Policy for Safeguarding Vulnerable Adults including MCA and DOLS

Policy For Safeguarding Vulnerable Adults Including MCA And DOLS

Why We Have This Policy

This Practice recognises it has a duty to prevent the abuse of vulnerable adults and respond promptly when abuse is suspected or reported. We ensure that all our patients and staff are treated with courtesy, dignity, fairness, and respect always. Our practice considers all incidents of abuse as being unacceptable and especially so when the victim is deemed to be vulnerable. We will promote a culture and environment in which abuse of any kind is not tolerated and is dealt with promptly when it does occur.

This policy applies equally to every member of employed staff within our practice regardless of occupation status or grade. Any breach of the policy, including failure to properly report or investigate an allegation of abuse, will be treated as a disciplinary offence. We are committed to pursuing equal opportunity and anti-discriminatory practice, whilst promoting and developing services and resources which are sensitive to protected characteristics that are identified in the Equality Act 2010.

This Practice is committed to ensuring that workers at all levels have the knowledge and ability to contribute effectively to the protection of vulnerable adults.

Definition Of A Vulnerable Adult

A vulnerable adult is a person aged 18 years or over who may be unable to take care of themselves or protect themselves from harm or from being exploited. This may be because they have a mental health problem, a disability, a sensory impairment, are old and frail, or have some form of illness. The ‘No Secrets’ guidance defines a vulnerable adult as someone “who is or may be in need of community care services by reason of mental or other disability, age or illness: and is or may be unable to take care of him or herself, or unable to protect him or herself against significant harm or exploitation.” (DoH 2000).

Understanding Abuse

An awareness of adult abuse is the key to protecting vulnerable adults from abuse. Abuse is mistreatment by any other person or persons that violates a person’s human and civil rights. The abuse can vary from treating someone with disrespect in a way that significantly affects the person’s quality of life, to causing actual physical suffering.

The Department of Health “recognises that abuse may not just be physical, sexual or an obvious act of cruelty. There are many types of abuse including mental, emotional, financial and discriminatory abuse. There is no hierarchy among these types of abuse. Depending on the circumstances, pernicious racist abuse can have as profound an effect as, for example, physical abuse on a vulnerable adult. Bullying or daily humiliations, perhaps presented as jokes by the perpetrators, can be as harmful as single acts of cruelty. Similarly, unintended abuse or neglect can have the same impact as deliberate”. (Stephen Ladyman, 2004)

Responsibilities

All allegations of abuse must be regarded as serious, reported appropriately and investigated immediately to serve the interest of individual service users and always act in such a way as to promote and safeguard their well-being, guided by codes of professional conduct where appropriate. Being alert to possible abuse and informing line management of actual abuse is the responsibility of all staff.

Team members have the right to form their own judgment and to challenge other opinions, including medical statements, where they believe this is in the adult’s interest. Where a team member’s concerns appear not to be taken seriously, it is appropriate to take them to a more senior person at the practice. Team members who take this action will be supported regardless of the outcome providing the allegation has been made in good faith.

Practice Responsibilities

• We commit to the provision of high-quality care and the continuous raising of standards through clinical governance and adherence to National Service Frameworks and other national policy initiatives
• Our employees will feel enabled and empowered to identify, report and act on abuse by promoting leadership skills and individual development
• Dr Tocca is the named individual within the practice with responsibility for the protection of vulnerable adults, who will promote awareness within the practice, work closely with and support staff in the protection of vulnerable adults from abuse
• New employees will receive vulnerable adult protection awareness training as part of their induction
• Where appropriate, staff will have the opportunity to access additional training in respect of the awareness of and protection from abuse of vulnerable adults
• There is commitment from senior partners to support and release staff for training which will facilitate the development of competencies in the joint prevention and tackling of vulnerable adult abuse
• Patients who are vulnerable adults will be enabled, empowered, and encouraged to complain if they are being abused

Your Responsibilities

• Assess the situation i.e. are emergency services required?
• Ensure the safety and wellbeing of the individual.
• Establish what the individual’s views and wishes are about the safeguarding issue and procedure.
• Maintain any evidence.
• Follow internal procedures for reporting incidents/risk.
• Remain calm and try not to show any shock or disbelief.
• Listen carefully and demonstrate understanding by acknowledging regret and concern that this has happened.
• Inform the person that you are required to share the information explaining what information will be shared and why.
• Make a written record of what the person has told you, using their words or what you have seen as your actions.

