OC Guidance on Safeguarding g, Mental Capacity, Deprivation of Liberties and the Prevent Strategy

Protecting Children and Adults at risk

Updated August 2019

Summary

Abuse, neglect, female genital mutilation (FGM), coercive behaviour, trafficking and radicalisation are often hidden in our society but can reveal themselves in a health care situation including during occasional health interactions.

This is why safeguarding children and adults at risk is an overriding professional duty for all registered optical practitioners and practices in the same way as for other health and social care practitioners and providers.

Part 1 of this guidance provides a simple five step guide for all optical staff and practices to safeguard children and adults at risk and to comply with all relevant legislation. It will help you to be vigilant, able to recognise and report abuse, and help keep your patients and colleagues safe. This part of the guidance has been updated in August 2019 in line with the revised Intercollegiate Guidance for Safeguarding Children (2019) and Intercollegiate Adult Safeguarding for Health Care Staff (2018).

Part 2 of this guidance sets out the responsibilities of optical staff and practices under the UK-wide Prevent Strategy. This requires healthcare providers to work with partner organisations to identify individuals at risk of radicalisation and to refer them to regional Prevent teams for support. The steps to follow in such cases are similar to those for safeguarding other adults, young people and children who are at risk.

ACTION

Practices should ensure that all staff¹ are familiar with this guidance and know what to do if they suspect or observe signs or symptoms of suspected abuse, neglect, FGM, coercive behaviour, trafficking or radicalisation.

A copy of this guidance including

• up-to-date local Safeguarding team contact information
• up-to-date Prevent team contact information

should be readily available in all practices.

¹ All staff means all staff including receptionists and back office staff and not just registrants or staff in patient facing roles. Anyone can spot patterns or unusual behaviours in any role at any time.

NHS England and/or Local Health Boards should regularly notify practices of up-to-date contact information for local Safeguarding and Prevent teams.

If, for some reason, this is not available, up-to-date safeguarding information can be found via the link below or by downloading the apps

www.myguideapps.com/nhs_safeguarding/default/

play.google.com/store/apps/details?id=com.antbits.nhsSafeguardingGuide&hl=en_GB

itunes.apple.com/gb/app/nhs-safeguarding-guide/id1112091419?mt=8

Prevent team contact information should be available on the local police or Council website but local arrangements can vary. In practice it is probably best to search the Internet for ‘Contact my local Prevent team’.

Registered practitioners should ensure that they understand their professional duties under this guidance and have completed appropriate training to Intercollegiate Level 2 for safeguarding children and adults at risk.

Pre-registration practitioners and students on placements should have the same understanding as registered practitioners by, as a minimum, having read and understood this guidance.

In the case of registered practitioners in Scotland this means also holding a current Protection of Vulnerable Groups (PVG) certificate for each health board where you practise. If you are applying to join a health board’s ophthalmic list your PVG certificate must be dated within 28 days of application.

This guidance will continue to be updated periodically as legislation is revised and in the light of experience.

Remember: if you feel uncomfortable about a particular situation, have concerns about a patient’s or other person’s safety and suspect abuse or radicalisation, you must record the facts and raise the issue with an appropriate person or organisation. This may be a designated or senior person in your organisation, your professional or representative body, or a local safeguarding official.

Part 1: Safeguarding children and adults at risk

What to do if you observe/suspect abuse or neglect

Any optical practitioner or member of practice staff who detects possible signs of neglect or abuse in a child or adult (including possible domestic or elder abuse) should take immediate action as below.

1.   Observe

Note factual signs and symptoms of potential or suspected abuse or neglect without alarming the child or adult concerned or alerting a possible abuser.

If appropriate, listen sympathetically to what a child or adult tells you (as they are often ignored) but do not agree not to tell anyone what they have told you.

2.      Discuss

Do not delay. Discuss your concerns with your manager, senior professional, designated staff member or, if you are a pre-registration optometrists with your supervisor, depending on your practice procedure.

If appropriate, seek advice from the local authority safeguarding team.

Remember, particularly in the case of a child, you may be the only person to have noticed anything unusual or whom they have confided in. You therefore have a professional duty to act as their advocate. This means making sure that the issue is raised with an appropriate person. This is an integral part of being a healthcare professional in a privileged position of authority and trust.

