Memorandum by the Prevention of the Professional
Abuse Network (EA9)
1. POPAN
The Prevention of Professional Abuse Network
(POPAN) has 13 years experience of working with the victims and
survivors of abuse by health and social care professionals. We
work with people concerned with abuse by doctors, nurses, counsellors,
psychotherapists and all kinds of complementary therapists across
public, private and voluntary sectors. POPAN categories of abuse
are defined as sexual, physical, psychological, financial and
discriminatory[90].
POPAN works with around 300 people each year and is funded by
the Department of Health and charitable trusts.
Whilst our work with older people has not been
extensive (Action on Elder Abuse provide a more specialist and
targeted service) we believe that our experience and knowledge
of abuse by care workers is relevant to this Inquiry.
Throughout this submission "abuse"
is defined according to established Department of Health guidelines
published in "No Secrets"[91]
and reproduced here at Appendix 2.
2. RESPONSE TO
SPECIFIC COMMITTEE
QUESTIONS
2.1 How prevalent is elder abuse?
1. Despite numerous high profile cases of
serial abuse, multiple abuse inquiries and increasing numbers
of professionals being found guilty by regulators there has been
no effective work to determine the prevalence of abuse. Data on
the abuse of health staff by patients is collected nationally
with all NHS trusts required to submit annual figures. However,
there are no procedures in place for recording or reporting abuse
by staff and there is no national collation of statistics and
no sign of this work being taken up by central government; neither
the Department of Health,[92]
the National Clinical Assessment Authority, the Commission for
Health Improvement nor the National Patient Safety Agency[93]
collect this information.
2. In 2003 POPAN undertook a survey of information
from a selection of health regulators, government agencies and
police services. This showed that categories of abuse established
in "No Secrets" (physical, sexual, psychological, financial,
neglect, discriminatory) are rarely used, that government agencies
have no relevant data and that police service recording is patchy
and inconsistent. The Metropolitan Police Service is currently
developing its policy for vulnerable adults and is looking at
how to record "non crime book" reports, including abuse
types.
3. Using verified information regarding
the number of practitioners and list size it is possible to estimate
the number of people at potential risk of abuse by professionals.
The following tables show indicative figures in order to provide
guidance on the probable extent of the problem.
General Practitioners
| Figure 1 |
|
| GPs (no) | 34,505
|
| Abusive (no) | 19
|
| Abusive (%) | 0.055
|
| Av List size | 1,779
|
| No patients at risk |
33,761 |
| | |
19 is the number of doctors found guilty of sexual abuse
by the GMC in 2002 and is used here as an indicative figure. Number
of GPs and list size are taken from an Office for National Statistics
report of 30 September 2001[94].
| Figure 2 |
|
| GPs (no) | 34,505
|
| Abusive (no) | 1
|
| Abusive (%) | 0.0029
|
| Av List size | 1,779
|
| No patients at risk |
1,780 |
| | |
For comparative purposes this table shows the number of people
at risk of abuse by an individual abusive doctor.
Social Care Workers
| Figure 3 |
|
| Practitioners (no) | 1,200,000
|
| Abusive (%) | 0.055
|
| Abusive (no) | 660
|
| No clients | 25
|
| No clients at risk | 16,500
|
| Figure 4 |
|
| Practitioners (no) | 1,200,000
|
| Abusive (%) | 0.000083
|
| Abusive (no) | 1
|
| No clients | 25
|
| No clients at risk | 25
|
| | |
The number of social care practitioners shown in Figures
3 and 4 was estimated by the General Social Care Council. The
actual figure is not known. The number of clients is an estimate
to enable analysis. As caseloads vary widely in the sector we
have not attempted to calculate an average. The percentage of
abusive practitioners used in Figure 3 (0.055%) is based upon
that used for GPs in order to allow for comparisons.
Figure 4 shows the number of people at risk from one abusive
practitioner.
These tables have been selected from a range of estimates
to provide initial indicators of the breadth of the problem. Further
work is needed to ensure comprehensive estimates of prevalence
across all sectors. Appendix 1 provides further tables based on
differing estimates of percentages of abusive practitioners.
4. Much of the data that does exist comes from the case
files of charities providing a service to the victims of abuse.
POPAN works with around 300 people each year.
5. The Sexual Offences Bill now before Parliament will
criminalise sexual activity between providers of care and any
of their clients who are vulnerable through mental disorder or
learning difficulty. The Mental Incapacity Bill and the Mental
Health Bill also outline offences relating to the neglect or exploitation
of vulnerable people. At the time of writing it is not clear how
the Government intends to monitor the use or impact of these measures.
6. There is no research data on the proportion of discriminated
against communities affected by this kind of abuse.
RECOMMENDATION 1
The collection of standardised data on abuse by health and
social care professionals should be established as routine practice
for all providers and regulators and the results collated and
published by central government.
