Learner name Qualification undertaking Highfield Level 3 Diploma in Adult Care (RQF)
Learner name Qualification undertaking Highfield Level 3 Diploma in Adult Care (RQF)
Tutor name Start date Expected End date Highfield Level 3 Diploma in Adult Care (RQF)
Y/650/3408
Unit 14
Learner Workbook
-6858089027000The Principles of Safeguarding and Protection in Care Settings
-457200-457201005172075-47625000
Outcome 1: Understand the national and local context of safeguarding and protection from abuse.
1.1 Identify relevant legislation, principles, national policies and frameworks and local systems that relate to safeguarding and protection from abuse and neglect.
1.2 Explain the roles of different agencies in safeguarding and protecting individuals right to live in safety and be free from abuse and neglect.
Agency Role
1.3 Explain how reports on serious failures in upholding individuals rights to live free from abuse and neglect have influenced current practice.
Explain and give an outline of THREE different reports into serious failures to protect individuals from abuse. Try to ensure that one of these relates to the sector in which you work.
***You will need to do some research for this question***
Case 1:
Case 2:
Case 3:
1.4 Identify sources of information and advice about own role in safeguarding.
Source What can they provide
Outcome 2: Know how to recognise signs of abuse and neglect.
2.1 Describe the terms:
Safeguarding
Abuse
Harm
2.2 Describe factors that contribute to an individual being more at risk of abuse or neglect.
2.3 Explain what is meant by the following terms.
2.4 Identify indicators that an individual may be being abused.
Type of abuse Signs and Symptoms
Physical abuse
Domestic abuse
Sexual abuse
Psychological abuse
Financial/material abuse
Modern slavery
Discriminatory abuse
Institutional/organisational abuse
Neglect/acts of omission
Self-neglect
2.5 Identify indicators of perpetrator behaviour.
Outcome 3: Understand ways to reduce the likelihood of abuse and neglect occurring.
3.1 Explain how the likelihood of abuse may be reduced by:
Working with person-centred values
Enabling active participation
Promoting choice and rights
Supporting individuals with awareness of personal safety
Working in partnership and co-production with others
Managing risk
Focusing on prevention
3.2 Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse.
Outcome 4: Know how to respond to suspected or disclosed abuse and neglect.
4.1 Explain the actions to take if there are suspicions that an individual is being abused or neglected.
4.2 Explain how to respond if an individual discloses that they are being abused or neglected.
4.3 Identify issues relating to consent to share information.
4.4 Explain how to share information about suspicions or disclosures of abuse or neglect.
4.5 Explain how to keep the individual and others informed and involved about their safeguarding concern in line with policies and procedures.
4.6 Identify ways to ensure that evidence of abuse or neglect is preserved.
4.7 Explain when and how to seek advice and support in relation to responding to safeguarding concerns.
4.8 Explain how to respond to suspicion or disclosure that a child or young person is being abused or neglected.
Outcome 5: Know how to recognise and report unsafe practices.
5.1 Describe unsafe practices that may affect the wellbeing of individuals.
5.2 Explain the actions to take if unsafe practices have been identified.
5.3 Describe the actions to take if suspected abuse or unsafe practices have been reported but no action has been taken in response.
Outcome 6: Understand the principles of online safety.
6.1 Explain the importance of balancing online safety measures with the benefits individuals can gain from accessing online systems, and the individuals right to make informed decisions.
6.2 Describe the potential risks to individuals presented by:
The use of electronic communication devices
The use of the internet
The use of social networking sites
Carrying out financial transactions online
6.3 Explain ways to work inclusively with individuals to reduce the risks presented by each of these types of activities.
Learner name Qualification undertaking Highfield Level 3 Diploma in Adult Care (RQF)
Tutor name Start date Expected End date Highfield Level 3 Diploma in Adult Care (RQF)
Y/650/3408
Unit 14
Learner Information Book
-6858089027000The Principles of Safeguarding and Protection in Care Settings
-457200-457201005172075-47625000
Outcome 1: Understand the national and local context of safeguarding and protection from abuse.
1.1 Identify relevant legislation, principles, national policies and frameworks and local systems that relate to safeguarding and protection from abuse and neglect.
The Care Act 2014 defines adult safeguarding as protecting an adults right to live in safety, free from abuse and neglect. In Wales, a working definition currently is, a person who is 18 years of age or over, and who may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of themselves, or unable to protect themselves against significant harm or serious exploitation.
Adult safeguarding is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect. Safeguarding balances the right to be safe with the right to make informed choices, while at the same time making sure that the adults wellbeing is promoted including taking into consideration their views, wishes, feelings and beliefs in deciding on any action. Health and social care organisations have particular responsibilities, but every worker has a part to play.
As a worker, it may be thought of as abuse or neglect if you cause harm to someone or do not do the things you should to prevent harm. It is important that you know the ways of working to safeguard adults in your workplace.
An adult at risk of harm is defined as someone who has needs for care and support, and is experiencing, or at risk of, abuse or neglect and is unable to protect themselves.
Under the Care Act 2014, your local authority has the lead role in relation to adult safeguarding and must:
make enquiries, or ensure others do so, if it believes an adult is subject to, or at risk of, abuse or neglect
establish whether any action needs to be taken to prevent or stop abuse or neglect, and if so, by whom
set up a safeguarding adults board (SAB)
arrange, where appropriate, for an independent advocate
cooperate with each of its relevant partners.
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) or is experiencing, or is at risk of, abuse or neglect
as a result of circumstances that put them at risk, is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.
There are national policies on safeguarding adults, e.g. guidance, regulations, and training as well as local systems, e.g. organisational safeguarding policies and local multi-agency adult safeguarding groups.
In their guidance about compliance, The Fundamental Standards of Care, the Care
Quality Commission (CQC) has catalogued a list of publications related to safeguarding.
