Financial abuse – the misuse of a person’s funds and assets, or obtaining property and funds without the persons full consent and can involved theft of a person’s property or funds Institutional abuse – can happen in a setting such as a care home, hospital, nursing home or school – a place where there are vulnerable people who should receive support and care. Abuse in an institution can include the following: neglect, physical abuse, verbal abuse and sexual abuse
Self neglect – an individual neglects their basic needs such as personal hygiene, feeding and not attending medical appointments. This can be as a result of a degenerative disease like dementia, a brain injury or the side effect of psychiatric medication Neglect by others – a person/people who are supposed to provide support for those who are unable to fully support or provide for themselves but that care and support is not given or is taken away. Neglect may include lack of food or drink, medical aids (like hearing aids/walking sticks) or medical support . 2 Identify the signs and/or symptoms associated with each type of abuse Physical abuse – the physical signs would include bruises, scratches or burn marks. The physical signs of abuse may be hard to see as the abuse could have been carried out in places that are easy to cover up under clothes etc. There could also be emotional or “invisible” signs of physical abuse. If abuse has been carried out in childhood then the child could be become aggressive and their school work could start to suffer.
They may also be very shy and not want any physical contact of any kind. As adolescents, people can turn to substance abuse to help them cope with day-to-day life. These behaviours can be carried into adult life, with adults suffering from long term depression, self-harm and suicide attempts. Studies have also shown that physical abuse in childhood can lead to post-traumatic stress disorder. Sexual abuse – there are very likely to be physical signs but they are likely to be around the genital area and so will generally be covered up and not seen.
They may not be seen until a hospital admission happens as a result of the abuse and an examination takes place. The physical signs could include bruises, scars and chafing around the genitals and bleeding from the genital area. However, there could be other physical sign, for example, there could be bruises on the victims arms if they have been grabbed or restrained or on the face if they have been hit. Victims could begin to show signs of a sexually transmitted disease which if untreated could lead to serious illness or infertility.
Girls and woman could also show signs of being pregnant. Pregnancy can have serious and potentially fatal complications on a young girl whose body may not yet be fully developed. Mental and behavioural signs and symptoms can include sudden changes in behaviour or sexual awareness, self-harm, chronic shyness and aggression. Children’s school work can suffer and even suffer from an increase in truancy from school. Emotional/psychological abuse – the physical signs of emotional abuse are likely to be self inflicted, i. e. he victim could resort to self harm or suicide attempts which can leave lasting scars, illness or successful suicide attempts. Self harm can be the physical manifestation of depression or anxiety as a result of the emotional abuse. Emotional abuse, however, tends to leave no physical marks caused by the abuser who tend to leave mental scars on the person they abuse. Victims can suffer from symptoms like being agitated, aggressive, or becoming withdrawn and uncommunicative. Victims could also start showing sings normally associated with illnesses such as dementia like rocking and biting.
In children the signs and symptoms could be similar to those shown in adults – they can become withdrawn, aggressive and truancy from school can become the norm. The victim of emotional abuse can turn to substance abuse, like drink or drugs, to help them deal with the stress of the abuse that they suffer from. Financial abuse – Like emotional abuse, this may not leave physical signs of abuse caused by the abuser, but should the victim withhold money or property that the abuser may want, then there may be bruises or scratches from being hit or punched.
The victim may turn to self-harm as a way of dealing with stress. Direct signs and symptoms of financial abuse may be; bills not being paid, the victim not having food in the house, unusual financial transactions or clothes and property looking old, shabby, out-dated and dirty. Adults who have previously been living alone may suddenly have an acquaintance living with them or post, like bank statements being redelivered to a different address. Institutional abuse – usually occurs in places where there are vulnerable people who should normally receive support and care for example, in a ospital, care home or school. The abuse can include neglect, physical abuse and discriminatory abuse. The abuse in a hospital could take the form of inflexible or set routines which are set to the times best suited for the staff and hospital rather than what is best for the patients. For example, patients can be made to get out of bed, washed and dressed early in the morning to fit in with times for staff breaks. Or patients’ rights can be abused if a hospital does not provide places for prayer or show signs of religious intolerance.
