Safeguarding and Clinical Coaching: 10 Recommendations for Success -

There were an estimated 498,260 concerns of abuse raised during 2020-21, an increase of 5% on the previous year. That’s almost an additional 25,000 matters where vulnerable adults have been identified as being at risk of abuse or neglect with the most common location of the risk being the person’s own home.

In line with the NHS Long Term Plan’s aim to boost ‘out-of-hospital’ care, support people to age well, give people more control over their health with a more personalised approach and to drive digitally enabled care services into the mainstream, the role of the Clinical Coach has evolved.

At HN, we use AI-powered predictive analytics to identify and predict vulnerable individuals at risk of requiring immediate hospital or healthcare support.

Using this data, we minimise the impact of adverse health and wellbeing events by offering individuals a holistic care and support service in the comfort of their homes through our clinical coaching approach. Our work has been shown to reduce unplanned care events, such as visiting A&E, which may see a patient hospitalised unnecessarily.

Managed by registered healthcare professionals in partnership with the individual concerned, we consider the physical, psychological, emotional and social aspects of health to develop a bespoke coaching programme which supports their wellbeing needs and priorities.

As we work with a vulnerable cohort, we do encounter situations where individuals are at risk, are subject to abuse or neglect and require protection.

Professional safeguarding training is no longer enough

Safeguarding training tends to be one of the core components of Mandatory and Statutory Training (MAST) in healthcare settings with a requirement to complete a refresher every 1-3 years.

Our society however has changed significantly following two years of restrictions as a result of the pandemic. The forced isolation led to challenges to our physical, mental health and social wellbeing and we are now dealing with the fallout.

Self-isolating, shielding and socially distancing disproportionately impacted on vulnerable populations such as older people, those living with learning disabilities, minority communities and people with underlying health conditions.

It also greatly impacted other vulnerable individuals – those living alone with no/limited support network, those needing care at home, people in abusive relationships and the alarming fears faced by girls and women going about their day-to-day lives.

With this increasing and wide-reaching impact, the role of safeguarding has never been more critical.

A review of professional healthcare training in relation to safeguarding is needed to ensure we have the current knowledge base, best-practice know-how, legislative awareness and skills to respond to and keep abreast of the changing landscape.

Our 10 recommendations for effective safeguarding

Based on our experience, we have set out 10 recommendations for organisations on how to safeguard effectively:

Ensure safeguarding remains a priority in your organisation
Demonstrate and evidence your commitment to tackling safeguarding
Ensure staff are trained and skilled to identify safeguarding issues as they arise
Ensure staff are conversant with current policy and procedure
Invite and welcome patient engagement and feedback at all times and at all levels
Take time to empower, inform and support your patients
Know where to go for help, support and guidance from internal and external colleagues
Work collaboratively with partners, stakeholders and the wider multidisciplinary team
Proactively seek support to learn, reflect and debrief following safeguarding incidents
Treat everyone with respect, kindness and compassion.

All our clinical coaches undertake an accredited clinical coaching programme over six months. They exercise and develop their competencies in interviewing, questioning, uncovering, probing and listening to support in their holistic assessment of a patient’s health and wellbeing goals and objectives.

This professional ‘curiosity’ and partnering with the patient forms the foundations of an inclusive therapeutic relationship and a platform of mutuality, trust and respect. These skills are essential for our Clinical Coaches as part of their duty to support patients with their health and wellbeing goals in an environment which is free from harm and abuse.

Working in partnership with patients is essential

Patient engagement in all aspects of their health and wellbeing is fundamental and is the keystone of our clinical coaching programme. Indeed, patients themselves can help to safeguard their own wellbeing when permitted, empowered and enabled to do so.

Our Patient and Public Involvement (PPI) Strategy provides multiple avenues for our patients to engage, feedback and contribute to the services provided. This allows us to ensure the service provided is safe, caring and responsive to their needs at that time, to monitor and drive quality and improvements, to ensure the service continues to meet and exceed patient needs, and to inform change or development of further packages to meet future requirements.

The principles encompassed within the Care Act emphasise the need to empower people, to balance choice and control for individuals against preventing harm and reducing risk, to respond proportionately to safeguarding concerns and to work with others to find solutions.

In such circumstances we refer to our local policy, our professional duty and our legal responsibility. We always:

Respectfully acknowledge the situation the patient finds themselves
Fact-find to ensure we have an accurate understanding of the concern
Support our patients by using a risk:benefit approach
Ensure patients are fully informed of the risks, benefits, options and potential outcomes
Use professional, clinical and coaching techniques to encourage and empower the patient to better protect themselves
Provide guidance and signposting on where they can get additional support
Ensure we record decisions to refer/not to refer/override
Explain the extent of any required information sharing
Ensure we avail ourselves as a point of contact where appropriate
Keep the matter under review and ensure the patient is informed at all stages.

However, we acknowledge this may not be possible in all circumstances due to the individual nature of such matters, where there are clear reasons for not doing so, and/or where such engagement would put the patient at further/immediate risk of harm.

Nothing short of effective multi-disciplinary teamworking is acceptable

At HN, we recognise the importance and benefits of the multi-disciplinary approach when dealing with safeguarding concerns. While our clinical coaches work remotely, they align to patients in a given geographical area (by Integrated Care System or Primary Care Network footprint for example).

Effective communication is fundamental to safeguarding. A collective approach, sharing information, knowing the roles and responsibilities of those involved and shared responsibility means that safeguarding issues are more likely to be identified at an early stage. It is important to see effective safeguarding as a marker of good care rather than an outcome of poor care.

We are aware that exposure to safeguarding matters can also be stressful and traumatic for our staff and it is essential to have suitable procedures in place to allow for personal reflection, professional support and ‘down-time’ as appropriate.

Summary

Safeguarding is about us all – our colleagues, our families, our neighbours, our friends and our patients. If safeguarding truly is everyone’s business, then everyone needs to be able to recognise it, know how to report it and only then can we progress to putting a stop to it.

The consequences of having poorly informed staff, an absence of robust policy, ignoring or failing to identify safeguarding concerns when engaging with patients and working in isolation could lead to abuse and neglect being missed.

Ahead of National Safeguarding Adults Week 2022 in November, bringing together organisations from across the country to engage in dialogue, share best practice and raise awareness of what being safe means, there is time to reflect on safeguarding in your area to ensure opportunities to intervene are not missed and those vulnerable people under our care are treated with empathy and compassion.

By Scott Beat, Clinical Quality and Compliance Manager at HN