Safeguarding and protection in health and social care HSC M3 L2 Extended Diploma HSC.ppt

Safeguarding and protection
in health and social care
Unit No: HSC M3
Unit Code: J/508/3711
By Oguchi Martins Egbujor
By Oguchi Martins Egbujor 1

Unit Aim
The aim of this unit is to provide learners with knowledge and
understanding of safeguarding and protection of children, young
people and adults in health and social care

Learning Outcomes
1. LO1: Understand legislation, policies, procedures and codes of
practice in relation to safeguarding and protection.
2. LO2: Understand the role and responsibilities of the health and
social care practitioner in relation to safeguarding.
3. LO3: Understand types of abuse.
4. LO4: Understand action to be taken by the health and social care
practitioner in response to evidence or concerns that an individual
is at risk or has been harmed or abused.
5. LO5: Understand the benefits of working in partnership in relation
to safeguarding and protection.

Safeguarding Vulnerable Group Act 2006
(Regulated Activities (Adult) Regulation 2012
Regulated Activity for Adults from 10th September 2012 will identify
the activities provided to any adult which, if any adult requires them,
will mean that the adult will be considered vulnerable at that particular
time. The SVGA will no longer label adults as ‘vulnerable’ because of
the setting in which the activity is received, nor because of the personal
characteristics or circumstances of the adult receiving the activities

Safeguarding
Safeguarding relates to the need to protect certain people who may be
in vulnerable circumstances; these group of people may be at risk of
abuse or neglect due to the actions and inactions of another persons.
Egbujor (2020)

What Is Safeguarding?
Safeguarding means protecting a citizen's health, wellbeing and human
rights; enabling them to live free from harm, abuse and neglect. It is an
integral part of providing high-quality health care. Safeguarding
children, young people and adults is a collective responsibility.
https://www.england.nhs.uk/safeguarding/about/#:~:text=Safeguardin
g%20means%20protecting%20a%20citizen's,adults%20is%20a%20colle
ctive%20responsibility.

What Is Safeguarding?
Safeguarding means protecting your right to live in safety, free from
abuse or neglect. Local authorities have duties under the law towards
people who are experiencing abuse or neglect (or are at risk of either).
https://www.mind.org.uk/information-support/legal-rights/health-and-
social-care-rights/safeguarding-in-social-care/

The Care Act 2014
1. Lead a multi-agency local adult safeguarding system that seeks to
prevent abuse and neglect and stop it quickly when it happens
2. Make enquiries, or request others to make them, when they think an
adult with care and support needs may be at risk of abuse or neglect and
they need to find out what action may be needed
3. Establish Safeguarding Adults Boards, including the local authority, NHS
and police, which will develop, share and implement a joint safeguarding
strategy
4. Carry out Safeguarding Adults Reviews when someone with care and
support needs dies as a result of neglect or abuse and there is a concern
that the local authority or its partners could have done more to protect
them
5. Arrange for an independent advocate to represent and support a person
who is the subject of a safeguarding enquiry or review, if required.

Safeguarding and Protection
Harold Shipman: The killing of elderly people
https://www.youtube.com/watch?v=thSLlUskkMM
Ian Huntly: The Killing of Jessica chapman and Holly Wells
https://www.youtube.com/watch?v=_UqyhgvMtc4

LO1
Understand legislation, policies, procedures
and codes of practice in relation to safeguarding and protection

LO1.1: Safeguarding
1. Central to high quality health and social care provision
2. Protection of health, well-being and human rights
3. Freedom from harm and abuse.
Protection:
1. Detecting and preventing harm and abuse.

Harm
Harm is defined as all harmful conduct and/or behaviour that causes
physical or psychological harm for example harassment and
intimidation, causing fear, alarm or distress; unlawful conduct which
adversely affects property, rights or interests such as theft, fraud or
extortion, behaviour that causes self-harm and self neglect
• https://www.adultprotectionsouthlanarkshire.org.uk/info/55/more_a
bout_harm

Abuse
Abuse is when someone causes us harm or distress. It can take many
forms, ranging from disrespect to causing someone physical or mental
pain. It can occur in someone’s home, a care home, hospital or a public
place. Often the people who commit abuse are taking advantage of a
special relationship.
(Somerset Safeguarding Adults Board)
https://ssab.safeguardingsomerset.org.uk/protecting-adults/what-is-
abuse/

Types of Abuse and Harm
• Financial Abuse
• Physical Abuse
• Psychological abuse
• Sexual Abuse
• Neglect/act of omission
• Discriminatory Abuse
• Modern Slavery
• Exploitation
• Self-harm
• Self-neglect
• Mate crime
• Institutional Abuse, etc.

Freedom from Harm and Abuse
It means protecting an adult’s or vulnerable people’s rights to live in
safety, free from abuse and neglect. The aims of safeguarding are to
prevent harm and reduce the risk of abuse or neglect to vulnerable
people with care and support needs.
https://ssab.safeguardingsomerset.org.uk/protecting-adults/what-is-
safeguarding/

The Office of Public Guardian (OPG)
The Office of Public Guardian (OPS) was established by Mental Capacity
Act (MCA) 2005 to protect people at risk of abuse and neglect. OPG
published its Safeguarding Policy in May 2013.
Mental Capacity Act 2005 specified that organisations and service
providers must put in place policies, procedures and systems to ensure
that they comply with safeguarding vulnerable people.
(Egbujor, O., 2020)

Safeguarding Adult Policy
• Empowerment -Presumption of person led decisions and informed
consent.
• Prevention -It is better to take action before harm occurs.
• Proportionality – Proportionate and least intrusive response
appropriate to the risk presented.
• Protection -Support and representation for those in greatest need.
• Partnership -Local solutions through services working with their
communities
• have a part to play in preventing, detecting and reporting neglect and
abuse.
• Accountability -Accountability and transparency in delivering
safeguarding. By Oguchi Martins Egbujor 17

Signs of Physical Abuse
• History of unexplained falls or minor injuries
especially at different stages of healing
• Unexplained bruising – in well protected
areas, on the soft parts of the body or
clustered as from repeated striking
• Unexplained burns in unusual location or of
an unusual type e.g. burns caused by
cigarettes and rope burns etc.
• Unexplained fractures to any part of the body
that may be at various stages in the healing
process
• Unexplained lacerations or abrasions
• Slap, kick, pinch or finger marks
• Injuries/bruises found at different stages of
healing or such that it is difficult to suggest an
accidental cause
• Injury shape similar to an object
• Untreated medical problems
• History of frequent changing of General
Practitioners or reluctance against General
Practitioner consultation or visit
• Weight loss – due to malnutrition or
dehydration; complaints of hunger
• Appearing to be over medicated
• Accumulation of medicine which has been
prescribed for the client but not administered
• Ulcers, bed sores and being left in wet
clothing.

