Protecting adults from abuse

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