Safeguarding Week - 22 June to 28 June 2020
Safeguarding Week is an opportunity for all agencies to raise awareness of safeguarding in Leeds.
Safeguarding Week is hosted jointly with the Leeds Safeguarding Children Partnership and Safer Leeds. The week provides is an opportunity to tell people who use your services about the support that is available to them; an opportunity to remind staff and volunteers about their responsibilities, and what they can do to support people to be safe. It is also an opportunity celebrate and share good practice.
This year, the COVID-19 pandemic places restrictions on how agencies can do this; but we ask that all agencies consider how best they can raise awareness during these difficult times; and this may include the additional work you are undertaking to support people to be safe from abuse and neglect during the pandemic.
This year the three Boards will provide a menu of learning and useful materials on their websites that we hope will be useful and informative to services in the city. The Leeds Safeguarding Adults Board will provide key messages and learning below from Safeguarding Adults Reviews. For information on materials provided by Safer Leeds external link and the Leeds Safeguarding Children's Partnership external link, please refer to their websites duing safeguarding week.
Throughout the week the Boards will be active on social media and we invite all our partners to post information on their own activities using the hashtag #safeguardingweek2020. Help us to promote the week by using all the materials which are now available for you to download on the Leeds Safeguarding Children Partnership website external link.
Safeguarding children, young people, adults and families remains a priority for all of us, especially during this challenging time. Help us to make Safeguarding Week a success by raising awareness and showcasing and celebrating the fantastic work that you do to protect and safeguard all people in Leeds.
Themes from Safeguarding Adults Reviews
Introduction to Learning Briefings
The Leeds Safeguarding Adults Board is pleased to provide you with a series of briefings, setting out learning themes from reviews that we have conducted over recent years. We will publish a new one each day during Safeguarding Week.
Regrettably, several of these reviews concern people's circumstances where to publish the full review reports who cause risk to others. However, we hope the references to the experience of these people help to explain the importance of the learning that is being described.
Our Ambition: Learn from experience to improve how we work
Monday: Professional Curiosity
Professional curiosity, or respectful uncertainty is a combination of looking, listening, asking direct questions, checking out and reflecting on information received. It means not taking a single source of information and accepting it at face value. It means testing out your professional assumptions about different types of families. It means triangulating information from different sources to gain a better understanding of family functioning which, in turn, helps to make predictions about what is likely to happen in the future. It means seeing past the obvious.
An example from one of the reviews undertaken by the Board is where a person's partner was asked why she had bruises on her back and he responded by saying that she kept falling over the lawnmower when she got in the bath. If we are exercising our professional curiosity, we would be asking why the lawnmower is kept in the bathroom and how the person was tripping over it and if the answer is not clear, to respectfully challenge it.
The Board has also conducted a review in relation to the circumstances of a person who died from complications related to untreated pressure ulcers, where those who were supporting them were rightly keen to respect their decision to not have treatment, (a decision for which they had mental capacity). However, professional curiosity would have meant additionally asking the person why they had made such a decision, enabling them to explore the person's thinking and also their understanding of the potential risks and likely impact of the decision.
Managers can use supervision to support practitioners to have the skills and confidence to sensitively explore underlying, often emotive and difficult issues that a person in need or at risk, may not automatically disclose. Managers can help practitioners avoid assumptions, acknowledge unconscious bias and see the world through the eyes of the person in need of support to understand the reasons behind someone's presentation, behaviours or decisions.
As practitioners, ask these questions to help you think in a professionally curious way:
1. Ask yourself why someone is behaving a certain way; think broadly about what this might mean.
2. Find out about the person's history; you can't hope to understand their thinking without knowing their past.
3. Be aware of people's responses to questions and read body language; are they seeming reluctant to answer the question, is something being held back? If so, why might that be?
4. Use your imagination and try to think from different perspectives when you analyse what is happening in a person's life.
