Safeguarding Adults Awareness Week

I learnt from my Twitter stream (thanks to Lindsay_Pike) that as well as being Carers’ Week, this week is also ‘Safeguarding Adults Awareness Week’.  I had never come across this as a ‘week’ before so used my carefully honed research skills to type ‘Safeguarding Adults Awareness Week’ into Google to see what it might be about.

There seem to be some local events arranged in Windsor, Kent and a nice sand sculpture in Cornwall as well as other places, it had certainly completely passed me by.

While the very scientific poll undertaken in Rotherham on the site of the councillor who was promoting it says that

76 % of the people surveyed were aware of safeguarding. A similar survey two weeks ago showed 54% recognition. The campaign of posters on the back of buses had been particularly successful.

I wonder if this ‘week’ though is truly ‘national’ and how important awareness is to identification and work to fight against abuse of adults who might be at risk of abuse.

There is a vast chasm between awareness of abuse towards adults and children – for me the division is arbitrary at best. Abuse of a person with knowledge/power/influence towards someone who lacks the ability – cognitive/physical or emotional to guard against it should be tackled regardless of the age of the so-called ‘victim’.

Why should society deal differently with the perpetrator according to the age of the person who is abused if the power differential is equivalent?

This is why I find the divisions and differences between the way that safeguarding is managed in childrens and adults services so different.

There are a lot of assumptions made though in the world of safeguarding. One is that anyone ‘old’ or anyone ‘disabled’ is automatically a s0-called ‘vulnerable’ adult. That isn’t necessarily the case.

But when someone who is at risk of being abused is – the responses from all parties can be patchy.

Perhaps that is why there is a differential in the way that safeguarding is investigated – the determination of being at risk is more straightforward with children because there are clear age boundaries to guide when an action is abuse and when it isn’t.

With adults, it is a value judgement about capacity and power relationships and that loaded word that I can’t quite find a perfect replacement for – vulnerability.

What makes one adult more vulnerable to abuse than another and is there a continuum of vulnerability that can cloud the way investigations are dealt with? In some situations it is brutally clear – Winterbourne View, for example, but when an historically abusive relationship between a husband who is physically violent towards his wife progresses as she develops dementia – at what point does it become an issue for social services to step in?

Between two ‘capacitious’ adults where there are no children involved, this would not be a situation for social services. With a progressive dementia or other vulnerability, it does.

For me, this is a very live issue as I work with a few people who have historically been in abusive relationships and when we intervene and when we are able to intervene becomes a very key judgement in a safeguarding investigation.

The key issues of human autonomy and human rights come into play in so many of the judgements we make regarding decisions of when and how to investigate safeguarding issues and what is and is not a safeguarding issue.

For me, I find I relate much more to the philosophical tenets of rights, responsibilities and ethics as I try and fit together the marginal decisions and the importance that an assessment of capacity can have on the life of another. The ability to reflect on the day to day decisions that might otherwise be taken speedily become more evident and more clear.

I can’t escape of the heavy moral responsibility that I feel in my day to day work. Every decision I make about prioritising, about capacity and in much clearer terms about hospital admissions weigh increasingly with the thought of implication, choice, rights and outcomes.

A thoughtless and unexamined practitioner is a dangerous practitioner.

Sometimes we can choose to overcomplicate and overanalyse but without consideration we can forget the power that we have.

So this week of Safeguarding has more or less passed me by but it is something that I’ll ponder on for much more than a week. I hope that next years’ week, if it exists, has some more thought and coherence behind it (and that it doesn’t coincide with Carers’ Week!).

Safeguarding

I have a few safeguarding investigations underway at various stages at the moment. There are a lot running concurrently and while wanting to patter off the usual gripes and groans about workloads increasing at different rates, at different times of the year – I can safely blame my current predicament on a shortage of staff and of people who have trained up to complete safeguarding investigations within our team.

Historically, it would have been one of those situations which would have been lead by the social workers in a multi-disciplinary team – because the local authority provides additional training for us in this respect and it is seen to fit into the ‘social work’ role and domain  but over the last year, this training and this role has been extended to other disciplines.