This can be found on the CQC website: www.cqc.org.uk
Useful policies, guidance and codes of practice referring to safeguarding in adult social care can be found on the following websites:
ADASS The Association of Directors of Adult Social Services - www.adass.org.uk/
For example - Deprivation of Liberty Safeguards Guidance - 31 MARCH 2015. This relates to providing care in hospitals and care homes to support individuals in a way that doesnt restrict their freedom: Department of Health/Gov.uk
For examples - www.gov.uk/government/publications/adult-safeguardingstatement- of-government-
Key pieces of legislation are listed below:
In England, the Care Act 2014 makes it the duty of local authorities to make enquiries if someone is being abused or neglected or is at risk of abuse or neglect in their area. They must also set up multiagency safeguarding adults boards to review cases when people die as a result of neglect or abuse and where it is suspected that agencies could have done more to safeguard them.
https://www.gov.uk/guidance/care-and-support-statutoryguidance
In Wales there are different arrangements with overall similar intentions, for example,
there are regional safeguarding and protection boards. There are then area adult protection committees. You can find out more information here:
www.ssiacymru.org.uk/home.php?page_id=3015
The Mental Capacity Act 2005 aims to protect and empower people who are unable to make choices for themselves.
The Human Rights Act 1998 gives specific rights to every person living in the UK, for example the right to life and freedom from torture and degrading treatment.
The Data Protection Act 1998 regulates the way in which personal data needs to be managed and therefore protects peoples data from being placed in the wrong hands, which may increase the risk of abuse or neglect.
The Equality Act 2010 protects people from discrimination and disadvantage due to protected characteristics including race, gender, disability, sexual orientation,
gender reassignment, religion, and age.
www.gov.uk/government/collections/mental-capacity-act-making-decisions
www.legislation.gov.uk/ukpga/1998/42/contents
www.gov.uk/data-protection/the-dataprotection-act
www.gov.uk/equality-act-2010-guidance
1.2 Explain the roles of different agencies in safeguarding and protecting individuals right to live in safety and be free from abuse and neglect.
Safeguarding adults reviews (SARs)
Safeguarding adults boards (SABs), which are set up by local authorities, must arrange a SAR when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is suspicion that partner agencies could have worked more effectively to protect the adult. SABs must also arrange a SAR if an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect. SABs are free to arrange a SAR in any other situation involving an adult in its area with needs for care and support. In Wales SARs are called serious case reviews.
As we have touched upon in the last section, multi-agency protection arrangements gather a variety of people from different organisations.
Lets take a look at the roles of some of these in more detail:
Providers of health & social care support: they support and care for individuals in a person-centred way, empowering them to have choice and control and by giving them a voice to express themselves. Their policies and procedures cover guidelines on safeguarding and protection of those they provide care and support for and their workforce.
Social Services: they lead and coordinate the safeguarding arrangements. The Adult Services Department Safeguarding Team will initiate inquiries into alleged abuse and ensure the safety of the victim, e.g. by accommodating them in a safe place.
Providers of health and social care services: they support and care for individuals in a person-centred way, empowering them to have choice and control and giving them a voice to express themselves. Their policies and procedures cover guidelines on safeguarding and protection of those they provide care and support for and their workforce.
Police: they will investigate and prosecute if the abuse has fulfilled the elements of a criminal offence. Police will work together with the Disclosure and Barring Service (DBS) to check police records of people who want to work in care. They can also give you advice and provide you with fact sheets, e.g. on elder abuse and neglect, protective behaviour, victims rights or prevention and reduction of domestic violence.
Care Quality Commission: this is the independent regulator for all health and social care services in England. The CQC gives guidance to care providers on how to implement the governments standards in their policies and procedures. It also inspects care providers, checks whether they comply with these standards and publishes results on its website.
Social Care Institute for Excellence: this is a charity which aims to improve care by researching and analysing care practice to find out and share which strategies work best. SCIE provides training, learning materials and consultancy for social care workers to improve their knowledge, and also information so that individuals and persons in its network know their rights and can make informed decisions.
Independent Safeguarding Authority: this has been created to prevent unsuitable people from collaborating with vulnerable individuals. The ISA has set up a vetting and barring system, the Protection of Vulnerable Adults scheme (POVA), which creates a list of people who are barred from collaborating with vulnerable individuals who are 18 or over. As from December 2012 the Independent Safeguarding Authority and the Criminal Advice Bureau merged into the Disclosure and Barring Service (DBS). Anyone who seeks a profession in adult social care has to have clear DBS checks and be checked against the POVA list before they can start working.
Advocacy and advisory services: they provide advocates who try to establish a persons feelings, wishes and beliefs and help the individual to make these needs and wishes known. Advocates work in partnership with the individual and offer them help and support, e.g. when composing a complaint, for making informed choices or reporting incidents of abuse.
All these agencies, along with others, e.g. Age UK and MIND, are working together to
ensure that adults who may be vulnerable are safeguarded and that harm and abuse is prevented by providing information, advice and education about the issues surrounding abuse and neglect.
1.3 Explain how reports on serious failures in upholding individuals rights to live free from abuse and neglect have influenced current practice.
Explain and give an outline of THREE different reports into serious failures to protect individuals from abuse. Try to ensure that one of these relates to the sector in which you work.
***You will need to do some research for this question***
Sadly, having the best legislation, policies and procedures and codes of practice in place and valuing ethics like the duty of care doesnt always protect individuals from abuse.
In terms of the number of victims, one of the biggest cases of abuse in British history is that of Harold Shipman, a general practitioner, who was alleged to have murdered more than 250 patients over the course of his career.
In 1998, when a relative of his last victim reported him to the police after finding a forged will, a police investigation was launched. Shipman was tried before court and subsequently, in January 2000, found guilty of killing fifteen female patients by administering lethal injections of diamorphine (heroin). He was sentenced to fifteen consecutive life sentences in Wakefield Prison, West Yorkshire. After his arrest in 1998, jewellery was found in Shipmans garage which he had stolen from his patients: the value amounted to over 10,000.
At the time of the trial Alan Milburn, the secretary of state for health, initiated the Shipman Inquiry, an independent private investigation into Harold Shipmans actions. The sixth and final report into the inquiry in 2005 found that Shipman had killed over 250 patients since 1971, most of them elderly and women, but with one of his victims being as young as four.
The Shipman Inquiry concluded that serious failures had occurred in protecting Shipmans patients. There were some major concerns the team had discovered which led to subsequent recommendations of better control of the use of potentially harmful drugs, changes in the way doctors are regulated and better training for coroners to raise awareness for suspicious deaths. The Harold Shipman case was so shocking because it brought to light the magnitude of abuse that could happen without anyone noticing or asking questions.