Signs of Psychological Abuse
• Ambivalence about carer
• Fearfulness expressed in the eyes;
avoids looking at the carer,
flinching on approach
• Deference
• Overtly affectionate behaviour to
alleged perpetrator
• Inability to sleep or tendency to
spend long periods in bed
• Change in appetite – Loss of
appetite or overeating at
inappropriate times
• Unusual weight gain/loss
• Tearfulness
• Unexplained paranoia
• Low self-esteem
• Excessive fears
• Anxiety, confusion or general
resignation
• Agitation
• https://southerntrust.hscni.net/ab
use

Safeguarding and Signs of Abuse
• The Explanation of the Legislation and the Principles of Safeguarding
• https://www.scie.org.uk/safeguarding/adults/practice/gaining-access
• https://www.cpdonline/signs of abuse

Prevention of Abuse
Effective prevention of abuse and harm in safeguarding should be
defined broadly and should include all adults with care and support
needs and services. However, it should not mean adopting an overly-
protective or risk-averse approach. Prevention needs to take place in
the context of person-centred support, with individuals empowered to
make choices and supported to manage risks.
Everyone has a role to play in preventing abuse and neglect; including
the adult themselves and their carers, staff, professionals and
volunteers, and the local community / general public.
https://www.llradultsafeguarding.co.uk/preventing-abuse-and-neglect/

Prevention Interventions
• Supporting adults to safeguard themselves
• Training and education for staff and volunteers
• Awareness-raising
• Providing information and advice
• Advocacy
• Policies and procedures
• Community links
• Legislation and regulation.

LO1.2: Legislation, Policy, Procedure
Legislation, policies, procedures and codes of practice in relation to the
safeguarding and protection of:
• Children and young people
• Adults.
Children and Young People
• Equality Act 2010
• Children Acts 1989, 2004
• Human Rights Act 1998
• General Data Protection Regulation (GDPR)

Children and Young People Cont.
• Public Interest Disclosure Act 1998
• United Nations Convention on the Rights of the Child 1992
• Working Together to Safeguard Children 2013, 2015
• the role of the Local Safeguarding Children Board
• related policies and procedures
• codes of practice relevant to sector
• current legislation as relevant to Home Nation.

Children Act 1989
A child in need is defined under the Children Act 1989 as a child who is
unlikely to achieve or maintain a reasonable level of health or
development, or whose health and development is likely to be
significantly or further impaired, without the provision of services; or a
child who is disabled.
Local authorities are required to provide services for children in need
for the purposes of safeguarding and promoting their welfare.
Children in need may be assessed under section 17 of the Children Act
1989.

Section 47 Children Act 1989
Local authorities, with the help of other organisations as appropriate,
have a duty to make enquiries under section 47 of the Children Act
1989 if they have reasonable cause to suspect that a child is suffering,
or is likely to suffer, significant harm.
Such enquiries enable them to decide whether they should take any
action to safeguard and promote the child’s welfare and must be
initiated where there are concerns about maltreatment.
This includes all forms of abuse and neglect, female genital mutilation,
or other so-called ‘honour’-based abuse, forced marriage and extra-
familial harms like radicalisation and sexual exploitation.

The Responsibilities of Local Authority
Within one working day of a referral being made, a local authority
social worker should acknowledge its receipt to the referrer and make a
decision about the next steps and the type of response that is required.
This will include determining whether the child requires immediate
protection and urgent action is required; any services are required by
the child and family and what type of services

The Responsibilities cont.
The child is in need and should be assessed under section 17 of the
Children Act 1989. Chapter one of Working Together to Safeguard
Children provides details of the assessment process; if there is
reasonable cause to suspect the child is suffering or likely to suffer
significant harm, and whether enquiries must be made, and the child
assessed under section 47 of the Children Act 1989. Chapter one of
Working Together to Safeguard Children provides details of the
assessment process; and further specialist assessments are required to
help the local authority to decide what further action to take.

Adults
• Care Act 2014
• Health and Social Care Act 2012
• Equality Act 2010
• Mental Capacity Act 2005
• No Secrets 2000
• Human Rights Act 1998
• General Data Protection Regulation (GDPR)
• Public Interest Disclosure Act 1998
• Local multi-agency Safeguarding Adults policy and procedures, the role of the Local
Safeguarding Adults Boards
• related policies and procedures
• Codes of practice relevant to sector
• Current legislation as relevant to Home Nation

Vulnerable Adult
A vulnerable adult is defined as someone who is aged 18 or over who
has either a dependency upon others in the performance of, of a
requirement for assistance in the performance of basic functions; a
severe impairment in the ability to communicate with others; or has a
reduced ability to protect themselves from assault, abuse or neglect.
(Southampton University, 2009)

Code of Practice for Safeguarding
• Respect all individuals whatever their age, developmental stage, ability,
sex, sexual orientation or ethnicity.
• Place the safety and wellbeing of a child, young person or vulnerable adult
first. It must be placed before any personal or organisational goals and
before loyalty to friends and colleagues
• Form appropriate relationships with children, young people and vulnerable
adults. These should be based on mutual trust and respect.
• Be aware of the relative powerlessness of children, young people and
vulnerable adults compared to staff members.
• Be committed to actively preventing the exploitation and abuse of children,
young people and vulnerable adults.

