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Welcome to the sixth edition of the newsletter from the Gloucestershire Safeguarding Adults Board (GSAB). The GSAB is a multi-agency partnership that is committed to promoting the health and well-being of adults at risk in our community.
Unfortunately due to COVID-19 we were only able to hold the first two of our GSAB Roadshows and had to cancel the remaining four. This edition of the newsletter covers the content of the roadshows, which were aimed at the Voluntary and Community Sector (VCS), but should be of interest to all those who work with adults at risk.
As well as this newsletter, we also send out GSAB Alerts to those signed up to our mailing list. Alerts are sent via email and provide information on hot topics. To sign up for GSAB Alerts, please visit https://www.gloucestershire.gov.uk/gsab/ and sign up in the top right hand corner of the homepage.
GSAB Vision
“To provide assurance that adults at risk are safeguarded from abuse and neglect. All partner agencies of the GSAB will work together to assure that people who have care and support needs are empowered to be kept safe from harm, abuse and neglect and that when abuse occurs, partner organisations respond effectively and proportionately”.
How to report a safeguarding concern
Contact the Adult Help Desk:
Information that would be helpful includes:
- Why you are concerned
- The name, age and address of the adult at risk
- If anyone lives with them
- If they are getting help from any organisation
- Who may be causing the abuse
Don't delay in reporting the abuse, even if you are not sure about some of these details.
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What is Safeguarding?
The Local Authority duty under section 42 of the Care Act 2014 is about protecting adults with care and support needs from abuse and/or neglect. There is a difference between safeguarding under section 42 of the Care Act and supporting people who may be at risk in a wider sense.
For example, an older person living alone at home alone with developing confusion, and finding it increasingly difficult to manage, may be in need of some support to maintain their independence. While they may be at risk because of their circumstances, a safeguarding enquiry would not be appropriate as a way of addressing this.
The fact that a person has needs for care and support does not necessarily mean that a section 42 enquiry will be needed if they experience abuse, as they may be well able to resolve the issue themselves. The focus for a statutory safeguarding enquiry is on adults who are not able to protect themselves because of their care and support needs. So a person with a profound learning disability may lack the capacity to protect themselves because of their learning disability and will therefore need a section 42 enquiry to be undertaken on their behalf to ensure they are protected.
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The Referral Process
If you become aware of a situation of possible abuse and neglect affecting an adult with care and support needs, where possible a conversation should be had with the individual before contacting the local authority. This is to find out their views on the situation, how they feel and what action they would like to take, if any. Their consent to raise the concern should be sought but you should make it clear to them that you have a duty to raise the concern regardless of their consent.
Safeguarding concerns are raised with the Adult Helpdesk. The Adult Helpdesk will take information and pass the concern on to the Safeguarding Adults Team. There are currently five practitioners in the team.
Cases are risk assessed and given a priority of high, medium or low based on what other measures are already in place to reduce the risk. If no measures are in place the concern would be given high priority, and sent on to the appropriate team for urgent attention.
The Referral
The Safeguarding Adults practitioner will contact the person who raised the concern and explore the adult’s history, for example have there been any previous safeguarding concerns?
Multi-agency partners are contacted to gather information about the adult and their situation; practitioners will choose the most appropriate person to help build a full picture of what is happening.
A decision is then made as to whether it meets the criteria for a section 42 enquiry, or whether other actions are needed.
The practitioners make recommendations on the best course of action and these are passed to the frontline team to progress (this is frequently, though not always, the Adult Social Care locality team).
The Care Act added self-neglect as a category of abuse potentially requiring a section 42 response. However this would only be necessary if the risks to the person were high and they were not engaging with the support offered. For further guidance on how to respond in such cases, please see the GSAB Self-Neglect Guidance, which is available on the GSAB website: https://www.gloucestershire.gov.uk/media/2090520/gloucestershire-revised-best-practice-guidance-self-neglect-march-2018.pdf
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POhWER Advocacy Services
Advocacy means enabling the voice of the person to be heard, speaking for those who can’t and supporting those who can. Advocacy is about supporting, enabling and empowering people to express their views and concerns and access information and services where needed.
Independent Advocacy
Supporting people holistically means that they:
- receive consistent support
- do not have to repeat their story to different advocates
- can rely on advocates having a understanding of who they are and what matters to them
Independent Health and Social Care Advocacy is a service delivered by POhWER that is designed to deliver a combination of statutory advocacy roles for people who live in Gloucestershire.
POhWER can offer an information and advice support service if you are unsure if an advocate is needed or what type of advocate you need. POhWER uses an integrated service so individuals can be supported by the same advocate avoiding the need to work with different advocates.
Different types of advocate:
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Independent Care Act Advocacy (ICAA) – to represent and support a person with a substantial difficulty in understanding or going through the Care Act process, when there is no one else to support them. This enables the person to be involved in the process as fully as possible and where necessary to be represented by an advocate who speaks on their behalf.
