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NVQ level 5 Lead person centred practice

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    Person centred practice are ways of commissioning, providing and organising services rooted in listening to what people want, to help them live in their communities as they choose. These approaches work to use resource flexibly designed around what is important to an individual from their own perspective and work to remove any cultural and organisational barriers. People are not simply placed in pre-existing services and expected to adjust, rather the service strives to adjust to the person. Person – centred practice is treatment and care and considers the needs of the individual. Person centred practice:

    Persons perspective is listened to and honoured.
    Individuals have a role in planning the supports they receive and the staff that are hired. Regularly look at peoples lives to see what is working and not working. Employees know their roles and responsibilities in supporting people. Staff are matched with people based on skill and common interests. Person-centred practice is treating patients as they want to be treated.

    This involves: GETTING TO KNOW THE PATIENT AS A PERSON- health care workers need to get to know the person beyond the diagnosis and build relationships with patients and carers. SHARING OF POWER AND RESPONSIBILITY – respecting preferences and treating patients as partners in setting goals, planning care and making decisions about care, treatment or outcomes. ACCESSIBILITY AND FLEXIBILITY – meeting patients individual needs by being sensitive to values, preferences and expressed needs. Giving patients choice by providing timely, complete and accurate information they can understand, so they can make choices about their care. COORDINATION AND INTEGRATION – working as a team to minimise duplication and provide each patient with a key contact at the health service. Teamwork allows service providers and systems working behind the scenes to maximise patient outcomes and provide positive experiences. ENVIRONMENTS – physical and organisational or cultural environments are important, enabling staff to be person centred in the way they work.

    1.4, EXPLAIN HOW PERSON CENTRED PRACTICE INFORMS THE WAY IN WHICH CONSENT IS ESTABLISHED WITH INDIVIDUALS. Person-centred care has been defined as treating people as individuals and ensuring they are fully involved in the planning process. By being involving, discussing and consulting with the individual regards their care plans, it can be deemed that verbal consent has been given to the care provider. By enabling the individual to make choices and contribute in the decision making process the individual has consented to the care to be administered. Choice involves providing the person with alternatives from which to choose and respecting the decision that is made, as far as possible. Consent means giving permission, an informed decision, permit, approve or agree. A persons capacity to consent is considered to be affected by three main processes: comprehension ( ability to understand and retain information ) decision making ( ability to weigh up information and reach a decision) and communication ( ability to communicate the decision made ) A person may be unable to give consent for several reasons including: Mental health problems

    Brain injuries
    Learning disabilities
    Legally a competent adult can either give or refuse consent to care, even if that refusal may result in harm to harm to them. You must respect their refusal just as much as they would their consent. It is important that the person is fully informed with regards the consequences of their refusal EG: medication has been refused. If an individual refuses to give consent a record should be made. If an individual lacks the Mental Capacity to give consent to care. The Mental Capacity Act 2005 allows people over the age of 16 to appoint a proxy decision maker. The MCA has been in force since 2007 and applies to England and Wales. The primary purpose of the MCA is to promote and safeguard decision making within a legal framework. It does this in two ways: By empowering people to make decisions for themselves wherever possible and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision making process. By allowing people to look ahead for a time in the future when they might lack the capacity for any number of reasons.

    1.5, EXPLAIN HOW PERSON CENTRED PRACTICE CAN RESULT IN POSITIVE CHANGES IN INDIVIDUALS LIVES. Person centred planning can be a life changing, enriching experience and is now evidenced based practice. Recent research ( Robertson et al, 2005 ) has shown that person centred planning is associated with benefits for individuals and led to significant changes in the areas of social networks, contact with family, contact with friends, community based activities, scheduled day activities and levels of choice. Results:

    30% increase in size of social networks
    2.4 times more contact with family
    41% increased contact with friends
    35% increase in activities
    2.8 times more choice making.

    3.1, EVALUATE HOW ACTIVE PARTICIPATION ENHANCES THE WELLBEING AND QUALITY OF LIFE OF INDIVIDUALS. Wellbeing and quality of life for most people is enhanced through meaningful involvement and activity. It is crucial that individuals are involved in decisions that affect them. There are many ways in which such involvement can be facilitated and encouraged. Services should recognise the importance of social contact and companionship and on-going links with social networks. Your organisation should support continued community involvement, easy access to transport and the opportunity to participate in social and leisure activities. Maintaining social contact is also important to social identity and fulfilment. Active support is a proven model of support that encourages people with learning disabilities to plan the best use of their time, with the correct level of support to engage or participate in all activities that make day -to-day living. It empowers and motivates, changing the focus of support from caring for to supporting and working with. Active support underpins all areas of health and social care as it is so person-centred values into action. Services are changing their approach to support from the “hotel” model to the active support model. Active participation is an approach that enables individuals to be included in their care and have a greater say in how they live their life in ways that matter to them. The benefits of active participation can be divided into primary benefits and secondary benefits.

    Primary benefits include:
    Physical benefits including greater activity levels.
    Increased independence and autonomy in what people do.

