to research confirming what will make safeguarding more effective. The perspective of the person being safeguarded is the primary focus. It is about having conversations with people about how we might respond to improve the safety, well-being, and the overall quality of life of adults who are at risk. It is about acknowledging these adults as experts in their own lives and working alongside them.

 

1.4The purpose of adult safeguarding work is to bring about a more person centred response, by exploring the individuals circumstances with them (and/or their representatives; advocates or in circumstances where an individual lacks mental capacity a Best Interest Assessor). Empowering them to identify what they want, understand their options and what can realistically be achieved in their situation. This includes asking them what they want by way of outcomes at the beginning, throughout interventions and then again at the end, to understand the extent of what has been achieved.

 

1.5Living a life that is free from harm and abuse is a fundamental right of every person. When abuse takes place, it needs to be dealt with swiftly and effectively in ways that are proportionate to the concern. The person at risk sits at the centre of any safeguarding concern and must stay as much in control of the decision-making as is possible. The right of the individual to feel in control throughout the process is a critical element in the drive to achieving more personalised care and support.

 

1.6In British Forces Germany (BFG) the main statutory agencies: British Forces Social Work Service (BFSWS), Service Police, BFG Health Services, Ministry of Defence Schools need to work together effectively to deal with suspected or actual adult safeguarding concerns to prevent harm, abuse and promote safer communities.

 

1.7Safeguards against, abuse, neglect, exploitation and poor practice need to be integral throughout the delivery of care and support services. All services commissioned, contracted and their monitoring arrangements should include a process to enable any person at risk of abuse, neglect or exploitation access to the appropriate multi-agency services. Statutory agencies have a duty to work together in partnership.

 

1.8The BFG Safeguarding Board (SB) has a critical role to play in terms of strategic leadership and the management of safeguarding services across partners.

All adults may become vulnerable to abuse or harm as a result of changing life events. Adults react differently to adverse circumstances some becoming more vulnerable whilst others show resilience to similar challenges, for example two people with the same illness may not have the same level of vulnerability. An individual risk assessment needs to be undertaken to determine the person’s vulnerability, resilience to adversity and the presence of protective factors.

Safeguarding an adult at risk is a multi-agency responsibility ranging from prevention to coordinating a multi-agency adult safeguarding plan. This policy may be read in conjunction with:

  • BFGHS Complex Health Needs Management (Adults and Children), April 2011.
  • SIBFG 3364 Prevention of Suicide and Deliberate Self Harm (DSH) in BFG ANNEX 2.
  • SOBF(G) 3351 BFG SB Child Protection Procedures (Safeguarding Part A).
  • SIBFG 3301 Allegations Management (Safeguarding Chapter 7 Part A).
  • SOBF(G) 3352 Regulations for "Suitable Person" Checks for Personnel Working with Children and Vulnerable Persons.

Scope

This policy covers individuals who are subject to service law or service discipline as defined in the Armed Forces Act 2006. Consequent requirements, in meeting any specific needs deriving from an adult’s vulnerability, may therefore fall to the responsibility of the Command.

This procedure applies to all those working with Adults in British Forces Germany geographical area of responsibility (AOR)

The procedure applies to all Agencies. Agencies are responsible for ensuring that the procedure is adhered to operationally and will ensure that all persons comply with the operation of this procedure.

 

2. Safeguarding Adults – Who is at Risk?

2.1The Care Act 2014 states that the safeguarding duties apply to an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs),
  • is experiencing, or at risk of abuse or neglect,
  • as a result of those care and support needs is unable to protect themselves from either the risk of or the experience of abuse and neglect.

The term ‘adult at risk’ is used in this policy to replace ‘vulnerable adult’. This is because the term ‘vulnerable adult’ may wrongly imply that some of the fault for the abuse lies with the victim of abuse. We use ‘adult at risk’ as an exact replacement for ‘vulnerable adult’ as that phrase is used throughout existing UK government guidance. This document will therefore refer to ‘adult at risk’ as an exact replacement for the definition of a 'vulnerable adult.’

 

2.2The National Service Framework (Produced by the DOH, 2009)

This concentrates on the mental health needs of working age adults and covers health promotion, assessment and diagnosis, treatment, rehabilitation and care, and encompasses primary and specialist care and the roles of partner agencies. The Framework also touches on the needs of children and young people, highlighting areas where services for children and adults interact, for example the interface between services for 16-18 year olds, and the needs of children with a mentally ill parent.

Adults ‘who may be eligible for community care services’ are those whose independence and well-being would be at risk if they did not receive appropriate health and social care support. They include adults with physical, sensory and mental impairments and learning disabilities, whether present from birth or due to advancing age, chronic illness or accident.

They also include family and friends who provide personal assistance and care to adults on an unpaid basis. They are not a self-defined community, but a group that has been created by social policy.

An adult at risk can therefore be a person:

  • Who is a victim of domestic abuse.
  • With a mental health problem (including dementia, PTSD).
  • With a physical disability.
  • With drug and alcohol related problems.
  • With a sensory impairment.
  • With a learning disability.
  • Who has a physical illness.
  • With an acquired brain injury.
  • Who is frail and/or is experiencing a temporary illness.
  • Subject to allegations of abuse (inter and extra familial).
  • Is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse.
  • Lacks the mental capacity to make particular decisions and is in need of care and support.

In addition, some members of society are subject to negative discrimination as a result of gender, race, religion, belief, ethnicity, sexuality, disability, age, marital status, etc. and that this disadvantage can increase vulnerability.

Where a young person is aged 18 or over but is still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with through adult safeguarding arrangements.

