In this article
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:
- Principle 1 – Empowerment – Presumption of person-led decisions and consent
- Principle 2 – Protection – Support and representation for those in greatest need
- Principle 3 – Prevention – Prevention of harm and abuse is a primary objective
- Principle 4 – Proportionality – Proportionality and least intrusive response appropriate to the risk presented
- Principle 5 – Partnerships – Local solutions through services working with communities
- Principle 6 – Accountability – Accountability and transparency in delivering safeguarding
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.
- 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
- Protecting children from abuse and harm
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
There are ten types of abuse listed in the Care Act (2014).
- 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, or withholding medication, adequate nutrition and heating.
- Discriminatory abuse – including racist, sexist 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.
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:
- 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.
- 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 including dental care or treatment and also including the neglect of, or unresponsiveness to, a child/young person’s basic emotional needs
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.
Occupational health is about the effect of health on work, and work on health. Employees in public-facing roles may disclose a health issue to an occupational healthcare worker that raises concerns about their ability to work safely with children and/or vulnerable adults, such as significant mental health problems that could mean children and/or vulnerable adults are or could be at risk.
Occupational health also has a role in protecting the health of employees working directly in the often-distressing field of child and vulnerable adult protection, for example, police officers, social workers and NHS staff. The provision of support services from occupational health can ensure that individuals at risk of psychological harm and distress as a result of their work are helped to manage and mitigate this risk.
Employees with alcohol and other drug issues can lead to other safeguarding concerns such as, but not limited to, homelessness, sexual exploitation and domestic violence.
Occupational healthcare workers 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. All safeguarding concerns vary according to the nature of harm, the circumstances it arose in and the people concerned.
The roles and responsibilities of an occupational healthcare worker in regard to safeguarding
Occupational healthcare workers have an individual responsibility to safeguard people, to identify and respond to allegations of abuse and neglect. Occupational healthcare workers have a duty not only to safeguard all employees that they support, but also to those people who come into contact with the individuals that they support.
An occupational healthcare worker’s role in adult safeguarding is to work in a way that prevents and protects those they support and 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.
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.
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.
What legislation do occupational healthcare workers have to follow in regard to safeguarding?
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).
The Equality Act 2010 – this Act aims to protect people or groups of people who have one or more “protected characteristics”. These protected characteristics are features of people’s lives upon which discrimination, in the UK, is now illegal.
The protected characteristics listed in the Act are:
- Sexual orientation
- Gender reassignment
- Marriage and civil partnership
- Pregnancy and maternity
- Religion and belief
Under the Act:
- Every individual has the right to be treated equally and fairly and not be discriminated against regardless of any “protected characteristics”.
- Every individual has the right to be treated with respect and dignity.
- Health services have a duty to ensure that services are fair and meet the needs of everyone, regardless of their background or current circumstances.
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
Health and Safety at Work etc. Act 1974 – the Act covers a wide range of issues relating to workplace health, safety and welfare across different sectors. Employees have a general obligation under the Act to take care of others and cooperate with employers’ health and safety requirements.
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 and children safe.
The Public Interest Disclosure Act 1998 – this Act, often referred to as the Whistleblowers Act, encourages staff to report suspected wrongdoing and protects those that 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.
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.
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).