A guide to the safeguarding of children, young people and adults

It is a requirement that all individuals working in a healthcare setting have a basic awareness of how to safeguard adults and children. You need to be able to understand and recognised signs of abuse.

As part of our commitment to preventing and reducing risk and the experience of abuse and neglect East Kent Hospitals (EKHUFT) wants to ensure you know how to raise a concern. We all have a duty to do something about safeguarding. Safeguarding is protecting a person’s right to live in safety, free from abuse and neglect. Creating a safe and welcoming environment, where everyone is respected and valued, is at the heart of safeguarding. When everyone understands safeguarding and their right to be safe, people who have nowhere else to turn to can be protected.

This guide must be read by every individual who is engaged to undertake activities directly on behalf of EKHUFT – whether a volunteer; employee, external consultant, member of agency staff or company contractor.

Introduction

EKHUFT is committed to having effective safeguarding arrangements in place to seek to prevent and protect individuals from harm or abuse, regardless of their circumstances.

The context of Safeguarding is firmly embedded within the core duties of all organisations across healthcare. Healthcare providers are required under statute and regulation to have effective arrangements in place to safeguard and promote the welfare of children and adults at risk of harm and abuse in every service that they deliver. For example, Section 11 of the Children’s Act 2004 places a statutory duty on EKHUFT to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children.

It is also an NHS requirement that all staff have a basic awareness of Adult Safeguarding.

However, there is a distinction between EKHUFT’s responsibilities to provide safe and high-quality care to patients and contracted suppliers responsibilities to ensure that the risk of safeguarding is actively managed across services delivered to EKHUFT. It is important for all employees contracted to work in EKHUFT to remember that an NHS Patient is in the direct care and control of EKHUFT. It is your responsibility as a contracted employee to support EKHUFT by immediately escalating a safeguarding concern to them for any follow up, any investigation and referral.

This Guide has been written to help everyone who works within EKHUFT as a contracted employee to develop a basic awareness of Safeguarding. After reading it you will:

Understand the risk of safeguarding and recognise the indicators of a potential safeguarding concern.
Know what action to take if you have concerns.
Know how to report your concerns and or where to seek advice.

If you have any concerns or questions about this guide then please raise them with your Line Manager, who will then inform EKHUFT.

Your responsibilities

There is an expectation that anyone working on behalf of EKHUFT as a contracted employee is able to:

identify a safeguarding concern; and
escalate concerns, relating to patient care, to EKHUFT.

What you need to know

Children and young people

Even if you do not work directly with children, the importance of protecting children from harm is universally recognised and underpins government policy in the area of child abuse even though the specific policy changes over time. It is important to realise that the term ‘children’ means infant, child and young people from birth until their 18th birthday

Children can be hurt by adults at any age, from any class, sex, race and sexual orientation.

What should I look out for?

Someone may abuse or neglect a child or young person by inflicting harm, or by failing to act in preventing harm. This harm may be physical or psychological and will affect the child or young person’s current and future wellbeing.

Children and young people may be abused in a family, the abuser(s) may be someone known to the child, more often than not the person responsible for the abuse has a close relationship with the abused child. However, we are increasingly recognising that children and young people can also experience risk and come to harm as they are influenced by a whole range of environments and people outside their home (this is called contextual safeguarding). Parents and carers have little influence over these contexts, and young people’s experiences of extra-familial abuse can undermine parent-child relationships.

Any child can be at risk of abuse regardless of the age, sex, ethnicity, ability or disability. Those most at risk are babies and young children, those with learning difficulties and those with physical disabilities. Adolescents are also at risk of abuse and they may respond in ways that put them at further risk of harm, for example, by running away.

Physical abuse

This may involve hitting, shaking, throwing, poisoning, burning, drowning or scalding, or otherwise causing physical harm to a child.

Examples of physical abuse you might notice:

Bruises on a child
Observing a child being overly chastised.

Emotional abuse

This is the persistent emotional ill-treatment of a child such as to cause severe and persistent effects on the child’s emotional development. It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed on children. This can also feature limitation of exploration and learning as well as overprotection. It may involve serious bullying causing children frequently to feel frightened or in danger, or the exploitation or corruption of children It may involve seeing or overhearing the ill treatment of another.