This safeguarding policy follows the April 2019 guidance and confirms that:

• All members of the dental team (clinical and non-clinical) have read this document
• The practice has a named Safeguarding Practice Lead and all members of staff know who it is
• The practice have a named Freedom to Speak Up guardian who is independent of the line management chain and not the direct employer, who can ensure that policies are in place and that staff know how to contact them.
• All members of staff know how to access the NHS Safeguarding app to search for local safeguarding contact details
• The practice has an updated Safeguarding Policy and it has been regularly reviewed
• We have identified staff training needs.
• All members of staff undertaken the appropriate level of safeguarding training

This document, along with the weblinks provided to pertinent supporting guidance, resources, free training opportunities and video links have been discussed in team meetings to consider how they may be embedded into practice

Mental Capacity Act (MCA)

The MCA was introduced into England and Wales in 2007. It sets out who can make decisions, in which situations, and how they should go about it. It applies to all those involved in providing health and social care and is supported by a Code of Practice 2007 which gives guidance on its implementation and has statutory force. This includes doctors, nurses, allied health professionals and care staff. The Code of Practice can be found here.

The starting point of the Act is it should be assumed that an adult (aged 16 or over) has full legal capacity to make decisions for themselves (the right to autonomy) unless it can be shown that they lack capacity to make a decision for themselves at the time the decision needs to be made. This is known as the presumption of capacity. The Act also states that people must be given all appropriate help and support to enable them to make their own decisions or to maximise their participation in any decision-making process.

The Act sets out how capacity should be assessed and procedures for making decisions on behalf of people who lack mental capacity. ‘The underlying philosophy of the MCA is that any decision made, or action taken, on behalf of someone who lacks the capacity to make the decision or act for themselves must be made in their best interests’

How We Apply The Principles Of The Mental Capacity Act (MCA)

This Practice applies the MCA principles and follows the framework who lack capacity to make decisions, or who have capacity and want to make preparations for a time when they may lack capacity in the future.

The policy will support the service provider (our dental practice) in first treating all of its service users on the basis that they are able to make their own decisions.

Consistent with the legislation the service provider must make a decision for a person in their best interests, if there is evidence that they cannot make the decision (at the time it needs to be made) because of mental incapacity and it is appropriate within the decision making responsibilities of the MCA.

The Act Outlines:

• Who can make decisions for people who lack capacity
• In which situations this can be done
• How they should go about this

Scope

The aim of this policy is to ensure that throughout the work of This dental practice we will promote the welfare of adults in ensuring the principles of the MCA are embedded into practice. We aim to do this by ensuring that we comply with the MCA Code of Practice and upholding the rights of adults with care and support needs ensuring it is integral to all we do.

This policy addresses the responsibilities of employees; it is the responsibility of Lighthouse Dental Practice (provider manager) and the MCA Lead to brief staff on their responsibilities under the policy.

Joint working and effective collaboration is essential to promote the rights and freedom of individuals. This is supported by:

The commitment of all staff and clear lines of accountability, to comply with the principles of the MCA and the Code of Practice, which protects them from liability

Practice developments that take account of the need for staff training and continuing professional development so that staff have an understanding of their roles and responsibilities and those of other professionals and organisations in relation to MCA

Building confidence among staff regarding how and when to assess and individual’s mental capacity, and how to make a best interests decision when necessary

Breaches Of Policy

For employees, failure to adhere to the MCA Policy could lead to dismissal or constitute gross misconduct.

The Five Statutory Principles Of The MCA

• A person must be assumed to have capacity unless it is established that they lack capacity
• A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
• A person is not to be treated as unable to make a decision merely because he makes an unwise decision
• An act done, or decision made, under the Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
• Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

What Is Mental Capacity?

A person lacks capacity in relation to a matter if, at the material time, he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.

Capacity is decision and time specific, assessing capacity refers to assessing a person’s ability to make a particular decision at a particular moment in time, rather than being an overarching judgement about an individual’s ability to make decisions in general. Staff cannot decide that someone lacks capacity based upon age, appearance, condition or behavior alone.

Having mental capacity means that a person is able to make their own decisions by weighing up relevant information. All staff should always start from the assumption that the person has the capacity to make the decision in question (principle 1).

Staff must also be able to show that they have made every effort to encourage and support the person to make the decision themselves (principle 2).

Staff must also remember that if a person makes a decision which is considered eccentric or unwise, this does not necessarily mean that the person lacks the capacity to make the decision ( principle 3).

Under the MCA, staff are required to make an assessment of capacity before carrying out any care or treatment if they have reasonable belief someone lacks capacity – the more serious the decision, the more formal the assessment of capacity needs to be.

Deprivation Of Liberty Safeguards (DoLS) In Dental Practice

DoLS are an amendment to the Mental Capacity Act. They apply were introduced as an amendment to the Mental Capacity Act (MCA) and came into force in April 2009. The DoLS are additional safeguards to protect the rights of people who are deprived of their liberty in their own best interests to protect their health and safety.

DoLS are used in hospitals and care homes, so their significance might not be immediately obvious to the dental profession. Yet practices need to understand the safeguards and the implications when someone who is subject to a DoLS order moves in and out of their care. This is because there is substantial evidence that culture – ‘the way we do things around here’ – and leadership can support services to deliver high-quality compassionate care.

