Unit 7: Principles of Safe Practice in Health and Social Care

Task 1

Duty of Care

P1. Explain the implications of a duty of care in a selected health or social care.

Case study 2: Wellings NHS Trust, Ward 3B

Ward 3B is a female surgical ward with 32 beds in bays and two side wards for more serious cases. Amina Patel is the
ward manager and she is supported by a team of registered nurses, nursing associates and healthcare assistants.

The keypad used to gain entrance to the ward is broken and so the doors are propped open to save the staff having
to leave their duties to let people in.

The service users come into the ward for surgical procedures, some of which are planned and others are emergency
procedures

Lizzy D. was admitted to the ward for a routine procedure on her left hand. The surgery went smoothly and there
were no complications. Following a visit from her husband, Lizzy complained of pain in her hand and on examination,
the nurse on duty, noticed that it was swollen and discoloured.

Lizzy stated that this had ‘suddenly happened’ and that she could not explain it. She was given medication to reduce
the swelling and the pain. Because the nurse was busy, she did not record either the issue or the medication given to
Lizzy. This particular nurse often forgets to record medication, and Amina has spoken to her about this on several
occasions.

The following day, Lizzy’s husband again visited and following this, Lizzy complained of the same swelling and pain in
her hand. The husband had insisted on drawing the curtains around the bed at the visit, stating that he had
important mattes to discuss with his wife. Visiting is never supervised on the ward, and staff leave people to chat.

Amina administered pain relief but didn’t record this. She did question Lizzy about her hand, but Lizzy turned her
face away and refused to answer.

Legal obligation to protect wellbeing and prevent harm.

All professionals have legal obligations to protect ones wellbeing and to prevent harm as it is apart of their duty of
care towards service users. With professionals following the duty of care this ensures that they also follow the
policies and procedures (given by CQC, their organisation or professional bodies) in order to provide care in line with
the holistic needs and preference of service users like Lizzy and others that may be impacted by the actions taken
place. The professional must not perform any actions that may risk or cause harm to the service user.

Upholding the rights and promoting the interests of individuals experiencing abuse or neglect.

Professionals must uphold the rights and promote the interests of individuals experience abuse or neglect for them
to be free of harm and pain, so that they can make their own decisions in their life. Professionals working with those
who have suffered abuse and or neglect should be aware of their patients trust issues due to past experiences, so
being calm, empathetic, friendly would help to make them feel secure and safe. They may trust the professional
more as a relationship/ bond forms, which would make them trust you with caring/ treating them and with they may
come to you with any personal issues that they may have. For example, a service user may be anxious, afraid,
isolated, vulnerable. This may make it difficult for them to ask for support when they need it. This may mean that
you may need to advocate for them as they trust you to do so. They begin to trust you as you build a strong bond
with them and the communication between the two of you is good, which allows the service user to be more
comfortable sharing their personal issues and makes it easier for them to discuss their preferences and requirements
they need to get better as soon as possible. All service users have different needs and preferences that must be met.
They also may struggle to protect themselves or may have difficulties in understanding the consequences of their or
your choices. They may not be aware of the benefits or rights they can receive. Their rights must be always
protected as they may not be able to do so themselves.

Protecting health, safety and wellbeing.

Service providers and users’ health, safety and wellbeing should be always protected. This creates trust between
service providers and users. Service users may feel more obliged to go with the recommendations that the
professionals recommend as they’re seen competent and experienced due to their social role. This is why
professionals must analyse the impact of their actions or failures on users (before giving recommendations) to
ensure that greatest outcomes of care are achieved, preventing any further harm or injuries to others health and
wellbeing. They also must look after themselves whilst delivering care to users. They should make the users aware of
their condition and the best treatment and benefits of treatment.

Ensuring safe practice.

Safe practises are followed by professionals to keep themselves and service users safe. Every organisation has
certain safety procedures that must be implemented in all circumstances by all professionals apart of that
organisation. When these procedures are followed all are benefited from it as it maintains safety in the work
environment. If they’re not followed it can cause injury and harm to oneself, or may be even death. This can result in
investigations taken place, which is time consuming, expensive, etc. For example, there may be many hazards in a
service users home, extra attention and safety measures should be carried out before any tasks are taken.
Professionals must receive health and safety training before following up the regulations of the care quality
commission. This is to help maintaining a safe practise, and so that regulations are implemented to ensure the most
effective level of care/ treatment.

Code of conduct

Code of conduct is a regulation that must be followed by all professionals apart of health and social care
organisations. It informs professionals how to act around patients, how to remain safe and how to keep patients safe
whilst providing the most effective treatment available to them. For example, the professionals on the ward that
Lizzy is being treated at, do not follow the code of conduct. It is mentioned in the case study that the professional
provided her medication but then never recorded down the dose, time of when the medication was administered.
This would put Lizzy in danger as another provider would assume she hasn’t been given her medication and then
would give her another dose of medication, which can lead to overdose and possibly death. This is the professional
not following the duty of care they have, to protect service users.