A patient has the right to request treatment and personal cares by a person of the same gender. If this is denied to them then this could be a form of institutional abuse. But, if there are problems with staffing, e. g. there are physically no male staff members to help with personal cares of a male patient, then options should be discussed with the patient and staff should try to get a chaperone if one is requested. Children can suffer from institutional abuse when they are in hospital but child specific abuse could include not providing suitable play areas/toys or child friendly activities.
Children also may require different eating utensils, not providing these could mean younger children finding it hard not to eat and not being able to eat at all, especially if we did not supply to baby milk. Both adults and children can be victims of being addressed in inappropriate ways and subjected to unsuitable language for instance swearing or racist language. Self Neglect – signs include malnourishment, dehydration and a lack of medical aids, like hearing aids or walking sticks. People who suffer from self neglect could also have poor personal hygiene and unsanitary housing conditions.
This can lead to new or exacerbation of medical conditions, which are likely to go untreated if they suffer from self neglect. Self neglect could also mean the suffer is homeless and without basic needs. Neglect by others – some sings are similar to those displayed by self neglect but are caused when a person has had a care and support network in place but failings are apparent by lack of care. Signs might include dehydration, malnutrition, improper sleeping and housing conditions, lack of necessary aids like hearing aids or walking sticks and untreated or undiagnosed medical conditions.
If a patient is bed bound or finds it hard to walk around and may be sitting for long periods of the day, they are at risk of developing pressure sores. If these are not treated and looked after by moving the patient or by applying suitable dressings, then the skin around the sores breaks down and becomes necrotic very quickly. Prevention against bed sores is the best way of looking after a patient’s skin. Neglect by others can lead to behavioural changes in a person, particularly those who may have learning difficulties or those who find it hard to communicate.
A change in behaviour, e. g. if the patient becomes aggressive, can be their way of communicating the effect the neglect is having on them. 1. 3 Describe factors that may contribute to an individual being more vulnerable to abuse There are various people who are vulnerable to abuse in society. Factors could include: the setting – where the abuse takes place, (e. g. hospital, care home), the individual – a child, an elderly person, a person with learning difficulties, or a group of people – more than one child in a family, a certain group of people (e. . those who are from different cultural backgrounds or are have a different sexual orientation). A child is vulnerable to many forms of abuse including physical abuse, emotional abuse and neglect. They are vulnerable to abuse as they may not be physically strong, may not have an understanding of what is being done to them is wrong and may be too scared to speak out about what is happening to them meaning the abuse can go on for some time without being noticed. A person with learning difficulties may need support with washing, dressing and feeding.
If any of this support is taken away or not given in the first place, this would count as neglect. If a patient is supported at home with the help of just one or two carers then lack neglect could go unnoticed for some time. The patient may not have the means or the ability to report the abuse for themselves. Abuse may not be noticed until an admission into hospital where the neglect could become apparent. An elderly patient could be vulnerable to self-neglect for example, due to a mental illness or dementia.
If the patient does not leave the house often or not have visitors the neglect could go unnoticed and may be only be presented on admission to hospital. They may not have care in place to support them at home so prior to discharge they should either be going home with support or be placed in a suitable care home with the patients/carers consent. Outcome 2 Know how to respond to suspected or alleged abuse 2. 1 Explain the actions to take if there are suspicions that an individual is being abuse 2. 2 Explain the actions to take if an individual alleges that they are being abused.
When you work in an institution that provides health care and support for people you need to build up a good relationship with those in your care. A good relationship includes building trust between you and your patients. Trust works both ways. Your patients need to be able to trust you and what they say is in confidence or that information is only shared with those who need to know. But you also need to trust that your patients are being totally honest with you. Being open and honest with your patients hopefully leads to them being honest with you.
