Safeguarding Adults

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Safeguarding Adults

• Mary Wynne
• RBKC Safeguarding Adults Coordinator

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Backround

• In 1998 the Longcare Inquiry raised concerns
  about the protection of vulnerable adults in
  regulated settings
• In 1998 the DoH embarked on producing an Adult
  Protection policy framework to offer greater
  protection to vulnerable adults.

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No Secrets Guidance 2000

• Local Authorities have a lead role to
• make sure there is an effective policy in
  place to protect vulnerable adults at risk from
  abuse
• To ensure there is a consistent and effective
  response where concerns, formal complaints and
  anxieties have been raised.

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Underlying Principles of No Secrets

• Primary aim is preventing abuse-training staff,
  CRB/POVA List checks, contracts, public awareness
• Agencies to work together on the prevention,
  identification, investigation of alleged,
  confirmed or suspected abuse
• Clear understanding of who does what
• All staff and volunteers have a duty to act on
  any concern or suspicion
• All agencies have a duty to act on an allegation
• Management has a key role in setting standards of
  practice, taking decisions and fostering an open
  and supportive culture

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No Secrets

• There can be no secrets and no hiding place when
  it comes to exposing the abuse of vulnerable
  adults
• No Secrets March 2000

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Key Features of the RBKC policy

• Local Policy launched Nov 2002-must be
  followed-signed up by partner agencies (health
  trusts,police,RBKC,housing)
• Includes all agencies with an emphasis on
  achieving a shared approach
• Includes all vulnerable adults in all settings
  and all forms of abuse
• Sets out a clear process for responding to
  concerns

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Who is a Vulnerable Adult?

• A person aged 18 years or over
• 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 or
  herself, or unable to protect him or herself
  against significant harm or exploitation.
• (Who Decides Lord Chancellors dept 1997)

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What is Abuse?

• Abuse may consist of a single or repeated acts.
  It may be physical, verbal or psychological, it
  may be an act of neglect or an omission to act,
  or it may occur when a vulnerable person is
  persuaded to enter into a financial or sexual
  transaction to which he or she has not consented,
  or cannot consent. Abuse can occur in any
  relationship and may result in significant harm
  to, or exploitation of, the person subjected to
  it
• No Secrets DoH March 2000

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Forms of Abuse

• Financial or material-theft, forced changes to a
  will, preventing access to money, loans between a
  VA and member of staff or paid carer, loans made
  under duress
• Physicalhitting, slapping, pinching,hair
  pulling, pushing, kicking,inappropriate
  application of techniques (control restraint),
  misuse of medication, force feeding, involuntary
  isolation
• Sexual-non-contact-inappropriate looking,
  photography, indecent exposure,
  innuendo,harassment, enforced witnessing of
  sexual acts
• Contact abuse-inappropriate touching, forced
  masturbation of either or both persons, sexual
  assault, rape

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Forms of Abuse

• Psychological/emotional-prevention of using
  services, denial access to friends, lack of
  stimulation and meaningful occupation, verbal
  threats and humiliation, intimidation
• Neglect or acts of omission- failure to provide
  food,shelter or clothing,failure to provide
  medical care,hygiene or personal
  care,inappropriate use of medication, denial of
  educational,social and recreational needs, lack
  of stimulation or emotional warmth

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Forms of Abuse

• Discriminatory-unequal treatment, verbal abuse,
  inappropriate use of language, derogatory
  remarks, harassment, deliberate exclusion
• Institutional Abuse - occurs when the rituals and
  routines of a service result in the lifestyles
  and needs of individuals being sacrificed in
  favour of the needs of the institution

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The Local Picture

• Operational matters
• Safeguarding Adult investigations are coordinated
  by the appropriate social work adult team.
• There is good liaison with the Metropolitan
  Police and the Community Safety Unit whose
  safeguarding adults lead is a Detective Sergeant
  from that unit.

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Strategic Structure

• The RBKC Safeguarding Adults Management Committee
  meets
• quarterly and is chaired by the Head of Adult
  Social Care. Membership
• includes senior managers from the following
  agencies-
• Housing
• Social Services
• Crown Prosecution Service
• Community Safety Unit and Community Safety Team
• Health-including PCT, Acute Trusts (Chelsea
  Westminster, Royal Brompton, Royal Marsden,
  Mental Health Trust)
• Voluntary Sector (Equal People, MIND, Age
  Concern, London Cyrenians, ADKC, Migrant Refugee
  Forum)
• Independent Sector (Care UK, Goldsborough Home
  Care)
• Commission for Social Care Inspection

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Making Links with Health

• Much successful work has been undertaken with
  the statutory sector in order to try to raise
  awareness of the Safeguarding policy-
• Chelsea Westminster Hospital developed
  internal procedures
• PCT-there has been an agreement to introduce
  safeguarding adult questions to the Quality and
  Outcome Framework as part of the annual
  monitoring of GPs.
• PCT Learning from Experience Group
• The Central North West London Mental Health Trust
  (CNWL) now has a safeguarding adults steering
  group

