Topic outline

  • 1. Framework for Provision of Adult Social Care

    Councils have a duty to undertake a needs assessment under Section 9 of the Care Act 2014 where it appears that an individual needs care and support. If the assessment identifies that the individual meets the eligibility for a service and the provision of the service is mandatory, the local authority must make arrangements for the service(s) to be provided.

    The assessment covers an individual's autonomy (including their mental capacity), physical and mental health and safety, the management of daily routines, the home environment and involvement in the family and wider community life.

    The way in which adult social care should be provided has been the subject of further legislation and policy documents in relation to mental capacity - see Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

    • 2. Provision of Health Services

      Health services have a duty to provide safe and effective care to all patients and to recognise that all patients may be in vulnerable situations while receiving health care. However, some patients may be at particular risk of harm as they are less able to uphold their rights and protect themselves from harm or abuse. Conditions such as dementia may mean a patient has greater dependency, yet is unable to hold service to account for the quality of care they receive. NHS Organisations have responsibilities to take additional measures to ensure that those patients receive high quality care and that their rights are upheld, including their right to be safe. Delivering this will test the true level of service quality.

      The Liberating the NHS (2010) white paper describes a better NHS that:

      • Is genuinely centred on patients and carers;
      • Achieves quality and outcomes that are among the best in the world;
      • Refuses to tolerate unsafe and substandard care;
      • Eliminates discrimination and reduces inequalities in care;
      • Is transparent, with clearer accountabilities for quality and results;
      • Gives citizens a greater say in how the NHS is run.

      • 3. The Personalisation Agenda

        'Putting People First, a Shared Vision and Commitment to the Transformation of Adult Social Care' (2007) sets out the Government's commitment to a personalised adult social care system and was co-produced by central and local government, the sector's professional leadership, providers and the regulator. This document sets out a shared vision for the transformation of adult social care services aimed at enabling people to live their own lives as they wish, confident that services are of a high quality, are safe and promote their own individual needs for independence, wellbeing and dignity.

        The aims of the personalisation strategy are:

        • To give people using services access to a range and choice of services and control over the shape of their lives, including giving people a clear understanding of how much is to be spent on their care and support, and allowing them to choose how they would like the funding to be used to suit their needs and purposes;
        • To ensure such choice and control is available to all those who use social care services, which will include the most vulnerable, while at the same time keeping them safe;
        • To support people using social care services to maximise their independence and quality of life and to enable them to participate in their local community;
        • To provide as much help and support as necessary to carers to enable those for whom they provide care to remain living with their families;
        • To ensure that support is available to everyone within the community through the development of accessible and universal services.

        The Care Act (2014) replaces a number of other Acts, secondary legislation and statutory guidance. The principles of the Personalisation Agenda are still strongly evident in the Care Act, with its emphasis on identifying and recording clear outcomes for the individual, and also on putting the individual at the heart of any assessment or service provision.

        • 4. Scope of Safeguarding Adults Procedures

          4.1 An Adult at Risk

          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 or neglect.

          Local authority statutory adult safeguarding duties apply equally to those adults with care and support needs regardless of whether those needs are being met, regardless of whether the adult lacks mental capacity or not, and regardless of setting, other than prisons and approved premises where prison governors and National Offender Management Service (NOMS) respectively have responsibility.

          Those adults eligible for support under these Safeguarding Procedures are those who are aged 18 years and over and who are, or may be eligible, to receive support from social care or health services and who may be unable to take care of themselves, or be unable to protect themselves against serious harm or exploitation and whose independence and well-being would be, or is at risk if they did not receive appropriate health or social care support. In these procedures, the term Adult at Risk is used.