5. Maintain an open mind. Try to avoid making assumptions, taking information at face value and jumping to conclusions.
6. Trust your instincts and raise concerns if something about someone's behaviour or situation does not feel right.
Tuesday: Information Sharing
Safeguarding adults practice achieves the best outcomes when it is multi-agency; working together is a fundamental principle of the Leeds Approach to Safeguarding. We know from reviews undertaken in Leeds that silo working is not helpful and that single agencies carrying risk alone struggle. The LSAB undertook a Safeguarding Adults Review into the circumstances of three women who died from complications that were related to pressure ulcer harm. In all three situations, practitioners and agencies were supporting the person within in their own service and not sharing information about risk across the multi-agency partnership. The reasons for this were often well-intentioned and based on a desire, especially in one case, to not embarrass or impede the dignity of the person. However, this meant that other professionals were not able to work with the service to develop creative approaches to managing the harm she was experiencing. Similarly, had the person's relatives been aware of the problem and involved in discussions about key areas of risk and concern, it may have been possible to develop a safeguarding plan that reduced the distress and pain that she experienced.
Another review undertaken by the LSAB concerned 'Dorothy' who had early onset dementia. She used a wheelchair, was unable to speak up for herself and was cared for by her husband. The Court found that he had assaulted her. As can be the case, following her death, several agencies had information about what was happening that once collated, gave a bigger picture of the abuse she experienced. If this had been shared beforehand, and ideally included discussions with her son, daughter and sister who all had more information about her life, the collective understanding of the risks would have evidenced the need for a different approach.
Too often however, people and organisations feel they cannot share information. Out of fear of doing the wrong thing, sometimes information that could make a real difference to someone's safety is not passed on. This is why we have developed this policy. We recognise that to support practitioners to make decisions about these important and sometimes difficult areas of practice, we need to provide clear guidance.
Sharing the right information at the right time with the right people, is fundamental to good safeguarding practice. Good information sharing enables practitioners and agencies to work together effectively, in the interests of supporting people within our communities to be safe and to feel safe. Click this link for the LSAB: Information Sharing Policy
The Policy explains why it is so important to record well and explain your decision-making when you share information; this can be known as defensible or accountable practice. You could use the following pointers to help think through how to record the decision-making process:
1. Ensure your recording is clearly worded, without acronyms and understandable to all
2. Set out the evidence on which you are basing your decision.
3. Demonstrate in your recording that you have evaluated all the relevant options and information.
4. Show the information you weighed up to reach that decision; show the working out.
5. Record any disagreement with the decision and why that has been over-ridden – what justifies that?
6. Refer to relevant legislation, policies and procedures.
7. Clearly state the actual decision itself.
Wednesday: Conducting difficult conversations
We know that a fundamentally important part of safeguarding is being open and honest with people, asking questions that can feel intrusive and my result in distress. This is not easy. Several reviews that the Leeds Safeguarding Adults Board has conducted over recent years have shown how hard it can be to have those conversations and the consequences of not doing so. This is about the need for practitioners to be able manage difficult conversations that help us to see and understand the whole person, and enable people to make informed decisions about risks, harm and their care and support.
Good support sometimes involves difficult conversations. This may involve talking to people about extremely personal and sensitive subjects that all of us would find difficult if we were in that position. Understandably sometimes people will be reluctant or resistant to having these conversations or reluctant to accept support that threatens their sense of privacy and dignity. Equally it can be difficult for practitioners to broach such subjects or know how to manage such sensitive conversations.
An example of balancing dignity with care from one of the cases at the centre of the thematic review undertaken of the experience of three women whose deaths were contributed to by pressure ulcer harm. Each of the women had the mental capacity to make decisions in relation to their care, but all were, in some way, resistant or reluctant to engage in particular interventions that could have reduced their risk of harm.
