Safeguarding Vulnerable Adults

What is safeguarding?

Safeguarding can prevent the vulnerable patients we see every day from being subjected to any type of physical or mental harm. Living a life free from abuse and neglect is a basic human right and has a significant impact on a person’s overall health and wellbeing. This article focuses on the safeguarding of vulnerable adults. It includes consideration of what makes an adult vulnerable, the key things to look out for in your practice, and what you can do to protect vulnerable adults from harm.

How is it relevant to the dental team?

The General Dental Council (GDC) has now added ‘safeguarding children and young people’ and ‘safeguarding vulnerable adults’ onto the recommended core topics to be covered by all dental professionals in their continuing professional development (CPD) cycles (GDC 2015). The Care Quality Commission regulates and inspects health and social care services. It believes that safeguarding cannot be achieved by one agency alone; in fact, every agency working with children and vulnerable adults has a responsibility to keep them safe (Care Quality Commission 2015).

Who is vulnerable?

The Department of Health (2011) defines a vulnerable adult as someone:

‘who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation’.

This is a broad definition and can include the elderly and those with mental or physical disabilities. However it is important to remember that patients without a recognised disability may also find themselves in situations where they become vulnerable. Some patients see members of the dental team more regularly than they see their GPs and other healthcare professionals, which allows us to build a strong relationship with the people we see. This makes our role in safeguarding invaluable. Patients will communicate and interact with the receptionists, dental nurses and clinicians during their visits, giving each member the opportunity to pick up on the common signs and symptoms of abuse.

Different types of abuse

Abuse may be any act that results in harm. Abuse also encompasses neglect, which is failing to care appropriately for a vulnerable individual. Abuse and neglect can occur anywhere and unfortunately are often carried out by those in positions of power and trust, such as family members, carers or neighbours (NHS 2015).

The Social Care Institute for Excellence (2013) recognise seven areas of abuse in adults. These are:

Physical abuse;
Emotional abuse;
Sexual abuse;
Neglect and acts of omission;
Financial abuse;
Discriminatory abuse;
Institutional abuse.

Physical abuse is intentional physical harm. Examples include hitting, slapping, pushing, neglect, force-feeding, giving unnecessary medications or withholding medications. If you suspect physical abuse, it is important to consider the following points:

Does the patient have any physical injuries such as bruising, cuts, abrasions, burns, broken/fractured bones, or broken teeth? If so, have they sought medical help for these injuries or has there been a significant delay in seeking treatment?
Does the patient and/or carer have an acceptable explanation for the type of injury the patient has?
Does the patient have any unexplained weight loss which could be a result of not being fed adequately?
How does the patient seem? Are they behaving unusually? Do they seem withdrawn, scared or upset?

Emotional abuse can be just as harmful as physical abuse to a vulnerable adult’s wellbeing. It can include shouting, intimidation, bullying behaviour, humiliation and acts of manipulation. Emotional abuse can be harder to recognise unless it is being carried out in public. However, some commons signs are:

A patient experiencing emotional abuse may show a change in their usual behaviour. They may appear scared, confused or depressed.
The patient may appear to have low self-esteem.
You may notice the interaction between the adult and their carer involves shouting or degrading behaviours.
The carer may answer questions that you have directed at the patient. This is quite common and often completely harmless. However, if you notice this and any other signs then it could be an indication that the carer does not want the patient disclosing any details of the abuse to you.

Sexual abuse involves any type of sexual act performed without consent from the other individual. A vulnerable adult cannot consent to anything that they do not have the mental capacity to understand. Signs include:

Sexually transmitted infections.
Injuries to the groin or oral cavity. The patient may show signs of discomfort when sitting down.
Bruising or injuries to arms or legs if the patient has been restrained.
An usual preoccupation or obsession with anything sexual.
Pregnancies.
Unexpected changes in behaviour. The patient may become withdrawn or behave in a way that is out of the ordinary.

Neglect and acts of omission involve failing to care for a vulnerable adult appropriately. Those in positions of care have a duty of care to that individual which also includes helping them to access appropriate medical and dental treatment when it is required. Common signs of neglect are:

Several failed dental appointments with no explanation.
Poor oral hygiene, possibly leading to advanced periodontal disease or multiple carious lesions.
Poor general hygiene.
Weight loss, malnourishment or dehydration.
Inappropriate clothing for the weather, such as a lack of warm clothing in the winter.
Untreated medical problems.

Financial abuse can include theft of money or placing pressure on a vulnerable adult to either give the abuser money or sign money over to them without proper consent. Signs may include:

Failed dental appointments due to lack of money to pay for treatment.
Evidence that the vulnerable adult has signed over all their financial responsibilities to another person, and evidence that they may not be aware of their financial situation or are being kept in the dark about it.
Frequent loss of valuable possessions or money.
Untidy appearance, shabby clothes and shoes.
Inability to pay bills.

Discriminatory abuse is any type of abuse of an individual based on their gender, sexual orientation, disability, age, race or religious beliefs. Discriminatory abuse can involve one or more of the areas described above so the signs would link in with those already mentioned.

Finally, institutional abuse can occur in settings such as care homes, supported housing and hospitals. As with discriminatory abuse, institutional abuse can include various types of abuse. Therefore the signs may be a combination of those described above. Physical and behavioural signs are indicators of whether or not someone is being abused so it is important to monitor both each time you see a vulnerable adult.