For my part, while I don’t want to discuss any of the details of any of the cases, there are some interesting comparisons to make in some of the factors involved.

In two of them, the people with whom I work are the alleged ‘perpetrators’ – both ‘incidents’ took place with residential care settings. This is not as uncommon a situation as might be assumed. We are often, with the resources we have, placing people where the beds are – sometimes there is little choice in the process because there is such a limited resource of the right type of beds in the right type of areas. It may be pot luck where a bed turns up and who might be placed in the room next door. This isn’t meant to scare anyone in this position but it is an interesting recognition of the status of the older adult in our society and perhaps a remnant of the ‘work house’ model.

There are some and actually a lot of excellent residential and nursing care homes and a lot I personally know that have thoroughly devoted and hard-working staff but the care homes that we work with exclusively are privately operated. Times are hard and everyone has to pay attention to base line costs. Placements can be ‘worth’ thousands and homes may feel either pressured (by social services departments, by social workers, by their own wish to ‘help’) to take placements that might not be ideal for all the residents already in situ.

While there is a lot of excellent work done in smaller group homes for younger adults with learning disabilities, the cost of smaller homes is much higher and the funding for older adults is much lower in general so there is less attention, less choice and arguably poorer quality of service. Often the quality depends as much though on the individual members of staff who may be working on particular days as the physical layout of the home but it figures that paying at minimum wage level is barely going to promote extensive loyalty to a particular care home or team. Some companies capitalise on these matters by feeding off the better nature of caring members of staff and it’s hard to argue for raising costs at the moment when money is so short but it comes as no surprise when quality is poor.

Abuse within residential homes between one resident and another can be dealt with in different ways and I have seen very different approaches used – from the ‘trying to brush things under the carpet’ type approach where the care home were terrified of local newspapers and family members of other residents finding out what had happened and trying to cover up a serious criminal offence committed by one resident on another – to an over compensation and a crack down on what might be assumed to be a relatively minor incident with very little risk to either party, that would happen in any situation when you put together a group of people.

In all these situations, there is a balance of risk assessment that needs to be considered particularly where capacity and understanding is a factor.

One of the interesting points for me is that I am party of the investigation process of other social workers in other teams. This led me into one particularly tricky situation as one of them I felt was, to be frank, making a complete hash up of the process and was adding little coherence or clarity. I tried not to be over-critical to a point that I felt her practice was pretty poor and I did raise this. I know, it isn’t very comradely but I felt no great affinity due to the way that things had been done.

I tried to highlight it as a very clear training need rather than as poor practice and I do genuinely believe it was because she either hadn’t been guided particularly well by her manager or hadn’t a clear handle on the process herself.

Then I found out she was actually an unqualified worker. She shouldn’t have been carrying out safeguarding investigations at all. Cue the slightly guilty feeling along with more than a little frustration geared towards her manager who has both badly advised her in the processes of the investigation and has placed her in a position to do work that she really shouldn’t have been doing. It is a completely different team and service area from the one in which I work so I have to be measured and I’ll probably wait for the conclusion to input more about this particular matter as I’ve made my feelings and thoughts known but I can guess why it has been done.

Staffing levels and funding. The cuts are not going to be brushed off easily.

Of the others I have in progress, one is a very straightforward (because there is a stack of substantial evidence that is irrefutable) but unpleasant, another seems to be a little more difficult to extract as it may have depended on a few misunderstandings but it may not have.

I know it has been recorded and researched that adult abuse is rife. I know there are reams of policies written about it but it does still seem to be misunderstood in a lot of settings – particularly the policies where a service user – usually either residential or day services – is an alleged perpetrator. Sometimes the policies which try to compartmentalise don’t allow for much give or if someone is both an alleged victim and an alleged perpetrator.

Perhaps it is due to societal predispositions and assumptions about the status of who a ‘victim’ is and who a ‘perpetrator’ might be.