 

2.3Mental Capacity Act 2005

The Mental Capacity Act 2005 (MCA 2005) is a legal framework which protects people who may lack capacity to make decisions for themselves. It also sets out how decisions should be made on their behalf. The act covers all sorts of decisions, from life-changing events to everyday matters. The act says that:

‘a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or disturbance in the functioning of the mind or brain.’

The presumption is that adults have mental capacity to make informed choices about their safety and how they live their lives. Mental capacity and a person’s ability to give informed consent are at the heart of decisions and actions taken within this policy. Every time we become involved on a safeguarding issue we need to take into account the ability of adults to make informed choices about the way they want to live and the risks they want to take.

This includes how able they are:

  • To understand what is likely to result from or affect their situation.
  • To take action themselves to prevent abuse.
  • To take part as fully as they can in making decisions about getting other parties involved.

 

Deprivation of Liberty Safeguards

Deprivation of Liberty Safeguards (DoLS) are part of the MCA 2005, and this provides protection to people who have a mental disorder and who do not have mental capacity to make decisions about their care & treatment. This applies to people accommodated in a hospital or care home who receive care and treatment. The Supreme Court ruling on the 19th March 2014 extended this to people living in the community who receive care and treatment. The ‘Acid Test’ is if the person is under continuous supervision and control and is not free to leave then DoLS needs to be considered.

 

2.4Mental Health Act 1983

The Mental Health Act 1983 (MHA 1983) provides legislation by which people diagnosed with a mental disorder can be detained in hospital or police custody and have their disorder assessed or treated against their wishes, unofficially known as "sectioning".

Section 1 of the Mental Health Act 1983 defines what is a ‘mental disorder’ and who is ‘mentally disordered’.

 

2.5The Safeguarding Vulnerable Groups Act 2006

The Safeguarding Vulnerable Groups Act (SVG) recognises that any adult receiving any form of health care is vulnerable. Whilst there is no formal definition of vulnerability within healthcare, some people receiving health care may be at greater risk from harm than others, sometimes as a complication of their presenting condition and their individual circumstances. The risks that increase a person’s vulnerability should be appropriately assessed and identified by the health care professional at the first contact and continue throughout the care pathway.

 

2.6SOBA(G) 3352

Following a wide consultation process in 2008, and duly noting the unique circumstances found within BFG AOR, the Command’s full definition of an adult at risk is available in SOBA(G) 3352, the following is an extract and not an exhaustive list: A person is an adult at risk if he/she has attained the age of 18 and he/she:

  • Is in or has been in residential accommodation, i.e. attending rehabilitation or convalescence centres in BFG or who have been attending residential special schools (residential accommodation means accommodation provided for a person in connection with any care or nursing he/she requires, or who is or has been a pupil attending a special residential school).
  • Receives any form of healthcare (healthcare includes treatment, therapy or palliative care of any description).
  • Is detained in lawful custody for example, detained in Service Custody, host nation police custody or prison.
  • Is at a point of handover to his/her unit, having been interviewed by Civil or Service Police in relation to serious offences.
  • Is in contact with the Probation Service.
  • Is in receipt of a welfare service which provides support, assistance, advice or counselling to individuals with particular needs.
  • Receives any service or participates in any provided activity which is specifically targeted at individuals with age-related needs, disabilities or physical or mental health conditions (age-related needs include needs associated with frailty, illness, disability or mental capacity).
  • Was in receipt of direct payments from a UK local authority or other social services body in lieu of social care services prior to arriving in Command.
  • Requires assistance in the conduct of his/her own affairs as a result of mental incapacity.
  • Is a victim of exploitation or crime, for example, is suffering from lack of inclusion in protective social networks, including education and employment.

 

2.7Abuse

‘Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experiences of abuse and neglect, while at the same time making sure that the adult’s well-being is promoted, including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action.’ (Care Act 2014 – Statutory Guidance 2017, 14.7).

For the purpose of this document, the term abuse is defined as:

‘… a violation of an individual’s human and civil rights by any other person or persons which results in significant harm.’ (Department of Health, 2000)

Abuse may be:

  • A single act or repeated acts.
  • An act of neglect or a failure to act.
  • Multiple acts, for example, an Adult at Risk may be neglected and also being financially abused.

Abuse is about the misuse of power and control that one person has over another. Where there is dependency, there is a possibility of abuse or neglect unless adequate safeguards are put in place.

Intent is not an issue at the point of deciding whether an act or a failure to act is abuse; it is the impact of the act on the person and the risk of harm to that individual.

Abuse can take place in settings such as the person’s own home, day or residential centres, supported housing, educational establishments, or in nursing homes, clinics or hospitals.

A number of abusive acts are crimes and informing the Police must be a key consideration.

Forms of abuse (as defined in the Care Act 2014) - Any of these forms of abuse can be either deliberate or be the result of ignorance, lack of training, knowledge or understanding. Often if a person is being abused in one way they are also being abused in other ways:

