Select Committee on Health Second Report

1  Introduction

1. "The voice of older people is rarely heard by those who have a responsibility for commissioning, regulating and inspecting services."[1] This remark was made to us by Gary Fitzgerald, representing the charity Action for Elder Abuse. Mr Fitzgerald pointed out that many people would be familiar with the case of Victoria Climbié, a child tortured and murdered in the care of a relative, but few knew about Margaret Panting, a 78-year-old woman from Sheffield who died after suffering "unbelievable cruelty" while living with relatives. After her death in 2001, a post-mortem found 49 injuries on her body including cuts probably made by a razor blade and cigarette burns. She had moved from sheltered accommodation to her son-in-law's home — five weeks later she was dead. But as the cause of Margaret Panting's death could not be established, no one was ever charged. An inquest in 2002 recorded an open verdict.

2. We announced our intention to hold this inquiry on 23 October 2003 with the following terms of reference:

A small, but significant, proportion of older people experience abuse from those who care for them; either in the context of informal care (by family and friends), or health and social care staff. A commonly used definition for elder abuse is: "a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person."

In light of this definition the Committee will examine the prevalence and causes of abuse of older people:

How prevalent is elder abuse?

Is there adequate research data on the extent of abuse of older people? How robust is the evidence, and what are its shortcomings? Have specific issues, such as abuse in black and minority ethnic communities been neglected? Which types of abuse are most prevalent?

What are the causes of elder abuse?

Who are the abusers? What is their relationship to the victim? What are the triggers for abuse? Do factors such as age, illness, race and gender affect the incidence of abuse?

The settings of elder abuse

Are there differences between abuse committed in a domiciliary or family setting and abuse in an institutional setting? Are there institutional factors that help create an abusive environment or are the risks greater in the domestic setting where care workers are more likely to be working alone?

What can be done about it?

What interventions are successful in preventing elder abuse? What more can be done to protect older people?

Informal carers:

Which organisations should take the lead in cases of abuse by informal carers? Can older people be encouraged to come forward and report abuse? Are adequate systems in place to detect abuse opportunistically? What more can be done to support and protect informal carers?

Formal carers

Are clinical and care guidelines (e.g. NSFs, NICE etc) adequate? Are effective performance management systems in place? Is the new regulatory framework adequate or do other institutional structures need to be in place? What is the role of CHI/CHAI, the NCSC and other regulatory bodies in the protection of vulnerable elders and should their roles be strengthened? What is the role of inspections? What is the role of staff training? What restrictions can be introduced or improved on the recruitment and monitoring of staff? Are arrangements for the Protection of Vulnerable Adults adequate? Are there particular concerns about older people making use of Direct Payments to employ care workers?

Recommendations for national and local strategy

How can the Government's strategy be improved? Are existing government standards and guidelines adequate? What are the policy options? What are the priorities for action?[2]

3. Fundamental to progress in the prevention of elder abuse is the recognition that it exists within society. Tessa Harding, Senior Policy Adviser for Help the Aged, described it as "an extremely hidden topic."[3] Many witnesses argued that the recognition of elder abuse was at a comparable stage to that of child abuse 20 years ago. One of the factors that influenced the slow rate of progress in the field of child abuse was the refusal of professional bodies and society overall to acknowledge the extent of the problem.

4. We wanted our inquiry to raise awareness of the problem of elder abuse. On 11 December 2003, we took oral evidence from representatives of Action on Elder Abuse (AEA); Help the Aged; the Prevention of Professional Abuse Network (POPAN); the Community and District Nursing Association (CDNA); the Registered Nursing Home Association; the Association of Directors of Social Services (ADSS); the UK Home Care Association; and the National Care Homes Association. On 22 January 2004, we took evidence from representatives of the National Care Standards Commission (NCSC); the Commission for Health Improvement (CHI); the General Social Care Council (GSCC); and from Dr Stephen Ladyman, MP, Parliamentary Under-Secretary of State for Health and officials from the Department of Health (hereafter 'the Department').

5. In addition, we received 40 written memoranda from a variety of professional bodies, pressure groups, charities and individuals that were invaluable in helping us form our conclusions. We are most grateful to all who presented written or oral evidence.

6. Our specialist advisers in this inquiry were Melanie Henwood, an independent health and social care analyst, and Chris Vellenoweth, an independent health policy adviser. We wish to express our gratitude to them for their help on technical matters, for giving us the benefit of their knowledge of care for older people, and for the enthusiasm and expertise with which they assisted us at each evidence session.

1   Ev 146 Back

2   Health Committee Press Notice 42, Session 2002-3. The definition of elder abuse used here was derived from Action on Elder Abuse. Back

3   Q 2  Back

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Prepared 20 April 2004