New guidance on training in adult safeguarding has been published. Adult Safeguarding: Roles and Competencies for Health Care Staff was published in August 2018. The guidance is referred to as an intercollegiate document as it has been developed by a wide range of different healthcare organisations, including the Royal College of General Practitioners. The guidance sets out minimum training requirements relating to adult safeguarding. A similar intercollegiate document has existed for many years in the area of child safeguarding. This reflects not only the importance of the subject matter but also the key message that all healthcare organisations and staff must work within a common framework to ensure that adults at risk are adequately protected. Martin Hodgson examines the guidance and what it means for those working in general practice.
What is adult safeguarding?
All healthcare organisations have a duty outlined in legislation to make arrangements to safeguard adults who may be at risk from harm, abuse or neglect. The legal duty was included within the Care Act 2014. Chapter 14 of the Care and Support Statutory Guidance that accompanied the Act replaced the previous guidance, No Secrets.
Safeguarding is defined in the guidance as protecting an adult’s right to live in safety, free from abuse and neglect. It describes safeguarding adults as “everyone’s responsibility” and requires healthcare providers to work with local Safeguarding Adults Boards (SABs) and co-operate with other relevant agencies, such as local authorities, the police and social care agencies.
Healthcare providers are required to protect people against all forms of abuse and mistreatment, including physical abuse, emotional and psychological abuse, sexual abuse, financial abuse and neglect. Staff must be trained to recognise and prevent other forms of abuse, including self-neglect, domestic abuse, discrimination, radicalisation and modern slavery.
The intercollegiate document
Adult Safeguarding: Roles and Competencies for Health Care Staff applies to all healthcare organisations, including general practice. The document states that healthcare organisations must ensure that those who use their services are adequately safeguarded and it sets out a framework designed to help them understand the competencies and training required to support staff in undertaking this core professional role.
The competency framework
The competency framework is set out in section A of the intercollegiate document. A number of levels are identified, each of which identifies a group of staff and the knowledge, skills, attitudes and values they should have.
For instance, Level 1 is the minimum entry level for all staff working in healthcare settings. The document states that all staff at Level 1 should be able to meet the core competencies and demonstrate the knowledge and skills set out in the framework.
The levels are as follows.
Level 1: all staff working in healthcare settings.
Level 2: all practitioners who have regular contact with patients, their families or carers, or the public.
Level 3: registered healthcare staff working with adults who engage in assessing, planning, intervening and evaluating the needs of adults where there are safeguarding concerns (as appropriate to role).
Level 4: specialist roles — named professionals.
Level 5: specialist roles — designated professionals.
The levels in relation to practice staff
In a primary care setting, Level 1 includes non-clinical staff such as receptionists and administrative staff.
Practitioners at Level 2 are described in the guidance as any health practitioner on a regulatory professional register, such as the Nursing and Midwifery Council or General Medical Council registers. The guidance states that Level 2 should include administrators for safeguarding teams, health students, phlebotomists, pharmacists, medical staff and GP practice managers.
Level 3 practitioners are those who work on cases where there may be specific safeguarding concerns. They include safeguarding professionals, medical staff, general practitioners, registered nurses, etc.
Named professionals, and equivalent roles at Level 4, are those staff identified within NHS funded health services as safeguarding leads. They usually have responsibilities for providing advice and expertise to other staff and ensuring appropriate safeguarding training is in place. Specialist roles will include named GPs and doctors for organisations commissioning primary care. Their activities may include providing teaching and training to primary care staff and supporting practice safeguarding leads.
The guidance notes that the staff groups identified are not exhaustive lists. If uncertain about which staff should be included within each category practitioners are advised to approach their individual colleges and professional bodies.
Section B of the intercollegiate document sets out the education and training required to support effective practice.
The document identifies a number of key principles underpinning training.
Training needs to be flexible, encompassing different learning styles and opportunities.
Inter-professional and inter-organisational training and education are encouraged in order to share best practice, learn from serious incidents and develop professional networks.
The effectiveness of training programmes and learning opportunities should be regularly monitored.
Iindividuals should be encouraged to maintain an education, training and learning log to demonstrate up-to-date knowledge, skills and competencies.
e-Learning is appropriate to impart knowledge at Levels 1 and 2 and to support interactive team-based learning at Level 3, however, it should not be the only form of learning undertaken.
As a general principle, the document states that face-to-face adult safeguarding training at all levels should form no less than 50% of the content of courses.
The following minimum training requirements are defined:
a mandatory session of at least 30 minutes duration should be included in the general staff induction programme or within six weeks of taking up a post within a new organisation — this should provide key safeguarding information and appropriate action to take if there are concerns
at Level 1 over a three-year period, staff should receive refresher training equivalent to a minimum of two hours providing key adult safeguarding guidance
at Level 2 over a three-year period, professionals should receive refresher training equivalent to a minimum of 3–4 hours — this should include the training required at Level 1 and will negate the need to undertake refresher training at Level 1 in addition to Level 2
at Level 3 over a three-year period, professionals should receive refresher training equivalent to a minimum of eight hours — this should include the training required at Levels 1 and 2
named professionals should attend a minimum of 24 hours of education, training and learning over a three-year period — this should include clinical leadership, appraisal, and supervision training
designated professionals should attend a minimum of 24 hours of education, training and learning over a three-year period.
Both named and designated professionals should participate regularly in support groups or peer support networks for specialist professionals at a local and national level, according to professional guidelines. Attendance should be recorded.
The document recognises that many professionals also need equivalent child safeguarding and protection education, training and learning. Shared aspects of adult and child safeguarding training may be delivered together where appropriate.
Practitioners should be encouraged to reflect on safeguarding practice and share best practice as part of their professional development, documenting their key learning and number of hours.
Implementation of the new training guidelines will not only contribute to compliance with the Care Act, in England it will also support compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the Fundamental Standards. Regulation 13 for instance (Safeguarding Service Users from Abuse and Improper Treatment), requires primary healthcare providers to have systems and processes in place to prevent the abuse of service users.
The standards are enforced by Care Quality Commission (CQC) inspectors. CQC guidance on what inspectors should look for is included in Key Lines of Enquiry, Prompts and Ratings Characteristics for Healthcare Services. This requires inspectors to ask how a service provider’s systems, processes and practices keep people safe and safeguarded from abuse. It also prompts them to ask if there are arrangements to safeguard adults from abuse and neglect which reflect relevant legislation and local requirements.
The new intercollegiate guidance sets out minimum training requirements relating to adult safeguarding.
A general practice should use the document to determine the knowledge, skills, attitudes and values that staff should have relating to safeguarding adults.
A mandatory adult safeguarding training session of at least 30 minutes duration should be included in the general staff induction programme or within six weeks of taking up a post within a new organisation.
The intercollegiate document includes a range of more in-depth advice about role competencies and training recommendations. It can be downloaded from the RCN website.