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Safeguarding Guide for Occupational Healthcare Workers

Responsibilities, worrying signs, legislation, concerns and required training for robust safeguarding

Safeguarding Responsibilities for Occupational Healthcare Workers

Occupational healthcare workers protect and promote the health of people at work. They have direct contact with employees and are often approached with health-related questions and problems.

Employees often see their occupational healthcare worker as a “first port of call” and seek advice on various matters, such as:

  • A non-work-related condition
  • Where to get the best advice on a health issue or personal problem at home
  • Health and safety at work

Occupational healthcare workers are responsible for ensuring that people who use their service can live free from harm, abuse and neglect; this is fundamental to high-quality care and support. As an occupational healthcare worker, you need to understand your responsibilities around safeguarding and the standards that you need to follow.

What is Safeguarding?

Safeguarding is an area of occupational healthcare work activity concerned with the care and protection of adults who have care and support needs and who may be at risk of abuse or neglect. This is a major concern for occupational healthcare workers who have prime responsibility for ensuring as far as possible that the vulnerable clients they work with are protected.

Safeguarding means protecting people from harm including physical, emotional, sexual and financial harm and neglect. Occupational healthcare workers have a duty to recognise the signs and symptoms of abuse and to act on any concerns. Duties to safeguard are required by professional regulators and service regulators and are supported by law.

Safeguarding adults at risk means protecting their right to live in safety and free from abuse and neglect.

Adults at risk means anyone aged 18 or over who:

  • Has needs for care and support.
  • Is experiencing, or is at risk of, abuse or neglect.
  • As a result of those care and support needs, is unable to protect themselves from either the risk of or the experience of abuse or neglect.

Safeguarding also means that individuals are adequately supported to access care and support where this is needed, so that they are able to stay well and maintain a high quality of life. This is achieved by different organisations working effectively together to prevent and stop both the risks and experience of abuse or neglect. Safeguarding aims to balance the right to be safe with the right of the individual to make informed choices and to have their wellbeing promoted at all times.

Safeguarding adults is shaped by six principles:

  • Protection – it is crucial to be an ally for individuals who have experienced or who are at risk of abuse. Supporting and representing these individuals in the appropriate manner can help to protect them from further harm.
  • Accountability – in the event of a disclosure, if an adult or young person entrusts you with information that you know could be indicative of abuse, you must be clear with the individual that you need to report what you have heard.
  • Empowerment – it’s important for any person who has been a victim of abuse to feel that they have control over their situation. Support and encouragement are key to effective working with a victim of abuse or neglect.
  • Partnership – it is important to work in partnership with your local authority and all services or organisations in your community that might be able to assist in detecting and reporting abuse.
  • Prevention – it is sometimes possible to take action before harm has come to an individual. If you know the signs and indicators of abuse, you will understand when something is not quite right and will be better placed to report any concerns for an individual’s wellbeing.
  • Proportionality – when a safeguarding incident occurs, you should report your concerns in a manner that is appropriate for the risk presented. For example, if you suspect that a child is in immediate danger, dialling 999 is the recommended response.

Occupational healthcare workers may occasionally need to advise about young people (aged 16+) in the workplace, who would be covered by child safeguarding legislation, as childhood lasts until a child’s 18th birthday. They may also be required to be aware of issues that affect the parent or carer of the young person that may have an impact on the wellbeing of the young person. In addition, an occupational healthcare worker may work with a client whose health condition may put a child or vulnerable adult at a safeguarding risk inside or outside the workplace, therefore occupational healthcare workers need a full awareness of both adult and child safeguarding.

Safeguarding children is defined in Working Together to Safeguard Children as “protecting children from maltreatment; preventing impairment of children’s health or development; ensuring that children are growing up in circumstances consistent with the provision of safe and effective care.”

Child safeguarding is a set of actions that can be taken to encourage children’s welfare and protect them from harm.

It means:

  • Protecting children from abuse and harm
  • Preventing children’s health and development from being damaged
  • Making sure that children are safe and well-cared for as they grow up
  • Doing things to make sure that children have the best outcomes
Risk factor of abuse

What Risk Factors Make Someone More Likely to Experience Abuse?

