Safeguarding 1

EMPOWERMENT

A RIGHTS-BASED

APPROACH

PARTNERSHIP

PROPORTIONALITY

ACCOUNTABILITY

PREVENTION

NATIONAL STANDARDS

FOR ADULT SAFEGUARDING

2019

NATIONAL STANDARDS

FOR ADULT SAFEGUARDING

2019

About the Health Information and

Quality Authority

The Health Information and Quality Authority (HIQA) is an independent statutory

authority established to promote safety and quality in the provision of health and social

care services for the benefit of the health and welfare of the public.

HIQA’s mandate to date extends across a wide range of public, private and voluntary

sector services. Reporting to the Minister for Health and engaging with the Minister for

Children and Youth Affairs, HIQA has responsibility for the following:

▪▪ Setting standards for health and social care services — Developing personcentred standards and guidance, based on evidence and international best

practice, for health and social care services in Ireland.

▪▪ Regulating social care services — The Chief Inspector within HIQA is responsible

for registering and inspecting residential services for older people and people

with a disability, and children’s special care units.

▪▪ Regulating health services — Regulating medical exposure to ionising radiation.

▪▪ Monitoring services — Monitoring the safety and quality of health services and

children’s social services, and investigating as necessary serious concerns about

the health and welfare of people who use these services.

▪▪ Health technology assessment — Evaluating the clinical and cost-effectiveness

of health programmes, policies, medicines, medical equipment, diagnostic and

surgical techniques, health promotion and protection activities, and providing

advice to enable the best use of resources and the best outcomes for people who

use our health service.

▪▪ Health information — Advising on the efficient and secure collection and sharing

of health information, setting standards, evaluating information resources and

publishing information on the delivery and performance of Ireland’s health and

social care services.

▪▪ National Care Experience Programme — Carrying out national service-user

experience surveys across a range of health services, in conjunction with the

Department of Health and the HSE.

About the Mental Health Commission

The Mental Health Commission (MHC) was established under the Mental Health Act 2001

to promote, encourage and foster the establishment and maintenance of high standards

and good practices in the delivery of mental health services in Ireland.

The MHC’s remit includes the broad spectrum of mental health services including

general adult mental health services, as well as mental health services for children and

adolescents, older people, people with intellectual disabilities and forensic mental health

services.

The MHC’s role is to regulate and inspect mental health services, support continuous

quality improvement and to protect the interests of those who are involuntarily admitted

and detained under the Mental Health Act 2001. Legislation focuses the MHC’s core

activities into regulation and independent reviews.

In addition, under the provisions of the Assisted Decision-Making (Capacity) Act 2015,1

the MHC’s remit has been extended to include the establishment of the Decision Support

Service (DSS). The DSS will support decision-making by and for adults with capacity

difficulties and will regulate individuals who are providing those supports. The main

functions of the MHC are:

Regulation:

▪▪ Registration and enforcement — registering approved centres and enforcing

associated statutory powers, such as attaching registration conditions.

▪▪ Inspection — inspecting approved centres and community mental health services

and reporting on regulatory compliance and the quality of care.

▪▪ Quality improvement — developing and reviewing rules under the Mental Health

Act 2001. Developing standards, codes of practice and good practice guidelines.

Monitoring the quality of service provision in approved centres and community

services through inspection and reporting.

Independent reviews:

▪▪ Mental Health Tribunal Reviews — administering the independent review system

of involuntary admissions. Safeguarding the rights of those detained under the

Mental Health Act 2001.

▪▪ Legal Aid Scheme — administering the mental health legal aid scheme.

1 At the time of writing, the Assisted Decision-Making (Capacity) Act 2015 is not fully commenced, therefore, the Decision Support Service is

not operational.

Table of contents

INTRODUCTION

1. Background

2. Adult safeguarding principles

3. Purpose of the national standards

4. Interaction with national standards

5. How the national standards should be used

6. Themes in the national standards

7. Structure of the national standards

8. Key terms used in this document

9. How the national standards were developed

10. Summary of the National Standards for Adult Safeguarding

THEME 1. Person-centred Care and Support

Standard 1.1

Standard 1.2

THEME 2. Effective Care and Support

Standard 2.1

Standard 2.2

THEME 3. Safe Care and Support

Standard 3.1

Standard 3.2

THEME 4. Health, Wellbeing and Development

Standard 4.1

THEME 5. Leadership, Governance and Management

Standard 5.1

Standard 5.2

THEME 6. Responsive Workforce

Standard 6.1

Standard 6.2

THEME 7. Use of Resources

Standard 7.1

THEME 8. Use of Information

Standard 8.1

Standard 8.2

Glossary of Terms

Bibliography

Appendix 1

Membership of the Advisory Group and the HIQA and MHC Project Team

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

INTRODUCTION

1. Background

The Health Information and Quality Authority (HIQA) and the Mental Health Commission

(MHC) recognise the importance of increasing the quality and safety of services for all

adults in Ireland, especially those who may be at risk of harm. Having National Standards

for Adult Safeguarding in place allows for a consistent approach to preventing and

responding to harm when it does occur. National standards provide a framework for

the continual development of person-centred, high-quality, safe and effective services.

However, a system-wide approach to addressing safeguarding requires policy and

legislation to also be in place. The Government is committed to safeguarding adults

through relevant legislation and national policy and the Department of Health announced

that a new national adult safeguarding policy was to be developed for the health sector.2

This, together with national standards and service provider policies and procedures, will

provide a system-wide approach to addressing safeguarding in Ireland.

This approach requires services putting people at the centre of everything they do, for

example by communicating with them in a way they can understand, respecting and

promoting their autonomy and ensuring that they participate in decisions about their lives.

All adults have the right to be safe and to live a life free from harm. 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. It is fundamental to highquality health and social care.

Safeguarding relies on people and services working together to ensure that people using

services are treated with dignity and respect and that they are empowered to make

decisions about their own lives. As a starting point, everyone must be presumed to have

capacity to make their own decisions recognising that capacity can change over time.

Each person’s welfare should be promoted and they should receive care and support in

an environment where every effort is made to prevent the risk of harm. Health and social

care services have a responsibility to do everything possible to prevent harm as a result of

abuse, neglect or exploitation.

2 In December 2017, the Department of Health announced that a new national adult safeguarding policy was to be developed for the health

sector. This acknowledges the need to build further on the existing range of policies, procedures, codes of practice and legislation aimed

at protecting and safeguarding adults in the health sector in Ireland. At the time of developing these national standards, the Department of

Health was in the process of developing a national policy that will assist in framing legislation on safeguarding for the health and social care

sector. This policy will apply across all health and social care services.

Health Information and Quality Authority and Mental Health Commission

Any adult may need help to protect themselves at any point in their lives. There may be

times when a person is more vulnerable to abuse, neglect and exploitation, and this may

mean that they are unable to adequately protect themselves from a wide range of potential

harm. Any adult can go through a period of risk and need care and support. This care and

support should be balanced and proportionate to manage or mitigate risk in order for the

person to live a safe and fulfilling life.

Services have a responsibility to ensure that if harm occurs or is likely to occur that it

is stopped and reported as quickly as possible. Services must respond effectively when

harm does occur in order to minimise the impact of harm. However, there may be times

when a service will need to respond to a safeguarding concern in a manner that is not in

accordance with the person’s wishes. This response must be proportionate and tailored

to the person’s circumstances, respect the person’s will and preferences; be the least

restrictive; applied for the shortest possible time; and subject to a timely review.

2. Adult safeguarding principles

The national standards are underpinned by key principles that emerged from the

literature and engagement with a wide range of stakeholders. These principles should

be reflected in the ways health and social care services deliver care and support to all

people using their services. These principles should not be viewed in isolation, as all of

the principles interact with each other to ensure that services place people using their

services at the centre of what they do. The principles are:

▪▪ Empowerment — people are empowered to protect themselves from the risk

of harm and to direct how they live their lives on a day-to-day basis according

to their will and preferences. This requires people having access to the right

information in a way they can understand, making decisions about their lives

and being supported to engage in shared decision-making about the care and

support they receive.