But abuse is also happening on all scales, like in the case of Winterbourne View, a private hospital for persons with learning disabilities and challenging behaviour. In 2011 the BBC current affairs documentary programme Panorama broadcast an undercover investigation into physical and psychological abuse at Winterbourne, with carers repeatedly assaulting and unnecessarily restraining individuals. This particular case has been the catalyst for change in the sector and a determined effort to move further towards increased person-centred approaches in care and support.
1.4 Identify sources of information and advice about own role in safeguarding.
When working in adult social care you have the duty to promote the interests, rights, and wellbeing of the individuals you support or care for. To develop your skills, understanding and knowledge about your own role in safeguarding and protecting individuals from abuse it is imperative that you know how to access sources of information and advice.
Information and advice can either come from within your organisation or from beyond.
Sources from within your workplace that help your development with regards to safeguarding and protection are as follows:
Policies and procedures: these have been referred to throughout this and other units. Your organisations policies and procedures are your foundation, so make sure you familiarise yourself with them. They will give you guidance on abuse prevention and recognising the signs and symptoms, but also on procedures when abuse has occurred.
Manager/supervisor: they can mentor you and offer guidance about what is expected of you in your work role with regards to safeguarding and protecting vulnerable adults. Your manager/supervisor should always be your point of contact for any questions or concerns you might have. They can also help if your issues are too complex to be solved by just reading the policies and procedures.
Learning and development: a lot of organisations offer safeguarding training to raise awareness of abuse and neglect, and to explain signs and symptoms and lines of reporting. Other awareness training which informs you about the specific challenges of some conditions will be invaluable, too, e.g. dementia, autism, or challenging behaviour awareness.
Colleagues: they will often be your first choice of information source as they are collaborating with you and will have more skills and experience to advise you in extremely specific situations. They will also be able to point you in the direction of other potential sources of guidance.
Examples of external sources of advice and information:
Professional bodies/trade unions, such as the Royal College of Nursing,
the British Association of Occupational Therapy and the Chartered Society of Physiotherapy
(these are examples, some information is only available to members).
Social Care Institute for Excellence (SCIE): this organisation aims to improve care by
researching and analysing care practice to find out and share which strategies work best. www.scie.org.uk/Social services: the adult social services department of your local authority will be able to provide advice and support on safeguarding and protecting vulnerable adults.
The regulator in your country will give you guidance on government policies.
Carers direct helpline 0300 123 1053: this offers all week telephone support and advice to carers in regard to their own support and safeguarding and protection of the individuals they care for. www.nhs.uk/conditions/social-care-and-support-guide/pages/carers-rights-care-act-2014.aspxOutcome 2: Know how to recognise signs of abuse and neglect.
2.1 Describe the terms:
Safeguarding
Abuse
Harm
Protecting an adults 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 adults 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.
https://www.scie.org.uk/safeguarding/adults/introduction/what-isAdults can be vulnerable to abuse and neglect, especially if they have care and support needs. Abuse is a violation of a person's human and civil rights by any other person. It is where someone does something to another person, or to themselves, which puts them at risk of harm and impacts on their health and wellbeing.
Abuse comes in many forms and can often have a damaging effect on the health and wellbeing of an individual, the effects may be short term, or may last a long time. The signs of abuse aren't always obvious, and the victim may not tell anyone what is happening to them - sometimes they may not even be aware they are being abused.
https://www.lancashiresafeguarding.org.uk/lancashire-safeguarding-adults/what-is-safeguarding-and-abuse/Harm is defined within the Act, as all harmful conduct and/or:
behaviour that causes physical or psychological harm for example harassment and intimidation, causing fear, alarm, or distress
unlawful conduct which adversely affects property, rights, or interests such as theft, fraud, or extortion
behaviour that causes self-harm and self-neglect
https://www.adultprotectionsouthlanarkshire.org.uk/info/55/more_about_harm#:~:text=What%20is%20harm%3F,as%20theft%2C%20fraud%20or%20extortion
2.2 Describe factors that contribute to an individual being more at risk of abuse or neglect.
Abuse and neglect can take place anytime and anywhere. Abuse has the potential to happen wherever there are relationships involving power. Statistics show that in most cases of abuse the abuser has been known to the victim beforehand. Some particular situations increase an individuals vulnerability to the risk of abuse or neglect happening.
Examples are:
In an individuals own home, it is easier for an abuser to hide their actions from others. The home is a private space where no one sees whats going on apart from, maybe children. One person might have more power than the other due to physical strength, or to having more money, knowledge, or higher status in society. In a caring relationship this power would be used to support the weaker person but in an abusive one it will be turned against them. Although domestic violence is generally associated with violence against women, there is a high percentage of men who suffer from abuse. Unfortunately, society still portrays the image of the man as being more powerful which leads to many men being too ashamed to ask for help.
Organisational abuse is more likely to happen when standards are poor and routines are planned to fit around a rota or workers feel unsupported by their management. This can lead to a way of working that everyone begins to see as acceptable. They do not try to challenge the situation because they are afraid of speaking out about what is being accepted by the majority. This can happen in any kind of organisation such as residential care, shelters, day centres, clinics, and drop-in centres.
Any workplace where individuals display difficult or challenging behaviour that workers are not trained or supported to deal with.
Particular care and support needs of the individual such as a sensory condition, a mental health issue, dementia, or a learning disability. A reaction could be taken as a symptom of their condition rather than an attempt to tell someone what is happening to them.
The community: abuse can happen in the community when a dominant group of people abuses a minority or individuals. A classical clich is that of the mafia threatening and oppressing whole neighbourhoods, a modern-day notion being the conflict between gangs. But we can also read about it in the papers on a regular basis: ethnic minorities, homeless or homosexual people being harassed, bullied, raped, robbed, or beaten up by members of the community. These abusive groups derive their dominance quite often from supremacy in numbers.
Stressful situations: sometimes abuse occurs because stress and pressure have built up due to personal circumstances or working conditions, e.g. a staff member is overworked, and/or has not had sufficient education and training.
