safety, free from abuse and neglect
those at risk –
nursing homes, care homes,
those risk at abuse or neglect… can be anyone in the community
doesn’t apply to everybody – just those who are unable to PROTECT themselves from abuse or neglect- eg dementia being looked after by relatives
doesn’t apply just to the old – anyone who is vulnerable, could be learning disabilities, ethnicities, specific group (gay people)
eg physical violence, sexual exploitation, emotional, financial, homelessness, drugs trade, trafficingng, forced marriage, slavery, bonded labour, hate crime (race, sexual orientation etc), fraud n theft, trading standards, service neglect, radicalisation, extremism , self neglect
physicical sexual emotional neglect institutional financial discriminatory
The Care Act (2014) –
includes self neglect – where there is no perpetrator.
RASIING A CONCERN
it’s simply raising a concern – not saying something is definitely going on. for exploration.
There is a Systm1 template.
Contacting Adult Protection Services below is for non-urgent (i.e. not today but sometime this week).
MARAC form for high risk Domestic Violence or risk of murder.
You don’t need victim consent if the situation is high risk. Are they under duress? THat duress might be subtle e.g pressure from the whole family.
We have to share any information that may lead to a crime – that is what will protect you from sharing information and confidentiality. There are more criticism from homicidal cases about GPs not sharing information than sharing information! So share information if you think the person is at risk in order to protect that individual.
GENERAL RESOURCE PAGE
Autonomy and right to self-determination/Self Advocacy VERSUS Public (and family) expectation – prevention of neglect/abuse. This is a difficult call.
Best interest decision or valid consent given.
Mental Capacity Act – MCA 2005 statutory principles summary
IT IS A CENTRAL ACT!!!! It’s protect people’s rights, (but often used, unfortunately, to force people onto certain pathways!!!). Don’t be one of them. ‘What’s the point in being safe if it merely makes you miserable?’ Lord Justice Mumby (paraphrased)
everyone myust be presumed as having capacity unless established otherwise
right to have support to achieve capacity and make your own decision
right to make what might be seen as eccentric or unwise decisions (people have the right to refuse treatment).
action can be taken in a person’s ‘best interests’ where they lack capacity
the action must be the least restrictive intervention poassible
as a gp you have to help patient’s with
- retain information
- understanding the information
- using that information to weight things up
- ability to express their choice#
The smoker case. I know you say `100 cigs will lead me to cancer but I think the divine light will save me.
They have a statutory right to this. It takes time, energy and commitment.
Eg the patient who has dementia will have varying levels of capacity during the day. You need to pick a time when they are most likely to have capacity eg visiting during daylight hours (when they are more likely to be lucid) with only one other staff present (who they know), and not after just being woken up. Perhaps when they are most settled. And talking to staff to see if they are in the most receptive and expressive state.
dialogue and giving it time is the key to consent. if it’s not terribly urgent – take your time to work thins out.
DEPRIVATION OF LIBERTY (DoL)
DOL = severe restriction by the state (or on behalf of) leading to loss of our freedom and choice.
DOLS = one of the legal processes to pretect us if we need to be deprived of our liberty (to safeguard us from unnecessary or inappropriate DOL).
DOL is DIfferent to DoLS
DOLS came into effect 2009 – part of the MCA
DOLS is what we do to people
DOLS = the legal safeguards we put into protecting someone.
DOLS do not impose restrictions on people
DOLS are bnot a safeguarding tool
DOLS are not an alternative to the MCA
DOLS are not new
A DOL may not be abad thing
A person is deprived of their liberty if they are subject to continuous supervision and control and not free to leave
Free to leave is hypothertical – if they were to try
Restictions of liberty vs Deprivation of liberity
eg smoking in a hospital
Depends on the degree and intensity of control.
Continuous supervision and control and not free to leave. You need authorisation.
eg GPs sedating patients, diabetic we force down a low sugar diet,
Ask nursing or care homes if patients have a DOLS authorisation in place. If not get one., esp if you think you may be doing a DOL.
DOL is for people who lack capacity.
DOLS is a second safety net that’s all. The best interest action may be
1. the least restrictive action eg covert medication for epilepsy rather than holding them down when an attack happens
2. end up being a DOL but is still the right things to do.
Nursing staff wanting sedation to numb the patient so not hitting other patients – get a DOLS assessment in place. Nursing homes and Care homes should know how to initiate one.
Things you should know about Adult Protection – from Seemab.
radicalisaation -eg travel abroad and getting involved in extremism- extremism can be even animal rights, etc.
this is not about race, religion or ethnicity – its about preventing the exploiutation of adults and children susceptible to radicalisation
there is no single profile of a terrorist
prevent is not health staff about spying on terrorists. it aims to support and redirect at risk people before any criminal activity has taken place.
concerned people, campaigners, political activisits does not make them extremisits (or radicalists). If they want to do it through criminal acts (eg violence), then they are!
Children and adults are at risk of becoming involved in violent extremism (the real nasty evil people get others to do the dirty work). THey do it through a form of grooming (befriending, dialogue, building trust – just like in child exploitation etc).
Right wing terrorism
Animal rights extremism
If you have a concern – go by your gut feeliong
Seemab or Matt
to self, to others, perceived risk.
perceieved risk – have you thought about,..,,. what if.. is there anything that frightens you.
dfont forget use s1 safeguarding template
make an alert if 3rd party information received eg neighbour – even if unsubstantiated. it’s not our job to investigated. refer on for the exploration to happen. let the right people do the right job.
you puit in the concern not the informer.
Matt Oconnor head of safeguarding