Select Committee on Health Second Report


Abuse of older people is a hidden, and often ignored, problem in society. The profile of child abuse has been dramatically raised in the past few years and the Government has acted to introduce controls and measures to identify and tackle that problem; but abuse of older people remains in the background. It has been put to us that 500,000 older people in England are being abused at any one time, yet many people are unaware of the problem and few measures have been taken to address it. Moreover, we are disappointed that the Department has not commissioned research to establish a more precise figure. Abuse occurs in institutional settings, but more often in the home. It can be perpetrated by care staff, relatives, friends and strangers, and can take many forms — sexual abuse, financial abuse, abuse of medication in controlling and sedating patients, physical abuse, neglect and behaviour designed to degrade and humiliate.

Much abuse is not reported because many older people are unable, frightened or embarrassed to report its presence. Often care staff take no action because they lack training in identifying abuse or are ignorant of the reporting procedures. The lack of reporting results in difficulties in determining the true scale of the problem and this is compounded by a dearth of research. Further, varying definitions of 'elder abuse' exist within the health and social care sectors. To enable the extent of the problem to be accurately determined and for uniformity we recommend that an agreed, consistent and comprehensive definition should be applied by all government departments, statutory agencies, independent bodies, charities and organisations. We further recommend that performance indicators should be established as soon as possible to enable accurate measurement to be undertaken. We call for the National Minimum Standards for domiciliary care to require reporting of adverse incidents.

We recommend that the Department reviews the frequency and effectiveness of the inspection of NHS establishments providing care for older people and, in recognising the importance of lay personnel having an input into the inspection process, we urge that further measures are taken to increase user engagement.

The over-prescription of medication is sometimes used in the care environment as a tool for managing residents, and for care staff it can be a means to ease the burden of care of the elderly, especially of those with dementia. The frequency of review of medication and the administration of drugs by unqualified staff is of particular concern to us. We therefore recommend measures are taken to ensure compliance with the National Service Framework target that all people over 75 years of age should normally have their medicines reviewed at least annually, and those taking four or more medicines should have a review every six months. We further recommend that the National Care Standards Commission and its successor body should ensure that medication systems within care homes and domiciliary care reflect good practice and that they disseminate procedures that exceed the national minimum standard.

We have concern about the incidence of financial abuse of older people. We advocate that the prevention, detection and remedying of financial abuse should be included as specific areas of policy development by adult protection committees and we endorse the recommendations in the Draft Mental Incapacity Bill relating to the abuse of powers of attorney.

The lack of training in issues relating to elder abuse (for example, identification, prevention and reporting) is encountered in all the settings in which abuse occurs. We call for mandatory training in the recognition, reporting and treatment of elder abuse for those professionals working and caring for older people. We also recommend that signed-off induction training of domiciliary and other social care workers approved by the appropriate sector skills council should be sufficient for them to apply for registration with the GSCC.

We recognise that there is a case for further guidance to require all local authorities to establish multi-agency vulnerable adults' protection committees and we strongly endorse any measures that make available advocacy services for older people. We further recommend that advocates on elder abuse drawn from black and minority ethnic communities should be identified, trained and deployed. Additionally, we recommend that as a part of the general training of social care workers, issues of ethnicity and culture be included in the curriculum.

While welcoming the introduction of the Single Assessment Process, and the opportunities that it presents for regularly reviewing the care of older people, we believe it is vital that these targets are met in all authorities. We recommend that the Department should monitor the compliance of authorities, and should report on the outcomes of the process. Currently there are no standards for adult protection contained within the National Service Framework. In order to ensure consistent good practice, we recommend that this omission is rectified.

The registration of workers in the care environment was of particular concern to us. We propose that the Government should attend to the issue of registering domiciliary care workers as a matter of the utmost urgency. We urge the Government to expedite the implementation of the Protection of Vulnerable Adults list fully across both health and social care settings. We also recommend that the Department keeps under review the operation of the scheme.

We call for CSCI and CHAI to publish at an early date their joint plans for regulation and to ensure that the health care needs of residents in those settings registered as social care provision are met; for the Minister to require the annual reports of CSCI and CHAI to include details of their joint working and of the experience of the adequacy of the regulation of the health care aspects of care home services provision; and for the Government to keep under review the operation of the respective Commissions.

We call for implementation of stricter controls to ensure that certification of the death of a resident in a care home owned or managed by a GP, or a close relative, should be performed by a GP other than the owner/manager. We further recommend that the practice of the payment of retainer fees to GPs should be abolished.

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Prepared 20 April 2004