Leeds Health Pathways

1. Background Information and Scope of Pathway

Quick info:
This pathway was developed to guide clinicians when managing suspected adult safeguarding issues.
Author: Belinda Sharratt - Deputy Designated Nurse Safeguarding Children and Adults

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Adult Safeguarding is everybody’s business and this is set out clearly in The Care Act 2014

2. Referral Information and Useful Contacts

Quick info:
Everyone has the right to live in safety, free from abuse and neglect. If you feel that a patient is suffering or is at risk of suffering abuse or neglect then you can make a referral (raise a concern) to adult social care:

In office hours Telephone: 0113 2224401
Out of Office Hours Telephone: 0113 3780644
CCG safeguarding team email: leeds.safeguarding@nhs.net

A referral to adult social care should be followed up in writing, using the Raising a concern form.

The Leeds City council website contains further information is relation to make a safeguarding referral
http://www.leeds.gov.uk/residents/Pages/Safeguarding-adults.aspx
http://www.leeds.gov.uk/residents/Pages/Emergency-out-of-hours-services.aspx

The CCGs Safeguarding team are available to offer advice to practice staff in relation to any safeguarding matters and can be contacted on: 0113 8431713.

If there are concerns regarding the management of a case the Leeds Safeguarding Adults Board (LSAB) has produced a Dispute Resolution and Escalation Process

3. Training and Further Resources

Quick info:

All health care organisations have a duty outlined in legislation to make arrangements to safeguard and promote the welfare of adults at risk of harm or abuse. All staff that come into contact with adults have a responsibility to safeguard and promote their welfare and should be able to identify and be aware of the actions to take if they have any concerns. Access to appropriate safeguarding training is a key component to fulfil these responsibilities.

Training:
On line safeguarding training can be accessed at:
http://www.e-lfh.org.uk/home/

It is the responsibility of the safeguarding lead GP to cascade safeguarding information and updates to the rest of the general practice.Evidence of participating in updates and clinical discussions can be used to support level 3 practitioners training requirements. The safeguarding lead GP should ensure the practice has a process for the implementation of learning from safeguarding case reviews and audit findings. All primary care practitioners can identify opportunities for arranging in-house safeguarding training, which can be done through the CCG safeguarding team. It is the responsibility of all primary care practitioners to manage and record their own safeguarding training compliance with regards to their role.

Resources to support practitioners in meeting their required safeguarding competencies include utilising a blended approach including the following:-

Safeguarding Training Schedule - Provided by the CCGs Safeguarding Team.
GP Team meetings
GP Safeguarding meetings including peer group meetings
Reflections on discussions
Attendance at conferences/ safeguarding meetings
Reflect on cases your working on/ patients you have discussed sought advice on – what do/ did you do differently
eLearning
Reading relevant research
CCG Learning briefings
CCG training schedule
TARGET events – hot topics/ longer safeguarding sessions

The Prevent training and competencies framework https://www.england.nhs.uk/publication/prevent-training-and-competencies-framework/ provides specific guidance on the level of Prevent training required for healthcare workers and should be used to ensure that all healthcare practitioners meet the required training requirements.

In addition, the CCG safeguarding team offer primary care practitioners the opportunity to attend face to face and/or virtual safeguarding training sessions. The training schedule is circulated to all practice managers and safeguarding leads, as well as being available on the online booking system referenced below.

As of the 1st March 2021 we are now using an online booking system for all our training sessions. The new system can be found here: Primary Care Extranet – Online Training Booking.

If you do not have access to the Primary Care Extranet, please request an account from the CCG Comms Team, email: leedsccg.comms@nhs.net.

Alternatively contact the CCG SAFEGUARDING TEAM on: 0113 8431713/ leeds.safeguarding@nhs.net for more information.