Abuse and neglect can occur anywhere to anyone; however, there are risk factors that can make a person more vulnerable to abuse.

An adult at risk of abuse may:

  • Have an illness affecting their mental or physical health
  • Be physically dependent on others
  • Have a sensory impairment
  • Have a learning disability
  • Suffer from drug or alcohol problems
  • Have low self-esteem
  • Be unable to make their own decisions
  • Have a previous history of abuse
  • Have negative experiences of disclosing abuse
  • Be of increasing age
  • Be frail
  • Have experienced a lack of access to health and social services or high-quality information
  • Financial hardship, tenancy/home security risk
  • History of chaotic lifestyle

There is no way to know which children are most vulnerable to abuse, but there are some factors for abuse and neglect risk to be aware of including, but not limited to:

  • Very young children
  • Children with disabilities and health problems
  • Children who have already been, or are currently being, abused and/or neglected
  • Parents who are young when their child is born
  • Parents who are poorly informed about parenting
  • Parents with mental health issues, especially untreated issues, for example depression, antisocial personality disorder, substance abuse and related disorders
  • Single parent households
  • Intimate-partner violence
  • Parents experiencing emotional and/or financial stress
  • Poverty, poor housing and deprivation
  • Social isolation
  • Violence in the community

These lists are not exhaustive, and other adults and children might also be considered to be at risk.

The Types of Abuse Adults Can Encounter

The Types of Abuse Adults Can Encounter

There are ten types of abuse listed in the Care Act (2014).

These are:

Physical Abuse

This may involve physical violence, misuse of medication, inappropriate restraint or sanctions.

Sexual Abuse

This can include verbal sexual abuse, non-consensual touching, fondling, physical restraint, cornering, tickling, kissing, excessive cleaning of genitals, enemas, intercourse, sodomy, oral sex, invasion of privacy and stalking.

Psychological Abuse

This includes emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, harassment and verbal abuse.

Financial or Material Abuse

Including theft, fraud, exploitation, pressure in connection with wills, property, inheritance or financial transactions, and misuse or misappropriation of property, possessions or benefits.

Neglect and Acts of Omission

Including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, withholding medication, and inadequate nutrition and heating.

Discriminatory Abuse

Including racist or sexist abuse or abuse based on a person’s disability.

Domestic Abuse

Including psychological, physical, sexual, financial and emotional abuse, and so-called honour-based violence.

Modern Slavery

Includes slavery, human trafficking, forced labour and domestic servitude.

Organisational Abuse

Including neglect and poor care practice within an institution or specific care setting such as a hospital or care home.

Self-Neglect 

Includes a wide range of behaviour neglecting to care for personal hygiene, health or surroundings and includes behaviour such as hoarding.

Man suffering domestic abuse
Support for woman from abuse

The Types of Abuse Children Can Encounter

Statutory guidance across the four countries of the UK describes four main categories of child abuse, and these definitions will normally be reflected in local organisations’ policies and procedures.

The four categories are:

Neglect

This is the persistent failure to meet a child/young person’s basic physical and/or psychological needs, likely to result in the serious impairment of the child/young person’s development. Neglect may occur during pregnancy, for example, as a result of maternal substance abuse, maternal mental ill health or learning difficulties or a cluster of such issues. Where there is domestic abuse and violence towards a carer, the needs of the child may be neglected. Once a child is born, neglect may involve a parent or carer failing to:

  • Provide adequate food, clothing and shelter, including exclusion from home or abandonment
  • Protect a child/young person from physical and emotional harm or danger
  • Ensure adequate supervision, including the use of inadequate caregivers
  • Ensure access to appropriate medical care or treatment – also including neglect of, or unresponsiveness to, a child/young person’s basic emotional needs

Physical Harm/Abuse

This may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child/young person. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child/young person. Harm can also occur due to practices linked to faith and culture, for example, Female Genital Mutilation (FGM).

Emotional Harm/Abuse

This is the persistent emotional maltreatment of a child/young person such as to cause severe and persistent adverse effects on the child/young person’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child the opportunities to express their views, deliberately silencing them or “making fun” of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child’s developmental capacity, as well as overprotection and limitation of exploration and learning, or preventing the child from participating in normal social interaction. It may involve seeing or hearing the ill treatment of another. It may involve serious bullying, including cyberbullying, causing children/young people frequently to feel frightened or in danger, or the exploitation or corruption of children/young people. Some level of emotional abuse is involved in all types of maltreatment of a child/young person, though it may occur alone.

