Victims of complacency?

In 2001 Nottingham Crown Court jailed an agency worker for 12
years for raping a 24-year-old woman with learning difficulties.
The man, Philip Kambeta, had forged references and details of his
employment background to get relief work in residential care homes.
The abuse only came to light because the victim became pregnant as
a result of the assault.

Recently, the Department of Health has announced that Criminal
Records Bureau checks are to be put on hold for staff in adult care
settings supplied by nursing and domiciliary care agencies and for
staff who were already in post on 1 April 2002. In addition, the
launch of the Protection of Vulnerable Adults (Pova) register has
been suspended for an unspecified period.

Despite the recent raft of initiatives for people with learning
difficulties, is this indicative that the government is still not
taking the needs of vulnerable adults seriously? This article
reviews some of the policy initiatives in recent years and assesses
how far we have actually come.

There seems to be a smug belief that community care policy put an
end to abuse of people with learning difficulties. Moving people
out of long-stay institutions was a step forward in terms of
recognising the right of people with learning difficulties, and
other vulnerable people, to choose how they should live. However,
in real terms their options were restricted. Most had little choice
about where to live and who to live with.

Research evidence shows that people with learning difficulties are
still more vulnerable to abuse than other groups, with perhaps
different kinds of risk to deal with, now that they are living more
independently in the community. Adults with learning difficulties
are exposed to many kinds of abuse, ranging from sexual abuse to
bullying.¹ Abuse can take place in various contexts,
such as in public places, day services and in people’s homes.
Therefore it is crucial that there is awareness of these risks and
that there are procedures in place to protect vulnerable
adults.

As a recent interview with the then criminal justice minister Lord
Falconer on BBC’s Newsnight showed, this government, while
acknowledging the vulnerability of people with learning
difficulties in several recent initiatives, has once again
prioritised the needs and protection of children over vulnerable
adults.² The discussion concerned the difficulties
experienced by the Criminal Records Bureau and the need to delay
the checks of some groups of staff in order to “catch up”.
Inevitably, this decision will result in vulnerable adults
continuing to be cared for by unchecked staff. This means an
increased risk of abuse and, inevitably, more victims. The need to
safeguard vulnerable adults is recognised one day, but not the
next, when economic constraints force a prioritisation of
workloads.

Since coming to power, Labour has introduced a series of laws and
policies about protecting vulnerable adults (see below). But has
the implementation of these measures been successful?

No Secrets, the Department of Health guidance on
developing and implementing multi-agency policies and procedures to
protect vulnerable adults from abuse, published in 2000, has been
mostly successful but is not strong enough. Prior to this guidance,
protection for vulnerable adults nationally was inconsistent and a
number of agencies in the late 1990s had not addressed the issues
at all.

Learning difficulties protection procedures had been introduced in
some places, influenced primarily by the work of the late Ann Craft
and her colleagues at the department of learning disabilities at
the University of Nottingham, but there had been little effort to
work in a multi-agency way when implementing them. Other areas had
started to address the vulnerability of older people and people
with mental health needs, but few had combined policies to meet the
needs of all service user groups and all agencies.

The introduction of No Secrets (under section 7 of the
Local Authority Social Services Act 1970), with its expectation
that local multi-agency codes of practice would be developed and
introduced by October 2001, was undoubtedly welcome and has gone a
long way to raising the issues of vulnerability and ensuring
adequate responses to reported situations of abuse.

But there has been further inconsistency in the ways that it has
been implemented. To ensure positive responses from staff and a
commitment to protecting people there has to be relevant training
for all staff and a commitment from managers to recognise this as a
priority. There has also been criticism that No Secrets did not
push harder for the establishment of adult protection committees
but rather suggested that “agencies may consider that there are
merits” in doing so.

The Home Office’s Speaking up for Justice report in 1998
included 78 recommendations, including legislative change (in the
Youth Justice and Criminal Evidence Act 1999), which were widely
acclaimed. These aimed to address the situation where, for many
years, vulnerable adults had been unable to access justice which
had further impacted on staff, who saw little point raising their
concerns when it was unlikely that they would be taken seriously.
This also gave perpetrators the “all clear” to abuse with little
chance of detection because their victims were often unable to
disclose. Staff often had little understanding of how to recognise
abuse because of the lack of training and no clear reporting
systems.

