1. Introduction – What is Culturally Competent Practice

To practice in a way which is culturally competent (also called ‘culturally appropriate’ practice), staff and services need to understand and be respectful of the beliefs, practices and cultures of diverse communities. This is very important when working with people whose cultures do not reflect those of mainstream services.

Cultural identity covers many different things. For example, it might be based on a person’s ethnicity, country of birth or religion, or it might be about their sexuality or gender identity. Lesbian, gay, bisexual and transgender people have their own cultures, as do Deaf people who use British Sign Language. Cultural identity is an important part of a person’s wellbeing.

Practitioners need to be able to recognise, and respond to, issues linked to the cultural identity of people they are working with. A failure to do this can mean that opportunities to identify issues which are important to the person or understand why they are acting in a certain way are lost. The importance of this approach has been highlighted by Safeguarding Adults Reviews (SARs) nationally.

2. Why is Culturally Competent Practice Important?

Actions taken in response to safeguarding adults’ concerns (including referrals, safeguarding enquiries, assessments and safeguarding plans) must always take account of issues relating to cultural identity within the lives of the adult and their family.

When adults are treated in a way which is sensitive to their cultural identity, they are more likely to engage well with staff and services and achieve better outcomes, which will keep them, their families and communities safer.

When adults are not supported in a way which recognises their cultural identity, they can:

• feel marginalised and discriminated against;
• suffer low self-esteem and low self-confidence;
• miss out on opportunities to stay safe;
• have their actions misunderstood;
• feel stressed and anxious; and
• experience a loss of rights.

3. Cultural Competence and Safeguarding

Understanding and communicating well with people from different cultures is an important part of providing person-centred care, including safeguarding adults (see Making Safeguarding Personal chapter). Everyone is part of one or more cultures  and people can identify with more than one culture.

As also noted in Section 2, people are more likely to have their needs identified, receive appropriate support and experience positive outcomes (including being protected from harm) if their culture is recognised and taken into account by practitioners.

A person’s cultural identity can sometimes make it hard for them to ask for help from services or to protect themselves. This can be because they:

• are worried they will not be believed;
• do not know how to ask for help;
• are worried about possible repercussions for them and / or their family;
• have a lack of trust in statutory services or people in positions of authority;
• fail to realise that their experience amounts to abuse or neglect.

Also, if practitioners do not directly ask the adult about possible abuse and neglect it can mean they do not have the opportunity to ask for help.

Factors linked to culture can also increase or reduce the level of risk the adult is likely to experience. A failure to consider this can lead to an inaccurate assessment of risk, and safeguarding issues may not be recognised.

Issues of culture and faith can never be used to justify behaviour which constitutes the abuse of an adult or child (see for example the chapters on Honour Based Abuse, Female Genital Mutilation (FGM) and Forced Marriage).

4. Role of Practitioners

In providing culturally appropriate care, practitioners should have a respectful and sensitive approach which aims to understand how culture can affect different aspects of people’s lives, including the way they feel, behave and are responded to by other people and organisations.

Practitioners do not need to share the same cultural values as the adult to be able to practice in a culturally competent way, nor do they need to be experts on different cultures. However, they do need to be aware of their own cultural values and how these might sometimes be different from the people they are supporting and how that might impact on the adult and their family. This will help them understand people better and provide a more appropriate response.

It is important that practitioners do not make assumptions that all adults from the same ethnic background or same religion will share the same cultural identity or values.

Practitioners should also think about how their actions – and those of the organisation they work for – could affect people from different cultures, including making it harder for them to seek help or engage with support.

When assessing if someone lacks mental capacity or giving information to support someone to make a decision, you should also take cultural factors into account. Using the Mental Capacity Act to make a ‘best interests’ decision must include considering the person’s beliefs and values.

5. Providing Culturally Appropriate Care – Practice Guidance

Often, small changes make a big difference to people. The most important things which practitioners can do include:

• listening to the adult, spend time getting to know them and their families (where appropriate), ask questions about their lives and beliefs;
• asking about what is important to the person, and what being safe means to them;
• trying to understand and meet people’s preferences, and remember that the adult is the expert in their own life;
• do not make assumptions, be aware of your own cultural values and beliefs and how that may impact on the adult and their family;
• look at the adult’s life and experiences as a whole, including their cultural needs, and protect them from discrimination.

Remember that some people may be put off reporting abuse or neglect or engaging with services because of concerns about their cultural differences. It is also important to remember factors which can make it hard for some adults to keep themselves safe or ask for help: These include:

• not being able to read or write;
• not being able to hear;
• not speaking English as a first language;
• fear of authority;
• limited social networks;
• poor quality / temporary housing / frequent house moves which means their access to services is disrupted;
• poverty;
• living in a closed or close-knit community – which can make adults worry about bringing shame on their family.

1. Introduction

Adults who use care and support services, and those of partner agencies, are at the centre of the personalisation agenda and the Care Act 2014. Feedback from adults and carers about their service experience and outcomes – that were either achieved or not achieved – are vital to providing effective and appropriate services.

2. Co-production

Co-production is a way of working whereby everybody – adults who use services, carers and staff – works together on an equal basis to create a service or come to a decision which works for them all.

However, the definition of co-production does change in different settings (see What is Co-production? TLAP).

The Care Act states:

Co-production is when you as an individual influence the support and services you receive, or when groups of people get together to influence the way that services are designed, commissioned and delivered.

The TLAP National Co-production Advisory Group says:

Co-production is not just a word, it is not just a concept, it is a meeting of minds coming together to find shared solutions. In practice, co-production involves people who use services being consulted, included and working together from the start to the end of any project that affects them. When co-production works best, people who use services and carers are valued by organisations as equal partners, can share power and have influence over decisions made.

The New Economics Foundation notes six main aspects of co-production:

Recognising people as assets: People are seen as equal partners in designing and delivering services, rather than as passive beneficiaries or burdens on the system.

Building on people’s capabilities:Everyone recognizes that each person has abilities and people are supported to develop these. People are supported to use what they are able to do to benefit their community themselves and other people.

Developing two-way reciprocal relationships: All co-production involves some mutuality, both between individuals, carers and public service professionals and between the individuals who are involved.

Encouraging peer support networks: Peer and personal networks are often not valued enough and not supported. Co-production builds these networks alongside support from professionals.

Blurring boundaries between delivering and receiving services:The usual line between those people who design and deliver services and those who use them is blurred with more people involved in getting things done.

Facilitating not delivering to:Public sector organisations (like the government, local councils and health authorities) enable things to happen, rather than provide services themselves. An example of this is when a council supports people who use services to develop a peer support network.

3. Involving Adults who use Services

Adults who use services should be involved at each level of development, delivery, and review of care and support services in order to:

• ensure that services are developed to meet the care and support needs of adults;
• ensure that the services which are provided are of good quality;
• ensure positive outcomes for those who use the service.

