Safeguarding and Child Protection in Healthcare

Introduction

Safeguarding is a fundamental concept that involves the responsibility of protection of children, the youth and vulnerable adults from factors such as harm or abuse, discrimination or neglect. This responsibility mostly falls upon organizations; an organization has the duty of ensuring that their employees, partners, programs, vendor or volunteers do not harm the aforementioned groups of people (Braye et al, 2011). Organizations should also ensure that any concern regarding the safety of these groups of people is dealt with and that if occurred, are reported to the authorities tasked with the mandate of tackling the issue (Department of Health, 2010).

The concept of child protection is no different from safeguarding. It is basically the process by which structures and measures are designed to prevent or deal with abuse or harm inflicted to individual children through work programs or actions. Child protection involves protecting the child from suffering or risk of harm.

In general medicine, adult abuse is a significant cause of harm experienced by the patients. There is a fundamental duty to act on the complaints and to protect those who require protection by the doctors. It is therefore crucial to look at the presentation and the effect of abuse on general hospital settings and how the same can be curbed within these settings. It is also important to look at the evolution and development of child protection and safeguarding practices over time and illustrate the principles within which approach towards safeguarding practice has been done (Boland et al, 2014). Child protection and adult safeguarding is everybody’s business. According to Johnson & Boland (2019), this work is complex in nature and can therefore offer a number of difficulties in its practice to professionals. It is estimated that one in four adults who are vulnerable are at risk of abuse or harm. This is, however, not just limited to older people (Gibson et al, 2016). This basic fact presents the significance of this topic in both local and professional practice.

This study significantly aims at critically analyzing the policies and measures in practice surrounding safeguarding and in doing so, presenting systematically reviewed evidence on the development of safeguarding in practice. In doing so, the most viable solution to the case study has been provided.

The Development of Safeguarding

The concept of child protection and adult safeguarding has grown over the years, with increasing population being made aware of the fact that children, the youth and adults who are vulnerable are exposed to risks of neglect, abuse, discrimination and exploitation by people in positions of power and trust over them (Dixon et al, 2013). International development activities have also contributed towards this growth. As a result of this growth, efforts meant to ensure that there is no infliction of harm resulting from the activities of different organizations and settings have significantly increased. This increased number of efforts and measures towards the realization of a protected population has often been implemented towards target communities and populations. Employees, partners and volunteers have, in that regard, to engage with the members of the groups of people concerned either directly or indirectly.

There is a growing awareness of adult abuse at the risk of inflicting harm. This often- hidden problem has, through a number of significant occasions, been brought to the attention of various national governments, including the UK. For instance, the horrific and displeasuring abuse of individuals with learning disabilities was revealed by the BBC’s Panorama programme ‘Undercover care, the abuse exposed’, accessible through www.bbc.co.uk/programmes/b011pwt6 (Boland et al, 2014). The incident occurred at Winterbourne View Hospital. This incident justifiably led to the arrest of a number of people, and consequently, the conviction of 11 of them, all of whom were employees of the hospital.

Whenever safeguards are insufficient, harm is inflicted upon patients. The findings of the Francis Report within the NHS Foundation Trust have recently highlighted the results of the deficiencies of safeguards (Boland et al 2014). Safe guarding incidents have presented themselves in various parts of the UK and across social and health care sectors. This has been shown by data collected from the Health and Social Information Centre (Health and Social Care Information Centre, 2013).

Reasonable measures to protect and safeguard the mentioned population groups have to be put in place by the relevant organizations. These measures include those meant to protect the people whom we work and the communities which undergo such risk. Regardless of whether agencies play reactive or proactive roles, all agencies need to clearly understand their role in adult safeguarding (Stevens, 2013). The appropriate agencies need access to relevant information in timely manners, effective communication of information continues to be a problem and not only to the demands of the provisions of data protection.

Poor communication has often been identified to be major problem in the maintenance of effective safeguards of vulnerable adults (Reid et al, 2009).Service users should be empowered in a bid to strengthen this practice. This adult safeguarding practice process continues to pose challenges in multi0 agencies. This is despite the efforts made by these agencies towards their commitments to working in partnerships. The concept of child protection and adult safeguarding is now a moral duty of every individual. This concept is now a standard practice in clinical practice. As a result, clinicians have to undertake safeguarding training as a fundamental training in England (Johnson & Boland, 2019). The aim of governments should be the improvement of better communication between the states and the organizations involved. As a result, the Protection of Freedoms Act 2012 was introduced by the UK government. Consequently, the services of the Independent Safeguarding Authority were merged with the Criminal Records Bureau. This formed a new organization, known as the Disclosure and Barring Service. The operations of this newly formed organizations aim towards ensuring that only acceptable people continue to work with the service- user group members; children and vulnerable adults (Home Office, 2012).