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Making Links with Crime Disorder

• Safeguarding adults is linked into the Domestic
  Violence work -MARAC
• Report to the Safer Surer Policy Board
• Present to monthly Partnership Tasking Group
• Working with the Community Safety Partnership
  Inspector to explore how we can make use of the
  Crime Prevention Design Advisors in safeguarding
  enquiries as they currently do in domestic
  violence cases.
• Make better links with the Safer Neighbourhood
  Teams

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Training Programme

• Training budget funded by HHASC and PCT
• Six courses run on a multi-agency basis
• Training strategy is being reviewed with a view
  to developing a more comprehensive multi-agency
  training programme from a pooled budget
• SAC undertakes briefings to agencies

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Public Awareness

• Public information booklet produced Nov 2005
• More accessible version being developed for
  people with LD.
• Elder Abuse Awareness Day on 15th June 2006
  2007-marked with a leafleting campaign, included
  all GP practices, libraries and CABs as well as
  leafleting members of the public on Kensington
  High Street
• RBKCs Media and Communications Officer is
  assisting in developing a public awareness
  strategy on safeguarding adults

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Equality Impact Assessment

• Equality Impact Assessment completed in
  December06. The assessment revealed some
  negative impact in relation to the Asian
  community, older men and young people with mental
  health problems. This is being addressed in the
  action plan.

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Prevention

• Contract officers and commissioners of services
  ensure that provider agencies have clear
  expectations in relation to knowledge about the
  safeguarding adults policy and their role in it.
  Therefore all contracts for services working with
  vulnerable people include Safeguarding Adult
  requirements e.g. provider agencies must have
  robust recruitment practices and make Criminal
  Record Bureau POVA list checks.

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Monitoring

• The RBKC safeguarding adults monitoring system
  has been in place since the launch of the policy
  and enables us to look at trends e.g. where the
  safeguarding adult alerts are coming from, type
  of abuse, who the perpetrators are etc. The use
  of case monitoring information informs the
  prevention strategy.

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Monitoring Figures

• The number of safeguarding adult referrals to
  RBKC social work teams significantly increased by
  45 in 2006/7.
• Suggests greater awareness of the policy than an
  increase in abuse
• CSCI found that the median number of referrals
  among councils of adult abuse cases rose by 32
  from 2005-6 to 2006-7.

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Monitoring Figures by Type of Abuse

• Financial Abuse35
• Physical Abuse25
• Psychological Abuse20
• Neglect9
• Sexual8
• Institutional1.4

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Monitoring Figures for 2006/7

• Total referrals for Older People 58 of all
  alerts.
• Total referrals for People with Learning
  Disabilities 20 of all alerts
• Total referrals for People with Physical
  Disabilities 13 of all alerts
• Total referrals for People with Mental Health
  Problems 7 of all alerts

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Alleged Perpetrators

• Care Worker31
• Relative21
• Friend10
• Spouse/Partner3
• Health worker2.8
• Other VA2.8
• Stranger2.8
• Neighbour2.2
• N/K19

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Outcomes of Enquiries

• Outcomes of enquiries in terms of progressing
  them through the criminal justice system are
  extremely low. In the last 18 months few have
  been identified. This is a national concern. The
  recent Action on Elder Abuse Research report
  (March 2006) identified that out of 639 referrals
  to social services only 5 (0.75) resulted in a
  decision to precede with a criminal prosecution.

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RBKC WCC Policy Review

• The joint WCC and RBKC policy procedures were
  published 5 years ago and are currently being
  reviewed by a multi-agency task force.
• Launch expected May 2008

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Pan London Procedures

• Representatives from the London Adult Protection
  Network met with the Social Care Institute for
  Excellence in Oct. Dept of Health policy leads
  are pleased for SCIE to go ahead with developing
  Pan London Procedures.
• The DoH are also interested in using this project
  as a way to assist with the review of No
  Secrets.

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Met Police- Vulnerable Adults Policy Review

• Violent Crime Directorate heading this review
• Police want to maximise the process and capture
  all allegations in whatever format is suitable
  for VAs.
• Want to ensure non-crime reports are flagged to
  ensure intelligence is properly gathered
• The policy will break down the issues into 3
  categories-
• Domestic Violence-using the DV Standing
  Operational Procedures but include additional
  guidance for vulnerable adults
• Hate Crime SOP (this will also include
  children)
• Abuse in Care Settings (regulated and
  unregulated)

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National Developments
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Review of No Secrets

• Commitment made by Ivan Lewis (Parliamentary
  Under Secretary of State for the Department of
  Health) on 14th June 2007 to-
• To review 'No Secrets' guidance and to consult
  with other government departments that have an
  interest in this field . Legislation will be
  considered
• Develop national reporting requirements so that
  each individual council can monitor abuse

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Push for Legislation

• The Association of Directors of Adult Social
  Services called for social workers to be given
  powers to enter the homes of vulnerable adults
  they believe are at risk of abuse.
• Care workers would also be legally obliged to
  take appropriate action when they suspect a
  vulnerable adult is being abused, in the wake of
  recent abuse cases.
• Action on Elder Abuse are also co-ordinating a
  national campaign to push for legislation

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Elder Abuse Prevalence Study June 2007

• Carried out over two years by independent
  researchers at National Centre for Social
  Research and Kings College, London,
• Survey of around 2000 people aged 66 and over who
  live in their own homes (including sheltered
  housing).