Information Sharing

If you plan to raise the issue with a safeguarding team or official, you should consider and agree with the person you have discussed the issue with, whether it is appropriate to seek the child’s/ parent’s/person’s agreement to reporting the information, for them to be informed of the report, or whether doing so would place them at increased risk. Seeking the child’s/parent’s/person’s agreement might be appropriate, say, when abuse or radicalisation by a third party, such as an estranged parent, sibling or other person is suspected.

Relevant personal information can be shared lawfully if it is to keep a child or individual at risk safe from neglect or physical, emotional or mental harm, or if it is protecting their physical, mental, or emotional well-being. The Data Protection Act 2018 specifically includes ‘safeguarding of children and individuals at risk’ as a condition that allows practitioners to share information without consent. Information can be shared legally without consent, if a practitioner is unable to, or cannot be reasonably expected to, gain consent from the individual, or if seeking consent could place a child or adult at risk.

3.      Act

If appropriate, inform your local safeguarding team and supply them with a copy of your recorded observations (using the model referral form at Annex 3).

When reporting information, reports should be restricted to

• the nature of the injury, suspicious behaviour or concern
• facts which support the

You and the person with whom you are sharing the information must agree what the patient/relatives/legal guardians/carers/person will be told, by whom and when, and you should keep a note of what has been agreed together with a copy of the referral form.

4.    Confirm

Confirm telephone notifications in writing by fax, email or letter within 48 hours. If you are using a non-secure method of communication consider anonymising or password protecting the notification.

You should receive confirmation of referral within one working day. If you have not heard back within three working days, contact again. Keep contacting (including considering using another route) until you receive confirmation of receipt or other substantive communication or advice.

If you are/will not be available to do this, make sure by agreement with an appropriately senior person in the practice that this will happen and record that agreement as part of Step 5 below.

5.    Record

Ensure that all observations, advice sought, advice received and actions taken are recorded and stored confidentially and separately from the patient’s optical record.

In the unlikely event that you come across an individual in optical practice who is at immediate risk of harm, contact the police.

Be Vigilant

Awareness is by far the greatest protection for children and people at risk. See Annex 1

• what to look out for – common signs and symptoms of abuse or neglect
• what to look out for – inappropriate staff behaviour towards a patient

Any optical practitioner or member of staff who detects inappropriate behaviour by a colleague (also described in Annex 1) should take immediate action by following the five steps outlined above.

Local Advice and Support for Safeguarding

All local authorities in England, Wales, Scotland and Northern Ireland have duties to make arrangements to promote co-operation and co-ordination between local agencies regarding local protection procedures, including NHS England Regional Teams and Local Health Boards (LHBs).

In England and Wales local authorities have duties under the Children Act 2004 to promote cooperation between themselves, NHS England Regional Teams and Local Health Boards to improve the wellbeing of children, to make arrangements when carrying out their normal functions to safeguard and promote the welfare of children, and to establish a Local Safeguarding Children Board (LSCB).

Across the UK specialist safeguarding experts are available to provide advice and support to local practices and practitioners about whether to make a referral of suspected abuse or neglect.

In the case of children in England, Wales and Northern Ireland designated safeguarding doctors or nurses and protection officers perform these functions.

In England, every Clinical Commissioning Group (CCG) is required to have a designated safeguarding doctor and designated safeguarding nurse.

Public Health Wales has a structure of designated and named safeguarding professionals in each of the seven health boards.

In Northern Ireland, each Health and Social Services Trust has designated professionals for child protection.

In Scotland child protection advisors and nurse consultants fulfil this role. Some health boards in Scotland also have Child Protection Nurse Advisors.

All NHS England Regional Teams and CCGs should issue health care providers, including all optical practices, with up-to-date

• local guidance if appropriate
• local safeguarding team contacts for advice or referral
• information on local training opportunities
• details of the designated doctor and nurse available for advice and The contacts for relevant local safeguarding teams/officials should be
• able to receive confidential information 24 hours a day
• prepared to give advice to front-line optical staff and practices in respect of safeguarding children and adults at risk

(NB the local contacts are likely to be different for children and adults at risk.)

Optical practice managers should ensure these contact details are readily available in the practice. If you have any problem identifying the correct person in your area, please contact your LOC/ROC/AOC or local NHS professional or management contacts.

Safeguarding Training for Optometrists and Opticians

All optometrists, contact lens and dispensing opticians should complete safeguarding training to Level 2 of the Intercollegiate Safeguarding Guidance for Adults (2018) and children (2019). They should then receive refresher training equivalent to a minimum of 3-4 hours at least every three years.

Practices should incorporate these requirements into CET planning and annual appraisal systems.

