Safeguarding is the process by which vulnerable members of the community are looked after. Aspen Medical Practice place great importance on the issue of safeguarding.

Safeguarding comprises:

• Child Protection
• Adults at Risk (Vulnerable Adults)
• Information Sharing

Children Protection

Dr Meade is Safeguarding Lead for Children.

Child protection is a part of safeguarding and promoting welfare. This refers to the activity that is undertaken to protect specific children who are suffering, or at risk of suffering significant harm.

Abuse and neglect are forms of maltreatment of a child. An individual may abuse or neglect a child by inflicting harm or failing to act to prevent harm. Neglect or abuse, physically, emotionally or sexually, can have major long-term effects on all aspects of a child’s health, development and wellbeing. Sustained abuse is likely to have a deep impact on the child’s self-image and self-esteem, and on his or her future life.

What our staff do if child abuse is suspected:
‘To do nothing is not an option’ – You must always tell someone if you come across or suspect an individual is at risk or is being abused.

Anyone who works, or has contact, with children has a duty to report actual or suspected abuse. This includes family, paid or unpaid carers, social workers and health workers, volunteers, managers and staff in private and voluntary agencies.

• Be aware and alert to possible abuse.
• If there is clear past or imminent danger to the safety of the child call the police and consider admitting the child to a place of safety, usually a hospital.
• If confident that a referral is needed, please contact Children and Families Helpdesk on 01452 426565 (during office hours), but if you are concerned about the immediate safety of a child please contact the Police on 101 at any time.
• If you are unsure that a referral should be made please contact the helpdesk 01452 426565 to talk through your concerns.
• If concerns are still present make a formal referral to Children and Families Helpdesk on 01452 426565 or via childrenshelpdesk@gloucestershire.gov.uk
• If you have managerial responsibility for a member of staff or a volunteer who has been accused of abusing a child, consult the Human Resource Department of the company or charity.

Adults at Risk

Dr Jarvis is Safeguarding Lead for Vulnerable Adults.

Health care professionals have a privileged access through our role in caring for those individuals who may be vulnerable in society to the risk of abuse. It is our duty to be alert to this possibility and to be proactive in raising concerns, liaising with other professionals involved in the individuals care and if concerns exist, reporting this to the Somerset social services.

It is important to consider if other individuals may be at risk as well as the identified case.

Gloucester Social services have a comprehensive policy on their website www.gloucestershire.gov.uk.

It is important that if a patient is a vulnerable adult this is highlighted in their records so that all who come into contact with them are aware of this situation.

The practice holds a register of vulnerable adults.

Who is a vulnerable adult?

A vulnerable adult is any person who is 18 years and over in need of community care or support services because of:

• Old age
• Mental health issues
• Physical disability
• Hearing, seeing and/or communication disabilities
• Learning disabilities
• Inability to protect themselves against significant harm or being taken advantage of
• Long term illness/condition
• Misuse of substances or alcohol

Types of abuse and what to look for

The following provides information about the different types of adult abuse and what to look for. We should all know about the main signs and symptoms that suggest that some form of abuse may have taken place. However, you should not suggest that a person is being abused because one or more of these signs and symptoms are present without more detailed investigation.
Abuse may be deliberate or be caused by poor standards of care, lack of knowledge, understanding and training. Abuse can happen anywhere. A person may be abused in:

• Their own home, where they live alone, with relatives or with others
• Care homes
• Nursing homes
• Day centres
• Workplaces
• Hospitals
• Prisons
• Other places in the community

Physical Abuse

Typical examples are:

• Slapping, hitting, kicking, spitting, pushing
• Unapproved use of physical restraint or restriction
• Use of force or threat of force
• Harsh manual handling (including inappropriate use of hoists)
• Misuse of medication