Resources:

Leeds Safeguarding Adults Board offer additional information, policies, training, resource and advice in relation to adult safeguarding, mental capacity and deprivation of liberty safeguarding. These can be accessed via their website:

http://www.leedssafeguardingadults.org.uk/Pages/default.aspx

Safeguarding Adults West and North Yorkshire and York Multi-Agency Policy and Procedures

Practice Guidance: Decision Support Tool for Raising a Safeguarding Concern

Guidance on Adult safeguarding training requirements are set out in the intercollegiate document: Adult Safeguarding: Roles and Competencies for Health Care Staff (2018) https://www.rcn.org.uk/professional-development/publications/pub-007069.

Template Primary Care Safeguarding Policy

The CCG Safeguarding team have developed this template policy that can be adopted fully as the practice Adult and Child safeguarding policy or in parts and added to your current policy.

4. Safeguarding Concerns about an Adult

Quick info:
The aim of adult safeguarding is to:

Stop abuse or neglect wherever possible;
Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs;
Safeguard adults in a way that supports them in making choices and having control about how they want to live;
Promote an approach that concentrates on improving life for the adults concerned;
Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult,
Address what has caused the abuse or neglect.

The safeguarding duties apply to an adult who:

Has needs for care and support (whether or not the local authority is meeting any of those needs) and;
Is experiencing, or at risk of, abuse or neglect; and
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

Types of Abuse:
Physical abuse – Physical abuse can be defined as any intentional act causing injury or trauma to another person by way of bodily contact including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.

Domestic Abuse – any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to:

psychological
physical
sexual
financial
emotional and so called ‘honour’ based violence.

Controlling behaviour is a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

Sexual abuse – including rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.

Psychological abuse – including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.

Financial abuse – including theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits.

Modern slavery – encompasses slavery, human trafficking, and forced labour and domestic servitude. Traffickers and slave masters use whatever means they have at their disposal to coerce, deceive and force individuals into a life of abuse, servitude and inhumane treatment.
(See - Learning Briefing - Modern Day Slavery and Human Trafficking Nov 17 )

Discriminatory abuse – including forms of harassment, slurs or similar treatment; because of race, gender and gender identity, age, disability, sexual orientation or religion

Organisational abuse – including neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

Neglect and acts of omission – including ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, care and support or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating

Self-neglect – this covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.
The LSAB have developed some new guidance for practitioners around Self-Neglect: https://leedssafeguardingadults.org.uk/Documents/Safeguarding/LSAB%20Self%20neglect%20policy%20(v1).pdf

Dealing with a Disclosure - When listening and responding to a disclosure, remember this may the first time that the individual as told anyone what is happening to them.

Stay calm and not express dismay or shock
Allow the person to express their feelings, including their fears
Try to discover what the person is afraid of and when they feel most at risk
Listen carefully to what the person is saying
Assure the person that they are being taken seriously
Demonstrate regret that abuse has taken place and the impact that it must have had on the person physically and emotionally
Reassure them that there is help available
Summarise their account and check that you have it right
Explain the safeguarding adult process in a way that is meaningful to the person, and provide them with information such as leaflets and contact details for the local authority safeguarding adult service.
Be open and honest about what will happen next.
Document everything things are clearly and accurately as possible.

5. Factors to Consider When Making a Judgement

Quick info:
Mental Capacity Act
The Mental Capacity Act 2005 is a law that protects and supports people who do not have the ability to make decisions for themselves. It also provides guidance to support people who need to make decisions on behalf of someone else.

The Act covers important decisions relating to an individual's property, financial affairs, health and social care. It also applies to everyday decisions, such as personal care, what to wear and what to eat. It also allows us to plan ahead for a time when we are unable to make these decisions for ourselves.

The Act covers anyone aged 16 years or older.

The five statutory principles are:

A person must be assumed to have capacity unless it is established that they lack capacity.
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.

The Two-Stage Test

Does the person have an impairment of, or a disturbance in the functioning of the mind or brain?
Does the impairment or disturbance mean the person is unable to make a decision when they need to?

In law, a person is said to lack capacity if they cannot do one or more of the following things:

Understand the information given to them
Retain that information long enough to be able to make a decision
Weigh up the information available to make a decision
Communicate their decision.