Service commissioners should ensure that adults who use services can:

• have their views considered in the development of new strategies and services;
• contribute to the review and performance management of existing strategies and services;
• receive information on planning and delivering of new services in an accessible and jargon-free format;
• contribute to meetings and decision making where practicable. This may include practical support (for example, reimbursement of expenses; considering the time and venue for meetings) and other assistance (for example help to deal with jargon – see TLAP Care and Support Jargon Buster, stress, power imbalances);
• access appropriate training and mentoring support to enable them to contribute to planning arenas.

Social workers and service providers should ensure adults:

• have easy access to a charter on their rights and responsibilities within the service;
• have easy access to clear information on all the services available (see Information and Advice chapter);
• have access to information on their care and support options (see Care and Support Planning chapter);
• are fully involved in the assessment process and development and review of their individual care plan and have their needs, wishes and goals incorporated into their plan;
• receive information on how to make comments, complaints and compliments about the service they receive;
• contribute to the evaluation of the service.

User led organisations (ULOs) are one approach to facilitating user involvement as referenced in the Care and Support Statutory Guidance. ULOs are organisations that are run by and controlled by people who use care and support services, including disabled people of any impairment, older people, and families and carers. See also A Commissioner’s Guide to Developing and Sustaining Local User-Led Organisations (SCIE).

1. Introduction

Staff across all organisations must treat adults with care and support needs, and their carers, friends and family with dignity, compassion and respect at all times and in all circumstance.

Staff must adopt a culture of care that respects the privacy, dignity, culture and individuality of all patients under its care and staff (see also Equality, Diversity and Human Rights in a Safeguarding Context).

2. Principles

All staff must:

• recognise the diversity, values and human rights of adults;
• uphold and maintain their privacy, dignity and independence;
• provide care, support and treatment in a way that ensures their dignity, and treats them with compassion and respect at all times;
• ensure that they have privacy when they want it, treating them as equals;
• provide any support they might need to be autonomous, independent and involved in their community;
• help adults maintain relationships that are important to them
• put adults at the centre of their care and support by enabling them to make decisions (see Making Safeguarding Personal chapter);
• all communication with adults and their families must be respectful and compassionate. This includes using or facilitating the most suitable means of communication and respecting their right to engage or not to engage in communication;
• provide information that supports them in the safeguarding process, or others acting on their behalf, to make decisions;
• support adults, or others acting on their behalf, to understand the care and support provided, including risk and benefits and their rights to make decisions;
• staff must make sure that they provide appropriate care and support that meets people’s needs, but this does not mean that care and support should be given if it would be against the consent of the person (see the chapters on Consent in Relation to Safeguarding and Mental Capacity);
• address them in the way they prefer, including their favoured name;
• have regard for the protected characteristics as defined in the Equality Act 2010, that is: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation (see also Equality, Diversity and Human Rights in a Safeguarding Context).

3. Personalised Care and Support through Involvement

Adults should be involved in and receive care and support that respects their right to make or influence decisions. Staff should:

• explain and discuss their care and support options with them in a way that makes sense to them;
• respect their right to take informed risks, while balancing the need for preference and choice with safety and effectiveness (see Managing Risk);
• ensure that things that are important to the adult in relation to their care and support are established as part of their assessment, development and review of their plans;
• promote and respect their autonomy, privacy, dignity, compassion, independence and human rights at all times by:
  • placing their needs, wishes, preferences and decisions at the centre of assessment, planning and delivery of care and support;
    • respect their personal preferences, lifestyle and care choices;
    • when providing intimate or personal care, the organisation must make every reasonable effort to make sure that they respect the preferences of individuals in relation to who delivers their care and treatment, such as requesting staff of a specified gender;
  • have clear procedures followed in practice, monitored and reviewed that ensure staff understand the concepts of privacy, dignity, independence and human rights and how they should be applied;
  • ensuring that the need to maintain confidentiality or disclose information is taken account in the assessment of the individual circumstances (see South Tyneside Multi Agency Information Sharing Agreement);
  • actively listening to and involving adults, or others acting on their behalf, in decision making and ensuring there are clear records that evidence the decisions made and methods in which the decision was achieved;
  • provide information to help them, or others acting on their behalf, to understand their care and support, including the risks and benefits, and their rights to make decisions;
  • make adults aware of independent advocacy services wherever they are available, and cooperate with independent advocacy services (see Independent Advocacy);
  • know how to raise a concern or complaint about the organisation, and how it will be dealt with (see Whistleblowing).

4. Managing Risk through Effective Procedures about Involvement

Procedures must ensure that:

• care and support options, and the risks and benefits of those options, are explained to the adult / their representative;
• choices and preference of the adult are expressed by them or others acting on their behalf;
• the choices of adults are respected and accommodated unless:
  • the choice places other people at risk of harm or injury;
  • it would not be reasonable to expect the service to have the resources needed to achieve the choice;
  • if to meet choice is not within the stated aims, objectives and purpose of the service provided;
  • the adult does not have capacity to make that decision or is subject to a legal restriction that prohibits them making a choice (see Mental Capacity and Consent in Relation to Safeguarding);
• individualised assessments and plans of care and support are based on the adult’s needs, choices and preferences;
• any reasonable adjustments are made so that the adult is enabled to be involved in decision making.

1. Introduction

This chapter outlines the main issues and relevant legislation in relation to equality, diversity and human rights which should be applied when implementing safeguarding adults procedures and processes, as well as all other aspects of providing services to adults with care and support needs.

2. Equality Act 2010

The Equality Act 2010 ensures there is consistency in what an organisation does to provide services in a fair environment and comply with the law. This includes all the people who use its services, their family and friends and other members of the public, staff, volunteers and partner agency staff (see also 5.2, Protected characteristics).

The Equality Act references ‘protected characteristics’: all of which must be considered when implementing safeguarding procedures. These are

• age;
• disability;
• gender reassignment;
• race;
• religion or belief;
• sex;
• sexual orientation;
• marriage and civil partnership;
• pregnancy and maternity.

See Section 5.2, Protected characteristics for more information.

An organisation’s commitment to equality and diversity means that every person supported by it has their individual needs comprehensively addressed. They will be treated equally and without discrimination. This is regardless of any protected characteristics or another aspect that could result in them being discriminated against. The organisation is also committed to protecting individuals’ human rights. Failure to make reasonable adjustments in the care of a certain group with a protected characteristic (for example, a learning disability) may violate the Equality Act. Public bodies should have a process by which they consider how to promote equality.

3. Commitment to Equality, Diversity and Human Rights

The organisation should express its commitment to equality and diversity by:

• respecting the ethnic, cultural and religious practices of people who use the service and making practical provision for them to be observed as appropriate;
• reassuring people who use the service that their diverse backgrounds enhance the quality of experience of everyone who lives and works in any service provided by it;
• protecting people’s human rights – treating them and their family and friends, fairly and with respect and dignity;
• accepting adults who use the service as individuals;
• supporting people to express their individuality and to follow their preferred lifestyle, also helping them to celebrate events, anniversaries or festivals which are important to them;
• showing positive leadership and having management and human resources practices that actively demonstrate a commitment to the principles of equality and diversity;
• developing an ethos throughout its service that reflects these values and principles;
• expecting all staff to work to equality and diversity principles and policies and to behave at all times in non-discriminatory ways;
• provide training, supervision and support to enable staff to do this;
• having a code of conduct that makes any form of discriminatory behaviour unacceptable. This applies to both staff, people who use services and their family and friends, which is rigorously observed and monitored accordingly.