A significant factor in Mrs A's death was that the primary source of infection was a large pressure ulcer in the natal cleft, (the groove between a person's buttocks) which was only seen during hoist transfer. This position meant it would be potentially invasive to check in between her buttocks as part of every routine skin check; and Mrs A was understandably reluctant to let staff look at her bottom. The carer explained at Mrs A's inquest that it would take two staff using four hands to separate her buttocks in order to properly see this particular area and Mrs A was desperately embarrassed and the carers didn't want to force the matter, being keen to maintain her dignity.
It is immediately obvious from this example how difficult such conversations can be for practitioners. To provide support however, these conversations are necessary and need to be managed in the most sensitive and respectful way. Practitioners need the skills to do so and the support of their managers to plan and hold these difficult conversations; one element of the important learning here is simply about us acknowledging how hard these conversations can be and for practitioners to be honest about that themselves, seek advice and support and plan in advance how to have that discussion. Remember, that often people will not remember the detail of what you say, but they will recall how they felt, so think about your delivery and things that make a difference, like where to have the conversation, where people sit and how you will pitch your tone. If there are any risks from the person you are talking with, look after yourself too and consider how to de-escalate any tension and ensure that everyone, including you, feel safe.
In the review conducted in relation to Dorothy, who was frail, had early onset dementia and had experienced years of domestic abuse, good practice was identified in relation to a nurse challenging Dorothy's husband and carers and questioning the level of bruising on her arms. The recording showed a sensitive and careful conversation taking place that explored the nurse's concerns and was clear about the next steps, including the safeguarding referral she decided to make. When interviewed later, the nurse advised that knew the discussion would be difficult and she had planned it in advance, thinking through what she needed to say, how she would say it and anticipating possible responses and how to handle those. This example shows how recognising the challenge in advance and planning pays off.
Difficult conversations: planning considerations
Of course, not all difficult conversations can be planned in advance, but where they can, planning makes all the difference, not least to your confidence. It can help to think through these prompts when planning a difficult conversation. Use them yourself or talk through with your supervisor. If you have conducted difficult conversations in the past, it can be useful reflective learning to look back at that situation and consider what happened against these prompts, asking yourself if anything could have been differently and whether that would have impacted on the outcome.
- Where will you have the conversation? Does anyone need additional support (including interpreter etc.). Is the space private and without interruptions?
- How long are you allowing for the conversation? Is this enough time? It can help to tell the person at the start of the conversation how long you have, 'this will take about fifteen minutes'.
- Check the room layout and the position of the chairs. Consider any health and safety concerns.
- Plan how you will open up the conversation; this helps you take control and also set the scene, ensure your role is clear and the purpose of the discussion.
- Think about what you have to say – what is the key message? Make sure you are clear about that in advance and know how you are going to say it. It can be useful to write these down, even if you don't refer to your notes; it helps your thinking.
- Place yourself in the person's shoes; how might they feel and why? Bear in mind a person's culture and their heritage.
- Consider how you can use language that isn't inflammatory and that is easy to understand - make sure you avoid jargon and acronyms.
- Think about how you feel about the conversation; anxious? apprehensive? Being aware of this can help you manage your own responses during the conversation.
- Reflect on the possible responses you may receive and consider how you plan to reply in order to ensure the best outcome.
- Consider what you will say to end the discussion and explain the potential next steps. Again, if you have thought this through in advance it helps you to conclude the conversation effectively.
- Finally, ensure that you have support and someone to talk to afterwards about what was said what you are doing next and how you feel.
Thursday: Safeguarding Support and Guidance for Frontline Practitioners
Safeguarding adults can, of course, mean supporting people through times of high risk. Dealing with abuse, harm, risk and neglect can be hard work and doing so alone, without reflective support and guidance can be tough and risky; risky to your emotional and professional well-being and risky in terms of safeguarding the person from harm. Silo working in safeguarding is never a good thing.
In reviews conducted by the Leeds Safeguarding Adults Board recently, the need for frontline practitioners to seek and be provided with reflective and timely support and guidance from their supervisor has been highlighted by practitioners participating in case practitioner events.
Practitioners have said:
'Supervision sometimes feels like a luxury. But we need to talk through what's happening'.