If this leads to you suspecting or if a patient tells you about abuse then there are certain things you should do. Firstly, if you do have a good relationship the patient may want to tell you about what has happened. However, you should ask a trusted colleague to talk to the patient too. The patient may want you to stay with them whilst they tell what has happened to them. If you suspect any abuse has taken place then you should talk to a trusted colleague or line manager who can set in motion the taking and recording information and making referrals, for example to social services.
Abuse can be committed in any setting – at home, at school, in a care home or hospital, and it can be carried out by almost anyone. An alleged incident of abuse could have been committed by a colleague. You should talk to a colleague not implicated in the allegation and you can always use the Harrogate District Foundation Trust Whistleblowing policy. The policy states that “The Policy acknowledges it is a disciplinary matter to victimise a bone fide whistle-blower” so you are protected under the policy if you have a genuine complaint. Every employee must be aware of their duty to report an allegation or complaint of abuse, assault or sexual misconduct, even if the patient is unwilling or unable to pursue the complaint”. As an employee you are actively encouraged to report any incidents of abuse that may have occurred in the hospital. If you have reported an incident of abuse and you feel that no/not enough taken action has been taken then you should report the allegations and your concerns to your line manager or Matron.
You can use the Whistleblowing policy and you can also report any allegations to another agency, for example, the police or the Quality Care Commission (CQC). When you have been told about an alleged incident of abuse or suspect abuse has taken place you must: * Report your concerns to a senior member of staff or independent agency verbally and in writing * Never make a promise regarding the allegation, for example, never promise to not tell anyone else about the compliant * Don’t investigate or question anyone yourself. 2. Identify ways to ensure that evidence of abuse is preserved * Keep a written record – of any phone messages, witness statements etc. Make sure that you only state the facts that have been presented to you. Never state opinions or assumptions. Bank statements, bills etc. counts for a written record and can be used as evidence in cases of financial abuse. All written records must be signed, dated and timed * Any evidence taken, written and physical needs to be kept in a safe place where it can’t be damaged or destroyed. If physical or sexual abuse has taken place then clothes, blankets etc. hould not be washed and kept in sealed plastic bags. You should also encourage the victim not to wash too. * Any physical sign of abuse or injury should be recorded on a body map or hand drawing. A description should be written including size, shape, colour, positioning etc. You should also take photographs of the abuse as a record. * Do not touch or move anything where the alleged crime took place. This is to prevent vital evidence being destroyed, moved or contaminated. * It is important that you do not touch the victim unless it is for their immediate well-being. This is to prevent any contamination of evidence that may be on the victim.
If you do have to touch or come into contact with the patient in any way then you should document where and why you have done so. Outcome 3 Understand the national and local context of safeguarding and protection from abuse 3. 1 Identify national policies and local systems that relate to safeguarding and protection from abuse The North Yorkshire Safeguarding Children Board (NYSCB) was established in 2006 along with other local safeguarding children’s boards around the country. NYSCB seeks to protect all children against all forms of abuse or from witnessing violence and abuse.
The NYSCB is a multidisciplinary agency with nominated senior members from each member agency, which includes; Children and Young People’s Service, Police and Health. The board also receives advice and expertise from a designated doctor and nurse. The chair of the board is independent of all agencies. The NYSCB has five Locality Forums and Sub-Groups which includes a sub-group in Harrogate. This is to make sure that it meets all its aims and objectives. North Yorkshire Local Authority has a general duty under the Children Act 1989 and Children Act 2004 to safeguard and promote the welfare of children who are in need. The Board’ meets four times a year. Local health authorities have a duty of care to protect those who are in their care. A vulnerable person can be a child or adult and we have to be alert for any signs of abuse. We should then work with other agencies such as the local police and social services, as well as with national agencies like the CQC. Local Police and charities can also offer support and help in instances of alleged abuse. National polices such as Protection Of Vulnerable Adults (POVA) help us deal with adults who may be more at risk of abuse.