Key documents which outline the principles of the MCA and roles within this are:

GP Practice Mental Capacity Act Self-assessment Tool

The Mental Capacity Act - Code of Practice

The Mental Capacity Act Toolkit recently produced by the BMA

The GMC have also produced a decision making toolkit. This interactive tool will help you decide what to do when you doubt your patient’s capacity to make decisions about their care.

This includes a flow chart for decision making when patients may lack capacity

Independent Mental Capacity Advocates (IMCAs)
Independent Mental Capacity Advocates (IMCAs) can support and represent people when they lack mental capacity to make certain important decisions.

In Leeds the Advocate service can be accessed at - http://www.advonet.org.uk/

What is the risk?
Assessing the risk to vulnerable people against their right to make choices about how to live their life is difficult, and in any given situation different people will have different views on striking the right balance. Professionals must have a common understanding of the principles they are working to, the legal structures in place, and the documentation that can help and that they need to complete.

It can be helpful to bear in mind the following key principles:

Risk work should be person-centred and empowering.
The Mental Capacity Act asserts people’s right to make decisions, even unwise ones, if they have the capacity to do so. The Mental Capacity Act and the code of practice and Deprivation of Liberty Safeguards that accompany it are all key legal considerations in evaluating risk.
Government guidance is that 'people have the right to live their lives to the full as long as that does not stop others from doing the same’.
Risk assessments should always consider the benefits of the proposed action on the adult at risk and weigh these against any risks.
The person’s strengths should always be considered when evaluating risk.
Multi-agency working is important in assessing and managing risk, but should always take place within a person-centred framework that avoids blanket restrictions.
Decisions on risk should be reasonable, proportionate, accountable and defensible, and rooted in evidence-based practice and partnership working.

N.B. If there is a safeguarding concern about a child then Safeguarding Children procedures should be followed irrespective of the views or wishes of the adult.

Multi- agency/professional working
Ask the individual who is there support network and how they can help. Remember that individuals very rarely live in total isolation and often have more than one professional involved in the wider life at any given time. Consider if there any other professionals or support networks you could communicate with, sharing information is key to keeping people safe.

Record Keeping
Always follow your organisational records keeping policy and any which you must adder to from your professional body.

Good record keeping helps to manage workload and case management more effectively and safely.

Records should capture all contacts with a patient and who the contact was with and by whom.

Try to avoid jargon and abbreviations as these are open to misunderstanding and misinterpretation.

Always records the facts. If you give an opinion may sure that this is clear within the records.

Record clearly the decision making, analysis of the situation and plan of care.

Review the effectiveness of any plans.

Record any wishes or feelings which the individual may express. If they are communicated via a carer or member of the family make sure that this is clearly recorded.

If an interpreter is used clearly records this. Try to avoid using family members, especially when dealing with safeguarding concerns.

Records any contacts you have with other professionals.

Consent and confidentiality:
The BMA have produced a toolkit in relation to consent
The purpose of this tool kit is to act as a prompt to doctors when they are seeking consent by providing answers to common questions raised by this process

https://www.bma.org.uk/advice/employment/ethics/consent/consent-tool-kit

Information sharing is a vital part of safeguarding.

Adult serious case reviews frequently highlight failures between safeguarding partners such as local authorities, GPs and health, the police, housing, care providers, to communicate and work jointly. Such failures can lead to serious abuse and harm.

The Care Act emphasises the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, and to respond proportionately to safeguarding concerns.

Organisations/ professionals need to share safeguarding information with the right people at the right time to:

Prevent death or serious harm
Coordinate effective and efficient responses
Enable early interventions to prevent the escalation of risk
Prevent abuse and harm that may increase the need for care and support
Maintain and improve good practice in safeguarding adults
Reveal patterns of abuse that were previously undetected and that could identify others at risk of abuse
Identify low-level concerns that may reveal people at risk of abuse
Help people to access the right kind of support to reduce risk and promote wellbeing
Help identify people who may pose a risk to others and, where possible, work to reduce offending behaviour
Reduce organisational risk and protect reputation.

