Safeguarding Consent Capacity and Information Sharing Crispin Evans

Safeguarding: Consent, Capacity and Information Sharing. Crispin Evans: Interim Safeguarding Lead for Local Division Mersey Care NHS Foundation Trust

Hello Devised by Crispin Evans

Content • • • What to remember? Legal Frameworks/ principles Consent The barrier The Basics Can you keep a secret? Record keeping The case study! Defensible decision making. Devised by Crispin Evans Usual rules of Confidentiality, apply

What to remember? Why do we work in the area we do? We are professionally curious ! We want to know more? We ask questions! Good partnership need what? Communication! Information Sharing! Devised by Crispin Evans

How many years? 2018 General Data Protection Regulation (GDPR), 1998 Data protection Act If an image does not link to the 2014 Care Act subject on the slide, an alternative could be used. 2005 Mental Capacity Act

The Principles Mental Capacity Act • • The Presumption of Capacity All Practicable Steps Unwise Decisions Best Interests If an image does not link to the Encourage participation subject on the slide, an alternative • could. Least Restrictive be used. Care Act • • • Empowerment Prevention Proportionality Protection Partnership Accountability

Consent: choice Before a doctor, a nurse or anyone else looking after your health can treat you, they need your consent. That means they must get your agreement, and you need to understand the likely benefits and possible risks before agreeing.

The barrier- is it us? We are in a rush? We lack confidence? We are discourteous? Don’t like the patient? Don’t like the environment? Over worked? Custom and practice? We need to look at ourselves in a mirror?

The Basics This is simple! This is person centred! • • • Politeness- the introduction Who are you? What is your role? Record keeping and sharing! Who are they? What’s the problem? Assessment, intervention or care plan. • Check back they understand. • You have to explain the effects of the apple.

Can you keep a secret? • • We have legal duties. However the public (and colleagues)perception. The rules of the game. General Data Protection Regulation (GDPR) not a barrier. • We will keep notes! They will be safely stored! • Ideally we will share with consent! • But can in certain circumstances share without consent!! Be clear, be open and empower.

Record keeping WHY ARE RECORDS VALUABLE? • Records are valuable because of the information they contain and that information is only usable if it is correctly and legibly recorded in the first place, is then kept up to date, and is easily accessible when needed. WHY GOOD RECORD KEEPING IS IMPORTANT • You can work with maximum efficiency without having to waste time hunting for information. • Those coming after you can see what has been done, or not done, and why. • Any decisions made can be justified or reconsidered at a later date. • Everyone who records service user’s information should be aware that records are also kept because one day they may be needed If it is not recorded it did not happen. • • A Health Record may be called as evidence in legal proceedings or a professional misconduct hearing. The Data Protection Act 1998 (from May 2018 this will be referred to as General Data Protection Regulations) gives individuals the right to Access their Health Records held manually or on computer.

As you walk through that door! We presume. Its professional curiosity. What decisions are to be made? Can we support that decision? Its how we talk and the consequences when we don’t. This is Personal!!

The case study! Let me tell a local story • he was difficult. – smoked to much, maybe drank to much – the family said worse – of a generation. • he was opinionated. • he knew what he wanted – Even if it was unwise.

When it became real Consent and Capacity • What he wanted. • How can it be supported • What he needed to know. • How and when he was told. The consequence. • It was not what he wanted. • It was not the professional who lived with it.

What he needed • Time • Support with communication. – In this case it was primarily his hearing aid and glasses. – the correct information. • To be clear what would be the consequences of his decision making.

Okay some situations Due to risk. Consequences of decisions. We often need to do more. – While being proportionate. Need to consider Coercion and Control Consider how me make decisions

Le gis lat ion /m od els us ed : te na ti o or op Pr • Law used in decision making • Policy • Models/Methods • What informed your decision making Not forgetting Human Rights Act Triangle of defensible recording Person-centred, record: • • Voice of the person Person’s actions Information from those who know the person Information, advice, guidance and support given Why was • what was ruled out? • this least restrictive? • this the least intrusive? • Intervention proportionate?

Defensible decision making Guidance; • Defensible or Justifiable decision making follows the word “because”: – I chose this course of action because… – I ruled this out because… … in absence of legislation use policy, model, method, theory or research. Include; • Who is intervening, purpose, actions, … • If a professional is struggling to identify outcomes from interventions raise in supervision. • Summary of work should include, progress, barriers and how barriers have been addressed. – Referrals made, – Appointments offered, – Information/advice given – Assessments – Access to advocacy – Voice of the person – Support in making decisions

Multi Agency Risk Assessment Tool and Guidance MARAM • If you have Mental Capacity you can make an unwise decision. • However for professionals that doesn’t mean we can walk away. • The MARAM was first adopted by Knowsley but it has been adopted by the other Merseyside Authorities and now the Board. • It is a robust multi-agency decision making tool. Which is especially helpful when dealing with complex risky, often unclear cases. • It clarifies information sharing. • It provides clear prompts. • If done correctly it is a record. • It also provides assurance of what can or couldn’t be done. Devised by Crispin Evans

References; Consent in Adults, Adolescents and Children in Emergency Departments (2018) https: //www. rcem. ac. uk/docs/RCEM%20 Guidance/Consent%20 guidan ce%20(revised%20 Jan%202018). pdf Information sharing Advice for practitioners providing safeguarding services to children, young people, parents and carers (2018) https: //assets. publishing. service. gov. uk/government/uploads/system/ uploads/attachment_data/file/721581/Information_sharing_advice_pr actitioners_safeguarding_services. pdf https: //www. scie. org. uk/care-act-2014/safeguarding-adults/ Type is set up so that it is placed at an equal distance rom the top and left hand edge of the coloured blocks.