Some level of emotional abuse is involved on all types of ill-treatment of a child, though it may occur alone.

Examples of emotional abuse you might notice:

Parents/carers calling their children unkind names or belittling them so they feel unloved.

Neglect

This is the persistent failure to meet a child’s basic physical and / or psychological needs and is likely to result in the serious impairment of the child’s health or development. It may involve a parent or carer failing to provide adequate food, clothing, shelter, including exclusion from home or abandonment, failing to protect a child from physical and emotional harm or danger, failure to ensure adequate supervision or failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to a child’s basic emotional needs.

Examples of neglect you might notice:

Children being inappropriately dressed for the season
Ingrained dirt, very unkempt presentations.

Sexual abuse

Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet).

We know that sexual abuse often takes place from someone known to the child or family It is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.

Contextual safeguarding

Child sexual exploitation

Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual.

Trafficking/Modern Slavery

Children and young people are trafficked for a variety of reasons; this can be either into the UK or around the UK. The most common reasons are domestic work, sexual exploitation, and criminal activity such as cannabis cultivation or street crime.

County lines

Commonly involves the illegal distribution and dealing of seriously dangerous drugs from one city/town to another. The most common drugs involved are heroin and cocaine (crack and powder), but also MDMA, cannabis, amphetamines and spice. Gangs sometimes use violence to threaten children and young people when recruiting them. Gangs also violently assault children and young people working for them if they find their drugs or money to be missing. Weapons such as firearms, knives, bats, acid are sometimes used to make violent threats.

Radicalisation

Radicalisation can be really difficult to spot.

Children who are at risk of radicalisation may have low self-esteem, or be victims of bullying or discrimination. Extremists might target them and tell them they can be part of something special, later brainwashing them into cutting themselves off from their friends and family.

What should you do if you suspect any child abuse is taking place?

If you are concerned a child or young person is being abused or they tell you they are being abused, we expect you to DO SOMETHING

Never promise the child confidentiality (you may need to speak to another professional)
Listen carefully
Stay calm and reassure the child
Report the concern to the staff responsible for the patient and your line manager
Talk to the safeguarding team for further advice and support (out of hours this is Social Services).

Information sharing is vital to safeguarding and promoting the welfare of children and young people. A key factor identified in many serious cases is because staff have noticed something but not shared their concern or undertaking any action. Where there are concerns about the safety of a child, the sharing of information in a timely and effective manner between organisations can reduce the risk of harm. Confidentiality is not a barrier to sharing information if you have a concern about a child, make sure you speak with the clinician caring directly for the child or young person.

Referral mechanisms

Referrals to specialist services would normally be undertaken by the clinical team, but if you have concerns that your concern is not being acted upon speak with your line manager or the EKHUFT safeguarding teams.

Legislation

The Children Act 1989

Allocates duties to local authorities, courts, parents, and other agencies in the United Kingdom, to ensure children are safeguarded and their welfare is promoted. It centres on the idea that children are best cared for within their own families; however, it also makes provisions for instances when parents and families do not co-operate with statutory bodies.

The Children Act 2004

The Children Act 2004 states that the interests of children and young people are paramount in all considerations of welfare and safeguarding and that safeguarding children is everyone's responsibility. Safeguarding in the broadest sense can only be achieved by improving a wide range of outcomes for children and young people, including their health, education and development, safety, and economic circumstances. The Children Act provides a legislative spine for the wider strategy for improving children's lives. This covers the universal services which every child can access, and more targeted services for those with additional needs.

Sexual Offences Act 2003

The age of consent (the legal age to have sex) in the UK is 16 years old.

The laws are there to protect children. They are not there to prosecute under-16s who have mutually consenting sexual activity but will be used if there is abuse or exploitation involved.

To help protect younger children the law says anyone under the age of 13 can never legally give consent. This means that anyone engaging in sexual activity with a child who is 12 or younger will be subject to penalties set out under the Sexual Offences Act 2003.

The law also gives extra protection to young people who are 16 to 17 years old. It is illegal to:

Take, show or distribute indecent photographs
Pay for or arrange sexual services
For a person in a position of trust (for example, teachers, care workers) to engage in sexual activity with anyone under the age of 18.

