GP dilemma: Safeguarding a vulnerable elderly patient

The dilemma: I am worried that the son of an elderly patient may be preventing his mother from accessing appropriate treatment - what should I do and what are my safeguarding obligations?

Dr Bobby Nicholas, medicolegal adviser at Medical Protection responds:

Input from family members can be useful in caring for a patient but there can be situations where the actions of a family member raise safeguarding concerns. With a growing elderly population, the safeguarding of vulnerable adults is likely to play an increasing role in general practice.

What is meant by ‘vulnerable adult’?

‘Vulnerable adult’ is a frequently used term and can be defined as ‘a person who is 18 years of age or over, and who is or may be in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of him/herself, or unable to protect him/herself against significant harm or serious exploitation’.1

Not all elderly patients are automatically vulnerable adults simply by virtue of their age, but factors such as frailty and cognitive impairment may play a part in making an elderly patient more vulnerable to abuse than the general population.

Doctors need to be aware of the importance of safeguarding considerations in such patients. Abuse can take different forms – physical, emotional and financial – and can arise from within a family, through carers or in a residential/nursing home environment.

Your obligations

In this scenario, you should sensitively explore your concerns with your patient in the first instance. If it is appropriate and safe to do so, clarify the situation with the son.

It is important to establish whether the patient has the capacity to make a decision on accessing treatment, what she wants in terms of treatment and with whom she wants this information to be shared with.

If the patient lacks capacity, the Mental Capacity Act says that any decision taken should be in the patient’s best interests but the patient should still be involved in the decision-making process as much as possible.2 It is also important to clarify if the patient put a Lasting Power of Attorney in place relating to health and welfare when they had capacity.

Clearly you will need to consider the potential safeguarding issue here if you have concerns that the son is not acting in the patient’s best interests. The GMC’s Good Medical Practice states ‘you must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised’. It also states that ‘whether or not you have vulnerable adults…as patients, you should consider their needs and welfare and offer them help if you think their rights have been abused or denied’.

There are provisions in each part of the UK relating to safeguarding.3 The CQC considers that regulated providers of health and adult social care services all have a key role in safeguarding children and adults in their care who may be at risk of abuse and neglect.4

Depending on your assessment of the situation, you should also discuss your concerns with your practice safeguarding lead and follow any local policies or protocols regarding raising concerns. This may involve informing social services so that appropriate steps can be taken.

Safeguarding vulnerable adults often manifests in complex scenarios, so you should keep clear, contemporaneous records of your discussions and actions taken. You should also be mindful of the GMC’s confidentiality guidance.5

The GMC has provided some interactive guidance and resources for older adult safeguarding which may assist, which you can access here. If you have any queries, do not hesitate to contact your medical defence organisation.

References

  1. Government consultation paper 'Who decides?' issued by Lord Chancellor’s Department (1997)
  2. Mental Capacity Act (2005) Chapter 9, Part 1, Section 4
  3. The Care Act in England (2014), Social Services and Well-being Act in Wales (2014)Adult Support and Protection Act in Scotland (2007) and Northern Ireland Adult Safeguarding Partnership 
  4. CQC. New safeguarding statement
  5. GMCs confidentiality guidance

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