    An opportunity for individuals in health and social care settings to have a say in matters of direct concern to their lives. Increased opportunities for social contact and interpersonal relationships. Encouraging involvement and self-awareness. Individuals become more involved in the community and more aware of opportunities and what they can hope for themselves. Increased opportunities for learning and development of important skills, knowledge, education and employment. Enhanced wellbeing with increases in self-confidence, self-esteem and self-belief. The benefits of active participation included the above primary benefits where the individual gains from its application in real world of health and social care practice but there are also some secondary benefits.

    The secondary benefits: can be described as benefits that occur as a result of active participation but are not a direct aim of active participation. These included: Decreasing the likelihood of abuse. As the individual engages positively by actively participating is area of their life, such as in personal care, the scope for abuse by others is reduced. Decreasing vulnerability. As individuals gain in their self-confidence and self-esteem they are less prone to exploitation and harm from others.

    Active participation is an approach that empowers individuals in the activities and relationships of everyday life leading to them living as independently as possible. The importance to the individual as an active partner in their own care or support is that it brings physical, psychological, relational and over all wellbeing benefits. Service user participation has resulted in an impact upon the service users, themselves, the organisation and also what the organisation does. For individual service users, the benefits of participation may include increased confidence and self-esteem, the chance to acquire new skills and improved material resources if, for example it helps them to acquire paid employment.

    Participation leads to greater satisfaction and improved quality of life for instance, older people mental health service users and people with disabilities who have had greater control in decisions about the support they receive, report greater satisfaction and better health than those who have not. LISA GOTTS.

    Today caregivers are adopting outcomes based practice methods to achieve desired patient care goals. Outcomes based practice ( sometimes called outcomes management ) involves a combination of teamwork, continuous quality improvement and process and outcome measurement. Outcome based care is about putting the person at the centre of the care service and not prescribing a standard service to everyone. It is about delivering meaningful outcomes to every individual and helping people to lead more fulfilling lives. Outcome based care requires careful planning which involves working with the people who use our services to help them identify and achieve the things they want to do. Delivered well, outcome based care increases interest and motivation and creates the enthusiasm needed to support people to lead a more fulfilling life. Key benefits of outcome based care:

    The service users desires, aspirations, abilities and talents are explored and utilised to help ensure they lead a more fulfilling life. It empowers care workers to work more closely with service users to understand how best to enable their independence. The service can respond more easily to changing needs and preferences. It contributes to maintaining a service users independence.

    It enables service users to exercise more choice and have more flexibility in the day-to-day delivery of their service. It encourages partnership working between all stakeholders involved in the delivery and management of an individuals care. It uses resources such as funding and time to gather effect. It provides a basis for evaluating the effectiveness of services. A fundamental part of outcome based care is looking for opportunities to
    support people in activity throughout the day. This means thinking about the activities that need to be completed- key tasks such as personal care, travel or meal preparation. The practice of outcome based care ensures that service users are involved in their daily living choices, no matter what their physical or mental ability. Of course not everyone using our support services can undertake all tasks independently, people need different levels of support. The role of the care worker is to provide enough support to enable the service users successful participation. A key principle of outcome based care is helping service users to engage little and often so that they build up experiences of success and increase their motivation.

    1.2, DESCRIBE HOW YOU CRITICALLY REVIEW APPROACHES TO OUTCOME BASED PRACTICE. Outcome based practice was introduced as a new way of working. Instead of, a needs based approach to care and the support offered, it became outcomes/results based accountability. A ‘needs’ based delivery of care was difficult to measure in terms of success or failure where as an ‘outcome’ based delivery was more focused on achievement. Outcomes in a social care context are concerned with quality of life rather than simply levels of ability, health, employment or housing status. At a community level this can be about people feeling safer, people being healthier, communities being stronger. At an individual level outcomes can be framed in terms of the steps a person needs to take in order to improve aspects of their lives relating to their own safety and security. For instance: Outome based practice is a disciplined way of thinking and moving from ‘talk to action’ quickly- from strategy to implementation. It is about re-focusing on the difference you are making to peoples lives, meeting their goals- knowing where you/re heading helps you change what your doing. Outcome based practice:

    Offers a framework for strategic planning and enables all stakeholders, commissioners, service providers and communities alike, to improve the lives of children, young people, families and adults. Helps identify the activities that will make the most difference to individuals and communities. Can be used to improve the improve the performance of programmes, agencies and service systems through compelling links between
    service activity and outcomes for users. Can dramatically improve partnership working by creating a common language, shared ownership and maximising the contribution of all stakeholders.

    Outcome based practice focuses on the individuals goals and steers the carer away from a needs based care delivery. It also has measurable aims and objectives where needs based care has not. The work becomes driven and specific because there is a goal in mind. When outcomes were first introduced into care some care professionals had difficulties seeing the differences between an ‘outcome’ and a ‘need’. some professionals felt their role had been reduced because the individual became the ‘expert’ in their own care and the centre of the planning. This meant the care professional needed to come to terms with this new way of delivering services.