  • Physical: This includes hitting slapping, pushing, kicking, giving the wrong (or no) medication, restraint or inappropriate sanctions, or only letting them do certain things at certain times.
  • Sexual: This includes rape, indecent exposure sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, taking sexual photographs, making someone look at pornography or watch sexual acts, sexual assault or sexual acts the adult didn’t consent to or was pressured into consenting.
  • Domestic abuse: This includes psychological, physical, sexual, financial or emotional abuse and coercive and controlling behaviour. It also covers so-called ‘honour’ based violence.
  • Psychological: This includes emotional abuse, threats of harm or abandonment, depriving someone of contact with someone else, humiliation, blaming, controlling, intimidation, putting pressure on someone to do something, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or support networks.
  • Financial or material: This includes theft, fraud, and internet scamming, putting pressure on someone about their financial arrangements (including wills, property, inheritance or financial transactions) or the misuse, stealing or misappropriation of property, possessions or benefits.
  • Modern Slavery: This covers slavery (including domestic slavery), human trafficking and forced labour. Traffickers and slave masters use whatever they can to pressurise, deceive and force individuals into a life of abuse and inhumane treatment.
  • Neglect and acts of omission: This includes ignoring medical, emotional or physical needs, failure to provide access to appropriate healthcare, social care and support or , educational services, withholding the necessities of life, enough nutrition, heating, medication.
  • Discriminatory: This includes types of harassment or insults because of someone’s race, gender or gender identity, age, disability, sexual orientation or religion and other forms of harassment, slurs or similar treatment.
  • Organisational: This includes neglect and poor care in an institution or care setting such as a hospital or care home, or if an organisation provides care in someone’s home. The abuse can be a one-off incident or repeated, on-going ill treatment. The abuse can be through neglect or poor professional practice, which might be because of structure, policies, processes and practices within an organisation.
  • Self-Neglect: This covers a wide range of behaviour which shows that someone is not caring for their own personal hygiene, health or surroundings. It includes behaviour such as hoarding. Abuse can take many forms. It might not fit comfortably into any of these categories, or it might fit into more than one. Abuse can be carried out by one adult at risk towards another. This is still abuse and should be dealt with. The adult at risk who abuses may also be neglecting him/herself which could also be reason for a safeguarding referral.

 

Adult Safeguarding and the Prevent Agenda

Although BFG is not a ‘specified authority’ as per the ‘Counter-Terrorism and Security Act 2015 (Schedule 6), BFG maintains the duty to work in ways that prevent people, including children and young people, from being drawn into terrorism.

Changes that may arouse concern in regard to adults with whom staff come into contact with may include:

  • Reports of unusual changes in behaviour, friendships or actions and requests for assistance.
  • Indication of vulnerable person being insistently befriended by individuals or groups with radical views.
  • Evidence of service users/staff accessing extremist material online.
  • Use of extremist or hate terms to exclude others or incite violence; writing or artwork promoting violent extremist messages or images.

Any staff member who is concerned that a service user is at risk of radicalisation or may have become radicalised should refer to the ‘Extremism and Radicalisation Procedure’ about what to do.

The aim of radicalisation is to attract people to their reasoning, embed their extreme views and persuade vulnerable individuals of the legitimacy of their cause. Prevent is the governments counter terrorism strategy. It aims to provide support to young individuals at risk of being groomed into terrorist activities before any crimes are committed.

Any or all of these types of abuse may be perpetrated as a result of deliberate intent, negligence or ignorance.

Where children are present and domestic abuse is an issue please follow the Safeguarding Children Policy and Procedures Germany.

 

3.Safeguarding Adults at Risk – What To Do?

3.1Principles of Good Practice

The Department of Health (DoH), recommends the following principles of good practice when safeguarding adults:

Principle 1 – Empowerment – Presumption of person led decisions and consent.

Principle 2 – Protection – Support and representation for those in greatest need.

Principle 3 – Prevention – Prevention of harm and abuse as a primary objective.

Principle 4 – Proportionality – The least intrusive response appropriate to the risk presented.

Principle 5 – Partnerships – Local solutions through services working with communities.

Principle 6 – Accountability – Accountability and transparency in delivering safeguarding.

Everyone involved in safeguarding adults, whatever their role, should:

  • Develop an understanding of the issues which constitute abuse and recognise those individuals to whom the procedures apply.
  • Take matters of potential abuse seriously and discuss concerns with their line manager.
  • Actively listen to and record concerns without asking leading questions.
  • Be timely, sensitive and maintain confidentiality as appropriate to each situation.
  • Work in a coordinated way with other professionals within BFGHS and with other agencies.
  • Apply the principles and practice of this safeguarding adult’s policy consistently.
  • Promote human rights.
  • Support the rights of individuals, by respecting self-determination and informed choice wherever possible.
  • Acknowledge risk as an integral part of choice and decision-making.
  • Take action to safeguard any adult at risk in a way which is proportionate to the perceived level of risk and seriousness.
  • Ensure that risk assessments are completed and that they are recorded and reviewed in order for risk to be minimised.
  • Be effective in providing or negotiating solutions that are as simple and practical as possible and aim to prevent the risk of abuse recurring.
  • Be sensitive to every individual’s identity including culture, beliefs and ethnic background, gender, disability, age, sexuality and status.
  • Consider people’s mental capacity and ability to consent at all stages of the safeguarding adult’s process.
  • Consider other responses which could be used instead or alongside safeguarding adults– e.g. domestic abuse.
  • Undertake training and develop skills appropriate to their role.
  • Acknowledge that ‘it could happen here’, and be prepared to question care practices that could be abusive.

 

3.2Key Stages

There are four key stages in protecting and supporting adults who require safeguarding:

  1. Identify concerns.

  2. Make decisions; making a reasoned decision about whether to refer through multi-agency procedures.

  3. Multi-agency safeguarding responses - working in partnership to assess, investigate and develop a protection plan.

  4. Outcomes and any learning.

 

What to do if you suspect abuse?

Suspicion that an adult at risk may be suffering abuse may arise through:

  • A disclosure of abuse by the adult at risk themselves.
  • A complaint or expression of concern by any other adult, who may be another member of staff, a member of the adult’s family, a member of the public, another service user etc.
  • Something which a member of staff observes for themselves.

 

The person first aware of the situation

This person has three key responsibilities: to ensure the person is safe, to inform a line manager, and to make a full record.

Make Safe

  • The person first aware of the situation must deal with the immediate needs of the adult at risk. This may include taking reasonable steps to ensure they are in no immediate danger, and seeking medical treatment if required as a matter of urgency:
    • DO NOT discuss the allegation of abuse with the alleged perpetrator.
    • DO NOT disturb or destroy articles that could be used in evidence, and where an assault of any kind is suspected do not wash or bathe the person unless this is associated with first aid treatment necessary to prevent further harm.

