See Something? Say Something! by Dawn Rideout

I wonder what springs to mind when you think of protecting those most at risk of harm in our community?

Do you think of the unkempt elderly lady, with cluttered house and signs of self–neglect, the gentleman with dementia who lost his life savings to a financial scam, the middle aged man with a learning disability subject to modern day slavery, or perhaps the young woman with mental health difficulties who died at home only to be found deceased several years later?  Or does your mind instinctively turn to the shocking stories of neglect, abuse, and even death of babies, toddlers, and young children?

Stories about harm to children often gain the greatest media coverage, but all of the scenarios mentioned above involving adults are examples of recent cases that don’t necessarily make it to the front pages of our news feeds. Therefore, it can be difficult for us to recall with the same detail the names and the stories of the adults harmed or abused. Nonetheless, some of those most at risk of harm, including here in Dumfries and Galloway, are in fact adults and we have seen all different types of harm occurring in our region.

So how ready are you to face the challenges that you may come across in your day- to- day role when faced with adult support and protection (ASP) situations such as those mentioned above? 

As health care staff we not only have a moral responsibility, but also a statutory responsibility under the Adult Support and Protection (Scotland) Act 2007 to be involved in the prevention of harm to adults by identifying and referring concerns to Social Work and by cooperating with our social work colleagues who are  undertaking inquiries. This includes adults who we might see at home, in clinics, in residential settings or in our hospitals. As healthcare workers we might be the only people who set eyes on some of the most at risk members of our communities. This places us in a unique position to recognise and respond when something just isn’t right. The 5R’s of Public Protection are a helpful prompt to remind us of the steps we need to take.

Please check out our links to short videos on each of the 5R’ s in next week’s Core Briefing.

We know that people are often cautious about making referrals to Social Work because they feel that adults should have the ability to make their own choices about how they live. Of course it is right that adults should be involved in decisions that affect them. However when these choices are leading to harm, for example a diabetic man refusing treatment for an infection risking the loss of his leg, or a lady living in a home that is cluttered to the extent that it causes a fire risk, then we do have a duty to act. It is important to note that we still need to make a referral when we identify a concern even if the adult at risk is already known to social work as this could be a new worry, an increased risk or a missing piece of the jigsaw.  

Our 7 minute briefing on Beacon under “Referral and Contacts” includes advice on how to make a referral and what information to include. Link

The development of ASP champions is an exciting move to increase awareness of ASP on the ground across the organisation. If your area doesn’t yet have a champion, please get in touch to find out more about the role.

Additionally, Turas, LearnPro and face-to-face training delivered by the Public Protection Team and by the multiagency partnership are all avenues to finding out more about your role and responsibilities in protecting adults at risk of harm.

TURAS ASP link

SA and MA Training calendar

Friday 17^th February is the final day of Public Protection Week Link to Calendar of events

and we hope that you or your team have managed along to some of the sessions and are able to share the learning with your teams.  

The Social Services Council have an iPhone and Android App that can help with understanding and decision making in ASP and we recommend downloading this to your phone as it is a great resource to have to hand.

Public Protection is everyone’s responsibility and next week the Public Protection Team have stands at various sites. We are at Mountainhall Treatment Centre on Monday 20th February (National ASP Day) and DGRI on Tuesday 21^st February. If you see us, please say hello and together let’s help raise the profile of ASP here in D&G.

#SeenSomethingSaySomething

Contact Us

The Public Protection Team can also offer supervision, advice and support to anyone who wishes to discuss concerns about an adult at risk of harm.

Phone: 01387 244300 

Email: dg.asp@nhs.scot or dg.childprotectionteam@nhs.scot

Useful Links

NHS Public Protection Accountability and Assurance Framework

NHS Education for Scotland public protection national e-learning education resource

Adult Support and Protection Code of Practice

Adult Support and Protection (Scotland) Act 2007: guidance for General Practice

Dawn Rideout is a Senior Public Protection Advisor for NHS Dumfries and Galloway

A Certain Darkness is Needed to See The Stars by Sarah Gemmell

There are only two certainties in life, being born and dying.

Sadly children are not exempt from the latter.