    Program planning or management tools are outcome models that assist in an efforts proposal, funding and implementation phases. They illustrate the logic, theory of change and anticipated flow of an intervention, providing markers against which both incremental and ultimate progress may be measured Models:

    1, The logic model: the most widely used of these models, providing a graphic overview of a program, outlining the outcomes to be accomplished along with how they are to be achieved and for what groups. A logic model generally includes the target group, the resources to be used activities and objectives. Best used for describing a program in the broadest strokes, it can be an extremely useful tool particularly at the earliest stages of a project.

    2, Outcome funding framework: stresses key shifts in the thinking that traditionally has influenced human service programs. It encourages funders to think like investors and encourages programs to shift from emphasizing service activities to focusing on performance targets, defined in terms of client changes gained. The model also uses milestones, or sequential steps toward achieving ultimate targets, to allow for ongoing assessment and
    mid-course program corrections.

    3, Results based accountability ( RBA): Starts with the desired ends and works backward toward the means to achieve them. RBA first describes what a desired result would look like, then defines that result in measurable terms and finally uses those measures to gauge success or failure. RBA asks and answers three basic questions, what do we want, how will we recognize it, what will it take to get there. This model distinguishes between population accountability and program accountability. Its inclusion of the crosswalk, a tool for matching RBA with other outcome models, is a unique and useful aspect of the framework.

    4, Targeting outcomes of programs (TOP ): based on a hierarchy of sequential steps in planning, implementing and evaluating programs. It helps answer four basic questions: why have a program, how should it be conducted, has the program design been implemented, what are the benefits delivered.

    1.4, EXPLAIN HOW OUTCOME BASED PRACTICE CAN RESULT IN POSITIVE CHANGES IN INDIVIDUALS LIVES. Health and social care is increasingly moving towards outcomes-based services. An outcome describes the measurable impact of the service on a persons life. Every individual has different needs and goals and an outcomes-based service places these at the heart of its delivery rather than using a ‘one sixe fits all’ approach. This represents a major shift in the way services are designed, commissioned, delivered and evaluated. The importance of outcomes in social care has been widely recognized for many years. A focus on outcomes which encourages service users to express the outcomes they want for themselves provides scope for user empowerment and choice. It involves moving from a traditional activity-based approach to serve planning and delivery to a more flexible and responsive model where new thinking is needed about how to measure success. Outcomes based approach is used as a means of improving performance, accountability and consistency in service provision which can only result in positive changes in individuals lives. Outcomes refer to the impacts and end results of services on service users. They may be general EG: improve the health of older people or individualized and person-centred
    where they based on the priorities and aspirations of individuals. Whether or not outcomes are perceived as successful may depend not just on the activities and skills of service providers and care managers but also on the goals and expectations of service users. By involving people in thinking and planning for their own services it also creates a more responsive service which is able to respond to users changing needs and preferences. Outcomes will be monitored and reviewed regularly to ensure the service is continuing to meet the service users wishes and needs. EG: whilst the overarching outcome might be for an individual to regain independence and control over his own life, progress may be better monitored if there are a series of bite-sized outcomes such as being able to: Make a simple meal

    Dress and undress without help
    Wash or shower on their own
    Organise own shopping needs
    And so on for the whole range of other activities of daily living. This is likely to give the individual a more rapid sense of achievement as areas of independence and regained. Benefits of outcome focused care planning:

    Promotes independence and responsibility (empowerment )
    Improves use of key social work skills- communication, negotiation, partnership working, task or goal centred planning ect. Enables people to exercise some choice and control which will hopefully lead to an improved quality of life. Treating people as individuals- feeling valued and respected. Compatibility with and respect for cultural and religious preferences. Puts the service user at the centre of the assessment- having ‘a say‘- takes account of preferences. Raises expectations within the community about what can be achieved and promotes the use of the community as a resource. Prompts you to consider different ways of meeting need and achieving outcomes.

    Psychological health is important with respect to how we function and adapt and with respect to whether our lives are satisfying and productive. As manager this applies to both your staff and the people in our care. General
    well-being does simply mean that you are free from anxiety and depression. People with long-term physical health conditions will often have psychological and emotional needs resulting from the burden of illness-related symptoms, the disability associated with the physical illness and the impact of living with more than one physical condition at any time. The links between physical and mental health are clear. There are shared risk factors for illness: illness regularly presents with both psychological and physical symptoms and being physically ill, particularly on a chronic basis, often has an impact on mental health and psychological wellbeing. The concept of holistic health and well-being incorporates several different facets including physical, intellectual, emotional and social.

    Theories relating to the psychological basis for well-being: Well-being is a dynamic cincept that includes subjective, social and psychological dimensions as well as health related behaviours. The Ryff Scales of psychological well-being is a theoretically grounded instrument that specifically focuses on measuring multiple facets of psychological well-being. Definitions of Theory-Guided Dimensions of well-being:

    High scorer: possesses a positive attitude towards the self acknowledges and accepts multiple aspects of self, including good and bad qualities, feels positive about past life. Lower scorer: feels dissatisfied with self, is disappointed with what has occurred with past life. Is troubled about certain personal qualities, wishes to be different than what he or she is. Positive relations with others

    High scorer: has warm, satisfying, trusting relationships with others, is concerned about the welfare of others, capable of strong empathy, affection, and intimacy, understands give and take of human relationships. Low scorer: has few close, trusting relationships with others, finds it difficult to be warm, open and concerned about others, is isolated and frustrated in interpersonal relationships, not willing to make compromises to sustain important ties with others. Autonomy