▪▪ A rights-based approach — people’s rights should be promoted and protected

by health and social care services. These include the right to autonomy, to be

treated with dignity and respect, to be treated in an equal and non-discriminatory

manner, to make informed choices, the right to privacy and the right to safety. A

rights-based approach is grounded in human rights and equality law.

▪▪ Proportionality — staff working in health and social care services should take

proportionate action which is the least intrusive response appropriate to the risk

presented and takes account of the person’s will and preferences.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

▪▪ Prevention — it is the responsibility of health and social care services to take

action before harm occurs. Preventative action includes care, support and

interventions designed to promote the safety, wellbeing and rights of adults.

▪▪ Partnership — effective safeguarding requires working in partnership, that is,

health and social care services and the person using the service, their nominated

person and professionals and agencies working together to recognise the

potential for, and to prevent, harm.

▪▪ Accountability — health and social care services are accountable for the care

and support they deliver and for safeguarding people using their services.

This requires transparency in the ways in which safeguarding concerns are

responded to and managed.

While the arrangements that a service puts in place will vary depending on the size and

complexity of the service, these principles apply regardless of the setting.

3. Purpose of the national standards

It is recognised internationally that the setting and implementation of standards are

important levers in promoting improvements in the quality and safety of care and

support. They also help to set the expectations of people using services, the public,

providers and professionals.

National Standards for Adult Safeguarding:

▪▪ offer a common language to describe adult safeguarding in health and social

care services

▪▪ help people using services to understand what they should expect from a service

committed to promoting their rights, health and wellbeing and protecting them

from the risk of harm

▪▪ enable a person-centred approach by focusing on the people who use services

and placing them at the centre of everything that the service does

▪▪ create a basis for services to improve the way in which they promote the rights,

health and wellbeing of people using services

▪▪ help to reduce harm and respond to harm when it does occur by identifying

strengths and highlighting areas for improvement

▪▪ promote practice that is up to date, effective and consistent.

Health Information and Quality Authority and Mental Health Commission

The purpose of the standards is not to set out specific procedural detail which is best

described in operational policies and procedures. National standards are supported by

a legislative framework, national policy and local policies, procedures and structures

which interact with each other to consistently ensure the prevention of harm and the

appropriate response to safeguarding concerns.

4. Interaction with national standards

Reference is made to safeguarding at a high level in a number of national standards

developed by HIQA. In existing national standards, emphasis is placed on promoting

people’s rights and respecting their autonomy, privacy and dignity. The role of staff in

facilitating people to be as independent as possible and to exercise personal choice in

their daily lives while also safeguarding them from abuse is also outlined. Similarly, the

autonomy, capacity and involvement of people using services in decisions about their

care and treatment are key themes in the MHC’s Quality Framework for Mental Health

Services in Ireland. While elements of safeguarding are included in existing national

standards, a dedicated set of national standards for adult safeguarding:

▪▪ focuses attention on the area of safeguarding

▪▪ supports service providers to:

»» understand what safeguarding is

»» identify ways to prevent harm from occurring

»» respond proportionately when harm does occur, with the rights and interests

of the person at risk of harm to the fore.

▪▪ sets out what people using services can expect from those services.

These standards are not intended to replace existing standards and frameworks.

Some service providers may be in a position that other existing standards or frameworks

are also relevant to them.

5. How the national standards should be used

HIQA and the MHC’s aim in developing these standards is to improve the experience

of all people accessing health and social care services, reduce their risk of harm, and

promote their rights, health and wellbeing. Although HIQA only has a legal mandate to set

standards for the safety and quality of certain health and social care services,3 Section 7 of

the Health Act 2007 outlines HIQA’s role in promoting safety and quality in the provision of

3 Health and social care services provided by the HSE or a service provider in accordance with the Health Acts 1947 to 2007, Child Care Acts,

1991 and 2001, the Children Act 2001 and nursing home services as defined in section 2 of the Health (Nursing Homes) Act 1990.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

health and social services for the benefit of the health and welfare of the public.

Under the Mental Health Act 2001, the statutory mandate of the MHC is to ‘promote,

encourage and foster the establishment and maintenance of high standards and good

practices in the delivery of mental health services and to take all reasonable steps to

protect the interests of persons detained in approved centres’.

These standards have been approved by the Minister for Health. This places a

responsibility on all residential services for older people and people with disabilities and

all publicly-funded health and social care services to begin implementing these national

standards. As these standards have been jointly developed and approved by the MHC,

they should be implemented by all mental health services.

People interact with and move between a wide range of health and social care services

and should expect the same level of care, support and commitment to safeguarding from

all of the services that they use (that is, all health services, including mental health and

social care services). Safeguarding should form part of the culture of any service. People

accessing any health and or social care services should expect that their risk of harm is

reduced and their rights, health and wellbeing are promoted and protected by each of the

services that they come into contact with.

Therefore, HIQA and the MHC took a broader focus in developing these adult

safeguarding standards by actively engaging with stakeholders from a wide range

of health services — including mental health and social care services, — throughout

the standards development process. This included people using services, advocates,

practitioners, service providers and policy makers. This has resulted in a set of standards

that have been designed to apply to all health and social care services. Therefore, it is

envisaged that all health services will adopt these national standards, approved by the

Minister for Health, to promote people’s rights, health and wellbeing and reduce the risk

of harm.

6. Themes in the national standards

HIQA uses an established framework to develop national standards. This framework

was developed following a review of national and international evidence, engagement

with national and international experts and applying HIQA’s knowledge and experience

of the health and social care context. Figure 1 illustrates the eight themes under which

the standards are presented. The four themes on the upper half of the circle relate to the

dimensions of safety and quality in a service, while the four on the lower half of the circle

relate to the key areas of a service’s capacity and capability.

Health Information and Quality Authority and Mental Health Commission

Figure 1. Standards development framework

The four themes of quality and safety are:

▪▪ Person-centred Care and Support — how services place people using their

services at the centre of what they do in order to protect them from harm. This

includes how services communicate with people using these services to ensure

they are well informed, involved and supported. In the context of safeguarding,

this includes making sure that people’s rights are upheld and promoted.

▪▪ Effective Care and Support — how services ensure that safeguarding is part

of the routine delivery of care in and between services using the best available

evidence and information.

▪▪ Safe Care and Support — how services protect people from the risk of harm and

respond to safeguarding concerns when they arise.

▪▪ Health, Wellbeing and Development — how services work in partnership with

people using the service to develop the skills to protect and promote their

own physical, mental, emotional and social health and wellbeing and protect

themselves from harm.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Delivering improvements within these quality and safety themes depends on service

providers having capacity and capability in the following four key areas:

▪▪ Leadership, Governance and Management — the arrangements put in place

by services for clear accountability, decision-making, risk management and

performance assurance to reduce the risk of harm and respond to safeguarding

concerns, underpinned by effective communication among staff.

▪▪ Responsive Workforce — how services plan, recruit, manage and organise their

workforce to ensure enough staff are available at the right time with the right

skills and expertise to reduce the risk of harm and promote the rights, health and

wellbeing of people using services.

▪▪ Use of Resources — how services plan, manage and prioritise their resources

to reduce the risk of harm and promote the rights, health and wellbeing of each

person.

▪▪ Use of Information — how services use information as a resource for planning,

delivering, monitoring, managing and improving services to keep people safe.

7. Structure of the national standards

The national standards are set out according to the above eight themes. The eight themes

are intended to work together, and collectively they describe how a health or social care

service promotes the rights, health and wellbeing of people using its services and how it

puts in place measures to reduce the risk of harm to people using its services.

Each standard consists of three sections:

▪▪ Standard — describes the high-level outcome required to contribute to delivering

care and support that promotes the rights, health and wellbeing of people using

services, reduces the risk of harm and responds appropriately and effectively

when harm does occur.

▪▪ Features — taken together, these will enable progress towards achieving the

standard. The list of features provided under each standard statement is not

exhaustive, and the health or social care service may meet the requirements of

the standards in other ways. While it is expected that all health and social care

services will work to achieve each standard, not all features within each standard

are relevant to all services.