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Independent Mental Health Advocate (IMHA) – for those being detained under certain sections of the Mental Health Act, subject to Guardianship, a Community Treatment Order or an informal inpatient in a mental health hospital. An advocate can support by helping the person to understand sections and their rights, preparing and supporting at meetings, assisting with access to records and helping communication with staff.
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Independent Mental Capacity Advocate (IMCA) – provides independent safeguards for people who lack capacity and have no one else to represent them. This can include a change of accommodation, serious medical treatment (including DNAR), a care review and safeguarding.
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Deprivation of Liberty Safeguards (DoLS) – to act as an independent person for those involved in DoLS, providing a 39A, C and D and a Paid Person’s Representative (RPR).
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Independent Health and Complaints Advocacy (IHCA) – provides support to make a complaint about any NHS funded service, including a range of self help tools for people empowered to make their own complaint. Support in drafting complaint letters and attendance at complaint meetings.
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Social Care Complaints (non-statutory service) – for people who are eligible for Care Act Advocacy and want to complain about their experience of adult social care.
POhWER can be contacted on:
Tel: 0300 003 1162 Monday to Friday, 08:00-18:00
Email: glosadvocacy@pohwer.net
Website: www.pohwer.net
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WHAT IS THE MENTAL CAPACITY ACT (MCA)?
The MCA is law which support people in their decision making. Not all people can make all of their own decisions all of the time. When the Mental Capacity Act 2005 came into force, it did so to boost protection and empowerment for individuals who lack the capacity to make decisions about their own care and treatment and to help others plan ahead for when they may find themselves in a similar position.
The MCA is based on 5 fundamental principles:
 The MCA looks at decisions which need to be taken at that particular time. It is common for people to have capacity to make some decisions, but not others. There are very few people who are not able to make any decisions for themselves. It is important not to assume a person lacks capacity just because of their illness or disability. Due to illness or disability a person’s ability to make a decision may change over time.
The second principle is very important. This is there to assist the person by giving them the best possible chance to make their own decision.
Some people, probably most of us at some time, make unwise choices. Making an unwise choice is not the same as someone lacking capacity.
Principles 4 and 5 are the process to be followed where a person does not have capacity for the decision. A best interests decision must be taken in the person’s best interests and it must be the least restrictive decision of those available.
How do we assess a person’s capacity?
Firstly, you need to know if a person has an impairment or disorder of the mind or brain. Examples will include dementias, learning disability, delirium or intoxication. Just because of an impairment/disturbance, this does not mean that the person lacks capacity. They may or may not, but this needs to be assessed.
The second step is to understand if the impairment/disturbance is the reason why the person cannot make the decision for themselves. The MCA does this by getting the assessor to ask a series of questions:
- Does the person have the ability to:
- Understand the information?
- Retain information related to the decision?
- Weigh up or use the information while considering the decision?
- Communicate the decision by any means?
This is not always as easy as it sounds. If you are presenting information to a person, think about the best way that they will be able to take it in. Think about the content as well, what is relevant for them?
You can assess if a person can understand information by asking them to repeat some key information from earlier in the conversation or by asking for the information in a slightly different way.
The person will need to retain this information for long enough to make the decision. Think about decisions for a meal choice, this would only have to be retained for a short amount of time, until the meal. For decisions around care or serious medical treatment, this is a more complex decision and information may need to be held for a longer period of time.
When you are assessing if a person can weigh up information, you have to be able to explain what options are available and think about how they can look at the pros and cons and come to their decision. If they cannot, they will lack capacity for this decision.
To demonstrate capacity the person must be able to communicate their decision which means to be able to demonstrate their choice, it does not have to be verbal.
Best Interests Decisions:
If a person is found to lack capacity for a particular decision, there is a decision which now has to be made in their best interests. It is very important to understand that this decision is not what you think should happen, but a decision based on a number of different factors starting with what would the person want if they had capacity. This will not always be clear but in many cases the person, even lacking capacity, can still have a view they will share. It may be that family/carers know what the person would want because they have shared that information in the past. Before a best interest decision can be taken, you must consider the best interests checklist:
Involve the person in the decision as much as possible - do whatever is possible to permit and encourage the person to take part, or to improve their ability to take part, in making the decision.
Consider their wishes and feelings – the person’s past and present wishes and feelings:
- Any beliefs and values (e.g. religious, cultural, moral or political) that would be likely to influence the decision in question.
- Any other factors the person would be likely to consider if they were making the decision or acting for themselves.
- Take all practicable steps to assist the person concerned in expressing their wishes and feelings – remember the 2nd principle!
- Consider the views of the carers, family, or people who may have an interest in the person’s welfare, if it is practical and appropriate to do so
- Could they regain capacity? Consider whether the person is likely to regain capacity (e.g. after receiving medical treatment). If so, can the decision wait until then?
- Take account of all relevant circumstances - weigh up all of these factors in order to work out what is in the person’s best interests.