Safeguarding Training for Other Practice Staff

All non-registered practice staff should complete safeguarding training to Level 1 of the Intercollegiate Safeguarding Guidance for Adults (2018) and children (2019).

This can be achieved by all non-registered staff studying this guidance, discussing anything they do not understand or any concerns they have with their manager, senior professional or designated staff member (see page 2, section 2) and signing to acknowledge they have read and understood the contents and know what steps to take should a situation arise with regard to safeguarding or Prevent. A template form for this is at Annex 6. Practices should file and retain staff forms for reference purposes. Refresher training should be undertaken every three years.

Studying this guidance and discussing any points that are unclear with a manager is sufficient to meet level 1 requirements of the Intercollegiate Guidance for Adults (2018) and children (2019).

Female Genital Mutilation

If you have any concerns regarding FGM in respect of a patient or any other person under 18 you should follow the steps in this guidance.

All healthcare professionals in England and Wales have a legal obligation to report any case of FGM in girls under the age of 18 to the police by telephoning 101 or 999 if there is an immediate risk.

If there is no immediate risk, you can also contact the National Society for the Prevention of Cruelty to Children on 0800 028 3550.

Further guidance on FGM is available from the Department of Health and Social Care.

Participation in Safeguarding Assessments/Plans

People who have been victims, or who are at risk, of abuse or neglect have the same eye health needs and health care rights as other members of society.

Social services may ask optical practices and practitioners to provide information about patients they have examined, or to take part in safeguarding assessments. They may also ask practitioners to provide eye care services to patients as part of a locally agreed safeguarding plan for those individuals.

If the practice or practitioner chooses to provide these eye care services local protocols and guidelines should be followed.

GP or Hospital Referrals

Optical practitioners may need to refer patients with suspected abuse or neglect to their GP or hospital e.g. if the practitioner notices a retinal haemorrhage. In such cases, practitioners should continue to refer the ocular/general health issue as normal, and in parallel, follow the five steps above, making the GP or hospital referral known to the local safeguarding team.

Mental Capacity and Deprivation of Liberty Safeguards

People who lack the mental capacity to make certain decisions for themselves, for example with regard to their medical care or entering into sales contracts, are considered particularly at risk. Lack of capacity is usually the result of a disability, mental or physical condition or trauma that affects the way the mind or brain works. This can be a temporary or permanent condition and can affect a broad range of decisions or only decisions on a certain issue.

Mental Capacity and Deprivation of Liberty Safeguards were introduced as part of the Mental Capacity Act 2005 to give protection to people who lack mental capacity.

The Mental Capacity Act sets out five statutory principles to protect people who lack capacity to make particular decisions, but also to maximise their ability to make decisions, or to participate in decision-making, as far as they are able. Professionals working with people who may lack capacity should be guided by these principles and the supporting examples set out in the Act.

The five statutory principles are:

1. A person must be assumed to have capacity unless it is established that they lack
2. A person is not to be treated as unable to make a decision unless all practicable steps to help them to do so have been taken without success.
3. A person is not to be treated as unable to make a decision merely because they make an unwise decision.
4. An act done, or decision made, on behalf of a person who lacks capacity must be done, or made, in their best interests.
5. Before the act is done, or the decision is made, consider whether the outcome can be achieved as effectively in a way that is less restrictive of the person’s rights and freedom of

NHS Standard Contract holders in England are required to nominate a Mental Capacity and Deprivation of Liberty Lead. This person would be expected to have a working knowledge of the relevant legislation and be in a position to provide support and advice.

Very occasionally in the case of eye care, Deprivation of Liberty Safeguards (DoLS) can be used to compel a person who lacks capacity to accept medical treatment. In such cases there are strict legal standards to ensure that any action taken is in the person’s best interests and that the intervention is minimally restrictive.

Part 2: Playing your part in the Prevent Strategy

The Prevent Strategy is part of the UK-wide counter-terrorism strategy to which the NHS is a signatory. The Prevent agenda requires healthcare organisations to work with the police to contribute to the prevention of terrorism.

The definition of ‘at risk’ has been widened to include individuals who might be at risk of being radicalised. These individuals should be identified and referred to the regional Prevent team contacts for appropriate advice and support. Advice on signs that an adult or child may have been or is being drawn into terrorism are at Annex 2.

Practices should ensure that they have procedures in place to allow for the referral of such individuals to local Prevent team contacts.

