Barred from entry?

    This month finally sees the introduction of the government’s
    latest safeguard to protect vulnerable adults from care workers who
    may abuse or harm them.

    From 26 July it will become a statutory requirement for registered
    care providers in England and Wales to check whether a care worker
    is on the Protection of Vulnerable Adults (Pova) list before
    employing them. The list is a centrally held register containing
    the details of care workers known to have harmed, or placed at risk
    of harm, a vulnerable adult in their care.

    As laid out in the Care Standards Act 2000 (see panel), the Pova
    list will be operated on behalf of the Department of Health by the
    Department for Education and Skills. The DfES already runs a
    similar scheme, List 99, which bars unsuitable people from working
    with children in education settings.

    A potential employer requests a Pova check by ticking a new box on
    the Criminal Records Bureau (CRB) forms that all social care staff
    must complete before taking up a post.

    Many in social care have campaigned for the introduction of a
    Pova-like initiative to curb the abuse of vulnerable adults, who
    are often older, have mental health problems or learning
    difficulties. Children have long had this protection through the
    Protection of Children Act list that bans unsuitable staff from
    working in children’s services.

    Registered care homes and domiciliary care agencies have waited a
    long time for the Pova list, which was supposed to be up and
    running in June this year. The government response to the health
    committee’s inquiry into elder abuse admitted the hold-up was
    because it was waiting for the CRB to modify the way it dealt with
    its disclosure forms.

    The government is committed to preventing abuse, but is the Pova
    list worth the wait?

    Sally Hughes, social care policy officer at mental health charity
    Mind, believes so. She says that as the health and social care
    sectors are large employers with mobile workforces “it is
    reasonable to have a fair amount of control over bad employees”.
    For Hughes the Pova list is another quality control mechanism
    employers can use when recruiting staff to work with vulnerable
    people.

    Gary FitzGerald, chief executive of campaigning charity Action on
    Elder Abuse, is equally supportive of a measure that will catch
    some employees who currently may evade detection. “Our helplines
    repeatedly hear about individuals who have resigned after being
    accused of abusing clients,” he says.

    But will it end the abuse that makes shocking headlines? No, says
    FitzGerald: “There’s a small group of serial abusers and Pova will
    never catch them because they know how to play the system. We can’t
    afford to rely on registration alone.”

    This view is echoed by Stephen Lowe, policy officer at Age Concern
    England. He has heard anecdotal evidence that paedophile websites
    encourage abusers to target older people because of the lack of
    protection for them. “Abuse is about power, and people who misuse
    power over children will misuse power over adults,” he says.

    Establishing the Pova list sends a clear message that protecting
    vulnerable adults is as important as protecting children. Kathryn
    Stone, director of Voice UK which works with people with learning
    difficulties who have been abused, says: “It is a very important
    step but will only be as effective as the people who use it and the
    people who enforce it.”

    So are employers geared up to meeting Pova’s requirements? Stone
    says many residential care providers still do not fully know about
    it. “The information that has been put out about Pova has not been
    far-reaching or clear enough.” She urges the Department of Health
    to work with service commissioners, providers and advocacy and
    support groups on how they can use Pova effectively.

    About three-quarters of the 25,000 care homes in England are not
    members of any national association and therefore unlikely to have
    a main source of information for Pova. Registered Nursing Home
    Association chief executive Frank Ursell believes such providers
    need further clarification on when to invoke the list. He asks if
    institutions should notify Pova when they suspend a member of staff
    because abuse is suspected or only once an employee has been found
    guilty.

    “Home owners are between a rock and hard place as the Care
    Standards Act says they have to report people almost before finding
    them guilty, but the Human Rights Act and employment legislation
    says you have to treat them fairly,” he adds.

    One hindrance to Pova’s success is that it relies on job applicants
    declaring all the names they have used. If a candidate withholds
    this information there is very little that can be done. The Pova
    list is not retrospective and employers are obliged to report staff
    only for incidents of abuse occurring after 26 July, so it may be
    months before names start appearing on the Pova list.

    One concern that arose during the consultation on Pova, which ended
    last March, was the cost of an initial Pova check. This will now be
    free. A PovaFirst, as it is known, enables employers to check the
    list to see if a person is recorded on it. If they aren’t, they can
    be employed while the full CRB check goes ahead.

    While the government has listened to some fears, it has ignored
    others. The most controversial decision is the Pova list’s phased
    introduction. Initially, Pova will not apply to staff working with
    vulnerable adults in the NHS or independent hospitals, clinics or
    other facilities, or through independent medical agencies.

    Mind strongly disagrees with this decision. According to Hughes,
    people with mental health problems overwhelmingly use NHS services,
    and as NHSstaff will not be subject to Pova, users will continue to
    be put at risk. She adds: “Pova should be introduced as parliament
    intended: across the board.”

    A Department of Health spokesperson defended the government’s
    position, saying that most abuse of adults takes place in their own
    homes and points out that the scheme will eventually cover the NHS
    but not until next year at the earliest.

    So will the Pova list do the job? The last word goes to a
    Department of Health spokesperson: “Pova is not going to replace
    what should already be happening in social care – good employment
    practices and picking up on undesirable people in the recruitment
    process.”

    Care Standards Act 2000

    The Protection of Vulnerable Adults (Pova) duty is laid down in
    section 80 of the Care Standards Act 2000. Residential care home
    providers and domiciliary care agencies are obliged to refer a care
    worker to the Pova list if they are suspended, dismissed or
    transferred to a non-care role because they are thought to have
    harmed, or placed at risk of harm, a vulnerable adult in their
    care. They must also check against the list before offering anyone
    employment in care work, and may not employ anyone on the list.

    Care workers are first placed provisionally on the list and can
    appeal to the secretary of state and then to the Care Standards
    Tribunal (CST) to have their name removed. Unless an appeal
    succeeds, names remain on the list indefinitely. After 10 years,
    they can ask the CST to review their case. If they were under 18
    when they were listed they can request a review after five
    years.

    It is a criminal offence for anyone confirmed on the Pova list
    to seek employment in a care position. If found guilty in a
    magistrate’s court, they can be fined and imprisoned for up to six
    months – or up to five years if convicted in a crown court.  

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