Balancing individual rights with risks

Balancing the individuals' rights with risks means that the individual's needs, rights and risks may be different to
others and that other people's choices can negatively or positively impact others. This is the reason why it is
important to remember that all individuals are their own independent people, which means that they have a right to
make informed decisions, despite the risk involved. For example, if Lizzy wants to have surgery, but it’s dangerous,
the service provider cannot force her to choose a different form of treatment. Instead, they should carry risk
assessments that will then ensure that risks of danger are minimised, so that she can have the form of treatment she
chose, whilst also bettering her health and wellbeing.

Acting in a persons best interest

Acting in a person's best interest is when one must make choices that would make the circumstances of a situation
much better. Consent from the service user must be given before doing so, unless they dont have the mental
capacity to make decisions of their own, when decisions need to be made. Lizzy has many choices within her
treatment plan, such as what clothes and food she’d like to have. Lizzy is mentally capable of making decisions of her
own. Her decisions and choices should be respected.

M1. Assess the importance of balancing individual rights with a duty of care in a selected health or social care
setting.

Balancing individual rights with risks and acting in a person’s best interest

Service users cannot be forced by service providers to do anything they don't want to do. For example, the service
user chooses a risky from of treatment, even if the service provider doesn't agree to their decisions, they cannot
force them to choose nowhere option of treatment. The service users cannot be forced to change their decisions
about their own treatment, despite the thoughts of the service provider, even if they think it’s better to choose a
different and less risky form of treatment.

All service user's have the right to make their own decisions in their own care, the professionals must uphold their
rights by supporting them and helping them be aware of their rights. The independence of service users can be
maintained by providing advocates for their rights. Service users rights can be promoted by; supporting service users
in making informed decision to do with their care, resolve any conflicts that clash in with their care, minimising any
risk to prevent harm, respecting them and the chooses that they make, promote personal-centred care by involving
the users and making them the centre piece of their care, reporting any issues or problems that may occur and
following all law and legislations to prevent misconduct.

They all have the right to make decisions unless they lack the mental capacity, which then they can’t make medical
or financial decisions, but they can make personal decisions, such as, what clothes they want to wear, etc. The
service user would be provided an advocate to help with the medical and financial decisions apart of their care. The
advocate can be a family member or a professional, who would make decisions in their best interest, on their behalf.
Acting in the best interests of the service user means to make a decision that would be best for them and their
treatment, so that they can get better. The Mental Capacity Act 2005 gives rights to those who lack capacity
(legislation.gov.uk, Mental Capacity Act 2005). One of the principles is to act in the best interest of the service user.
The importance of this is so that the service providers take into account the service users preferences and needs to
make decisions in their best interest. This'll preserve the dignity and respect of the individual.

If a professional tries to restrict a service user will make them resist receiving care, which means their health and
wellbeing will worsen. This would make them feel that they’re losing their independence, because the professionals
has more power over them and their care, as they're being restricted to certain treatment, that they may not even
agree with. This then could build resentment within the service users, which then will make them resist support,
help or treatment from the professionals, as they're not being able to make their own choices freely, without any
restrictions.

Maintaing the balance of the duty of care and rights of the service user is difficult for the service provider because
they must not resist the service user so much they resist care, entirely, but they should be able to make sure that the
service users choice of treatment wouldn't cause high risks of harm to them. They can maintain the service users
duty or care, whilst balancing their rights by allowing for them choose their own choice of treatment, whilst
maintaining their safety by taking risk assessments. Compromises must be made, so that both the service user and
provider are satisfied. For example, a service users who has arthritis wants to make a cup of tea on their own but the
professional does not allow it because of the risk of the service user burning themselves, as it's there on a high risk
that they’d likely do so. This may make the service user feel upset, as they're not being given the opportunity to be
independent. This creates conflict between the service user and the professional, so to avoid this situation from
escalating, they must come up with a compromise that satisfies the both of them. This is called having a balance of
the rights and the duty of care of the service user, which is important because it helped create better care for the
service user, as they can be more satisfied with their care as their right are not be put to the side and ignored.
Service users independence is promoted by them having the rights and power for their own decisions to be made in
their own care.

There are many concerns in Lizzy's case, such as, the key pad not working. This puts al, service users at risk and
service providers too, as unwanted/ random people can enter the ward and cause harm to anyone. Unauthorized
visitors could enter the ward with the intention to harm the service users/ providers, such as Lizzy husband. Lizzy's
husband could also be able to access the ward without permission/ supervision, which could mean that Lizzy could
be at risk of abuse. Her husband is potentially abusing her, which could mean unsupervised visits where he's closing
the curtains may be the reason to her being harmed and her situation would potentially escalate because her
husband hasn't got caught yet and may be used to/ comfortable with it.

