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Safeguarding within remote consultations
Watch Bola Abolade discuss safeguarding and whose responsibility it is.
Yeah, safeguarding is actually preventing an adult’s right to live in safety free from abuse and neglect. It’s becoming quite broad now because previously, before the act 2014, it used to be seven times of– several types of abuse. But now instead, because it’s getting broader, it’s about ensuring that the patient is safe and ensuring that we actually manage our patients in the way that they have the confidence in the services we provide, they are safe in our environment, and for me, I want to believe safeguarding is everybody’s responsibility. So it is you, there is I. And also to believe that with safeguarding, it could be you that would be in that position. And also, safeguarding, you have to think family.
It’s about thinking beyond that particular person you are looking at. It’s about not being judgmental about that particular individual. Its about thinking about a holistic approach to safeguarding there might be from all that is that actually happening, an example would be self-neglect. Are we looking– just at self-neglect there, do we think about some mental health conditions? Do we think about emotional situations? There is a case of domestic abuse, are we thinking about is any child involved, with any previous history, that will affect that person being safe, or what it is that we need to do? Who do we work with, who do we let on to it? Who are the people that we need to contact?
Who do we need to speak with? Because safeguarding need multi agency procedure, during which, by the time we do that, it’s going to get the patient to a satis– to a positive outcome. Positive outcome for the patient is what we have to focus on.
If we need to do a remote consultation, one first thing that we need to look at are the criterias for safeguarding. And the first criteria, if it is adult safeguarding, has to be 18 years or over. For children, it’s less than 18 years. Sometimes, we do have children who are in transition period, maybe 17 going to 18, in which case we have to liaise with the children’s service to know whether there’s any background history. So apart from the age, we should be looking at the patient’s condition. Does the patient have care and supportance. And what do I mean by that? Is it patients independence and activities of daily living? Does the patient have capacity to make that decision?
Is the patient dependent on others for maybe mobility, or the finances, or probably even their independence, generally. I see a patient able to do that. Or one other thing we need to look at is is this patient able to protect themselves from the risk of abuse or harm? If the patient meets any of these criteria, then we should think that the patient needs to be safeguarded and protected. First one is the physical abuse, which is quite immediate. You can see a bruise, you can see an injury. You can see a wound.
But the commonest thing when it comes to maybe hospital or patient care is, which is when it comes to multiple groups with pressure ulcer, or maybe the patient have got category three or category four pressure ulcer]. Those are naturally safeguarding conditions. Also, when it comes to incidences like domestic abuse, you want to see whether the patient is afraid, whether the patient feels controlled. It depends on what the patient tells you. I know that the patient might not be able to tell you. Maybe the alleged perpetrator is close by, and they not be able– they’re not able to tell you. You should watch the body language of the patient.
Is this patient looking at the other person before they can have a say? Do they appear afraid? With neglect, neglect could be lack of a person, a professional, to give care to a patient who lacks capacity or lack– or a patient who is not able to protect themselves. For instance, it could be institutional neglect. If the patient presents to us and what we are supposed to do. Because according to section 44 of the Care act, it says that neglect of a patient who lacks capacity is a criminal incident.
So if we didn’t do what our professional role and responsibility, probably we are supposed to give medication to patients, or we are supposed to probably do the dressing of a patient as a nurse, or the patient, we are supposed to see them, and we neglect them. Because safeguarding the patient can tell us that. And with cases like modern slavery, human trafficking, you might see that the patient is actually afraid or somebody has come with them to the hospital and they’re looking at that person before they could answer a question. Or probably, this patient, he doesn’t have a hospital– GP registration, doesn’t have a home address, again, afraid and scared.
Probably look unkempt, or maybe the clinic and the patient have been coming to your clinic with the same cloth or dress. Then you’ll want to wonder, is this patient or this particular person is in a cause of modern slavery or human trafficking? So some of that is sort of things we look at. And cases like institutional abuse, this is related to institutions. It’s inherent, this form of incidences, both as professionals. It is suspected that we have our professional hats on, that we are suspicious. That our attitude of duty of care should just come up all the time. The duty of care. One other thing we need to consider is it in public interest.
For instance, somebody said neglecting is a case of public interest because this fire is going to affect anybody that is close to them, or is it in the patient’s best interests? Are we looking at the patient’s best interests? And behaving because of the patient’s best interests. These are the reasons why you need to raise the safeguarding concerns.
First and foremost, our observation is very important as professionals. Our communication is equally important, because as professionals we need to gain the confidence of the patients. When we are speaking to our patients and they can see compassion in us, they’ll be able to disclose more to us. And as professionals, with regards to safeguarding, there is one of the principles which is called empowerment. Empowerment is ensuring that the patient is involved. We let the patient know what our concern is. Even though some patient might tell you, “No, I don’t want anybody to be in trouble. I don’t want– my husband is a good person. I don’t want that,” or “my son,” it’s good they are a good person.
And their son is privately taking their money or really lots of druggy things do happen, especially with their finances. “I don’t want my son to be in trouble.” Yeah, one thing– we need to gain their confidence. We need to let them know that I’m concerned for you. And I’m just going to be acting in your best interest. And in such cases, ensuring that every patient can confide in us, they can not, we need to tell them what our concern is. And we need to let them know that, well, I know that you don’t want your son or your husband to be in trouble.
