Changing the culture
106. Written evidence from the NCSC observed that
"the single most important way to tackle elder abuse is to
raise awareness of the way that older people should be treated
by society as a whole, and the standards of care and behaviour
to which they are entitled."[89]
We agree that a clearer understanding and better information about
the standards of care that people should be able to expect should
help in tackling both the unintentional abuse reflective of poor
practice, as well as ensuring that abusive behaviour is more likely
to be challenged.
107. Help the Aged, and other witnesses, made the
point that in tackling elder abuse it is essential to bring about
a fundamental change both in the culture of organisations, and
— more profoundly — in the attitudes of society. Awareness
of elder abuse remains low, and people are insufficiently conscious
of what behaviour constitutes abuse and should simply not be tolerated.
Challenges by society to ageist and discriminatory attitudes will
bring about change over time. In seeking a change of culture that
recognises the human rights of older people, and the fact that
any abuse is a violation of those rights, we believe that the
NSF for Older People could do more. The NSF is, in our view, very
welcome for the explicit message it presents that age discrimination
is unacceptable. Professor Ian Philp for the Department told us
that the NSF created a "framework for change that emphasised
treating old people with dignity and respect", but acknowledged
that there were not specific levers within the NSF concerned with
targeting elder abuse. Professor Philp referred us to the review
of the NSF that is being undertaken by CHI, the Social Services
Inspectorate and the Audit Commission, and suggested that the
implementation of the Single Assessment Process provided an opportunity
for inquiry to be made into the presence of any abuse: "We
have within the single assessment process for the first time the
possibility of systematically and proactively identifying and
managing older people at risk of or receiving abuse."[90]
108. Tackling the problem of elder abuse requires
not just specific strategies, but also a general emphasis on raising
standards and improving the regulation of health and social care
services. We recognise the range of measures that the Government
has taken to raise standards of care. In particular, the introduction
of the NSF for Older People provides an opportunity to drive up
standards. The development of regulation of care services is also
welcome, but we recognise that this is a gradual process that
will not bring change overnight.
109. We urge those undertaking the review of the
NSF for Older People to pay particular attention to opportunities
for tackling elder abuse. We welcome the potential for the Single
Assessment Process to address the possibility of abuse in all
assessments of older people. However, we believe that more can,
and should, be done. This may require the development of additional
standards and milestones within the NSF.
110. There are no standards for adult protection
contained within the NSF. In order to ensure consistent good practice,
we recommend that this omission is rectified. The policies and
procedures set out in No Secrets could be used to form
the benchmark of a NSF standard. This action would allow for quality
performance-management and audit, both at local and national level.
111. AEA commented on the need to "recognise
that all nations and cultures are different, often with unique
histories, traditions, religions and experiences and that these
need to be taken into consideration when responding to issues
as sensitive as elder abuse."[91]
They contended that while it was difficult for mainstream
communities to recognise and admit abuse of older people, it was
doubly so for some minority communities who might feel alienated.
AEA also recognised that the definition of elder abuse might vary
from culture to culture, making detection even more difficult.
112. The CDNA suggested that "cultural differences
and language barriers can be a trigger for abuse."[92]
If care workers failed to recognise the cultural, religious and
ethnic diversity of those they are caring for, this could be considered
a further form of elder abuse, depriving the individual of their
personal identity and leading to low-esteem.[93]
113. We recommend that advocates on elder abuse drawn
from black and minority ethnic communities should be identified,
trained and deployed. Further, we recommend that training given
to social care workers relating to ethnicity is assessed to ensure
it takes proper account of elder abuse.
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