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No Secrets is far from perfect but is it as weak as the Cornwall scandal seems to suggest, asks Kathryn Stone

For some time, organisations working in adult protection, including the national learning difficulties charities Voice UK, Respond and the Ann Craft Trust, all three of which are founder members of the Adult Protection Alliance, have had concerns over the effectiveness of the government guidance No Secrets. Sadly, those concerns have been once again highlighted by the Cornwall scandal.

No Secrets, published in 2000, gives guidance to local agencies which have a responsibility to investigate and take action when a vulnerable adult is believed to be suffering abuse. It offers a structure and content for the development of local interagency policies, procedures and joint protocols. It states that the "lead agency should be the local social services authority" and that the chief officer for the lead agency "will have a particularly important part to play".

In her interview with Community Care (Carol Tozer says Cornwall Council social services shouldn't be blamed over adult abuse case), Cornwall's adult care director, Carol Tozer, suggests that, despite representing the lead authority, she did not have the power to go into another organisation - the Cornwall Partnership NHS Trust - and say, "I want to look at what you're doing". This may well be a failing of No Secrets to give the lead authority a specific legal power to do so. But what about political, moral or managerial power? The health care trust should have been challenged.
Perhaps an indicator of the systemic failures might lie behind this line in the joint investigation report: "The council and health care organisations have failed to agree commissioning strategies to provide care in the community for people with learning disabilities." It is puzzling that such a situation could occur; that organisations charged with the provision of care, adult protection and other services for vulnerable people appeared not to get on.
If senior managers were experiencing such difficulties, it is unsurprising that social workers were too. In Cornwall, social workers felt unable, we're told, to challenge medical practices in the health trust, such as the routine use of enemas for one service user, despite the potential abusiveness, because they felt they lacked the expertise. A social work principle is to challenge oppressive behaviour but clearly they need managerial and organisational support to do so. Whistle-blowing procedures exist within most agencies; it's clear, from the Cornwall experience, that we need to find ways to raise concerns between agencies.

Medical knowledge
Cornwall's response now is to make sure social workers record when they lack the medical knowledge to back up concerns. However, surely it would be better to have social workers fully supported to challenge perceived questionable practice and then record that's what they did and why, and what response they got. Quote people. It's a powerful way to record.

Unquestionably, No Secrets is long overdue a review. For example, we need to be much clearer about police involvement. Currently, there are some social workers who confuse "being the lead agency" with leading the investigation. The outcome of this has disastrous results for criminal investigations. That said, No Secrets promotes collective responsibility for abuse of vulnerable people and for acting on concerns. Its status (under section 7 of the Local Authority Social Services Act 1970) means that it must be implemented unless there are "exceptional circumstances".

Councils must challenge
As the lead agency, local authorities must take their roles seriously. If a partner organisation does not, you challenge it. You alert councillors, their senior management and boards. You complain to them. You join with partners who do take it seriously and collectively bring pressure to bear. You complain to the Healthcare Commission and Commission for Social Care Inspection. You report them to the Department of Health and the secretary of state. You take responsibility.
Any revisiting of No Secrets owes it to the services users of Cornwall and others who are or could be abused to provide a mechanism for raising concerns about an agency's commitment to adult protection.
According to Tozer, "adult protection procedures are only as strong as the ownership given to them by agencies". But isn't ownership partly achieved through dynamic leadership? There was clearly a difficult relationship between the trust and the council - but nobody, it seems, wanted to face up to it, make a phone call and say we've got to get this sorted.
Sadly, for those service users and families who suffered as a result of this frosty relationship, it will now be sorted four years too late. CC
Kathryn Stone is chief executive of Voice UK, a national charity that works with people with learning difficulties who have been abused or the victims of crime, and their carers