If a suspicion of abuse is raised then a referral should be made to Social Services. If there is a case of abuse when the referral is received a strategy meeting is arranged. The case of the vulnerable adult is discussed and information shared with the relevant people/agencies e. g. the doctor and nurse in charge of care of the patient whilst in hospital, a social worker, the police etc. There will then be a Case Conference where the patient in question will be invited along with a person of support should they wish to bring someone.
Plans will be made to offer more support to the patient and to make sure they are safer in the future. Initially the patient will be asked if they want a referral to be made and the allegation to be investigated. But the Police or Social Services may make the decision for the referral to be made if it would prevent anyone else being hurt. Other national policies and acts include: The Mental Health Act 2007, Safeguarding Adults 2005 and the Child Protection Act 1989. 3. 2 Explain the roles of different agencies in safeguarding and protecting individuals from abuse
The Quality Care Commission (CQC) focuses on quality of care, acts quickly to eliminate poor care and make sure care is centred on people’s needs. The CQC follows the requirements set out in the Health and Safety Act 2008 to protect people who use the health and social care services. Where regulations have been breached or a person has been found unfit for work the CQC will undertake any work needed to consider what action is needed and will pass any information to the local safeguarding partnerships (Polices, Social Services, Local Health Authority), normally at a strategy meeting.
If providers of health care fail to meet requirements of law, the CQC has the power to intervene and take any action necessary. The CQC also monitors the use of the Mental Health Act 1983 to protect those whose rights are restricted under the act. If North Yorkshire County Council Social Services receive a complaint about an alleged abuse against a child they will: * Decide if no further action is required or * Offer the family support to resolve any issues or * Call an initial child protection conference if there is good reason to be concerned about harm or risk of harm to a child
If the child is decided to be at risk they will be placed on the child protection register and a child protection plan is made which plans details of how to protect the child and set out the actions for the family and work for each professional involved. The Police have a duty to investigate any accusations of abuse carried against children, young people and vulnerable adults. The Police will be invited to Safeguarding meetings where information will be shared about any cases. 3. 3 Identify reports into serious failings to protect individuals from abuse
One report into serious failings to protect an individual from abuse is as follows: On 25th February 2000, Victoria Climbie died in intensive care at St Mary’s Hospital, London. Victoria died after being subjected to abuse from her great-aunt Marie-Therese Kouao and her boyfriend Carl Manning. At the time of her death she had sustained 128 injuries which were the result of being burnt with cigarettes, beaten with bike chains and belt buckles and she had received hammer blows to her toes. She had also suffered from starvation.
At her great-aunts request, Victoria had been sent to live in France with Kouao where she was to be enrolled in school. However, after just a few months of enrolling her at the school in 1998, the school reported Climbie’s repeated absenteeism and how she often fell asleep in class. She travelled to France and then to England under the passport of Anna Kouao, another girl Kouao was going to take to France but whose parents had pulled out at the last minute. Victoria spent all her life in England known as Anna. They had left France and moved to London in 1999 after Kouao owed the French Government ? 000 paid in wrongful child benefit payments. Between 26th April and June 2009 Kouao and Climbie made 18 visits to Ealing Social Services for housing purposes and the staff noticed Climbie’s unkempt appearance but took no action. When Kouao got a job at Northwick Park Hospital in June 1999 she nor Ealing Social Services made no attempt to enrol Climbie in any day care activities in the first month. In June 1999 Climbie and Kouao met a distant relative, Esther Ackah on the street who noticed a scar on Climbie’s cheek. Kouao said she got the cut on her cheek after falling from an escalator.
But after also visiting Climbie’s house, Akcah thought the housing was unsuitable and anonymously called Brent Social Services on 18th June 1999. They faxed a referral to Children’s Social Services that same day but the referral was not picked up until three weeks later on 6th July. A few days after making the initial phone call, around the 21st June, Ackah range Social Services again where she was told that “something may have been done”. The duty manager claimed Social Services had never received the referral on 18th June but had logged the details of the phone call on 21st June when the details of the case where not deemed very serious.
