Recently in Adult protection Category

Just to let you know we've got a conference on safeguarding adults at risk in Birmingham on 21 March.
We ran a similar conference last year in London, which went really well - lots of good debate and interesting insights into issues including latest policy, the role of the Care Quality Commission, serious case reviews, the deprivation of liberty safeguards and managing within constrained budgets.
Be great to see as many of possible of you there.

Anyone interested in serious case reviews specifically may want to also attend our forthcoming conference on SCRs, in London on 29 February. This will look at how to conduct effective SCRs, best ways of learning and disseminating lessons and an introduction to new reviews of domestic violence killings. Do go along.

I was recently alerted to this research on what service users want out of the adult protection and safeguarding process produced by charity coalition Altrum and the University of Stirling. Here are the key points:-

• Listen to what the person wants to say about their lives, their values and abilities and how they want to use services to live their lives.
• Ask what the person thinks is wrong and can be changed.
• Be ready to share the agenda and give the person choices about how things are done.
• Offer an advocate who can build a relationship with them that will see them through the changes and challenges they may face.
• Find ways to make meetings relaxed with breaks and alternative ways of presenting information if wanted.
• Let the person know the bigger picture and what to expect next.
• Explain why the process is the way it is, for example, why information might need to be shared or withheld.
• Remember that information and trust go hand in hand, one can help build up the other.

How far should self-neglect be addressed by the adult safeguarding system was the topic of an online debate yesterday on the Local Government Group's Adult Safeguarding Community of Practice.
Professor Suzy Braye and Dr David Orr, who recently conducted research into the issue, (the findings of which are summarised in the video above), were taking questions from community members on the topic.
Issues raised included:-

• The fact that self-neglect is seen as an adult safeguarding issue (alongside abuse and neglect) in some areas but not others, and that it is not covered by the definition in No Secrets.
  
• How self-neglect manifests itself and the risk that it masks exploitation or abuse.
• Responses to self-neglect, the need for better inter-agency communication and dealing with issues of capacity.
• The impact of self-neglect on practitioners, including anxiety.

One of Orr and Braye's strongest conclusions is the extent to which good social work, building strong and trusting relationships with the person, was key to successfully responding to self-neglect; yet, conditions to support good social work were often lacking in local authorities.

The other author of the research was Michael Preston-Shoot, who helped Community Care draw up a guide to responding to self-neglect cases last year.

The Care Quality Commission has released the latest 10 reports from its post-Winterbourne View inspections of learning disability hospitals and similar services, and the results are a bit of a mixed bag.
Of the 10, which includes NHS and private sector services, four were fully compliant with the two standards being assessed - safeguarding and the care and welfare of service users - while two had moderate concerns with both (no provider had major concerns with either).
If you work in this area it may be worth taking a look at the inspection reports but the full story from the 150 inspections will be told in an overview report this spring.

This response to today's Equality and Human Rights Commission report on human rights breaches in home care services comes from former social worker Di Galpin, senior lecturer in practice development at Bournemouth University's school of health and care and co-author of the National Competence Framework for Safeguarding Adults.

The Equality and Human Rights Commission report on the abuse of older people makes for more dismal reading on the care of older people in Britain today. Sadly this is not new to many of us who have worked in the care sector.  Yet our voices have gone unheard, leading to many, such as myself, leaving the profession in disgust. 

It is estimated up to 340,000 older people in the UK are abused each year in their own homes.  The abuse of older people now parallels that of children  with many experiencing emotional, psychological, physical, sexual and financial abuse perpetrated against them by those charged with providing care and support,  for example, partners, wider family and professional carers. Although abuse appears to pervade the lives of a substantial number of older people cries of indignation from wider society and government are strangely silent, unlike in cases of child abuse, such as Baby P and Victoria Climbie, which resulted in mass media coverage, government inquiries and the reform of childcare systems, most recently through the Munro review. 

I believe the Human Rights Act 1998 provides a framework from which we should develop care provision for those most vulnerable, a guide to practice that can help provide an ethical  and moral foundation and reframe care as compassion rather than care as a commodity to be bought ad sold in a free market. Yet the Human Rights Act 1998 is under attack with some sections of the media (Daily Mail) condemning it as a 'whingers' charter' and the Conservative Party actively seeking its removal from public life.

However, the extension of human rights is fundamental to ensuring older people are treated with dignity and respect by those charged with caring for them.

The Human Rights Act (HRA) 1998 makes it unlawful for public authorities, such as NHS hospitals and carers employed by local authorities to act in breach of the fundamental rights and freedoms set out in the European Convention on Human Rights. Problems have arisen as original definitions of  what constituted a 'public authority' were too narrow and excluded private and voluntary sector providers leaving many individuals outside of the protection offered by the Act. This loophole was partially addressed in the Health and Social Care Act 2008. Section 145 of the act provides that individuals placed in an independent care/nursing home by a local authority are covered by the Human Rights Act 1998. However, section 145 does not confer human rights obligations on other independent care providers contracted by the local authority, therefore, independent domiciliary care agencies fall outside of the Human Rights Act 1998.

This is disastrous for those most vulnerable in society, as it leaves working in a manner consistent with human rights in an individual's home to the discretion of the provider. That's why I'm delighted that the EHRC has called for human rights protections to be extended to people receiving home care arranged by councils from independent sector agencies. I think the government should also extend such protection to the increasing numbers of people purchasing care services through direct payments.

