There were an estimated 498,260 concerns of abuse raised during 2020-21, an increase of 5% on the previous year (NHS Digital, 2021). Put into perspective, that’s almost an additional 25,000 matters where vulnerable adults who have care and support needs have been identified as being at risk of abuse or neglect.
The most common type of risk during this period related to neglect and acts of omission, with the most common location of the risk being the person’s own home. (NHS Digital, 2021)
Why is this relevant to clinical coaching?
In line with the NHS Long Term Plan (2019) to boost ‘out-of-hospital’ care, support people to age well, give people more control over their health with a more personalised approach and to drive digitally enabled care services into the mainstream, the role of the Clinical Coach has evolved.
At HN, we use AI-powered predictive analytics to identify and predict vulnerable individuals at risk of requiring immediate hospital or healthcare support.
Using this data, we minimise the impact of adverse health and wellbeing events by intervening through our unique clinical coaching approach. Our work has been shown to reduce unplanned care events which may see a patient hospitalised unnecessarily, and we provide holistic care and support to patients in the comfort of their homes.
We invite those considered to be at the greatest risk into our clinical coaching service, which is managed by registered healthcare professionals, where in partnership with the individual concerned, we consider the physical, psychological, emotional and social aspects of health to develop a bespoke coaching programme to support their wellbeing needs and priorities.
With increasing safeguarding concerns, the fact that most safeguarding issues arise in the person’s own home and as we work with a vulnerable cohort, we do encounter situations where individuals are at risk, are subject to abuse or neglect and require protection.
Professional safeguarding training is no longer enough
Safeguarding training tends to be one of the core components of Mandatory and Statutory Training (MAST) in healthcare settings with a requirement to complete a refresher every 1-3 years.
Our society however has changed significantly following two years of restrictions as a result of the COVID pandemic. The forced isolation led to challenges to our physical, mental health and social wellbeing and we are now dealing with the fallout.
Public Health England (2020) identified that self-isolating, shielding and socially distancing disproportionately impacted on vulnerable populations such as older persons, those living with learning disabilities, people with underlying health conditions and minority communities.
We also became increasingly aware of the impact this had on other vulnerable individuals - those living alone with no/limited support network, those needing care at home, people in abusive relationships (highlighted further with the enactment of the Domestic Abuse Act 2021) and the alarming fears faced by girls and women going about their day-to-day lives.
With this increasing and wide-reaching impact, the role of safeguarding has never been more critical.
A review of professional healthcare training in relation to safeguarding is required to ensure we have the current knowledge base, best-practice know-how, legislative awareness and skills to respond to and keep abreast of the changing landscape.
Our 10 recommendations for effective safeguarding
Based on our experience, we have set out 10 recommendations for organisations on safeguarding effectively:
All our Clinical Coaches undertake an accredited clinical coaching programme over six months. They exercise and develop their competencies in interviewing, questioning, uncovering, probing and listening to support in their holistic assessment of a patient’s health and wellbeing goals and objectives.
This professional ‘curiosity’ and partnering with the patient forms the foundations of an inclusive therapeutic relationship and a platform of mutuality, trust and respect. These skills are essential for our Clinical Coaches as part of their duty to support patients with their health and wellbeing goals in an environment which is free from harm and abuse.
Working in partnership with patients is essential
Patient engagement in all aspects of their health and wellbeing is fundamental and is the keystone of our Clinical Coaching programme. Indeed, patients themselves can help to safeguard their own wellbeing (The Health Foundation, 2013) when permitted, empowered and enabled to do so.
Our Patient and Public Involvement (PPI) Strategy provides multiple avenues for our patients to engage, feedback and contribute to the services provided. This allows us to ensure the service provided is safe, caring and responsive to their needs at that time, to monitor and drive quality and improvements, to ensure the service continues to meet and exceed patient needs, and to inform change or development of further packages to meet future requirements.
The principles encompassed within the Care Act emphasise the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, to respond proportionately to safeguarding concerns and to work with others find solutions.
In such circumstances, we refer to our local policy, our professional duty and our legal responsibility. We always:
however we acknowledge this may not be possible in all circumstances due to the individual nature of such matters, where there are clear reasons for not doing so, and/or where such engagement would put the patient at further/immediate risk of harm.
Nothing short of effective multi-disciplinary teamworking is acceptable
At HN, we recognise the importance and benefits of the multi-disciplinary approach when dealing with safeguarding concerns. While our Clinical Coaches work remotely, they align to patients in a given geographical area (by Integrated Care System or Primary Care Network footprint for example).
Effective communication is fundamental to safeguarding. A collective approach, sharing information, knowing the roles and responsibilities of those involved and shared responsibility means that safeguarding issues are more likely to be identified at an early stage. It is important to see effective safeguarding as a marker of good care rather than an outcome of poor care. (National Institute for Health and Care Excellence, 2015)
We are aware that exposure to safeguarding matters can also be stressful and traumatic for our staff and it is essential to have suitable procedures in place to allow for personal reflection, professional support and ‘down-time’ as appropriate.
Safeguarding is about us all - our colleagues, our families, our neighbours, our friends and our patients. If safeguarding truly is everyone’s business, then everyone needs to be able to recognise it, know how to report it and only then can we progress to putting a stop to it.
The consequences of having poorly informed staff, an absence of robust policy, ignoring or failing to identify safeguarding concerns when engaging with patients and working in isolation could lead to abuse and neglect being missed.
Ahead of National Safeguarding Adults Week 2022 in November, bringing together organisations from across the country to engage in dialogue, share best practice and raise awareness of what being safe means, there is time to reflect on safeguarding in your area to ensure opportunities to intervene are not missed and those vulnerable people under our care are treated with empathy and compassion.
Scott Beat, Deputy Safeguarding Lead, HN