Older Mind Matters

Adult Safeguarding - "keeping the sick from harm and injustice"

Last week I took part in a GMC conference at the University of Chester, Adult safeguarding – everybody’s responsibility. Whilst preparing for it, I looked back at the Hippocratic Oath and, in one classical version, regarding the sick, the oath asserts “I will keep them from harm and injustice”. Duties of a doctor go back a long way – Hippocrates was a Greek philosopher and physician, who lived from 460 to 377 BC. I thought that the phrase, “first do no harm”, was attributable to him, but in fact Of The Epidemics, translated by Francis Adams, says “The physician must … have two special objects in view with regard to disease, namely, to do good or to do no harm”, thus encapsulating two ethical principles, beneficence and non-maleficence and, to me at any rate, linking directly with the GMC’s Duties of a Doctor.

The Care Quality Commission defines safeguarding as: “safeguarding means protecting people's health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.” The BMA toolkit for GPs says this: “safeguarding is about keeping vulnerable adults safe from harm. It involves identifying adults who may be vulnerable, assessing their needs and working with them and with other agencies in order to protect them from avoidable harms.” No contest then, this sounds like something health and social care professionals should be fully signed up to.

The content of the conference was all good stuff, but it was the interactive discussions that I found both surprising and perplexing. It looks as though people struggle with the interfaces between the Mental Capacity Act (a way of making decisions for people when they are unable to make those decisions for themselves); Deprivation of Liberty Safeguards (DoLS) (a way of lawfully authorising that someone without capacity may be deprived of their liberty); and safeguarding. These are all good people, trying to do their best by their service users, and trained in the use of the Mental Capacity Act, how come these processes fuel difficulties and complicate care delivery? Might it be the bureaucratic processes involved, uncertainties about who is responsible and who should do what, competing demands on time, low morale coupled with budgetary cuts, role confusion, de-professionalisation of care …. Maybe it’s all of these and more.

Some more useful resources

GMC (2012) Raising and acting on concerns about patient safety

NHS England Safeguarding Policy

Skills for Care Briefing: Care Act implications for safeguarding adults  


2 comments (Add your own)

1. Venetia Young wrote:
The day was really interesting. I specially enjoyed the case discussion.
The GP perspective on adult safeguarding is very interesting in my current role as Adult Safeguarding lead GP for CCG in Cumbria.. For me it is all about setting up preventative and safer systems within the practice and forging relationships outside it. Everything a good GP does especially in relation to the elderly is about thinking of safety and context. The case we discussed at the day in Chester was a good one with both adults being vulnerable. A GP panellist could have said:

GPs have continuity of records and so I think have more of a responsibility to be proactive and engaged than other professional groups.
care of people with alcohol problems in the practice:
Alcohol AUDIT questionnaire used with more than just new patients
Alcohol asked about whenever patients present with dyspepsia, poor control of diabetes, functional diarrhoea, hypertension,
knowledge about brief interventions (30 minutes training is all that is required)
Motivational interviewing training
register of alcohol problems
Named doctor or two doctors chosen by the patient when adults are at risk
proactive approach to cases. In this case the crisis could have been used to talk with the son about how things might change and how would he like his future to be?
Good health checks for people with chronic alcohol problems with consideration of diet and need for supplementation with Vit B complex
family circumstances and relationships. Asking about bereavements- 'drowning of sorrows' my experience says is very common with alcohol.
needs for more sustaining social opportunities
developing a good relationship so that problems get dealt with early rather than late

Relationships with D&A services whether or not there are shared care arrangements
good relationships with social care - they can visit practices of be on the phone - we don't have to wait for bits of paper to arrive!
good relationships with the police and understanding the risk of violence/homicide especially in long term drinkers developing neurological problems and possible frontal lobe damage with increased impulsivity. (this was one of our DHRs and another had alcohol on top of depression and an exhausted carer)
Commissioning of D&A services including dementia assessments as many bed blockers/ revolving door patients are languishing in hospital with undiagnosed/untreated alcoholic dementia.
PHE seems to have been disempowered by the move into CC certainly in our area. They need encouragement to pull their weight and ensure alcohol is taken seriously across police and DV agencies.
Perhaps the government poor response to the alcohol strategy should be taken up as a major safeguarding concern!! I wonder how politicians are with their safeguarding training!

Sun, March 20, 2016 @ 8:40 PM

2. Dave Jolley wrote:
I had missed this and your earlier blog about DoLS, which mentions Lady Hale and her gilded cage. Most people feel the Mental Capacity Act is well written and thought through. DoLS was less well regarded from the start and things have got worse with cumulative problems derived from a series of court rulings which threaten to bankrupt the country and test the sanity of everyone. The Law Commission is attempting a further redraft of its attempt to rescue things. I guess all of this is related to 'safeguarding' - But I like most the references you give to much older wisdom

Fri, April 29, 2016 @ 7:55 AM

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