This Patient Safety Supplement focuses on adult safeguarding within older persons’ services and services for persons with disability.
Its purpose is to highlight the key role staff play in recognising and responding to abuse of vulnerable adults in order to put in place appropriate safeguarding measures.
Read the full supplement
Safeguarding means putting measures in place to promote and protect people’s human rights and their health and wellbeing, and empowering people to protect themselves. Safeguarding is everyone’s responsibility, if you have a safeguarding concern you must report it to your line manager and the person responsible for safeguarding in your service. HSE and HSE funded services for older persons’ and for persons with disability should have a nominated Designated Officer to report any safeguarding concerns to. In other areas please check with your line manager what your local process requires. If you have a safeguarding concern, report it immediately as any delay could result in further harm to that vulnerable person.
Mary’s Story - How to respond initially to a safeguarding concern
Mary is 80 years old living at home with some support provided by her son Tom who lives nearby. Due to mobility issues Mary was admitted to a HSE respite centre. During admission bruising was observed on Mary’s wrists and upper arms. Mary disclosed to Staff Nurse Teresa that Tom can lose his temper and be rough with her at times and that she is fearful of Tom but relies on him for support and doesn’t want to upset him. Teresa reassures Mary and listens as she shares her worries. Mary also gives consent to have her injuries medically assessed. Teresa explains to Mary that she is concerned this is a safeguarding issue and will inform her Manager and also the Designated Officer for Safeguarding, Alan, to identify how best to support Mary. Alan meets Mary and a safeguarding preliminary screening is undertaken where Mary outlines that she is happy to have a safeguarding plan developed but does not want staff to discuss the issue with her son. Alan explains to Mary that given the nature of the concern (physical abuse) he has a responsibility to notify Gardaí*. Alan reassures Mary that she will not have to make a statement if she doesn’t wish to. An interim safeguarding plan is put in place, including holding a case conference with Mary and the local Safeguarding & Protection Team. Here further actions are agreed on such as; plans for a home-assessment to consider additional home support needs; application for increase in respite provision and day care, and arranging a pendant alarm. Mary’s wishes on how to proceed are also clearly outlined in the plan. On discharge home, Mary is informed of further avenues for support including legal routes and also who to contact in emergencies.
*Staff are obliged to notify the Gardaí of concerns that could be criminal in nature, even without a person’s consent
Safeguarding Concerns and Incident Data
The HSE Safeguarding and Protection Teams received almost 12,000 notifications of safeguarding concerns in 2021, a 10% increase on notifications from the previous year. Over 850 incidents related to safeguarding were reported on the National Incident Management System (NIMS) in 2021. Incidents and allegations of verbal, physical, sexual, emotional and financial abuse and incidents of neglect and infringement on a service users’ dignity and human rights to feel safe and secure in their own home, area of residence and day services were reported.
Comment from the HSE National Safeguarding Office (NSO)
by Tim Hanly, General Manager - National Safeguarding Office
All people have the right to be safe and to live a life free from abuse. The HSE policy demands a zero tolerance approach to all concerns of adult abuse. In practice this means that all safeguarding concerns are responded to by way of a preliminary screening. The will and preference of the adult involved should be evident throughout the process. We must uphold adults’ right to self-determination even when this involves risk. Mary’s particular case demonstrates the challenges in responding to safeguarding concerns, minimising risk while respecting the adult’s wishes. Ensuring staff can recognise indicators of abuse is the important first step in responding to safeguarding concerns.
HSE Recommendations
- All staff to complete the HSeLanD eLearning module: Safeguarding Adults at Risk of Abuse
- Services for older persons and for persons with disability must nominate a safeguarding Designated Officer to respond to safeguarding concerns and coordinate responses.
- Managers should promote and facilitate ongoing learning on adult safeguarding for staff within relevant services.
Comment from ALONE
ALONE is a national organisation with a vision for an Ireland where older people can age happily and securely at home. ALONE supports the responsibility of all service providers, statutory and non-statutory, to ensure that older people are treated with respect and dignity. Every effort should be made to support an environment for older people that promotes welfare and prevents abuse. For further information on the support that ALONE provides, please visit www.alone.ie
Resources and Strategies for Adult Safeguarding
- There are a number of Resources and strategies to inform safeguarding practices in the HSE and HSE funded services including the:
See the HSE National Safeguarding Office website for more information
- Further information on promoting safeguarding of vulnerable adults is available at Safeguarding Ireland
- Information on the United Nations World Elder Abuse Awareness Day on June 15th each year is available at https://www.un.org/en/observances/elder-abuse-awareness-day/
This Patient Safety Supplement was developed by:
- HSE National Safeguarding Office - safeguarding.socialcare@hse.ie
- ALONE - hello@alone.ie
- Patient Safety Together Team of the Quality & Patient Safety Incident Management Team, NQPSD
This supplement was approved for publication by the National Clinical Director, NQPSD & the HSE NPSA Committee