Other factors that may contribute to an individual being more vulnerable to abuse or neglect might lie within themselves.
These predisposing factors could be age, mental health issues, dementia, learning disabilities or a previous history of having been abused themselves. Lets take a look at the predisposing factors in more detail:
Age - according to the American psychoanalyst Erik Eriksons stages of psychosocial development, the last stage of a persons life is characterised by reflection on their life. They look back on their experiences and achievements and either like what we see, which will give them integrity, the feeling of having been true to themselves or they dislike it, which could lead to feelings of despair and depression as they realise it is now too late to change things. These feelings could lead to older people resigning themselves to the way they are treated or, if they are lonely, they might crave any social contact even if it is abusive.
Mental health - People with mental health issues quite often have a distorted view of the world, e.g. if a person lives with schizophrenia and hears voices in their head, they can feel very depressed at times. Their trust in their own perceptions, their confidence and self-esteem will be low, which will make it easier for an abuser to persuade them that what is happening to them is their own fault and is acceptable. Their inability to see things clearly might cause them to think that they deserve the treatment because something is wrong with them.
Dementia - this is the term for a group of disorders that have in common a decline in the functioning of the brain. An individual with dementia will gradually lose the ability to think, reason and remember, which means they could forget the names of relatives and friends or not recognise them. As you might imagine, it is exceedingly difficult and frustrating for family members to care for a person with dementia who does not know who they are. Because of the confusion and anxiety, the condition causes in the brain of those affected, they might turn to behaviour that is difficult to respond to or harmful to themselves or others. It is therefore essential that carers have a good network of guidance and support as caring for someone with dementia is extremely challenging and a stressed carer might lose control and turn abusive if a situation overwhelms them.
Learning disabilities - although a learning disability as such doesnt make a person more likely to be abused, it is the imbalance of power held by the care worker or their informal carer that puts the person with a disability at risk. Individuals with learning disabilities quite often rely on others for support with personal care, and if they have been in the care system for a long time they might be used to doing as they are told. They might lack the mental capacity to distinguish right from wrong and to make informed decisions. They might not know their rights and thus passively accept what is happening to them.
History of abuse - sadly, a history of being abused can make an individual more vulnerable to further abuse if they are not given the chance to work through the experience, e.g. through therapy. Being abused hits on the victims feelings of lack of self-worth and self-esteem: they feel disenfranchised and may lack the confidence needed to change their situation as they might feel it is their own fault. An abuser will often blame the victim, e.g. by saying, You make me angry or You are hurting me by not doing what I ask of you.
Eventually, the victim might resign themselves to the conclusion that all the attention they will ever get is negative. An abuser is good at detecting insecurities in other people and might seek them out as being vulnerable.
2.3 Explain what is meant by the following terms.
2.4 Identify indicators that an individual may be being abused.
Type of abuse Signs and Symptoms
Physical abuse is an individuals body being injured or hurt due, for example, to assault, hitting, slapping, or pushing. It can also be the wrong use of restrictive practices (see below).
Examples could be the misuse of medication or using inappropriate restraint such as locking someone in a room, tying them to a chair or using inappropriate physical sanctions. Injuries that are unexplained or havent
been treated. There could be a number of injuries of different ages and in
different places.
Examples include:
broken bones
bruises
unexplained loss of clumps of hair
bite, burn or scald marks.
Domestic violence is any incident of
threatening behaviour, violence, or abuse
(psychological, physical, sexual, financial, or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality. It includes psychological, physical, sexual, financial, and emotional abuse, and so-called honour-based violence. Signs of domestic violence can be any of
those relating to the different types of
abuse or neglect that can occur in any incident.
Modern slavery: this 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. Signs of physical or psychological abuse, being malnourished or unkempt, appearing withdrawn
Rarely being allowed to travel on their own, seemingly under the control and influence of others, rarely interacting or
appearing unfamiliar with their neighbourhood or where they work
Having few or no personal belongings or documents
Avoiding eye contact, appearing
frightened or hesitant to talk to
strangers and law enforcers
Financial or material abuse is the use of a persons funds and belongings without their permission.
This could be theft, fraud, internet camming, coercion in relation to an adults financial affairs or arrangements, including in connection to wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions, or benefits. Bills not being paid
Loss of assets such as a house being sold and the money from the sale disappearing
Expenditure higher than the living conditions suggest
Not having enough food or clothing
Sexual abuse is when a person becomes involved in sexual relationships or activities that they do not want to be involved in. They may have said that they do not want to be involved or they may be unable to give consent. Sexual abuse includes 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 to. Pain, sores and bruising around the inner thighs and genital, anal or breast areas
Bloodstained underwear
Pain and discomfort when walking or sitting
Sexually transmitted infections and pregnancy are indicators for sexual activity and can indicate abuse if the person does not have the capacity to provide consent
Neglect is also known as the omission to act or failure to act. It is a failure to meet the basic needs of the individual. It includes ignoring medical, emotional, or physical care needs, failure to provide access to appropriate health, care, and support or
educational services and the withholding of the necessities of life, such as medication, adequate nutrition, and heating.
Self-neglect is a persons failure or refusal to take care of their own basic needs. Neglecting to care for ones personal hygiene, health or surroundings can include a wide range of behaviours such as hoarding. Indicators of neglect by others and of self-neglect are similar.
They include:
malnutrition
dehydration
bedsores
dirty clothing and bedding
taking the wrong dosage of
medication
Psychological abuse results in a person feeling worthless, unloved, or uncared for. It includes 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 Anxiety
Lack of confidence
Low self-esteem
Organisational abuse happens where services provided are focused on the needs of the organisation. For example, not providing choice over mealtimes or bedtimes because this is easier for the organisation. It includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home or in relation to care provided in ones own home. This may range from one-off incidents to ongoing ill-treatment. It can be through neglect or poor professional practice as a result of the structure, processes, policies, and practices of the organisation. Poor care standards
Rigid routines
Lack of staff learning,
development and
support
Discriminatory abuse refers to an individual or group being treated unequally because of characteristics identified in the Equality Act 2010. It involves ignoring a persons values, beliefs and culture and includes forms of harassment, slurs or similar treatment because of race, sex, gender reassignment, age, disability, sexual orientation, religion, or similar belief, marital or civil partnership status, pregnancy, or maternity. Poor service that does
not meet the persons
needs
Verbal abuse and
disrespect
Exclusion of people from
activities and/or services.
