APPENDIX 5
Memorandum by Social Services Directorate
Worcestershire County Council (EA5)
INTRODUCTION
Worcestershire County Council welcomes the establishment
of the inquiry and believes it is timely to examine the impact
of "No Secrets". However, whilst accepting the
need to have a focus on elder abuse, Worcestershire County Council
would wish to see the terms of reference extended to all vulnerable
adult groups. Adult protection work is concerned with a wide range
of vulnerable adults, of which elders are a part, ie people experiencing
physical/learning disabilities and mental health issues. The latter
group of individuals has particularly been neglected in terms
of research.
The commonalties across service groups in terms
of strategic developments, prevention, investigation and recovery
need to be recognised and brought together in order to prevent
any inequality in how the abuse of vulnerable adults is addressed.
The inquiry is asked to take a very broad approach
to examining the underlying societal value systems, which affect
the prevalence of the abuse, eg ageism. It should also take account
of the need to approach the subject from a whole systems approach,
eg the role of the criminal justice system which includes enforcement
routes, "speaking up for the justice", the work of domestic
violence units and community policing.
COMMENTS OF
SPECIFIC TERMS
OF REFERENCE
Prevalence of Elder Abuse
— Worcestershire County Council has
limited statistical evidence at this point in time as the systems
for collecting it are still being developed. However what is available
could be provided to the inquiry. Local authorities will be at
varying states in their area but all should hold some data, which
should be examined by the inquiry.
— In terms of research data, the inquiry
should consult people such as Professor Paul Kingston, University
of Wolverhampton; Professor Hilary Brown, Solomons.
— The causes of elder abuse relationships
of abusers to "victims" and triggers are documented
in local authority policies and procedures. The link for Worcestershire's
policy and procedures is www.worcestershire.gov.uk.
Settings of Elder Abuse
These are explored in the policy and procedures
document—see above.
What interventions are successful in preventing
elder abuse? What more can be done to protect older people?
— The recognition that elder abuse
happens is fundamental to any progress in prevention. It is a
commonly reported statement that adult/elder protection is currently
at the stage child protection was at 20 years ago. One of the
factors that influenced progress in that field was the refusal
of society overall, and some professional bodies, to acknowledge
the extent of abuse. Adult abuse/protection work has the very
real capacity to outstrip child protection work based on the numbers
of vulnerable adults and the existence of a category of abuse
which rarely applies to children, ie financial abuse.
— The protection of all vulnerable
adults requires the existence of robust, accessible, high quality
services, which address holistically the individual needs of vulnerable
people. This requires a proactive, rather than reactive, mindset
and ranges from perhaps most easily identified areas of health
and social care provision through a whole continuism to such issues
of financial regulation, eg Bank's code of conduct. As long as
resources and services remain under pressure the potential for
abuse is unnecessarily magnified. Staff working in this field
need to be adequately trained and qualified and recognition of
the necessary skills need to be validated in both professional
and monetary terms. There is a need to bring forward, as matter
of priority, outstanding legislation, eg Sexual Offences Act and
Mental Incapacity Act; without the enactment of such statutory
powers both vulnerable adults, and those engaging with them, are
exposed to an unsafe environment. The dependency on "professional
judgement" and "best interests" is not always good
enough to protect vulnerable adults.
INFORMAL CARERS
— Whilst acknowledging the particular
issues related to abuse by informal carers, eg carer stress/breakdown/interpersonal
relationships, it does not appear appropriate that abuse perpetrated
by "informal" carers should be removed from the mainstream
response to abuse. Experience would suggest that abuse by "informal"
carers often reflects a long-standing history of complex personal
relationships and may indeed be inter-generational. The inquiry
is asked to give consideration to exploring the issues of carer
stress as opposed to pre-existing factors, eg a history of domestic
violence, sexual offences.
— The ability of elders, and indeed
all vulnerable adults, to report abuse is directly related to
the whole issue of their vulnerability. People continue to behave
as they do because it fulfills their needs. Changing that behaviour
is dependent on a realistic alternative being provided. This relates
to the previously identified issue of robust services and also
highlights the need for substantial resources to be targeted at
advocacy services. These have been found to be empowering and
significant in the ability of vulnerable adults to make positive
progress.
— Support for informal carers needs
to be under-pinned by sufficient resources in the preventative
field. The issue of informal carers being abused by those they
care for needs to be addressed as an issue in its own right.
FORMAL CARERS
— The lack of national performance
indicators relating to adult abuse/adult protection could appear
to be indicative of the lack of central government commitment
to this area of work. Whilst the issue of funding being related
to performance is a subject for debate the fact that no new resources
are targeted towards adult protection begs a fundamental question
for its priority in the government's agenda.
— Worcestershire County Council's experience
is that the creation of the National Care Standards Commission
has brought the issue of adult protection into intense relief.
Sound working relationships exist that promote a focus on adult
protection in care homes. This demands the commitment of substantial
amounts of time, effort and skills, which have not necessarily
been recognised or accounted for in the workload of the Commission.
— The effectiveness of any regulatory
body is dependent on the skills of staff, adequate resources,
commitment and ability to make enforcement powers "stick".
Worcestershire County Council recognises the need to collate its
contract compliance powers with the statutory powers of the National
Care Standards Commission and works constructively to achieve
this.
— Efforts are frustrated by several
significant factors, eg:
— The government's continuing failure
to implement the POVA list—by implementing this there could
be substantial and significant impact on the protection of vulnerable
adults. There is hardly a day that goes by that the lack of this
tool is not lamented by those engaged in Adult Protection work.
— The inquiry is asked to facilitate
this section of the National Care Standards Act as a matter of
urgent priority.
— The ability to recruit adequately
trained and skilled staff in care homes. The overreliance of care
homes on agency and adaptation nurses is of particular concern.
The latter issue highlights issues not only for the individual
concerned, there can be little argument that some are subject
to "abuse" in their own right, but also reflect the
lack of priority given to this critical area of work.
— The ability of abusive staff
to infiltrate the care system is of massive concern. Consideration
needs to be given to the current CRB checks, which includes the
concerns of providers regarding the costs incurred.
— With the apparent "crack
down" on those exploiting young people consideration needs
to be given to the potential for abuse carers to move more proactively
into areas of adult abuse. There is already some evidence that
web-sites are being created, targeting vulnerable older women.
— The systems for ensuring appropriate
use of medication (NSF/"Free Nursing care"/NCSC Pharmacy
Inspectors) need to be built upon. The issue of chemical restraint
and chemical management should be explored, particularly in regard
to those individuals experiencing mental health problems.
— The working practices and relationships
with care homes undertaken by GPs should be examined, eg "prescribing
without visiting the individual" and "blanket"
coverage of homes.
RECOMMENDATIONS FOR
NATIONAL/LOCAL
STRATEGY
— "No Secrets" currently
focuses attention on adult abuse and represents a sound framework
for taking adult protection issues forward. It was inevitable
that this focus would lead to an increase in identified incidents
of abuse. This highlighted the deficiencies in the overall services
and structures that support vulnerable adults in some areas.
— No additional resources were identified
to implement "No Secrets" for any of the vast
range of partnerships agencies. Consequently a high-risk area
of activity is seriously under-funded with inevitable effects,
such as the undermining of the very policies and procedures designed
to protect vulnerable adults and the potential disaffection of
staff engaged in this work.
— Any strategy that this inquiry constructs
must be underpinned by a resource allocation which is realistic
and equitable.
— A representative of Worcestershire
County Council would be willing to give oral evidence to the inquiry.
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