Current policy ,legislation and professional involvement. In day to day life abuse activities are growing rapidly and the measures to prevent them are also getting more specific .The exercise of power by the state on this sector is the most important thing to solve this problem. The government bodies are making different plans, policies to prevent abuse and create a healthier society and the nation. Mckibbin et al (2008) states that range of legislation and policies are designed to protect individual, groups, and vulnerable adults from abuse these are-
"The Care Standard Act 2000"
"Whistle Blowing Policy"
"Physical Intervention Policy"
"Complaint Procedure in Care Home"
Confidently and disclosure
Trust is an integral part of our ability to provide consistent high standards of care and such it must not be broken.
A person's trust is not a right but a special privilege, which means you must exercise care and thought in your handling of confidence. You must never divulge a confidence placed in you by a service user, colleague, relative etc.
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Only where the nature of the confidence may have a detrimental impact upon the standard of care should consider passing it on and then only to the registered Manager, never anyone else.
Due to the nature of the work that is conducted within the home, and the confidentiality of information passes between residents, medical staff and statutory agencies and workers, all staff are required to sign a confidentiality agreement whereby you agree not to disclose any information relating to any resident without first obtaining permission from the resident and their assigned worker.
Physical intervention policy
Working with people who can behave aggressively has always presented management difficulties for staff.
Some of the people that we work for occasionally behave in a way that leaves us no option but to intervene physically for their own or other's safety.
Every effort must be made to ensure that potentially volatile situations are avoided using non-confrontational approaches aimed at enabling the resident to take responsibility for his/her actions and consequences that follow.
As a staff team we work together to reduce risks around violence and look at ways in which we can do this. Primarily, this is done by writing with Care Plans. The Care Plan needs to outline the aims and methods to be used with residents to gain achievements and life goals.
When writing Care Plans, Risk Assessments will be a functional part of this process. Both Care Plans and Risk Assessments need to reflect the principles of O'Brien and Wolfensberger regarding the provision of normalizing services.
Once a comprehensive Care Plan package is in place the staff team are able to work with a clear and defined approach offering consistent care and support to the people we work with.
The recording of incidents is a vital process in the safety of the staff.
All episodes of violence must be recorded. Staff are made aware of these procedures and the following must always be completed:-
Incident and Violent Episodes Forms
By the correct recording of Violent Episodes (VE) staff can look at the antecedents to behaviours in relation to the consequences. Often it is possible to develop strategies for reducing incidents in relation to this.
Incident and Violent Episode Forms give the staff team the opportunity to reflect and access.
Feedback and support is given in the form of supervision. All staff receives regular supervision every two to three weeks. This allows staff the opportunity to access their actions and reflect on work practice.
When looking at violence toward staff, there are a number of preventive measures that need to be considered and put into practice.
Ensuring the staffing levels is appropriate to the task. If there is a high risk, evaluate whether levels are adequate and if not have the flexibility to have extra staff on one given shift.
Rotating high risk jobs thus ensuring the same person is not always at risk. The team should also have the ability to evaluate a task and decide what action if any is necessary.
Always on Time
Marked to Standard
Make sure a senior member of staff on duty can make quick decisions if necessary.
Ensuring the whole staff team is aware of particular guidelines, Risk Assessments and Care Plans.
Making available the appropriate information for a particular task to be understood so that this can be undertaken with minimal risk.
Staff training is essential for all aspects of our jobs and can give staff some of the necessary tools for coping with and lessening violence. This should encourage a more positive body language and this in turn should lessen violent episodes within the service. We clarify with all residents that violent behaviour is not acceptable however we shall not judge or condemn their behaviour.
You must acquaint yourself with and abide by all and each of the issues current for the time being of the Company's Using Physical Intervention Policy. The Company revises all such policy and procedural documents on a regular basis responding to
changes in contemporary care practice, the needs of the Company and the needs to ensure continued efficiency. The responsibility to maintain awareness of and act upon on-going revision of such documents remains wholly that of the individual staff member. Although these various statements and procedures are not formally expressed terms of your Contract of Employment, compliance is regarded as important by the Company and failure to abide by the same way lead to disciplinary action.