4. Care Quality Commission and Human Rights

‘Respecting diversity, promoting equality and ensuring human rights will help to ensure that everyone using health and social care services receives safe and good quality care.’ (Care Quality Commission)

The Care Quality Commission employs the commonly agreed ‘human rights principles’ in their inspection frameworks. These are sometimes called the FREDA principles:

• fairness;
• respect;
• equality;
• dignity; and
• autonomy (choice and control).

These principles and standards should be at the heart of safeguarding process and in the planning and delivery of care to adults with care and support needs and their family and friends. The organisation should also encourage and support its staff to develop knowledge and skills and, where relevant, provide organisational leadership and commitment to achieve human rights based approaches.

The organisation should encourage positive practice and a learning culture that promotes human rights. Staff must take swift action if they think someone’s human right are being breached (see Responding to Signs of Abuse and Neglect chapter).

5. Guidance

5.1 Types of discrimination

All staff involved in the safeguarding process should be familiar with the following types of discrimination.

• Direct discrimination occurs when a person is treated less favourably than others in similar circumstances on the grounds of race, colour, national or ethnic origins, sex, marital status, sexuality, disability, membership or non-membership of trade union, ‘spent convictions’ of ex-offenders, class, age, political or religious belief.
• Discrimination by association applies to race, religion or belief, sexual orientation, age, disability, gender reassignment and sex. This is direct discrimination against someone because they associate with another person who possesses a protected characteristic (see Section 5.2, Protected characteristics below).
• Perception discrimination is against an individual because others think they possess a particular protected characteristic. It applies even if the person does not actually possess that characteristic.
• Indirect discrimination occurs when a condition or requirement is imposed which adversely affects one particular group considerably more than another.
• Harassment is defined as unwanted, unreciprocated and / or uninvited comments, looks, actions, suggestions or physical contact that is found objectionable and offensive. Harassment is particularly liable to occur as part of sexual or racial discrimination.
• Victimisation occurs when an employee is treated badly because they have made or supported a complaint or raised a grievance under the Equality Act, or because they are suspected of doing so. People are not protected from victimisation if they have maliciously made or supported an untrue complaint.

5.2 Protected characteristics

Under the Equality Act 2010 these are as follows.

• Age: Where this is referred to, it refers to a person belonging to a particular age (for example 32 year olds) or range of ages (for example 18 – 30 year olds).
• Disability: A person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities. The Act includes a protection from discrimination arising from disability. This states it is discrimination to treat a disabled person unfavourably because of something connected with their disability. The Equality Act places a duty on public bodies to promote equality of opportunity between disabled people and others. There is a duty to make reasonable adjustments for disabled people relating to the provisions of services and “encourage persons who share a relevant protected characteristic to participate in public life”.
• Gender reassignment: A transgender person is someone who proposes to, starts or has completed a process to change their gender. The Act does not require a person to be under medical supervision to be protected – so a woman who decides to live as a man but does not undergo any medical procedures would be covered. It is discrimination to treat transgender people less favourably because they propose to undergo, are undergoing or have undergone gender reassignment than they would be treated if they were ill or injured.
• Marriage and civil partnership: In England and Wales marriage is not restricted to a union between a man and a woman and includes a marriage between a same-sex couple. Same-sex couples and mixed-sex couples can also have their relationships legally recognised as ‘civil partnerships’. Civil partners must not be treated less favourably than married couples (except where permitted by the Act). The Act protects employees who are married or in a civil partnership against discrimination.
• Pregnancy and maternity: Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth. Protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.
• Race: Race refers to a group of people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.
• Religion or belief: Religion has the meaning usually given to it but belief includes religious and philosophical beliefs including lack of belief (for example atheism). Generally, a belief should affect life choices or the way a person lives for it to be included in the definition. In the Equality Act, religion includes any religion. It also includes a lack of religion.
• Sex: Both men and women are protected under the Act.
• Sexual orientation: Whether a person’s sexual attraction is towards their own sex, the opposite sex or to both sexes. The Act protects bisexual, gay, heterosexual and lesbian people.

6. Human Rights Act 1998

See also Equality and Human Rights Commission

The Human Rights Act 1998 (HRA) lays down the fundamental rights and freedoms to which everyone in the UK is entitled. The rights set out in the European Convention on Human Rights (ECHR) are incorporated in the HRA. It sets out people’s human rights in different ‘articles’, which are all taken from the ECHR. They are:

• Article 2: Right to life;
• Article 3: Freedom from torture and inhuman or degrading treatment;
• Article 4: Freedom from slavery and forced labour;
• Article 5: Right to liberty and security;
• Article 6: Right to a fair trial;
• Article 7: No punishment without law;
• Article 8: Respect for private and family life, home and correspondence;
• Article 9: Freedom of thought, belief and religion;
• Article 10: Freedom of expression;
• Article 11: Freedom of assembly and association;
• Article 12: Right to marry and start a family;
• Article 14: Protection from discrimination in respect of these rights and freedoms;
• Protocol 1, Article 1: Right to peaceful enjoyment of property;
• Protocol 1, Article 2: Right to education;
• Protocol 1, Article 3: Right to participate in free elections;
• Protocol 13, Article 1: Abolition of the death penalty.

Human rights law applies to public bodies and other organisations carrying out functions of a public nature. A number of these articles relate to working with adults with care and support needs, in particular Articles 2;3;5;8.

The HRA can be breached in three ways by public bodies if they:

• inflict explicit physical abuse or allow neglect of a person;
• intervene in a person’s life unlawfully and disproportionately;
• fail to intervene to protect a person from being abused or neglected by other persons.

6.1 Articles 2, 3, 5 and 8

6.1.1 Article 2 Right to Life

Article 2 applies in health and social care situations and requires an independent investigation into some deaths – coroner inquests – and may involve a breach of human rights with the state or public organisations implicated.

6.2 Article 3 Inhuman and Degrading Treatment

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

Degrading treatment would occur if it “humiliates or debases an individual showing a lack of respect for or diminishing his or her human dignity or arouses feelings of fear, anguish, or inferiority capable of breaking and individuals moral and physical resistance.” Pretty v UK [2002] 2FC 97

Article 3 is breached most frequently when public bodies carry out or are responsible for abusive care and treatment; that is allowing or ignoring actions when they should not have done so.

There is a positive duty under Article 3 for a public body to intervene when abuse is performed by one private individual against another person.

6.3 Article 5: Deprivation of Liberty

People who lack mental capacity are one of the categories when people can be deprived of their liberty (see Mental Capacity chapter and Deprivation of Liberty Safeguards chapter). Legal procedures are set out in the Mental Capacity Act 2005 (MCA) and the Mental Health Act 1983 and should be followed. If they are not adhered to, it may lead to a breach of Article 5.