          An Adult at Risk may, therefore, be a person who:

          • Is elderly and frail due to ill health, physical disability or cognitive impairment;
          • Has a learning disability;
          • Has a physical disability and/or a sensory impairment;
          • Has mental health needs including dementia or a personality disorder;
          • Has a long-term illness/condition;
          • Misuses substances or alcohol;
          • Is under the psychological and physical control or coercion from another individual or individuals due to a domestic abuse situation;
          • Is a carer such as a family member/friend who provides personal assistance and care to adults and is subject to abuse;
          • Is unable to demonstrate the capacity to make a decision and is in need of care and support;
          • Is in a position of dependency on others;
          • Is socially isolated.

          (This list is not exhaustive).

          Individuals who are not in receipt of services but fulfil the above criteria are eligible for support under these Procedures. Adults who are meeting their assessed care needs through Direct Payments, Personal Budgets, Personal Health Budgets or Self-Funded Placements (adults funding their own care arrangements) will be afforded the same support to access these Procedures.

          Where concerns are identified there needs to be careful consideration at the outset of any concern being raised that the Safeguarding Process is the most appropriate way to take the issue forward. The use of the Safeguarding Threshold Risk Assessment Guidance will support decision making in respect of this.

          If an adult is being abused but they are not covered by these Procedures, they must be signposted to other appropriate agencies or services (see Chapter 8, Guidance and Useful Contacts).

          • 4.2 Safeguarding Adults

            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 experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

            The aims of adult safeguarding are to:

            • Stop abuse or neglect wherever possible;
            • Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
            • Safeguard adults in a way that supports them in making choices and having control about how they want to live;
            • Promote an approach that concentrates on improving life for the adults concerned;
            • Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
            • Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult; and
            • Address what has caused the abuse or neglect.

            • 5. Application of these Procedures

              Organisations should always promote and prioritise the adult’s safety and wellbeing in their safeguarding arrangements. People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Professionals and other staff should not be advocating “safety” measures that do not take account of individual well-being, as defined in Section 1 of the Care Act.

              These Procedures should guide and inform the practice of all individuals within all organisations working in partnership to safeguard adults at risk. They should be applied in all situations where an adult has met the definition of an adult at risk.

              These Procedures apply to:

              • Any setting: Abuse can happen anywhere, in public or private places. It can take place when an adult lives alone or with others;
              • Any perpetrator(s): It must be recognised that anyone can, and may, abuse others and cause harm. For example:
                • People in positions of trust;
                • Unpaid carers, including relatives, family members, friends and neighbours;
                • Professional staff;
                • Paid care workers;
                • Volunteers;
                • Other service users or adults at risk;
                • Acquaintances;
                • Local residents;
                • Strangers.

              The Procedures are described, outlining stage by stage, and by roles and responsibilities and including any particular issues to be considered at each stage.

              In the event of any difficulties in using these Procedures, you should contact your Organisation's Safeguarding Lead. Alternatively, you can contact the Safeguarding Adults Team.

              Key Principles of Member Organisations of the Sunderland Safeguarding Adults Executive Board

              Member organisations of the Sunderland Safeguarding Adults Executive Board:

              • Recognise that it is every person's right to live their life free from violence and abuse in accordance with the principles of respect, dignity, autonomy, privacy and equity;
              • Re-affirm their commitment to a policy of zero tolerance of abuse within each of their member organisations;
              • Take seriously the duty placed on public agencies under Human Rights legislation to intervene proportionately to protect the rights of citizens;
              • Act on the principle that any Adult at Risk of abuse or neglect should be able to access public organisations for advice, support and appropriate protection and care interventions, which enable them to live without fear and in safety;
              • Recognise that, except where the rights of others would be compromised, citizens have a right to make their own choices in relation to safety from abuse and neglect. Interventions will be based on the presumption of mental capacity unless it is determined that an adult does not have the ability to understand and make decisions about his or her own personal well being and safety;
              • Recognise the right to privacy. Information about an adult who may be at risk of abuse and neglect will only be shared within the framework of the Information Sharing and Confidentiality Agreement. See also Information Sharing and Confidentiality Agreement;
              • Recognise their public duty to protect the human rights of all citizens including those who are the subject of concern but who are not covered by the Safeguarding Adults Procedures. This duty falls on each of the Board's member organisations who will offer signposting, advice and support, as appropriate to their organisations;
              • Recognise the importance of appropriate feedback being given to those who report abuse or neglect;
              • Aim to create an integrated range of services and opportunities delivering timely and appropriate responses to individuals' needs and supporting them in leading fulfilled and healthy lives;
              • Endeavour to empower people to make informed choices about support that suits them and allows them to achieve the outcomes they want to maximise their independence and quality of life. This includes safeguarding those people whose independence and well-being are at risk of abuse and neglect.