Literature Review

According to Tseloni et al (2010), international trends have depicted continuous declines in the rate of crimes in the UK since the 1900s. The majority of calls to the police are now characterized by incidents which are classified as non- crimes; these include incidents of public protection, vulnerability and safeguarding. The change in statistical data has called for changes in policy from focus on crime- oriented guidelines or policies towards focus on community measures of prevention and vulnerability (Bartkowiak-Theron & Asquith, 2017).

There is need of a clear understanding in the role agencies play in adult safeguarding (Perkins et al, 2007). This aspect poses the need for agencies to access appropriate information in their fight against negative factors involved in adult safeguarding. As earlier stated by Stevens (2013), one of the major contributory factors to ineffective safeguarding practice is poor communication. For instance, a number of warnings and opportunities missed for intervention were revealed from the serious case review of Stephen Hoskin. In this instance, there was availability of adequate information across partnership agencies; however, the failure to share this existing information resulted in avoidable death (Flynn, 2007).

Stevens (2013) also explores the concept of empowerment as a significant tool in safeguarding practice; in that through service- user’s empowerment, the quality of safeguarding is improved. There are, however, certain organizations which operate in risk- averse environments where this aspect is weighed against risk reduction. In these organizations, therefore, there is the day- to- day dilemma of the balancing of empowerment to the behaviors associated with risk taking while working in a culture where the risk is averred (Allen and Brodzinski, 2009). Although the roles and responsibilities of practitioners are still unclear, the Department of Health (2012) in the UK has outlined the government’s objective as to ensure better integration through clarifying the roles and duties across the whole system.

When it comes to adult safeguarding, Brown (2010) emphasizes on the concept of ‘vulnerability’. However, in using the terms ‘vulnerable adult’, it is criticized that there is an increased likelihood of self- inflicted harm. For instance, the individuals may be treated to be unable to make their own decisions, this treatment by practitioners makes them disempowered making them ‘vulnerable’. The creation of vulnerability is dependent on how the society constructs the term. This idea has also been shared by Hollomotz (2011). This study also shares the same argument.

As a result of the effects of social construction, Williams (2011) provides support to the suggestion made by the Department of Health that the use of the term ‘vulnerable adult’ should in fact be discouraged, and instead the terms should be replaced by ‘adult at risk’. This enables focusing on the risk, rather than focusing on the individual vulnerability. The use of this suggested term provides for a better reflection on policies and the relevant legislations. Critics however highlight that there may be the danger of a widened scope of who is to be protected. The use of the terms ‘adult at risk’ does not provide for specificity. Therefore, there may be confusion regarding the subjects of safeguarding adults. Without clear and appropriate legislation, the scope of the work on safeguarding adults is widened and may be differently interpreted across various settings.

Everyone can be exposed to possible abuse circumstances. There are, however, specific people who may be at risk of being abused because of some circumstances; these circumstances may include social circumstances and medical conditions. These specific and identified circumstances increase the likelihood of abuse and harm. This concurs with the findings of Straughair (2011). Mencap (2012) also goes on to outline the fact that there is four times the risk of an adult with disability being subjected to abuse and harm, compared to an adult without disability. This ‘abuse’ may occur in various ways. In his study, Mencap (2012) identified abuse to occur commonly in the form of neglect; this particularly points towards psychological abuse. The study by Stevens (2013) also highlights the aspect of financial abuse being common to the elderly people. 70% of the cases are being induced by a member of the victim’s family. Existing research may even be unable to accurately estimate the prevalence of this type of abuse. This is because this abuse is often hidden and very well undetected. Within the concept of personalization, it is paramount to consider issues of mental capacity and to balance the concept of empowerment to the risks. It is important for an individual practitioner to reflect on the responses and measures to vulnerable adults and to share the learning to other professionals.

There are three concepts involved when it comes to safeguarding, according to the government (Stevens, 2013). These three concepts have been highlighted to be protection, empowerment and justice. The dilemma that arises in practice entails an overlap in empowerment where the individual makes decisions that seem to be unviable. These individuals should, according to the concept of empowerment, always retain the right of making decisions, even if they make poor decisions. Multi- agencies, governments, organizations and other individuals involved should, therefore, balance this concept with the elements that bring about risk. Safeguarding should empower the service users; work that has failed to involve service users has been criticized in existing literature.

Methodology

This study presents an empirical exploration; entailing a systematic review of a variety of relevant literature and relevant policies. The study presents evidence on the development and the challenges faced in practice in safeguarding. The systematic review was conducted in a bid to identify some of the key elements that need further research and investigation. A number of databases were involved in the review: Cochrane, Medline, PsycINFO, Cumulative Index of Nursing and Allied Health Literature among other databases. A literature search was conducted across these databases. The process of literature search is an academic and well organized process focused on collecting literature only relevant to the topic being studied (Harvard, 2007).

