Public Protection Policy

Effective Public Protection responses require agencies to work together, at all levels, to raise awareness and understanding and promote a collaborative response to ensure that those identified as being at risk of harm are protected.

The Scottish Borders Public Protection Committee supports a Think family approach which means building the family dimension into every aspect of Public Protection with the aim of achieving better outcomes for adults, children and families. This includes staff in adult services being able to identify children’s needs, and staff in children’s services being able to recognise adult’s needs.

Strengthening communication between different agencies, relating to risk, to enhance and improve processes and coordinate the support and delivery of services is an essential component of this approach.

Professional curiosity is essential when working with children, families, and adults at risk. Practitioners should be inquisitive, open-minded, and analytical in their approach, seeking to understand the full context of an unborn child’s, child’s, or adult’s circumstances and the impact of parental or carer behaviour. By applying professional curiosity, practitioners can identify risks, uncover hidden issues, and provide more effective support for individuals and families. This responsibility applies across all safeguarding work—because asking the right questions and challenging assumptions can prevent harm and save lives.

1 Child Protection

Child protection refers to the processes involved in consideration, assessment and planning of required action, together with the actions themselves, where there are concerns that a child may be at risk of harm.

The protection of children and young people includes unborn babies, and children and young people under the age of 18 years. While child protection procedures may be considered for a person up to the age of 18, the legal boundaries of childhood and adulthood are variously defined. There is overlap.

Child protection is part of a continuum of collaborative duties upon agencies working with children. The Getting it Right for Every Child (GIRFEC) approach promotes and supports planning for such services to be provided in the way which best safeguards, supports and promotes the wellbeing of children, and ensures that any action to meet needs is taken at the earliest appropriate time to prevent acute needs arising.

2  Adult Support and Protection

An Adult at Risk is a person aged sixteen years or over who:

1. Is unable to safeguard their own wellbeing, property, rights or other interest;
2. Is at risk of harm, and
3. Because they are affected by disability, mental disorder, illness or physical or mental infirmity, is more vulnerable to being harmed than adult who are not so affected.

An adult is at risk of harm if another person is causing (or is likely to cause) the adult to be harmed, or the adult is engaging (or is likely to engage) in conduct which causes (or is likely to cause) self harm. The entirety of a person’s particular circumstances can combine to make them more vulnerable to harm than others.

The Adult Support and Protection (Scotland) Act 2007 primarily places an emphasis on support but also provides a framework for intervention if someone requires protection.

The Adult Support and Protection (Scotland) Act 2007 introduced both duties and powers. Duties include duty to inquire, investigate and co-operate where it is known or suspected that an adult may be at risk of harm. Powers include three protection orders that can be applied for, through the Sheriff Court, if there is evidence that an adult is at risk of serious harm (Assessment Order, Removal Order, Banning Order).

3 Capacity

It is important to note that at the point of referral to social services capacity does not need to be evidenced and consent is not required.

An adult at risk of harm may or may not have capacity. Having capacity does not necessarily mean that an adult is able to safeguard their own well-being, property, rights and other interests.

The Adult Support and Protection (Scotland) Act: Code of Practice refers to ‘unable’ as ‘lacking the skill, means or opportunity to do something’. As such, a distinction should be made between an adult who lacks these skills and is unable to safeguard themselves and one who is deemed to have the skill, means and opportunity to keep themselves safe, but chooses not to do so. An individual’s inability to safeguard themselves is not the same as an adult not having capacity. Also, an adult may also be considered unwilling rather than unable to safeguard themselves and so may not be considered an adult at risk.

It is important to remember that all three elements of the ‘Adult at Risk of Harm’ definition (also known as the three point criteria) must be met; the presence of a particular condition does not automatically mean they are an ‘Adult at Risk of Harm’. It is the whole of an adult’s circumstances, which can contribute to make them more vulnerable to harm than others; an individual’s vulnerabilities, medical conditions and abilities can fluctuate and change overtime.

Capacity is not an all or nothing concept. It can fluctuate from day to day and can be partial or full. An adult is assumed to have capacity unless assessed as having impaired capacity.

Further information can be found in the Mental Capacity Act 2005, https://www.legislation.gov.uk/ukpga/2005/9/contents.

4  MAPPA (Multi Agency Public Protection Arrangements)

The purpose of MAPPA is public protection. MAPPA requires police and justice services to work together with other agencies (including NHS) to assess and manage the risk posed by certain categories of offender:

• Sex offenders who are subject to notification requirements under the Sexual Offences Act 2003.
• Mentally disordered restricted patients.
• Other offenders who are assessed by the Responsible Authorities as posing a risk of serious harm by reason of their conviction.