Inform

  • Inform their line manager immediately – or another line manager if their line manager is implicated in the allegation.
  • If the allegation concerns a member of staff of any organisation, ensure that procedures for managing allegations against members of staff or volunteers are followed.
  • If it is thought that a crime has just been committed, contact the Service Police.

Record

  • Record details of the allegation and the actions taken, in the case file of the person involved if this is available, and if not available, somewhere else that can be kept secure. Include dates and times of the incident and/or the disclosure or complaint, what the adult at risk has said, the appearance and behaviour of the adult at risk, and any injuries observed.

 

Line Manager

The line manager also has three key responsibilities: ensure that immediate needs have been dealt with, to clarify the situation, to make a referral:

Immediate Needs

  • The line manager must ensure that the alleged victim is safe, and that any emergency medical treatment has been arranged.

  • They must ensure that no potential forensic evidence is lost.

  • If the alleged perpetrator is also an adult at risk, then the line manager must ensure that their needs are being met and that other adults at risk safety is not threatened.

Clarify

  • The line manager should clarify the facts stated by the member of staff, but should NOT in any circumstances discuss the allegation with the alleged perpetrator, or, if possible, the victim.
  • The line manager should clarify issues of consent and confidentiality.

Referral

  • >The Service Police should be contacted if it is thought that a crime may have been committed. If a child may also be at risk, a referral must be made to CRT.

 

Good Practice Guidance

For the person first aware of the alleged abuse:

  1. Consider the person’s immediate safety - e.g. medical attention, emergency service police - you should make sure that emergency assistance, where required, is summoned immediately.

  2. Where there are suspicions that a crime may have taken place the service police should be contacted immediately.

  3. Assure the person making the complaint or allegation that they will be taken seriously.

  4. Reassure the person that you will take steps to protect them from further abuse.

  5. If the person is making a disclosure listen carefully to what they are saying, stay calm, clarify the facts of the abuse but avoid detailed investigation.

  6. Do not be judgmental or jump to conclusions.

  7. Do not give any promises of confidentiality. The wishes of the adult at risk will be respected but they must be informed that the information given to an individual member of staff is not confidential to that member of staff and that there is a duty to report their concern to their line manager or direct to BFSWS and/or the Police.

  8. Explain that you have a duty to report what you have been told to your line manager and their concerns may be shared, especially if other adults at risk are at risk.

  9. Any recordings made from what the adult at risk has said should be factual. However, if the record does contain an opinion or an assessment, that should be supported with factual evidence. Opinion should be stated as such, and facts differentiated from hearsay, which is something that has not been seen or heard first hand by a witness.

  10. Never prevent or persuade another person from raising concerns, or suspicions of abuse.

  11. Consider any risks to the alleged victim and any other adult at risks or children which may result from the situation, allegation or disclosure. Immediately inform BFSWS CRT if there are concerns that a child or young person living in the same household as the adult at risk could also be at risk.

  12. Consider your personal safety in the situation or any risks which might arise from your actions.

Consider the person’s mental capacity and ability to consent.

If consent has been obtained, record the persons’ understanding of how the information will be shared and used, and what they would like to see happen in support of their safety/justice.

If a person has capacity but says that they do not want to engage with the safeguarding process consider whether confidential or personal information can be shared without that persons consent (if in doubt, take legal advice).

For any safeguarding adults concerns that may involve a crime, contact should be made with the Service Police – making it clear that you are reporting a crime that involves the safeguarding of an adult. You should clearly detail the nature of the allegation and obtain an incident number for use in future safeguarding adults’ processes. Contact with the Service Police could be done by the referrer.

 

3.3Risk Assessment

When making an assessment of risk the following matrix may be of use [adapted from Daniel B. and Wassell, S. (2002) *

*Note: Not to be used where harm or suspected harm has already occurred - in this case an immediate referral MUST be made to the Royal Military Police and to CRT.

risk assessment matrix

 

3.4Referrals

Referrals should be made to CRT by telephone, followed by a written referral using a Multi-Agency Referral Form from CRT These will then be assessed and appropriate advice provided and actions taken.

CRT Civilian (Inside BFG) 0049 (0) 800 724 3176 or (Outside BFG) 0049 (0) 521 2089 9847.

 

3.5Purpose of the Safeguarding Adult Referral

Once a referral has been received CRT needs to consider whether the concerns identified should be investigated under the safeguarding adult procedures.

The decision should consider an outcome, which supports or offers the opportunity to develop, or maintain, a private life which includes those people with whom the adult at risk wishes to establish, develop or continue a relationship.

The referral stage involves:

  • Establishing the wishes and best interests of the person at risk.
  • Gathering information about the allegations/concerns.
  • Ensuring the person at risk is protected from further harm.
  • Deciding whether the concern/allegation requires an investigation for which a strategy discussion/meeting would be required.

 

3.6Information Gathering

Information gathering is not an investigation, but a process of collecting enough information to enable a decision on whether a safeguarding referral (or an alternative process/action) is required. This may involve consulting other agencies or departments.

 

3.7The professional referrer should always be contacted in relation to their referral in order to:

  • Acknowledge receipt of their alert.
  • Acknowledge the referrers concerns.
  • Clarify and/or gather more information about the allegation/concern.