One of the best lessons I’ve learnt and one of the most useful as I try to follow through all these pieces of work simultaneously is to try and cast aside as many assumptions as possible. The longer you work with people the more you realise how wholly misconceived  some of these assumptions can be.

No Secrets or No Action?

Yesterday, Community Care reported that as a response to the consultation on changes to the ‘No Secrets’ guidance on Safeguarding Adults published in 2000, Safeguarding Adults Boards will be mandatory for all English local authorities and an inter-ministerial board will be created between the Department of Health, Department of Justice and Home Office.

Well, it’s a start, I suppose. In my own experience, procedures and support have been virtually toothless in safeguarding adults procedures  – especially if there are additional areas of incapacity involved where the abused party is not able to make statements or complaints themselves.

I could share many stories of lack of action – mostly as the procedures which currently exist do not have much force to them.

We do our investigations and reach conclusions but personally, I can say that response from the police has been minimal if it exists at all – and then where do ou go with the information? The investigations can be paper exercises and the offending party is told to act in a specific way.  Vulnerable adults don’t pluck on the same heartstrings as vulnerable children even though the act of abuse is no better or worse.  Abuse of someone who is vulnerable is abuse, regardless of the age of those concerned.

This is currently one of the most frustrating issues about the work that I undertake. Hopefully these ‘boards’ will push for more action to be taken when there are cases brought to them.

The positives are that now there is a law against mistreatment of vulnerable adults (thanks to the Mental Capacity Act 2005) – in fact, we are dealing with an issue which might lead to prosecution at present,  but the amounts of times things have had to be ‘let go’ due to lack of motivation to make changes or we are told that cases will not be brought to court because the victim is not a reliable witness, well, I wouldn’t like to say.

More focus on adult protection is, without doubt, a priority in my view. Hopefully, this places it as a priority.

Protected: Decisions

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Protecting Adults

A quick comment about this story about a couple with learning disabilities who were awarded damages of £100,000 against Hounslow Council which was subsequently withdrawn from them following an appeal.

They had been victimised over a period of time by local ‘youths’ who had been using their home as some kind of ‘safe house’ in which to take drugs and store stolen property.

Judges ruled Hounslow Council was not negligent in failing to look after the couple, who have learning disabilities…

The judges said they had “every sympathy” for the family, but the council was not responsible.

It was a groundbreaking initial judgement made back in May 2008 because Hounslow were charged with not adequately protecting vulnerable adults.

A social worker had told police the vulnerable pair were being exploited, but was informed that no action could be taken unless the couple complained themselves.

The council employee had also called for the couple to be rehoused.

Lawyers for the couple argued the social worker should have realised they were in danger and had them moved.

Hounslow Council took their case to the Appeal Court which ruled the council had no duty of care to the couple.

Sir Anthony Clarke, who headed the appeal judges, said: “There is an important difference between a case where children assert that a duty of care is owed to them and a case like this where the claimants are adults living in the community, albeit vulnerable adults.”

This really sums up the difficulty with the Safeguarding Adults procedures as they are at present. Adults, however vulnerable or lacking of capacity, are treated by the law in exactly the same respect all adults are – namely being responsible for pressing charges and for giving evidence in court in order to bring any kind of prosecution.

I actually have sympathy for the social worker in this case because our hands are very much tied. ‘Having people moved’ is not a straightforward process – unless perhaps we are considering residential or more supported housing. I have had exactly a similar argument with an older adult where she was exploited in her home and we were asked to consider residential care. This is a woman who would by no means be considering any kind of residential care placement if it weren’t for the exploitation but because there were difficulties relating to taking the matter to court to deal with the perpetrator, we were left with the option of her having to move out of the home she had lived in comfortably for 20 years into a more supported setting, simply to make her safe.

It makes me angry that we have to remove people from homes when it is others that are creating the difficulties around them.

I can only hope that situations like this highlight and inform the current debate about needing new and more effective legal mechanisms to protect vulnerable adults in the community.