A deprivation of liberty under the MCA describes a best interest decision made in regard to a person who lacks mental capacity to decide about care, treatment or living arrangements. Such deprivations must be legally authorised under the provisions of the MCA (sections 4A-4B) or by order of the Court of Protection.

6.4 Article 8: Respect for private and family life, home and correspondence

Article 8 protects a person’s right to respect for their private life, their family life, their home and correspondence (for example, letters, telephone calls and emails).

6.4.1 Private life

A person has the right to live their life privately without government interference. This is a broad concept as interpreted by the courts, and covers areas such as:

• sexual orientation;
• lifestyle choices;
• how someone chooses to look and dress;
• the right for someone to control who sees and touches their body. In health services, for example, staff cannot leave someone undressed in a ward, or take a blood sample without the person’s permission;
• the right to develop a personal identity;
• to make friendships and other relationships;
• a right to participate in essential economic, social, cultural and leisure activities. In some circumstances, public bodies, such as the local authority, may need to help someone enjoy their ability to participate in society;
• the media and others being prevented from interfering in someone’s life.
• personal information (including official records, photographs, letters, diaries and medical records) being kept securely and not shared without the person’s permission, except in certain circumstances (see Data Protection chapter).

6.4.2 Family life

People have the right to enjoy family relationships without interference from government. This includes the right to live with their family and, where this is not possible, the right to have regular contact. This includes couples who are not married, between an adopted child and adoptive parent and a foster carer and foster child.

If a local authority makes an unjustified intervention in the life of person lacking mental capacity it may also breach Article 8: London Borough of Hillingdon v Neary [2011] EWHC 1377 (COP).

6.4.3 Home life

Everyone has a right to enjoy their existing home peacefully. Public bodies, therefore, should not stop a person from entering or living in their home without very good reason. They also cannot enter it without the person’s permission.

A right to home life does not mean, however, a right to be given housing.

6.4.4 Restrictions to Article 8

There are times when public bodies can interfere with someone’s right to respect for private and family life, home and correspondence. In such situations, the authority must be able to show that such action is lawful, necessary and proportionate in order to:

• protect national security;
• protect public safety;
• protect the economy;
• protect health or morals;
• prevent disorder or crime; or
• protect the rights and freedoms of other people.

Article 8 is not an absolute right. Interference with private life and family life is legally permissible but must be justified within the terms set out above.

A breach of Article 8 would occur if interventions are taken which are:

• inconsistent with the relevant law;
• consistent with the law but disproportionate and therefore unnecessary; or
• for a purpose other than the criteria listed above.

6.5 Article 10 Freedom of Expression

Article 10 is the freedom to hold opinions and to receive and impart information and ideas without inference from the State. This right is not absolute but subject to several provisos. Restrictions can only be justified if they are for a specific purpose, for example:

• public safety;
• the prevention of disorder or crime;
• the protection of health and morals;
• the protection of the reputation or rights of others;
• preventing the disclosure of confidential information.

The Care Act guidance warns local authorities against “abusive interventions that risk breaching the adult’s right to family life if not justified or proportionate“ Care and Support Statutory Guidance (Department of Health and Social Care).

1. Introduction

Making Safeguarding Personal (MSP) is a person-centred and outcome focused approach to safeguarding adults. It emphasises that the adult concerned must always be at the centre of adult safeguarding, and that their wishes and views should be sought at the earliest opportunity. MSP requires professionals to see adults as experts in their own lives and to work with them in order to identify strengths-based and outcomes focused solutions. Professionals must work in a way that enhances individual involvement, choice and control as part of improving quality of life, wellbeing and safety.

MSP seeks to achieve:

• a personalised approach that enables safeguarding to be done with, not to, people;
• practice that focuses on achieving meaningful improvement to people’s circumstances (outcomes) rather than just the process of ‘investigation’ and reaching a ‘conclusion’;
• an approach that utilises social work skills rather than just ‘putting people through a process’, with the ultimate aim of improving outcomes for people at risk of harm.

MSP is led by the Local Government Association (LGA) Safeguarding Adults Programme and by Association of Directors of Adult Social Services (ADASS).

The Care and Support Statutory Guidance also states:

‘…it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised …. Making safeguarding personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Nevertheless, there are key issues that local authorities and their partners should consider. (para 14.14-14.15)

2. Key Areas for Effective Practice

MSP can be divided into a number of key areas:

• person led and person centred:  being safe and well means different things to different people, this means the safeguarding process should be person-led and recognise people as the experts in their own lives. It should engage the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Professionals should be interested, and look for the full picture of a person’s experience.
• focused on outcomes, not process: safeguarding is not about undertaking a process but is a commitment to improve outcomes by working alongside people experiencing abuse or neglect. The key focus is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them (and their representatives or advocates if they lack capacity) how best those outcomes might be realised and then seeing, at the end, the extent to which desired outcomes have been realised. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding investigation, support planning and response.

3. Safeguarding Outcomes

A high quality service keeps people safe from harm. The Adult Social Care Outcomes Framework (ASCOF) reflects this priority, and emphasises the need for services to safeguard adults whose circumstances make them vulnerable and protect them from avoidable harm. Findings from this work have highlighted the clear benefits of asking adults about their experiences of support services.

1. Introduction

Prevention is a key principle of adult safeguarding:

‘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” Care and Support Statutory Guidance: 14.13)

Agencies must emphasise to all their staff the need for preventing abuse and neglect, wherever possible.

Observant professionals and other staff making early, positive interventions with individuals and families can make a huge difference to the lives of adults who are experiencing or at risk of abuse or neglect, which may prevent the deterioration of a situation or breakdown of a support network.

Agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adult procedures.

2. What does Prevention mean?

Effective prevention 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.

3. Prevention Interventions

Key to the successful prevention of abuse is an open culture with a genuinely person-centred approach to care underpinned by a zero tolerance policy towards abuse and neglect.

Some of the most common prevention interventions include:

• 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.

3.1 Supporting adults to safeguard themselves

One of the most effective ways to safeguard adults who may be vulnerable to abuse or neglect is to enable them to safeguard themselves. Empowerment and choice need to be at the core of adult safeguarding and practice, working with and supporting adults to recognise and protect themselves from abuse. It also means taking a risk-enabling approach within services and ensuring that people who use services have genuine choice.

If people are to protect themselves from abuse, staff need to support them to:

• be aware of what abuse is;
• be aware of who might potentially exploit or harm them;
• be informed about their rights and have the skills and resources to be able to deal with it;
• have the information, knowledge and confidence to take action;
• be supported to be aware of how they can reduce the risks of being harmed or exploited (for example, avoiding potentially risky situations).

3.2 Training and education

See also Safeguarding Training for Staff and Volunteers

Some of the most common prevention interventions are training and education for staff and volunteers.

South Tyneside Safeguarding Adults Board should ensure that relevant partners provide training for staff and volunteers on the policy, procedures and professional practices that are in place locally, which reflects their roles and responsibilities in safeguarding adult arrangements.

Training should take place at all levels in an organisation and be updated regularly to reflect best practice. To ensure that practice is consistent, no staff group should be excluded.