Legislation implements by the "Care Standard Act 2000" and the CQC aims to ensure that care home operates in a legal way in the release of care to the customers. "Health and Safety at work Act 1974" is to give and preserve safe and healthy working conditions in workplace. "Data Protection Act 1998", it is applies confidentiality. "Disclosure Act 1998" about abuse and whistle blowing. "The Human Rights Act 1998" shows a whole range of rights and freedom of people. DOH (1998)
Strengths and weaknesses in current legislation and policies: In every policies and programmes there can be strength and weakness side so it s the important factor to identify which one is strength and weakness factor . We can make our strength more stronger and decrease or eliminate the weakness when we are well known about these factors. Here are some of the strength and weakness factors in current legislation and policies;
CRB Check (Adult protection): CRB and POVA will give that the employee (candidate criminal offence report) but it is doing only in the UK. When candidate from abroad did crime there in his back home country, CRB in UK wont show those crimes, in that case its better to check the foreign police clearance certificate as well.
Whistle Blowing Policy: It's the way to Improve the legislation practices and is a democratic option to build a healthier policy. But in some cases whistle blowing can create misunderstanding between the staffs and can decrease the motivation and security of the employees and can lead to worse condition as well.
Complaint Procedure: It will improve the service at the same time most demented people wont be able to complaint due to their disability
Residential Care Home Manager
Managers may direct workers directly or they may direct several supervisors who direct the workers. The manager must be familiar with the work of all the groups he/she supervises, but does not need to be the best in any or all of the areas. It is more important for the manager to know how to manage the workers than to know how to do their work well. Annie Phillips (2003)
Manager should have sufficient qualification and experience and no bad remark in Criminal record Bureau (CRB) records. (Frances 2004). Customers may be various and to meet the variety of their requirements, as a manager we have to be clear about what exactly each is seeking, what is needed is a way of thinking about the array of customers of residential care home.
Social care council
The general social care council is responsible for registration of all social care workers. The council regulates their conduct and their training. It will support for the setting and maintaining good practice standards. (Frances 2004). With having higher powers of operation in this sector social care council should be highly responsible for the better conduct and operation of the activities.
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These group of people are the direct responsible groups who café the target group so they should be well trained, and to be as per the standard set by the council. Workers should free from CRB and required to register with the council and need to be appropriately qualified (minimum NVQ 2) Should be able to give personal care, followed best practice, allow the residents to maintain their dignity, privacy and respected their individuality through out. (Frances 2004)
Working practice and strategies used to minimise abuse
Approaches To Adult Protection
There are many working practices implemented to minimise abuse in Health and Social Care Sectors the practices follows
Adams (2007) states that "in England, multiagency codes of practice aiming to tackle and prevent abuse of vulnerable adults developed in the light of the publication of the official guidance No Secrets (DOH and Home Office,2000)".
Protection of Vulnerable Adults (POVA)
Adams (2007) states that "The protection of vulnerable adults (POVA) scheme was introduced in England and Wales in a phased programme from 2004,as required in the Care Standard Act 2000".This formed a list of persons considered not fitting to with vulnerable adults in England and Wales.
People considered harmful to vulnerable adults could be referred by health and social care setting managers or employers of care for enclosure on the inventory These providers also could request for checks alongside the POVA list as part of an application for a CRB disclosure regarding persons apply for vacancies in care work. National minimum Standard were introduced for residential care
Under the POVA actions 'safeguarding adults' partnership have been set up from 2005 in each CQC area. Alerts may be triggered by inspectors, sometimes when inspecting or investigating a complaint. Safeguarding inspectors will deal with any safeguarding adult's matters arising from this. Where there are concerns about the fitness of the manager of an establishment, registered person, or service or a breach of the Care Standard Act 2000, the CQC could be the main investigating agency. A safeguarding plan should be produced through a case conference, normally reviewed within six months.
Registered providers of health and social care services are bound by law to produce a complaints procedure, specifying how service users, carers or patients can complain about the services. The procedure normally involves the complaint being investigated or responded to first by the service provider, although if the complaint is made to CQC inspection. The CQC may decide itself to carry out an investigation.