Key messages:

Adults have a general right to independence, choice and self-determination including control over information about themselves. In the context of adult safeguarding these rights can be overridden in certain circumstances.
Emergency or life-threatening situations may warrant the sharing of relevant information with the relevant emergency services without consent.
The law does not prevent the sharing of sensitive, personal information within organisations. If the information is confidential, but there is a safeguarding concern, sharing it may be justified.
The law does not prevent the sharing of sensitive, personal information between organisations where the public interest served outweighs the public interest served by protecting confidentiality – for example, where a serious crime may be prevented or a child is at risk.
The Data Protection Act enables the lawful sharing of information. There should be a local agreement or protocol in place setting out the processes and principles for sharing information between organisations.
An individual employee cannot give a personal assurance of confidentiality.
Frontline staff and volunteers should always report safeguarding concerns in line with their organisation’s policy – this is usually to their line manager in the first instance except in emergency situations.
It is good practice to try to gain the person’s consent to share information.
As long as it does not increase risk, practitioners should inform the person if they need to share their information without consent.
Organisational policies should have clear routes for escalation where a member of staff feels a manager has not responded appropriately to a safeguarding concern.
All organisations must have a whistleblowing policy.
The management interests of an organisation should not override the need to share information to safeguard adults at risk of abuse.
All staff, in all partner agencies, should understand the importance of sharing safeguarding information and the potential risks of not sharing it.
All staff should understand when to raise a concern with the local authority adult social services.
The six safeguarding principles should underpin all safeguarding practice, including information-sharing.

There are several publications which give advice and support in relation to sharing information:

NHS England Quick Guide: Sharing Patient Information

Seven Golden Rules for Information Sharing

Social Care Institute for Excellence - Adult Safeguarding: Sharing Information

Information Sharing: Advice for practitioners providing safeguarding services to children, young people, parents and carers

6. Deprivation of Liberty Safeguards

The Deprivation of Liberty Safeguards (DOLs) is part of the Mental Capacity Act 2005. The aim is to ensure that anyone who does not have the capacity to make a decisions about their care, treatment, living arrangements, do not have inappropriate restricts to their freedom placed upon them. Any arrangements which do deprive a person of their liberty must be in their best interest, least restrictive and in accordance with their wishes when safe to do so and be lawful.

The Supreme Court in the “Cheshire West” case ruled that the “acid test” for a deprivation of Liberty is that the person is:

Under continuous supervision and control

And

Is not free to leave.

This ruling lowered the threshold for a deprivation of liberty and extended the scope to include people living in their own homes and supported living arrangements.

If it is felt that an individual is being restricted of their liberty while in hospital or a care home, then it is responsibility of the manager or Trust to apply to the supervisory body (Local Authority) for an authorisation of a deprivation of liberty. If you feel that someone in one of these environments maybe being deprived of their liberty then speak to the manager. When a GP visits a care setting they should be notified if there is a DOLs in place.

When a person is living in their own home or supported living arrangement and in receipt of care from the local authority, then it is the responsibility of the Local Authority to apply for the DOLs. If the individual is in receipt of only fully funded care from health then it is the responsibility of the CCG to apply for the DOLs via the court of protection. If you feel that an individual living in their own home or supported living arrangements may be deprived of their liberty then contact the local authority for guidance

NB: The deprivation of liberty safeguards do not apply to a person subject to detention under the Mental Health Act.

Leeds Deprivation of Liberty Safeguards (DoLS) Helpline
The helpline is available to organisations, professionals or members of the public if they need advice in relation to deprivation of liberty safeguards. Advice can be given on any matter relating to deprivation of liberty safeguards, including:

whether a deprivation of liberty is occurring
how to apply for deprivation of liberty safeguards (DoLS)
how to report an unauthorised deprivation of liberty
how the DoLS authorisation process works
how a person's rights will be protected

Telephone: 0113 855 2347 Monday - Thursday, 09:00 - 17:00; 09:00 - 16.30 on Friday

Independent Mental Capacity Advocates (IMCAs)
Independent Mental Capacity Advocates (IMCAs) can support and represent people when they lack mental capacity to make certain important decisions.