Signs and Symptoms

• A history of unexplained falls or minor injuries especially at different stages of healing
• Unexplained bruising in well-protected areas of body such as inside of thighs or upper arms, and so on
• Unexplained bruising or injuries of any sort
• Burn marks of unusual type such as burns caused by cigarettes, carpet burns and rope burns
• History of frequent changing of General Practitioners or the General Practitioner not being able to see the vulnerable person
• Storing of medicine which has been prescribed for the vulnerable adult but not given
• Malnutrition, ulcers, bed sores and being left in wet clothing

Psychological / Mental / Emotional Abuse

Typical examples are:

• Blame, insults, humiliation
• Controlling, intimidation, bullying, harassment
• Being stopped from seeing other people
• Being locked away
• Verbal abuse, swearing, threats, using tone and volume of voice to intimidate, body language
• Denying the right of the person to make their own decisions

How to report suspected abuse of a vulnerable adult

‘To do nothing is not an option’ – You must always tell someone if you come across or suspect an individual is at risk or is being abused.

• Be aware and alert to possible abuse.
• If you are suspicious discuss your concerns with the adult help desk 01452 426868.
• If concerns are still present make a formal referral to Gloucester safeguarding adults team socialcare.enq@gloucestershire.gov.uk
• If you have managerial responsibility for a member of staff or a volunteer who has been accused of abusing a vulnerable adult, consult the Human Resource Department of your company or charity.

Community Autism Drop-ins

Independence Trust are organising drop-in sessions for autistic adults over the age of 18, adults seeking diagnosis or who are on the waiting list for diagnosis and those who self-identify as autistic. They will be held in Gloucester, Cheltenham, Stroud and Coleford. A drop-in for Tewkesbury is coming soon. For most attendees, the drop ins are a social space but there is also an opportunity for healthcare professionals to speak to Independence Trust staff about anything autism related, such as diagnosis, support, sign-posting, etc. The community autism support and advice service currently have one-to-one support available for those with a diagnosis.

There is no need to book.

To register interest in volunteering at any of the sessions, please contact Lauren on 07527 602786 or email: lauren.woods@independencetrust.co.uk

Information Sharing

Why do we need to share information?

Information is shared to:

• Safeguard and promote the welfare of vulnerable adults and children
• Identify patterns of abuse over time
• Make services better
• Improve the quality of the service
• Protect staff

How much information should be shared?

Information should be shared on a ‘need to know’ basis. Only share enough information to achieve the necessary outcome. Where sharing fact and opinion it should be made clear which is which. If a vulnerable adult or child’s family has agreed to information being shared, only this information should be given and no more.

Consent

Informed consent is permission given by the vulnerable adult/child or a person acting in their best interests who understands why particular information needs to be shared, who will use it and how, and what might happen as a result of sharing or not sharing the information.
Consent is permission given by the vulnerable adult or a person acting in their best interests or child’s family to share information about them.

Rules to Sharing Information within an Agency

The welfare of the vulnerable adult/child must be the first consideration in all decision making about information sharing.
Professionals can only work together to safeguard and promote the welfare of vulnerable adults/children if they share relevant information.

• Only share as much information as is needed to make a decision – but share enough to achieve the purpose for which information is being shared
• It is good practice to get consent to share information every time. The exception to this is where a professional has a duty to share the information
• Where someone would be put at risk of serious harm
• A Police investigation into a serious offence would be damaged
• You should make sure people know what is happening to their information and that they have the right to see it if they ask to do so

Sharing Information between Agencies

There is little difference in the rules about sharing information in an agency or with another agency. The person giving consent might think that the information will not be shared with other agencies. It is always good practice, therefore, to tell them.
If someone has asked for something confidential to be kept from others within an agency a decision has to be made about whether it is serious enough for information to be shared with someone else.

Sensitive and Non-Sensitive Information

The Law defines sensitive personal information as information about the person’s:

• Physical or mental health or condition
• Racial or ethnic origins
• Political opinions
• Membership of a trade union
• Religious beliefs
• Sexual life
• Criminal offences

Any other information that identifies a person is non-sensitive information.

