Safeguarding Vulnerable Adults

Safeguarding Vulnerable Adults

Aim To understand duty of care to vulnerable adults

Objectives:

- Discus the meaning of safeguarding vulnerable adults

- Discuss the different types and signs of abuse

- Discuss raising safeguarding concerns

GDC Outcomes A, C, D

Introduction

As healthcare professionals, we have a duty to help protect our patient s welfare and human rights. This is known as safeguarding and is a statutory responsibility under the Care Act 2014. The eighth principle of the GDC Standards for the Dental Team further supports this and stresses the importance for awareness of local procedures involving raising concerns.1

A vulnerable adult is defined by The Department of Health as an individual who is aged 18 or over that is or may need community care services because of a disability (mental or other), age or illness and is someone who could be unable to look after themselves or protect themselves from harm or exploitation.

There has been an increase in the number of vulnerable adults who are victims to abuse and neglect. Between 2019-2020, 475,560 safeguarding concerns raised. This is an alarming 14.6% increase compared to the previous year.2

Abuse

There are several types of abuse, which are outlined below in Figure 1.

Figure 1 Types of Abuse

Physical

Physical presentations of abuse commonly include the four B s : bruising, burns, bite marks and bone fractures. However, other signs include lacerations, abrasions and intra-oral wounds.

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Unusual areas of injury are found in the triangle of safety. This triangle consists of the ears, sides of the face, tops of shoulders and neck. If injuries are untreated, bilateral, or on soft tissues that do not coincide with a reasonable explanation or pattern, then concerns should be raised.3 For example a uniformed circular burn found on an individual s arm is characteristic of a cigarette burn.

Financial

This includes theft, forced spending and signing over assets or income to the abuser, without the vulnerable adult having given valid consent. Signs that this may be occurring are an inability to pay for treatment or attend appointments due to cost, as well as loss of money and possessions.

Sexual

Sexual abuse includes any form of sexual assault or indecent exposure. It is essential to be attentive for signs such as difficulty walking or sitting, pain from the groin, pregnancies, sexually transmitted diseases, bruising and withdrawn behaviour.

Institutional

Institutional abuse can occur across places such as care homes and hospitals. Staff may mistreat vulnerable adults, such as by keeping them isolated and preventing them from seeing loved ones. In addition, not respecting their privacy and dignity, or not providing appropriate food, drink and medication.

Emotional

Emotional abuse involves leaving someone feeling frightened and intimidated, through means of manipulation, humiliation or verbal hostility. Indicators for this type of abuse may consist of low self-esteem, upset and a change in of appetite.

Discrimination

This includes prejudice of protected characteristics under the Equality Act 2010, which entails: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or beliefs, sex and sexual orientation. Derogatory remarks or denying access to fundamental rights is discrimination. Often if someone is being discriminated against, they will appear frustrated.

Modern Slavery

Between March 2019 March 2020, there were 7779 UK recorded police cases of modern slavery crimes, which was a significant increase compared to the previous year.4 Modern slavery comprises of human trafficking, sexual exploitation, debt bondage, forced labour and domestic servitude. Signs include malnourishment, living in overcrowded accommodation and lack of personal identification documents.

Neglect

This involves a failure of meeting basic needs, such as cleanliness, food, shelter and warmth. Indicators include poor personal hygiene, untreated injuries and medical problems. It is also key

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to be aware of dental neglect. If a vulnerable adult is not being brought to dental appointments, has repeated toothache, difficulty eating and poor oral hygiene, the issue of dental neglect should be raised.

Raising Safeguarding Concerns

Policies and procedures in dental settings help to protect those suffering from abuse. These protocols are regulated by the Care Quality Commission (CQC). Dental nurses can help assist in assessment of a vulnerable adult, as well as during history taking. Clinical photographs of injuries are a useful adjunct to thorough record keeping.

If you have safeguarding concerns about a patient, you have an ethical obligation to raise them immediately. Every practice will have a safeguarding lead, who ensures that local safeguarding procedures are carried out correctly and in a timely manner.

All actions should be contemporaneously documented. It is vital to gain valid consent from the patient before sharing any confidential information. The patient should be informed of where or who their information is being passed onto.

Dental defence unions can offer advice and support. It is crucial to reassure the patient and keep them safe. These situations are often fragile and so should be approached in a sensitive and empathetic manner.

Summary

Safeguarding vulnerable adults is imperative. The number of cases of abuse are rising, so vigilant awareness is required to identify signs. Detailed clinical examinations and history taking are fundamental to comprehensive records. Familiarisation of who your safeguarding lead is, will help reduce any delays in raising concerns. It is important to stay uptodate with safeguarding procedures and guidelines. As dental healthcare professionals, we have an ethical duty to protect the safety of our patients. Abuse can cause detrimental suffering and we can help put a stop to it.

Further Information

Visit https://www.scie.org.uk/safeguarding

References

1. Standards.gdc-uk.org. 2021. General Dental Council - Raise concerns if patients are at risk. [online] Available at: [Accessed 11 April 2021].

2. NHS Digital. 2020. Safeguarding Adults England, 2019-20 - NHS Digital. [online] Available at: [Accessed 11 April 2021].

3. bda.org. 2021. 2.3.1 Physical. [online] Available at: [Accessed 11 April 2021].

4. HM, 2020. 2020. UK Annual Report on Modern Slavery. London: HM Government, pp.1-53.