Adult Safeguarding in Social Care – HSE Role
1 This SIM provides advice to inspectors whose operational work requires them to become involved in incidents in social care activities and settings. For consistency, the term 'people who use care services' has been used to describe patients, residents and any other clients in health and social care premises.
2 To inform FOD operational teams about safeguarding processes to protect vulnerable adults. This advice does not cover 'safeguarding children' although some principles may apply.
3 HSCSU is aware that, in some instances, FOD operational teams may not be aware of the role of safeguarding teams. There is potential for parallel enquiries being made by other authorities and the need or potential to share information. An understanding of the safeguarding process will help ensure that HSE is consistent in its handling of incidents involving vulnerable persons and help secure efficient use of resources by avoiding duplication of any investigations, information gathering or subsequent remedial action. It will also help inspectors to determine when and how they may need to liaise with a safeguarding team, and what information it is appropriate to share.
What is Safeguarding?
4 The safeguarding of vulnerable adults (SOVA) or protection of vulnerable adults (POVA) relates to the processes and arrangements to protect vulnerable persons from potential or actual abuse. A vulnerable adult is someone aged 18 or over who is, or may be:
- in need of community care services because of mental or other disability, age or illness and
- unable to take care of themselves, or unable to protect themselves against significant harm or exploitation.
5 'Abuse' is a violation of a person's human and civil rights by any other person(s), the definition of abuse is wider than some may realise and covers more than intentional harm. It may:
- be a single or repeated act(s)
- be physical, verbal, sexual, psychological, institutional, discriminatory, or financial
- be an act of neglect or failure to act.
6 The Mental Capacity Act can also apply to adult safeguarding incidents and other organisations (eg Police) may use this legislation to pursue abuse or neglect cases.
7 Each Local Authority (LA) acts as the lead co-ordinating agency for safeguarding and together with other key agencies, including the local NHS services and the police, should have safeguarding procedures in place. LAs are required to have local safeguarding boards that set the high level, strategic direction for safeguarding across their geographical area.
8 When an incident is reported by relatives or members of the public, or when a care provider (whether public or private) identifies an incident, or potential incident, which places a vulnerable person at risk there is a requirement for a safeguarding alert to be raised with the safeguarding board at the LA.
What is HSE's role?
9 RIDDOR reportable incidents to patients and service users may in some circumstances fall within the definition of abuse and may be a safeguarding issue, for example:
- if a nursing home fails to ensure the safety of a resident during hoisting;
- if a care provider failed to implement adequate controls, identified through assessment, which contributed to severe scalding during bathing;
- if a care provider failed to assess an individual's care needs and this contributed to harm.
10 Supplementary guidance, on the application of Section 3 (HSWA) to public safety matters, has been developed to help decide whether an incident is a matter for HSE to investigate.
11 Where a reported incident overlaps with a safeguarding issue, and HSE decide to make further enquiries about the incident or to investigate it fully, approaches to the local safeguarding team may be appropriate. HSE should also inform the relevant care regulator in line with any liaison agreements. Additionally, HSE may be invited to attend a LA safeguarding meeting.
12 FOD operational teams will need to decide whether to attend such case meetings depending upon the circumstances and whether the incident meets HSE investigation criteria. Inspectors should be aware that individuals or employers that might have committed breaches may be present. Those individuals may be asked to explain the circumstances and what will be done to prevent recurrence. In such instances, HSE Inspectors will need to consider the timing of their attendance to ensure that any investigation is not prejudiced. In addition, the employer being investigated may be the LA, who may also have the safeguarding lead. This will also need to be considered carefully.
13 HSE may be asked to provide assistance to a Serious Case Review. In those circumstances, the inspector should discuss with the SCR how best to assist without prejudicing any ongoing investigation into criminal offences. It is likely that the police will be involved as they usually sit on the Safeguarding Panel, and should be fully aware of what should and should not be disclosed. However, this does not prevent an inspector from sharing factual information.
Action to take
14 Summary of actions for HSE operational teams:
- Ensure supplementary guidance on application of Section 3 HSWA to public safety matters is followed when incidents are being selected for investigation;
- Liaise with safeguarding teams as appropriate.
- Where investigation requires views or expert opinion (eg on level of care or actions taken by the provider) consider approaching the local safeguarding lead, who may be able to provide assistance.
- Consider whether attendance at a serious case review, would assist in an investigation and help ensure compliance and reduction of risk.
- Consider what information can and cannot be disclosed.
15 The health and safety of people who use care services is covered by the general requirements of Section 3 of the Health and Safety at Work Etc Act 1974, (HSWA s.3) and by the risk assessment requirements of the Management of Health and Safety at Work Regulations (MHSWR reg.3). Section 28 of HSWA covers the disclosure of information, obtained by Inspectors when exercising their powers, to other government departments or enforcing authorities.
16 The Health and Social Care Services Unit would welcome information about any incidents, close working with others or initiatives on this issue. Contact should be made using the general email account: [email protected].