Good, timely supervision can seem difficult to manage for stretched services, but it's essential to developing and supporting practitioners so they are confident, competent and focused on the person's needs and the risks. This will take place in different ways, according the service, but frontline practitioners need that support ………and challenge. Effective safeguarding supervision is essential to our development and supports practitioners to reflect on their working practices, make decisions and consider the impact they have on outcomes for citizens.
Supervisors, ask yourself: Are you prioritising supervision? Is it reflective & supportive yet challenging? Do you think through scenarios and hypothesise in the session? Do you challenge constructively? Is it recorded? Have you thought about talking through cases in a reflective, supportive way during team sessions? Treating such discussions as a source of learning and development can help you gain an understanding of the level of understanding of key practice issues in your team and embed important practice messages.
Practitioners, ask yourself: Are you prioritising supervision? Do you prepare? Do you welcome feedback? Are you ready to reflect and learn? Remember, it's a two-way process.
We know that when services are under pressure, it can be easy for us to work inwardly and 'just get on with it'. However, we also know that it makes a massive difference if we are able to talk through the difficult issues that don't necessarily have an absolutely right or wrong answer.
One to one guidance, or supervision is important for a number of good reasons:
- Maintenance of quality of care and support;
- Ensure that practitioners feel supported;
- Support on-going learning and development;
- Celebrate achievements;
- Supporting problem solving; and
- Providing the opportunity to reflect on think through risk.
For both supervisors and practitioners, useful questions to use in these discussions to consider how to identify and manage risk are:
Friday: Talk to me, Hear my voice
Talk to me, hear my voice
'Talk to me, hear my voice is the phrase that explains the Leeds Safeguarding Adults Board key ambition; to put the person at the centre of all we do in safeguarding adults in Leeds and to explicitly seek to understand that person's voice; their wishes, feelings and lived experience.
The phrase came into being because of the experience of one person about whose experience the Leeds Safeguarding Adults conducted a review, Dorothy. Dorothy had been assaulted by her husband and experienced serious physical and emotional harm prior to her death. She was frail, had early onset vascular dementia, Chronic Obstructive Airways Disease and seizure activity caused by epilepsy. At the end of her life, she was doubly incontinent and had difficulty communicating her wishes and feelings. She used a wheelchair to move around the ground floor of her home. After her husband gave up work he became her full-time carer providing her with personal care and supporting all her daily activities, until she died.
Dorothy's experience emphasises the importance of person-centred practice - In the last year of her life Dorothy saw a significant number of practitioners in a range of settings, none of whom asked her views about what was happening at home.
Throughout all contact with agencies Dorothy's views were not asked for or included. It appears that some practitioners presumed Dorothy did not have capacity, and therefore all communication was through her husband/carer.
There was no assessment of Dorothy's mental capacity, and therefore it is not known whether she could have made at least some of the decisions or contributed her wishes, views and feelings in relation to these. There was no consideration of enabling her to communicate in other ways.
Dorothy's husband/carer was therefore able to define what the issues and challenges were, whilst Dorothy was either unable or did not have the opportunity to express her view.
The review highlights the need for agencies to consistently ensure that a person's voice is heard during assessments about their health, care and support, and in relation to concerns about their safety. The review identified that the needs and voice of the carer, although very important, should not overshadow those of the person with care and support needs.
It should not be assumed that a person is unable to offer comment on their situation, or express their wishes, feelings or views, even if they do lack the mental capacity to make particular decisions.
In situations where there is a possibility of the person being harmed by their carer, they should be spoken to in private with the right support and representation. Useful support for safeguarding adults with care and support needs at risk of or experiencing domestic abuse had been produced by the LGA and ADASS and can be found here: Practice guidance safeguarding and domestic abuse ~ LGA and ADASS
Citizens of Leeds have worked with the Board to explain why listening to their voices means so much. Please see the films of their views here: LSAB You Tube Films Talk to Me Hear My Voice