Safeguarding adults

1. Safeguarding
SAFEGUARDING
Safeguarding Adults
Louise Butler -Tri- Borough Professional Standards Team
WCC
Denise Roach – Tri- Borough Professional Standards Team
LBHF
Zivai Muyengwa- Operational Lead Adult Safeguarding
Clinical Nurse Specialist
What to do next if I have concerns about abuse or
neglect in elderly patients

2. Adult Safeguarding Procedures: The four stage
process
Concern- pre
referral Enquiry
Safeguarding
plan and
review
Closing the
Enquiry
London Multi-agency adult safeguarding policy and procedures 2015

3. SAFEGUARDING ADULTS
Raising adult safeguarding concerns flowchart
If no update from the local authority received within 24hrs, call
Tri-borough SGA Helpline
Tel no: 020 7641 2176 or contact Safeguarding CNS
 Ensure patient consent is obtained – if patient is not able/lacks
capacity to give consent contact Safeguarding Adult Team
 Complete DATIX incident report (ensure that it is categorised as
Safeguarding / Safeguarding Adults)
 Complete and submit safeguarding adult concern form to relevant
local authority
 Once submitted scan the form and save in the alerts and safeguarding
folder in Cerner
 Ensure patient is safe
 Gather information
 Involve the patient – seek their side of the story and gain consent,
where possible, to inform others including social services *
 Seek advice from a senior colleague if required
 Record details in medical records
If, following your investigation and advice, you feel that a safeguarding
concern needs to be raised with the local authority safeguarding team
do the following:
If you have a safeguarding concern about an adult patient
* Consent is required prior to submitting Safeguarding concern form to the Local Authority. If the patient
lacks capacity please seek further advice.
Notes:
Consider whether a serious crime has been committed and whether police involvement is required
Should any issues related to children be identified when managing a vulnerable adult please refer to the
safeguarding children policy (Safeguarding of Children & Young People)
SGA Flowchart _v.2

4. What do we already know?
• What are the main principles of the Care Act 2014?
• What are the six safeguarding principles?
• What are the local authority duties relating to adult
safeguarding?
• What are the partner duties and responsibilities
relating to adult safeguarding?

5. • How do we effectively engage with people to agree their desired
outcomes in response to abuse allegations
• What happens when people won’t/ can’t engage
• How and in what circumstances will advocacy be made
available?
• How to work with people when their desired outcomes cannot
be realised
• How does MSP work in circumstances when the adult at risk has
made a LPA or other arrangements?
• What does success look like in working along an MSP ethos in
partnership e.g Legal profession and National Health Service
What would the adult at risk want to happen next ?
Making Safeguarding Personal/ Person-centred care
and Safeguarding: Chapter 14

6. This situation has been brought to your attention by the A&E Nurse who
describes Mrs Annie McMannus as a 88 year old lady who was admitted to the
department after saying she accidently pushed over by her husband Phil aged
90.She sustained a fracture neck of femur and is visibly shaken. Phil is a long term
heavy alcohol user and is known in the local area by the police and council anti-
social behaviour team.
Previous admissions into the department indicate that there is a long history of
domestic violence .Previous incidents of abuse involved strangulation, and there
has been an escalation of abuse & increase in frequency which Annie frequently
denies. Annie discloses that Phil goes missing for long periods of time and gets
brought back by the police.
Safeguarding Adults Case study 1 Elder Domestic Abuse

7. Safeguarding Adults Case study 1 Elder Domestic
Abuse
• What are the issues here and what decisions need
to be made ?
• Which agencies would be best placed to support
this situation and why ?
• What value would the safeguarding framework
add to this situation

8. Safeguarding Adults Case study 2 – Pressure Ulcers
Joan Dunne is a 98yr old lady with no next of kin admitted following a
collapse on the floor at home ? stroke. Documented that patient lives alone
with paid carers by the council going in X2 daily to support daily living
activities but no District Nurse input for dressing or medication. Joan was
previously mobile. Noted that patient experienced urinary incontinence prior
to admission.
Grade 2 pressure ulcers recorded on buttocks but no documented evidence
of any other pressure ulcers recorded. No wound care assessment or care
plans were initiated but documented that Cavilon was applied and patient
repositioned regularly.
Good documentation from physiotherapist and OT regarding mobility and
transfers with nursing input
Patient was transferred to the ward where Nurses noted that patient had
grade 4 pressure ulcers on her buttocks not grade 2.

9. Q1. What is your agency’s responsibility? Would you put
in SA?
Q2. What questions would you ask Joan to obtain
informed consent
Q3. What reports would you expect to see or request
Q4. What are your responsibilities under the Care Act if
Joan appears to have substantial difficulty in taking part in
this process
Safeguarding Adults Case study 2 – Pressure Ulcers

10. MCA practical application: You have a legal duty to refer to the
Mental Capacity Act Code of Practice – http://tinyurl.com/3dxjrn5
 No matter who the person or
what the decision is that they’re
faced with, the starting point is
that they can make it themselves,
with support
 They need to be offered support
to make an informed decision if
possible or (if it turns out they
can’t make a decision) express
their views or feelings
 You don’t forfeit your right to
choose to do something silly the
older you get if you have full
capacity
 Unwise decisions - we’re all
human and we’re all individuals
 The safest option isn’t necessarily
in their best interests.
 Find out what the person wants
and see if it can be followed. Ask
the views of family and friends.

11. Anif Ahmed is a 73 year old lady who presents to the oncology department
with advanced breast cancer 1 year after an initial consultation. Anif speaks
no English and her husband acts as interpreter. There was no further
treatment possible and she is dying and the team recommend palliative care.
Mrs Ahmed requires full nursing care, and progressing to assistance with
feeding. She speaks little English and appears to have little insight into her
condition. But she makes it clear that she wants to go home to die.
Her husband appears to control all visitors and only allows her to eat what he
brings in.No independent translator had been arranged. Her husband
continues to demand further treatment.
An MDT was held with husband, with input from every consultant involved,
palliative care, OT, physiotherapy, discharge team and nurses. The professor
spelt out clearly what was happening but without consultation had a DNAR
order signed by 2 consultants. The husband rejected this forcibly. The MDT
said they would support a home discharge but he refused all help saying that
'once she gets home she will be able to do everything for herself'
Safeguarding Adults Case study 3 DNAR

12. Q1 What are the issues here
Q2 Is this a safeguarding concern
Q2 How would you manage this situation?
Q 3 Where does the clinician stand in making DNAR
order against the express wishes of the patient/NOK?
Safeguarding Adults Case study 3 DNAR

13. Families role in safeguarding and medical decision
making
 Winspear v City Hospitals Sunderland NHS Foundation
Trust (2015)
 “ even in an emergency there may still be an opportunity to try
to communicate with the person or friends family”
 Best interest means something broader than clinical judgement
 The fact that a physician considers that the treatment is futile
is not a sufficient reason not to communicate the decision
 Duty to consult part of the procedural to comply with Article 8
 Purpose of consultation not merely to obtain the views of
relevant persons “in particular” views of what P “attitude
would be”

14. SAFEGUARDING ADULTS
What is coming next?
 E-mailing instead of faxing of forms to raise concerns to
Adult Social Care
 Any other changes will be on the intranet-the Source

15. SAFEGUARDING ADULTS
For all forms raising adult safeguarding concerns send
these to Adult Social Care and also copy the safeguarding
team at:
imperial.safeguarding.adults@nhs.net