Sexual Abuse

This involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetrative acts, for example rape or oral sex, or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may include non-contact activities, such as involving children in looking at, or in the production of, pornographic sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse, including via the Internet. Sexual abuse is not solely perpetrated by adult males; women can also commit acts of sexual abuse, as can other children.

What Safeguarding Issues Do Occupational Healthcare Workers Need to be Aware of?

Abuse and neglect can take many forms, ranging from exploitation and disrespectful treatment to physical harm. It can be at a low level, and take place over a long time, or it can take place over a short time and be more extreme. It is all abuse.

Organisations and individuals should not be constrained in their view of what constitutes abuse, neglect or harm and should always consider the circumstances on a person-centred basis. Adult and children safeguarding concerns vary according to the nature of harm, the circumstances it arose in and the people concerned.

Occupational Healthcare Workers often see patients in times of distress and difficulty. It is likely that you may come into contact with someone who is at risk or suffering from abuse or neglect. The abuse or neglect can be deliberate, or the result of ignorance or a lack of proper training.

Recognising abuse or neglect is crucial, and it may:

  • Be a single act or repeated acts
  • Cause harm temporarily or over a period of time
  • Occur when a person is persuaded to enter into a transaction to which they have not consented to, or cannot consent to
  • Be an act of neglect or an omission to act
  • Occur through deliberate targeting/grooming
  • Occur in any relationship
  • Be perpetrated by an individual or as part of a group/organisation
  • Be the result of deliberate intent, be unintentional, or be through negligence or ignorance
  • Involve several abusive acts which are crimes, and informing the police must be a key consideration

Who may abuse or neglect? In short, anyone.

This may include, but is not limited to:

  • Strangers, that is members of the public not known to the abused
  • Spouses/partners
  • Other family members
  • A relative or unpaid carer
  • Neighbours, friends
  • Paid staff including professionals such as nurses
  • Volunteers
  • Another adult at risk
  • People who deliberately exploit adults they perceive as vulnerable to abuse
  • Children

The Roles and Responsibilities of a Occupational Healthcare Worker in Regard to Safeguarding

Occupational Healthcare Workers will have an individual responsibility to safeguard people, to identify and respond to allegations of abuse and neglect. Health services have a duty to safeguard all patients, but also to provide additional measures for patients who are less able to protect themselves from harm or abuse. Safeguarding adults and children covers a spectrum of activity from prevention through to multi-agency responses where harm and abuse occurs. Multi-agency procedures apply where there is concern of neglect, harm or abuse to a patient defined under the Care Act (2014) guidance as vulnerable.

Occupational Healthcare Workers role in safeguarding is to:

  • Recognise – you should have a clear understanding of what the different signs and symptoms of potential abuse, harm and neglect can be. Robust safeguarding training can help you to spot these signs and symptoms.
  • Respond – it is essential that you respond appropriately and do not ignore the situation.
  • Report – concerns need to be reported without delay. Confidentiality is important, so only share information with those who are a part of the safeguarding process.
  • Record – you should make precise, comprehensive notes that detail everything about your safeguarding concern.
  • Refer – if the safeguarding risk is urgent and you suspect somebody is under immediate or severe threat, you should contact the relevant local authority or police services.

Occupational Healthcare Workers have a duty to make sure that:

  • Safeguarding concerns are dealt with promptly, appropriately and reported in a secure and responsible way to all relevant agencies.
  • Steps are taken to escalate or alert those able to protect patients and/or others at risk from harm and minimise risk of abuse.
  • Appropriate and proportionate measures are in place to protect from harm all those who work with them, or come into contact with them.

Occupational Healthcare Workers may find it difficult to accept the patient’s choices such as declining services or acting against advice about how to manage their safety. They may be concerned that they are failing in their duty of care and that they could be found to be reckless or negligent. A duty of care is a requirement placed on an individual to exercise a reasonable standard of care while undertaking activities or omissions that could foreseeably harm others. However, duty of care also includes respecting the person’s wishes and protecting and respecting their rights.