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Elder Abuse Prevalence Study

• The findings of the study show that
• - 2.6 or 227,000 people were neglected or
  abused by family, close friends and care workers
  in the last year.
• - 4 or 342,400 people were neglected or
  abused in the last year by family, close friends
  and care workers, neighbours and acquaintances
  (i.e. a broader definition of those who might
  abuse).
• - Mistreatment is broken down into neglect
  (1.1), financial abuse (0.7), psychological and
  physical abuse (both 0.4) and sexual abuse
  (0.2).
• -The majority of the incidents involved a
  partner (51) or another family member (49)
  followed by a voluntary or paid care worker (13)
  and close friend (5).

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Elder Abuse Prevalence Study

• The full Cominc Relief Report can be found
• at -
• http//www.comicrelief.com/elderabuse.

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New Joint Commission - 2009

• The Care Quality Commission, a forthcoming merger
  of the Commission for Social Care Inspection, the
  Healthcare Commission and the Mental Health Act
  Commission, will extend existing enforcement
  powers over local authorities, independent
  providers and the NHS where service users are
  being put at risk, the government announced.
• The commission will be able to close orgs, issue
  statutory warning notices requiring improvement
  within a specified time, impose fines in lieu of
  prosecution, increase frequency of
  inspections . The powers of the commission will
  be included in the new health and social care
  bill due to be introduced in parliament this year.

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New Vetting Barring Scheme

• The Safeguarding Vulnerable Groups Act 2006
  provides the legal framework for the new vetting
  and barring scheme. The Act is a major element of
  a wide-ranging and ambitious programme of work
  established across government to address the
  systemic failures identified by the Bichard
  enquiry into the Soham murders. The DfES, DoH and
  the Home Office are drafting the Regulations
  Guidance that will underpin the scheme. The
  scheme is expected to affect 11 million workers.

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Dignity in Care

• Dignity in Care Campaign-update
• Care Services Minister Ivan Lewis announced there
  are now 1000 individuals who have been recognised
  as 'Dignity Champions' and been rewarded for
  going that extra mile in improving the service
  that older people receive.

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Joint Committee on Human Rights Aug07

• This report focuses on The Human Rights of Older
  People in Health Social Care settings.
• Argues elder abuse is a serious and severe human
  rights abuse and in certain circumstances, amount
  to a criminal offence.
• Argues HRA gives legal force to the concepts of
  dignity, respect, equality and fairness.
• The HRA functions to provide a legal framework
  for service providers to abide by and empower
  service users to demand that they be treated with
  respect for their dignity.

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Human Rights Gap

• The House of Lords ruled in June that the Human
  Rights Act 1998 did not apply to the residents of
  private care homes. This has raised concerns that
  as the ruling is based on the legal proposition
  that private care homes do not provide functions
  of a public nature this leaves residents without
  recourse to challenge human rights abuses.
  Baroness Ashton-Minister for Human Rights has
  pledged to plug the loophole as a matter of the
  utmost urgency.

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New Criminal Offence of Neglect Mental Capacity
Act 2005-

• Recent Prosecution for Neglect-Oct07
• The Managing Director of a care home company and
  other members of staff have been prosecuted on
  the basis that they had neglected residents at an
  old peoples home in Gloucestershire.
• Residents sleeping beside their own waste
• Mouldy faeces found in one of the rooms,
• Filthy toilets
• Lack of any stimulating activities for the
  patients.
• The prosecutions follow a joint operation between
  the local police and CSCI.

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CPS Consultation Crimes Against Older People-

• The CPS published a public consultation on its
  draft policy for prosecuting crimes that are
  carried out against older people. It sets out how
  the CPS prosecutes these cases and supports
  older people who are victims witnesses
• www.cps.gov.uk

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Recent CSCI Publications

• Better Safe Than Sorry -Improving the system
  that safeguards adults living in care homes Nov
  2006
• Safeguarding Adults-CSCI Protocol-Feb 2007
• In Safe Keeping - supporting people who use
  regulated care services with their finances-May
  2007
• Rights, Risks Restraints-an exploration into
  the use of restraint in the care of older people
  Nov 2007
• Social Care-Choosing the Right Service for You
  Jan 2008- guidance and advice for the public

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Helpful Websites

• Action on Elder Abuse-www.elderabuse.org.uk
• Voice UK- www.voiceuk.org.uk