In Leeds the Advocate service can be accessed at - http://www.advonet.org.uk/

7. Family and People Around Individual

Quick info:
Think Family Work Family
To ‘Think Family’ means that all staff need to remember that people rarely live in complete isolation and therefore we need to assess the needs of the wider family when we’re working with a child, or vulnerable adult.

To ‘Work Family’ means services putting this into practice and coordinating their work together.

The Council have published a One Minute Guide to provide practitioners and the public with a quick explanation of the ethos of the Think Family Work Family approach in Leeds and a website to provide resources and additional information.

www.thinkfamilyworkfamily.org.uk

Carers
When we are providing services and/or support to an adult at risk there may also be a carer who requires additional support or intervention.

Carers Leeds offer:

Advice and information at their offices on The Headrow, Leeds LS1 6PT, which are open for drop-in on Monday - Friday from 9.30 am - 3.30pm.
A carers advice line, open on Monday - Friday from 09.00 am - 4.30 pm. Telephone: 0113 380 4300.
Wellbeing sessions for carers, such as massage or Reiki.
Social events
Yellow Card Scheme at GP Practices. This informs a GP practice that an individual is a carer.

Their website can be accessed at http://carersleeds.org.uk/

8. Female Genital Mutilation (FGM)

Quick info:
Female Genital Mutilation (FGM) is illegal in England and Wales under the FGM Act 2003, the amended Serious Crime Act 2015 also made it a crime to fail to protect a girl from the risk of FGM. It is a form of child abuse and violence against women. FGM comprises all procedures involving partial or total removal of or injury to the external female genitalia for non-medical reasons. It is a traumatic and violent act and as immediate and long term health consequences.

The age at which FGM is carried out can vary according to the community and can occur from birth, through childhood, teenage years to just before marriage or first pregnancy. It is a deeply rooted practice, widely carried out mainly amongst ethnic populations in Africa, parts of the Middle East and Asia.

The prevalence of FGM in the UK is difficult to estimate because this is a hidden crime but it is believe that FGM may happen to girls and women in the UK as well as overseas. Although there is no requirement for an automatic referral of an adult woman who has experienced FGM to adult social care, professionals should fully assess individual cases and refer as appropriate, have an awareness of the support services available and assess the potential risks to any female children within the same household/family.

Multi-Agency Statuary Guidance on FGM has been published to provide information on FGM, including the law, provide strategic guidance and also advice and support to front-line staff.

Leeds Social Care has developed a One Minute Guide in relation to FGM:
http://www.leeds.gov.uk/docs/45%20-%20Female%20Genital%20Mutilation%20-%20September%202015.pdf

Mandatory reporting:
Section 5B of the 2003 Act introduces a mandatory reporting duty which requires regulated health and social care professionals and teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 onwards.

‘Known’ cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation.

The Home Office has published guidance in relation to the mandatory reporting of FGM. The purpose of this document is to give professionals subject to the duty and their employers an understanding of the legal requirements it places on them, a suggested process to follow, and an overview of the action which may be taken if they fail to comply with the duty.

The Home office (2015) FGM Resource pack includes case studies, links to organisations and resources can be found at:
www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-mutilation-resource-pack%20%20

Organisations that can help:
NSPCC FGM helpline: 0800 028 3550
www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital-mutilation-fgm

For a list of other organisations who can provide advice and support on FGM see the ‘Contact, helplines and clinics’ section of the FGM resource pack:
www.gov.uk/government/publications/female-genital-mutilation-resource-pack/female-genital-mutilation-resource-pack#contacts-helplines-and-clinics

Enter a postcode to find local organisations
www.gov.uk/female-genital-mutilation-help-advice

Training:
NHS England have produced a training package for health professionals, which includes information on statuary duty, resources and information