Discrimination can be either direct or indirect.
Physical abuse is an individuals body being injured or hurt due, for example, to assault, hitting, slapping, or pushing. It can also be the wrong use of restrictive practices.
Examples could be the misuse of medication or using inappropriate restraint such as locking someone in a room, tying them to a chair or using inappropriate physical sanctions. Injuries that are unexplained or havent
been treated. There could be a number of injuries of different ages and in different places.
Examples include:
broken bones
bruises
unexplained loss of clumps of hair
bite, burn or scald marks.
2.5 Identify indicators of perpetrator behaviour.
Perpetrators of family and domestic violence are responsible for and make decisions about their use of violence. This is demonstrated in the fact that perpetrators are rarely indiscriminately violent. Many perpetrators are not violent in their workplaces, social networks or communities but choose when, where and how they use violence.
https://www.wa.gov.au/system/files/2021-10/CRARMF-Fact-Sheet-3-Perpetrator-characteristics.pdfOutcome 3: Understand ways to reduce the likelihood of abuse and neglect occurring.
3.1 Explain how the likelihood of abuse may be reduced by:
Working with person-centred values
Enabling active participation
Promoting choice and rights
Supporting individuals with awareness of personal safety
Working in partnership and co-production with others
Managing risk
Focusing on prevention
Person-centred care means collaborating with the individual to plan their care and support to meet their unique needs. This cuts down the risk of negative, unfair, or harmful treatment and neglect. The individual is put at the centre, able to choose and control how they want their care and support to be.
Person-centred care should help the individual to make their own choices, assess and take risks. It is important they understand the consequences of the decisions they could make. For example, if a friend brings an individual some food (on a hot day) that has been out of the fridge for a while it is their right to weigh up whether it is likely to make them ill and
to decide whether to eat it. In this way those who receive care and support can contribute to their own safeguarding.
In Adult Social Care alongside the Care Act 2014 is the Making Safeguarding Personal initiative led by the Directors of Adult Social Services and the Local Government Association. It introduced the phrase no decision about me, without me and asserts that safeguarding should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing, and safety. Following the six principles above will help this to become a reality.
In social care person-centred values include:
individuality - focus on the individuals personal needs, wishes and values.
rights - e.g. to express themselves and be kept safe from harm, as well as the right to respect, dignity and equality.
choice - the ability to make decisions gives you control over parts of your life.
privacy - giving the individuals space where and when they need it and treating them in a dignified way.
independence - puts the emphasis on what the individual can do rather than on what they are unable to do.
dignity - to treat someone politely and with respect, valuing their individuality and ethical and moral standards.
respect - showing consideration for the individuals opinions and feelings.
partnership - involve the individual and their family/friends in the decision-making process.
Working in a person-centred way works in partnership with the individual and focuses on their unique needs, therefore minimising the risk of degrading treatment and neglect. Respecting someone and treating them with dignity is the opposite of abusing power to harm them.
Active participation describes a way of working that makes sure an individual can take part in the activities and relationships of everyday life as independently as possible. They are an active partner in their own care and support. Ensuring someone has the right equipment that they need to get around or to eat and drink without help are good examples of resources that support active participation.
It embeds two central values of person-centred social care: the individuals rights and their independence or autonomy. The individual should be included in all aspects of their care as an equal partner who is the expert in relation to their own care and knows best what way of life matters most to them.
Active participation reduces the risk of abuse through empowerment of the individual; feeling an equal partner in the care relationship, they will be more confident in making complaints and voicing disapproval.
Risk enablement plays a natural part in self-directed care and support. It empowers the individual to take control over their care, doing what they can to prevent themselves from being harmed or injured and agreeing the care and support that they need. For example, if an individual wants to go to the bathroom on their own but has mobility problems and is also feeling weak due to being unwell, risk enablement would be used to ensure they have the mobility equipment they need, and that they have a way of calling for help if they get into difficulty. Being in control increases their self-confidence. As confidence grows, they are more likely to be open about reporting anything they are unhappy about. As a result, the risk of abuse and neglect happening is reduced.
Risk enablement involves supporting individuals to identify and assess their own risks, enabling them to take the risks they choose. It is a key part of person-centred care and emphasises that the individual is he expert on their care.
An organisation that is active and positive about safeguarding adults will:
be open and clear about how they look out for each individuals wellbeing.
be open and clear about how they put into practice the CQCs Fundamental Standards and Code of Conduct for Healthcare Support Workers and Adult Social Care Workers in England www.skillsforhealth.org.uk/about-us/news/code-of-conductand-nationalminimum-trainingstandards-for-healthcare-supportworkers- or the equivalent in other countries.
show how workers should look out for abuse and neglect by publicising signs and indicators on posters or leaflets.
be responsible for providing learning and development for workers on safeguarding adults.
treat all allegations of abuse or neglect seriously.
promote the values of person-centred care Promoting choice and rights Putting individuals who receive care and support in control of their care can reduce the chance of abuse or neglect happening. It means making sure that in any care environment dignity and rights are promoted.
Lines of communication between individuals and workers are always open.
Relationships are based on trust. Individuals play an active part in decisions about their care and support.
Individuals are aware that they can share their concerns or complain and that they will be taken seriously.
Individuals are supported to be as independent as possible to reduce their reliance on others who may take advantage of them. Individuals know their rights and understand how they can expect to be treated. Every citizen has specific rights that are protected by law. The Human Rights Act 1998 is the main piece of legislation that outlines the rights of people in the United Kingdom.
The main rights relating to social work are:
right to life
freedom from torture and inhuman or degrading treatment
right to liberty and security
protection from slavery and forced labour.
right to respect for private and family life
freedom of thought, belief, and religion
freedom of expression
freedom of assembly and association
right to marry and start a family.
protection from discrimination
protection of property
right to education
The ability to make decisions gives you control over parts of your life, which is extremely important for your mental and emotional wellbeing. You are probably taking for granted this ability to make choices, but imagine how a vulnerable, dependent adult individual might feel. Sometimes it is easier for a caregiver in their daily work routine to make choices for them as giving options could be more challenging and time-consuming.