Principles of Care
• Be Non-judgemental
• Be Empathetic
• Be Supportive
• Be Genuine and authentic
• Be Collaborative

Code of Conduct:
Health & Social Care Workers
1. Be accountable by making sure you can answer for your actions or
omissions.
2. Promote and uphold the privacy, dignity, rights, health and wellbeing of
people who use health and care services and their carers at all times.
3. Work in collaboration with your colleagues to ensure the delivery of high
quality, safe and compassionate healthcare, care and support.
4. Communicate in an open, and effective way to promote the health, safety and
wellbeing of people who use health and care services and their carers.
5. Respect a person’s right to confidentiality.
6. Strive to improve the quality of healthcare, care and support through
continuing professional development.
7. Uphold and promote equality, diversity and inclusion.

The Children, Schools and Families Act 2014
updated the Act of 2010 .
The Children, Schools and Families Act 2014 updated the act of 2010. It
brought changes to the law to give greater protection to vulnerable
children, better support for children whose parents are separating, a
new system to help children with special educational needs and
disabilities, and help for parents to balance work and family life.
http://www.legislation.gov.uk/ukpga/2014/6/contents/enacted

Protection of Freedoms Act 2012
The Government improved disclosure and barring services by scaling
them back to 'common sense levels', while ensuring a continued
service to help safeguard children and vulnerable adults by those who
work or volunteer with them, but that they operate in a way which
reduces the burden on employers and better respects the civil liberties
of the individual.
A review into the Vetting and Barring Scheme and the Criminal Records
Regime and the subsequent recommendations were included within
The Protection of Freedoms Bill. The Protection of Freedoms Act
(2012).

Equality Act 2010
The Act prohibits direct and indirect discrimination on the basis of the
above protected characteristics.
1. Age
2. Disability
3. Gender reassignment
4. Pregnancy and maternity
5. Race
6. Religion or belief
7. Sex
8. Sexual orientation

Direct and Indirect Discrimination
Direct discrimination happens when someone is treated unfavourably
in the workplace because of a protected characteristic. Whereas,
indirect discrimination happens when policies and procedures – which
apply to everyone – exclude a certain group of people.
https://www.healthassured.org/blog/indirect-discrimination

The Care Act 2014 Video
• https://www.youtube.com/watch?v=yNErFxqPXwc
• https://www.youtube.com/watch?v=5g6c3geCD_k
• https://www.youtube.com/watch?v=W_GGxcVg-XA
The Care Act 2014 sets out a clear legal framework for how local
authorities and other parts of the system should protect adults at
risk of abuse or neglect. Local authorities have new safeguarding
duties.

Mental Capacity Act 2005
• Https://www.youtube.com/watch?v=tsthYJV0yig
The Mental Capacity Act (MCA) is designed to protect and
empower people who may lack the mental capacity to make their
own decisions about their care and treatment. It applies to people
aged 16 and over.
It covers decisions about day-to-day things like what to wear or
what to buy for the weekly shop, or serious life-changing
decisions like whether to move into a care home or have major
surgery.
(NHS, 2021)

Legislations
• Safeguarding Vulnerable Groups Act 2006
• Data Protection Act 1998
• The Human Rights Act 1998
• Police Reform Act 2002
• Health and Social Care Act 2008 (Regulated Activities)
Regulations 2014 (regulation13)
• The Charities Act 2006
• The Protection of Freedoms Act 2012 (DBS)

Safeguarding Policies
• Charities Commission May 2013
• Sir Michael Bichard Report 2004
• Fraser Guidelines (House of Lords 1985)
• Gillick Competency Assessment (Lord Scarman
1985)
• SOVA (Safeguarding of Vulnerable Adult)
• Safeguarding Children and Young People
(Under 18yrs) Policy Paper 14th July 2014
• Disclosure of Barring Services (DBS)

Professional Standards
Jointly Produced By
• Association of Chief Police Officers (ACPO)
• Department of Health (DoH)
• Commission for Social Care Inspection (CSCI)
• Office of Public Guardian (OPG)
• Ann Craft Trust (ACT)
• VOICE UK
• Practitioner Alliance against Abuse of Vulnerable Adult (PAVA)

National Framework Standards 2005
Safeguarding Vulnerable Adult
• Standard 1: Local Authority establish Inter-Agency Partners
• Standard 2: Partners recognise/accountable Safeguarding
• Standard 3: SA Policy to include rights to live free of abuse
• Standard 4: Policy on Zero-Tolerance of Abuse and Neglect
• Standard 5: Ensure appropriate development/training
• Standard 6: Access to info on safety from abuse/violence
• Standard 7: Local Multi-Agency policies and procedures
• Standard 8: Partners have policy/procedures in line with LP
• Standard 9: Multi-Agency has detailed procedures of stages
• Standard 10: Safeguarding procedures be accessible to all
• Standard 11: Include service users as partners at all stages

Standard 9
Stages of Safeguarding Procedures
• Alerting
• Referral
• Decision
• Safeguarding assessment strategy
• Safeguarding assessment
• Safeguarding plan
• Review
• Recording and Monitoring

Professionals
• Independent Safeguarding Authority (ISA)
• Local Authorities (Social Services)
• Charities Commission
• Police (ACPO/HMIC)
• Health and Social Care professionals
• Care Quality Commission (CQC)
• Office of the Public Guardian (OPG)
• NSPCC
• NHS England
• Department of Health

Professionals’ Regulatory Roles
Safeguarding Vulnerable Groups
• Care Quality Com (CQC)
• Department of Health
• Police
• Social Services
• Safeguarding strategy meetings
• DBS
• Dept. for Education
• Charity Commission
• Investigate complaints of Social &
HealthCare Prov.
• Vulnerable Adult Policy
• Investigate Allegations of criminal
Abuse
• Welfare of Vulnerable ppl
• Multi Agency Allegation
Management Meetings
• Info on criminal records
• Child’s safety/protection
• Investigate Actions of Trustees

DBS
The Disclosure and Barring Services exist to help organisations
identify people who are unsuitable for certain types of work,
especially work involving access to or contact with vulnerable
groups, including children, by issuing DBS certificates of any
criminal, police or similar records, including checks against the
Barred Children’s and Barred Adult list

Inter-Agency Working
• Charity Commission
• NSPCC
• Save the Children
• Christian Aid
• People in Aid
• EveryChild and the Tearfund
• NCVYS

LO2
Understand the role and responsibilities of the health and social care
practitioner in relation to safeguarding.

