Government plans to put safeguarding boards on a statutory footing will need to tackle a series of funding and membership problems that currently limit impact, finds Vern Pitt
“There’s a danger they become toothless tigers,” says Pete Morgan, chair of the Practitioners Alliance Against Abuse of Vulnerable Adults (Pava), about the present state of safeguarding adults boards.
The boards, which exist in most areas in England, are designed to provide multi-agency leadership, develop policies and hold member agencies to account on the protection of vulnerable adults, including by reviewing serious cases.
However, experts warn they vary too much in their funding, membership and ability to co-ordinate agencies’ work to keep adults safe.
Action on Elder Abuse chief executive Gary FitzGerald says: “We know from the research we’ve done that [boards vary] considerably and that has less to do with priorities than the levels of funding,”
He says boards need sufficient staffing and administrative support to be effective, but this is seldom there.
The lack of funding can be related to the issue of who is represented on the boards from member agencies.
FitzGerald says board meetings must be attended by those within the organisations who have the authority to make changes to safeguard vulnerable adults, but warns: “It is totally variable and there are anxieties and concerns across the country that in some cases junior staff, representing agencies, are not able to make the commitments.”
This can affect areas such as the provision of training for safeguarding staff across agencies by the board.
Morgan, who is head of service for safeguarding adults at Birmingham Council, says that while boards can develop training packages, they need senior officers on member agencies to commit to training.
He says such joint working is worthwhile because it can save agencies money, adding: “Each agency is going to have to develop training for its staff. What you do is pool resources so it’s not labour intensive. Then you have one group developing a consistent package for all as opposed to five or six agencies doing it independently.”
One solution to the membership problem may be for the government to write membership into law and stipulate boards must be attended by a senior member of staff.
However, while requiring councils, the NHS and the police to place senior officers on the board seems straightforward, identifying senior leadership for other key groups is far more difficult, says Morgan: “It can be hard to get someone who represents GPs or care homes,” he says.
Learning from the experience of safeguarding children boards, which have been in operation since 2006, would not help solve this problem, says Morgan, as children’s services lack the large range of independent sector providers characteristic of services for vulnerable adults.
The Care Quality Commission’s adults senior policy lead, Paul Coleing, says consistency of membership is another issue, adding: “You don’t want a different person at each meeting.” He argues that without seniority and consistent commitment it is tough to show leadership on safeguarding.
There are also cultural barriers that can hamper action, notably between the police and the NHS, says Richard Crompton, safeguarding adults lead at the Association of Chief Police Officers.
While health professionals are, understandably, minded to maintain patient confidentiality he says this can clash with the nature of police work.
“We operate on the basis of intelligence and information that is provided to us. If there are problems with the exchanging of that sort of material between agencies then it damages our investigative function. It’s the lifeblood of policing really and without it we’re very limited in what we can do,” he says.
Morgan claims one thing the police and NHS have in common is that they are less used to the sort of external scrutiny of safeguarding that an effective board should bring. “Some agencies are more used to being open and transparent about how they are assessed,” he says.
Morgan says safeguarding incidents are often investigated internally by the NHS even though solutions may be multi-agency in nature.
However, Steve Shrubb, director of the NHS Confederation’s Mental Health Network, says internal investigations do not preclude referrals to safeguarding boards as the two processes are distinct.
Legislation could impose a duty to co-operate on agencies, which may help tackle these problems, though the government has made no explicit commitment on this score.
There is certainly strong support in the sector for putting boards on a statutory footing – 92% of respondents to the 2008 consultation on reviewing the No Secrets adult protection review backed the plan.
However, it is almost certain that legislation will not be brought forward before the general election, expected on 6 May, and while a re-elected Labour government would pursue legal backing for safeguarding boards, the Conservatives have made no such commitment.
In the meantime, it will be up to local agencies to address the problems of funding, membership and joint working as best they can, to ensure vulnerable adults receive the protection from abuse they need.
Case study: Milton Keynes adult safeguarding board: ‘We’ve turned round our board’s performance’
Milton Keynes has already taken action to modify its safeguarding board. Following a one-year period with interim arrangements due to staff absences they decided to radically overhaul a system that was not satisfactory.
Deputy chair of the board and director of standards at primary care trust NHS Milton Keynes Gillian Prager says: “The focus on safeguarding in Milton Keynes was not as high as it should been.”
Former board member and day activities manager for Age Concern Marianne Cockburn says another problem was the consistency of attendance and the membership. “There was always a new face,” she says.
So when Prager and Lynda Bull, the council’s director of community well-being, approached agencies about changing the board’s membership the response was positive. “It was amazing how people cleared their diaries,” she says.
Now the board operates at director level with 10 members, including voluntary sector and service user groups.
Meeting every two months, the board restricts itself to strategic decisions with three sub-groups discussing incidents, operational issues and procedures. Member of the policy and procedure panel Detective Sergeant Paula Searle applauds the change: “The board is now a bigger driver towards improving services and there is more clarity around how that should work.”
If goals are not achieved there are strong lines of accountability for board members. Prager says: “Board members shouldn’t be committing to anything that they think is going to be difficult to deliver.” If they did not deliver, she would expect the members of the adult safeguarding board to report the inaction to the relevant agencies.
The Scottish model
One model for multi-agency leadership on safeguarding, backed by statute, is up and running in Scotland. The Adult Support and Protection (Scotland) Act 2007 required councils to establish adult protection committees, with mandatory representation from the local police and NHS board.
Other members could include representatives of regulator the Care Commission. The act requires committees to provide advice and information to its statutory members on safeguarding adults but does not require them to oversee serious case reviews.
Committees must also promote co-operation between members.
This article is published in the 18 February issue of Community Care magazine under the heading Toothless tiger