Therefore, when talking to the individual about their choices you should always encourage questions and listen carefully to the remarks being made. If they want to seek a second opinion, you should support them in their wish. They might also want to talk to the manager or supervisor to hear their views.
An individual who knows their rights, is independent and able to make choices is more likely to speak up when it comes to abusive situations. They will have the confidence to know how to help themselves and whom to turn to, which makes them less likely to become victims of abuse.
3.2 Explain the importance of an accessible complaints procedure for reducing the likelihood of abuse.
It is important that individuals feel able to challenge poor standards of care. They
should know how to complain and feel confident to make a complaint without the fear of reprisal. Ask your employer to tell you what to do when someone wants to complain.
Information should be available in different, user-friendly formats. These should explain clearly what abuse is and also how to express concern and make a complaint.
Individuals should be informed that their concern or complaint will be taken seriously, be dealt with independently and that they will be kept involved in the process to the degree that they wish to be. They should be reassured that they will receive help and support in acting on their behalf. They should also be advised that they can nominate an
advocate or representative to speak and act on their behalf if they wish. If an adult has no appropriate person to support them, and has substantial difficulty in being involved, they must be informed of their right to an independent advocate.
An open and honest culture can encourage individuals to raise concerns before they come to harm. You should do what is appropriate in your role to try to resolve any concerns. If someone is still unhappy you must tell them how to complain. There should be a recorded process with agreed timescales. You may need to support the individual to make a complaint by explaining the process and supporting them to communicate. It is really important to make sure their voice is heard as this is part of developing a way of working that puts the individual at the centre of their care.
If an individual is unhappy with the services they receive, it is your duty of care to advise them about the complaints procedures and support them in filing a complaint, if necessary. Ensure that you familiarise yourself with the complaints procedures of your workplace, so you know how your organisation expects you to respond to them.
If a person wants to make a complaint, you should:
take them to a quiet room to give them privacy.
ensure that you outline the confidentiality policy to explain that you may need to pass on
details that are given to you if there is a risk to the safety of the individual or others, making sure that the individual understands.
listen to the complaint calmly and actively, assuring the individual that you are taking their feelings seriously. You should not judge or engage emotionally but be polite and attentive. If appropriate, you could apologise to the individual and try to defuse the situation, but do not try to resolve their problem at this stage.
explain to them the complaints policy that is in place and offer your support.
clearly explain whom the complaint should be made to and assure them that you will let them know the outcome.
thank them at the end of the conversation and inform your line manager about the exchange as soon as possible.
The individual might ask you to function as an advocate for them. Advocacy enables the individual to appoint a person to speak on their behalf and make sure that their wishes and needs are being heard. An advocate is the voice of the individual: they express the
individuals views and fight for their rights if necessary.
Outcome 4: Know how to respond to suspected or disclosed abuse and neglect.
4.1 Explain the actions to take if there are suspicions that an individual is being abused or neglected.
If someone makes an allegation of abuse to you the first and most important response, is you believe what you are told. One of the biggest fears of those being abused is that no one will believe them DO NOT MAKE THIS FEAR A REALITY. Another common fear for people that are being abused is that it is somehow their fault YOU MUST REASSURE THEM IT IS NOT THEIR FAULT AND THEY ARE IN NO WAY TO BLAME.
Confidentiality
In general, of course, the right of every person to confidentiality is a key part of good practice. However, abuse is one of the few situations where you may have to consider it is not possible to maintain this. You will always need to be clear, when someone alleges abuse that you cannot promise to keep what they tell you confidential. This is not always easy; very often when someone tells you about the abuse, they have suffered they will start by saying if I tell you something, will you promise not to tell anyone? You cannot guarantee this, so do not make this promise it is one you cannot keep. It is never acceptable to tell someone one thing and do another, so you must be clear from the start about what your responsibilities are and make it clear that you may have to share what they tell you with others. You can however reassure someone by saying I cant promise not to say anything to anyone, but I can promise to only tell people who will help you. You can also tell them that while some information may have to be shared it will only be on a need-to-know basis and only among agencies directly involved in the investigation.
Workers across a wide range of organisations need to be vigilant about adult safeguarding concerns in all walks of life. Findings from serious case reviews have sometimes stated that if professionals or other workers had acted upon their concerns or sought more information, then death or serious harm might have been prevented. Regardless of the safeguarding concern everyone should understand what to do, and where to go to get help and advice. You should know what to do if you suspect abuse. All suspicions have to be followed up in a formal way. It is your responsibility to respond to suspicions in line with your workplaces safeguarding policies and procedures. You must understand:
what you should do if you suspect abuse or neglect is taking place, including whom you should report to in the first instance
what you should do if it is not appropriate to raise your concerns with that person
what you should do if you feel that your concerns have not been addressed or if you experience a barrier in any part of the process.
You could have suspicions against:
a colleague
a person close to the individual
your line manager
other workers or people involved with the individual
In each of these cases you need to know how to take action to comply with your duty of care of safeguarding the adults you are supporting.
According to organisations promoting good practice in safeguarding vulnerable adults, there are four key priorities in responding to concerns or allegations of abuse:
Priority 1: Protect
Priority 2: Report
Priority 3: Preserve
Priority 4: Record and refer.
Before you start talking to someone about your suspicions, you need to ensure that they are based on facts and have nothing to do with a potentially biased view because of personal dislikes. It is especially important that you get your facts right if you spot signs and symptoms of abuse. Accusations can leave a mark on someones reputation, stigmatise them, even if it turns out later on that these were unfounded and false.
Therefore, the first thing you need to do when you spot signs and symptoms of abuse or neglect is to record your suspicions as factually as possible, including dates and times when an observation has been made. State what has raised your concern in the first place and include in your document any evidence you might have. You may want to try to find out more by asking the individual questions, but make sure that they are open questions, e.g. How did that happen? and not suggestive in any form, e.g. Did that happen while Sam was on duty, as this would be considered a leading question. But be careful with this approach as it could easily lead to you overstepping the line and acting outside the boundaries of your role.