There is now ONE website from which you can link to all the NHS programme outputs. This should be your first point of call for the NHS work on FGM, and it links to partner organisations including Department of Health and Social Care, NHS DIgital and others.
www.england.nhs.uk/ourwork/safeguarding/our-work/fgm/

E- Learning for all professionals to recognise and prevent FGM can be accessed at - www.fgmlearning.co.uk
www.e-lfh.org.uk/programmes/female-genital-mutilation/

Leeds have produces a One Minute Guide in relation to FGM

The Leeds Safeguarding Children Partnership have developed a flow chart to advice on the management of a FGM case

The intercollegiate safeguarding curriculum, which places requirements upon everyone working in NHS settings, already includes FGM at all levels. More recently, we have discussed the challenge of knowing what good looks like, and what training/content/quality would meet this requirement. We recognise that not all training is a high enough quality yet. To support this we developed training standards, linked to the curriculum, but which provide more detail on what content would be sufficient to meet the curriculum
https://www.england.nhs.uk/wp-content/uploads/2018/04/fgm-standards-for-training-healthcare-professionals-1.pdf
Booklet See CARE OF GIRLS & WOMEN LIVING WITH FEMALE GENITAL MUTILATION-A CLINICAL HANDBOOK

9. Forced Marriage and Honour Based Violence

Quick info:
If any professional has a concern regarding forced marriage or honour based violence they must seek advice and act upon it.

A forced marriage-
There is a clear distinction between a forced marriage and an arranged marriage. In arranged marriages, the families of both spouses take a leading role in arranging the marriage, but the choice of whether or not to accept the arrangement still remains with the prospective spouses. However, in forced marriage, one or both spouses do not consent to the marriage but are coerced into it.

Duress can include physical, psychological, financial, sexual and emotional pressure. In the cases of vulnerable adults who lack the capacity to consent to marriage, coercion is not required for a marriage to be forced.

The provision of consent is essential within all marriages – only the spouses themselves will know if they their consent is provided freely.

Forcing someone to marry is a criminal offence. It is child abuse, domestic abuse and a form of violence against women and men; it should form part of existing child and adult protection structures, policies and procedures.

Forced Marriage One Minute Guide

www.gov.uk/forced-marriage

Call: 020 7008 0151 (Mon-Fri: 09.00-17.00) Email: fmu@fco.gov.uk
Web: www.gov.uk/forced-marriage
Address: Forced Marriage Unit, Foreign & Commonwealth Office, King Charles Street, London, SW1A 2AH
For all out of hours emergencies, please telephone 020 7008 1500 and ask to speak to the Global Response Centre.
Police 101 ask for SPOC for HBV or main safeguarding office at Elland Road – 0113 3859590.

Multi-agency practice guidelines: Handling cases of Forced Marriage
These practice guidelines have been developed alongside the statutory guidance “The Right to Choose” issued in November 2008, Forced Marriage (Civil Protection) Act 2007. The statutory guidance sets out the responsibilities of Chief Executives, Directors and Senior Managers within agencies involved with handling cases of forced marriage. It covers issues such as staff training, developing inter-agency policies and procedures, raising awareness and developing prevention programmes through outreach work.

This document seeks to supplement the statutory guidance with advice and support for front line practitioners who have responsibilities to safeguard children and protect adults from the abuse associated with forced marriage. As it is unlikely that any single agency will be able to meet all the needs of someone affected by forced marriage, this document sets out a multi-agency response and encourages agencies to cooperate and work together closely to protect victims.

Honour-based violence
The terms “honour crime” or “honour-based violence” or “izzat” embrace a variety of crimes of violence (mainly but not exclusively against women), including assault, imprisonment and murder where the person is being punished by their family or their community.

They are being punished for actually, or allegedly, undermining what the family or community believes to be the correct code of behaviour.

In transgressing this correct code of behaviour, the person shows that they have not been properly controlled to conform by their family and this is to the “shame” or “dishonour” of the family. It can be distinguished from other forms of abuse, as it is often committed with some degree of approval and/or collusion from family and/ community members. Victims will have multiple perpetrators not only in the UK; honour based violence can be a trigger for a forced marriage.

