This information may be of assistance if you think someone may be vulnerable or is being abused. It explains how to spot adult abuse, what you can do if you are being abused or you suspect somebody else is, and what the James Paget University Hospitals NHS Foundation Trust does to prevent it happening.
We recognise that the abuse of adults is a reality. We don't believe that this is acceptable and are committed to confronting and eliminating adult abuse whenever it comes to our notice and involves people to whom we provide services.
We ensure that our staff are trained to be alert in detecting signs or symptoms of adult abuse.
- it is everyone's responsibility to report abuse, if known to be occurring
- it is every adult's right to live free from abuse in accordance with the principles of respect, dignity, autonomy, privacy and equality
Our Safeguarding Adults team works in partnership with other local statutory bodies, ensuring that appropriate policies, procedures, and practices are in place and implemented.
Questions and answers
Previously these adults were referred to as vulnerable adults. Since the Care Act 2014, there is no longer a specific definition of a vulnerable adult. Instead the Act states that 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.
Very often the need for care and support for adults can be linked to their learning disability, mental health issues (including dementia), age and frailty, physical disability, substance misuse or illness.
However, certain characteristics do not automatically mean that someone is vulnerable so just because they have a disability or are older does not mean that they cannot keep themselves safe or make their own decisions.
Anyone is at risk of abuse but people who are unwell, frail, confused and unable either to stand up for themselves or keep track of their affairs, are particularly vulnerable.
People who are most at risk of abuse include:
- Those who are isolated and don't have much contact with friends, family or neighbours
- People with memory problems or difficulty communicating with others
- People who don't get on with their carer
- People whose carer is addicted to drugs or alcohol
- People whose carer depends on them for a home and financial and emotional support
Other adults at risk include people who are open to abuse because of learning difficulties, physical disabilities or mental health issues or those living in violent relationships. This also includes those living in care homes, hospitals or institutions.
The main categories of abuse are listed below:
- Physical abuse – including assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.
- Domestic Violence – including psychological, physical, sexual, financial, emotional abuse; so called ‘honour’ based violence.
- 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 or Material 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, 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.
- 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.
It is not always easy to spot the signs of abuse. Often the person being abused feels embarrassed or in many situations frightened of the consequences of informing. Very often they make excuses for injuries or bruising or display a change in their usual behaviour. If it is financial abuse that is taking place, they may suddenly become short of money.
While it’s important to be able to recognise the signs of abuse, there is no definitive list of signs or signals. The following list provides some basic guidance that may indicate some of the signs that abuse is taking place:
What to look out for:
- Appearing frightened, stressed or subdued
- Unexplained changes in behaviour
- Unexpected behaviour
- Physical signs (such as bruising or other untreated injuries)
- Poor sleep patterns
- Actions of “gatekeepers” (such as relatives or carers) preventing contact with an individual
- Certain indicators may suggest a specific type of abuse
Abuse can happen anywhere anytime. People who abuse can be those that we trust or rely on. Some people will deliberately target others, whom they perceive as vulnerable, in order to exploit them. Some abuse may be unintended, and the abuser may not even realise that they are abusing someone, but as already mentioned, it is nevertheless still abuse.
- It can be pre-meditated or unintended
- Long-standing pattern of aggressive or violent behaviour within a family
- Lack of knowledge
- Anger and frustration
- Lack of proper training and supervision
- Poor management
The Trust’s Safeguarding Leads are responsible for acting as a source of information and support for staff, patients and visitors when they have concerns about safeguarding adults. There is a JPUH Safeguarding Adults Policy and Safeguarding Team internal webpage where information can be found about how to make a referral.
If a referral is needed this will go to either the Norfolk or Suffolk MASH (Multi-Agency Safeguarding Hub). The MASH is made up of professionals from Adult Social Care, Police and Health who will collectively decide what the next steps may be.
If you witness or hear about abuse:
- It's everyone's responsibility to report it
- Healthcare workers have a duty to report abuse if suspected
- Ensure the person is safe. If there is an immediate threat contact emergency services on 101 or 999
- Report concerns to the person in charge
- Refer concerns to relevant MASH – Norfolk patient - 0344 800 8020
Suffolk patient - 0808 800 4005
For general advice, or if you are unsure who to call in the hospital, please contact: Kelly Boyce, Safeguarding Vulnerable Adults Trust Lead on 01493 452231.