In the first instance you should always talk to your supervisor or line manager. These people are the first line of reporting procedures and will know how to proceed with your suspicions and set the adult safeguarding process into motion. This reporting of unsafe or illegal practice in the workplace is called whistleblowing. Most organisations will have a whistle-blowing policy which provides you with guidelines on how to address the issue. Policies are there for a reason, so make sure that you always refer to these.
There may be times, though, when you feel that it would be inappropriate for you to speak with your manager or supervisor, especially if you have concerns regarding their practice or the running of a service. You can then obtain support from the outside, e.g. the regulator in your country, union representative or local police.
In England, the CQC, for example, provide a confidential and anonymous service for
individuals who wish to raise concerns or whistle-blow. Whistleblowing is the
professional way of ensuring the wellbeing of individuals who might be depending on your observance to help stop abuse or neglect.
Should someone suspect you of abusing your power as a care worker, you need to make sure that you do everything you can to help the investigation to establish the truth.
4.2 Explain how to respond if an individual discloses that they are being abused or neglected.
Allegations of abuse or neglect could be made against a range of different people who have contact with the individual, e.g.
a colleague
a person close to the individual
your line manager
other workers or people involved with the individual
yourself
Again, it is important in each of these cases to be familiar with your organisations safeguarding policies and procedures.
Here are some key facts you need to bear in mind when reacting to allegations of abuse.
If an individual confides in you that they have been subjected to abuse, it is important that you take them somewhere where you can have privacy, so the person feels safe and comfortable talking to you.
If necessary, you have to initiate immediate medical care, e.g. first aid from someone trained to do so and try to preserve any evidence there might be.
You will need to let them know that whatever they are about to tell you cannot stay a secret between you but that it is your duty to take the matter further. Reassure them that all information they disclose will only be shared on a need-to-know basis.
If the individual still wants to tell you, make certain that you are using all your communication skills to reassure them that you are listening sensitively and attentively and that you are taking the matter seriously. You need to keep an open mind, listen attentively and not jump to conclusions. Dont ask any leading or specific questions.
React calmly to what is said, as overreacting or being judgemental might obliterate the safe atmosphere you have created. Also reassure the individual that they are doing the right thing by reporting the abuse.
If you can, without intimidating the individual, take notes during the conversation so you are able to write an accurate, unprejudiced report afterwards. Check with the individual that you have understood their account correctly.
Explain the procedures that will follow but dont make any promises as to what will happen after you have reported the abuse.
Record the conversation straightaway and in as much detail as possible. When drafting the report, it is helpful if you could draw on what was said using the exact same words the individual has used to make your account as neutral as possible. Ensure that you are only writing down facts, as your thoughts, assumptions or explanations have no place there.
Your report should include dates, times and incidents, whereabouts, which persons were present and what was said and/or done.
Sign and date your report.
Without any further delay you have to inform your line manager about the conversation. If the allegations have been made against them, you would need to report to their deputy or your supervisor. They will need your written record to pursue the matter further.
If the abuse has not happened in your workplace but outside, in a private environment or a setting where you dont have a formal duty of care, e.g. adult health or social care settings, then the Social Care Institute for Excellence (SCIE) suggests that you call the police and the local adult Safeguarding officer. If you are uncertain if abuse has taken place, you can contact the adult safeguarding coordinator, who will be able to guide and support you.
Once alleged abuse or neglect is reported, every area and county have its own multi-agency adult safeguarding procedures, which it must follow. For more information, search the internet for your local authoritys policies and procedures.
4.3 Identify issues relating to consent to share information.
Consent
A key issue in the protection of vulnerable adults is one of consent. Vulnerable adults have a fundamental human right to decide how and with whom they live. A person who is able to make decisions for themselves is entitled to refuse protection and to limit what you are able to do. In general, any action you take in relation to protecting a vulnerable adult must be with their consent. The issue of gaining consent before taking any action does not only apply to reporting abuse, but it also applies to providing evidence for any prosecution and to having any medical examination to record and confirm any injuries or forensic evidence. if you are faced with a situation where it is that abuse has taken place and the vulnerable adult is refusing to make a complaint, or to undergo a medical examination, then your only way forward is to try and give them as much clear information as possible and then refer the situation to your line manager for consideration as to whether any further action is possible. The steps you can take are limited; there is no legislation that gives vulnerable adults the right of protection as there is for children.
Reasons for refusing consent.
There are many reasons why people refuse to agree to any further action being taken. If you can find out the reason, you may be able to provide the information and support that people need. Some of the reasons are shown in the table below:
Reason for refusal Information to give
Fear of reprisals from the abuser Reassure that it will be possible to make sure that there is no need to have contact with the abuser, and the person can be protected.
Belief that it is their own fault Emphasise that it is NEVER the fault of the survivor, give information and reassurance about rights and that abuse is against the law. Confirm that abusers are bullies and criminals
Fear that services will be withdrawn Reassure that a complaint against a professional is taken very seriously, and that services are a right. No one will remove services because of a complaint. Assure that service provider is on the side of the survivor, not the abuser- even if the abuser is the employee.
Fear of medical examination Ask medical staff to explain the procedure and to reassure. Explain why it is important to provide evidence and show types of evidence that can be found from examination.
Fear of police investigation/ court appearance Explain support available for police interviews and for court appearances.
4.6 Identify ways to ensure that evidence of abuse or neglect is preserved.
In an emergency situation you must take action to protect the safety and wellbeing of the individual. If they need medical assistance, you should call for a suitably qualified worker, this will be different in a hospital to in the community where you would call 999 for an ambulance. If you suspect that injuries are not accidental, make the worker aware of this so they can preserve evidence that could be used in a criminal case. You should speak to your manager about the next steps to take. If an offence has been committed it may be necessary to contact the police and a safeguarding investigation may need to be started immediately.
As an incident of abuse might well classify as a criminal offence, you have to make sure that any evidence of it is preserved and not tampered with. Unless you are a police officer or have the authority to conduct an internal investigation, you are not allowed to collect any evidence. Thats why it is especially important that the location where the abuse has occurred is left undisturbed.