Honour Based Violence One Minute Guide

Leeds Social care has developed One Minute Guides in relation to Honour Based Violence and Forced Marriage: http://www.leeds.gov.uk/residents/Pages/One-Minute-Guides.aspx

Karma Nirvana

Karma Nirvana is an award-winning British human rights charity supporting victims of honour-based abuse and forced marriage. Honour crimes are not determined by age, faith, gender or sexuality. They run a national helpline offering direct support and guidance to victims and professionals.

Karma Nirvana provides training to the Police, NHS and Social Services. They act as expert witnesses in court, speak out in schools and attend awareness raising events nationally and internationally. In addition, our team lobby government and after ten years of campaigning, forced marriage became a criminal offence in 2014.

UK Helpline: 0800 5999 247
Monday - Friday: 9am - 5pm.
If you are in immediate danger call 999
info@karmanirvana.org.uk

10. Human Trafficking

Human trafficking is the recruitment, movement, harbouring or receiving of children, women or men through the use of force, coercion, abuse or vulnerability, deception or other means for the purpose of exploitation.

Anyone can be a victim of trafficking, women, men and children, British and foreign nationals. A person does not have to be transported across borders to trafficked.

People are trafficked for a number or reasons:

Sexual exploitation
Domestic servitude
Forced labour including in the agricultural, construction, food processing, hospitality industries and in factories
Criminal activity including cannabis cultivation, street crime, forced begging and benefit fraud
Organ harvesting

Duty to notify the Home Office of potential victim of modern slavery
From 1 November 2015, specified public authorities have a duty to notify the Secretary of State of any individual identified in England and Wales as a suspected victim of slavery or human trafficking, via the National Reporting Mechanism (NRM). This duty is intended to improve the identification of victims and help build a more comprehensive picture of the nature and scale of modern slavery, to improve victim identification and the law enforcement response.

The “duty to notify” is set out in Section 52 of the Modern Slavery Act 2015

The information that must be provided within a notification has been set out in the Modern Slavery Act 2015 (Duty to Notify) Regulations 2015. Where an adult has not consented to the referral, then the notification must not include information that identifies the person, or enables the person to be identified (either by itself or in combination with other information). The form must be signed to indicate an adult’s consent to being identified.

A specified public authority which includes information in accordance with the Regulations does not breach any obligation of confidence owed by the public authority in relation to that information.

Notification of child victims:
Although the duty to notify applies to both children and adults, as children do not need to consent to enter the NRM, specified public authorities agencies should generally complete a full NRM referral, rather than a notification. This enables fuller information gathering and assessment of the case to be completed.

The NHS have published a leaflet for guidance for health staff to Identifying and supporting victims of human trafficking

Hope for Justice
Is an organisation which provides support to and identification and rescue of victims, including advocacy and restoration, to help victims become survivors and then ‘over-comers’ with a renewed sense of hope and purpose for their future. They also provide training and information to professionals, and have a useful website.

http://hopeforjustice.org/united-kingdom/

Modern day slavery and human trafficking

Find out more at www.modernslaveryhelpline.org or to seek help or to report slavery call the helpline on: 0800 1212700

11. Domestic Violence

Quick info:
Go to domestic violence pathway - http://nww.lhp.leedsth.nhs.uk/leedspathways/detail.aspx?ID=9

12. Prevent

Prevent is part of the Government’s strategy for counter terrorism (CONTEST) and seeks to reduce the risks and impact of terrorism on the UK. The aim of Prevent is to ensure that there are preventative strategies in place across all agencies to support and divert people who may be susceptible to radicalisation, before they become directly involved in any illegal activity relating to acts of violence or terrorism. Health is a key partner in the Prevent agenda and raising awareness of Prevent among front line staff providing health care is crucial.