▪▪ What does this mean for me – this provides at-a-glance information for people

using services on what each standard means for them, and it also assists those

providing services to understand what is expected of them.

Health Information and Quality Authority and Mental Health Commission

8. Key terms used in this document

This section defines some of the key terms which are used throughout the standards.

A full list of relevant definitions is included in the Glossary of Terms section of this

document.

Abuse: a single or repeated act, or omission, which violates a person’s human rights or

causes harm or distress to a person. The main areas of abuse which cause people harm

are physical abuse, emotional abuse, sexual abuse, neglect of the person and financial

abuse. It is important to note that this is not an exhaustive list.

Adult: a person aged 18 years or older.

Adult at risk: a person who is aged 18 years or older who needs help to protect

themselves from harm at a particular time. A distinction should be made between an

adult who is unable to safeguard him or herself, and one who is deemed to have the skill,

means or opportunity to keep him or herself safe, but chooses not to do so.

Advocate: a person who assists an individual in making their views known. Advocacy

comes in different forms. This may include informal support or independent advocacy

services.

Capacity: in line with the Assisted Decision-Making (Capacity) Act 2015, ‘capacity’ means

‘decision-making capacity’ and refers to the ability to understand, at the time that a

decision is to be made, the nature and consequences of the decision in the context of the

available choices at that time.

Harm: the impact of abuse, exploitation or neglect on the person. Harm arises from any

action, whether by a deliberate act or an act of omission, that may cause impairment of

physical, intellectual, emotional, or mental health and wellbeing.

Nominated person: a person who has been expressly identified by the person using

the service and has been given authority by that person as an individual with whom

information in relation to them may be shared and who can assist them in making their

views known. A nominated person can be a family member or another person who has

an interest in the welfare of the person using the service. The involvement of any person

must be in line with the expressed wishes of the person using the service.

Person using services: a person who uses health and or social care services.

Safeguarding: measures that are put in place to reduce the risk of harm, promote and

protect people’s human rights and their health and wellbeing, and empowering people to

protect themselves. Safeguarding is fundamental to high-quality health and social care.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Service: any health or social care service where care and support is provided to adults.

Staff: the people who work in, for or with a health or social care service. This includes

individuals who are employed, self-employed, temporary, volunteers, contracted or

anyone who is responsible or accountable to the service.

9. How the national standards were developed

As a first step, a review of national and international literature on the issue of adult

safeguarding was undertaken by HIQA and the MHC and used to inform the development

of the national standards. This review took account of published research, investigations,

and reviews of adult safeguarding in Ireland, alongside legislation, standards, policy,

guidelines and best practice in other countries. All documents and publications were

reviewed and assessed for inclusion in the evidence base that informed the development

of the National Standards for Adult Safeguarding. The background document setting out

the findings of the literature review was published in May 2018 and is available on www.

hiqa.ie and www.mhcirl.ie.

HIQA and the MHC also established an Advisory Group, comprised of a diverse range of

interested and informed parties, including representatives from support and advocacy

groups, regulatory bodies, professional representative organisations, the Health Service

Executive (HSE) and the Department of Health. The group’s function was to advise HIQA

and the MHC on the development of the standards, and to support consultation and

information exchange. Both organisations would like to gratefully acknowledge the hard

work and commitment of the Advisory Group. The members of this group are listed in

Appendix 1 of this document.

HIQA and the MHC hosted an awareness-raising seminar on adult safeguarding, where

the background document setting out the findings of the literature review was published.

The seminar brought together practitioners, policy-makers and people using services to

share their experience and learn from each other.

Focus groups were organised with people who use health and social care services and

with staff working in these services to discuss their experiences and get their opinions

as to what the National Standards for Adult Safeguarding should address. Seventeen

focus groups were conducted with a total of 145 participants. One-to-one interviews

were held with key stakeholders who did not attend a focus group to ensure that their

opinions informed the development of the standards. HIQA and the MHC would like

to gratefully acknowledge those who participated for taking the time to attend these

sessions and meetings and contributing to the standards development process in such

a meaningful way.

Health Information and Quality Authority and Mental Health Commission

A national public consultation was carried out during a seven-week period from 1

August until 19 September 2018. HIQA and the MHC received 79 detailed submissions

on the national standards. Of the 79 submissions received, 44 were submitted on behalf

of organisations. Following the consultation, all submissions were analysed and the

standards were revised as appropriate.

A summary of these submissions is available to read in a Statement of Outcomes

document on both www.hiqa.ie and www.mhcirl.ie.

10. Summary of the National Standards for

Adult Safeguarding

Theme 1: Person-centred Care and Support

Standard 1.1

Each person’s rights are recognised and promoted.

Standard 1.2

Each person is supported to engage in shared decision-making

about their care and support to reduce their risk of harm and

promote their rights, health and wellbeing.

Theme 2: Effective Care and Support

Standard 2.1

The service effectively plans and delivers care and support to

reduce the risk of harm and promote each person’s rights, health

and wellbeing.

Standard 2.2

Each person experiences integrated care and support which is

coordinated effectively within and between services to reduce the

risk of harm and to promote their rights, health and wellbeing.

Theme 3: Safe Care and Support

Standard 3.1

The service strives to protect each person from the risk of harm

and to promote their safety and welfare.

Standard 3.2

Safeguarding concerns are effectively identified and managed, and

outcomes inform future practice.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Theme 4: Health, Wellbeing and Development

Standard 4.1

Each person is supported to develop the skills to protect and

promote their own physical, mental, emotional and social health

and wellbeing and protect themselves from harm.

Theme 5: Leadership, Governance and Management

Standard 5.1

The service has effective leadership, governance and management

arrangements in place with clear lines of accountability to reduce

the risk of harm and to promote the rights, health and wellbeing of

each person.

Standard 5.2

The service strives to continually improve the quality of the care

and support it provides to reduce the risk of harm and to promote

the rights, health and wellbeing of each person.

Theme 6: Responsive Workforce

Standard 6.1

The service plans, organises and manages the workforce to reduce

the risk of harm and to promote the rights, health and wellbeing of

each person.

Standard 6.2

The service supports staff to reduce the risk of harm and promote

the rights, health and wellbeing of each person by providing

training, development and supervision.

Theme 7: Use of Resources

Standard 7.1

Resources are used efficiently to reduce the risk of harm and

promote the rights, health and wellbeing of each person.

Theme 8: Use of Information

Standard 8.1

Information is used to effectively reduce the risk of harm and

promote the rights, health and wellbeing of each person.

Standard 8.2

The service shares information appropriately to keep people safe.

Health Information and Quality Authority and Mental Health Commission

THEME 1:

Person-centred Care and Support

Person-centred care and support refers to how services place the people using the

service at the core of what they do. The needs of each person using the service therefore

determine how the service operates. Person-centred care includes promoting people’s

rights, allowing people to make meaningful choices, supporting them to participate in

decisions about their lives and providing an individualised service that recognises their

will and preferences.

To deliver person-centred care and support, services work beyond making people feel

safe in order to support other aspects of the person’s wellbeing, such as making them feel

empowered and in control. These are core elements of promoting the rights, health and

wellbeing of people using services. Internationally, there has been a shift in how adult

safeguarding is approached: from a paternalistic approach to a rights-based approach.4

In a rights-based approach, proportionality is a key principle. This means that when

an intervention is required to safeguard a person, it is important to ensure that the

intervention is relevant to the person and is in line with their will and preferences.

However, there may be times when a service needs to respond to a safeguarding

concern in a manner that is not in line with the person’s wishes. This response must be

proportionate and tailored to the person’s circumstances, be the least restrictive, applied

for the shortest possible time and subject to a timely review.

4 A paternalistic approach is one which limits a person’s liberty or autonomy with the intention of promoting the person’s own good.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

To deliver person-centred care and support, staff respect and promote the rights of

people to live free from harm that arises as a result of abuse, neglect and exploitation.

It is critical that each person is empowered to know their rights and be supported to

promote and protect them.