3.3. Awareness raising

The public has a vital role in safeguarding adults through the prevention and recognition of abuse.  It is the responsibility of all agencies and organisations to ensure that there is a good level of public awareness of adult abuse and how concerns should be reported.

Public awareness campaigns can make a significant contribution to the prevention of abuse. They are more effective if backed up by information and advice about where to get help and training for staff and services to respond.

3.4. Information and advice

See also Information and Advice

Accessible information and advice are essential building blocks for prevention of abuse and for backing up public awareness campaigns. Information should be made available in a range of media and produced in different, user friendly formats for people with care and support needs and their carers.

Under the Care Act 2014, the local authority must provide information and advice to:

• the public about how to raise concerns about the safety or wellbeing of an adult who has care and support needs;
• support public knowledge and awareness of different types of abuse and neglect;
• cover how to keep oneself physically, sexually, financially and emotionally safe;
• support people to keep safe;
• cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised;
• provide information about the Safeguarding Adults Board.

3.5 Advocacy

See also Independent Advocacy

Advocacy can make a significant contribution to prevention of abuse through enabling adults at risk to become more aware of their rights and able to express their concerns.

Advocacy services may be preventative as they can enable adults at risk to express themselves in potential or actual abusive situations. Equally, their presence in enabling people to express themselves in other situations (for example when their needs are being assessed or at times of transition from children’s to adult services) may contribute to building confidence more generally and hence be preventative.

3.6 Policies, procedures and processes

Having robust, effective adult safeguarding procedures in place which are well-advertised and accessible and which all staff are trained in, is key to preventing abuse and neglect. There are, however, particular policies and procedures that can support the prevention of adult abuse. These include:

• whistleblowing (see Whistleblowing);
• complaints (see Complaints or Appeals in Relation to the Safeguarding Adults Process);
• risk management / assessments;
• promoting positive practice;
• recruitment and retention processes (see Safer Recruitment and Employment);
• disclosure and barring (see Disclosure and Barring);
• staff development, supervision and support (see Supervision);
• information-sharing protocols (see South Tyneside Multi Agency Information Sharing Agreement);
• effective recording (see Case Recording);
• codes of conduct;
• relevant standards for service (for example, Fundamental Standards, Care Quality Commission).

Effective planning in the context of person-centred care is a core element of good quality care and support, in conjunction with conducting a risk assessment. Effective care and support planning should consider any potential risks of abuse. Staff should understand the role of the care and support plan as being one facet in a strategy aimed at preventing abuse or neglect.

3.7 Community links

Both services and individuals benefit from having contact with a range of people in the community. Adults may be more vulnerable to abuse or neglect if they are isolated and cut off from families and friends. Reducing isolation through links with the community can mean there are more people who can be aware of the possibility of abuse, as well as providing links to potential sources of support for adults and their carers.

It is particularly important that carers are informed about existing services and sources of support in order to support their caring role and reduce stress, thus reducing the risk of abuse. See also Carers chapter.

3.8 Regulation and legislation

Regulation and legislation both can play a role in the prevention of abuse.

The Care Act 2014 introduced new duties and requirements of local authorities in a number of areas, including safeguarding adults.  It provides, for the first time, a legislative framework for those working in adult safeguarding.

Regulators have a key role to play in safeguarding – they can raise concerns about abusive practice and identify gaps in how standards are applied or interpreted, particularly in relation to workforce training, qualifications and skills and the effect of standards on safeguarding practice. See Care Quality Commission.

4. South Tyneside Safeguarding Adults Board and Safeguarding Children Partnership

See also Integration, Cooperation and Partnerships

Strategies for the prevention of abuse and neglect are a core responsibility of the South Tyneside Safeguarding Adults Board (SAB) and Safeguarding Children Partnership.

To prevent the abuse and neglect of adults, the SAB could involve commissioners and the Care Quality Commission to address poor quality care and to respond to intelligence that indicates the care and support services provided may be deteriorating. SABs can also involve local communities, by addressing hate crime or anti-social behaviour in a particular neighbourhood, and raising awareness of abuse and neglect so that members of the public can recognise abuse and know how to share their concerns.

1. Introduction

Safeguarding adults is the term used to describe all work to help adults with care and support needs to live in safety, free from abuse and neglect.

Safeguarding requires people and organisations to work together to prevent both the risk of and the experience of abuse or neglect. At the same time, the adult’s wellbeing must be promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs when deciding on any action.  This must recognise that adults are the experts in their own lives and that they sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Organisations should always promote the adult’s wellbeing in their safeguarding arrangements. People have complex lives, and being safe means different things to different people, as well as being just one aspect of what they want to achieve. 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 wellbeing (see Promoting Wellbeing chapter).

2. The Safeguarding Duty

Under section 42 of the Care Act 2014, local authorities have legal adult safeguarding duties which are to:

• make enquiries, or cause others to do so, when a concern has been raised about an adult in its area (whether or not they are ordinarily resident in it) to establish whether an action should be taken to prevent or stop abuse or neglect.
• This duty applies to an adult who:
  • has needs for care and support (whether or not the local authority is meeting any of those needs); and
  • is experiencing, or at risk of, abuse or neglect; and
  • 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.

Regardless of whether the local authority is providing any services to the adult, it must follow up any concerns about either actual or suspected abuse or neglect.

The adult experiencing, or at risk of abuse or neglect will be referred to as the ‘adult’ throughout this APPP, replacing previous terms of adult at risk or vulnerable adult.

Local authority statutory adult safeguarding duties apply equally to adults with care and support needs:

• regardless of whether those needs are being met;
• regardless of whether the adult lacks mental capacity or not (see Mental Capacity chapter);
• regardless of setting, except prisons and approved premises.

Within the scope of this definition are:

• all adults who meet the above criteria regardless of their mental capacity to make decisions about their own safety or other decisions relating to safeguarding processes and activities;
• adults who manage their own care and support through personal or health budgets;
• adults whose needs for care and support have not been assessed as eligible or which have been assessed as below the level of eligibility for support;
• adults who fund their own care and support;
• children and young people in specific circumstances as detailed below.

Outside of scope of this policy and procedure:

• adults in custodial settings (prisons and approved premises). Prison governors and HM Prison and Probation Service (HMPPS) have responsibility for these arrangements (see Adult Social Care, HMPSS and Ministry of Justice). The Safeguarding Adults Board does however have a duty to assist prison governors on adult safeguarding matters;
• local authorities are required to assess for care and support needs of prisoners which take account of their wellbeing (see Factsheet 12: Prisoners and people in resident in approved premises, Department of Health and Social Care). Equally NHS England has a responsibility to commission health services delivered through offender health teams which contributes towards safeguarding offenders.

2.1 Children and young people

See also South Tyneside Safeguarding Children Procedures

The Children Act 1989 provides the legislative framework for agencies to take decisions on behalf of children and to take action to protect them from abuse and neglect. Young people who receive leaving or after care support from children and family services, are included in the scope of adult safeguarding, but close liaison with children and family service providers is key to establishing who is the best person to lead or support young people through adult safeguarding processes.

The Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children. In all adult safeguarding work, staff working with the adult should establish whether there are children in the family and whether checks should be made on children and young people who are part of the same household, irrespective of whether they are dependent on care either from the adult, or the person alleged to have caused harm. See Whole Family Approach chapter.

Children and young people may be at greater risk of harm or be in need of additional help in families where adults have mental health problems, misuse substances or alcohol, are in a violent relationship, have complex needs or have learning difficulties.’ For further information see Working Together to Safeguard Children (Department for Education).

Abuse within families reflects a diverse range of relationships and power dynamics, which may affect the causes and impact of abuse. These can challenge professionals to work across multi-disciplinary boundaries in order to protect all those at risk. In particular staff may be assisted by using domestic abuse risk management tools as well as safeguarding risk management tools. Staff providing services to adults, children and families should have appropriate training whereby they are able to identify risks and abuse to children and vulnerable adults.

In respect of young carers, the Care Act 2014, alongside the Children and Families Act 2014, offers a joined up legal framework to identify young carers and parent carers and their support needs. Both Acts have a strong emphasis on outcomes and wellbeing.

2.1.1 Transition

The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of significant benefit. See also Transition to Adult Care and Support chapter.

Where there are ongoing safeguarding issues for a young person and it is anticipated that on reaching 18 years of age they are likely to require adult safeguarding, safeguarding arrangements should be discussed as part of transition support planning and protection. Conference chairs and Independent Reviewing Officers, if involved, should seek assurance that there has been appropriate consultation with the young person by adult social care and invite them to any relevant conference or review. Clarification should be sought on:

• what information and advice the young person has received about adult safeguarding;
• the need for advocacy and support;
• whether a mental capacity assessment is needed and who will undertake it.
• if best Interest decisions need to be made
• whether any application needs to be made to the Court of Protection.
• If the young person is not subject to a plan, it may be prudent to hold a professionals meeting.

2.1.2 Children and young people who abuse

If a child or young person is causing harm to an adult covered by the adult safeguarding procedures, action should be taken under these procedures, and a referral and close liaison with children’s services should take place.

Violence towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults experiencing or at risk of abuse or neglect, can be carried out by adults and by young people and children, some of which can cause serious harm or death.

2.2 Carers and safeguarding

Circumstances in which a carer could be involved in a situation that may require a safeguarding response includes when:

• a carer may witness or speak up about abuse or neglect;
• a carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals and organisations they are in contact with; or,
• a carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others.

Where there is intentional abuse, adult safeguarding under the Care Act should always be considered. See Carers chapter.

3. Who Abuses and Neglects Adults?

Anyone can carry out abuse or neglect, including:

• spouses / partners;
• other family members;
• neighbours or friends;
• friends;
• a paid or volunteer carer;
• acquaintances;
• local residents;
• people who deliberately exploit adults they perceive as vulnerable to abuse;
• paid staff or professionals;
• volunteers and strangers.

Abuse can happen anywhere, for example in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place where an adult lives alone, or with others.

4. Principles of Adult Safeguarding

There are six principles which apply to all sectors and settings including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

The principles should inform the ways in which professionals and other staff work with adults. The principles can also help the Safeguarding Adults Board and partner organisations more widely, by using them to examine and improve their local arrangements.

Empowerment: People are supported and encouraged to make their own decisions and give informed consent. People should always be treated with dignity and respect, and staff should work alongside them to ensure they receive quality, person-centred care which ensures they are safe on their own terms.

“I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

Prevention: Prevention and early support are key to effective safeguarding. The principle of prevention recognises the importance of taking action before harm occurs and seeks to put mechanisms in place so they don’t reoccur.

“I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionality: This means deciding the least intrusive response appropriate to the risk presented.

“I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”

Protection: This involves delivering support and representation for those in greatest need who may not be able to do it for themselves.

 “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: Effective safeguarding cannot be delivered in isolation. Local solutions are best achieved through services working with their communities, professionals and services as a whole.

“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: This recognises the importance of being open, clear and honest in the delivery of safeguarding, and ensuring there are systems in place to hold practitioners and services to account.

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

5. Aims of Adult Safeguarding

The aims of adult safeguarding are to:

• prevent harm and reduce risk of abuse and neglect for those adults with care and support needs;
• stop abuse or neglect wherever possible;
• safeguard adults in a way that enhances individual choice and control, as part of improving their quality of life, ;
• work alongside the adult to identify strengths-based and outcomes-focused solutions;
• 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 to help people understand abuse, how to stay safe and how to raise concerns;
• address the causes of abuse.

Safeguarding is not a substitute for:

• providers’ responsibilities to provide safe and high quality care and support;
• commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;
• the Care Quality Commission (CQC) ensuring regulated providers comply with the fundamental standards of care or by taking enforcement action; and
• the core duties of the police to prevent and detect crime and protect life and property.

6. Making Safeguarding Personal

See also Making Safeguarding Personal chapter.

Making Safeguarding Personal is a person-centred approach that promotes a commitment to improving outcomes for adults experiencing, or at risk of, abuse or neglect. The key focus is recognising that people are experts in their own lives and that developing a real understanding of what people wish to achieve will give the person greater control over their lives.

It involves working with the adult (and their representatives) to determine how best their outcomes might be realised and regularly evaluating the extent of which desired outcomes have been met. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding process, support planning and response.

Adults need to be encouraged to make their own decisions as far as practicably possible and are provided with support and information to empower them to do so. This approach recognises that adults have a general right to independence, choice and self-determination including control over information about themselves.

Making safeguarding personal It engages the adult in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.

Staff should work to deliver effective safeguarding n line with the six principles of safeguarding (see Section 2, Principles). They should ensure that the adult has accessible information so that they can make informed choices about safeguarding: what it means, risks and benefits and possible consequences.

7. Personal Budgets and Personal Health Budgets

Regardless of the adult’s preferred method of managing a personal budget, the local authority retains its duty of care with regard to the adult and their protection from abuse. The Integrated Care Board (ICB) also has responsibilities around the provision of personal health budgets.

Personalised care planning can enhance good safeguarding practice, bringing in people’s own resources and intelligence. Through empowering adults, organisations can help raise awareness of what is acceptable and use information from adults and their families to identify potential problems with providers.

The kind of support available to adults managing their own care and support includes advice on:

• managing money;
• safer recruitment;
• safeguarding and dignity;
• what to expect from services and individuals;
• using approved or accredited providers of employment services;
• contractual issues;
• who to contact if things go wrong;
• guidance on mental capacity issues;
• guidance on deputyship and Lasting Power of Attorney.

8. Raising Awareness

Partners should plan regular public awareness campaigns as these can make a significant contribution to the prevention of abuse. Such campaigns are more effective when supported by information and advice about where to get help, and when there is effective training for staff and services to respond. See also Safeguarding Leaflets and Safeguarding Posters.

9. NHS England -Serious Incidents

The NHS England Serious Incident Framework should be read in conjunction with the Never Events Policy and Framework. The Serious Incident Framework is not a substitute for safeguarding. Where safeguarding is indicated a safeguarding referral must be made, however a root cause analysis under the Serious Incident Framework may be considered an appropriate response to a safeguarding enquiry.

