Ensuring Rights and Preventing Harm, Interagency Guidelines

A Quick Guide

This is a summary for staff and carers about how to recognise harm and what to do immediately when harm is suspected, witnessed or reported. It is still essential to refer to the full guidelines: Adult Support and Protection In Orkney.

What are the Guiding principles supporting Adult Support and protection?

Any intervention in an adult’s affairs should:

• Provide benefit to the adult which could not reasonably be provided without intervening in the adult’s affairs.
• Be the least restrictive option available to provide that benefit.
• Must take account of the past and present wishes of the adult as far that they can be ascertained.
• Must take account of the views of others ( nearest relative; primary carer; guardian or attorney) where relevant.

What is abuse?

It is the violation of a person’s human rights. This happens through the misuse of power by someone in a dominant position. It also includes neglect (things that are not done to ensure someone’s well-being).

Who is an adult at risk?

The “Three Point Test” will help you assess if the adult, ie someone over 16, meets the criteria:

• Is the person unable to safeguard their own property, wellbeing, rights or other interests?
• Is the person at risk of harm, and
• Is the person more vulnerable because of disability, mental disorder, illness or physical or mental infirmity to being so harmed than a person not so affected?

Who can be an abuser?

Abuser or perpetrator can be a professional carer, informal carer, relative, spouse/partner, volunteer, other ‘adults at risk’ or any other person.

Where can abuse happen?

In any social or health care setting e.g. the family home, hospital ward, care home, day services, social clubs, activities etc.

Main Types of Abuse and Signs of these Types of Harm

Physical

Includes hitting, slapping, pushing, kicking, holding the person down (restraint), inappropriate sanctions. Signs include:

• Unusual or unexplained injuries.
• Misuse of medication: giving too much, too little or withholding medication.
• Fear of another person, disturbed behaviour.

Sexual

Includes rape and sexual assault. Signs include:

• Acts or actions they did to which the adult at risk could not, or did not, consent.

Financial or Material

Includes theft, fraud, exploitation, pressure to hand-over or sign-over property or money, financial transactions, misuse of property, possessions or welfare benefits, reduction in assets. Signs include:

• Unexplained debt, not paying bills for services.
• Sale of property, possessions, misuse of bank account by the perpetrator.
• Pressure over wills, property, inheritance, money.

Psychological

Includes emotional abuse, threats, abandonment, humiliation, intimidation, harassment, verbal abuse, controlling, not allowed contact with other people or services. Signs include:

• Pressure by family or professional to have someone moved into or taken out or care.
• Fear of another person.
• Hostile or rejecting behaviour by the care-giver.

Neglect and acts of omission

Includes failure to provide: medical or physical care; access to medical, social or educational services; appropriate medication, food or heating. Signs include:

• Person is found alone at home or in a care setting in a situation of serious risk.
• Unexplained deterioration in health.
• Long gap between illness/injury and getting medical care.
• Deprived of adequate food or heating.

Discriminatory

Includes making an unjust distinction on the basis of race, colour, age or gender etc. Signs include: 

• Prejudicial actions or remarks to the adult at risk about age, gender, disability, race, colour, sexual or religious orientation.

Information abuse

Includes denial of information or advice. Signs include:

• Failure to provide adequate information.
• Being misinformed.

Human Rights included in the 14 Articles of the Human Rights Act 1998. Signs include:

• Absence of information or not knowing rights.
• Being misinformed about rights.

What to do Immediately when harm is suspected, witnessed or reported

Always record everything in writing: actions, discussions, referrals, decisions etc.

You have a duty to immediately report suspected or actual harm to your line manager or supervisor. A ‘plan of action’ should be agreed in this discussion.

Get the person’s consent to action being taken where there is danger, suspicion or evidence of harm:

• If you are satisfied that the person can consent and doesn’t want any action taken their wishes may be respected but you must discuss the matter with your line manager. But if abuse that is a criminal offence is suspected a referral must be made to the Police regardless of whether they consent or not – see the next step below. Discuss with your line manager. Where the person is a patient, tenant or resident and does or does not consent, action must be taken.
• If you are unsure of the person’s capacity to decide, discuss with your line manager or supervisor and refer to the Social Work Service.
• If the person lacks the capacity to make this decision then you must take action by contacting the Social Work Service for guidance.

Contact the appropriate emergency service

Especially if the person is in immediate physical danger or there is evidence of physical or sexual harm. The emergency services are Police, hospital, Community Social Services (and outside office hours, the Emergency Social Work Service).

When abuse that is a criminal offence is suspected or reported

If the person:

• Can consent, then the Police must be contacted immediately. In the case of physical or sexual abuse, immediate referral is essential to ensure vital evidence is not lost.
• Does or does not consent (and they are a patient, tenant or resident in a statutory, voluntary or private institutional setting) contact the police.
• Does not consent and they are not a patient, tenant or resident as above, you must speak with your line manager who will refer the matter to the Police.

Record in detail the events and action taken. Line managers and supervisors can at anytime contact the relevant Duty Officer at Kirkwall Police Station on 101 to discuss or get advice.

Refer to Orkney Health and Care as soon as possible and within 24 hours. During office hours (09:00 to 17:00) contact the duty worker, on 01856873535. If outwith office hours, please call the Balfour Switchboard on 01856888000 and ask to speak to the Duty Social Worker.

Next steps

• Adult Protection Case Conference.
• Ongoing work with the vulnerable adult.
• Support for Staff.

Relevant procedures and legislation

• Adult Support and Protection in Orkney, March 2014 and summary flowchart.
• The Risk Assessment & Protection Plan.
• Single Shared Assessment and Care Management Policy and Procedure.
• Adult Support and Protection (Scotland) Act 2007.
• Adults with Incapacity (Scotland) Act 2000.
• Mental Health (Care and Treatment)(Scotland) Act 2003.
• Social Work (Scotland) Act 1968 as amended by NHS and Community Care Act 1990.