LO2.1: How the health and social care
practitioner safeguards individuals:
• Work within policies and procedures
• Duty of care
• Person-centred practice
• Monitoring, observation, reporting, recording
• Partnership working
• Confidentiality
• Whistleblowing

NHS Organisation Leaders and Boards cont.
1. Embrace complete transparency.
2. Train and support all staff all the time to improve the processes of
care.
3. Join multi-organisational collaboratives – networks – in which
teams can learn from and teach each other.
4. Use evidence-based tools to ensure adequate staffing levels.
(Berwick Report, 2013)

Safeguarding Individuals
Care Standard 3 states that there may be times when your duty to
safeguard the wellbeing of the individual is in conflict with your duty to
promote the individual’s right to take risks. It is your duty to ensure an
individual is kept safe and does not experience harm but these
situations may cause you a dilemma and you may not know the right
thing to do to keep them safe at the same time as enabling them to
make their own choices. You are required to use your professional
judgement to safeguard individuals at all times.

Whistleblowing in Health and social Care
A healthcare professional has a duty of care towards vulnerable
adults and a responsibility to draw attention to poor practice at
workplace. If you notice any instances of harm, abuse, or
neglect, then you have an individual responsibility to raise
concerns to somebody who can take action. Failing to come
forward about any wrongdoing that you have witnessed can
result in you being accused of colluding with the person(s) who
has caused the harm.
(Collier, 2020)

Protection for Whistleblowing
Under the Public Interest Disclosure Act 1998 (PIDA) and the
Employment Rights Act 1996, whistleblowing is protected. The
disclosures of wrongful acts are set out in the above laws and cover
things such as criminal offences and damage to the environment, but
they also cover safeguarding practices.
https://www.highspeedtraining.co.uk/hub/whistleblowing-
safeguarding-adults-in-healthcare/

Protection Under PIDA
You would be protected by the law if you have made a disclosure
related to one or more of the following safeguarding issues:
1. The health and safety of an individual has been, or is likely to
be, endangered. For example, if a healthcare setting is
neglecting the needs of its users.
2. Where somebody is trying to cover up wrongdoing. For
example, if the owner of a residential home is covering up
staff abusing patients.
3. A miscarriage of justice has occurred, is occurring, or is likely
to occur. For example, if someone has been convicted of
abuse but they are innocent.

Recording
Recording is an integral and important part of social care. It is not
simply an administrative burden to go through as quickly as possible,
but is central to good, person-centred support. Recording is vital:
• It supports good care and support
• It is a legal requirement and part of staff’s professional duty
• It promotes continuity of care and communication with other
agencies
• It is a tool to help identify themes and challenges in a person’s life
• It is key to accountability – to people who use services, to managers,
to inspections and audits
• It is evidence – for court, complaints and investigations

Reporting
Raising concerns at work, often known as whistleblowing, is the act of
reporting a concern about a risk, wrongdoing or illegality at work, in
the public interest.
Raising concerns should be the norm and accepted as an important
part of people’s day-to-day work as they reflect on their professional
practice and work to improve their service. Whistleblowing is an early
warning system that gives managers an opportunity to put things right
before anything catastrophic happens.
(Nursing Times, 2016)

Reporting Is Your Responsibility
When reporting concerns, you have a responsibility to put the safety
and wellbeing of service users and carers first. We recognise that
registrants take that responsibility very seriously. As a registrant, you
must support and encourage others to raise concerns. You must not
cover up any concerns they have, or prevent them from reporting their
concerns.
(HCPC, 2019)
• https://www.hcpc-uk.org/news-and-events/blog/2019/standards-in-
practice-how-to-report-concerns-about-safety/

Health and Care Professional Council
• The HCPC regulates individual registrants, rather than services or
practices. Whilst we are not able to investigate concerns about
services or practices ourselves, we do expect you to raise any
concerns you may have appropriately and promptly.
• If you are concerned about the management or practices of a health
or social care service you should raise your concern with the relevant
responsible body..

Responsible Authorities for Safeguarding
• The Care Quality Commission in England
• The Care Inspectorate Wales or the Health Inspectorate Wales for
services in Wales
• Healthcare Improvement Scotland or the Care Inspectorate for
services in Scotland
• The Regulation and Quality Improvement Authority or the
Department of Health in Northern Ireland
• If your concerns are about a care home, home care agency or other
adult social care service you can also contact the relevant local
council

Health and Care Professions Council
The HCPC is established under the Health Professions Order 2001 and
is the Statutory Regulator of 15 professions. The HCPC’s function is to
set and maintain standards for those professions, with the objective of
protecting the public.
Key elements of that statutory function include approving programmes
of education and training for the professions and maintaining a register
for the sixteen professions which is kept up to date online in real time.
https://www.hcpc-uk.org/about-us/corporate-governance/freedom-of-
information/who-we-are-and-what-we-do/

Duty of Care
According to Skills for Care, working as a health and social care
practitioner, you have a duty of care to all those receiving care and
support in your workplace. This means promoting wellbeing and
making sure that people are kept safe from harm, abuse and injury
Duty of care is a legal requirement; you cannot choose whether to
accept it. It applies as soon as someone has care or treatment.
Breaking this duty, for example through negligence, could result in legal
action.

