Safeguarding vulnerable adult dental patients

Dr Harry Bateau runs through the basic awareness that all members of the dental team should understand when dealing with vulnerable adult dental patients.

The General Dental Council (GDC) expects all registrants to be aware of the procedures involved in raising concerns about the possible abuse or neglect of children and vulnerable adults.

From April 2011, primary dental practitioners have been required to register with the Care Quality Commission (CQC) and comply with the regulations for safeguarding. (Regulations of the Health and Social Care Act 2008 Section 20).

 

Basic tenets

  1. There can be no secrets and no hiding place when it comes to exposing the abuse of vulnerable adults.
  2. Identify the need for immediate action to ensure vulnerable adults, who are at risk of abuse, receive protection and support.
  3. Recognise the need for an inter-agency framework leading to inter-agency arrangements and joint working. The lead agency with responsibility for coordinating the activity should be the local social services authority, but all agencies should designate a lead officer.
  4. There can be no secrets and no hiding place when it comes to exposing the abuse of vulnerable
  5. Identify the need for immediate action to ensure vulnerable adults, who are at risk of abuse, receive protection and support.
  6. Recognise the need for an inter-agency framework leading to inter-agency arrangements and joint working.
  7. The lead agency with responsibility for coordinating the activity should be the local social services authority, but all agencies should designate a lead officer.

 

Basic awareness protocols should include knowledge of:

  • No Secrets DOH 2000
  • ADSS 2005
  • Mental Capacity Act 2005
  • Safeguarding Vulnerable Groups Act 2006
  • ISA – vetting and barring scheme
  • No Secrets Consultation 2009-2011
  • Law Commission Report May 2011
  • Adult Social Care Bill

The department  of  health  definition of a vulnerable adult is “any adult who is vulnerable because of mental disorder, learning difficulties, physical and/or sensory impairment, other impairment or older age and who is unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation”.

 

Standards

The GDC standards (number seven and eight cover this). They should be read and understood.

There is a local multi-agency ‘safeguarding adults’ policy and procedure describing the framework for responding to any adult ‘who is or may be eligible for community care services’ and who may be at risk of abuse or neglect. And the practice staff should know about this. Each partner agency has a set of internal guidelines, consistent with the local multi-agency ‘safeguarding adults’ policy and procedures, which set out the responsibilities of all workers to operate within it.

 

What is adult abuse?

Abuse is a violation of an individual’s human and civil rights by any other person or persons.

Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent.

Abuse  can  occur  in  any  relationship and may result in significant harm to, or exploitation of, the person subjected to it. (No Secrets, Department of Health, 2000)

Forms of adult abuse include:

  • Physical
  • Sexual
  • Emotional
  • Neglect
  • Financial
  • Institutional

Broken down, each of these forms of abuse in detail include:

  • Physical: hitting; shaking; biting; grabbing; withholding food or drink; force-feeding; wrongly administering medication; unnecessary restraint; failing to provide physical care and aids to living

Sexual: sexual assault, rape; inappropriate touching/molesting; pressurising someone into sexual acts they don’t understand or feel powerless to refuse

  • Emotional or psychological: verbal abuse; shouting; swearing; threatening abandonment or harm; isolating, taking away privacy or other rights; bullying/ intimidation, blaming, controlling, or humiliation
  • Neglect: withholding food, drink, heating, and clothing; failing to provide access to health, social and educational services; ignoring physical care needs; exposing a person to unacceptable risk, or failing to ensure adequate supervision
  • Financial or material: withholding money or possessions, theft of money or property; fraud; intentionally

mismanaging finances; borrowing money and not repaying

  • Institutional abuse: the use of systems and routines which neglect a person receiving care. This can happen in any setting where formal care is provided
  • Discriminatory abuse: slurs, harassment, and maltreatment because of someone’s race, gender, disability, age, faith, culture, or sexual

 

How to respond?

  1. Remaining calm and not showing shock or disbelief
  2. Listening carefully to what is being said
  3. Do not asking detailed or probing questions
  4. Demonstrate a sympathetic approach by acknowledging regret and concern that what has been reported has happened
  5. Ensure that any emergency action needed has been taken
  6. Confirm that the information will be treated seriously
  7. give information about the steps that will be taken
  8. Inform them that they will receive feedback as to the result of the concerns they have raised and from whom
  9. Give the person contact details so that they can report any further issues or ask

 

Sharing information – the law

  • Frame work for sharing information safely
  • Be open and honest
  • Seek advice
  • Share with consent where appropriate
  • Consider safety and wellbeing
  • Shared information is necessary, proportionate, relevant and timely
  • Keep a record of information shared. (Information Sharing  Guidance DCFS 2008).

 

How to make a referral

Do not seek consent if so doing would:

  • Place a person (vulnerable adult, child, family member, yourself) at increased risk of significant harm, or serious harm to an adult, or
  • Prejudice the prevention, detection or prosecution of a serious crime, or
  • Lead to an unjustified delay in making enquiries about an allegation of significant harm to a child or serious harm to an

In a case where the patient refuses consent, you may still lawfully share confidential information  without  consent if you judge it is in the public interest.  e.g. tTo protect children from significant harm or adults from serious harm.

 

How to report/refer concerns/allegations

  • Share concerns
  • Consider emergency action
  • Report to line manager/safeguarding lead (PCT)
  • Refer to statutory agencies (e.g. adult social care or police)
  • Record decisions and

 

Mental Capacity Act 2005

  • Provides legal framework for making decision on behalf of those who lack capacity.
  • Assists and supports those who lack capacity by discouraging carers from being over restrictive and controlling

Advocates a ‘Best Interest’ checklist when making decisions on behalf of those without capacity.

Mental capacity is the ability to make a decision. Any assessment should be in two stages:

  1. Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (It doesn’t matter whether the impairment or disturbance is temporary or permanent.) e.g. mental disability from  acquired  brain  injury  If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?
  2. Capacity assessment – decision making: does the person have a general understanding of what decision they need to make and why they need to make it? Does the person understand that they need to have a tooth cavity filled and why it is needed? Does the person have a general understanding of the likely consequences of making, or not making, this decision? If the answer is yes then the pain decay would be halted. If the answer is no, continued pain which would get worse. Is the person able to understand, retain,

use and weigh up the information relevant to this decision? Cost, pain and discomfort, considered other methods for treatment, timing of treatment. Can the person communicate their decision (by talking, using sign language or any other means)? Would the services of

a professional (such as a speech and language therapist) be helpful?

 

Summary

This article has looked at safeguarding vulnerable adults and what is needed in practice to cover basic awareness.

The reader will leave this article understanding the basic awareness needs and have a detailed bibliography to learn more. And the dental professional will know the warning signs and where to go and what to do should in the case of a potentially vulnerable adult.

 

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