Understanding safeguarding

Example 1

Someone with dementia keeps letting themselves out of their home and wandering in the street putting themselves at risk. The correct course of action would be:

1.      Ask the person for consent to make a referral for a care act assessment.

2.      If the person is not able to consent, you can still make a referral.

The necessary response will involve a care act assessment, a risk assessment, consultation with their GP and possibly a meeting of multi-agency professionals (often known as MDTs).

Example 2

Mrs Thomas is being cared for at home by her husband. She uses a hoist for transfers and has four double-up home care visits a day.

Her husband is struggling to manage the complexities of her care and is worried he will get something wrong and cause her some harm. The correct course of action would be to:

1.      Ask Mr Thomas for consent to make a referral for a carers assessment.

2.      Ask Mrs Thomas for consent to make request a review of her current care and support needs.

3.      If Mrs Thomas is not able to consent, you can still make a referral.

The necessary response will involve completion of a Carers Assessment, a review of care and health provision for Mrs Thomas, completion of a risk assessment and possibly a meeting of multi-agency professionals (often known as MDTs)

Example 3

Mr Patel lives alone and is not coping. He appears to be lacking capacity to make decisions about his own care and support needs.

His daughter does not want to move him to residential care as she promised she would care for him at home.

Professionals have a suspicion that the motive for keeping Mr Patel at home could be to preserve his funds so his family can inherit his money.

There is no need to make a safeguarding referral for this case:

• There is no indication that Mr Patel's family have abused him.
• However, there's a difference of opinion where his health or care needs should best be met.
• As he appears to lack capacity to make the decision about how his care needs should be met a best interests meeting will need to be held with family and professionals to decide on his behalf.

1.      Carry out a mental capacity act assessment around Mr Patel's ability to make decisions about his own care and support.

2.      If Mr Patel lacks capacity, then call a best interest meeting.

3.      If Mr Patel does not lack capacity, then he can decide how his care and support needs are met.

Example 4

Antonia is in recovery as she is a dependent drinker. She attends regular appointments with her alcohol recovery worker and is engaging well with a trauma counsellor.

She has abstained from drinking alcohol for 3 months, however, a significant member of Antonia's family dies, and Antonia gets drunk at the wake following the funeral.

Antonia falls over in the car park whilst waiting for a taxi to take her home. She hits her head resulting in a cut. The bar staff call for an ambulance.

The paramedic crew who attends the accident recognise Antonia as they had previously been called to incidents when Antonia was drinking regularly. The paramedic crew raise a safeguarding concern for self-neglect without Antonia's consent.

There is no need to make a safeguarding referral.

• Antonia is already engaged with alcohol recovery services and there is no evidence of abuse or neglect.
• Antonia was not asked to give her consent for a concern to be raised and there is no obvious reason to over-ride Antonia's consent in this case.

Example 5

Someone with dementia living in a secure care home managed to leave the building because a carer did not close the external door.

They became lost and were found by the police, suffering from hypothermia:

1.      The person has suffered abuse by neglect as the door was left open and they were able to get out of an environment where they should have been kept safe, and

2.      as a result, they have come to harm (hypothermia).

Example 6 (follows on from example 2 above)

• Mr Thomas tried to move his wife using the hoist before the carers arrived to provide double-up support, and she fell from the hoist, sustaining a fractured neck of femur.
• Mr Thomas had been clearly told not to use the hoist on his own due to the risk of harm.
• As Mrs Thomas has suffered harm because of the direct actions of her husband a formal Safeguarding process needs to be followed using s42 of the Care Act.

Example 7 (follows on from example 3 above)

Following a best interest meeting, a best interests decision is made that Mr Patel's care needs will be best met in a care home.

• His family have locked him in the house and are refusing access to the GP and district nurse as they do not want him to move to a care home.
• He requires regular treatment for leg ulcers and diabetes which are not being carried out as health professionals cannot gain access to the property:

1.      Mr Patel is suffering from neglect as a result of his family's actions, and

2.      this could be leading to harm from infection and diabetes related problems.