To provide protection and reassurance for vulnerable witnesses, the
key measures under Speaking up for Justice included:

• Improvements in the identification of vulnerable
  witnesses.
• Greater communication about the needs of witnesses.
• Use of appropriate interview methods and pre-trial
  support.
• A range of measures available for use at trial.

These changes, together with the introduction of Achieving
Best Evidence, 2002, which replaced the Memorandum of Good
Practice and covers children and adults, offered vulnerable
adults the opportunity of a fairer hearing for the first time.
However, without substantial funding to cover its implementation
and the training required to inform professionals, the results have
again proved to be inconsistent across the country.

Set up in April 2002, the Ann Craft Trust (ACT) has been doing
valuable training with the Crown Prosecution Service. It is
recognised that the training should include an awareness of the
needs of vulnerable adults, not just information about the legal
process and changes in the law. These changes require a
considerable cultural shift for professionals who have
traditionally not worked with people with special needs.

However, when looking at the preparation of the police for these
changes, the lack of Home Office funding for training has been
particularly evident. Responses to these changes by police forces
are variable. Training has been patchy and setting up new video
suites to manage the changes has been difficult. This may have
something to do with the fact that the police are regionally
managed, as opposed to the Crown Prosecution Service, which has
developed a national training programme. Lord Falconer announced in
February at a workshop for justice practitioners involved in the
implementation of special measures that an extra £2m had been
made available to assist police forces in videotaping witness
statements. This is welcome funding, albeit somewhat overdue, and
is an acknowledgement of the need to offer appropriate interviewing
environments to vulnerable witnesses, including adults with
learning difficulties.

Two of the special measures – the role of the intermediary and
video-recorded cross-examination – have still to be fully
implemented. It is planned that they will be piloted prior to full
implementation and one has to hope that this is not a further
delaying tactic. These measures are seen as crucial assistance to
vulnerable witnesses to enhance their ability to give clear
evidence.

So what has been good? Effective networks of adult protection
professionals have been formed to share expertise and to campaign
for further changes to benefit the vulnerable people they work for.
There is the Adult Protection Alliance which involves the Ann Craft
Trust, Action on Elder Abuse, the Prevention of Professional Abuse
Network, Respond and Voice UK. Several regions have appointed adult
protection co-ordinators, established adult protection committees,
developed multi-agency policies and accessed training on related
issues. Adult protection is on the policy agenda and it is now
being implemented in practice.

In conclusion, we can celebrate the many government initiatives
since 1998, but we must not lose momentum. We have already talked
of a culture shift for the criminal justice system but it needs to
be wider than that. Multi-agency working, which is pivotal to the
success of the initiatives discussed above, requires us all to make
changes. Social care providers and their staff need to know that
things have changed and any concerns that they report will be taken
seriously. Those working in the criminal justice system need to
understand that vulnerable adults can make reliable witnesses. We
all need to recognise that working together is effective and
ensures the best outcomes.

Rebecca Calcraft is research fellow, centre for social
work, University of Nottingham and Deborah Kitson is director, Ann
Craft Trust 

References  

¹ NBeail and S Warden,
“Sexual abuse of adults with learning difficulties”, Journal of
Intellectual Disability Research, Vol 39, Part 5, October
1995, 382-387;  HBrown, V Turk and JStein, Sexual Abuse of
Adults with Learning Difficulties, Joseph Rowntree Foundation,
1994; C Sheard, JClegg, PStanden and J Cromby, “Bullying and people
with severe learning difficulties “, Journal of Intellectual
Disability Research, 45, (5): 407-15, 2001 

²
Newsnight, 30
January 2003

Labour’s policies

Labour’s policies and legislative initiatives specifically
concerning vulnerable adults include:

• Speaking up for Justice, 1998
• Youth Justice and Criminal Evidence Act, 1999
• No Secrets, 2000
• Care Standards Act, 2000
• Valuing People, 2001
• Achieving Best Evidence, 2002 This is not an
  exhaustive list and other initiatives should also have an impact on
  good practice – for example the Human Rights Act 1998 and the new
  Sexual Offences Bill.