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The aim of this audit is to determine the level of compliance of the Safeguarding Adults Policy implemented by a Primary Care Trust (PCT) in 2008, within local Learning Disability services.
This audit has been carried out by a group of students, comprising of a number of different health and social care professions as part of an inter-professional learning programme. In addition to the aim of the audit, it will encourage collaborative working and highlight the importance of team working.
‘Those with learning disabilities are amongst the most socially excluded and vulnerable groups in Britain today'(Department of Health. Valuing People: A new strategy for learning disabilities for the 21st Century. Department of Health, 2001) that’s a direct quote. Learning disabilities includes the presence of a significant mental impairment – presenting with difficulties in understanding new or complex information and learning new skills. Those with learning disabilities are said to have a low intelligence quotient (IQ) of < 70 and impaired social functioning which are manifested before age 18. Department of Health. Valuing People: A new strategy for learning disabilities for the 21st Century. Department of Health, 2001).
‘People with learning disability have an increased vulnerability to receive abuse, due to their dependence on others for personal care.’ This may lead to an ‘imbalance of power’ between the carer and the person being cared for and so may develop into mistreatment. Also due to ‘difficulties in communicating; lack of sexual knowledge and assertiveness; and guilt and shame at being disabled’ they can be seen as easy targets to be abused or neglected. (Cooke, L. B. and Sinason, V. (1998). Abuse of people with learning disabilities and other vulnerable adults. Advances in Psychiatric Treatment, 4, 119-125. Available from http://apt.rcpsych.org/cgi/reprint/4/2/119.pdf)
The government white paper valuing people (2001) highlights the importance of working in partnership with people with learning disabilities. Although many positive developments have taken place with regards to choice, independence, rights and inclusion of individuals, many people living with learning disabilities are experiencing abuse and neglect. Department of Health. Valuing People: A new strategy for learning disabilities for the 21st Century. Department of Health, 2001
Even though there is no single approach to guarantee the protection of all adults with learning disabilities, a set of approaches need to be built to decrease the likeliness of abuse occurring and increase the likeliness of abuse being reported when it does.(Safeguarding Adults with
Learning Disabilities, Department of Social Work at the
University of Hull. Available at http://www.thurrock.gov.uk/socialcare/pdf/safeguarding_learning_disabilities.pdf)
The safeguarding adult policy outlines various approaches and offers information with practical steps to help better safeguard people and it also highlights the importance of working together, through a multi-disciplinary team. To achieve this goal, it is important to raise awareness of abuse amongst professional staff by offering training and highlighting their responsibilities to their service users. This audit was a new audit as the policies were introduced quite recently.
1.2 The audit cycle
Clinical auditing was introduced into the NHS in 1993 and has been defined by the National Institute for Clinical Excellence as ‘a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, processes, and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery’. (Principles for Best Practise in Clinical Audit 2002, NICE/CHI).
NICE (2002) Principles for best practice in clinical audit
Figure 1. The stages of clinical audit. NICE (2002) Principles for best practice in clinical audit
1.3 The audit in terms of the audit cycle
Stage 1: Adults with learning disabilities are vulnerable to abuse; therefore compliance to the safeguard policy by health workers would increase quality of life for these patients. In preparation, small audit groups were formed and members were made aware of their roles and responsibilities.
Stage 2: The PCT safeguarding adult’s policy outlines standards expected by staff in protecting vulnerable adults to ensure good practise. In carrying out this audit these standards can be evaluated to confirm that the requirements by staff are being met.
Stage 3: The audit was conducted through a questionnaire relating to policy implementation to measure current practice against standards set. The audit was carried out on a small staff sample, to get a snapshot of current practice in the local services.
Stage 4: Based on the findings, an action plan to improve care will be suggested, that should be considered by staff.
Stage 5: A re-audit should be planned to determine whether suggested implementation have been successful. The method of re-audit should follow the original audit to give best insight of whether the changes suggested have made a difference.
(Benjamin, A. (2008) Audit: How to do it in practice, British Medical Journal, 336: 1241-
1245. available from http://www.bmj.com/cgi/content/full/336/7655/1241)
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