Care Act triggers surge in safeguarding cases

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4 Responses to Care Act triggers surge in safeguarding cases

1. 

   Jayne Purcell March 17, 2016 at 11:04 am #

   Gary Fitzgerald, chief executive of older people’s charity, Action on Elder Abuse. Hits the nail on the head
   “It would be useful to know how many of these enquiries were ‘delegated’ to care providers or others? What were the actual outcomes, and did they make a difference for victims? Unfortunately, the stocktake tells us nothing beyond providing the figure of 100,000, which makes it impossible to draw any meaningful conclusions.
2. 

   Deborah Barnett March 17, 2016 at 12:47 pm #

   I currently work in training and consultancy work, across a number of Local Authorities, developing safeguarding training, training in response to Safeguarding Adult Reviews, creating tools and developing practice to manage safeguarding in an effective manner. I also present at national conferences on safeguarding. I regularly listen to Local Authority, Health, Police, Housing, practitioner stories and difficulties and I would like to share some of my thoughts on why I believe referrals to safeguarding have increased.
   1. Local Authorities applied eligibility criteria (Fair Access to Care Criteria) to safeguarding cases. Some Local Authorities applied low, moderate, critical and substantial need, many just critical and substantial and occasionally only critical cases were accepted. This resulted in many Serious Case reviews as people were vulnerable to abuse and neglect, however, they did not meet criteria for Local Authorities. An example of this was Adult A from Stockport:
   Adult A was brought up by parents who had care and support needs themselves, resulting in his involvement in the Looked After System.
   • There was significant issues of domestic abuse within the family
   • ‘A’ displayed aggressive and abusive behaviour and drank alcohol at lunch time
   • Personal hygiene deteriorated
   • ‘A’ associated with much younger children
   • At the age of 17 he was described as having moderate learning disabilities by a Social Worker
   • ‘A’ was described as having Mental Health problems by the Police
   • As a young adult ‘A’ became homeless
   • ‘A’ was both subjected to and subjected others to criminal activity
   • ‘A’ was assaulted, had attacks on his accommodation and was subjected to cyber bullying
   • ‘A’ was assessed as having low spectrum Autism
   • ‘A’ was isolated and estranged from his family
   • ‘A’ received mobility and care components of DLA
   • Like many other people who have low level learning, disabilities, low level mental health issues, low Autistic spectrum disorder, substance misuse and was brought up in the Looked after system, ‘A’s capacity to make decisions was not considered and he was demonised for his behaviours.
   • ‘A’s diagnosis remained unclear, passed from service to service.

   The accumulation of difficulties, barriers, disabilities and instability of his background were not fully considered, resulting in a lack of protection and eventually his murder. Capacity assessments were not undertaken to determine his understanding of key issues like housing and tenancy, as well as care and support and his ability to make decisions not taken into account.

   Under ‘No Secrets’ guidance ‘A’s lack of eligibility for any individual adult service left him with little advice, support, guidance or appropriate intervention. The accumulation of risk factors was not considered. Many cases such as Gemma Hayter, Stephen Hoskin, Fiona Pilkington similarly did not meet Local Authority criteria for safeguarding. With the remit of current safeguarding it almost seems inconceivable that this could happen with such an accumulation of risk factors.

   In direct contrast to the above examples, (With current Care Act eligibility) should I be admitted to hospital with care and support needs and be neglected during my stay in hospital and then report this neglect, this would meet criteria for making a safeguarding Alert to the Local Authority. I would have care and support needs and as a result of those care and support needs be (at the time) unable to protect myself from abuse or neglect (3 part test). However, I am fully aware of services, am capable (when well) of accessing appropriate information and advice, legal redress and therapeutic services. I recognise the need to protect others who may also be suffering abuse and neglect in that environment and believe that the Care Act is correct in the approach offered, however, as a professional person with vast amounts of knowledge of services and support, I would now have access to safeguarding (Under the Care Act), when in the past people such as ‘A’, Stephen Hoskin, Gemma Hayter, Fiona Pilkington, Brett Martin did not have full access and were not safeguarded (Under ‘No Secrets’. This amounts to a massive increase in those eligible and where enquiries must take place.
   In addition to this safeguarding under the Care Act seeks to address not only protective measures, but also preventative measures, which were not fully identified within the ‘No Secrets’ guidance, again increasing the remit.
   2. Domestic abuse has been fully recognised under adult safeguarding. For many years we have seen huge campaigns about women being domestically abused and children being the most vulnerable. Consider the poster campaigns and adverts, we usually see a woman aged between 20 and 40 occasionally with children. Statistics on numbers of people who have disabilities or mental ill health who suffer domestic abuse are unclear, as much of this abuse is hidden or in the past has not been identified within safeguarding as domestic abuse. I recognise the importance of providing support and services to all people suffering domestic abuse. People who have care and support needs and cannot protect themselves from abuse and neglect, people who cannot get to the telephone, are dependent upon the perpetrator for care and support, social isolated and suffer domestic abuse are at significant risk. Tackling domestic abuse has been a key priority for many agencies over the years with little recognition of those eligible for safeguarding, little domestic abuse advertising about men being cared for by abusive family members, elderly people in domestic abuse setting, people who have autism being abused by family or partners, people who have learning disabilities being financially exploited and more. Since the Care Act all Domestic Abuse agencies and associated services have increased their knowledge in recognising and identifying adults who are vulnerable to domestic abuse and who have care and support needs. This has significantly increased referrals for safeguarding.
   3. Self- neglect prior to the Care Act was something that was all too often put into the too hard box and the person wishes to be left alone the only consideration. Since the Care Act self-neglect has been identified as something that must be considered for a safeguarding referral and enquiries made where there is concern. Using ‘No Secrets’ Guidance many Local Authorities chose to only accept cases where there was a victim and a perpetrator, leaving people who self-neglect without support, intervention, capacity assessment and the risk to others going unassessed. As agencies are trained in safeguarding under the Care Act referrals to safeguard people who sel-neglect have significantly increased.
   4. The Law Commission in their review of safeguarding identified that capacity assessments were not undertaken as the law intended. Many nurses, doctors, housing workers, provider staff and safeguarding partners were not / are not aware that if they have doubt about a person’s ability to understand a chosen treatment, service, tenancy, course of action (Where they have an impairment of, or disturbance in the functioning of mind or brain) then they must assess that persons capacity to understand that decision at that time. If treatment, care, support, services are imposed upon someone who cannot consent because they do not understand and there is no capacity assessment and best interest decision to determine the professionals legal jurisdiction to intervene, this becomes a safeguarding matter and potentially a crime. With increased training and awareness on matters of capacity and consent more referrals are being made where professionals recognise that there is a lack of capacity assessing and therefore potentially negligent or criminal practice.