Practice policies

Every member of the dental team has an ethical responsibility in safeguarding. A safeguarding policy should therefore be in place. This policy may involve appointing a member of the team as ‘safeguarding practice lead’ who has the responsibility to ensure that the local safeguarding systems and processes are followed, to provide advice and assistance to other members of the team, and to ensure that appropriate training in safeguarding is in place for everyone.

All members of staff must undergo Disclosing and Barring Services checks (previously known as Criminal Records Bureau checks) before becoming employed in a healthcare position, as this is considered to be a position of trust. All members of the dental team must be trained adequately in safeguarding to ensure they are aware of the possible signs and symptoms of abuse or neglect. Any concerns they have for a patient’s welfare must be reported urgently to a senior member of staff or the safeguarding practice lead. Any action taken due to concerns for a patient’s wellbeing should be well-documented and reviewed regularly to ensure that no incident is overlooked by any organisation.

Safeguarding also involves protecting the health and wellbeing of patients when they are in the care of the dental team. A whistleblowing procedure should be in place and this should be fully supported by the practice. The CQC (2015) set out new standards in April 2015 for all health and social care providers in relation to protecting vulnerable adults and children in healthcare situations. These standards state that any treatment or care must not:

(i) discriminate on the grounds of any of the protected characteristics of the Equality Act

2013 (age, disability, gender reassignment, marriage and civil partnership, pregnancy and

maternity, race, religion and belief, sex, sexual orientation).

(ii) include acts intended to control or restrain an adult or child that are not necessary to

prevent, or not a proportionate response to, a risk of harm to them or another person if the

adult or child was not subject to control or restraint.

(iii) be degrading to the adult or child.

(iv) significantly disregard the needs of the adult or child for care or treatment.

Staff should feel comfortable going to either a practice manager or the safeguarding practice lead to report concerns about a vulnerable patient, even if the report involves another member of staff.

Actions to take

If you suspect (or a patient directly discloses to you) that some form of abuse or neglect has taken place it is essential to keep that patient safe immediately. The patient must not be placed at any more risk because you have not taken the disclosure seriously. It is essential to remain professional and not show any signs of shock, disgust or disbelief. The patient is likely to feel bad enough about the incident and any type of reaction from you that is not calm and professional may make them feel much worse. It is incredibly important to let the patient talk openly without interrupting to prevent your own views and opinions from affecting what the patients discloses. The patient’s exact words should be recorded in note form. This keeps the records as accurate as possible and helps to prevent misinterpretation. You should also include notes of what you have said and the actions you have taken. Make records or even include photographs (if the patient gives consent) of any injuries or signs of abuse or neglect and add a detailed description. You should then gain consent from the patient to share this information with the appropriate people. Once consent is gained you should follow the policy for safeguarding vulnerable adults which is in place at your practice.

If a patient does not give consent for information to be shared, you should emphasize the reasons for your concerns and explain that the information will only be going to appropriate people. Whilst we must keep patients’ records and information confidential, we should not let patients believe that we are able to keep any serious offences or risks to their wellbeing a secret. We are able to discuss and gain advice from senior members of staff and our defence unions if we have serious concerns about a vulnerable patient before taking it further.

Things to remember

Your practice should have either a safeguarding practice lead or a senior member of staff that you would feel comfortable approaching with any safeguarding concerns.
Your practice should have a policy in place for safeguarding children and vulnerable adults with a procedure to follow if you have concerns, including the names of local authorities to contact. Is this easily accessible and/or displayed clearly anywhere?
All members of the dental team must be trained in safeguarding and feel comfortable recognising common signs and symptoms of abuse and/or neglect.
Safeguarding is the responsibility of every member of the dental team and any issues must not be overlooked or ignored.

Regulations

Data Protection Act 1998
The Mental Capacity Act 2005
The Care Act 2014
The Health and Social Care Act 2008

Useful links and resources

http://www.scie.org.uk/

https://www.england.nhs.uk/wp-content/uploads/2013/03/safeguarding-vulnerable-people.pdf

http://www.cqc.org.uk/sites/default/files/20150710%20CQC%20New%20Safeguarding%20Statement.pdf

References

Care Quality Commission (2015) Statement on CQC’s roles and responsibilities for safeguarding children and adults, Online at: http://www.cqc.org.uk/sites/default/files/20150710%20CQC%20New%20Safeguarding%20Statement.pdf [Accessed on: 18/11/15].

Department of Health (2011) Safeguarding Adults: The role of health services practitioners, London: Department of Health.

General Dental Council (2015) ‘Safeguarding’ becomes recommended CPD, Online at: https://www.gdc-uk.org/Newsandpublications/Pressreleases/Pages/Safeguarding-becomes-recommended-CPD.aspx [Accessed on: 18/11/15].

NHS Choices (2015) Abuse and neglect of vulnerable adults, Online at: http://www.nhs.uk/conditions/social-care-and-support-guide/pages/vulnerable-people-abuse-safeguarding.aspx [Accessed on: 19/11/15].

Social Care Institute for Excellence (2013) Adult Safeguarding Resource, Online at: http://www.scie.org.uk/publications/elearning/adultsafeguarding/resource/2_study_area_3_4.html [Accessed on: 18/11/15].