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.