   5. The publication of the Cheshire West case in 2014 involving Mig, Meg and ‘P’ has meant that the remit of deprivation of liberty safeguards both in the community as well as residential and hospital care has increased dramatically. Whilst many providers, hospitals, families and carers are not familiar with the current remit of Deprivation of Liberty safeguards, awareness is increasing. If a Deprivation of Liberty Safeguarding is not in place for someone who lacks capacity to make decisions about their care, services and treatment and is not free to leave that particular environment, then this is classed as an unlawful detention. Increased training means that as people become aware they are reporting concerns about unlawful detentions, increasing safeguarding referrals.

   6. There have been a number of articles about the removal of thresholds in safeguarding. It is my belief that this is often misinterpreted and misunderstood. For the Alert process to take place the Care Act eligibility 3 part test for safeguarding should apply without thresholds. To determine and prioritise cases, effectively risk assess, allocate the appropriate response and manage the increasing workload some thresholds need to be considered, e.g when information, advice and guidance should be offered, when roles and responsibilities can be allocated to others, when preventative measure are required, when another agency can hold a multi-agency meeting and when the Local Authority should hold a strategy meeting / case conference and when we consider the risk to others, criminal activity, public interest issues, co-ercive behaviour and the mental ill health over and above the needs wishes and person cented care provision of the individual. This cannot be dictated nationally in legislation as it is an issue of demographics and deployment of resources, however, is necessary to provide appropriate levels of response in a timely manner with increasing workloads.
   Many Local Authorities have interpreted that any thresholds within safeguarding are inappropriate, resulting in often chaotic and overburdened systems with low level cases swamping priority and urgent cases. Responses can often be disproportionate to the needs and wishes of the individual as individual workers seek to make sense of safeguarding workload. In an effort to make sense of personalised safeguarding the legal obligations to protect the public, protect the needs of those who cannot consent due to domestic abuse or mental ill health and the need to protect staff members with defensible decision making are being over looked and overridden by the person who has capacity stating that they do not want intervention. This has resulted in not only many more referrals at crisis point, but also more time spent by individual workers seeking safeguarding information and advice via Alerts / concerns.

   7. ‘No Secrets’ identified carers as eligible for safeguarding, however, it was not clear how this would be applied in all cases. The Care Act has clarified explicitly that the carers are now entitled to an assessment and should safeguarding issues arise it is very clear that a referral must be made. This clarification has resulted in an increase in carer referrals.
   7. Placing safeguarding adults in a statutory framework has meant that Clinical Commissioning Groups (CCG’s) and other Care Quality Commissioning (CQC) inspected services making safeguarding training mandatory In the past such services often only gave up their practice time for mandatory training and therefore did not receive sufficient training to understand when to make a referral and to whom the referral should go. Increased training and regulation with consequences financially and in status to the organisation has seen a rise and increased interest in the demonstration of the organisations ability to affectively safeguard, resulting in increased referrals.

   8. The Care Act places legal obligations on services to share information with the Local Authority for safeguarding purposes. In the past many would try to manage this in house for example Mental Health Services via Care Programme Approach and Health Services via other multi agency arrangements. This has led to more referrals from aspects of Health and Social Care that previously were under represented.

   I recognise that many of my thoughts are anecdotal, or relate to my primary, qualitative research with training, participants, in response to consultancy work, or through discussions with safeguarding leads struggling to manage safeguarding with limited resources and a changing environment. I also realise that further quantitative research is required to justify these beliefs. I do feel that the Care Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards are all excellent pieces of legislation that seek equality and protect the human rights of people. Expanding safeguarding remits, complex legislative frameworks, misinterpretation of advice and guidance and more responsibility placed on individuals, within a climate of decreasing resources, more stress than the public sector has seen in many years and constant case law changes / updates and research without local guidance, co-ordination, thresholds and clarity, create more referrals of those concerned that they do not know what they are doing and it is best to make a referral and work it all out from there.
3. 

   Sarah Jane March 19, 2016 at 11:09 pm #

   I want to know, why when a vulnerable person is in Supported-living accommodation, after they’ve been raped, or attached in that accommodation, why aren’t they moved to more safer housing? And don’t tell me that counselling would have been the answer, because you have no idea what it feels like, living in the same pit, where you’ve been raped. If it’s because the landlord would throw a tantrum, if the vulnerable moved out, that’s disgusting and immoral. Vulnerable victims need to feel secure for the rest of their lives. Not just around the time it happens. Makes me so angry though.
4. 

   Sarah Lund March 23, 2016 at 10:11 am #

   Nothing is being done about it. Just what I’d expect. There’s no way to encourage or discourage anyone from doing anything. It looks like we’re going to have to keep our fingers crossed. I don’t think we’re going to get the true safeguarding that we need. How sad.