There are many ways of preventing these concerns from getting worse and potentially be the reason for someone's
injury, such as; fixing the keypads soon as possible, having the door shut instead of left propped open, having those
who are visiting knock instead of walking in and out prevents intruders walking in, etc. They could also have visitor's
sign in and out every time they visit and can assure with the service user that they're actual visitors, which prevents
them harm from unwanted/ unknown visitors. This will then be somewhat of evidence that be used in an
investigation, if needed for any incidents that may occur. This would be showing good practice as the professionals
are maintain the duty of care to all the service users, by not letting visitors come into the ward without signing in,
which means their names have been recorded before entering the ward.

Another concern would be that the health professionals are not safeguarding Lizzy as the nurses leave her
unsupervised when her potentially abusive husband comes to visit. This would likely put Lizzy at risk of harm from
abuse (like her swollen hand), all because the nurses aren't monitoring and safeguarding Lizzy while her husband is
around is that. Here the professionals have failed to uphold their duty of care towards Lizzy, as she is being left alone
with her husband, putting her in a dangerous situation. This could be prevented if only Lizzy could have monitored
visits her husband to prevent any harm coming to Lizzy. This would minimise any chances of the husband abusing
her, as he's under supervision, which then keeps Lizzy safe from harm. This would be where the professionals are
maintaining the duty of care towards Lizzy, as its their responsibility to safeguard Lizzy from her husband.

Another concern could be that they are not recording down medication dose they're administrating to Lizzy. This
puts her at risk of harm and potentially worse, death. This could lead her to her having an accidental overdose, as no
one has recorded the dose down, which can imply to others hat she hasn't yet been given her medication. This is
may lead to them administrating her another dose of medication. Again, this doesn't meet the duty of care to Lizzy
and to prevent this form occurring, they can attend regular training again to ensure they fully comprehend their
duties they have and so that they know to record a service user medication for the users safety.

Complaints and Appeals

P2. Discuss ways in which complaints and appeals procedures address failure in a duty of care in a selected health
or social care setting.

Complaints and appeals procedures help point out misconduct of any sort within health and social care organisations
that may be towards a specific individual or an organization. There are many health and social care bodies that are in
control of the organisation's standard of care and procedures such as RQIA. RQIA stands for Regulation and Quality
Improvement Authority, which are a professional independent body that monitor and inspect the health and safety
of health care organisations (RQIA). These professional bodies have to make sure that these complaints are seen too,
as they have thew power to do so. Any complaints that are made, whether on call, email, letters or in person, must
be accurately recorded down as a copy of the exact complaint that was made. As soon as any complaints are made
they must be investigated thoroughly and as soon as possible The individual has the right to be informed of this right
away and must be kept in the loop of what is going on.

There are many reasons to why complaints are made and they are; discrimination, inequalities, treatment expenses,
etc. Neglect and abuse by professionals are also reasons to complain as it goes against the rules and regulation of all
health and social care settings. For example, Lizzy is being prescribed medication by a nurse who isn’t properly and
accurately recording the does of medicine that Lizzy has been taking. Many complaints could be made about the
service providers neglecting the service users, whilst visitors stay to visit their loved one. Instead of supervising
them, they have their own little discussions outside of the facility. This is the service providers neglecting the service
users, which should be complained about as it impacts service users.

In Lizzy's case, she is an NHS patient ward, so she would need to complain to NHS England. NHS England are the
people who pay and arrange the services/ treatment for the public. If Lizzy complains to them about the poor service
from the providers and isn't satisfied with the response from them or believes that more could be done, she should
then reach out to the Ombudsman for more guidance. The Ombudsman helps investigate any complaints made of an
organisation or employee apart of the organization (Ombudsman services). There are complaint issue guidelines put
up, that all health and social care organizations must follow, such as NHS complaints regulation 2009, The Local
Authority Social Services, etc. Organisations have a responsibility to follow up on these guidelines, which advise
them to investigate all complaints made against them. There is a time limit to making complaints, which is within 12
months of the incident taken place. Although, there are certain circumstances where the late complaint can be
acceptable, such as if the incident caused fear, trauma, needed long recovery from incident, being unaware of the
situation, lacking mental capabilities, etc. these are conditions that the individual's isn’t able to control and so their
reaction time would be delayed. Lizzy may fear the reaction of her husband and others, as she many not want the
attention drawn to her. This may be thew reason to why she may not want to make a complaint at the time the
incident took place. Complaints should be responded to correctly and as soon as possible, once it is made. The
person who made the complaint should be treated with respect and dignity, as this can be a worrying time for them,
and they may be traumatised from the incident. The complaint must be recorded by a provider who must inform the
person of their rights as they may not be aware of them. Support also should be offered if needed. All complaints
must be taken seriously no matter thew belief, gender, etc, of the person filing the complaint. After the complaint
has been correctly recorded, this must be passed onto someone (a professional) of higher authority, such as a
manager.