5  PREVENT

The Prevent agenda requires healthcare organisations to work with partner organisations to contribute to the prevention of terrorism by safeguarding and protecting vulnerable individuals who may be at greater risk of radicalisation and making safety a shared endeavour.

The Government’s national counter terrorism strategy is called CONTEST. CONTEST aims to reduce the risks from any/all types of terrorism, so that people can go about their lives freely and with confidence.

CONTEST has four national work streams:

• Pursue: to stop terrorist attacks
• Protect: to strengthen our protection against terrorist attack
• Prepare: where an attack cannot be stopped, to mitigate its impact
• Prevent: to stop people becoming terrorists or supporting terrorism.

Prevent is the main strand of concern to local authorities and NHS staff and it is required that all frontline staff have an awareness of Prevent and how it will affect their service area. Staff are required to complete the Prevent e-learning module.

6  Duties and Responsibilities

NHS Borders has a duty and responsibility to report issues and cooperate with the Local Authority and Police Scotland in respect to inquires and investigations for child protection and adults at risk.

It is the responsibility of all staff who are employed by NHS Borders to work in a way that will help prevent harm and abuse.

7  Significant Harm

Protecting children and adults involves preventing harm and/or the risk of harm from abuse or neglect. Child and Adult Protection investigations are triggered when the impact of harm is deemed to be significant. This can be the consequence from a specific incident, a series of incidents or a cumulative impact over a period of time.

Abuse and neglect are forms of maltreatment. Abuse or neglect may involve inflicting harm or failing to act to prevent harm. Children could be harmed at home, within a family or peer network, in care placements, institutions or community settings. Those responsible may be previously unknown or familiar, or in positions of trust, they may be family members. Children may be harmed pre-birth, for instance by domestic abuse against a mother or through parental alcohol and drug use.

Clarity on the definitions of harm in respect to Adult Protection can be found here http://www.actagainstharm.org/what-is-harm/

 8  Chronology

A chronology sets out details of significant events in a child's or adult’s life in sequential date order using a specified format and is used to inform assessment, analysis, decision making and planning.

9  MARAC

A Multi-Agency Risk Assessment Conference (MARAC) is a local meeting where representatives from statutory and non-statutory agencies meet to discuss individuals at high risk of serious harm or murder as a result of domestic abuse.

10 MATAC

Multi Agency Tasking and Coordination (MATAC) is a Police Scotland initiative to identify and manage the most harmful domestic abuse perpetrators.

11 Decision Making Forum

This is a police-led, multi-agency decision-making forum that reviews applications submitted under Scotland’s Disclosure Scheme for Domestic Abuse (Right to Ask / Power to Tell). The forum assesses whether disclosure is necessary, lawful, and proportionate to protect someone who may be at risk of harm from an individual they are in a relationship with.

Disclosure Scheme for Domestic Abuse Scotland - Police Scotland

1 Scottish Borders Public Protection Committee

The Scottish Borders Public Protection model recognises the broad and diverse range of Public Protection responsibilities. 

The aim of the committee is to shape the effective governance and delivery of the broad and diverse range of public protection services, through strategic oversight and close collaboration with partner agencies, service users and communities across Scottish Borders.

There are six delivery groups that support the work of the Public Protection Committee, each of which have a responsibility for audit, performance, assessment of risk, quality assurance and service improvement.

The delivery groups are as follows:

• Child Protection Delivery Group
• Adult Protection Delivery Group
• Violence Against Women and Girls Delivery Group
• Communication Delivery Group
• Learning and Development Delivery Group
• Learning Review Delivery Group

2  NHS Borders

The Scottish Government requires Chief Executives of Health Boards to have a responsibility for the delivery of high quality services to support Public Protection in accordance with statutory, national and local guidance. This includes the overall strategic direction for public protection and strategic management of all adult and child protection health services delivered by the Health Board.

The core functions for NHS Borders that support the development and delivery of this are detailed below and should be delivered across acute and community services:

Within NHS Borders the Chief Officer role is deputised, from the Chief executive, to the Director of Nursing and Midwifery. The Nurse Consultant for Public Protection is responsible for leadership, co-ordination and management of NHS Borders Public Protection services. Duties include:

• Ensure robust governance and accountability reporting frameworks in place.
• Ensure up-to-date procedures, guidance and policies are in place to support staff.
• Ensure that staff are trained and competent to be alert to the potential indicators of child and adult harm, abuse and neglect to know how to act on those concerns in accordance with local and national guidance.

