Most of the blame for the widespread institutional abuse of people with learning difficulties in Cornwall revealed by inspectors last week was directed at the NHS, not social care (Cornish abuse findings expose ‘lack of understanding’ of rights).
The Healthcare Commission and Commission for Social Care Inspection recommended that Cornwall Partnership NHS Trust, which ran the hospital at the centre of the investigation, be put on special measures. But criticism was also levelled at Cornwall Council in relation to its role as lead agency for protecting vulnerable adults.
Inspectors referred 40 people to the council under Protection of Vulnerable Adults procedures but said it “failed to adequately coordinate interagency arrangements in accordance with No Secrets guidance”. Social workers were also criticised for being too willing to accept the opinion of staff at the trust.
Director of adult social care Carol Tozer (pictured) accepts that the council’s record-keeping was not good enough though maintains this had already been corrected before the inspectors’ report was published.
But she believes much of the criticism is unfair and is more of an indictment of national problems with No Secrets than failings within Cornwall social services. She says councils have responsibility without power in relation to adult protection.
“The local authority has the lead role to co-ordinate and monitor but has no executive power to go into another statutory or non-statutory agency to say ‘I want to look at what you’re doing’,” she says.
She says police were involved in Pova proceedings at the earliest opportunity but multi-agency adult protection meetings and subsequent action plans were hamstrung by the fact that the health trust was sending managers who ran the services under investigation, and so could hardly be considered objective. The council had no power to change this.
Also, Tozer says, social workers were not able to challenge medical practice in the trust, such as the routine use of enemas for one person, because they felt they lacked the expertise to do so.
Social workers have now been told to make a record of any instances when they feel they do not have the medical knowledge to back up concerns. But the authority had no power to require an independent national expert, paid for by the trust, to give a second opinion.
And when action plans were agreed, Tozer says, social workers had no authority to make sure they were being followed within the trust or even referred to the right people.
Tozer is not sure that it would be right for councils to be given more power in this area. After all, these were services delivered by an NHS organisation which had not even been commissioned by the council.
But she says there should be a stronger duty on other agencies involved to implement the actions agreed at the multi-agency meetings. “Adult protection procedures are only as strong as the ownership given to them by agencies,” she says.
Tozer says the protection of vulnerable adults system was set up to deal with individual cases but has little to say about tackling the systemic issues highlighted in Cornwall.
She says that it is time for change.
NO SECRETS GUIDANCE
Issued in 2000, No Secrets is the national framework for local multi-agency policies to protect vulnerable adults. As guidance it does not have statutory power, but is issued under section 7 of the Local Authority Social Services Act 1970, requiring social services to comply unless there are exceptional circumstances.
It suggests creating an inter-agency framework for protecting vulnerable adults, with social services as the lead agency.
A multi-agency management committee should audit local policies annually.
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