The NHS have specific guidelines and procedures that put in place for those who filed in complaints to/ about thew
NHS organisations or the professionals within it. The procedure is called; The NHS Feedback and Complaints
Procedures (GOV.UK), which outlines what one must do when filing a complaint. Firstly, this procedure starts off by
getting the person to give feedback/ complaints about any issues they have of the organization or of a provider apart
of the organization. This feedback/ complaint is correctly recorded and then directly sent to a professional of higher
authority in the organization, such as the head of department. These feedback/ complaints would be investigated
and resolved as soon as possible. If any feedback is about duty of care misconducts, this implies that the service
users aren’t receiving the care, support and treatment they need to get better. If these issues weren’t resolved from
the feedback/ complaint that was made, the service user who made that complaint is allowed to then make a
complaint straight to the organization/professionals apart of that organisation. The organization/professionals apart
of that organization would have the direct information of that complaint, which must be delt with, in the appropriate
correct manner themselves, rather than the complaint being passed through others. The complaint must be dealt
with as soon as possible, if not done zo and the user who made the complaint is still concerned, they then can and
should be able to make a complaint to the ‘Parliamentary and Health Service Ombudsman’. This is where further
investigation can be made to sort out any misconduct and zo that the complaint is sorted out, finally satisfying the
user who made the complaint. The Ombudsman are the government official.

Complaints can be used to praise professional's hard work but are usually seen as a negative thing and is used to
provide feedback on misconduct. Sometimes they are used to provide areas for improvement and self-evaluation. It
is the duty of care for professionals and the organisation to make adjustments and improvements to the health care
setting, so that it's safe for not only the users, but for the providers too. For example, ensuring that medication is
properly recorded down into service users care plan, so that other professionals are aware that they’ve had their
medication, preventing overdose, for the patient’s safety.

Complaints must be accurately recorded and taken seriously, but also there is the legal procedures that must also be
considered. Care that is poor standard can impact the service users as it is deemed dangerous and harmful towards
them. This can also be seen as neglect and can be classed as criminal actions. All professionals in health care
organisations are obliged to follow ‘The Care Act 2014’. This act made safeguarding adults' compulsory duty that all
professionals must to follow up on.

Any suspicions (or one has witnessed it or has evidence) of another person that may be suffering from abuse, neglect
or harm, must be reported immediately to the authority (police) as it is a safeguarding matter that must be
investigated as soon as possible. For example, Amina questioning Lizzy on how her hand has become so swollen after
her husband left, if she suspected that she is being abused, Amina then must report it to the police, as it would
prevent any further abuse/ harm done. Sometimes service providers do not report these situations because of
disbelief, not wanting to get in trouble, etc, but there are many consequences that can occur to both the one getting
abused and the provider who didn’t report it. For example, If Lizzy happened to die due to her husband's abusive
actions and Amina didn’t bother to report it, then Amina would likely be charged with manslaughter or be fired or
she’d get a disciplinary, as she never reported it at the time and failed to follow up on the duty of care. Complaints of
misconduct or safeguard relating complaints are thoroughly investigated by the organisation.

P3.Describe the types and signs of abuse and neglect that may be experienced by different individuals.

There are many forms of abuse and neglect, they are; psychical, sexual, emotional, phycological, mental, financial,
domestic, etc. Each of these forms of abuse and neglect have many different actions and ways it can be shown
through many signs that can indicate abuse and or neglect.

Abuse is where one intentionally performs an action that causes damage to another person. Neglect is where one is
purposely not taken care of or one failed to care for them. An example of physical neglect is when Lizzy's psychical
care is being neglected when she is left alone by her provider with her spouse who is suspected of assaulting her.
Also, individuals with mental illnesses or health issues may physically neglect themselves perhaps by not doing their
personal care, which then makes them have poor personal hygiene. Professionals, such as carers could do this too by
not performing their personal care to the individual correctly/ efficiently. The signs of neglect can be, unexplained
weight loss, poor personal hygiene, dirty looking appearance, injuries, bruise, scars, etc.

Another form of abuse can be emotional abuse such as, making constant ‘funny’ jokes at someone about them, not
allowing them to have friends/ socialise, threating them, constantly humiliating someone, etc. Anyone can be
emotionally abused, especially children. There are many signs to emotional abuse such as, lack of confidence in
oneself, difficulties in maintaining relationships with others, etc. (NSPCC).

One form of abuse can be psychological abuse, which is when an individual is treated the wrong way to such an
extent that it has psychologically impacted them, leaving them with psychological trauma. There are many ways one
can psychologically abuse someone by verbal abuse like name calling, threatening, humiliating, etc, and gaslighting.
It is a form of abuse intended to cause one mental harm/ pain. Making one feel that they’re not good enough,
belittling them, intimidating them etc, are a part of this too. This can occur to anyone of any age, which will likely
impact them for their rest of their lives. It is long-lasting as it leaves phycological trauma and is much more difficult
to identify than psychical abuse. The signs that could be seen to identify this form of abuse can be depression,
anxiety, maybe self-harm, etc.