    High scorer: is self-determining and independent, able to resist social pressures to think and act in certain ways, regulates behaviour from within, evaluates self by personal standards. Lower scorer: is concerned about the expectations and evaluations of others, relies on judgments of others to make important decisions, conforms to social pressures to think and act in certain ways. Environmental mastery

    High scorer: has a sense of mastery and competence in managing the environment, controls complex array of external activities, makes effective use of surrounding opportunities, able to choose or create contexts suitable to personal needs and values. Low scorer: has difficulty managing everyday affairs, feels unable to change or improving surrounding context, is unaware of surrounding opportunities, lacks sense of control over external world. Purpose in life

    High scorer: has goals in life and a sense of directedness, feels there is meaning to present and past life, holds beliefs that give life purpose, has aims and objectives for living. Low scorer: lacks a sense of meaning in life, has few goals or aims, lacks sense of direction, does not see purpose of past life, has no outlook or beliefs that give life meaning. Personal growth

    High scorer: has a feeling of continued development, sees self as growing and expanding, is open to new experiences, has sense of realizing his or her potential, sees improvement in self and behaviour over time, is changing in ways that reflect more self-knowledge and effectiveness. Low scorer: has a sense of personal stagnation, lacks sense of improvement or expansion over time, feels bored and uninterested with life, feels unable to develop new attitudes or behaviours.

    4.1 EXPLAIN THE NECESSARY STEPS IN ORDER FOR INDIVIDUALS TO HAVE CHOICE AND CONTROL OVER DECISIONS. An informed choice means that a person has the information and support to think the choice through and to understand what the reasonably expected consequences may be of making that choice. It is
    important to remember that too much information is presented to them. Professionals and organisations must be able to demonstrate that they have taken these individual needs into account. Enabling people to make informed choices does not mean the local authority or provider organisation should abdicate its responsibility to ensure people have a good quality of life. EG: if a person chooses to stay in bed all day, every day, the local authority or provider organisation has a responsibility to explore what is happening and respond to this appropriately, working to ensure that the individual fully understands the consequences of their decision. It is not acceptable to simply accept such a decision at face value if this would put the individual at significant risk, as acts of omission can be considered to be abusive. It is important to involve people in decisions even when they do not use speech as their main means of communication. Person centred planning techniques point us towards many ways of listening to people in different ways other than relying on what they actually say, using tools such as learning logs, communication charts and supported decision making agreements and these should all be utilised if we are to demonstrate that we have truly attempted to communicate effectively with an individual. It is also imperative that professionals and organisations ensure that the views of others who know and care about the person are invited and taken into account in any decision making process, without these taking precedence over the individuals views and wishes. Where we are supporting people who have complex communication needs, person centred approaches are essential to ensure peoples involement in decisions which affect their lives. The steps to follow to ensure the individual has choice and control over decisions, when discussing outcomes they wish to achieve should be: Step 1

    Ensure who the individual wishes to be present and involved in any discussions and meetings. Step 2
    Ensure the individual understands the process as you proceed and can communicate their wishes. Step 3
    Seek consent from the individual to access information from others such as social worker, hospital. Never break confidentiality with others. Step 4
    Record everything discussed and check the individual agrees with your records by asking them to sign an agreement. Step 5
    Be open to feedback and regular evaluation and review of the plan to ensure it is working. Individuals needs and preferences constantly change.

    5.3 USE APPROPRIATE APPROACHES TO ADDRESS CONFLICTS AND DILEMMAS THAT MAY ARISE BETWEEN INDIVIDUALS, STAFF AND CARERS, FAMILIES AND SIGNIFICANT OTHERS. A typical day probably involves a race to coordinate resources, provide care, perform procedures, gather data, integrate information, respond to emergencies, solve problems and interact with diverse groups of people. In your role as health care professional you probably face more conflict and greater complexity than any other profession. The challenges of balancing competing interests, philosophies, training backgrounds, the endless quest for adequate resources and the emotional quality of the work you do, means conflicts and dilemmas are bound to occur during the courses of your practice. It is important to evaluate, manage and intervene by mediating when conflicts may and do impact upon the lives and outcomes of people within the provision. There are various appropriate approaches which can be used to address conflicts and dilemmas. Depending on the circumstances this could take the form of: One to one discussion

    Group discussion
    Using contracts
    Providing information to inform choices
    Mentoring for conflict resolution.
    First you must evaluate your own value systems, beliefs and attitudes in relation to the specific conflicts and dilemmas between people, workers and parents/carers, families and significant others to identify those: a) you can deal with objectively and fairly

    b) where expert advice and guidance is required
    Once this has been established it as a conflict you are able to deal with objectively and fairly you need to support and ensure that workers and relevant others are aware of the provisions systems, procedures and practices for addressing ethical dilemmas and conflicts and also negotiating agreed boundaries on behaviour. Part of your role is to develop effective systems and approaches to handle conflicts and dilemmas.