- Role of Advocate (where appropriate) – Family member/friend/IMCA
- Respect their culture, including their religious beliefs.
- Avoid discrimination – do not make assumptions about someone’s best interests simply on the basis of the person’s age, appearance, condition or behaviour.
- Have all available options been considered?
You may have to take very important decisions for a person lacking capacity and giving thought and looking at evidence in relation to the checklist helps you to make the best decision.
You are probably thinking “But who makes the decision?” This depends on what the decision is, for example a decision on a medical operation will have to be taken by the responsible medical professional; however a decision on where to go on a particular day will be one for the carer to take. There are many decisions and as many decision makers. In practice most day to day decisions will be taken by family or carers and they will have the best understating of what a person wants, likes or dislikes.
The Mental Capacity Act 2005 doesn’t just help people who lack capacity, it also helps you. By following the principles and process you can support people to have better lives.
Further information and guidance on the Mental Capacity Act in Gloucestershire can be found at: https://www.gloucestershire.gov.uk/health-and-social-care/adults-and-older-people/mental-capacity-act/
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Safeguarding Adults Reviews (SARs)
The Care Act 2014 provides a statutory duty to review serious cases.
Safeguarding Adults Boards (SABs) must arrange a Safeguarding Adult Review (SAR) when:
- An adult dies as a result of abuse or neglect, or experiences serious abuse or neglect and
- There is concern about how agencies worked together to safeguard them
The purpose of a SAR:
- To identify lessons to be learnt from the case and apply those lessons to future cases
- To improve how agencies work, singly and together, to safeguard adults
- SABs are free to arrange a SAR in any other situations involving an adult in its area with needs for care and support.
- SARs will not seek to lay blame, but where there is a concern about individual practice, processes exist to manage this.
- SARs must consider what happened and what could have been done differently.
- SARs provide recommendations and expect clear actions that improve responses
- SARs are proactive and keep adults with care and support needs safe from abuse or neglect in the future.
Those involved in a SAR:
- An Independent Reviewer, commissioned to undertake the review and write the report.
- All the services and agencies working with and supporting the person.
- Contributions from the family, friends, carers are also welcomed, as well as the person where possible.
SARs in Gloucestershire (2014-2019):
 The majority of SARs undertaken in Gloucestershire have involved self neglect.
Self Neglect:
- Self-neglect is defined as a serious failure to care for one’s own health, hygiene and/or surroundings
- It can present significant risks to life and wellbeing
- It can pose ethical and practical challenges to health, social care and voluntary services
- It often involves people in the community who are isolated and difficult to engage with
- A number of recent LeDeR Reviews have revealed people with learning disability are also susceptible to self-neglect
Gloucestershire also undertakes a LeDeR Review when an adult with a learning disability passes away for any reason.
LeDeR Reviews:
The Learning Disabilities Mortality Review programme, also known as LeDeR, reviews the deaths of people with learning disabilities, aged 4 years and over, irrespective of whether the death was expected or not. People with a learning disability typically die much earlier than the national average.
Reviews are carried out to identify good practice, showing what has worked well and also where improvements to the provision of care can be made; this helps to prevent similar deaths in future.
Every death notified to the programme has an Initial Review. Some deaths also require a Multi-Agency Review.
The Gloucestershire Local Area Contact is Cheryl Hampson Cheryl.hampson@gloucestershire.gov.uk To make a LeDeR Referral please use the following link http://www.bristol.ac.uk/sps/leder/notify-a-death/
The importance of information sharing:
- Safeguarding and promoting the wellbeing of adults with care and support needs is wholly dependent upon effective information sharing and collaborative working.
- Research and learning from Safeguarding Adult Reviews evidences the importance that information needs to be shared and collated effectively where there are concerns about an adult in need of protection or supportive services.
- Specifically for health we also must balance sharing information to protect and support others with maintaining a duty for confidentiality; decisions to share information is based on professional judgement, according to the need for safety and wellbeing of the individual concerned alongside legal, ethical and professional obligations.
Adult Safeguarding Training Pathway
Gloucestershire Safeguarding Adults Board offer the training needed to protect adults who have care and support needs. The GSAB have a recommended training pathway, which is suitable for volunteers who have a role in protecting adults from abuse and neglect.
Level 1 training is an E-Learning module that gives an introduction to Safeguarding Adults. This is free for anyone working or living in Gloucestershire. To access the E-Learning please contact the Workforce Development Team on proudtolearn@gloucestershire.gov.uk.
Level 2 training is a half-day face-to-face session delivered by a GSAB approved trainer. It is for all front line staff and volunteers that have direct contact with adults with care and support needs. You are required to complete the Level 1 E-learning prior to attending this course. The approved trainers can be contacted via the following website: https://www.gloucestershire.gov.uk/media/2095771/looking-for-a-safeguarding-adults-trainer-in-gloucestershire.pdf
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Safeguarding is everyone's responsibility
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