The Safeguarding Issues Occupational Healthcare Workers May Come Across

Understanding what abuse and neglect might look like and how to recognise warning signs is an important aspect of safeguarding. Some examples occupational healthcare workers might encounter may include, but are not limited to:

Self-neglect – this can be a complex and challenging issue for occupational healthcare workers to address, because of the need to find the right balance between respecting a person’s autonomy and fulfilling their duty to protect the adult’s health and wellbeing. It is important to recognise that self-neglect may present itself in many ways and it is unlikely to have a “typical” case.

Indicators associated with self-neglect include, but are not limited to:

  • Poor diet and nutrition
  • Poor personal hygiene, poor healing of medical conditions or injuries

Organisational abuse – this can be the mistreatment of people brought about by poor or inadequate welfare or support in the workplace, or systematic poor policies and practices that affect the whole workplace.

Bullying or harassment – this can be defined as deliberately hurtful or discriminatory behaviour. It is usually repeated over a period of time, and occurs when it is difficult for those bullied to defend themselves. It can take many forms, but the three main types are physical, verbal and emotional. The damage inflicted by bullying can often be underestimated. Bullying can cause significant distress to the individual so much so it affects their health and work.

Domestic violence and abuse – this is any type of controlling, bullying, threatening or violent behaviour between people in a personal or family relationship. Domestic abuse may be disclosed or exposed through occupational health assessments.

A series of complaints or comments from a client about staff workplace behaviours or attitudes.

Danger or risk to health and safety, such as where health and safety rules or guidelines have been broken.

Issues to do with the workplace in general, such as concerns over resources, products, people, staffing or the organisation as a whole, which impact negatively upon the health and wellbeing of employees.

Safeguarding concern

Where Should Occupational Healthcare Workers Go With a Safeguarding Concern?

It is often difficult to believe that abuse or neglect can occur in the workplace. Some concerns may be minor in nature but provide an opportunity for early intervention, for example advice to prevent a problem from escalating. Other safeguarding concerns may be more serious and need a response through multi-agency procedures and possible statutory intervention through regulators, the criminal justice system or civil courts.

If you witness or suspect that there is a risk of immediate harm to a person in your care, you must act straight away to protect their safety. Immediate concerns about abuse or neglect should be dealt with under local safeguarding procedures first. The person who raises a safeguarding concern within their own organisation should follow their organisation’s policy and procedures. This concern may result from something that you have seen, been told or heard.

You should report your concerns to the appropriate person or authority immediately; in the workplace this may be a designated safeguarding lead, or this may be the police in some situations. Involvement of the police is indicated in incidents of suspected theft and common assault, including sexual assault, and assault causing actual bodily harm.

Speaking up on behalf of people in your care is an everyday part of your role. Just as raising genuine concerns represents good practice, doing nothing and failing to report concerns is unacceptable.

Doctor Going Through Health Surveillance Questionaires With Patient, Part of Occupational Health Assessment

What Legislation Do Occupational Healthcare Workers Have to Follow in Regard to Safeguarding?

There are various legal powers and duties across the health, housing and social care sectors that may be relevant in specific cases. These include:

The Human Rights Act 1998 

Applies to anyone whose care or treatment is funded or provided by a public body. Section 6 requires all public authorities to act in ways that are compatible with human rights when making decisions.

The Care Act 2014 

Sets out statutory responsibility for the integration of care and support between health and local authorities. NHS England and Clinical Commissioning Groups are working in partnership with local and neighbouring social care services. Local Authorities have statutory responsibility for safeguarding. In partnership with health they have a duty to promote wellbeing within local communities.

Safeguarding Vulnerable Groups Act 2006 and the Protection of Freedoms Bill

This act was passed to help avoid harm, or risk of harm, by preventing people who are deemed unsuitable to work with children and vulnerable adults from gaining access to them through their work. Organisations with responsibility for providing services or personnel to vulnerable groups have a legal obligation to refer relevant information to the Disclosure and Barring Service (DBS).

Working Together to Safeguard Children 2010

The way that agencies and organisations should work together to carry out their duties and responsibilities under the 1989 Children Act and other legislation is set out in a document called ‘Working Together to Safeguard Children’.