    5.4 EXPLAIN HOW LEGISLATION AND REGULATION INFLUENCE WORKING RELATIONSHIPS WITH CARERS, FAMILIES AND SIGNIFICANT OTHERS In your working setting there are numerous legislations and regulations which influence your working relationship with carers, families and significant others. Your own provision will have its own regulations, code of practice and conduct, standards and guidance for both employers and employees which will dictate your own roles, responsibilities and accountability when leading others and also when managing working with the individuals family. There are also local, national, UK European and international legislation, standards, guidance and organisational requirements for the leadership and management of work with individuals, families, carers and significant others, which include: The need to achieve positive outcomes for people.

    The need to safeguard and protect people from all forms of danger, harm and abuse. Employment practices for the provision and service.
    Data protection, recording and reporting.
    Making and dealing with comments and complaints to improve services. Whistle blowing.
    Health & safety.
    Equality and diversity.

    These all affect the way you work with individuals and their families. The CQC regulates, inspects and reviews all adult social care services in the public, private and voluntary sectors in England. THE ESSENTIAL STANDARDS FOR QUALITY AND SAFETY- From 1st October 2010, every health and adult social care service in England is legally responsible for making sure it meets new essential standards as part of a new registration system which focuses on people rather than policies, on outcomes rather than systems. The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment, safety and safeguarding. The CQC will continuously monitor compliance with essential standards as part of a more dynamic, responsive, robust system of regulation accompanied by new enforcement powers.

    Standards an individual can expect from their care provider: THE ESSENTIAL STANDARDS:

    1) YOU CAN EXPECT TO BE INVOLVED AND TOLD WHATS HAPPENING AT EVERY STAGE OF YOUR CARE. You will always be involved in discussions about your care and treatment and your privacy and dignity will be respected by all staff. You will be given opportunities, encouragement and support to promote your independence. You will be able to agree or reject any type of examination, care, treatment or support before you receive it. 2) YOU CAN EXPECT CARE, TREATMENT AND SUPPORT THAT MEETS YOUR NEEDS. Your personal needs will be assessed to make sure you get care that is safe and supports your rights. You will get the food and drink you need to meet your dietary needs. You get the treatment that that you and your health or care professional agree will make a difference to your health and wellbeing. You will get safe and co-ordinated care where more than one care provider is involved or if you are moved between services. 3) YOU CAN EXPECT TO BE SAFE.

    You will be protected from abuse or the risk of abuse and staff will respect your human rights. You will be cared for in a clean environment where you are protected from infection. You will get the medication you need, when you need them and in a safe way. You will be cared for in a safe and accessible place that will help you as you recover. You will not be harmed by unsafe or unsuitable equipment.

    Your health and welfare needs are met by staff who are properly qualified. There will always be enough members of staff available to keep you safe and meet your health and welfare needs. You will be looked after by staff who are well managed and have the chance to develop and improve their skills. 5) YOU CAN EXPECT YOUR CARE PROVIDER TO CONSTANTLY CHECK THE QUALITY OF ITS SERVICES. Your care provider will continuously monitor the quality of its services to make sure you are safe. If you or someone acting on your behalf makes a complaint, you will be listened to and it will be acted upon properly. Your personal records including medical records, will be accurate and kept safe and confidential. LISA GOTTS

    A new direction for community services ( June 2006 ) the Government white paper identifies four goals to implement effective care and support for disadvantaged people: Better prevention services
    More choice and a louder voice
    Tackling inequalities and improving access to community service More support for people with long term needs.
    Our health, our choice, our say set out to ensure a more personalised service and to ensure service users had a voice regards needed improvements to services.

    In safe hands
    Established the national framework for development of local policies, procedures and guidance for the protection of vulnerable adults. ‘In safe hands’ provides for social services departments to take a co-ordinating lead with a range of other local partners including the NHS and the policy to develop and implement local arrangements to prevent, identify, respond to and ameliorate abuse of vulnerable adults in all settings and to take appropriate action against perpetrators of abuse.

    Putting people first
    ‘a shared vision and commitment to the transformation of Adult Social Care ( 2007) department of health. In the UK the government policy ‘putting people first’ stated that person centred planning must become maainstream. Putting people first recognises that person-centred planning and self-directed support are central to delivering personalisation and maximising choice and control. In 2010 guidance was issued to help councils use person centred thinking and planning to deliver the personalisation agenda. Putting people first is a public service reform programme which is co-produced, co-developed and will be co-evaluated. It recognises that to achieve real change, users and carers must participate at every stage. This marks a change in status of people who use services from consumers to co-producers,
    set out four areas on which councils and their partners should focus in order to personalise services. These areas are:

    Universal services- transport, leisure, health, education, housing and access to information and advice. Choice and control- shaping services to meet peoples needs rather than shaping people to fit in with the services on offer. Social capital- care and support that individuals and their carers can get from their local community ( friends, family, neighbours or community groups ) Early intervention and prevention- support that is available for people who need help to stay independent for as long as possible to keep their home or garden tidy, or to start taking regular exercise.