Healthcare professionals may meet and treat people who are at risk of being radicalised, such as people with mental health problems or learning disabilities that may have a heightened susceptibility to being influenced by others.

NHS England has developed a Prevent Training and Competencies Framework to support NHS providers to meet their contractual obligations in relation to the Prevent strategy. This includes training requirements and competences.

Leeds City Council has developed a One Minute Guide in relation to radicalisation and preventing extremism:
http://www.leeds.gov.uk/residents/Pages/One-Minute-Guides.aspx

Guidance can be found at

Revised Prevent Duty Guidance: for England and Wales
https://www.gov.uk/government/publications/prevent-duty-guidance/revised-prevent-duty-guidance-for-england-and-wales

Information Sharing and Governance Guidance for Prevent-
https://www.england.nhs.uk/publication/practical-guidance-on-the-sharing-of-information-and-information-governance-for-all-nhs-organisations-specifically-for-prevent-and-the-channel-process/

Leeds Safeguarding Children Partnership-One Minute Guide- https://www.leeds.gov.uk/one-minute-guides

Links to NHSE/ Home office Prevent e learning resources:
http://www.elearning.prevent.homeoffice.gov.uk
https://www.elearning.prevent.homeoffice.gov.uk/preventreferrals
https://www.elearning.prevent.homeoffice.gov.uk/channelawareness
Learning Briefing- PREVENT

If you believe someone is at risk of radicalisation you should speak to your line manager who will liaise with the PREVENT lead in the CCG. They can support you in making a referral to the local authority via the usual safeguarding procedures.
If you believe the individual may already be involved in terrorism or extremist activities, you should also contact the Anti-Terrorism hotline on 0800 789 321.
If the concern is urgent then use 999.

Key contact details:
Initially contact your line manger to discuss your concerns.

Other useful contact details for advice:
CCG PREVENT Lead:
Belinda Sharratt - Designated Nurse for Safeguarding Children and Adults. Contact on 0113 8431713 or leeds.safeguarding@nhs.net.

E learning module for Prevent can be found on the Leeds CCG training Schedule 2018/19

13. Making a Referral

In Office Hours Telephone: 0113 378 0644

Out of Office Hours Telephone: 07712106378

A referral to adult social care should be followed up in writing, using the Raising a concern form.

The Leeds City council website contains further information is relation to make a safeguarding referral

http://www.leeds.gov.uk/residents/Pages/Safeguarding-adults.aspx

http://www.leeds.gov.uk/residents/Pages/Emergency-out-of-hours-services.aspx

The CCGs Safeguarding team are available to offer advice to practice staff in relation to any safeguarding matters and can be contacted on: 0113 8431713 / leeds.safeguarding@nhs.net

Dispute Resolution
Where there is a concern that someone’s practice or decision making is not responding appropriately to a safeguarding concern, practitioners have a responsibility to respectfully challenge the other practitioner or organisation.

In order to support that challenge, a clear process needs to be in place to ensure that all professionals involved in multi-organisation work understand the steps they should take when these concerns arise.

When trying to resolve disagreements, practitioners and organisations should work within the following principles:

The safety and wellbeing of any person at risk of abuse or neglect, should be the primary consideration
The adult’s wishes and desired outcomes should be a central to how disagreements are resolved
Safeguarding responses should be proportional to the safeguarding concern
All practitioners have a shared responsibility to solve problems and resolve disagreements constructively.
Different professional perspectives, organisational responsibilities, and accountability frameworks need to be respected
Disagreements must be resolved in a timely manner
Concerns, actions, responses and outcomes must be recorded.

The LSAB have produced a dispute resolution and escalation process to support practitioners with this process

Support needs
If you feel that an individual is need of support but do not have safeguarding concerns a referral can be made for an assessment:

Contact Adult Social Care Services on 0113 378 0644

The council have produced a useful guide of the adult services which are available in Leeds

Children:
Safeguarding children
If you feel that a referral to social care for a child is required, contact the Duty and Advice Team:
Office hours: 0113 376 0336
Out of Hours: 0113 376 0469

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