A service is person-centred when people who use the service are encouraged and

supported to be actively involved in shared decision-making, for example, in the

planning and delivery of their own care and support and of the service generally.

People using services and or their nominated person should have a meaningful say

in how the service is delivered and are encouraged to advocate for themselves. Key

to this is staff providing information to people using services in a way that they can

understand and communicating in ways that will build trust.

Support in decision-making is also central to a person-centred approach to providing

a service. Each person is supported and encouraged to make decisions around their

personal welfare, affairs and property. As a starting point, it must be presumed that

everyone has capacity to make their own decisions5 recognising that capacity can

change over time. Services must ensure that each person has the information they

need to help them make decisions and that they get help from people who have an

interest in their welfare if they need it. Services have a responsibility to use appropriate

tools to facilitate communication and to allow time for a person to make a decision.

Person-centred services work with people’s strengths and networks to help them make

decisions and manage complex situations.

In order to prevent harm from occurring, services put measures in place to reduce risk.

This includes supporting people to understand what harm is and to develop the skills

to protect themselves from harm.

If a safeguarding concern arises, a person-centred service supports the person who

is at risk of harm or who has been harmed and explains the process to them in a way

that takes account of their communication needs. The person is kept informed and is

supported by staff throughout the process. If the person needs help to stay safe, this

is fully explained and the person is involved in determining how this happens. If harm

occurs, it is critical that each person is empowered to understand what safeguarding

procedures and criminal justice processes might involve.

5 When decision-making capacity is assessed, it must be in a time-specific, issue-specific way that considers whether a person is able to

understand the nature and consequences of the decision in the context of the available choices. The test is a functional one, which asks

whether the person can understand, retain and weigh up information and communicate his or her decision. Decision-making capacity is a not

a matter to be medically assessed, and cognitive impairment is relevant only to the extent that it actually impacts on decision-making. It is

recognised that capacity can fluctuate over time.

Health Information and Quality Authority and Mental Health Commission

People should choose the supports they receive in preventing and responding to

safeguarding concerns. A person’s family may play a key role in providing ongoing

care and support to a person before, during and after receiving a health or social care

service. Every person with an interest in the welfare of the person should be properly

informed about what safeguarding is and signposted to the appropriate supports

and services, but family involvement in preventing and responding to safeguarding

concerns should only be at the express will and preferences of the person.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 1.1

Each person’s rights are recognised and promoted.

Features of a service meeting this standard are likely to include:

1.1.1 Each person’s rights, such as the rights to autonomy, respect, dignity, privacy and

equality of opportunity and treatment, and non-discrimination are promoted and

protected by staff. All staff are aware of these rights as set out in legislation, national

policy and national standards.6

1.1.2 Each person is informed about and supported to understand their rights and

information about their rights is communicated in a way that they can understand.

1.1.3 Each person is treated with dignity and respect in a way that recognises and

promotes their individuality, and their equality is promoted in line with legislation.

1.1.4 Where a safeguarding concern arises, the person is informed about the supports

available to them and facilitated to access protection and support to keep them safe.

1.1.5 People are informed about and supported to access the justice system if there is

a concern that a crime may have been committed. Examples of this may include

contacting An Garda Síochána (Ireland’s National Police Service) or employing legal

representation.

WHAT DOES THIS MEAN FOR ME?

▪▪ My identity, values, beliefs and culture are respected by staff and other people

using the service.

▪▪ I am helped to understand my rights and staff support me to protect and

promote them.

▪▪ If I am at risk of harm, staff assist me in accessing support and, if necessary,

the justice system, for example by contacting the Gardaí.

6 The Equal Status Acts 2000-2015 (‘the Acts’) prohibit discrimination in the provision of goods and services, accommodation and education.

They cover the nine grounds of gender, marital status, family status, age, disability, sexual orientation, race, religion, and membership of the

Traveller community. The Acts also prohibit discrimination in the provision of accommodation services against people who are in receipt of

rent supplement, housing assistance, or social welfare payments.

Health Information and Quality Authority and Mental Health Commission

Standard 1.2

ach person is supported to engage in shared

decision-making about their care and support to

reduce their risk of harm and promote their rights,

health and wellbeing.

Features of a service meeting this standard are likely to include:

1.2.1 Each person has access to the information they need so that they can make

informed choices. Information is communicated in a way that they can understand.

1.2.2 Each person is presumed to have capacity to make their own decisions and is

supported to make them.

1.2.3 Each person is supported to assess the risks associated with the choices they make

and to weigh up the benefit and the potential harm. Each person has the right to

make a decision, even if others think this is an unwise decision.

1.2.4 Each person has the opportunity to discuss who they want involved in their care

and support with staff, for example a nominated person or a family member. Staff

ensure that such participation is with the person’s consent.

1.2.5 Each person is supported and facilitated to advocate for themselves.

1.2.6 Each person is informed about advocacy and support services and what they can

offer. They are facilitated and supported to access such services.

1.2.7 Each person and or their nominated person receives information on what

safeguarding is, how to prevent harm from happening and how to address harm if it

does happen.

1.2.8 Where a safeguarding concern arises, the person and or their nominated person, is

involved in the safeguarding process and is supported to exercise choice.

1.2.9 Where a service responds to a safeguarding concern in a way that is not in

accordance with a person’s wishes, they do so only after all other options have been

exhausted. Reasons for any decisions are explained to the person in a way that they

can understand.

1.2.10 Staff ensure that any actions undertaken to address harm:

▪▪ take account of the person’s will and preferences, beliefs and values

▪▪ are proportionate and tailored to the person’s circumstances

▪▪ are the least restrictive and are applied for the shortest possible time

▪▪ and are subject to regular review.

This is fully explained to the person at an appropriate time.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

WHAT DOES THIS MEAN FOR ME?

▪▪ I have all of the information I need to help me make decisions about my life,

including when I need help to keep myself safe.

▪▪ I am supported and encouraged to participate in decisions about my care and

support.

▪▪ I get help from the right people if I need help to make, or cannot make,

decisions about my care and support.

▪▪ If I need help to stay safe, this is fully explained to me and I get a say in how

this happens.

Health Information and Quality Authority and Mental Health Commission

THEME 2:

Effective Care and Support

Effective care and support in health and social care means consistently working towards

the best achievable outcomes for people using services. It means that services ensure

that appropriate and consistent support is in place so that people using services

lead fulfilling lives. In an effective service, care and support is planned and delivered

productively and in a timely way. Effective services are responsive to people’s range of

health and social care needs and recognise that each person’s needs are different and

change over time.

Effective services acknowledge that they often cannot effectively safeguard adults from

risk independently of other services. Therefore, they work in an integrated way with other

services, organisations and professionals (this is called ‘interagency working’). Effective

services build meaningful communication networks, connections and relationships, and

these relationships can be used quickly if there are adult safeguarding concerns. Staff

in effective services also develop relationships with other professionals and services in

order to build trust with people and communities. Staff communicate with each other in

a timely way, both in and between services, to reduce the risk of harm and promote each

person’s rights, health and wellbeing. Staff respect the values, opinions and contributions

of other staff from different disciplines and professional backgrounds and actively build

effective working relationships.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

To prevent adult safeguarding issues from arising and to deal effectively with them

if they do arise, staff across services use a common understanding and approach to

safeguarding, for example between acute and community services. Transitions between

services are well managed, recognising that this is a key time when harm can occur.

Where a person requires support from more than one service, one of the services takes

a lead role in coordinating the support, reviewing progress, monitoring the outcomes for

the person and communicating progress to all interested parties.

The delivery of health and social care and support is complex, and it must be well

planned, organised and managed to be effective. This involves clearly and regularly

documenting decision-making within services, and developing individual plans for

care and support for people using services. Effective planning involves risk assessment

and the service is aware of any issues that may put an adult at risk of harm. Services

recognise that there are benefits as well as potential harm when people using services

take risks in day-to-day life. However, adults are also supported to make informed

decisions about risk.7 This supports them to live the most whole and fulfilling life

possible.