    No secrets
    In march 2000 the government issued a guidance document, No secrets which gave social services departments a co-ordinating role in developing local policies and procedures for protecting vulnerable adults from abuse. It came about in response to the media coverage of adult abuse. It required all agencies: police, probation services, social services and health services, to work collaboratively to protect vulnerable adults. The no secrets created a framework for action within which all responsible agencies work together to ensure a coherent policy for the safeguarding of vulnerable adults at risk of abuse and a consistent effective response to any circumstances giving ground for concern or formal complaints or expressions of anxiety. As a result, the protection of vulnerable adults ( POVA) was established. POVA’s remit was to provide help and support to adults experiencing abuse, investigate cases where appropriate and protect people from further abuse. In 2007 more emphasis was placed on early intervention and prevention, reflected in a change of name to safeguarding of vulnerable adults from abuse ( SOVA). The SOVA register replaced the POVA register.

    Vetting and barring scheme/independent safeguarding authority The Safeguarding Vulnerable Groups Act 2006 provides the legal framework for the new vetting and barring scheme, which came into full force in October 2009. Background: The safeguarding vulnerable groups act is a major element of a
    wide-ranging and ambitious program of work established across government to address the systemic failures identified by the Bichard inquiry into Soham murders. The act was created in response to recommendation 19 of the Bichard Inquiry Report, which states: New arrangements have been introduced requiring those who wish to work with children or vulnerable adults, to be registered. The register would confirm that there is no known reason why an individual should not work with these clients. In March 2005 Sir Michael Bichard endorsed department for education and skills and department of healths proposal to implement recommendation 19 through the development of a central scheme whereby unsuitable people would be barred from working with children and/or vulnerable adults. The safeguarding vulnerable groups act recognises that any adult receiving any form of healthcare is vulnerable. There is no formal definition of vulnerability within health care although some people receiving health care may be at greater risk from harm than others, sometimes as a complication of their presenting condition and their individual circumstances. The risks that increase a persons vulnerability should be appropriately assessed and identified by the health care professional at first contact and continue throughout the care pathway. The independent safeguarding authority’s ( ISA ) role is to help prevent unsuitable people from working with children and vulnerable adults. Referrals are made to the ISA when an employer or an organisation, EG: a regulatory body has concerns that a person has caused harm or poses a future risk of harm to children or vulnerable adults.

    Local safeguarding adults boards
    Councils are responsible for ensuring they have in place safeguarding adults boards which have a critical role to play in terms of leadership and the management of safeguarding services across partners. Members of the board will include staff from a full rage of partners: Adult social care and other council departments, representation from district councils in two tier areas, NHS trusts and primary care providers the police, crown prosecution service and courts and key service providers. Representatives should be at a senior enough level to represent their organisation, influence its practice and consistently “ get things done “ The membership should be coherent even where some members will have remits that are either larger or smaller than
    the local authority area. Membership may also include key or reprehensive third sector organisations. Boards should have mechanisms to ensure that the views of people who have used ( or might need to use ) safeguarding services are central to the work of the board.

    1.3, EXPLAIN THE LEGISLATIVE FRAMEWORK FOR SAFEGUARDING VULNERABLE ADULTS. There have always been laws which provide guidance with the rights of service users and the requirements of those providing their care. Disability Discrimination Act 1995

    NHS Community Care Act 1990
    National Assistance Act 1948
    Mental Health Act 1983
    Chronically sick and Disabled Person Act 1986
    The first Act to be aimed specifically at the protection of vulnerable adults was the Care Standards Act 2000. The care standards act has had an enormous impact on everyone working in the social care sector. It created a new regulatory framework for all regulated social care and independent health care services. The act has two fundamental aims: Protect vulnerable people from abuse and neglect.

    Protect the highest standards of quality in the care that people receive. The aim is to ensure that children in care are protected from abuse and neglect, older people and people with disability who rely on care services get appropriate standards of care and the protection they deserve. Private hospitals and clinics provide modern standards of healthcare and patients who use child minders or day care can be assured that their children are in safe hands. The General Social Care Council ( GSCC ) was set up under the Care Standards Act 2000, along with the National Care Standards Commission ( NCSC ) and the Social Services Inspectorate ( SSI ). NCSE and SSI merged in April 2004 to become the Commission for Social Care Inspection ( CSCI ) which is now the Care Quality Commission ( CQC ).

    The Human Rights Act means that residents of the United Kingdom will now be able to seek help from the courts if they believe that their human rights
    have been infringed. It is likely that anyone working within health and social care will be working within the provision of the Human Rights Act, which guarantees the following rights: The right to life

    The right to freedom from torture and inhuman or degrading punishment The right to freedom from slavery, servitude and forced or compulsory labour The right to liberty and security of person
    The right to a fair and public trail within a reasonable time The right to freedom from retrospective criminal law and no punishment without law The right to respect for private and family life, home and correspondence The right to freedom of thought, conscience and religion

    The right to freedom of expression
    The right to freedom of assembly and association
    The right to marry and found a family
    The prohibition of discrimination in the enjoyment of convention rights The right to peaceful enjoyment of possessions and protection of property The right to access to an education
    The right to free elections
    The right not to be subjected to the death penalty
    With the introduction of the Human Rights Act the government had to show commitment to protecting the most vulnerable adults as well as children. In the past some people had not always been able to access their rights, this will now be regarded as violation of an individuals human rights.