But because I’m a professional and I’ve known about this now, I’ve got to inform maybe my line manager or probably inform somebody that I think will be of help to you. Sorry about that. It’s OK. I’m going to speak to somebody that could be of help to you, in which case you take down all the details. And we’ll still get a referral. If it’s in primary care, because it’s not in our care trust, we can’t always go the local authority of the patient and look for the ideal social care for that department. And we can still get a referral. And on the way there, you are doing it in the patient’s best interests.
And it is really important to document that you have discussed with this patient this is what the patient feels. But because some people will say, “Oh, the patient said she doesn’t want to get people into trouble.” Yes, I know, but you need to think about your own duty of care as well because the fact that you know means you need to do something about it. So even if it is only for record purposes, there have been so many cases of domestic homicide review that we do.
And apparently, we will say that it’s professionals that have let these people down and made them to be killed because if your patient has approached a professional and has expressed their concern, if we have not done anything with that information, the question will be, what did you do with that information? So the information is about working with other professionals to be able to safeguard the patient to protect them from such abuse.
You know, I think being proactive. And most professionals are very proactive. Be proactive. While you are talking to the patient, you are just checking your internet. I just see a lot of that in GP surgeries because I watch a lot of ITPs behind closed doors. Why the patient is complaining they are checking it on on Google, I was laughing yesterday because the patient was still complaining. And the doctor was googling it to show the patient this picture to be able to– for the patient to be interactive. So while you are talking to the patient, we should be proactive. We are professionals. Part of being responsible to be proactive because you don’t want to miss anything as a professional.
You don’t want to feel like you are like the patient down. This is my nursing days. I started nursing ‘77. And in the ’80s, when I was practicing as a registered nurse, by the time I go home, I want to reflect on my day. Is there something that I’ve missed? Is there anything that I was supposed to have done that I haven’t done? Is there somebody that I should have spoken to that I haven’t spoken to? Otherwise, you might actually not have your own peace as well you have not acted the way you should, especially if you come to know that the patient has come to harm.
If you see a patient you want to think, is there any child involved? Is there any child in that environment? Is the patient pregnant? In which case, you need to inform the midwifery service. You need to involve the broker midwife or involve the children’s services. Does this patient have any care support needs? Does the patient have anybody with learning disability? Is this patient a carer for another person who is vulnerable? Because we tend to come across that. Because this person that has come to you maybe is the mother of somebody who is vulnerable who is not able to help themself.
Or this patient that is coming to the hospital, an ED, and this patient is a carer for another person who have gotten dementia, in which case, the patient is safe. The person they are looking after is not safe because the patient, the person come, had to go out in the night. That is one key thing. One other thing we need to look at is making sure getting personal. Making sure getting personal is ensuring that we involve our patients in our decisions. Involvement is very important. All we want is a positive outcome. However, especially with cases like domestic violence, the patient doesn’t want you to get involved, which is a lot of the time.
They go back to the perpetrator But that does not stop you from acting because if you don’t act, and the patient accordingly goes back to the place that is deemed unsafe, then that would be a problem. Also, we want to look at patients’ condition, like a patient coming to us with maybe domestic violence and has is blind, a registered blind, not able to see. And I’ve got one– there was one particular story that moved me because this patient known to Moorfield hospital for being blind came into the hospital in one of the trusts that I’ve worked for with a domestic violence incident. And sometimes, we are pressed by beds, especially those who work in our acute care.
And somebody just came over a weekend and discharged this patient to go home without offering the patient any form of support. We look to look about little things that matters. I call them little things that matters for they matters. Does this patient actually need to maybe food? A cup of tea could do it sometimes. Discussing with the patient could make a lot of difference. Some people actually need somebody to listen to, somebody to listen to them, somebody to make their day. They really say maybe in the primary care in your pharmacy. Maybe the patient might actually do want newspaper, free newspapers. Little things that matter that could make a lot of difference in the lives of people.
Apparently, what we are here– when we come to work, we have to make people happy to ensure that we get the positive outcome for our patients.
NHS England describe safeguarding as “..protecting a citizen’s health, wellbeing and human rights; enabling them to live free from harm, abuse and neglect. It is an integral part of providing high-quality health care. Safeguarding children, young people and adults is a collective responsibility..”. [1]. Similar definitions can be found internationally when visiting charities such as CARE® and Save The Children®. You might like to visit your own governing body websites to see what initiatives are happening where you are in relation to safeguarding.
Safeguarding is an essential component of any consultation and remote consultations are no different in that regard.
The video at the top of this step is an interview with Bola Abolade, a nurse with many years of experience in the field of safeguarding. Watch this video now.
When you are watching this interview, make a notes on how Bola describes safeguarding, and whose responsibility it is. Listen out for the different safeguarding issues that you should be alert for. Bola also offers some useful advice for what to do if you have any safeguarding concerns and who to involve.
[1] NHS England. About NHS England Safeguarding [online] Accessed July 13 2020
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Conducting Remote Consultations and Triage
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