APPENDIX 27
Memorandum by Michael L-Strand, Adult
Protection, Human Rights and Equalities Services
1. It is difficult to comprehend, following
the publication of No Secrets, that the term "elder
abuse" appears in this document, and is being examined. The
protection of vulnerable adults is the critical issue, and not
just a proportion of those deemed to be vulnerable.
1.1 In Liverpool we have developed a truly
multi-agency approach to the protection of vulnerable adult. It
is lamentable that NHS agencies have thus far been excluded from
taking an active and leading role in the protection of vulnerable
adults.
1.2 The Royal Liverpool and Broadgreen University
Hospitals and Primary Care partners in the City are uniquely placed
to detect, report and prevent the abuse of vulnerable adults.
The NHS in Liverpool now reports more cases of suspected adult
abuse than any other agency, including the Local Authority.
1.3 Hospital Nurses, Community Nurses, Mental
Health Nurses, Hospital Doctors, Psychiatrists and General Practitioners
are ideally placed to identify potential or actual abuse. Social
Care Staff, NCSC staff and staff from other agencies are likely
to have limited contact with individuals over time, usually only
for a period "active" need.
1.4 Government strategy locally and nationally
to date has focused on the input of Social Care Services, Registration
and Inspection Units (latterly the NCSC) and the Police. Whilst
all of these agencies have their role to play, in many areas of
the UK NHS partners are an afterthought, or not part of the team
at all.
1.5 Work to date in Liverpool Acute Trusts
has shown that abuse is identified or disclosed during/following
attendance at the Emergency Department, Out-Patients Department
or following admission to Wards. Residents of Nursing/Residential
Care Homes have presented with a variety of issues ranging from
neglect and financial abuse to physical and sexual abuse. There
is no doubt that age, illness, level of dependency and capacity
to consent issues have major influence. Gender and Race, in our
experience have not been significant indicators. The prevelance
of abuse is not well known, and current statistics only give us
"tip of the iceberg" figures.
1.6 The identification of abuse is underpinned
by comprehensive Adult Protection Training, the appointment of
a Lead Physician for Adult Protection, a Lead Nurse for Adult
Protection and an Adult Protection Co-ordinator within the Acute
Trust.
1.7 A range of training strategies are in
place from half hour, two hour, half and full day awareness raising
sessions, to two day multi-agency investigative skills training.
This training is provided and delivered in conjunction with partner
agencies, usually the Local Authority. Whenever possible, we train
according to professional discipline for example we would train
hospital, mental health and community nurses together in one session.
1.8 The role of HM Coroner in the protection
of vulnerable adults requires examination and review. Many cases
of alleged or suspected abuse end in the Coroner's Court where
he has limited powers to act or enforce action, beyond determining
cause of death. Whilst the Coroners power recently to deliver
verdicts neglect contributory to death have been widened, they
do not go far enough in being able to order additional investigation
or referral to the Crown Courts in the case of negligence.
1.9 The establishment of independent scrutiny
committees in each economy to monitor the work of local Adult
protection committee's is essential. Ideally, this should be chaired
by HM Coroner for the locality, or an independent chair.
1.10 There are currently no data streams
for information to return at regional level, or to the centre.
The impact of available data on strategies for crime reduction,
fraud, benefit fraud, social inclusion, monitoring of established
care systems and a raft of other social, health and economic policy
should not be underestimated.
1.11 There is no central policy or strategy
for the work of adult protection committee's across England and
Wales and no mechanism for compliance with existing guidance.
The result of this is that some localities pay lip service to
no-secrets guidance, some have no procedures and some no mechanism
for investigation.
1.12 Because there are no specific targets
to me met, no performance indicators across agencies and no penalty
for failure to comply a patchwork system has developed. Additionally,
in the scheme of existing and competing priorities within the
NHS, Social Care and Criminal Justice adult protection will always
"take a back seat" because there is no requirement to
comply and no monies attached to success of policy and practice.
1.13 With regard to staffing and employment;
the introduction of the Criminal Records Bureau has done nothing
to increase the protection of vulnerable adults. The majority
of individuals who perpetrate abuse have no previous criminal
or civil convictions against them.
1.14 The appropriate induction of workers,
regular ongoing education and training and self awareness schemes
for staff are essential. As is appropriate, regular and effective
monitoring of compliance with this need by NCSC, CHAI and subsequent
agencies.
1.15 Perhaps the establishment of separate
divisions within inspecting bodies to look at induction, education,
training and compliance is required within regulatory agencies.
As would the establishment of formal links with Scrutiny Committee's
by these agencies. There currently is no joined up approach to
any of this work in many areas, and individual agencies appear
to be unable to make the necessary linkage.
1.16 The questions posed regarding lead
agencies for investigation is academic. The lead agency for investigation
needs to be determined locally, and with regard to the circumstance
and type of abuse alleged. Additionally, concurrent investigations
may be required where paid carers are involved, for disciplinary
or dismissal hearings to take place.
1.17 With regard to clinical and care guidelines,
these are inadequate. Indeed, the NSF for Older People makes little
or no reference to the protection of older people. We would suggest
that the issues of adult protection fall under Human Rights Legislation
and Equalities Legislation, as well as NSF's and NICE, SCIE guidelines.
The introduction of Adult Protection legislation is needed. We
would urge the Committee not to look at Child Protection systems,
and emulate their mistakes, but to strike out and develop a system
that comprehensively and nationally protects those adults most
at risk in society.
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