7 In the literature, making balanced decisions about risks is also called positive risk taking. This is the taking of calculated and reasoned risks,

which recognises that there are benefits as well as potential harm from taking risks in day-to-day life.

Health Information and Quality Authority and Mental Health Commission

Standard 2.1

he service effectively plans and delivers care and

support to reduce the risk of harm and promote each

person’s rights, health and wellbeing.

Features of a service meeting this standard are likely to include:

2.1.1 The service assesses the individual care and support needs of each person, with

maximum participation from the person. This is done when the person first accesses

a service and is regularly reviewed and updated as appropriate. As part of this

process, the service identifies and clearly documents any potential risks and how

they will be managed.

2.1.2 The service supports each person to make informed decisions about risk to support

them to live the most fulfilling life possible.

WHAT DOES THIS MEAN FOR ME?

▪▪ I am involved in planning my care and support. This sets out how my needs

will be met and how any risks to me will be managed.

▪▪ I am supported to live the most fulfilling life possible, even if this involves

some element of risk.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 2.2

ach person experiences integrated care and support

which is coordinated effectively within and between

services to reduce the risk of harm and to promote

their rights, health and wellbeing.

Features of a service meeting this standard are likely to include:

2.2.1 Arrangements are in place to encourage team working across disciplines,

including agreed communication pathways and understanding of the roles and

responsibilities of each team member in inter-professional working between health

and social care services.

2.2.2 The service effectively manages transition planning and planning for discharge.

There is effective communication within and between services during these periods

to minimise risk and to share necessary information with the person’s consent.

2.2.3 Where the person is moving from one service to another, this is planned and

managed in partnership with the person.

2.2.4 Arrangements are in place to clearly define responsibilities within and between

services to support people who require support from more than one service, for

example one staff member is identified as the lead coordinator across services.

2.2.5 The service puts arrangements in place to support interagency working,

communication and information sharing to meet the needs of people using services

in order to minimise the risk of harm to a person. The purpose of sharing a person’s

information is explained to the person and consent is sought, as appropriate.

2.2.6 The service builds networks and relationships across a range of services and

agencies so that they can respond effectively when a safeguarding concern arises,

for example with Gardaí and other statutory services, financial institutions, advocacy

and support groups.

WHAT DOES THIS MEAN FOR ME?

▪▪ All staff involved in my care and support work together to reduce the risk of

harm to me.

▪▪ I am involved in planning and managing any move between services or out of

a service to reduce the risk of harm to me during the move.

▪▪ My information is shared with the people who need it so they can care for and

support me effectively.

Health Information and Quality Authority and Mental Health Commission

THEME 3:

Safe Care and Support

Safe care and support recognises that safeguarding each person from harm is

paramount. Services promote the safe care and support of each person in two ways: by

preventing or reducing the risk of harm occurring, and by responding effectively and

appropriately if harm does occur.

In a safe service that works to minimise the risk of harm to people using its services,

safeguarding is part of the service’s culture and is embedded in its practices — rather

than being viewed or undertaken as a separate activity. It is therefore important that

services foster a culture of respecting people’s rights and protecting them from the risk

of harm. In order to achieve this culture, staff must be facilitated to work in partnership

with each person to support them in building capacity to protect themselves from

harm. Having this culture in place means that staff are confident in raising safeguarding

concerns where the behaviour of a staff member, family member, visitor or another

person using the service is the cause for the safeguarding concern.

Services have a transparent complaints process that is accessible to people using

the service, as well as a system for gathering ongoing feedback on the service. This

encourages people using the service, their family, their nominated person and advocates

as well as staff to both raise concerns and identify areas for improvement.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Staff know how to recognise and respond to harm. When harm occurs, or may have

occurred, staff work with people to respond to concerns about their safety or the safety of

others. Staff communicate the response to the safeguarding concern and the outcome of

the concern to the person.

To promote safe care and support, services have an adult safeguarding policy which

sets out the ways in which harm is prevented, recognised and addressed. This policy

is followed when harm is suspected or is happening and staff are trained in their roles

and responsibilities in implementing this policy. Where there are risks to the safety and

welfare of people, the service works with them to put in place all appropriate supports to

protect them and to minimise the effect on them.

Services report, manage and review safeguarding concerns in line with relevant national

legislation, policy, standards and guidelines, respecting the will and preferences, dignity

and privacy of each person using the service. Learning from incidents of harm arising

from abuse, neglect or exploitation is shared with staff and used to improve the delivery

of safe services. At times this will involve sharing learning between services that are

working with a person, or where the person moves between services, in order to reduce

the risk of harm.

Health Information and Quality Authority and Mental Health Commission

Standard 3.1

he service strives to protect each person from the risk

of harm and to promote their safety and welfare.

Features of a service meeting this standard are likely to include:

3.1.1 The service has arrangements in place to identify risk and protect each person from

harm and to ensure the least restrictive environment possible. These arrangements

are in line with legislation, national policy, standards and guidelines.

3.1.2 The service proactively manages risks. Measures are put in place for each person to

reduce the likelihood and impact of risks. These include assessing the needs of each

person at each stage of their engagement with a service and reviewing these needs

regularly thereafter.

3.1.3 Each person is encouraged to be respectful of the rights of others. This is

communicated in a way that each person can understand.

3.1.4 In exceptional circumstances, where it has been assessed that restrictive practices8

are required due to a serious risk to the safety and welfare of the person or others,

this is done in line with legislation, national policy, standards, guidelines and the

service’s policy.

3.1.5 The service reviews the use of restrictive practices regularly to ensure that the least

restrictive practice possible is in place for the least amount of time possible.

3.1.6 The service has a process in place that facilitates people using the service and staff

to provide feedback, make complaints and identify areas for improvement. Staff

communicate the outcomes from complaints to people using the service.

3.1.7 Staff are aware that there are different types of harm and know what to do to

prevent harm from occurring.

3.1.8 Staff work in partnership with people to support them to protect themselves from

harm, including supporting them to report safeguarding concerns for their own or

others’ safety, health and wellbeing.

3.1.9 Arrangements are in place for each person to look after their own personal

belongings and finances in a way that takes account of the will and preferences of

the person. Where a person needs support to do this, the service has transparent

and secure arrangements in place.

8 Restrictive practices are practices that intentionally limit a person’s movement, communication and or behaviour.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

WHAT DOES THIS MEAN FOR ME?

▪▪ I am protected from the risk of harm. Staff know how to respond to signs that

I might be at risk.

▪▪ I know how to tell a service what I think about it and how to make a complaint.

▪▪ I know that staff who care for and support me will follow up on my complaint

and tell me about the outcome.

▪▪ I know that my personal belongings are safe and secure and that if I need help

to manage my finances that I am consulted about this.

Health Information and Quality Authority and Mental Health Commission

Standard 3.2

afeguarding concerns are effectively identified and

managed, and outcomes inform future practice.

Features of a service meeting this standard are likely to include:

3.2.1 The service has an open culture that encourages each person and all people with an

interest in their welfare to raise safeguarding concerns. People know who to report

concerns to and can do so without being negatively affected as a consequence.

3.2.2 Where it is suspected or identified that a person is experiencing harm, staff

members know their responsibilities in responding to this. This includes recording

and reporting, and, where appropriate, escalating the concern and following up on

reports. This is done in line with legislation, national policy, standards, guidelines

and the service’s policy, as appropriate.

3.2.3 Staff work together in their own service and, where relevant, with other services to

respond to harm and identify actions to prevent harm from reoccurring to both the

individual concerned and other people using services.

3.2.4 Where one person’s behaviour is putting others at risk of harm, staff review any

factors that may be contributing to this behaviour and address these. Working with

the person, a plan is put in place to reduce the risk of the behaviour reoccurring.

3.2.5 Staff recognise harm and when harm does occur, staff know how to address the

harm and minimise its effect.

3.2.6 Individual safeguarding concerns are reviewed in a timely manner and outcomes

are communicated to the person and inform practice at all levels.

3.2.7 The service regularly evaluates its approach to identifying, responding to, managing

and learning from safeguarding concerns and the resulting outcomes. The service

uses learning from this to review its policies and procedures in order to reduce the

risk of harm to each person.