Abuse at Greenacres

I came upon a story over the weekend in the Daily Telegraph. It relates to a horrific series of abuses that took place in a residential home for adults with learning disabilities in Kent. No criticisms of money-saving private companies here this time, because this home was run by the NHS – in fact, by the West Kent NHS and Social Care Trust. To sum up, the residents of Greenacres

were subjected to repeated physical and psychological abuse, cruelty, and neglect, according to the “serious case review” carried out by Kent and Medway’s Safeguarding Vulnerable Adults committee.

The adults, who suffered from serious learning disabilities, were allegedly punched, slapped, force-fed, locked in toilets, and scrubbed down with a toilet brush by a care worker over a period of almost three years, according to a summary report by the committee, seen by this newspaper.

image asplosh at Flickr

More than damning, I’d say, and close to horrific. This is over a long period of time and without doubt premeditated. It was condoned by management who were, allegedly, present when these incidents took place.

And the Crown Prosecution Service drops the charges against the alleged perpetrator.

The review said prosecutors decided that although charges against the care worker “could probably have been proven, it was considered not in the public interest to prosecute the care worker when more senior staff and managers who had failed to deal with the abusive behaviour had not been prosecuted.”

Well, as a member of the public interested in natural justice for those who have been abused horrifically, I’d want a better reason than that as to what is in my public interest. As well as, of course, knowing why others can’t be prosecuted too.

Not least because I want to know if this person/people will ever be in the position to work with people again – not just vulnerable people but any people. The care worker and the managers responsible deserve custodial sentences – that is what would be expected if those who were abused were under 18 or did not have learning disabilities, so why is the system which we operate in so blatantly discriminatory?

The NHS trust’s former chief executive, Jonathan Wilkes, who retired in 2006, said he thought the CPS’s decision not to prosecute was “wrong” but admitted his organisation had “probably” failed to manage the home properly.

The trust which took over the NHS service said the worker was disciplined, but would not say if she still worked for the health service.

‘Probably failed to manage the home properly’??? That’s very gracious of him to admit that.

Let’s see

West Kent NHS and Social Care Trust, which ran the home until 2006, “failed to make adequate provision for senior management in the home” for six years. It said the running of Greenacres was weak due to sickness, but that there was also evidence managers had ignored reports that abuse was occurring.

So why no charge of corporate neglect? Why is Jonathan Wilkes himself not having to stand trial. Of course we are back to poorly funded and ineffective management but for SIX years. That is deeply rooted institutional incompetence.

Where are the rights of those who suffered this abuse over a period of years? How are these stories able to only drag themselves to minor public attention in a short column of a newspaper? Why isn’t this on the front page of the Sun? I’d happily back a campaign to bring every single person who condoned and knew that this level of abuse was happening to be sacked and prevented from ever working with vulnerable adults and children again.

Mark Goldring, the Chief Executive of Mencap, is quoted in the article saying

“What is most scandalous about this is that this abuse was chronic; according to this report it was going on for an extended period of time.” During that time, people knew it was going on, yet they did nothing.”

He said too often cases of abuse against people with learning disabilities did not result in a conviction. A parliamentary report earlier this year found that one per cent of allegations to one adult protection committee led to a prosecution.

One percent?!? We should all of us be scandalised by this. This is the area we need support in. Why can’t we provide the same standards for vulnerable adults that we come to expect for children? Why aren’t these kinds of cases the ones shouting at us through the front pages of the national press?

After all, the report the Telegraph saw was the unpublished report of the Safeguarding Adults Committee which was obviously leaked to them.

I know, all these questions are rhetoric. I don’t expect answers or at least, I know what they are. There isn’t the same level of public interest in these stories. This abuse is condoned because vulnerable adults make poor witnesses in court – I know this from having tried to bring a case to court where a child was abusive towards his elderly parent with dementia. You can fight and fight but in the end however you know the background the ‘unreliable witness’ card will always be drawn in the end.

It does go to show why the Safeguarding Adults procedures, guidelines and rules we work with are spineless and heartless.

I know there are current proposals to change them. It would help if we had more exposure for these types of situation though.