Dealing With Challenging Behaviour
An open discussion with any individual, where they are treated with
respect and dignity, can often find a solution. If possible and safe, when
working with a person whose behaviour is challenging:
• Take them to a quiet place
• Ask questions and listen carefully to what they say
• Take their feelings of being upset or angry seriously
• Try to find a way forward that they understand and can agree to.
(Care Standard 3)

Managing Conflicts and Situations
It is important that you get to know the individuals you are working
with as far as possible, so you can recognise what triggers their
distress. It is also important that you don’t get emotionally involved but
keep a clear head and look out for body language and reactions. If you
feel that a one-to-one situation between yourself and an individual has
the potential to become confrontational you should try to leave the
scene to give them time to calm down

Reporting
This places duties on responsible persons working on the premises to
report specific workplace accidents, occupational diseases and specific
dangerous occurrences or near misses to their local Health and Safety
Executive (HSE).
(The Reporting of Injuries, Diseases and Dangerous Occurrences
Regulations 2013 (RIDDOR)
• www.hse.gov.uk/riddor/
• Examples on Report (11 Tips)
• https://www.scie.org.uk/care-providers/recording#top-tips

LO2.2: How The Health and Social Care
Practitioner Safeguards Themselves
• Working within policies and procedures
• Duty of care
• Personal care
• Physical contact
• Technology
• Confidentiality
• Record keeping
• Whistleblowing

The Control of Substances Hazardous to
Health Regulations 2002 (COSHH)
This requires employers to assess the risks of potentially harmful
substances and take precautions to minimise these. They include, for
example, cleaning materials and medication.
www.hse.gov.uk/coshh/

The Provisions and Use of Work Equipment
Regulation 1998 (PUWER)
Anyone responsible for work equipment should ensure that it is
suitable for the job, well maintained, inspected regularly and only
operated by well-informed and trained staff. A breach of any of these
regulations is a crime in the UK and therefore needs to be reported
immediately. If any person suffers harm as a result, the offender may
be taken to court.
www.hse.gov.uk/work-equipment-machinery/puwer.htm

Recording Videos
• Https://www.scie.org.uk/care-providers/recording
• Tips for Recording
• https://www.scie.org.uk/care-providers/recording#top-tips
• Baby P BBC Video
• https://www.youtube.com/watch?v=-SUqyox5DDA

Manual Handling
Manual handling causes over a third of all workplace injuries. These
include work-related musculoskeletal disorders (MSDs) such as pain
and injuries to arms, legs and joints, and repetitive strain injuries of
various sorts. The term manual handling covers a wide variety of
activities including:
• Lifting,
• Lowering,
• Pushing,
• Pulling
• Carrying.

Manual Handling
The 1992 Manual Handling Operations Regulations which came into
force in 1993 and the E.C. Directive 90/269 add to the earlier Health
and Safety at Work Act 1974 with regard to lifting/manual handling.
They apply to all types of load, including clients in care environments.
The new laws increase the employer’s responsibility for providing safe
lifting conditions.

Principles of Manual Handling
Principles of Safe Manual Handling -Position the feet. ...
• Get a secure grip. ...
• Keep the load close to the body. ...
• Maintain good posture throughout the procedure. ...
• Use the leg muscles. ...
• Principles of Safe Manual Handling – Use body momentum.

NHS Organisation Leaders and Boards
1. Listen to and involve patients and carers in every organisational
process and at every step in their care.
2. Monitor the quality and safety of care constantly, including
variation within the organisation.
3. Respond directly, openly, faithfully, and rapidly to safety alerts, early
warning systems, and complaints from patients and staff. Welcome
all of these.

LO3
Understand Types of Abuse

LO3.1: Types of Abuse
• Self-neglect
• Physical
• Emotional
• Sexual
• Domestic
• Financial
• Institutional
• Bullying

Types of Physical Abuse
• Assault, hitting, slapping,
punching, kicking, hair-pulling,
biting, pushing
• Scalding and burning
• Physical punishments
• Inappropriate or unlawful use of
restraint
• Unauthorised restraint,
restricting movement (e.g. tying
someone to a chair)
• Making someone purposefully
uncomfortable (e.g. opening a
window and removing blankets)
• Involuntary isolation or
confinement
• Misuse of medication (e.g. over-
sedation)
• Forcible feeding or withholding
food
• Rough handling

Types of Discriminatory Abuse
Unequal treatment based on age,
disability, gender reassignment,
marriage and civil partnership,
pregnancy and maternity, race,
religion and belief, sex or sexual
orientation (known as ‘protected
characteristics’ under the Equality
Act 2010)
• Harassment or deliberate
exclusion on the grounds of a
protected characteristic
• Denying basic rights to
healthcare, education,
employment and criminal justice
relating to a protected
characteristic
• Substandard service provision
relating to a protected
characteristic

Types of Discriminatory Abuse
• Verbal abuse, derogatory
remarks or inappropriate use of
language related to a protected
characteristic
• Denying access to
communication aids, not
allowing access to an interpreter,
signer or lip-reader
• https://www.scie.org.uk/safegua
rding/adults/introduction/types-
and-indicators-of-abuse

Types of Psychological/Emotional Abuse
• Enforced social isolation –
preventing someone accessing
services, educational and social
opportunities and seeing friends
• Removing mobility or
communication aids or
intentionally leaving someone
unattended when they need
assistance
• Preventing someone from
meeting their religious and
cultural needs
• Preventing the expression of
choice and opinion
• Failure to respect privacy
• Preventing stimulation,
meaningful occupation or
activities

Types of Psychological/Emotional Abuse
• Intimidation, coercion,
harassment, use of threats,
humiliation, bullying, swearing
or verbal abuse
• Addressing a person in a
patronising or infantilising way
• Threats of harm or
abandonment
• Cyber bullying
• https://www.scie.org.uk/safegua
rding/adults/introduction/types-
and-indicators-of-abuse