Coming into a profession like nursing or medicine, the main drive for a lot of people is to make people better and to send them home. Thankfully for us in paediatrics, this happens for the majority of our patients, there is nothing better than seeing little ones recover and wave us goodbye as they leave the ward. On the occasions that this does not happen, it is heartbreaking for everyone involved.

Over my 22 years of nursing, I have experienced a number of child deaths, each one completely different. I feel it is fair to say that even though the team have the best intensions and always want to do their upmost for each patient and their family, we don’t always get it quite right, but is there such a thing as a “good death”?

We know that not getting it quite right is just not acceptable. We want to make sure that every child who is at the end of their life is given the best possible care. Families should have access to the highest level of support. We recognised that we need to have processes in place for this to be achieved.

In 2019 the CAPELLA team was created. CAPELLA stands for Community And Paediatric End of Life Linked Attributes team, it is also the brightest star in the sky. The team’s aim is to provide care and support to patients and their families in the last few weeks of the child’s life, in the environment that they choose. This could be at home, in the children’s ward or in one of the Children’s Hospice’s Across Scotland (CHAS).

The team consists of registered nurses and health care support workers from the acute children’s ward and Community Children’s Nursing team and a local paediatrician. The team work closely with CHAS to be able to provide some level of support, 24/7, in a way that the patients and families need. Unfortunately, it is not always possible to have nursing care face to face at every moment; however we strive to provide as much as we possibly can. We have also been extremely fortunate and are exceptionally grateful to the adult community services that can, when appropriate, help to support us too. The CAPELLA team will do their best to listen to the wishes of each patient and family which means the level of support may vary, dependant on what it is they ask for. There is a mix of face to face and over the phone support.

The nurses and health care support workers strive to provide the best nursing care for the patient, and/or support the families to be able do this. They administer medications, provide basic cares, allow families to have a break, support with any other children in the home and even make cups of tea or assist with anything around the home or simply be at the end of the phone if it means we can make this devastating time a little easier. The paediatricians are there to provide guidance and support to the patients and families, taking the lead from the families, and ensuring they are equipped with all the information they need and request. CHAS help to guide and support us and where possible provide nursing care in the home or at one of the hospices.

For me, being able to be at the forefront and providing the hands on support or being in the background to co-ordinate these processes, both equally as important as the other, it has been the most privileged experience of my career. I am extremely humbled to be able to try and allow families to have influence and control over the uncontrollable.

We are very fortunate to have been donated 2 supplies boxes so that we have an adequate amount of equipment stored safely when going into homes. These boxes were donated by the McQueen family in memory of little Tyler McQueen, a beautiful little lad who we cared for just before the CAPELLA group was started.

We have also been fortunate to have amazing memory boxes created and provided for use in Dumfries and Galloway by the Cranston family, in loving memory of Beri Cranston, a most precious and beautiful baby girl. The memory boxes are there for any family who lose a child. They are considerate of all ages and circumstances. There are other memory boxes available nationally from SANDS and SiMBA charities, these boxes are provided to families who have lost a baby.

The CAPELLA team are also there to support any family throughout their bereavement journey, inclusive of those we have had no prior involvement with. We can be contacted via email dg.capella@nhs.scot with any queries to assist with things like questions about where to find support moving forward. We are in the process of developing an information leaflet titled, “When Your Child Has Died, Information for You”. The purpose of the leaflet is to help guide families through what I am sure may be a very confusing and heartbreaking time, pointing them in the direction of support and providing advice.

The health professionals who support patients and families also need support. The CAPELLA team recognise this, which is why we ensure that all those professionals who are involved or have been affected are offered ongoing support and counselling. We always ensure staff are offered the opportunity to attend a debrief session where there is safe space to share their experience and feelings.

Is there such a thing as a “good death”?

 I say yes, with an amazing team and clear processes in place, we can make a massive difference to patients and families at such a devastating time.

Sarah Gemmell

Advanced Paediatric Nurse Practitioner/Paediatric Epilepsy Nurse Specialist

Supported by:

Sarah Murphy

Deputy Charge Nurse, Paediatric Ward

Dr Eccleston, Paediatrician