 

3.8As part of this information gathering process, the following issues will be considered:

  • Is the person an “adult at risk” by the definition?
  • What is the perceived type of abuse?
  • Where the alleged abuse took place?
  • The referrers view as to what is known of the wishes of the adult at risk in relation to the safeguarding issue.
  • Where there have been multiple low level concerns, their cumulative effect should be considered.
  • The perceived level of risk.
  • How the concern came to light?
  • The impact on the person(s) concerned.
  • The person alleged to have caused harm’s name and relationship to the adult at risk.
  • The involvement of any witnesses.
  • Any action that has already been taken to safeguard the adult at risk.
  • The health and social care support needs of the adult at risk and whether this support is provided by the person alleged to have caused harm.
  • Has the adult at risk’s needs been assessed (under a self-supported plan, Community Care Assessment)?
  • Is the adult at risk known to any other agencies or multi-agency processes e.g. MARAC.
  • To establish where possible the adult at risk’s mental capacity (decision/specific/competence).
  • Are there any children at risk who should be referred to CRT.

 

3.9Risk Assessment and Management

A risk assessment must be undertaken when a referral is made. This should clarify the degree of risk to the adult at risk and/or children. Risk should be constantly re-evaluated throughout the process to ensure adults at risk and all others involved are appropriately protected.

Risk assessment will seek to determine:

  • What the actual risks are - the harm that has been caused, the level of severity of the harm and the views and wishes of the adult at risk.
  • The person’s ability to protect themselves.
  • Who or what is causing the harm.
  • Factors that contribute to the risk, for example: personal; environmental; relationships resulting in an increase or decrease to the risk.
  • The risk of future harm from the same source.

A formal risk assessment can take place at any point. However, the most likely point at which a formal assessment will take place is after the strategy discussion or meeting.

 

3.10Deciding the action to be taken following assessment of the referral

Once the information has been gathered and assessed by CRT there are four possible courses of action that can be taken:

  • Where it is possible that a criminal offence may have taken place, the Service Police will take the lead in the criminal investigation.
  • Where it is identified that no crime has been committed BFSWS will co-ordinate further enquiry and assessment to understand the needs of the adult at risk.
  • Following further discussion and assessment it may be decided and recorded that pursuing a Safeguarding Adults Investigation is not required and no further action may be required , OR
  • Alternative actions such as reviewing the person’s health or social care support plan needs or a referral to another agency.

 

4. Safeguarding Adults - What To Do Flowchart

 what to do flowchart

 

4.1Safeguarding Strategy Discussion/Meeting

Where the decision has been made that the concerns meet the threshold intervention under safeguarding procedures, BFSWS will ensure that a strategy discussion or meeting takes place. The strategy discussion or meeting enables the responsible team to share the nature of the risk and identify options for safeguarding and that a safeguarding response is planned with the person and key agencies with duties or powers to act.

A safeguarding adult’s strategy discussion or meeting will take place depending upon the assessed level of seriousness and level of intervention. In some instances a number of strategy discussions or meeting may be required and sometimes these will need to take place on the same day, to ensure that a risk management plan is in place. If a strategy discussion or meeting is required, then this should be held within 5 working days of the threshold decision. Any variations in timescales should be recorded.

An assessment and investigation should not be delayed, whilst waiting for a safeguarding adult’s strategy discussion or meeting to be convened. Any interim action taken must be agreed by a BFSWS Manager.

Information at the strategy discussion or meeting, where relevant to a service provider, must be considered within the context of any other consultations or referrals raised, which relate to this provider. In addition to individual safeguarding processes, an overarching meeting focused on the provider may need to be put in place.

 

4.2The purpose of the strategy discussion or meeting

The strategy discussion or meeting aims to:

  • Agree a multi-agency plan to investigate the allegations and assess the risk to the person at risk who is being harmed or to the person at risk who is harming others, to assess any immediate risks and address any immediate needs.
  • Co-ordinate the collection of information about the abuse, neglect or exploitation through a clear plan of action.
  • Involve the adult at risk and/or their representative in decision making.

The strategy discussion or meeting will be chaired by a BFSWS Manager, who will act in an impartial and objective way in conducting the discussions or meetings and will facilitate the discussion or meeting to reach decisions and recommendations with the person at risk, wherever possible.

The strategy discussion or meeting must:

  • Consider the wishes of the person at risk in relation to the desired outcome for the process.

  • Consider any special needs of the adult.

  • Consider the need for advocacy.

  • Consider the mental capacity of the adult to be able to support and protect themselves from harm.

  • Consider support for the person at risk who may have caused the harm.

  • Agree an interim risk management plan.

  • Consider the health and social care needs of the adult.

  • Consider the need for legal intervention.

  • Identify who should be the key worker to support and liaise with the adult.

  • Share judgements about the risks and agree how the adult will be supported and the risks managed.

  • Consider the safety and well-being of other adults/children at risk and whether the concerns meet the thresholds for a safeguarding adult/child intervention.

  • If the person at risk is aged under 18 years old, a referral must be made to BFSWS.

  • If the person implicated in the safeguarding investigation works with children or young people under 18, a referral must be made to the Allegations Management Officer.

  • Consider action under any parallel proceedings (e.g. regulatory action; health and safety issues; serious incidents requiring investigation; disciplinary processes etc).

  • Agree what kind of assessments/investigations will need to take place and if so, how they should be conducted; by whom and within what timescales.

  • Agree who needs to be interviewed, when and by whom.

 

4.3 Who should participate in or attend strategy discussions/meetings?

Those who should be involved in the strategy discussion/meeting should be limited to those who “need to know” and who have a lead responsibility to ensure that an assessment and investigation is undertaken and contribute to the decision making process.

The views of the person at risk or their representative should be presented and recorded as part of the meeting/discussion, having been sought during the information gathering stage.

Those attending from partner agencies/organisations should be of sufficient seniority to make decisions as part of the strategy discussion/meeting concerning their organisation’s role and resources. They may also contribute to the assessment/investigation and to the agreed Safeguarding Plan.