    The Safeguarding of Vulnerable Groups ( SVG ) Act 2006
    Is in response to the Bichard Inquiry 2005, into the failings around Ian Huntley case. The SVG act is intended to prevent unsuitable people from working with vulnerable people and to reform current vetting and barring practices. The act sets out legal framework for the Independent Safeguarding Authority ( ISA ) scheme which was to be introduced in 2009 (but currently under review as a result of the 2010 General Election)

    Mental Capacity Act 2005 ( MCA)
    The MCA has been in force since 2007 and applies to England and Wales. The
    primary purpose of the MCA is to promote and safeguard decision-making within a legal framework. It does this in two ways: By empowering people to make decisions for themselves wherever possible and by protecting people who lack capacity by providing a flexible framework that places individuals at the heart of the decision making process. By allowing people to plan ahead for a time in the future when they might lack the capacity for any number of reasons. FIVE KEY PRINCIPLES

    1) A presumption of capacity-every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. This means that you cannot assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability. 2) Individuals being supported to make their own decisions-a person must be given all practicable help before anyone treats them as not being able to make their own decisions. This means you should make every effort to encourage and support people to make the decision for themselves. If lack of capacity is established it is still important that you involve the person as far as possible in making decisions. 3) unwise decisions-people have the right to make decisions that others might regard as unwise or eccentric. You cannot treat someone as lacking capacity for this reason. Everyone has their own values, beliefs and preferences which may not be the same as those of other people. 4) Best interests-anything done for or on behalf of a person who lacks mental capacity must be done in their best interests. 5) Less restrictive option-someone making a decision or acting on behalf of a person who lacks capacity must consider whether it is possible to decide or act in a way that would refer less with the persons rights and freedoms of action or whether there is a need to decide or act at all. Any intervention should be weighed up in the particular circumstances of the case.


    To establish whether there are lessons to be learnt from the circumstances of the case about the way in which local professionals and agencies work together to safeguard vulnerable adults and to learn from past experience. To review the effectiveness of procedures ( both multi-agency and those of individual organisations ) and to improve future practice by acting on the learning. To inform and improve local inter-agency practice and improve multi agency working. To improve practice by acting on learning ( developing best practice ). To prepare or commission an overview report which brings together and analyses the findings of the various reports from agencies in order to make recommendations for future action and to review safeguarding adults procedures. Adult abuse pervades the lives of many people around the world today. The current definition of adult abuse used health and social care today states abuse-may consist of a single or repeated act. It may be physical, verbal or psychological, it may be an act of neglect or failure to act or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he/she has not consented or cannot give consent. ( Department of Health 2000 ). Adult abuse has received increasing recognition over the past 40 years at national and international level. Initial focus has been on the abuse of older people, however there is now an awareness of the vulnerability of other groups of adults to abuse including those with learning difficulties and mental health problems. There have been several high profile cases of abuse in recent years resulting in serious case reviews. Two examples where serious case reviews or inquires have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults. THE BIRCHARD INQUIRY: following the case of Ian Huntley and the Soham murders. Although the abuse which took place was involving children, the report had far reaching affects on all areas of protection for both children and adult care. The Safeguarding Vulnerable Groups act is a major element of a wide-ranging and ambitious programme of work established across government to address the systemic failures identified by the inquiry. It introduced a requirement for those who wish to work with children or vulnerable adults, to be registered. This would confirm that there was no known reason why an individual should not work with these clients. The Public Interest Disclosure Act 1998 or ‘Whistlblowing’ is officially defined as ‘making a disclosure that is in the
    public interest’. it will usually occur when an employee discloses to a public body, usually the police or a regulatory commission that their employer is partaking in unlawful practices. A series of disasters, crimes and scandals in the late 1980s and early 1990s resulted in a number of public inquiries. These inquiries found that often people within the organisations knew of the potential dangers or malpractice and for a variety of reasons either were unwilling to raise the alarm or if they did raise it, did so with the wrong person or in the wrong way. An example is the drowning of four children at Lyme Bay. Before the canoe disaster at Lyme Bay an instructor had been so concerned about the safety standards at the activity centre that she had written to the managing director. In her letter she stated that if safety standards were not improved ‘you might find yourself trying to explain why someone’s child will not be coming home’, shortly after four schoolchildren drowned. Because he had ignored such graphic warning, the managing director was jailed for two years for manslaughter. Had whistle blowing policies been in place at the time, the instructor could have reported this by following the correct processes and their employment rights would have been protected. If you decide to blow the whistle on an organisation you are protected and your employer cannot victimise you. Whislleblowers are protected for public interest to encourage people to speak out if they find malpractice illegal or negligent behaviour by anyone in an organisation or workplace. MISUSE OF DRUGS ACT 1971

    The CQC providing external scrutiny on how other regulators and agencies work together, following the Governments response on the management of controlled drugs, after the fourth report of the Shipman inquiry. The CQC publishing their fifth annual report on safer management of controlled drugs in July 2012. Under statutory arrangements introduced as a result of the Shipman inquiry, the CQC is responsible for assuring that all providers of health and social care and regulatory bodies and agencies work together to create a safe environment for the management of controlled drugs. Recommendations in the report included the need for organisations to notify the CQC when the controlled drugs accountable officer changes, for the officers to have systems in place to assure the safe prescribing and administration of controlled drugs in all possible situations and the need to encourage the
    use of the Controlled Drug Requisition Form.