Another form of abuse can be sexual abuse, which is when an individual is perhaps forced to take part in sexual
activities or even get molested. This is where they have not consented to be involved in such acts, which makes it
forced upon them. This form of abuse could also be sexual jokes, harassment, comments, unwanted touching, etc.
Sexual harassment can be a ‘joke’ to some but still is a form of sexual abuse as it is unliked by the one receiving the
harassment. This form of abuse can occur to anyone of any age, which can impact ones life, in most likely all factors.
Sexual abuse of any sort can be very uncomfortable, intimidating, etc. Most sexual abusers do these things to feel
powerful and in control, whilst their victims are in a weaker position as they make the feel uncomfortable and
intimidated. The signs that could be seen to identify this form of abuse can be psychical, mental or emotional. Thew
signs are depending on the form of sexual abuse that occurred.

Another form of abuse can be discrimination, which may not often be seen as a form of abuse but people can be
discriminated against for many things such as their age, race, sexuality, their past, religion, gender, etc. In general,
people have their perceptions of others and are rather quick to judge others for their differences. The signs that
could be seen to identify this form of abuse can be if an individual is denied privacy, no access to their personal
belongings, not given options about their care plan, no recommendations for their treatment, no access to service
given to them, etc. Others signs may be when thew individual may show frustration or be anxious and may even
withdrawals from group activities or their even wanting treatment.

Another form of abuse can be physical abuse, which is when one intentionally causes psychical pain and harm to
someone else. Psychical abuse is done intentionally, meaning it is not done by accident. Physical abuse can occur to
anyone, of any age, at any time. Physical abuse is known to be aggressive actions, which can be anything that causes
psychical harm to someone such as, punching, hitting, pushing, slapping, pinching, etc. Many victims of this abuse
may feel that they deserved it or that it was some sort of joke, which may be the reason why Lizzy turned her head
away as she was being asked questions about her hand, by Amina. Amina was made aware that if something like this
occurs or whether something seemed off, that she should immediately report it as a safeguarding issue, ac it's part
of her duty to care. The signs of this form of abuse can be bruises that cannot be explained easily, such as Lizzy’s
bruised hand. Other signs can be broken bones, burns, malnutrition, gripping her tightly, grabbing of the arm
aggressively, etc.

Another form of abuse can be financial, which is when one forcibly takes control of an individual's finances. This can
occur to anyone, but mostly occurs with young and or vulnerable people. Financial abuse is when somebody takes
someone's money, without consent and withholds it from them. Majority of the time, the abuser is seen as a friend,
to the victim. The signs of this form of abuse could be when valuable items go missing, loss of money (which means
they may be unable to pay for care/ treatment), unexplainable withdrawals, etc. Financial abuse is a criminal offence
and all service providers must be aware of this. Even if they are offered money by users, they should politely decline
the offer. Scamming is allow a form of financial abuse, which involves false representations, use of another persons
bank account details, documents, cards, etc. This could make the individual confused or even scared.

P4.Explain the factors that may contribute to and reduce the likelihood of abuse and neglect for service users in
health and social care.

There are many factors that contribute towards an individual being vulnerable, which are; psychical vulnerability,
cognitive impairment, emotional vulnerability social vulnerability and staffing issues.

Psychical vulnerability has many factors, which include injury, casualties, etc. Lizzy is physically vulnerable as she just
had surgery. Having a psychical vulnerability is a psychical disability, which limits ones access from carry out many
tasks, such as, sports involving intensive movement, but it can be adjusted for them to be included jn the activity.
Those who are vulnerable are more open to risks of physical harm, fraud, etc. People who aren't disabled can
mistakenly be described as disabled, which is why one must be cautious with our immediate judgements, to prevent
offending others.
Cognitive impairment has many factors that contribute towards it such as, head injuries (brain damage) learning
difficulties from birth. Many people suffer cognitive impairment, which makes it difficult for them to identify or even
defend themselves when it comes to them being neglected, harmed or abused, in any way. This is because of their
condition and the factors that come along with it, such as having a hard time comprehending if they’re in any
safeguarding/ abusive situations. This implies that they are at more risk of being in those situations, as they’re more
vulnerable to pick on, due to their condition. They may not be aware on how to report situations like this.

Emotional vulnerability can negatively impact can service user's judgement. Many people suffer with mental illnesses
can be vulnerable to threats, which puts them at risk of things such as fraud, etc. Lizzy has a potentially abusive
husband, who is potentially abusing her. Lizzy is afraid of what her husband might do, so she chooses to disclose her
situation instead of telling anyone about it. This makes her emotionally vulnerable as she struggles to disclose this
safeguarding matter, out of fear, which could lead to mental health problems.