Types of Financial and Material Abuse
• Preventing a person from
accessing their own money,
benefits or assets
• Employees taking a loan from a
person using the service
• Denying assistance to access
benefits
• Rogue trading – e.g. unnecessary
or overpriced property repairs
and failure to carry out agreed
repairs or poor workmanship
• Undue pressure, duress, threat
or undue influence put on the
person in connection with loans,
wills, property, inheritance or
financial transactions
• Arranging less care than is
needed to save money to
maximise inheritance
• Denying assistance to
manage/monitor financial affairs

Types of Financial and Material Abuse
• Misuse of personal allowance in
a care home
• Misuse of benefits or direct
payments in a family home
• Someone moving into a person’s
home and living rent free
without agreement or under
duress
• Theft of money or possessions
• Fraud, scamming
• False representation, using
another person's bank account,
cards or documents
• Exploitation of a person’s money
or assets, e.g. unauthorised use
of a car
• Misuse of a power of attorney,
deputy, appointeeship or other
legal authority

Types of Organisational/Institutional Abuse
• Discouraging visits or the
involvement of relatives or
friends
• Run-down or overcrowded
establishment
• Authoritarian management or
rigid regimes
• Lack of leadership and
supervision
• Not offering choice or promoting
independence
• Misuse of medication
• Failure to provide care with
dentures, spectacles or hearing
aids
• Not taking account of
individuals’ cultural, religious or
ethnic needs

Types of Organisational/Institutional abuse
• Abusive and disrespectful
attitudes towards people using
the service
• Lack of respect for dignity and
privacy
• Failure to manage residents with
abusive behaviour
• Not providing adequate food
and drink, or assistance with
eating
• Failure to respond to abuse
appropriately
• Interference with personal
correspondence or
communication
• Failure to respond to complaints
• Insufficient staff or high turnover
resulting in poor quality care
• Inappropriate use of restraints

LO3.2: Signs of Abuse
Signs, symptoms, indicators and behaviours which may cause concern:
1. as related to the types of abuse in 3.1.

Signs of Physical Abuse
• History of unexplained falls or minor injuries
especially at different stages of healing
• Unexplained bruising – in well protected
areas, on the soft parts of the body or
clustered as from repeated striking
• Unexplained burns in unusual location or of
an unusual type e.g. burns caused by
cigarettes and rope burns etc.
• Unexplained fractures to any part of the body
that may be at various stages in the healing
process
• Unexplained lacerations or abrasions
• Slap, kick, pinch or finger marks
• Injuries/bruises found at different stages of
healing or such that it is difficult to suggest an
accidental cause
• Injury shape similar to an object
• Untreated medical problems
• History of frequent changing of General
Practitioners or reluctance against General
Practitioner consultation or visit
• Weight loss – due to malnutrition or
dehydration; complaints of hunger
• Appearing to be over medicated
• Accumulation of medicine which has been
prescribed for the client but not administered
• Ulcers, bed sores and being left in wet
clothing.

Signs of Psychological Abuse
• Ambivalence about carer
• Fearfulness expressed in the eyes;
avoids looking at the carer,
flinching on approach
• Deference
• Overtly affectionate behaviour to
alleged perpetrator
• Inability to sleep or tendency to
spend long periods in bed
• Change in appetite – Loss of
appetite or overeating at
inappropriate times
• Unusual weight gain/loss
• Tearfulness
• Unexplained paranoia
• Low self-esteem
• Excessive fears
• Anxiety, confusion or general
resignation
• Agitation
• https://southerntrust.hscni.net/ab
use

LO3.3: Factors Contributing To Abuse
Factors which contribute to an individual being vulnerable to harm or
abuse:
• Age
• Health
• Substance abuse
• Disability
• Isolation
• Social media
• Environment.

Factors Contributing To Individuals Being
Vulnerable To Harm And Abuse
• Pain
• Illness
• Anxiety
• Depression
• Fear
• Needs or expectations unmet
• Poor communication
• Stress/Tired
• Broken promises
• Mental health
• Immaturity
• Insecurity
• Lack of understanding
• Drugs
• Alcohol
• Loss of independence

Factors Contributing To Being Vulnerable To
Harm And Abuse cont.
• Grief
• Loneliness
• Family problems
• Lack of self-esteem
• Unable to express feelings
• Bored -lack of stimulation
• Labelling people as Difficult or Awkward

LO4
Understand action to be taken by the health and social care practitioner
in response to evidence or concerns that an individual is a risk or has
been harmed or abused.

LO4.1: Actions To Take If Harm or Abuse Is
Suspected or Disclosed
• Work within the policies and procedures
• Lines of reporting and responsibilities
• Maintain safety
• Preservation of evidence
• Confidentiality
• Listening, reassurance and non-judgemental

Suspected or Disclosed of Harm and Abuse
It is your responsibility to respond to allegations or suspicions in line
with Active’s safeguarding policy and procedure and whistleblowing
procedure. When abuse or neglect has taken place, it needs to be dealt
with quickly and efficiently. Information about the safety and welfare of
an individual must be shared with your line manager. It is important
that you take matters further if your manager has failed to deal with it.
https://activesocialcare.com/handbook/safeguarding-adults/respond-
to-suspected-or-disclosed-abuse

Dealing With Suspected/Disclosed
Harm or Abuse
In an emergency situation you must take action to protect the safety
and wellbeing of the individual. If they need medical assistance you
should call for a suitably qualified worker, or dial 999 for an ambulance.
If you suspect the injuries are not accidental, staff need to inform their
manager immediately and preserve evidence that could be used in a
criminal case. If an offence has been committed, it may be necessary to
contact the police and a safeguarding investigation may need to be
started immediately.
https://activesocialcare.com/handbook/safeguarding-adults/respond-
to-suspected-or-disclosed-abuse

Recording of Allegation of Suspected
Harm and Abuse
• Listen to what the person says
• Write down the exact words the person used when they disclosed it
to you
• Do not bombard them with questions: listen to what they say. If you
need to ask a question, make sure it’s an open one e.g. what
happened? Closed questions usually have a one word answer such as
Yes or No
• Make sure your record distinguishes between fact and opinion
• Record should be written in permanent ink and not pencil

Dealing With Aggressive Behaviour
If you require assistance, get help immediately. If a client in your care
exhibits aggressive behaviour follow the plan of care for that person
including any policies/procedures pertaining to the situation. Channel
your own emotions and energies into dealing with the situation. As
long as you can do so safely you should calm down someone who is
behaving violently and reach them by using the right words and body
language.