 

5.Consent and Information Sharing

5.1Consent and Information sharing when concerns arise should be in line with the framework of the Standing Instruction British Forces Germany 3341 Information Sharing Protocol. You should seek advice / refer concerns to CRT.

 

5.2Emergency or life threatening situations may warrant the sharing of information with the relevant services without consent.

 

5.3In the interest of being open and transparent consideration should be given to sharing information with carers, parents, family, partners etc. When the adult at risk has the ‘capacity’ to make the decision, it should be up to them to decide what information is disclosed to their carers/parents/family/partners, and records should reflect this. When the adult does not have the capacity, consideration should be given about when and with who to share information and clear decisions and actions should be documented in full. An assessment should be made as to whether the sharing of certain information with a particular person or organisation is in the adult’s best interests. Further guidance should be sort from a senior manager and or legal advice obtained.

 

5.4Wherever possible, actions following a disclosure or referral should comply with the expressed wishes of the adult at risk. However, consideration should be given to circumstances where an adult at risk’s wishes may be overridden. If a crime may have been committed, or other adults or children may be at risk, it could be necessary to override a person’s expressed wishes. If it is established that an adult lacks capacity to make a specific decision, then any decisions made should be done so, following the best interest principles in accordance with the Mental Capacity Act 2005.

 

6.Preserving Evidence

6.1If present during or after an alleged incident of physical or sexual assault:

  • Do not disturb the ‘scene’, seal off areas if possible, discourage washing/bathing, do not remove the adult at risk’s clothing/bedding.

  • If possible do not handle any items which may hold DNA evidence.

  • Minimise contamination of evidence by ensuring, where possible that the adult at risk and alleged perpetrator are kept apart and that other staff have contact with one or the other party but not BOTH.

  • Where possible request that the perpetrator remain at the location until the arrival of the service police. If circumstances permit, they should remain under supervision. The early arrest of the alleged perpetrator is a priority as evidence could still be present on their clothing/body.

  • Do not however put yourself at risk of abuse by taking such action, and do not attempt to restrain or arrest the alleged perpetrator yourself.

  • Obtain and record details of all persons present at the scene, and request that they remain at the location for the arrival of the Police.

 

7.Reporting and Recording

7.1Any information given directly by the adult concerned should be listened to and recorded carefully, using the person’s own words:

  • Make a note of your observations in relation to the environment, condition and attitude of the people involved and any actions you have taken.

  • Report your concerns or the information you have received immediately to the appropriate person within your own organisation.

  • If an adult at risk makes an allegation to you asking that you keep it confidential, you should inform the person that you will respect their right to confidentiality as far as you are able to, but that you are not always able to keep the matter secret.

  • If you suspect that the person you would normally pass any alerts to may be the perpetrator, or involved in some way, you will need to seek advice from the CRT or if out of office hours, the Joint Response Team.

  • Do not take ‘statements’ or investigate at this stage. Only clarify the bare facts of the reported abuse or grounds for suspicion, do not ask leading questions or ‘interview’ any party including witnesses.

  • Records of incidents, concerns and discussions should be written as soon as possible, with the date, time, your signature and designation made clear. If records are hand-written and then transferred, the original should be kept for evidential purposes.

  • Do not share information about the incident without agreeing this with your line manager or the CRT.

 

8.Managing Allegations Against Staff

8.1All agencies should have mechanisms for raising practice concerns with managers. All provider services should have in place a “Whistle-Blowing” policy and ensure that all staff are aware of this and how to access and use it. When it comes to raising concerns of adult abuse, no distinction should be made between staff and other persons. The adult at risk’s well-being is paramount. If at any point in the process, a member of staff feels that correct action is not being taken, they should report CRT/ICRS Allegations Manager and follow their organisation’s Whistle-Blowing procedures.

 

8.2If an allegation is made against a member of staff, their manager will need to clarify, when making a referral, what action he/she intends to take under the appropriate HR procedures. It is important to ensure that any action:

  • Protects the rights and wishes of the adult at risk.
  • Protects the rights of the member of staff concerned.
  • Enables managers to take appropriate action either on behalf of the adult at risk or against the staff member where appropriate.
  • Does not compromise any criminal investigation.

 

8.3To achieve these outcomes it will be necessary for managers to coordinate their disciplinary responsibilities with those of the “investigating team”, who will be working within these procedures.

 

9.Safer Recruitment

9.1The importance of ensuring employers make safer employment decisions and that they safeguard the health and safety of children and adult at risks in our society has been given paramount importance in Government legislation. The Ministry of Defence (MOD) has a responsibility to ensure that safer employment decisions are made and that children and adult at risks associated with the service community are protected against any harm and are secure in their environment. Please refer to SOBFG 3352.

 

10.Victim Support

Victims of abuse may wish to contact Victim Support or, with consent of the adult at risk, professionals may contact victim support for advice and guidance.

Civilian +49 (0)800 724 3176
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

References

Safeguarding Vulnerable Groups Act 2006 including (Commencement No. 3) Order 2009

SOBFG 3352 Regulations for "Suitable Person" Checks for Personnel Working with Children and Vulnerable Persons

JSP 913 Tri-Service Policy on Domestic Abuse and Sexual Violence 2011

Department of Health Safeguarding Adults; the Role of Health Service Practitioners March 2011

Daniel B, and Wassell, S (2002) Assessing and Promoting Resilience in Vulnerable Children, London: Jessica Kingsley Publishing

SIBFG 3341 Information Sharing Protocol

Mental Capacity Act 2005 Code of Practice. Department for Constitutional Affairs 2007

Care Act 2014

 