There are some individuals that are socially isolated or they have 'friends' that are only there for their personal
benefit and to take advantage of them for their own use. This is social vulnerability, which cause one to feel
vulnerable as they're constantly stressed, scared, shocked, etc, from the abuse and or social exclusion that they've
gone through. Leaving a negative impact on their mental health, as the situation may lead them to them being
depressed, lonely, excluded, etc.

These staffing issues can occur when an organisation is short on professionals or professionals haven't been properly
trained/ haven't been attending training. This could lead to higher risk of neglect, abuse and harm to service users
because the care teams will not be able to give a high standard of care without proper competence and skills from
training and less staff available. This could eventually lead to some service users not receiving effective treatment
they need to get better, meaning they’ll get worse, until the either receive the correct/effective care they need or
even worse, they die. Patients could wet themselves and could bleed through their bandages, causing infections,
develop bedsores or have overall poor hygiene, all because of the lack of staff available. There may be too many
service users being treated by one professional, so the professional would likely be rushing between service users to
move onto he next one.

There are many ways to prevent/ reduce the risk of any safeguarding matters from occurring, such as; training
professionals at health care organisations about safeguarding legislations and regulations, whistleblowing, etc.

Health professional must be able to identify any service users at risk of any potential safeguarding risks. They can
identify this by; recording any behavioural changes, which will then allow for them to see whether there is a pattern
to this behaviour change. They must be able to maintain a good relationship and have a good communication flow
with service users, as this allows for them to identify any changes of service users through observation and
communication of service users. Service users may feel more comfortable to talk to them about their situation, as
they have a good relationship with them, which means they trust them. They should be able to observe the service
users behaviour and routine so that if it changes, they’d be able to easily notice it. Being observant would increase
chances of them noticing these changes, so that they can prevent it from starting or escalating sooner, so that they
can immediately record it and report it. If health care professionals follow up on these things they’d be able to
prevent the risk of safeguarding issues. The professionals can observe Lizzy’s behaviour when her husband comes to
visit her at the hospital, which then can reduce the risk of her being situation escalating. She may come across as
scared or may flinch often when someone comes too close to her. These are signs of potential abuse. This would be
unlikely to happen as the staff go and have their own fun elsewhere, when the service users are visited.

Health care professionals must promote empowerment to all individuals, as it allows for them to take responsibility
in their actions that helped prevent their safeguarding situation to escalate. They can promote individuals by,
encouraging them to feel more comfortable and confident in their capability to make decisions and choices of their
own. They could empower them for speaking up and securing their safety, if they do so. The professional must
maintain a good trusting relationship with the service user, as it would put them at ease when speaking up about
their situation. They’d feel more comfortable to talk about it, as they trust the professional. All individuals have the
right to make decisions and choices in their own care, which promotes independence and personalised care.
Promoting Lizzy’s empowerment would help her gain the confidence and the control to speak up about her situation
of her potential abuse.

P5.Explain how to respond to concerns about abuse and neglect in the selected health or social care

M2. Assess the importance of recognising and responding to evidence or concerns about different types of abuse
and neglect in health and social care.

When and if a service user decides to speak up of a safeguarding matter to a trusted provider, it is vital that the
provider listens attentively, so that they later can report and record it accurately. Attentive listening is also important
so that the provider can provide the correct and empathetic feedback to the service user. This would make the
service user feel listened too. It is also vital that the situation is taken seriously and that they don’t jump to
conclusions, as it may not be true and false allegations can ruin one’s reputation.

The professional should not ask for many questions at once as the service user could become agitated and
distressed. This may be the reason they stop talking about the situation as they become overwhelmed with the vast
amount of questions thrown at them. The provider should inform the service user that if their situation is a
safeguarding issue then they cannot keep it a secret, as it must be reported. It is a part of their duty of care to report
it as they must keep the service user safe and away from harm. If it is a safeguarding issue they must immediately
report and record it to those of higher roles/ authority, such as their manager or the police, even if they are unsure,
but they can’t jump to conclusion.