On 6th July 1999 Climbie and Kouao moved into Carl Manning’s flat and it’s claimed Climbie’s abuse increased soon after. Brent Social Services sent a letter with details of a home visit to the Climbie’s old address but on arriving at the address and finding no answer they made no attempt to find out where the pair had moved to. The two social workers in charge of the case also admitted that they only had the haziest of idea’s what they were investigating. In July 1999 Kouao took Climbie to a friend, Priscilla Cameron’s house, where she was asked to take care of Climbie permanently.
Cameron agreed to take her for the night but for no longer. On 14th July 1999 Cameron’s daughter took Climbie too A & E at the Central Middlesex hospital after being concerned about a small burn on her face and a piece of loose skin hanging from her right eyelid. Kouao claimed the injuries were self-inflicted but later at the inquiry Manning admitted that he had beaten Climbie for repeatedly wetting the bed. After suspicions of abuse were raised by the A & E Senior House Officer Climbie was taken to a paediatric ward where she was placed under a 72 hour Police Protection Order preventing her from leaving the hospital.
But Kouao told doctors that Climbie had Scabies which lead to consultant Ruby Schwartz making a diagnosis of Scabies and stated the injuries sustained to Climbie’s face had be as a result of scratching. At the inquiry Schwartz said she had expected Social Services to follow up the case as they had received a report informing them of Climbie’s injuries, but after the diagnosis of Scabies, Social Services downgraded her level of care. The police officer assigned to the case lifted the police protection allowing Climbie to return home.
Under the Child Protection Act 1989 the officer was obliged to see Climbie on her own before she went home but this meeting never happened as the officer was attending a seminar on child protection. On 24th July 1999 Climbie went to A & E at North Middlesex Hospital with severe scolding to her head. Despite showing signs of neglect and physical abuse, consultant Mary Rossiter wrote “Able to go home” in her notes. In the inquiry, however, she said she did not mean that she wanted Climbie to actually go home but Climbie was, again, allowed to go home to her abusers.
For a short time during her stay in hospital Enfield Social Services took up the case before passing it to Haringey Council. A police officer and a Social Worker from Haringey Council were assigned to the case; however, they cancelled a scheduled appointment for the 4th August 1999 after they heard about the “scabies”. Neither, the police officer or the social worker knew anything about scabies so rang the Middlesex hospital for advice. The hospital told them they had not dealt with a case of scabies.
A doctor told the police officer that the injuries sustained by Climbie were consistent with a belt buckle but the officer claimed in the inquiry there was no evidence of child abuse. After the second admission Kouao kept Climbie away from hospitals and preferred instead to take her to churches to be cared for by the pastors. On one occasion she took Climbie to the Universal Church of the Kingdom of God where the pastor suspected Climbie being a victim of physical abuse. Kouao had told him that the injuries the Climbie had suffered were due to the fact that she was possessed.
The pastor took no action in reporting the injuries though, as he believed that a person could be possessed. During her short time in England, Climbie was known to four local authorities, two child protection police teams, two hospitals, an NSPCC centre and a few churches, yet she was allowed to go unprotected from the hands of two people who routinely and systematically abused her. Climbie’s death has lead to changes in child protection laws in England including the introduction of the Child Protection Act 2004. 3. Identify sources of information and advice about own role in safeguarding and protecting individuals from abuse All health care services will have their own policies relating to safeguarding. These policies provide information and advice on what you should do if an issue of safeguarding arises. At Harrogate District Foundation Trust these can be found on the intranet and also via e-learning services. There are various child protection policies found on the intranet. Colleagues are a vital source of information, support and advice.
Colleagues may also have experience of safeguarding issues and can help with the understanding of policies, procedures and ward based training needs. Training is another valuable source for advice and support. Safeguarding training like the Level 3 Safeguarding Children course is mandatory for all staff who work with children and all other staff in the hospital must be trained in Level 2 Safeguarding Children. Agencies like Social Services and the police offer support and information on their practices and how they carry out investigations.
