Transcript Slide 1

ADULT SUPPORT AND PROTECTION
Ensuring Rights and Preventing Harm
Treat Us
With Respect
Adult Support and Protection
Basic Awareness Training
For
Care Homes
Health Warning
Adult Support and Protection can be a very emotive subject
 It may remind us of professional or personal situations that we have had to deal with
 If you need to take time out please do so – don’t feel you need to ask!
Learning Outcomes
Recognise and understand who could be an adult at risk
Identify the signs and symptoms of harm
Be clear that you have a duty to report any concerns about actual or
Suspected harm
Be clear you have a responsibility to identify who you would report any
concerns to
Understand why you should challenge unacceptable attitudes and
poor practices
Be clear about the importance of advocating dignity and respect at
all times
THE CARE HOMES KILLER
Fourteen pensioners who died
in a care home fire could have
been saved if safety procedures
Evidence uncovered by a Sunday Herald investigation reveals a large
spike in blood infection deaths in Scottish care homes.
Over the past five years the number of care home deaths from
septicemia, also known as sepsis has risen by 50%, according to
reports gathered by the Care Inspectorate. The figures, obtained by
the Sunday Herald under Freedom of Information laws, are based on
reports compiled after deaths by care home staff rather than death
certificates.
were not "systematically and seriously
defective", a fatal accident inquiry has
concluded.
Seeing the scandal of abuse
in our elderly care homes
Hillcroft nursing home care
workers jailed for abusing elderly
residents Friday 10 January 2014
Cruel: Care worker Jonathan Aquino
slapping Maria Worroll. Aquino
was jailed for 18 months for
assault
Three nursing home staff have been jailed and a
fourth given a community sentence for tormenting
and abusing elderly residents with dementia, one
member of staff tipped a resident out of a wheelchair
actions described by the trial judge as "gratuitous
sport at the expense of vulnerable victims".
One in seven care homes is
failing to give elderly enough
food and water
17th October 2011
Crawley care home
staff arrested over
neglect
The Body in the Attic
Visitors were encouraged to ring ahead when they came to see relatives at the
home in Oxford. It gave the staff time to hide the stench of urine and scrape
faeces off the curtains
Not that they would ever see the 89 year old man whose suppurating pressure sores had
rotted the flesh down to his bones. He was locked away upstairs, in too much pain to
move and too much confusion to cry out.
For the last four months of his life Alec Taylor saw no one except the owner, who cleaned
his wounds by hacking at the skin around the sores with office scissors and ripping out
his rotting flesh, wearing gloves he had used to scoop faeces off the sheets.
Mid Staffordshire Inquiry - Would you
accept it?
•
•
•
“While I have given some specific examples of poor standards giving rise to dignity
issues, almost every case I quote of complaints about basic care is one in which the
dignity of the patient has been compromised.
It is difficult to imagine that in any such case those actually providing the care
would have been content to be the recipient of such care themselves or to
have seen a relative of their own treated in such a manner.
However difficult the circumstances, there is really no excuse for hospital staff, at
whatever level of seniority or skill, not respecting the dignity of patients”.
Robert Francis QC
Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust
Types/Categories of Harm
Categories of Harm

Sexual Harm

Neglect

Physical

Psychological/emotional

Institutional

Verbal

Finance or material

Discriminatory

Self Harm
What is harm?
Harm includes all harmful conduct and, in particular includes: 
conduct which causes physical harm

conduct which causes psychological harm (e.g. by causing fear, alarm or distress)

unlawful conduct which appropriates or adversely affects property, rights or
interests (e.g. theft, fraud, embezzlement or extortion)

