Your role as Alerter
Your role as ‘Alerter’ in the Safeguarding Process
- The ‘alerter’ raises a safeguarding concern within their own agency following own policy and procedures
- This concern may result from something that you have seen, been told or heard
- Make a referral to Safeguarding Adults where this is necessary
Your assessment should be holistic and thorough considering the patient’s emotional, social, psychological and physical presentation as well as the identified clinical need. You need to be alert to:
- Inconsistencies in the history or explanation
- Skin integrity
- Personal presentation e.g. is the person unkempt
- Delays or evidence of obstacles in seeking or receiving treatment
- Evidence of frequent attendances to health services or repeated failure to attend (DNA)
- Environmental factors eg. signs of neglect, the reactions and responses of other people with the patient
- Does the patient have capacity for the decision required?
- Are they able to give informed consent or is action needed in their best interests?
- Are there others at risk e.g. children or other vulnerable adults? THINK FAMILY and ensure a joined up approach to the families' needs
- Is immediate protection required?
- Has a crime been committed and should the Police be informed?
- Preserving any evidence
- Is any action that is being considered proportionate to the risk identified?
- What are the patient’s views/wishes?
- Cultural differences or religious beliefs
- Are there valid reasons to act even without the patient’s consent? E.g. where others are at risk; need to address a service failure that may affect others
Golden Rules: Holistic Assessment
These rules are focused on patients in an inpatient setting, but could easily apply in principle to patients being seen in General Practice, Out Patient Clinic, Day Service or in the Community/Patients Home.
- Does this fall under adult safeguarding duties as defined by the ‘Care Act?
- Are there any existing alerts relating to the patient?
- Is there any current agency involvement. Consider both statutory and private providers
- What are the home circumstances?
- Is the patient likely to require more input on discharge?
- Who else lives in the household?
- Skin integrity
- Nutritional state including hydration
- Personal presentation
- Person’s communication and behaviour
- Are any reasonable adjustments required
- Treat the person with dignity and respect
- Where is the patient being discharged to?
- Don’t transfer problems
- Is there any previous involvement/ support (consider statutory and private providers and informal carers) that needs re-engaging?
- Think about information sharing when transferring patient
- Will they be safe on discharge?
- Is this the patient’s choice?
- Does there need to be a referral to Adult Social Care?
- Have community nurse referrals been made?
- Has the care package been restarted?
- Check for outcomes of any Safeguarding referrals
- Does an alert need adding to patient notes?
- Consider use of communication aids/language line if required to involve the patient
- Take account of individual differences
- Listen carefully, remain calm and try not to show shock or disbelief
- Acknowledge what is being said
- Do not ask probing or leading questions which may affect credibility of evidence
- Be open and honest and do not promise to keep a secret
- Seek consent to share information if patient has capacity and if this does not place you or them at increased risk
- You may share information without consent if it is in the public interest in order to prevent a crime or protect others from harm (follow own organisation’s policy and procedures)
- Report concern following your safeguarding adult policy and procedures
- Make clear and concise referral so that person reading the form understands the key issues
- Do not delay unnecessarily
- Concern about a colleague should be raised through your organisations Managing Allegations against staff or Whistle blowing policy
Remember that you are accountable for what you do or choose not to do.
- You are accountable for your actions or omissions
- Make a legible, factual, timely and accurate record of what you did and why, to demonstrate transparent, defensible decision making e.g. capacity assessment made, best interest decision, any restraint which was required which must be proportionate to the situation.