WHAT DOES THIS MEAN FOR ME?

▪▪ I know who to talk to if I feel myself or others are at risk of harm. I know that

these concerns will be taken seriously.

▪▪ Staff who care for and support me understand their responsibilities in

protecting me from harm.

▪▪ My service knows what to look out for to keep people safe, and it actively tries

to improve the service when something goes wrong.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

THEME 4:

Health, Wellbeing and Development

A service focused on health, wellbeing and development looks for ways and

opportunities to promote, maintain and improve the health and wellbeing of people

using services. Improving the health and wellbeing of people using services is not just

the person’s responsibility or that of service providers. Instead, they work together to

achieve this outcome.

Working with people to improve their health, wellbeing and development is part of

empowering people to protect themselves from harm and to feel more in control of their

lives — both of which are key elements of safeguarding. This may include supporting

people to be more independent, to participate fully in decisions about their lives, to

undertake new challenges and educating people to empower them in areas such as

managing their own finances and managing challenging situations.

To support the health, wellbeing and development of people using services, the service

focuses on the abilities, goals, aspirations, health and wellbeing of each person and

works to empower and enable them. Staff support each person to assess their own

physical, mental, emotional and social wellbeing on an ongoing basis and to identify

actions and resources that can support them to maximise their quality of life.

Health Information and Quality Authority and Mental Health Commission

Each person is supported to enjoy a good quality of life and live their lives in keeping

with their own social, cultural and religious beliefs. People should be encouraged and

supported to be connected to their communities of identity and choice. Good health,

wellbeing and development in all aspects of people’s lives can be achieved through

providing accessible services that are based on need and narrow the educational,

employment, and health and wellbeing gap for those who are at greater risk of harm.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 4.1

ach person is supported to develop the skills to

protect and promote their own physical, mental,

emotional and social health and wellbeing and protect

themselves from harm.

Features of a service meeting this standard are likely to include:

4.1.1 The design and delivery of the service supports all aspects of each person’s

physical, mental, emotional and social health and wellbeing in line with the service’s

statement of purpose9 or equivalent, such as a mission statement.

4.1.2 The service ensures that there are practices and initiatives to promote the

maintenance and improvement of the health and wellbeing of each person.

4.1.3 Each person is supported to:

▪▪ assess their own physical, mental and emotional health and wellbeing on an

ongoing basis

▪▪ identify and develop the life skills they need to maximise their independence

and to develop and maintain social networks

▪▪ develop the skills to advocate for themselves and to protect themselves

from harm.

4.1.4 E

ach person is facilitated to access, in a timely way, the range of health and

wellbeing and development services which protect their health and help to keep

them safe, recognising the person’s range of needs beyond their current health and

social care setting.

4.1.5 E

ach person is supported and encouraged to participate in their communities of

identity and choice.

WHAT DOES THIS MEAN FOR ME?

▪▪ I have supports and opportunities to learn new skills and to understand, protect

and promote my rights, health and wellbeing.

▪▪ I am supported to deal with and recover from difficult situations.

▪▪ I am supported to participate in my community of identity and choice.

9 A statement of purpose, or its equivalent, describes the aims and objectives of the service, including how resources are aligned to deliver

these aims and objectives. It also describes in detail the range, availability and scope of services provided by the overall service.

Health Information and Quality Authority and Mental Health Commission

THEME 5:

Leadership, Governance and Management

The key components of governance include: leadership; decision-making; assessing,

balancing and managing risk; ensuring effective communication among staff members;

and providing assurance that the service is performing well.

A well-governed service is clear about what it does, how it does it and is accountable to

its stakeholders. Managers at all levels have an important role to play in strengthening

and encouraging their services’ quality and culture of safety. Effective management

ensures that a service fulfils its statement of purpose, or its equivalent, such as a mission

statement. It does this by planning, managing and organising the service to achieve its

outcomes in the short, medium and long term, and organising the necessary resources

to ensure the delivery of high-quality, safe and reliable care and support. Management

ensures that the service complies with relevant with legislation, national policy, standards

and guidelines.

Leaders and managers of health and social care services are accountable for the safety

and wellbeing of each person using the service. By putting measures in place to prevent

harm from occurring, leaders and managers reduce risk to the person, individual

staff members and the service itself. This can be done by responding to, monitoring

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

and evaluating potential or actual safeguarding concerns through the service’s risk

management system. Managers ensure that services operate in an integrated way with

other services, organisations and professionals, and have arrangements in place to define

responsibilities within and between services to support people who require support from

more than one service.

Management promotes a culture of safeguarding and this is evidenced in the service’s

practices. To minimise the occurrence of safeguarding incidents, and to respond

effectively when concerns arise, a well-led service has clear lines of accountability and

fosters an open culture of quality and safety. This culture is evident in the behaviour and

attitudes of leaders and managers at all levels of the organisation.

Safeguarding is part of the service’s overall policies and procedures and the way in which

the service operates. The service has an adult safeguarding policy that comprehensively

covers how the service works to prevent harm as a result of abuse, exploitation and

neglect and which clearly sets out the steps to be taken if an issue arises. Staff and people

using services are aware of how this policy and associated processes work, and the roles

and responsibilities of those involved are clear.

Management supports and empowers staff to exercise their professional and personal

responsibility to reduce the risk of harm to people using their service, and to promote

each person’s rights, health and wellbeing. Management actively involves staff in quality

improvement initiatives, which allows the service to better respond to identified risks.

Safeguarding principles of empowerment, rights, proportionality, prevention, partnership

and accountability are reflected in the service’s statement of purpose, or equivalent. A

statement of purpose, or its equivalent, describes the aims and objectives of the service,

including how resources are used to deliver these aims and objectives. It also describes in

detail the range, availability and scope of services provided by the overall service.

A well-governed and well-managed service monitors and evaluates its performance

to ensure that the care and support it provides is of a consistently high quality. The

feedback, concerns and complaints of people using the service, and those of their

nominated person, families, advocates and staff, are taken into account as part of this

evaluation process to reduce the risk of harm and to improve care and support.

Services learn from external reviews and inspections and ensure that recommendations

are put in to action to improve the care and support of people using the service.

Health Information and Quality Authority and Mental Health Commission

Standard 5.1

he service has effective leadership, governance

and management arrangements in place with clear

lines of accountability to reduce the risk of harm

and to promote the rights, health and wellbeing of

each person.

Features of a service meeting this standard are likely to include:

5.1.1 The service promotes openness and accountability at all levels so that staff can

exercise their professional and personal responsibility to report in good faith any

concerns that they have about the delivery of safe and effective practices in their

service, in line with service’s policy.

5.1.2 The service fosters interagency working and communication and has arrangements

in place to build networks, relationships and a common understanding of

safeguarding.

5.1.3 A senior identified individual at the highest level of the service has overall

accountability, responsibility and authority for promoting and managing

safeguarding within the service. This includes accountability and responsibility for

overseeing the implementation of these national standards.

5.1.4 The service has an adult safeguarding policy which describes how the service

minimises the risk of harm and abuse occurring, how it responds whenever harm or

abuse is suspected or has occurred, and how it escalates concerns, as appropriate.

This policy is developed and communicated in a way that people can understand.

5.1.5 The service’s policies and procedures reflect the aim of supporting people to

exercise their rights and promote their health and wellbeing and this is led and

supported by senior management.

5.1.6 The management of a service ensures that the service performs its functions as

outlined in relevant legislation, regulations, national policies and standards to

reduce the risk of harm and to promote the rights, health and wellbeing of each

person using the service.

5.1.7 The service sets out clear roles and responsibilities for staff in reducing the risk of

harm and promoting each person’s rights. There are clear reporting arrangements

and lines of accountability and staff know how to access support and advice, when

required. Staff are clear when they should make a referral to adult safeguarding

services in line with national policy.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

5.1.8 The service has an identified staff member, with appropriate knowledge and skills,

who advises and supports other staff to take the necessary actions if they have a

safeguarding concern.