Inclusion and Exclusion criteria

Literature search was based on key terms such as ‘adult safeguarding’, ‘abuse’, ‘child protection’ and ‘policies’. The inclusion criteria fundamentally focused on peer reviewed and published articles. Only literature related to nursing and social work were included in the review. Research based on mental health and behavioral sciences was also included as they are reliable in regards to safeguarding. The research also included literature that contained up to date information; focusing on literature that was published between 2010 and 2020. Literature found and utilized involved a range of sources; the study also included government guidelines and policies. The figure shows these criteria.

Case Study: Discussion

This study presents a complex case of safeguarding; mainly bringing out the concept of referral:

Mr and Mrs Siddiqi, Eman, Nahal and Mrs Awan all live in a privately rented property in the UK. There are concerns as to the cases of abuse or harm of both Mrs Siddiqi and Mrs Awan. The neighbor presented complaints of loud banging, shouting and swearing from their address.

Issues on safeguarding often occur obliquely. On analysis, it is in rare occasions that the abuse becomes the presenting complaint. A professional recognized by the person is often the one who raises concerns of abuse. These professionals include the social workers, home care givers or the members of the family. When working with adults at risk, clinicians should also acknowledge the possibility of undisclosed abuse (Boland et al, 2013).

Several themes emerge from the analysis of the case study. Firstly, there is unanimous concern over the prevailing inconsistencies in the definition of the scope and threshold of abuse of adults and the labelling of adults at risk as ‘vulnerable adults’. The second theme points towards the complexity in practice, especially in cases where empowerment has to be balanced to the elements of risk (Stevens, 2013). Issues were made even more complex in situations that involve considerations of mental capacity.

Safeguarding incidents have contribution greatly to the creation of awareness and the development in the changes in policy in safeguarding. Over 152 councils, 165 adult safeguarding referrals were made in 2011-12. These referrals were mostly made by the staff in social care. Staff in health care made fewer referrals. This is possibly because of the lack of awareness and identification of suspected abuse (Boland et al, 2014). There is need to understand the responsibilities of doctors in secondary care, especially those that arise for the procedures and policies that surround safeguarding adults. This is primarily because many of these patients can be considered to be adults at risk.

Following the implementation of the Care Act, statistics gathered have displayed the doubling of cases of adult safeguarding. Stocktakes compiled suggest the rise in safeguarding referrals, highlighting around 73% of councils involved in the increase (Community Care, 2017). Gibson et al (2016) present some of the complexities that may be presented to general practitioners in regard to safeguarding adults; these very complexities can be seen in the case study

Gibson et al (2016) also state that after receiving complaints or concerns, a person is required to legally act in a manner that is meant to protect the victim from risk. Certain factors should be taken into account; wishes, beliefs and feelings of the respective individual. First, the person addressing the safeguarding issue should mitigate any danger, then make safeguarding referral where deemed relevant. Before making a referral, it is crucial to ensure that the patient fits the criteria laid out for an adult at risk. The mental capacity to consent is also an important factor in making referrals. In cases where the patient lacks the capacity to consent, referral in their best interests is acceptable. The patient can be deemed to be unable to make a decision if:

(a They cannot comprehend information on the decision they should make

(b They are unable to retain the information in their minds

(c They cannot balance the information with the choices they make

(d They cannot clearly communicate their decision

The implementations of new policies, including the Care Act, underpin certain guiding principles in safeguarding. Protection from abuse and neglect has been cited as one of the key factors in the promotion of individual well- being. Six principles arise according to analysis from Johnson & Boland (2019); empowerment, prevention, proportionality, protection, partnership and accountability.

Conclusion

Recent developments in policies that are aimed towards safeguarding importantly consider involving service- users in the making of the decisions. This development of personalization aims towards giving the service users increased choice and control over their own social and health care. To support empowerment, the principles of autonomy and independence can be promoted through both safeguarding and personalization (Carr, 2011).

Personalization constitutes a very important element in the transformative care and support for the service groups (Department of Health, 2012). The study also further recommends implementation of protection of service user procedures. There should be better sharing of information between the organizations and the state. Safeguarding remains to be a very important activity that aims at protecting children and adults at risk. The way forward is guided by the ethical and policy frameworks of the national government. The individuals are tailored by the interventions and responses. It is necessary to know and understand what to do in such cases of abuse, how to react or respond to prevent abuse and where necessary, to know when to make a referral in safeguarding (Boland et al, 2014). Additionally, through the UK Care Act 2014, various differences in safeguarding measures have been shown. All in all, this policy emphasizes service user empowerment and the overall well- being rather than just focusing on their safety (Johnson & Boland, 2019). I would therefore advise on referral and effective communication to the relevant authorities.

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