Transcript Protection of Vulnerable Adults

Supporting and Protecting
Adults From Harm
A&E briefing
Aims of the session
• The briefing will enable staff to:
Recognise harm in an A&E/Unscheduled Care
setting
Identify related legislation and its implications
Know the reporting process
What does the Adult Support and
Protection (Scotland) Act 2007 do?
The Act introduced adult protection duties and
powers, including:
• Councils duty to inquire and investigate
• Duty to co-operate
When you think of an Adult at risk...
?
Who is an Adult At Risk?
The three point test:
Adults (over the age of 16) who –
a) are unable to safeguard their own well-being, property,
rights or other interests;
b) are at risk of harm; and
c) because they are affected by disability, mental disorder,
illness or physical or mental infirmity, are more
vulnerable to being harmed than adults who are not so
affected.
Need to satisfy all 3 parts to apply
Think of it in terms of “ does this person depend on others
for their needs”
Sarah
• 18 years old . Lives at home with
her Mum, Dad and brother. ? Mild
learning disability
• She arrives at A&E, ‘burns’ on the
tops of her legs, can’t get an appt
with her own GP.
• Examination ? Urine burns. No
story given as to what has
happened.
• Decision to treat and discharge
home
• She comments that she’s going to
be cold tonight and doesn’t like the
rain as she can’t sleep.
Duties of Cooperation
The ASP Act sets out statutory duties of co-operation for certain public bodies and
their office-holders: Councils; NHS services; the Police; the Care Commission;
the Mental Welfare Commission; and the Public Guardian.
Members and staff of all of these bodies are subject to statutory duties to:
 Report the facts and circumstances to the local Council when they know
or believe that someone is an adult at risk and that action is needed to protect
that adult from harm;
 Co-operate with the Council and each other to enable or assist the council
making inquiries.
David
• 50 years of age. Has a terminal
diagnosis.
• Admitted via Ambulance at
weekend – stomach pains
• Decision to admit for observation
• Tells Nurse that his cousin is his
carer and she ‘looks after me’.
Jokes that she might not for long
though as she was angry at him
for buying a new tv, bed and
bedroom carpet and that ‘there
would be nothing left for the
funeral’ and ‘her inheritance’.
Links to Professional
Guidance
NMC - You must act as an advocate for those in your care, helping them to
access relevant health and social care, information and support.
NMC - You must disclose information if you believe someone may be at risk of
harm, in line with the law of the country in which you are practising
General Medical Council.
All doctors have a duty to raise concerns where they believe that patient safety or
care is being compromised by the practice of colleagues or the systems, policies
and procedures in the organisations in which they work. They must also encourage
and support a culture in which staff can raise concerns openly and safely.
The Public Interest Disclosure Act 1998 protects individuals making disclosures
that ‘tend to show’ that the health or safety of a person is or may be endangered.
These are ‘protected disclosures’.
Links to Professional Guidance
Health and Care Professions Council’s standards of conduct, performance and
ethics.
• You must act in the best interests of service users.
• You are personally responsible for making sure that you promote
and protect the best interests of your service users. You must
respect and take account of these factors when providing care or
a service, and must not abuse the relationship you have with a
service user.
• You should take appropriate action to protect the rights of children and
vulnerable adults if you believe they are at risk, including following national and
local policies.
• You must protect service users if you believe that any situation
puts them in danger. This includes the conduct, performance or
health of a colleague. The safety of service users must come
before any personal or professional loyalties at all times.
Mary
•60 year old grandmother. Sold her house
to move in with her son, daughter in law
and two teenage grandchildren.
•Family report that she can’t be left on her
own and doesn’t manage to look after
herself.
•Ambulance called by family as Mary was
feeling unwell and was distressed.
•SAS reported to A&E Nurse that when
they arrived to collect Mary, they noticed
that the rest of the house was comfortable
and warm whereas her bedroom was
noticeably colder and untidy. There are
some concerns re personal hygiene.
•Mary herself showed some agitation
around the Daughter in law in particular.
Role of NHS Staff
•
Will report all cases where an adult is considered at risk
of harm to the Council and agree how to proceed with the
investigation. This includes instances where the
allegation is made against a NHS employee (Section 5)
•
Will co-operate with the Council making inquiries and with
each other where that would assist the Council.
Information and records regarding the adult will be
provided when requested under the Act. (Section 10)
•
A doctor, nurse or midwife may conduct a medical
examination during a visit or part of an Assessment Order
(Section 9)
•
It is an offence to prevent or obstruct any person from
acting under the Act and to refuse without reasonable
excuse to provide information. (Section 49, 50)
Things to look out for:
•
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•
•
•
•
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Unable/prevented from reporting
Dependent on others for care
Family pressure to control patient
Delayed treatment
Physical signs of abuse / neglect
Collateral history concerns
Financial abuse
George
• George lives in a care home. His only
son, Brian, lives in England. He phones
regularly but can only visit a few times a
year.
•George is brought to A&E by ambulance,
having fallen. A care assistant comes with
him but can only give basic information
about what happened.
•George is malnourished, complains of
having a sore mouth, appears dehydrated.
The care assistant doesn’t think that he
eats very much of what’s given to him and
tells the Nurse in A&E that he can be
‘difficult’.
•On examination, there are a number of
sore, red patches on his skin and some
bruising around his upper arms. George
does not know how he got these or what
happened to make him fall.
If you believe or know someone is
an adult at risk and in need of
protection ….
• Recognise
• Respond - Is the person in immediate
danger/in need of urgent medical
assistance
• Report - To your relevant Adult Protection
Network; Consider calling the police; Enter
on Datix
What does Social Work do when they receive your ASP Referral?
Your referral is sent to the
appropriate Social Work
Team and they begin an
inquiry into the adults
circumstances
No Further Action
required
ASP Investigation
Care Management
Approach
May be because for example:
•Appropriate supports are
already in place
•The adult declines the
support (and is not being
coerced etc.)
•No on-going risk of harm is
identified
ASP Case Conference
Multi agency Protection Plan
– taking into account the
wishes of the adult
ASP Protection Orders
(used only when necessary)
Assessment Order
Removal Order
Banning Order
Additional supports or
resources introduced into
care plan to manage issues
– Decision taken that further
work under ASP would not
benefit the adult
Add here - Additional
Local information
Summary
ANY QUESTIONS