conduct which causes self-harm
Adult Support and Protection (Scotland) Act 2007
Types of Harm
• Physical Harm: this can include hitting, slapping, pushing, kicking, misuse
of medication, restraint or inappropriate sanctions
• Sexual Abuse: this can include rape and sexual assault or sexual acts to
which the adult at risk has not consented, could not consent or was
pressured into consenting
• Psychological Harm: this can include emotional abuse, threats of harm or
abandonment, deprivation of contact, humiliation, blaming, controlling,
intimidation, coercion, harassment, verbal abuse, isolation or withdrawal
from services or supportive networks
•Financial, Material or Property: this can include theft, fraud, exploitation,
pressure in connection with wills, property inheritance, financial
transactions, or the misuse or misappropriation of property, possessions or
benefits
• Neglect and Acts of Omission: this can include 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 or heating
Types of Harm
• Discrimination: actions (or omissions) and/or remarks of a
prejudicial nature focussing on a person’s age, gender, disability,
race, colour, sexual or religious orientation
• Information Misuse: for example, failure to adhere to the
relevant Data Protection Act guidance, failure to provide adequate
and appropriate information about Complaints/Customer services
procedures
• Institutional Harm: for example, when an institution or
organisation is run for the ease and benefit of the institution and
not for the benefit of the clients/patients
• Denial of Human Rights: this can include denial of an
understanding of Criminal Justice processes or a fair hearing
Self-harm:
when a person engages, in any behaviour/ activity that directly
or indirectly causes harm/serious harm to his/her physical, psychological or
social well- being
may include: self-injury, poisoning, scratching, cutting/burning
skin, hitting self against objects, drug overdose, swallowing/ inserting objects
inside him/herself
other forms: staying in an abusive relationship, eating disorder, addiction to
alcohol or drugs, or neglecting own emotional or physical needs
Institutional Abuse
Southampton 2010
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ill treatment and wilful neglect
Winterbourne View 2011
- physical abuse, psychological abuse, general bullying and neglect
Ash Court 2012
- assault and physical abuse
- Intentional harm
Professional/Institutional Harm
Practices which deny residents rights of privacy, dignity, choice and independence
Requires a user led response to care
Any decision based on the needs of the service and not user focused has the capacity to
be abusive
Professional/Institutional Abuse
The misuse of therapeutic power and abuse of trust by professionals
The failure of professionals to act on suspected abuse/crimes
Poor care practice or neglect in services, resource shortfalls or service pressures that
lead to service failure and culpability as a result of poor management
systems/structures.
Case Studies
In your groups identify what types of harm are present in each scenario
Discuss and consider the impact this will have on the individual in each case
Discuss the impact this will have on the individual if this is allowed to continue
Discuss what action you would take for each of the scenarios
20mins
Human Rights Act 1998 - Convention of Rights
The Act Sets out that people have the right to:
•
Life (Absolute)
•
Prohibition of torture or to inhuman or degrading treatment or punishment (Absolute)
•
Liberty and Security (Limited)
•
Marry (Limited)
•
Respect for private and family life
(Qualified)
•
Freedom of thought,
According to the Human Rights Act 1998, it is
conscience and religion
unlawful for any public authorities, which include
(Qualified)
voluntary and private bodies which undertake
•
Freedom of expression
public functions, to act in a manner which is
(Qualified)
incompatible with rights guaranteed in the
•
Freedom of assembly
European Convention on Human Rights
and association
(Qualified)
3 Categories of Rights
Human Rights Act 1998 - Convention of Rights
The Rights that have an impact on providing dignified services include:
Article 8 - Right to respect for private and family life
Article 9 – Freedom of thought, conscience and religion
Article 10 – Freedom of expression
Article 14 – Prohibition of discrimination
Human Rights
•
Human rights are those basic standards without which people cannot live in
dignity. To violate someone’s human rights is to treat that person as though
she or he were not a human being.
•
The purpose of equality legislation is to promote equal treatment and to protect
vulnerable people from those who would do harm or take advantage of their
inability to protect themselves.
•
Care workers need to be aware of these laws in order to uphold them and to
help protect those they care for.
•
To advocate human rights is to demand that the human dignity of all people be
respected.
Human rights in action
Protecting dignity
A man detained in a maximum security mental health
hospital was placed in seclusion where he kept soiling
himself. Staff declined to clean up the faeces or move
him. His advocate successfully challenged this using the
right not to be treated in an inhumane and degrading
way.
The Right not to be Tortured or Treated in an
inhuman or degrading way
Inhuman treatment means treatment causing severe
mental or physical harm
Degrading treatment means treatment that is grossly
humiliating and undignified
Inhuman or degrading treatment does not have to be
deliberate
Seven care workers arrested after
'dungeon' found at care home
23rd Oct, 2013
A probe by the police, NHS and the Care Quality Commission has uncovered
what is alleged to be a “punishment room” at Veilstone Care Home in which
vulnerable residents were allegedly locked inside overnight. The unheated room
contained only a blow up mattress, a single light bulb and a CCTV camera.
Its door was locked from the outside, and alleged victims had no way of getting
out unless staff released them.
Dignity
Take 10 minutes to discuss and list definitions of dignity on flip chart paper
provided
Take 10 minutes to discuss and list barriers to providing dignified care
Social Media
Two care home assistants have been
suspended from duty and social services
called in after the pair posted pictures on
Face book
Care home workers sacked for 'mimicking
elderly by wearing their clothes and posting
pictures on Face book‘
In photographs clearly taken next to the home’s
elderly residents, the gurning duo pose with zimmer
frames and glasses, and in one shot incontinence
pants.
•Five workers at over 55s care home in Tyne and Wear
have been sacked
•Residents heard rumors of staff wearing their clothes
•Age UK boss said workers showed a 'lack of respect'
•Care home managers launch investigation
Be the Best You Can Be In Your Roles
Why?
Human Rights and other discriminatory Legislation
Quality of Care and Standards –
Quality Assurance and Care Inspectorate Inspections
Contract Terms
Others waiting to Whistle Blow on you
It could cost you your job
Dignity Challenge – Best Practice
Raised service user expectation
Raised profile in the media Bad publicity – Not in My Care Home!
Because you Care
What Would You Do?
A family member/you are to be admitted to your Care Home.
Would you be happy/supportive for this to go ahead?
If not why not?
If yes why? What makes this Care Home a good place to be?
Discuss in your groups.
Why dignity matters
in
Adult Support and Protection
Loss of
dignity
Loss of
health,
wealth,
personhood
even life.
Harm
Neglect
Disclosure
What Should You Do
Line Manager
Designated Person for
Adult Protection
Core Agency
Police
Health
Social Work
Who Should You Tell?
Do
Stop and listen
Keep calm
Make brief notes of concern/injury/disclosure
Tell the person they’re not to blame and have done the right thing by telling you
Do
Record the incident as soon as possible (use the person’s
own words)
Report the incident to the Designated Member of
Staff/Responsible Person
Refer to one of the Core Agencies without delay
Make sure you receive support
Don’t
Make a promise (confidentiality)
Panic, or appear shocked or angry
Make judgements
Don’t
Ask leading questions
(Ask What/Who/When/Where, but never Why?)
Criticise the alleged perpetrator
Attempt to carry out an investigation
Step-by-step Good Practice Guide
Consultation with Line Manager