While the government suggests that the Care Quality Commission's thematic review of home care services - announced yesterday - will help, do we really have any confidence anything will change given the CQC's failures in the Winterbourne View case?

This report appears after many others this year, highlighting the disgraceful treatment older people experience from those supposed to be proving their care, whether at home, in hospital or residential care.  A report by the Health Service Ombudsman on the abuse of older people in hospital settings suggests there is a culture of indifference from both government and staff to the abuse of older people. The Independent commented:

"For a while we may pause to express outrage.  But we then move on to the urgent business of our daily lives.  Spot checks and hit squads may arrest the worst practice.....But they will not do much about a society that has hardened its heart against the elderly."

Doing nothing is not an option.  We as individuals who make up society all have a role to play, however, so does government. The review of adult social care law undertaken by the Law Commission this year made clear to government the law pertaining to the protection of vulnerable adults requires strengthening, the current framework is clearly not working.  I would suggest it is time to stop treating older people as drain on resources and start showing older people we value them, and to those who abuse older people that this will not be tolerated any longer.  This will require legislation that truly regulates, and punishes abusers, when required, and a society that refuses to allow this to continue.

Just heard that Gary FitzGerald, chief executive of Action on Elder Abuse, has won the outstanding contribution to social care gong at the Great British Care Awards.
This seems to be a well-deserved award.
His commitment to the cause of making older people - and other adults at risk - safer is total, which means he stands somewhat outside the clubbable inner circle of adult social care.
Action on Elder Abuse is a pretty small charity and its funding has suffered over recent years - arguably a reflection of it and FitzGerald's outspokenness.
This means FitzGerald is both chief executive and researcher, policy manager and several other roles besides.
Despite this all, the charity has been effective in terms of its analysis, campaigning and support for people at risk through its helpline. Let's hope it - and FitzGerald - can successfully continue to perform this role in the years ahead.

Safeguarding adult boards are struggling to secure sufficient resources and the participation of key agencies, found a report published by the Social Care Institute for Excellence last week.
The man above is Michael Preston-Shoot, one of the authors, and in this video he provides an overview of the findings of the research into the current state of adult safeguarding boards.
The video comes courtesy of the Adult Safeguarding Community of Practice, an online forum for practitioners in safeguarding, which currently has 643 members (you need to register to join but it is free).
The community has its first webinar (an online televised conference) on 25 October, from 12-2, which will be on safeguarding adults in the health system and will be led by Jo Webber from the NHS Confederation.

There's some guidance out today on ensuring Care Quality Commission staff ensure they apply equality and human rights standards to care providers in their inspections and assessments of them.
It is a joint initiative between the CQC and the Equality and Human Rights Commission.
It sets out how equality and human rights law maps on to the essential standards that CQC inspects against and advice for inspectors on reporting suspected human rights/equality breaches to the EHRC.

I guess that's all quite abstract so here's an example from the guidance:-

Ms Porter lives in a care home for people with dementia. When the inspector first visited the care home, Ms Porter was able to indicate some responses to questions but as time progressed, this became more difficult for her. Ms Porter had never married and had lived with another woman for a number of years. This woman was her only visitor. Ms Porter's care plan stated that she was a vegetarian.
The inspector was concerned about two aspects of her care. Firstly, that since moving onto a pureed diet, Ms Porter was being given pureed food containing meat.
Secondly, she was receiving personal care from male carers which may not be culturally appropriate for her, as she had spent most of her recent life living with a woman. The inspector did not know whether Ms Porter was a lesbian or not. Many lesbians prefer to receive personal care from other women - as a cultural issue rather than an issue about sexual preference. This can also be a preferred option for many heterosexual women.
The inspector raised these issues with the care provider. In response, the care home improved the way that life history informed person-centred care planning. This included recording people's dietary needs and preferred gender of care staff - thus improving the service for everyone, regardless of their sexual orientation.

Deprivation of Liberty Safeguards (Dols) watchers (you know who you are) will be well aware that the number of applications for the safeguards from has been well below expected levels, with large variations between areas.

The implications are that people are being deprived of their liberty in care homes or hospitals without the protection that the Dols bring, and that this problem is particularly acute in certain areas. So how do you turn this situation around?

I was chatting to Dols expert Toby Williamson, of the Mental Health Foundation, the other day, who has a suggestion: the creation of an audit tool for care homes and hospitals to use to test whether residents or patients are being deprived of their liberty.

This would be tested on a sample of people in each area, ideally, so that local authorities and primary care trusts - who assess Dols applications - can gain an understanding of the extent to which people in their area are not being protected by the safeguards.

They can then work with care homes and hospitals to raise awareness of when they need to apply for a safeguard and provide training for staff where necessary.

It would all be done confidentially and without prejudice, so that care homes and hospitals wouldn't feel that this was a stick to beat them with.

It sounds a good plan but Williamson stresses that we need someone to design and implement such a tool. The Mental Health Foundation was considering it but could not source funding to do so.

He suggests that it is not a job for the Department of Health as this could appear heavy-handed. So do we have any other candidates? Maybe it's something for council or NHS bodies - the Association of Directors of Adult Social Services and the NHS Confederation, notably - to do in tandem with care provider organisations such as the English Community Care Association.