Failures in safeguarding vulnerable adults can and do result in tragedy and harm to individuals and professionals. It’s a tricky thing for GPs to get right – and vital to focus on.
The case of Joseph O’Hanlon, an alcoholic who was beaten to death in his home after concerns were raised about him being taken advantage of by drinking associates, was one which highlighted the issues around adult safeguarding. While steps taken by authorities in the case were said to have been reasonable and, in some examples, even excellent, the case led to calls for vulnerable adults to be treated in the same way as children at risk of harm. It was felt that had the case involved a vulnerable child ‘there would have been a much greater level of expectation in relation to the actions of professionals’.
A key tenet of safeguarding, both for adults and children, is that it is everyone’s responsibility. And all health care staff, from administrators and receptionists up to GP partners, have minimum standards of competency to meet.
Dr Joy Shacklock, the Royal College of GPs’ Clinical Champion for Good Practice and Safeguarding has said: “Safeguarding adults at risk of harm is a key duty for all who work in healthcare.”
Adult safeguarding: roles and competencies for health care staff
The publication of the Royal College of Nursing’s ‘Adult safeguarding: roles and competencies for health care staff’ in August 2018 was hailed as the first UK guidance to help healthcare staff better protect adults at risk of harm, abuse and neglect.
It was designed to be relevant to all healthcare and social care professionals and outlines to what degree staff at all levels must be proficient in the subject. In addition, it underlines the necessity for ongoing professional development and training within this area.
For ‘Level One’ staff, including receptionists and administrators, the document says there is a necessity to know the signs of possible neglect, harm or abuse and who to contact for advice over concerns. This includes the requirement to be willing to listen to concerns about risk, recognise how personal beliefs, experience and attitudes may influence safeguarding work and recognise how their own actions may impact on others.
‘Level Two’ staff, including GP practice managers, must have increased levels of competency including ensuring action is taken where necessary, including to organise advocacy for the individual where required. There is also a requirement to understand mental capacity legislation relevant to the country of practice, which varies between UK countries.
For staff considered ‘Level Three,’ including GPs, it outlines a comprehensive list of necessary competencies, knowledge and attitudes.
There is a further tier of competency for those in specialist roles including named GPs/doctors for organisations commissioning primary care.
The six principles of adult safeguarding
Six foundation principles of adult safeguarding, set out by the Department of Health, inform how professionals should engage with people at risk of abuse, harm or neglect.
The principles in themselves are open to a certain level of interpretation and highlight the potential for complexity in decision making and the balancing act involved in properly meeting safeguarding requirements.
The premise of the principles is around ensuring safeguarding is something that is done with patients and not to them.
The principles are:
- Empowerment There is a presumption of informed consent and for the patient to be involved in the safeguarding process, desired outcomes and any resulting action
- Prevention There is a duty to ensure help is given to allow patients to recognise what abuse is and pathways to support
- Proportionality A responsibility exists to provide the least intrusive response to the level of risk posed
- Protection This principle hinges around ensuring those who need support and representation to report abuse receive it.
- Partnership It’s necessary to ensure information is only shared to the degree that is helpful and necessary even where consent is obtained and that the patient has confidence in this.
- Accountability Patients need to know who is involved in the safeguarding process and in what ways they are involved.
What constitutes abuse, neglect and harm?
In order to fulfil obligations, GPs and their teams must be alert to the full range of potential abuse, neglect and harm and not constrained in their view of what can qualify as a potential safeguarding issue.
This can include:
- Physical abuse including inappropriate restraint or physical sanctions
- Sexual abuse including all non consensual or coerced acts, sexual harassment and non-contact acts such as indecent exposure and online abuse
- Psychological and emotional abuse inclusive of threats of harm or abandonment, coercion, isolation and unjustified withdrawal of support
- Financial or material abuse including theft, fraud, exploitation or coercion. ‘Cuckooing’ should also be considered, which is where a person’s property is taken over and used for illegal activity, particularly drug dealing
- Neglect and acts of omission inclusive of failing to provide access to appropriate health and social care, necessities of life or the necessary support to access those
- Self neglect as well as basics such as personal hygiene, health and environment. This may include certain behaviours such as hoarding
- Domestic abuse, which may occur within relationships irrespective of gender and is inclusive of coercive and controlling behaviour, female genital mutilation and honour based violence
- Discriminatory abuse unequal treatment due to any protected characteristics
- Organisational abuse may relate to one-off or ongoing failures or practices
- Modern slavery where people are forced to endure a life of abuse, servtitude or inhumane treatment.
An overview: safeguarding vulnerable adults
Adult safeguarding is a complex area of practice with heavy moral, as well as legislative requirements. It is an area that is open to interpretation at many stages, involves a wide client group and can involve many service providers.
The Care Act 2014, does not use the term ‘vulnerable adult,’ instead referring to adults with a care or support need – a reminder that all adults may fall into the category at certain times. A carer may be in need of safeguarding as a result of the pressures upon them or behaviour of their charge. Similarly an individual may become ‘vulnerable’ temporarily due to a specific period of ill health or mental strain.
GP practices must do everything possible to ensure adults at risk are protected via proper and effective training, information and protocols for all staff.
As well as being aware of legislative requirements, GPs may also have additional contractual obligations with commissioners in relation to safeguarding vulnerable adults.
Safeguarding is naturally interlocked with confidentiality, data protection and mental capacity legislation. Certain disclosures are required at certain times according to relevant legislation.
A breach in relation to responsibilities to safeguard vulnerable adults is a legitimate concern and can cause conflict in terms of doctor-patient confidentiality, for example.
For advice on any situation regarding safeguarding vulnerable adults contact us.