Human Rights Act 1998

When the articles of the European Convention on Human Rights (ECHR) were enshrined into our domestic law in October 2000 by way of the Human Rights Act, it meant a major change in the way children and their families could challenge decisions made by public bodies. When the Human Rights Act was implemented, it imposed upon “public authorities” such as the courts, prisons and local authority children’s services departments a positive duty to protect children and a duty to ensure their decisions do not breach a child’s human rights. The most likely Articles of the ECHR which are in play in regard to child protection cases are:

Article 8 – the right to respect for family and private life and Article 6 – the right to a fair hearing.

Safeguarding Adults

A vulnerable adult is someone who may need care because of a physical, learning or other disability, or because of their age or an illness. This definition also applies to an adult who is unable to take care of him or herself properly, or who is unable to protect him or herself from significant harm or exploitation.

The Care Act 2014 describes 11 categories of abuse:

Physical: assault, rough handling, unreasonable physical restraint
Domestic abuse: includes all types of abuse including honour-based violence, enforced marriage, female genital mutilation and culturally accepted practices which are illegal in the UK
Sexual and sexual exploitation: any non-consenting sexual act or behaviours to which an adult could not consent to or was pressured into consenting
Psychological/emotional: bullying, intimidation, verbal attack or other behaviour that affects the wellbeing of an individual
Financial or material: theft, fraud, misappropriating funds i.e. when using a person’s money for self-gain or gratification
Modern slavery and trafficking: including forced labour and domestic servitude
Discriminatory: psychological abuse that is racist, sexist or linked to a person’s sexuality, disability or age
Organisational: Observed lack of dignity and respect in the care setting, rigid routine, processes/ tasks organised to meet staff needs, disrespectful language and attitudes
Neglect and acts of omission: a person’s wellbeing is impaired, and care needs are not met, breaching duty of care
Self-neglect: neglecting to care for one’s personal hygiene, health or surroundings and includes behaviours such as hoarding
Mate crime: Be aware of Mate Crime - where someone pretends to be a friend but are doing so to draw a vulnerable person in to criminal activity.

When someone lacks mental capacity, for safeguarding or any other decision, the Mental Capacity Act (2005) applies.

The Mental Capacity Act provides the legal framework for EKHUFT when making decisions on behalf of people who lack the mental capacity to make decisions themselves. In order to enable compliance with the act it is necessary to:

Always assume a person has capacity unless it is proved otherwise
Take all practicable steps to enable people to make their own decisions
Not assume incapacity simply because someone makes an unwise decision
Always act, or decide, for a person without capacity in their best interests
Carefully consider actions to ensure the least restrictive option is taken.

Acting in someone’s best interests

Never make assumptions about an individual’s mental capacity based on age, appearance or medical condition. People living with dementia or a learning disability can still make some decisions if given the right support.

Human Trafficking and Modern Slavery

Children, young people and adults are trafficked into and around the UK or find themselves victims of modern slavery for a variety of reasons. The most common reasons are domestic work, sexual exploitation, and criminal activity such as cannabis cultivation or street crime.

Examples of concerns you might notice:

•the individual is accompanied by someone(not a relative) who appears controlling, insists on giving information and speaking for them, the relationship is unclear

•the individual provides vague and inconsistent explanations of where they live or go to school

•the individual has old or serious untreated injuries

• the individual may not tell the truth about their age.

Reporting a concern

You must immediately report any safeguarding concern.

Report the concern to the staff responsible for the patient and your line manager
Talk to the safeguarding team for further advice and support (out of hours this is Social Services).

You should know that it’s OK to share information about a safeguarding concern without the consent of the individual concerned if it is in the public interest, in order to prevent a crime or to protect others from harm.

Useful contacts

East Kent Child Safeguarding team

Email: ekh-tr.ekcpteam@nhs.net

Learn about our Safeguarding Children team on Staff Zone

East Kent Adult Safeguarding team

Email: ekh-tr.safeguardingadults@nhs.net

Learn about our Safeguarding Adults team on Staff Zone

Other contacts

Modern Slavery helpline: 0800 121700

NSPCC: www.nspcc.org.uk

Kent Safeguarding Children partnership: www.kscmp.org.uk

Kent & Medway Safeguarding Board: https://www.kmsab.org.uk/