In Lizzy’s case study, she is in a safeguarding issue, which involves her husband being abusive towards her but also
what her provider is doing to her, as she is administrating the wrong dose of medication to her. It is completely up to
her to open about her situation. Her situation is harmful and a struggle to go through, so when speaking up about it,
her provider, Amina, must be understanding, compassionate and empathetic towards her. Lizzy may be in stress
from speaking up about it, so Amina must make her feel as comfortable as possible. She has a lot going on in her life,
from just being out of surgery to going through this recent situation, to being abused at home by her husband. This is
a lot for someone to take on, and will have a negative impact on their health and wellbeing. This is a matter that
must be reported, as someone can’t just make such accusations so Amina must consider what the outcomes for Lizzy
if she keeps her situation a secret and does not report it. Amina must understand the impact of her situation and
that it has already put at increasingly harmful state and that if she doesn't report this, then Lizzy’s situation will
escalate. She also must maintain her dignity and respect Lizzy.
All safeguarding information is kept is personal so it’s kept private for only those who are safeguarding staff and of
authority can view/ have access to it. It is protected under The Data Protection Act, which was set out in 1998 and
The Human Rights Act 1998. The information is confidential, which means it will be stored safely, or locked away in a
file cabinet, on a USB stick, locked in a file with a secure password that is only accessed by some. This is to prevent
breach of confidentiality. Amina isn’t allowed to speak of Lizzy’s situation to anyone other than safeguarding staff
and police. Professional that witnesses safeguarding matters, must immediately report and record it. They could
report it to professional bodies outside of the organisation, this is known as whistleblowing. Whistleblowing is where
staff speak up freely about safeguarding issues within the organisation, without others having to know, the fear of
being harassed or bullied by other staff, etc. Sometimes, a service provider may witness a safeguarding matter occur,
but may not report it out of fear of what the consequences for themselves would be or for the service user, as they
may fear that they’d be making it worse for the service user such as Lizzy, or it may just be easier to not carry out
the whistleblowing procedures, but this is completely wrong. This is wrong because now the situation may escalate
further as what is being done to the service user is now more comfortable to do, as no one has reprimanded them
for misconduct so they’ll continue doing it.

If safeguarding allegations are not reported or recorded or is dismissed and not taken seriously, this can potentially
make the situation escalate and can increase danger, which can lead to death. Also, this would be the be the service
provider neglecting their duty of care to their service user, so it can lead to them getting a disciplinary or fired even.
All organisations have a policy describing how the professionals working there can be aware and understand the
actions of others and how to report and record these safeguarding matters. Sometimes the providers may fear or be
intimidated by the person they are whistleblowing, but either way they have a duty of care to their service users to
keep/ prevent them from harm, abuse and neglect, which means they must report it as it’s their duty to do so.

If Amina chooses to report this incident she may become a whistleblower for the Nurse who isn't recording the
medication they administered to Lizzy, so it vital to call out this misconduct, as it could lead to overdose, as other
professionals wouldn't be aware that Lizzy has already been given her medication, but they would give her more
when she doesn't need it. This is neglect, despite whether it is being done with intent or not. Amina an the service
user at harm, both must be assured safety, especially during this difficult time. Professionals must be aware that not
all care that is poor-quality is just straightforward abuse and sometimes it's neglect.

There are many reasons to whistleblowing, such as; if a service provider is mistreating service users or causing harm
to them, if a service provider repeatedly doesn’t provide food, medication and water, which are necessities, to the
service user, etc. Another example would be, constantly not helping service user's do their personal hygiene when
help is needed, such as, bathing, showering, toilet, etc.

Those in higher roles/ authority must take the whole situation and allegations seriously. The safeguarding procedure,
along with other procedures and policies must be followed when dealing with safeguarding matters. This is to put a
stop to the misconduct taken place in the organisation. They also must reassure the whistle-blower that they have
done the right thing and that they will be protected, zo that they feel safe in their work environment.

There are multi-agency safeguarding teams that are many agencies/ organisations that work together to make sure
that there is a group of professionals who meet up regularly for discussions and planning out the most effective ways
to identify and prevent any cases of abuse and neglect. They also can provide advocates for the service users/
providers who need support and need help to understand how the whole process works, as it may be all too
overwhelming for them as they may not understand the process.
When multi-agencies work together there are many skills that requires them to work effectively, such as effective
communication, effective coordination, organisational skills, etc. It is important for the team to have these skills, so
that they can prevent any of the professionals from becoming mixed up, lost or misinterpreted. Effective
coordination and organisational skills allows for the most effective care possible for vulnerable groups to ensure they
get the actual help and information that they need.

There are many different professional agencies that work together to form the multi-agency safeguarding team, a
few of these would be social services, police, health services, voluntary organisations and care quality commissions
(CQC).

Each of these professionals specify in different fields of work within the team.

Social services carry out many tasks such as; managing any questions asked and investigating complaints, carry out
reviews and provide unbiased advocates for service users, etc.

The authority (the police) collaborates by sharing necessary data that they have collected with other agencies such
as social services or health services so they can work together to help prevent abuse, neglect and harm.

The Care Quality Commissions (CQC) are the professional bodies organisation that set out the regulations and
standards of all health and social care settings, which must be followed by all professionals in health care, to ensure
safety for themselves and the service users. They do regular inspections to make sure they are following these
regulations set by them. The health care staff must attend regular training, which then can help them to identify
signs of abuse and therefore can be whistleblowers on abuse. The care quality commission agency does frequent
check-ups of all health care organizations to ensure that professionals are attending regular training, are maintaining
infection control, hygiene, effective care being provided, complaints being seen too, etc. They do these check-ups to
make sure organizations are providing proper effective care and to ensure that service users are satisfied with the
care they’re receiving (CQC, About us what we do and how we do it, page 4).