The police, local councils and safeguarding organisations publish guidance on the internet on how to ensure that evidence is preserved for later reference.
The main guidelines are as follows.
Dont touch anything unless it is necessary for the victims wellbeing and try to keep other people from entering the location where the abuse has occurred until police arrive.
Manage the abused person as little as possible and preserve anything you used to warm or comfort the victim, e.g. a blanket.
Dont clear away anything or tidy up, e.g. dont wash clothes or bedding or other items of potential evidence.
With the individuals consent, ensure written records, e.g. notes, bank statements, receipts, letters, evidence of power of attorney, are kept in a safe place or copied.
Try to keep the alleged perpetrator away from the victim.
If a person has just been sexually assaulted, ask them not to wash, drink, clean their teeth or go to the toilet until police arrive; keep any relevant clothes or bedding safely.
Try to get the persons consent to arrange for a medical examination as soon as possible.
Record any physical signs of injuries on a sketched body diagram, including shape, colour, and size.
If there are any witnesses whose memory, you feel, will not last over the duration of the enquiry, try to obtain written, signed and dated statements from them.
Always remember to sign and date your own records and notes.
Your first priority should always be the wellbeing of the individual and in very traumatic situations it might not be possible to follow these guidelines to the letter. Remember, though, that your initial response while waiting for the police might be essential for the investigation to proceed. Your actions or inactions in preserving evidence could determine success or failure of the inquiry; therefore, it is vital that you give your best in preserving any evidence.
Outcome 5: Know how to recognise and report unsafe practices.
5.1 Describe unsafe practices that may affect the wellbeing of individuals.
Unsafe practices lead to the possibility of potentially harming someone and therefore affecting their wellbeing. Unsafe practice could affect the physical and emotional/psychological wellbeing of an individual.
Unsafe practice in adult social care could be due to three different shortfalls:
Poor working practice
Anything you do during your daily routine as a social care worker has the capacity to harm another person if you have not been professionally trained and gained the skills, knowledge and understanding needed for your job role. A lack of training is one of the main risks that can lead to harm, e.g. if untrained staff are expected to move or manage a person; if they dont know how to keep track of medication intake, or dont store toxic liquids properly. As well as care workers being inadequately trained to fulfil the expectations of their work roles, there is also the problem of undertrained staff substituting for staff in senior positions, with responsibilities they arent ready and prepared for.
Resource difficulties
Imagine how difficult it would be to move people about without the correct equipment, e.g. a wheelchair or patient lift for getting individuals out of bed.
Unfortunately, quite a few service providers are lacking the funds to provide adequate equipment or the equipment they have is outdated or faulty. Carers and individuals will then have to make do with what is given, which might result in the individual feeling devalued and being put at risk of physical harm.
Another example of resource difficulties could be missing locks on doors, windows or medicine cabinets which increases the likelihood of accidental injuries. Being in a remote spot and not having transport to ensure individuals can participate in recreational activities could lead to them feeling frustrated and isolated.
Operational difficulties
These are difficulties that lie within the working environment, e.g. due to bad management. A shortage of personnel could lead to staff members being stressed, having to rush through their schedules and cutting corners due to a lack of time. Policies and procedures cannot be followed if carers have to manage double the workload due to a lack of staff, and the result could be that care plans are not being read and therefore the individuals needs are not being met. Poor hygiene standards and overworked and tired staff may also contribute to an unsafe environment for individuals. If agency staff
are being brought in, they are unlikely to have the time to familiarise themselves with policies and procedures or the individuals care plans, and therefore they may act in a situation-related, rather than in a person-centred, way.
5.2 Explain the actions to take if unsafe practices have been identified.
Apart from enabling the individual to have the lifestyle they wish and helping them to find ways to bring about the changes they desire, the person-centred approach also has the wellbeing of the individual in mind, thus trying to keep risks to a minimum. It is your duty as a care worker to ensure your own safe practice, so it is important that you raise any concerns you might have about the wellbeing of anyone you provide care and support to this could be poor working conditions or equipment or untrained staff, as well as suspected abuse. Therefore, if you consider an action to be unsafe and you feel you dont have the appropriate training, stop what you are doing and talk to your supervisor or manager immediately.
If this is not possible at the time and the task needs to be conducted, assess the risks together with a senior colleague and evaluate whether you have the expertise to
minimise the potential for harm. However, never instigate any action that lies beyond your job role.
Once the immediate problem is resolved, you have to raise your concerns with your line manager or supervisor and ask for help and support. It could be that more staff should be employed, new equipment needs to be bought, training opportunities created, or policies and procedures reviewed. It is the employers responsibility to ensure a safe environment which enables individuals to thrive.
There may be times when you feel that it would be inappropriate for you to speak with your manager or supervisor, especially if you have concerns regarding their practice or the running of a service.
You should refer to your organisations whistle-blowing policy. If necessary, you can find external support from your social care regulator, such as the Care Quality Commission (CQC) in England. They provide a confidential and anonymous service for individuals who wish to raise concerns or whistle blow.
5.3 Describe the actions to take if suspected abuse or unsafe practices have been reported but no action has been taken in response.
When abuse or unsafe practice has taken place, it needs to be dealt with swiftly and efficiently. Therefore, it is important that you take the matter further if management has failed to deal with it.
Whistleblowing is the reporting of unsafe or illegal practices in the workplace. Most organisations have a policy or agreed ways of working that will tell you how to raise your concerns. Your employer should provide or explain their whistle-blowing policy. You have a responsibility to report things that you feel are not right, are illegal, or if anyone at work is neglecting their duties. Speaking to your manager will normally be your first step. However, if it is this persons work that you are concerned about you can seek support from a more
senior person or from someone outside of your organisation, for example from the Care Quality Commission (CQC), a union representative, if you have one, or the local police. If you raise a concern with the CQC the information you give them will be dealt with in confidence, and you can raise concerns anonymously. The CQC has a quick guide to whistleblowing or guidance for workers that gives helpful advice on speaking out about poor care and what protection you will have from the law.
You can find more information here:
www.cqc.org.uk/content/report-concern-ifyou-are-member-staff
In Wales, an organisation Public Concern at Work is highlighted as a source of support in this area. Its website is http://www.pcaw.org.uk/