    1.5, EXPLAIN THE PROTOCOLS AND REFERRAL PROCEDURES WHEN HARM OR ABUSE IS ALLEGED OR SUSPECTED. All persons have the right to live their lives free from violence and abuse. This right is underpinned by the duty on public agencies under the Human Rights Act 1998 to intervene proportionately to protect the rights of citizens. These rights include Article 2: the Right to life, 3: freedom from torture ( including humiliating and degrading treatment ) and Article 8: rights to family life ( one that sustains the individual ). When an allegation of abuse is made the receiving agency must always notify the appropriate regulatory body within any stipulated time limits and also any other authority who may be using the service provider. Residential care homes are required under the Registered Homes Act 1984 ( as amended in 1991 ) ‘to notify the Registration Authority not later than 24 hrs from the time of its occurrence of any event in the home which affects the well-being of any resident’ and specifically of: Any serious injury to any person residing in the home ( Regulation 14 (1) (b). Any event in the home which affects the well-being of any resident ( Regulation 14 (1) (d). RESPONDING TO ABUSE AND NEGLECT

    Standards 6,7,8 and 9
    The primary responsibility of the ‘safeguarding adults’ partnership is to enable all adults who is or may be eligible for community care services to access appropriate services if they need support to live a life that is free from abuse and neglect. The framework for enabling adults to access such support is referred to as the ‘safeguarding adults’ procedures. They should ensure that those adults who is or may be eligible for community care services and who may be experiencing abuse or neglect, receive an assessment of the risk they are facing. Where they face a critical or substantial risk to their independence and wellbeing, community care services should be considered as part of a safeguarding plan. Where the assessment does not lead to community care services being provided or purchased other appropriate services should be signposted. The procedures should be based on the presumption of mental capacity and on the consequent right of such adults to make their own choices in relation to safety from abuse and
    neglect-except where the rights of others would be compromised. For people who are eligible for community care services and who have mental capacity. ‘safeguarding adults procedures should enable them access to mainstream services that will support them to live safer lives as well as providing specific services to meet additional needs. EG: some adults have impairments which mean that they need assistance to overcome current barriers to existing services in order to choose how to achieve a safer life.

    Standards 9.1 the multi-agency ‘safeguarding adults’ procedures detail the following stages: ALERT-Reporting concerns of abuse or neglect which are received or noticed within a partner organisation. Any immediate protection needs are addressed. REFERRAL -Placing information about that concern into a multiagency context. DECISION-Deciding whether the ‘safeguarding adults’ procedures are appropriate to address the concern. SAFEGUARDING ASSESSMENT STRATEGY-Formulating a multi-agency plan for assessing the risk and addressing any immediate protection needs. SAFEGUARDING ASSESSMENT-Co-ordinating the collection of the information about abuse or neglect that has occurred or might occur. This may include an investigation EG: a criminal or disciplinary investigation. SAFEGUARDING PLAN-Co-ordinating a multi-agency response to the risk of abuse that has been identified. REVIEW-The review of that plan.

    RECORDING AND MONITORING-Recording and monitoring the ‘safeguarding adults’ process and its outcomes.

    Based within the community care assessment time frame.
    Maximum time frame:
    ALERT- Immediate action to safeguard anyone at immediate risk. REFERRAL – Within the same working day.
    DECISION – By the end of the working day following the one on which the safeguarding referral was made. SAFEGUARDING ASSESSMENT STRATEGY – Within five working days. SAFEGUARDING ASSESSMENT – Within four weeks of the safeguarding referral. SAFEGUARDING PLAN – Within four weeks of the safeguarding assessment being completed. REVIEW – Within six months for
    first review and thereafter yearly.

    Receivers of alerts and referrals should respond by:
    Reassure the person.
    Remaining calm and not showing shock or disbelief.
    Listening carefully to what is being said.
    Not asking detailed or probing questions.
    Demonstrating a sympathetic approach by acknowledging regret and concern that what has been reported has happened. Ensuring that any emergency action needed has been taken.
    Confirming that the information will be treated seriously.
    Giving them information about the steps that will be taken.
    Informing them that they will receive feedback as to the result of the concerns they have raised and from whom. Giving the person contact details so that they can report any further issues or ask any questions that may arise.


    4.2, EVALUATE THE EFFECTIVENESS OF SYSTEMS AND PROCEDURES TO PROTECT VULNERABLE ADULTS IN YOUR OWN SETTING. Periodic audits of individual adult protection case records will enable strengths and weaknesses in current practice to be identified. Accurate and consistent monitoring of vulnerable adult data will enable you to base your workplace policy and practice on sound and relevant evidence, highlighting trends and assisting in the planning process. By monitoring and auditing the individuals complaints and by listening to members of staff, you should be able to determine and evaluate if the systems and procedures in your own work setting are effective in protecting vulnerable adults.

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