This usually involves a person making public some aspect of a group or organisation which they feel is wrong, dangerous, deficient or otherwise needing putting right through public attention. It is the activity of telling a third party, apart from colleagues or the employer, about malpractice. It will be unusual if any worker in the health and social care services does not come across some aspect of whistle blowing. This can arise directly or indirectly in three major ways, where:
You are the whistleblower: you notice practice you feel is not acceptable and you consider telling a third party, outside the line management, about it.
A colleague is the whistleblower: you see another person 'blowing the whistle' on practices they consider unacceptable.
The whistle is blown about practice involving you: where someone complains about, or 'blow the whistle' on, some practice with which you're connected.
Pritchard (1996) states that Case conference is very imp[ortant in to prevent abuse. A case conference brings people together to share their views and to discuss their work.It should be a forum where people can discuss their concerns,vent their feelings and anxieties and support each other. It is also a tool for organising future intervention. In summary the main purposes of a case conference are to:
Exchange information in a multi disciplinary forum
Assess the clien's situation and the degree of risk
Make decidion and recommendation which are to be implemented
Participants attending a case conference have several tasks to perform, namely:
To give and share information
The information given must be accurate.the participants gives factual information about the people they know( victim,abuser,or other important personnel). Obviousely participants voice their concerns,but they must also highlight the strength of a situation not just the negatives. Any gaps in information should always be identified and acknowledged.
To assess the level of risk
While handling a case of suspected abuse always need to do a risk assesment it is very important in case conference.
Decide on registration
Few authorities have 'at risk' register for adults.where they do exist conference participants must know what know what the defined criteria are for putting a person name on the register.
Co - ordinate future intervention
This will involve the formulation of a plan,which will state the tasks and responcibilities of everyone who will be involved. The keyworker will be responcible for ensuring that the plan s implemented and reconvening the case conference if there are difficulties in implementing the plan.
Following are some suggestion for further improvements in working practices to minimise abuse in health and social care context
When any one going to works for health and social care setting thet must check against POVA and CRB. POVA they can check new staffs with the provisional body whether they are free from Abusive offence in the United kingdom but here there is a drawback in case if the new employee is from outer United kingdom it will be harder to find whether the employee had any Abusive offence in their country.
So we can ask particular employee to give references and police clearance from their own country. So as employer of the organisation get a full detail of the new employee further more every employee must have a proper relevant training such as Manual handling, Adult protection and many more so as manager of the organisation make sure all the staffs are well trained for the job and the manager must do supervision and appraisal the the employee.
Whistle blowing is a good practice and it also got some disadvantages for an example in a residential care home all employees are from a certain country and in this team no one whistle blow about their country people to prevent this the manager always employ different ethnicity employees to the organisation and manager educate their staff about abuse. Communication and working in partnership is very important in minimising/preventing abuse in health and social care if not there are many more cases like Baby P,Victoria Climbie can happen future.
.1 identify and review exiting working practice and strategies designed to minimalism abuse in health and social care context
As we know abuse is a violation of an individual's human and civil rights by any other person or persons. So these violations should be restricted and some of the strategies to limit the abuse are being implemented everyday. Its very important to identify the practices and strategies to minimise abuse in health and social care sector. Some of the practices and strategies are as follows.
Safeguarding vulnerable adults: These special group of people need support from the society and nation and it's the responsibility of the nation to protect them and help them to live.
Domestic violence: Domestic violence has remained as a chronic problem in social sector. Strong support of family, friends and society are the base for preventing this problem. Government has also made strict rules regarding the domestic violence.
Racial harassment: Any type of behaviors that makes you feel distressed, alarmed or afraid can be categorized as harassment. This can include:
verbal abuse, such as name-calling, insults or racist jokes
vandalism and racist graffiti
nuisance phone calls, texts or emails
bullying, intimidation and threats
Physical abuse or violence.
Verbal and oral communication
Communication both with the service provider and user, involved in their care and support is necessary if any potential for harm and abuse is to be minimised. Care must be taken when communicating information, verbally to ensure it remains confidential. For example that is not overheard by others. Written records must be kept in secure place and only accessible to that person who need to know or are responsible for those communications.