RECOMMENDATION 2
The police services recording of reports of crimes should
be standardised to ensure that crime type and relationship to
victim are matched with the occupation of the offender and that
the "No Secrets" categories of abuse are used.
RECOMMENDATION 3
A long-term monitoring project should be set up in order
to gauge the effectiveness of all offences relating to the abuse
of clients by care providers.
2.2 What are the causes of elder abuse?
1. There has been very little research into the causes
and effects of professional abuse and none at all into the impact
on black and minority ethnic communities.
2. POPAN's work indicates that exploitative practitioners
deliberately target people vulnerable through physical frailty
or mental ill health.
3. In POPAN's experience people who sexually exploit
their patients are often male, often some way into their careers,
respected by their peers and hold positions of authority. In POPAN's
13 years of experience we have worked with the victims of abuse
by senior consultants, chairs of ethics committees and heads of
practice.
4. Health professionals have unique access to vulnerable
people and to settings and medicines that may be used by predatory
professionals to carry out abuse. There is an intrinsic power
imbalance between "sick people seeking help" and the
professional with the "power to heal". Doctors who commit
serious crimes against their patients may go undetected for years
and sometimes decades. Despite substantial shifts in the status
of professionals, doctors are still held in high regard and this
makes victims less likely to come forward and those responsible
for taking action less likely to do so.
RECOMMENDATION 4
Comprehensive research should be commissioned into the causes
and effects of abuse by health and social care professionals against
their patients and clients.
RECOMMENDATION 5
Research should be commissioned into the profile of health
professionals who abuse their patients.
RECOMMENDATION 6
A task force on the abuse of patients should be established
and administered by the Department of Health. This should involve
abuse survivors, patients, the public, the professions and other
stakeholders. It should be concerned with the abuse of patients
and clients by all health and social care workers, covering the
public and independent sectors and all relevant professions including
doctors, nurses, counsellors, psychologists, psychotherapists
and complementary therapists.
3. THE SETTINGS
OF ELDER
ABUSE
1. Inquiry reports have noted that open environments
that engage with external agencies and involve residents in a
meaningful way are less likely to foster abusive practice. In
particular we recommend the Beech House Inquiry[95]
report of the internal inquiry relating to the mistreatment of
patients residing at Beech House, St Pancras hospital during the
period March 1993-April 1996. Its thorough literature review[96]
and recommendations[97]
provide an excellent framework for services.
4. WHAT CAN
BE DONE
ABOUT IT?
See other responses.
5. INFORMAL CARERS
This area is outside POPAN's expertise.
6. FORMAL CARERS
1. Whilst we support the desire of inspection agencies
to listen to the views of service users we believe that more emphasis
should be placed on spending time with residents, in particular
in settings where there are known to be problems.
2. Inspection agencies do not have sufficiently strong
links with local and specialist support and advocacy agencies
and user and carer groups. This gap can allow for the avoidance
of timely review and inspection. The power of inspection agencies
to respond to expressed concerns in addition to routine inspections
is not widely known.
3. Advocacy agencies nationally are un-coordinated and
poorly funded. Whilst there are many examples of high quality
practice, there are wide variations in service standards and levels
of understanding of abuse. Inquiry reports have emphasised that
advocacy can have a vital role to play.
4. Training in awareness and prevention of professional
abuse in health and social care is extremely limited. There are
no standards on this issue for formal professional training and
it is almost non-existent in induction and internal training for
unqualified staff.
5. The most significant issues regarding staff recruitment
are the delayed introduction of the Criminal Records Bureau (CRB)
checks and the failure to introduce the Protection Of Vulnerable
Adults (POVA) list. Both these measures are expected to have a
significant impact on prevention.
RECOMMENDATION 7
CHI/CHAI, NCSC and MHAC should establish ongoing publicity
to ensure that all stakeholders are aware of their role and the
rights of service users.
RECOMMENDATION 8
CHI/CHAI, NCSC and MHAC should develop strong and ongoing
communication with local and specialist support and advocacy agencies
and user and carer groups.
RECOMMENDATION 9
A comprehensive and co-ordinated network of advocacy agencies
should be developed nationally.
RECOMMENDATION 10
Formal professional training and induction and training by
care providers should cover awareness and prevention of abuse,
reporting concerns and whistle-blowing.
7. RECOMMENDATIONS FOR
NATIONAL AND
LOCAL STRATEGY
1. See recommendations above. In our view the priorities
for action are recommendations 1 and 9.
November 2002.
90
The category of "neglect" is included within "physical
abuse". Back
91
DoH 2000. Back
92
Ref DH letter to POPAN dated 31 October 2003. Back
93
Ref NPSA letter to POPAN dated 6 November 2003. Back
94
ONS-General practitioners, dentists and opticians by NHS Regional
Office area, 30 September 2001: Regional Trends 37. Back
95
Camden & Islington Community Health Services NHS Trust 1999. Back
96
At Appendix C p 87 of the report. Back
97
At Chapter Seven p 63 of the report. Back
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