News

Social services departments in England are making progress in developing a multi-agency strategy to protect vulnerable adults from abuse, according to a major survey by Dinah Mathew, Paul Kingston, Claudine McCreadie, Janet Askham and Hilary Brown.

Throughout the 1990s the issue of adult abuse became increasingly recognised and in response individual social services departments in many parts of the country began producing policies and procedures. But development and implementation were erratic. In March 2000 the Department of Health, with the support of the Association of Directors of Social Services, issued No Secrets.¹

The guidance was launched at the annual conference of Action on Elder Abuse by the then social care minister John Hutton, who said: "When vulnerable adults are abused in any way it represents a complete betrayal of trust. We must all be determined to confront it wherever it occurs. It cannot be left to local discretion - we need a national response." He stressed the importance of all agencies being involved in tackling abuse, although local authorities were given the responsibility for co-ordinating local responses. Former ADSS older people's committee chairperson Jeremy Ambache told the conference: "It is not guidance you can choose to follow or not". No Secrets is section 7 guidance, which means that while it does not have the full force of statute, local authorities are expected to adhere to its principles.

The Nuffield Foundation has awarded a two-year grant to researchers from Kings College London, Canterbury Christchurch University and the University of Wolverhampton to look at the implementation of No Secrets. The first stage of the research involved a survey of local authorities, conducted between June and September 2001. Questionnaires were sent to all 150 councils with social services responsibilities in England. The response to the survey was extremely good - 80 per cent of councils participated. Some 118 questionnaires were returned, including three that combined the responses of two local authorities. The response rate was highest among county councils and lowest among London boroughs.

Local authorities were asked if they had written procedures for responding to concerns about adult abuse. The responses indicated how many had, or are expected to have, policies or procedures in relation to abuse. The findings indicate:

- 100 per cent with documents relating to referrals.

- 99 per cent with procedures about how to co-ordinate investigations into allegations.

- 94 per cent with protocols for information sharing between agencies.

Some 96 per cent of respondents said there was a multi-agency policy, finalised or in draft, on the protection of vulnerable adults from abuse in their area. Nearly all those who had a draft policy expected it to be finalised by 31 October, the deadline given by the department for implementation of "multi-agency codes of practice".

Many authorities were building on adult protection work already undertaken. Ninety-six councils (81 per cent) reported that they had developed previous policies. No Secrets requires that the statutory agencies, social services, health and police work in partnership to create a framework of inter-agency arrangements. Our survey asked social services how far they had consulted in the development of their multi-agency policy. The questionnaire included a list of relevant agencies and groups, and respondents were asked to indicate the level of consultation on a scale from 1 to 5, where 1 = no contact and 5 = full consultation and inclusion in decision-making groups (see graph in magazine).

Some respondents mentioned the difficulties of consultation on such a wide scale. One said: "Some of the agencies are not yet ready to make this a priority area, hence full consultation is difficult." This suggests that adult protection is still not considered high priority work within certain agencies, and that the promotion of the seriousness of adult protection work needs to continue.

In spite of the importance attached to child protection committees in achieving effective multi-agency working in the child protection system, No Secrets does not require a management committee for adult protection. Instead, agencies are urged to consider that there are merits in establishing a management committee. Despite this ambiguity 52 per cent (61 councils) have already established a committee for adult protection and a further 41 per cent (49 councils) are planning to establish one.

Those with a management committee listed the members - the mean size was 16, with a minimum number of six and a maximum of 29. All committees had social services, police authority and NHS representation. Apart from these agencies, there was enormous variety in committee membership. Only one in four committees had access to legal expertise on the committee.

Other agencies included on committees were Adult Education, the Benefits Agency and the Crown Prosecution Service.

No Secrets also requires agencies to have a training strategy for all levels of staff. Ninety-three per cent reported that they had or were in the process of developing these and 59 per cent indicated that they were already running inter-agency sessions. Multi-agency funding had been obtained in a minority of councils with four mentioning a local training consortium. One council worked with the local adult education service in the delivery of their training, and another had developed a video.

Fewer authorities had produced information for the public about the adult protection policy, with 73 per cent producing, or in the process of producing, information. Leaflets (mostly English language only) were the most usual, although radio broadcasts and website information had also been used by a minority of councils.

No Secrets emphasises the importance of monitoring referrals and investigations of cases of adult abuse in order to learn from experience. Ninety-two per cent of respondents reported that a monitoring system was in place or was in development. The survey did not attempt to gauge whether the information provided by the systems was being appropriately used to plan services. One respondent commented that although the authority kept records of referrals they were not being used as management information. More than two-thirds of councils have not yet produced an annual report.

No Secrets is one of many policy directives that social and health care agencies are being asked to implement. No additional funds were provided to assist local agencies in developing the ambitious framework for adult protection proposed in the guidelines. Only 23 per cent of councils had a designated budget for adult protection, and some of these indicated that this budget might not be renewable. Some 28 per cent of respondents stated that there was a post dedicated to adult protection work, but less than half of these were permanent posts. A further 22 per cent indicated that a post was being created. In spite of competing demands and pressure on resources, it is clear from the survey that many local authorities are committed to implementing the guidance. The willingness of so many authorities to complete a 12-page questionnaire for this research project is another indication of the level of commitment to adult protection - some even said it was helpful!

While a postal survey inevitably cannot provide a fully rounded picture of local developments, the findings of the survey suggest that the government's No Secrets document has, in the main, stimulated agencies to consider their response to adult protection.However, there is evidently considerable variation in the way that agencies are responding, which will be explored in the second stage of the research project involving site visits to a selection of local authorities. Watch this space.

Membership of management committees

Number of committees with members from agencies within the sectors below

Voluntary sector 37 (71%)
Inspection units 28 (54%)
Housing department 24 (46%)
Probation service 20 (38%)
Private-sector providers 20 (38%)
User or carer groups 16 (31%)
Legal department 14 (27%)
61 councils (52 per cent) have already established a committee for adult protection

Other agencies on committees were adult education, the Benefits Agency and the Crown Prosecution Service

Dinah Mathew is research associate, Janet Askham is professor of gerontology and Claudine McCreadie is research fellow at Age Concern Institute of Gerontology, Kings College London; Paul Kingston is professor of primary healthcare, School of Health, University of Wolverhampton; and Hilary Brown is professor of social care, Canterbury Christchurch University College.

References

¹ Department of Health, No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse, DoH, 2000

Background reading

1 H Brown and J Stein, "Implementing adult protection policies in Kent and East Sussex", Journal of Social Policy, 27, 3, 371-396, 1998

2 McCreadie, Update on Research in Elder Abuse, Age Concern Institute of Gerontology, Kings College London, 1996

3 Social Services Inspectorate, No Longer Afraid: the Safeguard of Older People in Domestic Settings, Department of Health, London, 1993