Use of IT in sharing information between professionals
Now day's mostly health and social care organisation use computer to keep data about service user. It is important to make sure that data remains protected under the Data Protection Act 1998. Important information specially documents of abuses which are highly sensitive and disclosure of this information can be occurred harm for victims, should be stored by using password. Any kind of data share between professional must be informed individual's before sharing.
In relation to supporting and protecting adult from abuse important information should not be withheld from those who have a right to that information. According to the British Law a person is innocent until it is proved that is guilty and it is important therefore that worker and other do not jump to conclusion or make assumption about a person's guilt. Adult Protection procedures are in place to make sure that no one is treated in oppressive manner which is abuse itself. So before knowing the abuser its not legal to assume them.
Everybody should take care in avoiding any kind of discriminatory practice when identifying, reporting and acting to protect individual from abuse. Individual legal right is that when investigating any case of abuse involve with them, they should free from any kind of blame and miss judgment.
Frame work of assessment
The aim of framework of assessment is protecting vulnerable people. There are different types of framework can save people from being abused. To minimise abuse in institutional care recruiting is so important. Proper selection of employee can reduce abuse in many ways, the process of selecting POVA employee can be clarified as follows;
Is it a care position set out sub sec. 80(2) &(c) of the Care Standard Act?
Continue with recruitment/selection process including CRB disclosure where Appropriate
Conduct recruitment /selection process including CRB check
Await CRB disclosure and conformation of POVA check.
Is it a care position set out sub sec. 80(2) &(c) of the Care Standard Act?
Apply for POVA first check as waiting would put provider of care breach of statutory staffing requirements
POVA first check shows that a person with the same name and date of birth is on the POBA list
Do not offer employment in a care position in a care home or with a domiciliary agency
Offer employment subject to CRB disclosure and conformation of the POVA check
Await CRB disclosure and final POVA check.
Offer (or confirm) employment in a care position in a care home or with a domiciliary care agency
Does CRB disclosure indicate that person should not be employed in a care position?
Does conformation shows that applicant on the POVA list
Working in partnership with service user
Care sector agencies working in partnership is only part of the overall strategy to protect vulnerable adult from abuse. Enabling service users to recognise abuse and knowing how to alert others to this another important strategy.
Decision making process and forums
Local authority social service departments are responsible for adult protection and has set adult protection forum. If not then the local policy and procedure will describe the decision making process in situation where suspected or actual abuse require investigation.
Strategy between professional and within organisation
Working in partnership is also crucial, especially when the service user is accessing a number of different services. Effective communication between professional and organisation is important to ensure that the service user is protected. Communicating information about changes, significant event and action ensures that all those involved with supporting the service user are monitoring their well being so that they shouldn't be abused.
Effectiveness of policies and strategies
Use of IT in sharing information is protective and secure than traditional paper work besides to make quickest service use of technology is also important. Oral communication between care professional is remain confidential which means this information is not overheard by other people. Anti- oppressive practice and anti-discriminatory practice decrease chance of further abuse and frame work of assessment shows how to assess service user or assess employee before entering care work (POVA framework, diagram 1.1)
Working in partnership within service user helps to stay closer with service user and give the opportunity to know their needs and demand. Multi agency working is very crucial to protect vulnerable adult from abuse which lacks in only one agency.
To do further improvement in care profession to protect vulnerable person from being abused local authority should closely monitor proper implementation of legislation. Care organisation shouldn't send care worker to the work, before making sure that they are skilled enough to work otherwise the same thing will happen what was happened in the case of Victoria climbie and Baby p. Those two children died in their early age under the same authority because of lack of experience of care worker.
Abuse has very bad impact in the society. Without preventing abuse activities in the society its very hard to develop and development and civilization may get worst. It should be removed from our society by making sure the proper implementation of rules and legislation. We have to consider that abuse destroys individual's hopes, desires and interest of life and finally leads to a great social problem in the community and a nation.
Changing individual's mentality is most important to minimize abuse. Besides. working in partnership is also a way to diminish it. Step of government and help of Non Government Organisations (NGOs) is extremely needed to remove it and make it a permanent result. Thus as we know abuse is a social problem and cannot be solved through one's effort only so every members of society should play active roles in preventing abusive activities.