It sets out the responsibilities of all agencies in the protection of children, and is aimed at staff in organisations that are responsible for commissioning or providing services to:

  • Children, young people and adults who are parents/carers.
  • Organisations that have a particular responsibility for safeguarding and promoting the welfare of children and young people.

The Mental Capacity Act 2005

In order to protect those who lack capacity and to enable them to take part as much as possible in decisions that affect them, the following statutory principles apply:

  • You must always assume a person has capacity unless it is proved otherwise.
  • You must take all practicable steps to enable people to make their own decisions.
  • You must not assume incapacity simply because someone makes an unwise decision.
  • Always act, or decide, for a person without capacity in their best interests.
  • Carefully consider actions to ensure the least restrictive option is taken.

The Deprivation of Liberty Safeguards 2009 (DoLS)

An amendment to the Mental Capacity Act 2005, provide a legal framework to protect those who lack the capacity to consent to the arrangements for their treatment or care, for example by reason of their dementia, learning disability or brain injury, and where levels of restriction or restraint used in delivering that care for the purpose of protection from risk/harm are so extensive as to potentially be depriving the person of their liberty.

The General Data Protection Regulations (GDPR) and the Data Protection Act 2018 

Introduced new elements to the data protection regime, superseding the Data Protection Act 1998. Practitioners must have due regard to the relevant data protection principles which allow them to share personal information. However, the GDPR and Data Protection Act 2018 do not prevent, or limit, the sharing of information for the purposes of keeping vulnerable adults safe.

The Equality Act 2010 

Lists nine protected characteristics, and health and social care providers come under the Act as employers and service providers, so they must not discriminate on the grounds of these characteristics.

  • Age
  • Disability
  • Sexual orientation
  • Sex
  • Gender reassignment
  • Marriage and civil partnership
  • Pregnancy and maternity
  • Race
  • Religion and belief

The Public Interest Disclosure Act 1998

This Act, often referred to as the Whistleblowers Act, encourages staff to report suspected wrongdoing and protects those who do against being dismissed or suffering a detriment by their employers. It also gives protection to employees against suffering a detriment or retaliation from another employee for reporting suspected wrongdoing.

The Terrorism Act 2000 

Makes it a criminal offence for a person to fail to disclose, without reasonable excuse, any information which they either know or believe might help prevent another person from carrying out an act of terrorism or might help in bringing a terrorist to justice in the UK.

Guide for occupational healthcare worker

Why is Safeguarding Training Important?

It is important that we all understand safeguarding, and know what to do should safeguarding concerns arise.

Safeguarding induction and training is essential for all staff appropriate to their role, including:

  • Information on types of harm, abuse and neglect
  • How to spot abuse
  • How to respond to concerns
  • Who to report concerns to

Training should be directly applicable to the responsibilities and daily practices of the person being trained, and to the care and support needs of the people that they are working with. An example of appropriate safeguarding training includes Safeguarding Vulnerable Adults (SOVA) Level 2, designed for people who are working with vulnerable adults and teaches the skills needed to safeguard people who are at higher risk of abuse, and Safeguarding Children Level 2, which teaches the skills needed to safeguard vulnerable children who are at higher risk of abuse.

Other training that provides additional skills and knowledge for effective safeguarding include, but are not limited to:

  • Equality and Diversity
  • Domestic Violence Awareness
  • Disability Awareness
  • Sexual Harassment in the Workplace
  • Resilience Training

Managers should evaluate changes in understanding and confidence before and after training, assessing this:

  • Immediately after the training
  • In regular long-term evaluations, for example as part of supervision sessions
  • Annually, for example as part of the performance management/appraisal process

Line managers should provide feedback through supervision and appraisals, acknowledging how occupational healthcare workers have learned from their experience of identifying, reporting and managing safeguarding concerns.

Occupational healthcare worker following legislation

How Often Should Occupational Healthcare Workers Renew Their Safeguarding Training?

Managers should assess occupational healthcare workers’ safeguarding knowledge annually, and run refresher training if needed. To help occupational healthcare workers increase their confidence in managing safeguarding concerns, they should at a minimum refresh their safeguarding training at least every 2 years and participate in continuing professional development (CPD).