Modern Slavery

At this practice we recognise that we have a duty in preventing abuse. The duty includes a responsibility in relation to prevention of Modern Day Slavery.

Where abuse of any kind is suspected or identified we ensure that we respond according to our practice procedures and local guidance and we ensure that suspected or identified victims are referred to the appropriate agency or agencies.

we consider all incidents of abuse and modern-day slavery to be unacceptable and especially so when the victim is a child or is deemed to be vulnerable.

We will ensure that through training we promote a culture and environment in which all team members can recognise abuse or enslavement of any kind. Team members know they must record details of any suspected or confirmed incident and they must report any incident promptly to the practice safeguarding lead, Dr Codrin Tocca

All referrals are followed up to ensure appropriate action has been taken.

Practice Procedures For Team Members

The following procedures are in place to safeguard our team members and our patients.

Prior to commencing employment, we ensure that all necessary pre-employment checks have been satisfactorily completed.

We confirm the identity of all our team members and their rights to live and work in the UK.

All team members are paid in line with National Living Wage requirements.

We ensure all team members know they can raise concerns without fear of recrimination and we ensure they understand our policy on Whistleblowing.

We have comprehensive policies for dealing with Violence, Bullying and Harassment and team members are required to familiarise themselves with the practice policies.

This practice takes modern day slavery seriously and understands that any breaches of the Modern-day Slavery Act 2015 can result in disciplinary action, changes to or cancellation of the registered person or provider by the CQC and punitive action under the Act.

Lighthouse Dental Practice safeguarding lead: Dr Tocca

This Statement on Modern Day Slavery was implemented on 01/02/2020 and will be reviewed annually. It is due for review on: 01/02/2021 or prior to this date in accordance with new guidance or legislative changes.

Honour Based Violence And Forced Marriage

At this practice we will take all reports of honour based violence and Forced Marriage very seriously. We will deal with each individual case sensitively and confidentially.

Honour Based Violence is defined as a collective and planned crime or incident, mainly perpetrated against women and girls, by their family or their community, who act to defend their perceived honour, because they believe that the victim(s) have done something to bring shame to the family or the community.

Honour Based Violence may include emotional, psychological, sexual and physical abuse, as a reaction to what is perceived as immoral behaviour that brings shame on the family or community. It is a direct violation of the victim’s human rights.

Behaviours That May Be Perceived To Be ‘Immoral’ In Some Communities May Include:

• Running away or coming home late.
• Ideological differences between parents and children.
• Westernisation.
• Refusing an arranged marriage.
• Participating in relationships outside marriage or an approved group.
• Wearing ‘inappropriate’ make up or clothing.
• Loss of virginity before marriage.
• Pregnancy outside of marriage.
• Homosexuality.
• Reporting/fleeing domestic abuse, coercive and controlling behaviour, forced marriage.
• Girls who ‘allow themselves to be raped’.
• Causing gossip about a family or community.

Honour-based violence can take many forms. It may or may not involve violence and may include:

• Murder.
• Personal attacks of any kind, including physical and sexual violence.
• Forced marriage.
• Forced repatriation (sending someone back to a country from which they originate without their consent).
• Written or verbal threats or insults.
• Threatening or abusive phone calls, emails and instant messages.

At this practice, if we are informed by a patient that they are victims of Honour Based Violence or we suspect someone is at risk of Honour Based Violence we will report it immediately.

We will call 999 if we suspect the individual is in immediate danger. We may also contact the Forced Marriage Unit.

Forced Marriage

Forced marriage is when an individual is faced with physical, emotional or psychological pressure to marry. Examples of this may include threats, physical violence, sexual violence or making an individual feel like he/she is bringing shame on their family or community.

Forced marriages are illegal in England and Wales and can carry prison sentences of up to 7 years. This includes:

Taking someone overseas to force them to marry (whether or not the forced marriage takes place).

Marrying someone who lacks the mental capacity to consent to the marriage (whether they’re pressured to or not).

At this practice, if we are informed by a patient that they are being forced into marriage or we suspect someone is at risk of being forced into marriage we will report it immediately.

We will call 999 if we suspect the individual is in immediate danger. We will also contact the Forced Marriage Unit.

Forced Marriage Unit

Telephone: 020 7008 0151 (Monday to Friday, 9am to 5pm)

Out of hours: 020 7008 1500 (ask for the Global Response Centre)

Email: fmu@fco.gov.uk

The following details should be provided to the Police or Forced Marriage Unit:

• Name of the individual(s).
• Registered address (if known).
• Age.
• Details of parent/ guardian/ next of kin (if known).
• Any information about where the person is being taken to (if known).
• When they were due back in the UK (if known).