Abbreviations

AOR - Area of Responsibility

BFG - British Forces Germany

BFGHS - British Forces Germany Health Service

BFSWS - British Forces Social Work Services

CRT - Central Referral Team

DNA - DeoxyriboNucleic Acid

DOH - Department of Health

DSH - Deliberate Self Harm

JRT - Joint Response Team

JSP - Joint Service Publication

MARF - Multi Agency Referral Form

MOD - Ministry of Defence

NHS - National Health Service

RMP - Royal Military Police

SIBFG - Standing Instructions British Forces Germany

SOBFG - Standing Orders British Forces Germany

SOFA - Status Of Forces Agreement

SVRM - Suicide Vulnerability Risk Management

UK - United Kingdom

 

Annex A

The Legal Context

There are many legislative responsibilities placed on UK local authorities and other agencies, to intervene in or be involved in some way with the care and welfare of adults who are believed to be vulnerable. Services may need to be provided as a result of neglect, illness, injury or mental disorder. Specific Acts of Parliament include:

National Assistance Act 1948

Including:

  • Duty to provide residential accommodation to those people aged 18 years or over ‘who by reason of age, illness, disability or any other circumstances are in need of care and attention, which is not otherwise available to them’.
  • Duty to promote the welfare of people with disabilities.
  • Arrangements whereby an application can be made to a court of law if a person assessed as having capacity is ‘suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and are unable to devote to themselves and are not receiving from other persons, proper care and attention’.

 

Health Services and Public Health Act 1968

Including:

  • Duty to make arrangements for promoting the welfare of old people.

 

Chronically Sick & Disabled Persons Act 1970

Including:

  • Provision of practical assistance in the home.
  • Assistance in obtaining television, library or similar recreational facilities.
  • Provision of recreational facilities outside the home.
  • Assistance to person in taking advantage of educational facilities.
  • Assistance with travelling to participate in any services provided.
  • Works of adaptation to the home.
  • Facilitating holidays.
  • Provision of meals.
  • Provision of a telephone.

 

NHS and Community Care Act 1990

Including:

  • Duty to carry out assessment of individual’s needs for community care services and providing any such services needed.

 

The Health and Social Care Act 2008

  • Introduced a new single regulatory framework for health and social care. The registered person, usually the owner or manager, has a duty to inform the registration authority within 24 hours of any event that threatens the well-being of any resident (Regulation 18 notification). The registration authority is the Care Quality Commission as far as I am aware still the same.

 

The Mental Health Act 1983 (revised and extended in 2007)

Provides a comprehensive legislative framework to support the needs of both children and adults. It is based on the presumption that the right of people who have been assessed as having a “disorder or disability of mind or brain” is safeguarded when they are being admitted to or treated within a psychiatric hospital. In addition, as much care and treatment as possible, both in hospital and outside, should be given on an informal basis - where the individual patient is able to exercise their own judgement in the matter (with certain additional safeguards in place for children and young people) and in the least restrictive conditions possible. The Act also presumes that the main emphasis of care within local communities, not within hospital settings. S. 135 specifically provides the authority to seek a warrant authorising a Police Officer to enter premises if it is believed that someone suffering from mental disorder is being ill-treated or neglected or kept otherwise than under proper control anywhere within the jurisdiction of the court or, being unable to care for himself, is living alone in any such place.

 

The Mental Capacity Act 2005

This Act became operational during 2007. Underpinning the Act are five statutory principles, the most important of which centre on the presumption of capacity unless proven otherwise and the requirement to enable mentally capable individuals (aged 16+), to make decisions for themselves, even where those decisions may be at variance with what other people and organisations feel would be best.

 Statutory Principles include:

  1. Any person, aged 16+ must be assumed to have the capacity to make his/her own decisions unless it is established otherwise.

  2. All practicable steps must first be taken to assist people to make such decisions.

  3. Any person who has capacity has the right to make an unwise decision.

The Mental Capacity Act also provides a statutory framework to enable social care (and allied disciplines) to intervene in the lives of a person (aged 16+), where it can be demonstrated that, in relation to a specific decision that needs to be taken, the person lacks mental capacity to make that decision and therefore a decision needs to be made by a third party in the person’s best interests. From April 2009, the Mental Capacity Act 2005 has made it unlawful to deprive of his/her liberty, any adult person lacking mental capacity that is living in a care home or staying in a hospital. This can only be lawful if a Deprivation of Liberty Standard Authorisation is in place or the Court of Protection has made a decision to this effect.

Statutory agencies’ practice is also informed by, and needs to refer to, the following relevant legislation:

 

The Public Health Act 1936

Allows District/Borough Councils to give notice to owners or occupies of premises, if those premises are “in such a filthy or unwholesome condition as to be prejudicial to health”. The notice can require the owner or occupier to clean the premises. If they do not, the District/Borough Council can arrange to carry out the works themselves.

 

Care Act 2014

The Department of Health have produced factsheets explaining the key aspects of the Care Act. The following is information specifically relating to guidance in relation to protecting adults from abuse and neglect:

“The existing legal framework for adult protection is neither systematic nor coordinated, reflecting sporadic development of safeguarding policy over the last 25 years” (Commission for Social Care Inspection)

 

Annex B

Factsheet

This factsheet describes how the Act sets out the first statutory framework for adult safeguarding, to set out local authorities’ responsibilities, and those of their local partners, to protect adults at risk of abuse or neglect.

What is “Safeguarding”?

“Adult Safeguarding” is the term that describes the function of protecting adults from abuse or neglect. This is an important shared priority of many public services, and a key responsibility of local authorities.

Safeguarding relates to the need to protect certain people who may be in vulnerable circumstances. These are adults in need of care and support who may be at risk of abuse or neglect, due to the actions (or lack of action) of another person. In these cases, it is critical that local services work together to identify people at risk and put in place, interventions to help prevent abuse or neglect and to protect people.