The Nurse Consultant Public Protection works alongside;

• The Public Protection Nurses who have delegated duties and responsibilities to support the delivery of the Public Protection Service.
• Senior managers across the organisation may also have delegated duties and responsibilities for some aspects of Public Protection work streams such as MAPPA and PREVENT.

NHS Borders has committed to ensuring the following:

• Provision of designated Lead Paediatrician for Child Protection.
• Provision of designated Public Protection Nurse specialists.
• Provide access to expert advice, consultation and training in relation to Child and Adult Protection for NHS Borders staff to enable them to fulfil their roles and responsibilities.
• Participation as a partner agency in the Tripartite Interagency Referral Discussions (IRD) for Child and Adult Protection.
• Provision of service for Child Protection comprehensive medical examinations and Child welfare medical assessments.
• Provision of Child Protection Supervision for health staff involved in child or adult protection cases.
• Provision of medical examination including any physical, psychological or psychiatric assessment or examination, of any adult believed to be at risk of harm.
• NHS Borders is represented at various multi agency forums including Public Protection Delivery Groups, National forums, MARAC, MATAC, PREVENT, MAPPA.
• Provision of MAPPA strategic lead to fulfill responsibility for restricted patients.
• Part 1 of the Adult Support and Protection (Scotland) Act 2007 introduces measures to identify and protect adults at risk of harm. Those relevant to NHS Borders are:

1. 1. Report the facts and circumstances of the case to the council, where they know or believe that a person is an adult at risk, and that protective action is needed; Section 5(3).
   2. Co-operate with a council making inquiries and with each other where that would assist the council; Section 5(2).
   3. Provide information and records as requested; Section 10.

3  All NHS Borders staff have a professional duty to recognise and respond to concerns about children and adults in accordance with the Scottish Borders Multi-Agency Child and Adult procedures where:

• they know or believe that an unborn baby, child or young person is known or believed to be at risk of significant harm or
• they know or believe that an Adult is at Risk of Harm and may be in need of care and/or protection.

Referrals should be made to Scottish Borders Social Services in line with the Scottish Borders Child and Adult Support and Protection procedures. If the child or adult is at immediate risk the police should be called.

4 All NHS Borders staff are responsible for:

• Ensuring that they listen to children and adults, considering their views and keep them informed of planned actions.
• Being alert to the potential indicators of abuse or neglect of children and adults and know how to act on those concerns in accordance with local and national guidance.
• Being aware of parental conditions such as drug and alcohol use, domestic abuse and mental ill health that may indicate that a child is at risk and that may impact on the child.
• Staff who work with adults are equally responsible to act upon child protection concerns about children with whom their client has contact. Practitioners should contact professionals working with the children to share information when necessary to do so, or where the threshold is met, make a child protection referral.
• Staff who work with children and families are equally responsible to act upon adult protection concerns about adults with whom a child has contact. Practitioners should contact professionals working with the adult to share information when necessary to do so, or where the threshold is met, make an adult protection referral.
• Taking part in relevant training so that they maintain their skills and are familiar with procedures aimed at protecting children and adults.
• Understanding the principles of confidentiality and information sharing in accordance with local and national guidance.
• Contributing when requested to do so, to the multi-agency meetings established to protect/reduce risk to children and adults.
• Seeking advice and guidance from the Public Protection Team if unsure about how to act upon a concern about a child or parent/ carer or adult at risk.
• Escalating issues to relevant operational and senior managers when professional disagreements arise in relation to the management of a child and/or adult protection concern, either within NHS Borders or with other partner agencies with reference to multiagency escalation procedures.
• Ensuring that concerns are accurately recorded in patient records; should reflect what was said and done by the people involved. Including what the person at risk said using their own words (their account), any injuries, witnesses, appearance and behavior of person at risk.
• Copies of all referrals into children’s and adult social care from NHS Borders MUST be copied to the Public Protection Health team via secure email and a copy retained within adult or child’s clinical record (protection@borders.scot.nhs.uk).

5 All operational managers and service leads are responsible for ensuring that: 

• Each team member is made aware of the Public Protection Policy and Scottish Borders Child and Adult Support and Protection Procedures.
• A culture exists that enables adult and child protection issues to be identified and addressed.
• A culture of reflection and continuous learning is fostered to support the ongoing review and development of best practice
• Is aware of the key procedures and guidance to be followed in the event they may be concerned a child or adult is at risk of abuse and neglect.
• Each team member is up-to-date with mandatory public protection training and other education and training commensurate to their role and level of responsibility as per the NHS Borders Public Protection Training Strategy.
• Relevant staff have access to regular Child Protection supervision as per NHS Borders Child protection Supervision Policy.