5.1.9 The service has risk management arrangements in place which identify and evaluate

risk and set out appropriate and timely action to safely manage safeguarding risks.

WHAT DOES THIS MEAN FOR ME?

▪▪ The service I use is well led and managed, and I know who is responsible for

my care and support.

▪▪ The staff caring for and supporting me know they can raise concerns if they

think I might be at risk of harm.

Health Information and Quality Authority and Mental Health Commission

Standard 5.2

he service strives to continually improve the quality

of the care and support it provides to reduce the risk of

harm and to promote the rights, health and wellbeing

of each person.

Features of a service meeting this standard are likely to include:

5.2.1 Arrangements are in place to review and evaluate the service to ensure that it is

delivering care and support that is in line with the principles of safeguarding, and

these are reflected in the statement of purpose, or its equivalent.

5.2.2 Arrangements are in place to review and evaluate the way in which the service:

▪▪ reduces the risk of harm

▪▪ promotes each person’s rights, health and wellbeing

▪▪ responds to safeguarding concerns

▪▪ takes action to improve staff practices and the outcomes for each person.

5.2.3 The service collects information to assess its performance in preventing and

responding to safeguarding concerns, appropriate to the service. Recommendations

from external reviews and inspections and actions to address these

recommendations are included in this assessment. This information is used to

identify strengths and highlight areas for improvement. It is also used to ensure that

issues are addressed appropriately, trends are detected and learning takes place.

WHAT DOES THIS MEAN FOR ME?

▪▪ Staff in my service are always looking for ways to improve the care and

support given to me and other people using the service.

▪▪ I have opportunities to share my views on the service and how it could be

improved to best suit my needs and the needs of others. I am informed of how

my feedback has been used to improve the service.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

THEME 6:

Responsive Workforce

Effective staff recruitment helps to ensure that there are sufficient staff available at the

right times and with the right experience, qualifications and skills to meet each person’s

needs. Safe and effective recruitment and workforce planning ensures that members of

staff have the necessary abilities to undertake their roles confidently and safely and to

meet the service’s requirements.

All staff working in a service have a role in promoting the rights, health and wellbeing

of the people using that service. They also have a role in reducing the risk of harm to

people using the service and need to know how to respond if they are concerned that

harm has occurred. Everyone involved in providing care and support should be trained

and competent in safeguarding knowledge and skills, appropriate to their role. Providing

education and training to all staff enables them to apply the necessary knowledge and

skills to reduce the risk of harm and to promote each person’s rights, health and wellbeing.

Staff exercise their professional judgment and are creative and flexible in their approach

to meeting each person’s care and support needs. As aspects of service provision and

the needs of people using the service change and develop over time, staff need to be

supported to participate in training and education to retain, reflect and build on their

safeguarding skills and knowledge.

Health Information and Quality Authority and Mental Health Commission

The workforce is key to delivering a safe, high-quality service and should be supported

to do this both individually and in effective teams. Retaining staff ensures continuity

of care for people using the service and supports people to build secure and trusting

relationships with staff. All staff receive support and supervision to ensure that they

perform their role to the best of their ability. This includes providing supports to manage

the impact of responding to harm that occurs as a result of abuse, neglect

and exploitation.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 6.1 The

service plans, organises and manages the

workforce to reduce the risk of harm and to promote

the rights, health and wellbeing of each person.

Features of a service meeting this standard are likely to include:

6.1.1 Staff recruitment is in line with relevant legislation, for example Garda vetting

requirements and any relevant registration, licensing, accreditation or other

regulatory obligations, and is informed by evidence-based human resource

practices.

6.1.2 The service ensures that, at all times, there is a sufficient number of staff who have

the required experience, qualifications and skills to meet the safeguarding needs

of each person, as outlined in the service’s statement of purpose, or equivalent

document.

6.1.3 Arrangements are in place to promote staff retention and continuity of care. This

supports people using services to build secure and trusting relationships with staff.

WHAT DOES THIS MEAN FOR ME?

▪▪ I know that the staff who care for and support me and others have been safely

recruited by the service.

▪▪ There is always enough staff to care for and support me and other people

using the service.

▪▪ I have the opportunity to build good relationships with the staff members who

care for and support me.

Health Information and Quality Authority and Mental Health Commission

Standard 6.2

he service supports staff to reduce the risk of

harm and promote the rights, health and wellbeing

of each person by providing training, development

and supervision.

Features of a service meeting this standard are likely to include:

6.2.1 Services identify, support and educate staff members to champion best practice

to reduce the risk of harm and promote the rights, health and wellbeing of people

using services — and to support other colleagues to make changes. This includes

sharing the learning with colleagues to support sustained improvement within

services.

6.2.2 As part of their induction, new staff members learn about their role and

responsibilities in reducing risk and promoting the rights of people using the service

and how the service supports them in doing so.

6.2.3 Staff are trained, appropriate to their role, in how to:

▪▪ promote people’s rights, health and wellbeing to reduce the risk of harm

▪▪ identify and assess potential risks and put measures in place to address

these risks

▪▪ reduce the risk of safeguarding concerns arising

▪▪ respond when a safeguarding concern arises.

6.2.4 Staff exercise their professional judgment and are creative and flexible in their

approach to meeting each person’s care and support needs and discuss this

approach with the person.

6.2.5 Staff receive regular supervision, or its equivalent, from their line manager or

another appropriate supervisor. Support and advice on managing safeguarding

concerns is part of this supervision.

6.2.6 A team-based approach to working is promoted through regular team meetings,

reflective learning and effective communication in relation to supporting each

person.

6.2.7 Staff have opportunities to train with staff from other disciplines, to reflect on their

practice together and to foster positive inter-professional relationships.

6.2.8 The service has a system in place to support staff to manage the impact on them of

working with people who have experienced harm.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

6.2.9 Fair and transparent arrangements are in place to support and manage a member of

staff if a complaint or a concern has been expressed about them.

WHAT DOES THIS MEAN FOR ME?

▪▪ I know that staff have the right skills and experience to care for and

support me.

▪▪ I receive care and support that is flexible enough to suit my changing needs.

Health Information and Quality Authority and Mental Health Commission

THEME 7:

Use of Resources

The use of resources theme relates to how resources are planned, managed and

delivered. Resources include human resources (which includes staffing), financial

resources and environmental resources. The way a service uses resources is important to

how safeguarding concerns are both prevented and responded to.

Effective management ensures that a service organises and aligns the necessary

resources to ensure the delivery of high-quality, safe and reliable care and support. It

is important that there is accountability for use of resources and that there is funding

allocated specifically to adult safeguarding. Decisions about funding are driven by

the needs of each person using the service. People using services are consulted on

environmental changes, such as upgrades to a service’s facilities or buildings, and on

changes to the service.

Resources are used effectively to create safe care and environments in which the people

using services are supported in promoting their rights, health and wellbeing. Resources

are also used to respond to safeguarding concerns as they arise. In times where there is

pressure on a service’s resources, resources are used and allocated in a way that does not

negatively affect people’s right to be safe.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 7.1

esources are used efficiently to reduce the risk

of harm and promote the rights, health and wellbeing

of each person.

Features of a service meeting this standard are likely to include:

7.1.1 The service identifies the resources it needs in order to promote the rights, health

and wellbeing of each person and to reduce the risk of harm.

7.1.2 The service effectively uses available resources to prevent and manage

safeguarding issues and concerns. The right of people to be safe when using

services is not diminished by pressure on resources.

7.1.3 Any refurbishment of a service’s facilities or buildings considers how the physical

environment can contribute to promoting each person’s rights, health and

wellbeing, for example having the least restrictive environment.

7.1.4 People using services are consulted on changes to the service or upgrades to the

facilities or buildings.

WHAT DOES THIS MEAN FOR ME?

▪▪ The service makes the best use of resources to keep me safe from harm and

promote my health and wellbeing.

▪▪ My views, and the views of other people using the service, are taken into

account when a service is building a new premises, refurbishing the existing

premises or changing how the service works.

Health Information and Quality Authority and Mental Health Commission

THEME 8:

Use of Information

For services, having access to good quality information and effective information systems

is essential for improving the quality of the service generally.