Volentry organisation help and support vulnerable individuals. They can't employ anyone that doesn't have an
Access NI, which is made compulsory by law. An Access NI is a criminal record check-up, like a DBS, which all
employees must have done to be employed (nidirect).

Any denied applications must be reported to other agencies available. This is vital as it ensures safety when many
different organisations are working together to provide the same thing such as with Lizzy, the police will be able to
check for other things on her husband's records for any previous charges he may have that she may be unaware of,
or if there has been a report filed of him bring abusive previously.

A multi-agency safeguarding team may also help with regards to the wards broken doors if during an inspection by
the Care quality commission these are not fixed it means that the ward is not following the health and safety
regulations and it is unsafe for patients and staff to work/be there. This implies that any complaints that are made by
service users that are reported to the proper organisation that can provide help, with the abuse allegations, social
services and voluntary services that could provide mental health support to Lizzy. When agencies work together as a
force of different professions to investigate safeguarding situations, it ensures that any further potential risk of
abuse to the user would be reduced. When they work effectively, the support the service user receives would be
much more effective, as they would understand the new needs and support the service users requires. The service
user would feel safe as they would receive support from professionals and would be regularly informed of the
progress of the investigation. This would prevent risks of any further abuse that may occur to the user and others.
In health and social care legislation, procedures and laws are put in place to make sure all professionals follow them.
If professionals were to follow all the legislations, procedures and laws set, such as the safeguarding act/ procedure,
abuse and neglect situations would and can be prevent. If not, then the victim suffering from the abuse and or
neglect would continue to suffer, and other service users aren’t ensured safety from abuse or neglect. The
importance of reporting and recording concerns of any safeguarding matter, is that it can be prevented from
escalating.

It important that service providers know how to recognise and identify abuse. All service providers should know the
signs and behaviours of different forms of abuse and neglect, so that they can identify it as soon as possible. Once
they identify it, they can have a discussion with the user, instead of immediately jumping to conclusions. They should
ask specific questions that allow for a better chance of the service users speaking up about their situation to them.
Questions involving who, where, when, what, would enable them to get a straight story of the situation, which
they’ll record and report down accurately. Making sure that one is listening to the user attentively as it shows that
your paying attention to them and they’ll feel worthy, valued and appreciated. This is why it’s important for them to
form strong bonds and relationships with their service users, so that they know their habits and usual self. This'll
make it easier to identify changes in behaviour and signs. If not, the consequences are that the service user is prone
to being harmed again. As explained in p3, there are many different signs to many different abuses. For example,
Lizzy’s swallow hand could be a sign of psychical abuse. Changes in the behaviours such as getting aggravated often
and withdrawals, lack of care for oneself/ personal hygiene, etc. Professionals would be able to recognise abuse by
seeing and identifying these signs. Too many questions at once may overwhelm the service user, especially if they’re
already got a lot on their plate and are in a vulnerable state, like Lizzy. Too many questions may be the reason to
why the service user no longer wants to discuss their situation any longer. Lizzy may feel that she’d be punished by
her husband if she spoke up about him abusing her, so this may make her feel threatened to not speak of her
situation, causing her to have to continue to deal with the abuse. Lizzy also may feel that the abuse is her fault and
that she deserves it, which may be another reason to why she may not speak of her situation.

Overall, safe practice is being promoted by safeguarding procedures that are set out to be followed up by
professionals to promote the safety/ safe practices for the service users. This procedure is also made to protect the
professionals too.

References:

https://www.rqia.org.uk/ (RQIA)

https://www.ombudsman-services.org/ (Ombudsman services)

https://www.gov.uk/government/publications/the-nhs-constitution-for-england/how-do-i-give-feedback-or-make-a-
complaint-about-an-nhs-service#:~:text=You%20can%20complain%20in%20writing,possible%20to%20investigate
%20your%20complaint. (GOV.UK)
https://niscc.info/app/uploads/2020/09/Induction-Programme-Social-Care-Workers-1.pdf (NISCC, Induction
Programme Social Care Workers, page 2-4)

https://www.nspcc.org.uk/what-is-child-abuse/types-of-abuse/emotional-abuse/ (NSPCC)

https://www.nidirect.gov.uk/articles/general-information-accessni-employers#:~:text=AccessNI%20checks%20UK
%20criminal%20records,disclosed%20in%20the%20AccessNI%20certificate (nidirect)

https://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpgacop_20050009_en.pdf (Mental capacity act 2005,

legislation.GOV.UK, code of practise)

https://www.cqc.org.uk/sites/default/files/20170504_CQC_About-us.pdf (CQC, About us what we do and how we

do it, page 4)

https://www.legislation.gov.uk/ukpga/2005/9/section/1 (legislation.gov.uk, Mental Capacity Act 2005)