Acting for vulnerable results

Eight years ago guidance sought to address shortfalls in the care of vulnerable adults. Ingrid Torjesen examines how nurses are now taking action to protect this client group

Safeguarding children has been a frontline priority for both the health service and local authorities for years, while vulnerable adults have been allocated a seat in the back row.

In 2000 the Department of Health acknowledged this when it published guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse – a term that also encompasses neglect. No Secrets created a framework that aimed to prevent abuse where possible, and where this failed, to ensure robust procedures were in place for dealing with incidents.

Local authorities were designated as the lead agency but all organisations in the health service, and the voluntary and the independent sectors, were intended to have a designated lead officer in safeguarding vulnerable adults.

A vulnerable adult is someone aged over 18 who may need services because they are unable to take care of themselves or protect themselves against harm or exploitation. They may have a mental or physical disability, an illness or be elderly.

The main difficulty with tackling abuse of vulnerable adults is recognising that it exists, a DH spokesperson says, because it is multifaceted. Abuse may be physical, psychological, financial or material, sexual, discriminatory, or an act of neglect or an omission to act. Neglect includes failure to provide access to appropriate health services or necessities of life, such as warmth or nutrition.

The spokesperson says many trusts are now putting increased emphasis on safeguarding by developing their own policies and procedures, appointing full-time safeguarding leads or introducing training for all staff. She cites one hospital that ensures relevant training for all new staff, from auxiliary to consultant level, as part of its induction programme, and another where training is consolidated at handover times to keep it refreshed.

Susan Roots, lead for safeguarding vulnerable adults at Medway PCT in Kent, says work there has intensified over the past 18 months as efforts to increase awareness have uncovered training needs.

Medway PCT contributes to a training budget held by Kent County Council, which employs a training consultant who organises multidisciplinary training on six levels.

Level one, available to all post-registration clinicians, covers basic awareness of the signs and symptoms of abuse and what to do. Level two focuses on the practitioners' role and includes determining risk, vulnerability and seriousness, and dealing with disclosures.

The higher courses are more specific. Level three deals with the knowledge and skills required to investigate an allegation and level four covers joint working with the police in criminal investigations. Level five is directed at people involved in determining the outcome of an investigation and level six covers post-abuse support for the vulnerable adult and their support networks.

The training consultant has negotiated for levels one and two to be incorporated into nursing student training by Canterbury Christ Church University in Kent and the University of Greenwich in London, the two universities that serve the area.

Ms Roots says: 'Raising general awareness is extremely important so that people begin to recognise situations where vulnerable adults may be put at risk. This is why we are keen that nursing students receive this training, so it comes as naturally to them as washing their hands.'

She adds that a lot of safeguarding issues with vulnerable adults revolve around dignity and good communication. 'It is important that clinicians communicate thoroughly and proactively with them, take dignity into consideration and consider privacy. All the basic elements of nursing are very paramount.'

Ms Roots emphasises adults can be temporarily vulnerable. 'You can have a situation where you have a younger adult who suffers a stroke or a traumatic incident of some kind. During the time they are dependent on those services, they can be considered a vulnerable adult.'

RCN adviser for older people Pauline Ford says many leads in safeguarding vulnerable adults are relatively new to their positions and for that reason, have only had time to focus on ensuring formal protection of vulnerable adults (POVA) procedures are in place, such as Criminal Records Bureau checks.

However, she says, their roles are now set to take on a whole new dimension as they try to ensure safeguarding principles are ingrained in all areas of nursing care.

Ms Ford recommends nurses ask patients if anything is making them feel particularly vulnerable, so steps can be taken to alleviate those concerns and minimise infringement of privacy and loss of dignity.

She adds that all nurses should receive training in safeguarding vulnerable adults, but concedes: 'There is no central directive about what should be included in nursing student training anymore, so only some universities will prioritise this.'

The DH is currently consulting on how its No Secrets guidance can be improved.

Pre-consultation events in Kent suggest more efforts should be made to raise awareness among the general public through national campaigns, as has happened with child abuse.
'We can raise the profile as much as we like with staff here on the ground but there also needs to be raised awareness nationally, even through popular programmes on television,' Ms Roots says.

Most importantly, police need powers of access, as they have in Scotland, she adds. 'If there is a vulnerable child you can remove that child from the environment
you feel is adding to that abuse but we can't do that with a vulnerable adult. The police don't have those powers.'

Penny Furness-Smith, joint lead on safeguarding vulnerable adults for the Association of Directors of Adult Social Services and corporate director of housing and community living at Luton Borough Council, agrees more should be done to improve community awareness and legislation.

She would also like to see a duty on different agencies to cooperate, which has been put at the heart of local area agreements.

'There is already a model of good practice in collaboration, good cooperation and multi-agency working in children's services across the NHS, local authorities and their partners,' she explains.
She adds that even though lessons can be learnt from children's services, it's important to remember that the status of adults is entirely different from children. 'Adults actually have rights in their own capacity, unlike children,' she says.

Ms Furness-Smith says it is vital that community nurses and GPs, who are most often the first point of contact for vulnerable adults, are trained so they can identify and take action on early signs of concern before circumstances deteriorate.

She believes nurses are ready and willing for this challenge. 'In a couple of the authorities I have worked in, more work has been needed to support the engagement of GPs but at the frontline the engagement of community nurses has been very positive.'