Dealing With Incidents
Immediately after a violent/aggressive incident check that anyone who
was injured or shocked is treated. The staff that dealt with the incident
and the clients involved or affected may not react at the time but a
delayed reaction is common. People may not recognise that a sudden
feeling of despair or panic, which they feel several days later, is related
to an earlier incident

Dealing With Accident and/or Incident
What should happen after an accident/incident to minimise the risk of
reoccurrence:
• Report and record
• Investigate what happened and why
• Evaluate and discuss how things could be improved
• Assess future risks and action plan to reduce future incidents
• Record appropriately and ensure all staff know and if there are any
changes made

LO4.2: The Responsibilities Of The Health And
Social Care Practitioner On Whistleblowing
• Reporting concerns of practice
• Reporting to the external body in response to no action being taken

Responsibility of Health and Social Care
Practitioner on Safeguarding
• Draw attention to unlawful actions taking place within an
organisation.
• Report the misconduct of a worker and/or manager to someone else
within the organisation.
• Encourage and enable workers to report serious cases rather than
disregard them.

Raising Concerns By Healthcare Practitioner
You will be able to justify raising a genuine concern about the safety of
patients or care standards if you do so honestly and reasonably, even if
you are mistaken. You may want to get independent advice first, or
contact your trade union or professional regulatory body. You can get
free, independent and confidential advice from the Whistleblowing
Helpline for NHS and Social Care on 08000 724725. You can also call the
independent whistleblowing charity Public Concern at Work for free
and confidential advice on 020 7404 6609.

Incidents Under Children Act 1989
For any concerns regarding child abuse, discussions and
decisions should be made as soon as possible, and the reasons
for those decisions should be recorded in writing. All information
should be kept confidential and stored securely. It is good
practice to keep concerns and referrals in a separate child
protection file for each child.
Records should include:
• A clear and comprehensive summary of the concern;
• Details of how the concern was followed up and resolved;
• A note of any action taken, decisions reached and the outcome.
• If in doubt about recording requirements, staff should discuss
with the designated safeguarding lead (or deputy).

Responding Under Children Act 1989
Within one working day of a referral being made, a local authority
social worker should acknowledge its receipt to the referrer and make a
decision about the next steps and the type of response that is required.
This will include determining whether the child requires immediate
protection and urgent action is required; any services are required by
the child and family and what type of services

Contacting CQC
Call on: 03000 616161
Email us at: enquiries@cqc.org.uk
Our opening hours are Monday to
Friday: 8.30am - 5:30pm
Tell us online at:
www.cqc.org.uk/GiveFeedback
Write to us at:
CQC National Correspondence
Citygate, Gallowgate
Newcastle upon Tyne
NE1 4PA

Reporting Anonymously or In Confidence
It is best to raise your concern openly with CQC, because that makes it
easier for them to follow it up. CQC will not disclose your identity
without your consent unless there are legal reasons that require them
to do so. This might be, for example, where your information is about a
child or vulnerable adult who is at risk, or where there is a possible
criminal offence. If this is the case, they may have to tell the police or
another official body, or if required to do so by a court.

Whistleblowing Helpline NHS and Social Care
Government-funded helpline operated by Mencap. It providers free,
independent and confidential advice. Open between 8am and 6pm
weekdays, with an answering service on weekends and holidays. Call
08000 724725

CQC Four Steps of Raising Concerns
• If you see an unsafe practice, risk
or wrongdoing, can you tackle it
yourself, there and then? A firm,
polite challenge is sometimes all
that is needed.
• Talk to your line manager about
the problem if possible, or
someone senior in the
organisation.
• If you do not feel able to raise
your concern with your line
manager or other management,
consult your own organisation’s
whistleblowing policy, if there is
one, and follow that.
• If you have tried all these, or you
do not feel able to raise your
concern internally, you can raise
your concern in confidence with
us at CQC.

LO4.3: The Boundaries Of Confidentiality In
Relation To The Safeguarding
Protection and Well-being of Individuals:
• Duty of care
• Consent
• Need to know
• Policy and procedures

Duty of Care For Health and Social care
Duty of care' is a phrase used to describe the obligations implicit in
your role as a health or social care worker. As a health or social care
worker you owe a duty of care to your patients/ service users, your
colleagues, your employer, yourself and the public interest. Everyone
has a duty of care and it is not something that you can opt out of
(Unison, 2013)

Principles of Duty of Care
You must take reasonable care to avoid acts or omissions which you can
reasonably foresee would be likely to injure persons who are so closely
and directly affected by your act that you ought to have them in your
contemplation when you are directing your mind to the acts or
omissions which are called in to question.”
(CSP, 2021)

The Purpose of Duty of Care
Duty of care is defined as a legal duty to provide a reasonable standard
of care to patients and to act in ways to protect their safety. The
purpose of this paper is to assist care providers to:
• Understand the principles of duty of care
• Understand how to meet their own duty of care obligations
• Understand the role of organisations, regulators and others in duty of
care
• Recognise where there may be risks to duty of care
• Appropriately raise concerns relating to duty of care

Consent
Permission for a registrant to provide care, treatment or other services,
given by a service user, or someone acting on their behalf, after
receiving all the information they reasonably need to make that
decision.
(HCPC)

Disclosure of Information
You must only disclose confidential information if:
• You have permission
• The law allows this
• It is in the service user’s best interests
• It is in the public interest, such as if it is necessary to protect public
safety or prevent harm to other people