              Key Values and Principles of All Those Working with Adults at Risk

              Care Act 2014: Key Principles of Safeguarding

              • Empowerment – People being supported and encouraged to make their own decisions and informed consent;

                “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens”
              • Prevention – It is better to take action before harm occurs;

                “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help”
              • Proportionality – The least intrusive response appropriate to the risk presented;

                “I am sure that professionals will work in my interest, as I see them and they will only get involved as much as needed”
              • Protection – Support and representation for those in greatest need;

                “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want”
              • Partnership – Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse;

                “I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me”
              • Accountability – Accountability and transparency in delivering safeguarding;

                “I understand the role of everyone involved in my life and so do they”

              Services will be provided irrespective of an individual's race, colour, gender, sexual orientation, age, type of disability, language, religion, political or other opinion, national or social origin, birth or other status.

              In achieving the principles and values set out above, all those who work with Adults at Risk will:
              • Support them to express their views and wishes;
              • Listen to their views and be open to change;
              • Enable them to make decisions and choices wherever possible;
              • Facilitate their independence wherever possible;
              • Assist them to maintain confidence and a positive self-esteem;
              • Ensure an appropriate balance between risk and choice;
              • Enable them to feel able to complain without fear of retribution;
              • Engage with family members and carers as partners;
              • Work in partnership with other professional colleagues to ensure services are coordinated;
              • Treat them with dignity and respect.

              Principles of Recording Information Across all Health and Social Care Agencies

              See Information Sharing and Confidentiality Agreement and Recording of Information.

              • 6. National Policy And Legal Changes

                The following publications are of relevance:

                Safeguarding Adults (Care Act Sections 42-47)

                Sections 42 – 47 are the relevant sections for Safeguarding Adults. The Care Act 2014 implements key recommendations made by the Law Commission and puts adult safeguarding on a legal footing, and from April 2015 each Local Authority must:

                • Make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to stop or prevent abuse or neglect, and if so, by whom;
                • Set up a Safeguarding Adults Board (SAB) with core membership from the Local Authority, the Police and the NHS (specifically the local Clinical Commissioning Group/s) and the power to include other relevant bodies;
                • Arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate adult to help them;
                • Cooperate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect.

                The Act also updates the scope of adult safeguarding (see Definitions, Categories and Indicators of Abuse).

                Counter-Terrorism and Security Act 2015

                Section 26 of the Counter-Terrorism and Security Act 2015 (the Act) places a duty on certain bodies (“specified authorities” listed in Schedule 6 to the Act), in the exercise of their functions, to have “due regard to the need to prevent people from being drawn into terrorism”.

                FGM Mandatory Duty to Report 2015

                Section 5B(11) of the FGM Act 2003 (as inserted by section 74 of the Serious Crime Act 2015) introduces a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 onwards.

                Modern Day Slavery Act 2015

                Makes provision about slavery, servitude and forced or compulsory labour and about human trafficking, including provision for the protection of victims; to make provision for an Independent Anti-Slavery Commissioner; and for connected purposes.  Sunderland has Modern Day Slavery Guidance.  Further information is also available on the Government's Modern Slavery website: Modern Slavery 

                See also Local Authorities Adult National Referral Mechanism Pathway

                See also the Police Transformation Unit Modern Day Slavery Poster, a useful 1 page guide for staff and public.