Why do we need to change the law?

Although protecting adults from abuse and neglect has been a priority for Local Authorities for many years, there has never been a legal framework for adult Safeguarding. This has led to an unclear picture as to the roles and responsibilities of individuals and organisations working in adult safeguarding. Strengthening safeguarding arrangements is a key priority for this Government.

Public Services and Government have a clear responsibility to ensure that people in the most vulnerable situations are safe. The Government is committed to preventing and reducing the risk of abuse or neglect to adults in vulnerable situations, whilst supporting people to maintain control over their lives and to make informed choices without coercion.

To do this, there needs to be greater incentives and clarity about the way in which public services collaborate and work together. New legislation is needed to provide a clear framework for organisations and to set out their responsibilities for adult safeguarding.

What does the Care Act do?

Safeguarding Adults Boards

Safeguarding is everyone’s business and it is important that organisations work collaboratively to protect people and put in place shared strategies. This legislation requires the local authority to establish a Safeguarding Adults Board (SAB) in their area, to develop shared strategies for safeguarding and report to their local communities on their progress.

The provisions in the Act set out the SAB’s core membership, which should include the Local Authority, the NHS and Police. Core members should meet regularly to discuss and act upon local safeguarding issues. The SAB’s obligations will be set out in guidance. Legislation will put SAB’s on a strong statutory footing, better equipped both to prevent abuse and to respond when it occurs.

One of the key challenges around effective safeguarding work, is the high number of different organisations and agencies involved. A strong multi-agency and multi-disciplinary approach is therefore essential, as each agency has different roles in preventing and protecting against abuse. Safeguarding Adults Boards will be able to determine their own strategic plan, with the local community, to determine how best the Board and its members should work to help protect adults in vulnerable situations from abuse and neglect.

Safeguarding Adults Boards will have three core duties:

  • It must publish a strategic plan for each financial year that sets out how it will meet its main objective and what the members will do to achieve this. The plan must be developed with local community involvement, and the SAB must consult the local Healthwatch organisation. The plan should be evidence based and make use of all available evidence and intelligence from partners to form and develop its plan.
  • It must publish an annual report detailing what the SAB has done during the year to achieve its main objective and implement its strategic plan, and what each member has done to implement the strategy as well as detailing the findings of any Safeguarding Adults Reviews and subsequent action.
  • It must conduct any Safeguarding Adults Review in accordance with Section 44 of the Care Act.
  • The Care Act Statutory Guidance also sets out addition measures for Safeguarding Adults Boards to adhere to in order to perform their duties fully.

Safeguarding enquiries by Local Authorities

The legislation will require Local Authorities to make enquiries, or to ask others to make enquiries, where they reasonably suspect that an adult in their area, with care and support needs, is at risk of abuse or neglect. The purpose of the enquiry is to establish what, if any action, is required in relation to the case.

The Act does not provide powers for Local Authorities, to enter a person’s property or take other similar action to carry out the enquiry. However, we are aware of the strong feeling from some that a specific power of entry, would give an opportunity to ensure that people who are unable or unwilling to ask for help can have their voices heard.

Safeguarding Adult Reviews

Safeguarding Adults Board’s will have to arrange for safeguarding adults review to take place in certain circumstances, where an adult dies or there is concern about how one of the members of the SAB conducted itself in the case. The aim of a review is to ensure that lessons are learned from such cases; not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again.

What will this mean in practice?

A care and support system that is built upon the protection and promotion of people’s human rights will lower the risk of people experiencing neglect or abuse. Whilst the reforms in the Care Act will set out a clear framework within which organisations must act, we also believe that safeguarding is everyone’s responsibility. We all need to be vigilant and to be able to recognise and report abuse. Care and support organisations must ensure they are meeting their own responsibilities for keeping people safe.

Local Roles and Responsibilities

Roles and responsibilities should be clear and collaboration should take place at all of the following levels:

  • Operational
  • Supervisory line management
  • Designated Adult Safeguarding Managers
  • Senior Management staff
  • Corporate/Cross Authority
  • Chief Officers/Chief Executives
  • Local Authority Members and local Police and Crime Commissioners
  • Commissioners
  • Providers of Services
  • Voluntary Organisations
  • Regulated professionals

The Care Act 2014 Care and Support Statutory Guidance stipulates the responsibilities each of these roles hold in regards to safeguarding. The statutory guidance should also be viewed in order to have sight of the full requirements required of SABs, Local Authorities and partner agencies.

 

Outcomes and Experiences

Achieving Good Outcomes

“Focusing on outcomes personalises safeguarding and entails working with people or their advocates from beginning to end of the process, whilst realising that their wishes may change along the way. People generally want more than one outcome and these are frequently hard to reconcile; they often relate to both wanting to be safe and wanting to maintain unsafe relationships. Safeguarding Adults Boards must also understand the role of family carers and ensure that policies, procedures and practice recognise their needs too.

Unless people’s lives are improved, then all the safeguarding work, systems, procedures and partnerships are purposeless. Currently Directors and Safeguarding Adults Boards are faced with a plethora of input/output data but no way of telling from it, if they really are making any impact. Directors must have a means of knowing what works and how they are making a difference to people.

The Department of Health recently completed a review of its data collection and concluded that it must do more to measure outcomes for service users. Some Safeguarding Adults Boards are developing new ways of capturing services users’ views, aggregating relevant quantitative data, trends and emerging outcome measures to monitor their effectiveness. ADASS and LGA have worked with a number of Councils on an outcomes focus through Making Safeguarding Personal including a range of responses to safeguarding (see their latest standards and performance report). Similarly they are supporting the NHS Information Centre to pilot outcome measures.”

(Safeguarding Adults: Advice and Guidance to Directors of Adult Social Services, March 2013)