LO5
Understand the benefits of working in
partnership in relation to safeguarding and
protection

LO5.1
The benefits of working in
partnership in relation to
safeguarding and protection:
• Expertise
• Working together towards
shared goals
• Defined roles and
responsibilities
• Intervention
• Referrals

Working In Partnership
• Individuals (Care Users)
• Advocates
• Friends and family
• Care Workers, colleagues and Managers
• Other professionals (district nurses, GPs, Pharmacists, Nutritionists,
Occupational Therapists, Social workers, etc.)
• Volunteer and community groups

Individuals, Advocates and Family
Advocate is someone who does not have any personal or professional
connections/interests with the paid organisation where you work, who
speaks up on behalf of the person expressing the person’s needs,
wishes and choices and does not impose his/her or other people’s
views or decisions upon the person.
Friends and family – the people who are significant to the person

Care Workers and Care Managers
Your colleagues and Managers – working in teams to cover for each
other and provide consistent round the clock support, working
together to communicate essential information, sharing ideas and
pooling skills and knowledge.
Volunteer and community groups – individuals and groups offering a
voluntary service to help support a person and allow a person to
actively participate in their community.

Other Professionals cont.
Other professionals such as social workers, district nurses and
occupational therapists etc. – working with or alongside professionals
and people from other agencies enables us to provide a joined up
service, maximises services and prevents a duplication of services.

Importance of Partnership Working
• It recognises the strengths and resilience of clients and how these can
be used to address their needs.
• It recognises peoples expertise
• It empowers clients to become actively involved rather than passive
recipients of their care and support
• Clients have rights to be consulted
• It is person- centred

Importance of Partnership Working cont.
• It gives everyone involved ownership and clarifies each persons roles
and responsibilities
• It enables clients to assert their rights
• It is inclusive and has the potential to prevent clients from becoming
marginalised or segregated
• It prevents us from imposing our own views and ways of doing things
for clients, so that we do things with people rather than for them and
thus moves towards equalising the balance of power.

Importance of Partnership Working cont.
• Some partnership working is a legal requirement, e.g. with regard to
aspects of the Mental Capacity Act
• It enable us to understand, respect and value each others
perspectives
• It enables us to make personalised and appropriate responses when
we are meeting peoples needs.

No Secret and User Involvement
No “secrets” contained a number
of references to the involvement
of people who use services. It
includes user groups and user-led
services among the list of
'responsible and relevant
agencies' when it comes to
creating and implementing the
guidance. It also recommended
that:
• the inter-agency framework
must take account of the views
of service users, families and
carer representatives.
• the multi-agency management
committee should audit
(preferably annually) the
working of its policies and
procedures, including evaluation
of community understanding of
them

No Secret and User Involvement
• agencies should learn from
experience by routinely
gathering information on the
outcomes of investigations and
users'/carers' views on how
policy has worked for them.
• inter-agency policy should be
available as a matter of routine,
in an appropriate form to
families and carers and (where
appropriate) to service
users.(18)

Responsibility of Healthcare Practitioner
Health and Social Care Practitioners have moral duty to 'blow the
whistle' to avoid serious harm and abuse to their clients and others.
The care practitioner may be in a situation where things are not done
correctly as it should be; for example where bad practices are being
concealed either by colleagues and/or management. This can impact
on the safety and welfare of care receivers. The care practitioner may
have discussed a dangerous situation that is unlawful with the manager
or the head on a number of occasions and nothing has been done
about it. In this situation, they need to 'blow the whistle' and report
the concerns directly to an external body best suited to deal with the
situation.

Reporting Concerns About Safety
1. You must report any concerns about the safety or well-being of
service users promptly and appropriately.
2. You must support and encourage others to report concerns and not
prevent anyone from raising concerns.
3. You must take appropriate action if you have concerns about the
safety or well-being of children or vulnerable adults.
4. You must make sure that the safety and well-being of service users
always comes before any professional or other loyalties
(HCPC)

Honesty and Trustworthy
Personal and professional behaviour
• You must make sure that your conduct justifies the public’s trust and
confidence in you and your profession.
• You must be honest about your experience, qualifications and skills.
• You must make sure that any promotional activities you are involved
in are accurate and are not likely to mislead.
• You must declare issues that might create conflicts of interest and
make sure that they do not influence your judgement.

The “Reasonable Standard” of Care
The law does not expect “the best care” to be provided, nor does it
permit “the worst care.” A reasonable standard can be described as the
standard expected of an individual according to their skills, job role and
responsibilities. What would be deemed reasonable for an experienced
staff member would therefore, be different to that of a less
experienced practitioner.
https://www.hcpc-uk.org/globalassets/resources/standards/standards-
of-conduct-performance-and-ethics.pdf

Responsibility of Healthcare Practitioner
Health and social care employees working with children are advised to
maintain an attitude of ‘it could happen here’ where safeguarding is
concerned. When concerned about the welfare of a child, staff should
always act in the best interests of the child. If staff have any concerns
about a child’s welfare, they should act on them immediately. If any
healthcare practitioners have a concern, they should follow their own
organisation’s child protection policy and speak to the designated
safeguarding lead (or deputy).

Positive Risk Taking By Care Users
Positive risk taking is an approach which is popular in social care and
mental health services. It allows service users to take decisions about
their own lives, even if those decisions could result in risks or mistakes.
It aims to find a balance between allowing people the choice to take
risks and feel in charge of their own lives – as well as enabling the
health or social care practitioner to help manage or minimise these
risks. Sometimes staff or services can become averse to taking any sort
of risks with people in their care. This can be detrimental to service
users and trap them in dependency, limit their autonomy, or at worse
make them institutionalised. (Unison)

Prevention Interventions
• Supporting adults to safeguard themselves
• Training and education for staff and volunteers
• Awareness-raising
• Providing information and advice
• Advocacy
• Policies and procedures
• Community links
• Legislation and regulation.

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