Broadly speaking there are three scenarios:

1. NHS identifies a safeguarding concern, for example through staff at Accident and Emergency seeing signs of physical abuse. This may warrant a safeguarding referral to the Local Authority but would not be routinely recorded as an SI.
2. If there are allegations against healthcare staff within the provider of a service to adults, then a safeguarding referral and SI would need to be declared. Equally if there is patient against patient abuse.
3. Lastly, there are incidents that are reported on STEIS that are not safeguarding issues, for example a pressure ulcer that was unavoidable (see the chapter on Pressure Areas and Safeguarding). Investigations will still be undertaken but without referral for a safeguarding. This is obviously dependent on the situation.

1. Aim

This Adults Policies, Procedures and Practice (APPP) Resource aims to provide practitioners working across South Tyneside with the tools they need to safeguard adults from abuse and neglect.

2. Structure

The document is structured into the following sections and appendices:

• Section 1: Introduction and Context – provides the context and the key information underpinning this South Tyneside Safeguarding Adults Board Policies, Procedures and Practice (APPP) resource..
• Section 2: Specific Safeguarding Situations – provides detail on the key safeguarding adults concerns, including how to identify signs of abuse and what action to take;
• Section 3: Identifying Abuse and Taking Immediate Action – explains the importance of being vigilant to possible signs of abuse and neglect, and how to act on any concerns;
• Section 4 – Safeguarding Enquiries Process – sets out the different stages of the safeguarding enquiry process, where there are concerns about an adult who is at risk of or experiencing abuse or neglect. It also includes supplementary information.
• Section 5: South Tyneside Safeguarding Adults Board – contains key information in relation to the role of the Safeguarding Adults Board and its partner agencies and staff who work with adults in the South Tyneside area.
• Section 6: Safer Working Practices -guidance keep adults are keep by ensuring that workers are recruited safely and receive safeguarding training and regular supervision;
• Section 7: Mental Capacity and Mental Health – outlines key principles and processes including mental capacity and deprivation of liberty safeguards;
• Section 8: National Guidance – provides information about a range of supplementary issues related to safeguarding adults;
• Section 9: Practice Guidance – information on key issues for multi-agency safeguarding adults practice;
• Section 10: Working with Care and Support Providers – sets out how commissioners work with providers to ensure that adults receive high quality, safe services. It details how good commissioning and effective contract monitoring can support providers to take early action to reduce risk and keep adults safe from harm;
• Section 11: The Care Act – provides key information for partner agencies about the provisions contained in the Care Act, including the role of the local authority.
• Appendices – includes supplementary information.

See also Forms, Leaflets and Posters for relevant forms.

See also Local Contacts for details of local teams and organisations.

1. Scope of this Adult Policies, Procedures and Practice Resource

This Adult Policies, Procedures and Practice (APPP) Resource covers:

• the legislative requirements and expectations on individual services to safeguard and promote the wellbeing of adults in the exercise of their respective functions, relating to adults with needs for care and support and carers; and
• a framework for South Tyneside Safeguarding Children and Adults Partnership to monitor the effective implementation of policies and procedures.

2. Safeguarding Duty

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

The adult experiencing, or at risk of abuse or neglect will hereafter be referred to as ‘the adult’ throughout the APPP.

3. Supplementary Guidance and Information

The chapters in this APPP should be read in conjunction with:

• Care Act 2014 and Care and Support Statutory Guidance;
• Adult Safeguarding Improvement Tool 

This APPP embeds relevant national documents including Safeguarding Children, Young People and Adults in the NHS Accountability and Assurance Framework which outlines the roles and responsibilities of the health service. It also takes account of national initiatives about housing and safeguarding and draws on the commitment for organisations to work together championed by the Association of Directors of Adult Social Services.

It is steered by the personalisation of health and adult social care through the national Making Safeguarding Personal programme (see Making Safeguarding Personal chapter). This arose following feedback from many people who had used safeguarding services, reporting that they felt they were being driven through a process and felt out of control. The shift in culture, by developing a personalised approach to supporting people, is a shared vision for all organisations working with adults who may be or are at risk of abuse and neglect.

The Mental Capacity Act 2005 (MCA) is pertinent throughout the APPP and staff should ensure that all decisions and actions are taken in line with the requirements of the Act.

Reference to key documents and resources are made throughout in particular:

• Care and Support Statutory Guidance;
• Skills for Care;
• Social Care Institute for Excellence (SCIE).

1. Context

The Care Act 2014 put adult safeguarding on a legal footing and required each local authority to set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the police and the NHS (specifically the local Integrated Care Board). Locally this is called the South Tyneside Safeguarding Adults Board (SAB).

One of the key functions of the SAN is to ensure that the policies and procedures governing adult safeguarding are fit for purpose and can be translated into effective adult safeguarding practice.

South Tyneside SAB has implemented this procedural framework to ensure consistency across South Tyneside in the way in which adults are safeguarded from abuse and neglect. All organisations involved in safeguarding are asked to adopt this policy and procedures in respect of their relevant roles and functions, but may wish to add additional organisation specific practice guidance, protocols and organisation operation manuals.

2. Principles of Adult Safeguarding

See also Making Safeguarding Personal chapter

The policy and procedures are based on the six principles of safeguarding (see Chapter 14, Care and Support Statutory Guidance ) that underpin all adult safeguarding work. See the Safeguarding: What it is and why does it Matter? chapter for more information.

South Tyneside’s multi-agency adult safeguarding policy and procedures are built on strong multi-agency partnerships working together, with adults, to prevent abuse and neglect where possible, and provide a consistent approach when responding to safeguarding concerns. This entails joint accountability for the management of risk, timely information sharing, co-operation and a collegiate approach that respects boundaries and confidentiality within legal frameworks.

3. Risk Management

Safeguarding is fundamentally managing risk about the safety and wellbeing of an adult in line with the six safeguarding principles (see Safeguarding: What it is and why does it Matter?). The aim of risk management is:

• to promote, and thereby support, inclusive decision making as a collaborative and empowering process, which takes full account of the individual’s perspective and views of primary carers;
• to enable and support the positive management of risks where this is fully endorsed by the multi-agency partners as having positive outcomes;
• to promote the adoption by all staff of ‘defensible decisions’ rather than ‘defensive actions’.

Effective risk management strategies identify risks and provide an action or means of mitigation against each identified risk, and have a mechanism in place for early escalation if the mitigation is no longer viable. Contingency arrangements should always be part of risk management. Risk assessments and risk management should take a holistic approach and partners should ensure that they have the systems in place that enable early identification and assessment of risk through timely information sharing and targeted multi-agency intervention. (See Managing Risk chapter).

4. Inter-agency Cooperation

The importance of effective multi-agency working is a common finding from Safeguarding Adults Reviews. South Tyneside Council, as the local authority, is the lead coordinating organisation for adult safeguarding. However, all other relevant organisations and partners including the NHS, the Department for Work and Pensions, the police and HM Prison and Probation Service have legal duties in relation to safeguarding adults.

