Adult Safeguarding – “keeping the sick from harm and injustice”

Last week I took part in a GMC conference at the University of Chester, Adult safeguarding – everybody’s responsibility. Whilst preparing for it, I looked back at the Hippocratic Oath and, in one classical version, regarding the sick, the oath asserts “I will keep them from harm and injustice”. Duties of a doctor go back a long way – Hippocrates was a Greek philosopher and physician, who lived from 460 to 377 BC. I thought that the phrase, “first do no harm”, was attributable to him, but in fact Of The Epidemics, translated by Francis Adams, says “The physician must … have two special objects in view with regard to disease, namely, to do good or to do no harm”, thus encapsulating two ethical principles, beneficence and non-maleficence and, to me at any rate, linking directly with the GMC’s Duties of a Doctor.

The Care Quality Commission defines safeguarding as: “safeguarding means protecting people’s health, wellbeing and human rights, and enabling them to live free from harm, abuse and neglect.” The BMA toolkit for GPs says this: “safeguarding is about keeping vulnerable adults safe from harm. It involves identifying adults who may be vulnerable, assessing their needs and working with them and with other agencies in order to protect them from avoidable harms.” No contest then, this sounds like something health and social care professionals should be fully signed up to.

The content of the conference was all good stuff, but it was the interactive discussions that I found both surprising and perplexing. It looks as though people struggle with the interfaces between the Mental Capacity Act (a way of making decisions for people when they are unable to make those decisions for themselves); Deprivation of Liberty Safeguards (DoLS) (a way of lawfully authorising that someone without capacity may be deprived of their liberty); and safeguarding. These are all good people, trying to do their best by their service users, and trained in the use of the Mental Capacity Act, how come these processes fuel difficulties and complicate care delivery? Might it be the bureaucratic processes involved, uncertainties about who is responsible and who should do what, competing demands on time, low morale coupled with budgetary cuts, role confusion, de-professionalisation of care …. Maybe it’s all of these and more.

Some more useful resources

GMC (2012) Raising and acting on concerns about patient safety

NHS England Safeguarding PolicySkills for Care Briefing: Care Act implications for safeguarding adults

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