If you do not have consent there are different rules for when you can share sensitive and non-sensitive information.

If none of the reasons below for sharing information apply, you must get consent before sharing information.

Rules for Sharing Sensitive Information without Consent

If you are considering sharing sensitive information without consent, make sure that one of the following applies:

• It is necessary to protect someone’s ‘Vital Interests’ and the person to whom the information relates lacks the capacity to consent (see Mental Capacity), OR if they are unreasonably withholding consent OR if consent cannot reasonably be expected to be obtained ‘Vital interests’ generally applies to life and death situations and serious and immediate concerns for someone’s safety.
• It is necessary to perform a legal duty given to an agency under an Act of Parliament, e.g. the prevention of crime, Sectioning under the Mental Health Act.
• It is necessary to establish, exercise or defend legal rights. This includes rights under the Human Rights Act 1998. (This is mainly used by Solicitors when they are preparing a case)
• It is in the ‘Substantial Public Interest’. (This would include, for example, a voluntary or community agency who have information that someone may be at risk of harm) and necessary to prevent or detect an unlawful act and obtaining consent would prejudice those purposes

Rules for Sharing Non-Sensitive Information without Consent

If you are considering sharing non-sensitive information without consent, make sure that one of the following applies:

• The information does not allow the individual to be identified, e.g, in requesting a second opinion/general advice about the availability of services or future actions or sharing statistical information
• The need to protect the person’s ‘Vital Interests’ overrides the need for confidentiality
• It is a requirement of a Court Order which is made available
• It is necessary to help detect or prevent a crime
• It is necessary in order to perform a legal duty given to an agency under an Act of Parliament
• It is necessary to perform a public function undertaken in the public interest, e.g. voluntary or community agency have information that would promote an adult’s welfare

The person should be told before the information is shared, unless:

• This would place someone at risk
• Prejudice a Police investigation
• Lead to unreasonable delay

If one of these applies, let the person know the information has been shared as soon as it is safe and possible to do so.

Protecting staff and other service users

A staff member or another service user might be put at risk if the information is shared between agencies or agencies. In these cases, a risk management strategy and line management support must be in place.

How to share information

Make sure that:

• Information is given to the right person
• The person understands the information is confidential and knows what to do with it
• A record is kept of what has been shared, when and with whom, and why. This should be noted on case records
• Correspondence is marked ‘Private and Confidential for Addressee Only’ or similar
• The addressee is aware that the information is being sent and is asked to tell us when they have received it

The following should be noted if information is asked for over the telephone:

• The name, job title, department and agency of the person making the request
• Reason for the request
• Main switchboard telephone number
• Check whether information can be provided. If in doubt, the person who is asking for the information should be phoned back. Information must only be provided to the person who has asked for it. Record all detail.
• Make sure that the way information is shared respects the dignity of the person, e.g do not share information in a public area.

Information Sharing Checklist

Before sharing personal information ask yourself:

• About your Right to Share the Information
• Do I already have informed consent to share this information?
• Is the information sensitive personal information?
• Do I need consent to share the information?
• Do I have a legal duty or power to share the information?
• Whose consent is needed? Whose information is it?
• Would seeking consent or informing about sharing information place someone at risk, prejudice a Police investigation or lead to unreasonable delay?
• Does the person who is giving consent understand the possible results of sharing the information?
• Would sharing the information without consent cause more harm than not sharing the information?

About the Information You are Sharing

• How much information is it necessary to share in this situation?
• Have I separated out fact and opinion?
• Do I need to check with someone else who told me this information or wrote this report before I share it?

About the Person You Are Sharing Information With and How You Are Sharing It

• Am I giving this information to the right person?
• Am I sharing this information in a safe way?
• Does the person I am giving it to know it is confidential?
• What will they do with it?

After sharing information ask yourself:

• Does the person know that the information has been shared? (Where this would not place someone at risk or prejudice a Police investigation)
• Have I recorded what has been shared with whom and why on case records?