227. We accept that training only goes so far to
improving the care and experience of older people in healthcare.
Whilst the majority of people working in healthcare are dedicated
professionals, striving to provide the best service to all those
within the care, there will inevitably be those who cannot or
do not meet acceptable standards of care. On our visit
to Sweden, we were informed about Lex Maria and Lex Sarah, two
laws which require all employees in residential care settings
or hospitals to report suspected abuse.
228. We were told in evidence that, in the UK, doctors
and nurses are already under a professional duty to report poor
issue is whether such a duty should be extended by legislation
to everyone caring for older people in healthcare institutions.
have supported the introduction of such a law. For example,
the Alzheimer's Society saw it as a way of raising the debate
about abuse and neglect "if you introduce that type of obligation
then necessarily you [
] expand people's knowledge about
what abuse is and not just [
] violent, aggressive forms
of abuse which people might talk about but also the neglect, so
that would be incredibly helpful.
229. Witnesses noted the difficulties faced by whistle-blowers
and suggested that staff, whilst protected by the Public Interest
Disclosure Act 1998, needed to know that it was legitimate to
speak out when things were not right.
Further, some witnesses, such as Action on Elder Abuse, whilst
supporting the proposal, offered a word of caution about how effective
such a duty would be "the caution I would give [
mandatory reporting exists in America and the best estimate is
one in five cases is actually reported and we need to be aware
that there are limitations of that.
230. From the provider side, ADASS noted that staff
had a moral obligation to report abuse and agreed that this duty
should also form part of an employee's contract of employment.
However, a key issue for staff would be to see that effective
action was taken at a management level when suspicions were brought
to their attention:
From a social services' perspective, our view is
that there is a moral duty and it should be custom and practice
that that is the case. The key thing, though, is that,
if we are to ensure that it is a moral duty and it is custom and
practice, that requires strong leadership and it requires people
like ourselves sitting around this table and others to make sure
that we can demonstrate that we take action against those perpetrators,
particularly of abuse.
231. The Minister was not sure whether a statutory
duty was required, although he stated "I am not saying I
would rule it out forever".
He pointed to existing professional standards and registration,
Every professional who works in health and, as
we register the social care workforce, in social care will have
professional standards that are non-negotiable, and part of those
professional standards, as well as the guidance that will operate
in any care setting in any part of the country, will be that if
somebody is being abused you have a responsibility as part of
your professional code of practice, as part of the policies that
apply in your workplace to report that [
] we have
recently gone through a process of registering social workers.
We are moving on to domiciliary care staff and we are moving
ultimately to people working in residential and nursing care settings,
and as part of that registration they have to meet certain professional
standards, including reporting abuse, so we are on a journey in
that respect in terms of those who work in residential and nursing
homes. I am not sure that the Chairman's fears would be
allayed as a consequence of having a law. 
232. Whilst we do not want to increase the burdens
on healthcare staff, we are conscious that they have a vital role
to play in ensuring that all patients and residents with whom
they come into contact are treated with dignity and respect and
are not subjected to abuse. They do this in two ways.
Firstly, they are responsible for their own conduct and ensuring
that they act in accordance with human rights principles and their
positive duties. Secondly, they are the eyes and ears of
the outside world. They will be the first to notice if
someone is being ill-treated. Older people with mental
health problems or who do not have visitors are especially vulnerable.
A duty to report suspected abuse is more than merely
a moral duty and we consider that such a duty should be a requirement
for all staff working in the NHS and in care homes. We
therefore recommend that the Government include a requirement
in both the Care Standards for Better Health and the National
Minimum Standards for Care Homes for Older People (or, as we have
already recommended, preferably in one set of integrated care
standards) that hospitals and care homes should have a policy
requiring all healthcare workers to report abuse or suspected
abuse, with protection for whistle-blowing and confidentiality.
233. We now go on to consider whether older people,
their relatives, advocates or carers, have sufficient information
to safeguard their rights and ensure that service providers meet
their responsibilities, and the difficulties they encounter in
raising concerns and complaints.