6 All staff have a responsibility to ensure they comply with any:

• Public Protection mandatory/bespoke training.
• A responsibility to identify any public protection learning needs as part of their continuous professional development.
• Contact the Public Protection team if required for any advice/support around public protection.
• Request supervision in relation to public protection issues if required.

Harm is not always easy to spot but there are situations to be aware of. Above all, trust your instincts – if something feels wrong, say something.

The following questions will help articulate why you are concerned about a child or adult:

1. Why do I think this person is not safe?
2. What is getting in the way of this person being safe?
3. What have I observed, heard or identified from the individual's history that causes concern?
4. Are there factors that indicate risk of significant harm is present, and in my view, is the severity of factors enough to warrant immediate action?
5. What can my agency do to help this child/young person or adult?

1 Recognising and Responding to a Child Protection Concern

Reasons which may alert staff to a child protection concern can include:

• Disclosure from child/young person.
• Suspected non accidental injury.
• Physical, emotional/psychological, neglect or sexual abuse.
• Not brought to health appointments/delay in seeking medical attention.
• Abuse (physical, psychological or sexual) or neglect of a child .
• Parental or carer behaviours that place a child or unborn baby at risk, e.g. drug or alcohol use, parental mental health concerns.
• Domestic Abuse identified during pregnancy or in families where there are children, even if the child is not present.
• Disclosure by child, parent or third party of abuse or neglect of a child.
• A child who is self-harming.
• Known history of child protection / child welfare concerns e.g. child's name on Child Protection Register.
• Suspicion of perplexing, fabricated and induced illness.
• Suspicion of Radicalisation.
• Disclosure of contact with a known schedule one offender (someone who has been charged with offence against a child under 16).
• Suspicion that a child may be a victim of trafficking, Child Sexual Exploitation (CSE), or Female Genital Mutilation (FGM)

NB: This list is not exhaustive.

2 Recognising and Responding to an Adult Support and Protection Concern

A person can be subjected to harm anywhere: In their home, where they work, in a hospital or care setting.

Harm can take the following forms:

• Financial
• Physical
• Psychological
• Sexual
• Neglect

Reasons which may alert staff to an adult support and protection concern may include:

• Disclosure from adult or family member/carer or other person.
• Overly frequent / inappropriate contact to the service.
• Is persistently having friends or strangers ‘hanging out’ at their house.
• Delay in seeking medical treatment.
• Medication and/or treatment not administered as prescribed.
• Neglect and self neglect.
• Misuse of medication such as not administering prescribed medication or over medicating.
• Indications during assessment of dehydration/malnutrition.
• Sudden increase in confusion.
• Demonstration of fear, alarm or distress while around certain people or situations.
• Unexplained or suspicious injuries/hiding injuries.
• Unexplained or concerning behaviour of relative/carer/friends.
• Concerns over money; giving it to another/unexplained debt.
• Trafficked person or Sexual Exploitation.
• Evidence of unlawful conduct, which appropriates or adversely affects property, rights or interests e.g. theft, fraud, embezzlement, extortion or exploitation.
• Known history of adult protection related concerns e.g. previous Adult Support and Protection referral process initiated.
• Victim of domestic violence/assault /coercive control /Modern Day Slavery.

NB: This list is not exhaustive.

Information Sharing Guidance recognises that information sharing between NHS services and partner agencies is essential to keeping children and adults safe from harm. Staff should understand when and how they can share information and should act in accordance with NHS Borders Information Governance and General Data Protection Regulations (GDPR):

• Remember that General Data Protection Regulations are not a barrier for sharing relevant, appropriate and proportionate information.
• The Caldicott Guardian provides leadership and informed guidance on complex matters involving confidentiality and information sharing and can support to ensure that information is processed legally, ethically and appropriately.
• If there is evidence that a child or adult is at risk of harm, relevant information can be shared with a statutory agency without delay. Consent is not required or appropriate because the information must be shared in order to protect the child or adult. Consent should only be sought when the individual has a real choice over the matter. However, it is good practice to inform the parents/child/adult that you plan to share the information, to support them to understand and engage with the process, if it is considered safe to do so and does not increase risk to the person and/or others.
• Professional judgment must always be applied to the available evidence about each specific emerging concern, and about what is relevant, proportionate, and appropriate to share.
• Decision as to whether and what information you share or decide not to share should be recorded in patient record.

The policy will be reviewed biannually or as required to reflect material changes in other related policy, procedures or guidance and/or changes in legislation.

Key Definitions: Abuse and Neglect