Prevent team contact information should be available on the local police or Council website but local arrangements can vary. In practice it is probably best to search the Internet for ‘Contact my local Prevent team’.

As in other safeguarding situations, the following steps should be followed:

1.   Observe

Note factual signs and symptoms of potential or suspected radicalisation without alarming the person or colleague concerned.

2.   Discuss

Alert and discuss your concerns with your manager, senior professional, designated staff member or, if you are a pre-registration optometrists with your supervisor, depending on your practice procedure.

If appropriate, seek advice from the local NHS Prevent team.

3.   Act

If appropriate, inform the local NHS Prevent team and supply them with a copy of your recorded observations (using the model referral form supplied in Annex 4).

When reporting information, reports should be restricted to

• the nature of the suspicious behaviour or concern
• facts which support the

4.  Confirm

Confirm telephone notifications in writing by email, secure fax or letter within 48 hours. If you are using a non-secure method of communication, consider anonymising or pass word protecting this notification.

You should receive confirmation of referral within one working day. If you have not heard back within three working days, contact again. Keep contacting (including considering using another route) until you receive confirmation of receipt or other substantive communication or advice.

If you are/will not be available to do this, make sure by agreement with an appropriately senior person in the practice that this will happen and record that agreement as part of Step 5 below.

5.   Record

Ensure that all observations, advice sought, received and actions taken are recorded and stored

confidentially and separately from the patient’s optical record.

Given the nature of optical practice and frequency of contact with patients, cases of suspected radicalisation amongst patients should be rare. However colleagues or other acquaintances may show these signs. If you have any concerns or questions, please contact your Optical Confederation representative body for advice and assistance.

Part 3: Responsibilities of for Optical Practitioners, Staff and Practices

Practice Protocol

Each optical practice should

• have safeguarding and Prevent protocol/procedures in place in line with this guidance and guidance from the College of Optometrists
• ensure that all members of staff and practitioners are aware of and understand the protocol/procedures.

Safeguarding and chaperone policies should already be in place as part of GOS compliance. However it is worth noting that the protocol/procedures should include:

• the appointment of the practice manager or another nominated senior professional as the responsible person within the practice to whom members of staff should refer safeguarding and Prevent concerns in the first instance
• a chaperone policy – a sample policy can be found at qualityinoptometry.co.uk
• a copy of this guidance in the practice
• local safeguarding team contact details
• local NHS Prevent team contact details
• a copy of any relevant local safeguarding guidance
• the procedures staff should follow where the nominated responsible person is unavailable (or inappropriate) g. contact number at company headquarters or a direct contact number to local safeguarding or NHS Prevent team.

Practitioners and Staff

• Be familiar with the common signs and symptoms of abuse, neglect or radicalisation and the

meaning of the term ‘looked after child’ (Annexes 1 and 2).

• Understand that for safeguarding purposes, a child or young person is defined as someone who has not yet reached their 18^th birthday
• Be alert to any signs of more widespread abuse g. in siblings or others attending with the patient
• Take personal responsibility for referring cases of suspected abuse, neglect or radicalisation of a patient by a family member, carer, or any other person, including for domiciliary patients a care home staff member, to the responsible person in the practice or other appropriate person
• Take personal responsibility for referring suspected abuse or neglect by an optical practitioner or a member of practice staff to an appropriate Staff should speak to the responsible person in the practice.
• The responsible person in the practice should apply their professional judgement to each case and should not make assumptions about a case on the basis of familiarity or assumed knowledge of the situation. Stick to observed facts and, if in any doubt, refer to the safeguarding or Prevent specialists.

Practices

• Fixed practices should identify a lead clinician in the practice with responsibility for safeguarding and Prevent procedures and ensure all staff are aware of who this is
• Domiciliary and mobile providers should similarly nominate a lead clinician and make all staff aware of who this is
• All practices should respond helpfully to a formal request by social services to provide information about a patient who is involved in a safeguarding assessment or to provide eye health services to a child or adult at risk as part of an agreed safeguarding plan
• All practices should play their part in identifying individuals at risk of being radicalised or involved in terrorist related activities, and refer them for further support.

Further Information

Details of relevant legislation and guidance are at Annex 5. For further information please contact your representative body or professional association.

ABDO members       Katie Docker kdocker@abdo.org.uk

AOP members           Regulatory Team regulation@aop.org.uk

FODO members        Member Support Team info@fodo.com

Optical Confederation

Originally published: 2014, updated 2017, updated August 2019