In the context of safeguarding, information is an important resource in planning,

managing, delivering and monitoring safe services. Having good-quality information

is central to planning and delivering services to people to reduce their risk of harm and

promote their rights, health and wellbeing. Good quality information can also inform

wider improvements that benefit all people using the service.

Information should be:

▪▪ relevant

▪▪ comparable

▪▪ accurate

▪▪ accessible

▪▪ reliable

▪▪ punctual

▪▪ timely

▪▪ clear.

▪▪ coherent

Each person’s personal information is recorded, stored and managed confidentially and

in line with legislation, national policy, standards and guidelines. While services should

always seek consent before sharing a person’s information, there may be times when

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

their information needs to be shared without consent. Where such information is shared, the

person to whom the information relates to is informed about this. Data protection legislation

allows for the sharing of information without consent where there is a substantial concern

for the person or another person and when there is a lawful basis to do so.

In order to provide coordinated care, there is a need for effective communication and

information exchange within and between services. It is essential that services have

defined arrangements in place for sharing information within and between services and

that all staff are aware of these arrangements. This ensures that where information is

shared it is done so in a way that protects the privacy and confidentiality of the person to

whom the information relates and that it complies with relevant legislation.

Health Information and Quality Authority and Mental Health Commission

Standard 8.1

Information is used to effectively reduce the risk

of harm and promote the rights, health and wellbeing

of each person.

Features of a service meeting this standard are likely to include:

8.1.1 Each person’s information is securely stored, collated and managed in line with data

protection legislation.

8.1.2 The service uses relevant information to inform and support the delivery of personcentred, safe and effective services and to improve outcomes for each person using

the service.

8.1.3 Staff inform people about the recording and intended use of their personal

information.

8.1.4 Arrangements are in place to facilitate each person and or their nominated person to

have access to their personal information in line with legislation and policy.

8.1.5 Each person’s personal information is retained and destroyed in accordance with

legislation and national policy.

WHAT DOES THIS MEAN FOR ME?

▪▪ My information is kept safe and is only used to help the service improve the

care and support they provide.

▪▪ I am facilitated to have access to my information.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Standard 8.2

he service shares information appropriately to keep

people safe.

Features of a service meeting this standard are likely to include:

8.2.1 Policies are in place for sharing and transferring information in an efficient and

timely manner to support effective safeguarding. This includes sharing information

within and between services in a way that protects the privacy and confidentiality of

the person to whom the information relates, in line with legislation, national policy,

standards and guidelines.

8.2.2 Arrangements are in place for staff to access information, appropriate to their role.

Staff know in what circumstances information about a person is shared, how to

share it appropriately and inform the person that this information has been shared.

WHAT DOES THIS MEAN FOR ME?

▪▪ When there is a safeguarding concern, my personal information is only shared

by staff if I agree to it or if it is being done to keep people safe.

Health Information and Quality Authority and Mental Health Commission

Glossary of Terms

Abuse: a single or repeated act, or omission, which violates a person’s human rights or

causes harm or distress to a person. The main areas of abuse which cause people harm

are physical abuse, emotional abuse, sexual abuse, neglect of the person and financial

abuse. It is important to note that this is not an exhaustive list.

Adult: a person aged 18 years or older.

Adult at risk: a person who is aged 18 years or older who needs help to protect

themselves from harm at a particular time. A distinction should be made between an

adult who is unable to safeguard him or herself, and one who is deemed to have the skill,

means or opportunity to keep him or herself safe, but chooses not to do so.

Advocate: a person who assists an individual in making their views known. Advocacy

comes in different forms. This may include informal support or independent advocacy

services.

Autonomy: the ability of an individual to direct how he or she lives on a day-to-day basis

according to personal values, beliefs and preferences.

Capacity: in line with the Assisted Decision-Making (Capacity) Act 2015, ‘capacity’ means

‘decision-making capacity’ and refers to the ability to understand, at the time that a

decision is to be made, the nature and consequences of the decision in the context of the

available choices at that time.

Equality: individuals or groups of individuals have equality of opportunity, and are treated

equally and no less favourably than other individuals or groups on different grounds set

out in equality legislation.

Exploitation: the deliberate maltreatment, manipulation or abuse of power and control

over another person; to take advantage of another person or situation.

Family: an individual who is a parent, guardian, son, daughter, brother, sister, spouse,

civil partner or cohabitee of the person using services.

Harm: the impact of abuse, exploitation or neglect on the person. Harm arises from any

action, whether by a deliberate act or an omission, which may cause impairment of

physical, intellectual, emotional or mental health and wellbeing.

Integrated care and support: health and social care services working together, both

internally and externally, to ensure people using services receive continuous and

coordinated care and support.

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

Neglect: whenever a person withholds, or fails to provide, appropriate and adequate care

and support which is required by another person. It may be through a lack of knowledge

or awareness, or through a failure to take reasonable action given the information and

facts available to them at the time.

Nominated person: a person who has been expressly identified by the person using the

service and who has been given authority by that person as an individual with whom

information in relation to them may be shared and who can assist them in making their

views known. A nominated person can be a family member or another person who has

an interest in the welfare of the person using the service. The involvement of any person

is in line with the expressed wishes of the person using the service.

Person using services: a person who uses health and or social care services.

Positive risk taking: the taking of calculated and reasoned risks, which recognises that

there are benefits as well as potential harm from taking risks in day-to-day life.

Restrictive practices: practices that intentionally limit a person’s movement,

communication and or behaviour.

Risk assessment: the overall process of risk analysis and risk evaluation. Its purpose is to

develop agreed actions for the identified risks. It involves collecting information through

observation, communication and investigation.

Risk management: the systematic identification, evaluation and management of risk. It is

a continual process that aims to reduce risk to an organisation and individuals.

Safeguarding: measures that are put in place to reduce the risk of harm, promote and

protect people’s human rights and their health and wellbeing, and empowering people to

protect themselves. Safeguarding is fundamental to high-quality health and social care.

Service: any health or social care service where care and support is provided to adults.

Shared decision-making: a two-way communication process between staff providing

health and social care services and the person using these services to help guide

decisions about the person’s care and support.

Staff: the people who work in, for or with a health or social care service. This includes

individuals who are employed, self-employed, temporary, volunteers, contracted or

anyone who is responsible or accountable to the service.

Statement of purpose: a document that describes the aims and objectives of the service,

including how resources are aligned to deliver its aims and objectives. It also describes in

detail the range, availability and scope of services provided by the overall service.

Health Information and Quality Authority and Mental Health Commission

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Health Information and Quality Authority and Mental Health Commission

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Health Information and Quality Authority and Mental Health Commission

Appendix 1 — Membership of the Advisory Group

and the HIQA and MHC Project Team in 2018

Advisory Group membership

Name

Organisation

Áine Flynn

Director of Decision Support Service, Mental Health Commission

Anne Dempsey

Communications Manager & Training Facilitator, Third Age Ireland

Anne O’Loughlin

Principal Social Worker (Retired), Irish Association of Social Workers

Ann-Marie O’Boyle

Investigator, The Office of the Ombudsman

Catherine Cox

Head of Communications and Carer Engagement, Family Carers

Ireland

Christine Barretto

Social Care Worker, Cheeverstown House Community Services,

Social Care Ireland

Ciara McShane

Regional Manager (Disability Services), HIQA

Conor Foy

Administrative Officer, Older Person’s Unit, Department of Health

Donal Hurley

Principal Social Worker, National Safeguarding Office, Health

Service Executive (HSE)

Emma Balmaine

Chief Executive, St John of Gods, Private Hospitals Association

Iris Elliott

Head of Policy and Research, Irish Human Rights and Equality

Commission

Ita O’Driscoll

Garda Sergeant, An Garda Síochána National Liaison Officer for

Older People, An Garda Síochána

Linda Moore

Standards, Compliance and Quality Officer, Health Quality and

Service User Safety (Mental Health), HSE

Mark Felton

Solicitor, The Law Society

NATIONAL STANDARDS FOR ADULT SAFEGUARDING

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