Organisations can achieve effective inter-agency working through creative joint working partnerships that focus on positive outcomes for the individual(s). Cooperation between organisations that take a broad community approach to establishing safeguarding arrangements, working together on prevention strategies and awareness-raising also supports the aims and objectives of South Tyneside’s Health and Wellbeing Board and Community Safety Partnership (see South Tyneside Safeguarding Adults Structures and Organisations).

The local authority and partner organisations should cooperate in order to deliver effective safeguarding, both at a strategic level and in individual cases, where they may need to ask one another to take specific action in that case.

The Care Act 2014 describes a general duty to cooperate between the local authority and other organisations providing care and support. This includes a duty on the local authority itself to ensure cooperation between its adult care and support, housing, public health and children’s services.

It also provides a new ability to request cooperation from a relevant partner or another local authority, in relation to an individual case. The local authority or relevant partner must cooperate as requested, unless doing so would be incompatible with their own duties or have an adverse effect on the exercise of their functions.

If an organisation is refusing to share information, the organisation conducting an enquiry can escalate to the Safeguarding Adults Board (SAB) to consider using Care Act powers, which place an obligation on organisations to comply with a request for information in order that the SAB can perform its duties.

The Care Act sets out five aims of cooperation between partners which are relevant to care and support, although it should be noted that the purposes of cooperation are not limited to these matters. The five aims include:

1. promoting the wellbeing of adults needing care and support and of carers;
2. improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
3. smoothing the transition from children’s to adults’ services;
4. protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect and
5. identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.

Organisations that refuse to comply with requests for cooperation or information should provide written reasons for the refusal.

5. Information Sharing

Sharing the right information, at the right time with the right people, is fundamental to good safeguarding practice, but it has also been highlighted as a difficult area of practice. The Care Act ‘supply of information’ duty covers the responsibilities of others to comply with requests for information as detailed above. Sharing information between organisations as part of day to day safeguarding practice is already covered in the common law duty of confidentiality, data protection legislation (see Data Protection Act chapter), the Human Rights Act 1998 and the Crime and Disorder Act 1998.

As a general principle people must assume it is their responsibility to raise a safeguarding concern if they believe an adult at risk is suffering or likely to suffer abuse or neglect, and / or are a risk to themselves or another, rather than assume someone else will do so. They should share the information with the local authority and/or the police if they believe or suspect that a crime has been committed or that the individual is immediately at risk.

Helpful guidance is set out in the Caldicott Principles.

Partner organisations may be asked to share information through agreed information sharing protocols. See South Tyneside Multi Agency Information Sharing Agreement.

6. Confidentiality

A duty of confidence arises when sensitive personal information is obtained and / or recorded in circumstances where it is reasonable for the subject of the information to expect that the information will be held in confidence.

Adults provide sensitive information and have a right to expect that the information that they directly provide and information obtained from others will be treated respectfully and that their privacy will be maintained.

The challenges of working within the boundaries of confidentiality should not impede taking appropriate action. Whenever possible, informed consent to the sharing of information should be obtained. However:

• emergency or life threatening situations may warrant the sharing of relevant information with the relevant emergency services without consent;
• the law does not prevent the sharing of sensitive, personal information within organisations. If the information is confidential, but there is a safeguarding concern, sharing it may be justified;
• the law does not prevent the sharing of sensitive, personal information between organisations where the public interest served outweighs the public interest served by protecting confidentiality – for example, where a serious crime may be prevented.

Whether information is shared with or without the adult’s consent, the information sharing process should abide by the principles of the Data Protection Act 2018. In those instances where the person lacks the mental capacity to give informed consent, staff should always bear in mind the requirements of the Mental Capacity Act 2005, and whether sharing it will be in the person’s best interest (see also Mental Capacity chapter).

The data protection legislation should not be a barrier to sharing information. It provides a framework to ensure that personal information about living persons is shared appropriately.

7. Wellbeing

The Care Act states that local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support. For safeguarding, this would include safeguarding activities in the widest community sense and is not confined to safeguarding enquiries under Section 42 of the Care Act 2014.

The Care and Support Statutory Guidance supports the need for safeguarding to be person led and outcome focused.

“14.14. In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised; and the case study below helps illustrate this.

14.15. Making safeguarding personal means it should be person-led and outcome focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.”

Wellbeing is a broad concept, and it is described as relating to the following areas:

• personal dignity (including treatment of the individual with respect):
• physical and mental health and emotional wellbeing;
• protection from abuse and neglect;
• control by the individual over day to day life (including over care and support provided and the way it is provided);
• participation in work, education, training or recreation;
• social and economic wellbeing;
• domestic, family and personal;
• suitability of accommodation;
• the individual’s contribution to society.

All organisations working with adults who are or may be experiencing or at risk of abuse and neglect, must aim to ensure that they remain safeguarded. This should underpin every activity through consistent safeguarding adults work. This includes any safeguarding activity that is outside the scope of a Section 42 Care Act 2014 enquiry.

The wellbeing principle should apply to all agencies involved in safeguarding adults.

8. Organisational Learning

It is essential that all aspects of safeguarding practice are monitored and scrutinised on a regular basis. All staff have a responsibility to audit their work.

All agencies need to take responsibility for organisational learning and implement changes to their practice as a result of audits, complaints, Safeguarding Adult Reviews, and most importantly feedback from adults about what works well and what needs to improve. Organisations need to provide opportunities for their staff for learning from themes and patterns of practice that can add value to learning from good practice; pinpointing necessary changes.

9. Values

South Tyneside Safeguarding Adults Board expects safeguarding to be given the highest priority across all organisations. There must be a shared value of placing safeguarding within the highest of corporate priorities. Organisations should be judged on the effectiveness of safe communities and their values towards safeguarding adults who may be at risk of, or experiencing abuse or neglect.

These values include:

• people are able to access support and protection to live independently and have control over their lives;
• appropriate safeguarding options should be discussed with the adult according to their wishes and preferences. They should take proper account of any additional factors associated with the individual’s disability, age, gender, sexual orientation, race, religion, culture or lifestyle;
• the adult should be the primary focus of decision making, determining what safeguards they want in place and provided with options so that they maintain choice and control;
• all action should begin with the assumption that the adult is best placed to judge their own situation and knows best the outcomes, goals and wellbeing they want to achieve;
• the individual’s views, wishes, feelings and beliefs should be paramount and are critical to a personalised way of working with them;
• there is a presumption that adults have mental capacity to make informed decisions about their lives. If someone has been assessed as not having mental capacity, to make decisions about their safety, decision making will be made in their best interests as set out in the Mental Capacity Act 2005 and Mental Capacity Act Code of Practice;
• people will have access to supported decision making;
• adults should be given information, advice and support in a form that they can understand and be supported to be included in all forums that are making decisions about their lives. The maxim ‘no decision about me without me’ should govern all decision making;
• all decisions should be made with the adult and promote their wellbeing and be reasonable, justified, proportionate and ethical;
• timeliness should be determined by the personal circumstances of the adult;
• every effort should be made to ensure that adults are afforded appropriate protection under the law and have full access to the criminal justice system when a crime has been committed.