discuss suspected or actual harm with your supervisor/line
manager as soon as possible

if your manager is not available, discuss with a suitable alternative
manager

describe fully the circumstances of the situation

identify courses of action to be taken

ensure record is made: that the discussion has occurred, with
whom & conclusions or actions planned
Part 1 Section 5 of ASPA imposes a duty to inform council social work
services of any concerns regarding an adult at risk, and a duty to report
to the police if it is suspected that a crime may have been committed.
Step-by-step Good Practice Guide
You witness or receive information about harm involving an
adult at risk.
Share your concerns regarding the risks and dangers involved.
Clarify:
 what happened, including whether it has happened before,






who was involved,
whether anyone else was present or within hearing distance
what the person thinks about the situation
what they want done about it
ascertain if potential risks to others
record any discussion and action taken
If the person is unconscious, in immediate physical danger or appears
to the victim of a crime you should contact the appropriate
emergency service (go straight to Step 3)
Step-by-step Good Practice Guide
Dilemmas / Confidentiality / What if?
“What if the person says I want to tell you something, promise you
won’t tell anyone else?”
Never promise to keep a “secret”.
All staff who have contact with adults who may be at risk of harm have a
responsibility to refer concerns or any disclosures made to them to an
appropriate person or agency. At times, this may pose a dilemma for staff who
may feel that by doing so this could alienate the adult at risk and / or the family,
carer or others and damage the potential for further work.
NONETHELESS
● To do nothing is not acceptable.
● To promise confidentiality is not acceptable.
● Relevant information will have to be shared in an adult support and
protection situation.
Step-by-step Good Practice Guide
Dilemmas / Whistle Blowing / What if?
“I report a suspicion/disclosure & it affects my relationship with the
service user or colleagues?”
You have a duty to report.
Failure to report concerns is a failure in your duty of care.
Whistle blowing procedures mean that you must be treated fairly when
reporting such concerns.
Policy: Whistle Blowing
Step-by-step Good Practice Guide
Contacting Emergency Services
If the person is in immediate physical danger telephone 999. Urgent
assistance or advice can also be obtained by contacting NHS24, social
work service (and outside office hours, the emergency social work
service).
Physical or sexual harm should always be reported to the police as soon
as possible, in order to preserve vital evidence.
Note:


Staff members should never put themselves at risk
Record action taken.
What might happen next?
 Referral to social work services
 Councils duty to inquire
 Inter-agency Referral Discussion (IRD)
 Adult Support and Protection Case Conference
 Duty to consider the importance of providing advocacy and other
support services
 Staff support
 Recording
Dignity isn’t all about hi-tech
systems and processes
I’ve had a nice bath
My hair done and I am having
II
a lovely dinner – it’s not
Rocket Science
Key Message
If you suspect that harm has taken place, is taking
place or that an adult may be at risk of harm, or if
you witness any incidence of harm, or if a
disclosure is made to you, you must report it to
your line manager
YOU HAVE A DUTY OF CO-OPERATION