When the need arises, they will also share information between themselves and the local health authority and will attend safe guarding conferences. Outcome 4 Understand ways to reduce the likelihood of abuse 4. 1 Explain how the likelihood of abuse may be reduced by: * Working with person centred values – which can include individuality, rights, choices and dignity. It’s important that a patient has a say in the care they receive and how they receive it. If you treat a patient as an active member of their care then you pay greater attention to the care you give.
This should reduce the risk of allegations of abuse and neglect. * Encouraging active participation – if you involve the patient in their care plan and talk with them instead of about them they will feel like they still have control over their care. If a patient feels involved in all aspects of their life and feel they are listened to and able to voice opinions they are more likely to speak out if they are being abused or treated unfairly. * Promoting choice and rights – this means people can see they are being listened to and are being taken seriously.
Having confidence in patients and the choices they make encourages openness and they will voice any concerns they may have. 4. 2 Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse A patient who raises a complaint may have needed a lot of courage to say anything in the first place, even if there is good, open communication between staff and patients. Complaints need to be taken seriously and actions need to be set in motion as soon as possible. There may not be an easy, speedy resolution to a compliant but the patient must be kept fully informed at all stages of the complaints procedure.
This, whilst not completely allying their fears, will at least let them know that their complaint has not been forgotten. The first step to take when dealing with a complaint would be to talk to the nurse in charge, ward sister or ward manager as soon as possible. However, if a complaint is against a member of staff on the ward or a doctor, they may not feel comfortable talking to another nurse on the ward. In this instance the patient can be referred to the Patient Experience Team (PET) within Harrogate District Hospital.
PET can explore options available to the complainant, ask them what they hope to achieve and work with them to achieve their goals. PET can also provide information about Advocacy services which can offer support to the complainant. Support is a very important thing to offer to anyone making a complaint. This will hopefully make sure that, as long as the complaint is genuine, the person will not drop the complaint at any time. Any complaints need to be carried through to a satisfying outcome so that the same mistakes aren’t made again in the future.
Having supportive, easy complaints procedures in place for staff, patients, relatives and carers makes it harder for abuse to go unnoticed. Outcome 5 Know how to recognise and report unsafe practices 5. 1 Describe unsafe practices that may affect the well-being of individuals Poor work practices can cause unnecessary pain and suffering to patient and put staff and patients at risk. They can include: * Not moving a patient properly e. g. only one member of staff helping a patient out of bed when two staff members may be needed. Not helping a patient take medication which could be vital or help a patient ease their discomfort * Not disposing of waste properly – if a sharps bin is overflowing, a needle could fall out unnoticed and harm someone who will then need blood tests and potentially any medication to counteract any side effects. Bins should not be left to fill with rubbish and overflow. Any waste, especially that from patients with infections can easily spread the infections throughout the hospital * Lack of resources which includes lack of training/lack of knowledge, lack of time, understaffing and lack of/poorly maintained equipment.
Staff should be trained how to use equipment properly and how to maintain it, they should also receive training on moving and handling patients safely and how to recognise the signs of abuse. Understaffing could mean patients don’t receive the full care and attention they need. 5. 2 Explain the action to take if unsafe practices have been identified 5. 3 Explain what to do if nothing has been done in response If I have identified problems with unsafe practices then I would firstly report my concerns to the nurse in charge or my line manager.
I would make a written record of any compliant that I have made via the Datex forms found on the Harrogate District Foundation Trust intranet. There may be ways that I could stop any unsafe practices myself, for instance reporting any broken equipment or replacing hand gel in dispenses. There could be unsafe practises that I could not stop myself but by escalating these issues I would expect the problems to be rectified and problems made safe. But, if nothing was done about issues then I would escalate to my matron or chief nurse and I could use the whistleblowing policy or report any failings to a governing body like the CQC.