Mental Capacity Act
The Mental Capacity Act (MCA) is designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment. It is a law that applies to individuals aged 16 and over.
Examples of people who may lack capacity include those with:
•a severe learning disability
•a brain injury
•a mental health condition
•unconsciousness caused by an anaesthetic or sudden accident
However, just because a person has one of these conditions does not necessarily mean they lack the capacity to make a specific decision.
Someone can lack capacity to make some decisions (for example, to decide on complex financial issues) but still have the capacity to make other decisions (for example, to decide what items to buy at the local shop).
The MCA says:
•Everyone has the right to make his or her own decisions. Health and care professionals should always assume an individual has the capacity to make a decision themselves, unless it is proved otherwise through a capacity assessment.
•Individuals must be given help to make a decision themselves. This might include, for example, providing the person with information in a format that is easier for them to understand.
•Just because someone makes what those caring for them consider to be an "unwise" decision, they should not be treated as lacking the capacity to make that decision. Everyone has the right to make their own life choices, where they have the capacity to do so.
•Where someone is judged not to have the capacity to make a specific decision (following a capacity assessment), that decision can be taken for them, but it must be in their best interests.
•Treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms possible, while still providing the required treatment and care.
The MCA also allows people to express their preferences for care and treatment in case they lack capacity to make these decisions. It also allows them to appoint a trusted person to make a decision on their behalf should they lack capacity in the future.
People should also be provided with an independent advocate who will support them to make decisions in certain situations, such as serious treatment or where the individual might have significant restrictions placed on their freedom and rights in their best interests.
You can find out more about MCA on the NHS website .
Deprivation of Liberty Safeguards
Deprivation of Liberty Safeguards are a part of the MCA and relate to people who are placed in care homes or hospitals for their care or treatment and who lack mental capacity.
The Deprivation of Liberty Safeguards are an amendment to the Mental Capacity Act 2005. They apply in England and Wales only.
The Mental Capacity Act allows restraint and restrictions to be used – but only if they are in a person's best interests.
Extra safeguards are needed if the restrictions and restraint used will deprive a person of their liberty. These are called the Deprivation of Liberty Safeguards.
The Deprivation of Liberty Safeguards can only be used if the person will be deprived of their liberty in a care home or hospital. In other settings the Court of Protection can authorise a deprivation of liberty.
Care homes or hospitals must ask a local authority if they can deprive a person of their liberty. This is called requesting a standard authorisation.
There are six assessments which have to take place before a standard authorisation can be given.
If a standard authorisation is given, one key safeguard is that the person has someone appointed with legal powers to represent them. This is called the relevant person's representative and will usually be a family member or friend.
Other safeguards include rights to challenge authorisations in the Court of Protection, and access to Independent Mental Capacity Advocates (IMCAs).
You can find further information about DoLS here .
Mental Health Act information
The Mental Health Act 1983 (as amended by the Mental Health Act 2007) is a law which deals with the admission and treatment of people with a mental disorder.
A mental disorder is defined in the Act as “any disorder or disability of the mind”. However, this does not include people who are dependent on alcohol or drugs, or people with a learning disability unless it is associated with “abnormally aggressive or seriously irresponsible behaviour”.
Being admitted under the Mental Health Act is often called being 'sectioned'.
Most people who are subject to the provisions of the Mental Health Act are looked after by specialist mental health services (Norfolk and Suffolk Foundation Trust - NSFT) and will be admitted to one of their psychiatric beds if they need in-patient care.
Sometimes, a 'sectioned' patient is admitted to the James Paget University Hospital because they need physical health care which the mental health services cannot provide. In this case, NSFT will retain oversight of all Mental Health Act-related matters.
The Mental Health Act Code of Practice tells everyone how to use this law and what they must do.
You can find out more about the Mental Health Act here.
Please see below for more information about adult safeguarding subjects including Domestic Abuse and our Modern Slavery Act statement.