By Elaine Aspinwall-Roberts
When the Care Act 2014 came into effect in April 2015, self-neglect was included as a safeguarding issue for the first time, along with domestic abuse and modern slavery. This came as a surprise to commentators and it has remained something of a contentious addition, as self-neglect is not a crime and there is no perpetrator, as with the other ‘new’ types of abuse.
However, one potential advantage of this inclusion was that a clearer picture of the numbers of people self-neglecting and coming to the attention of social services might be provided. Previously any figures around the prevalence of self-neglect had been anecdotal, so this seemed to offer a real opportunity to understand the scale of the problem of self-neglect.
In early 2015, the Health and Social Care Information Centre (now NHS Digital) published the results of a public consultation about what changes needed to be made to the data that is collected around adult safeguarding. One question in the consultation asked local authorities whether they agreed that the new ‘types of risk’ categories (self-neglect, modern slavery, domestic abuse) should be included in the national data return. Three-quarters of the 108 respondents agreed that the ‘new’ types of abuse should be included in the national data return.
In relation to recording self-neglect cases, of the 98 local authorities who responded, 64% were planning to record data on self-neglect anyway, and 88% said they were definitely or probably going to be able to report on self-neglect. So the consultation showed that most local authorities were happy to record and submit self-neglect data and it was not going to present too much of a problem. It appeared that for the first time there might be robust figures around the prevalence of self-neglect.
No requirement to collect self-neglect data
However, when the guidance for completing the 2015-16 return was published, in March 2015, the decision had been made that self-neglect should be included only on a voluntary basis, despite the positive response to mandatory reporting from local authorities in the consultation. This was because, as the guidance stated, ‘further developments’ since the consultation had ‘highlighted that it is likely that most self-neglect cases will not be the subject of a section 42 enquiry’ under the Care Act. It gave no indication of what these ‘further developments’ were.
Fast forward then to the safeguarding adults statistics for 2015-16, published by NHS Digital in October 2016. The figures for self-neglect do not appear in the main report. However, from the appendices included the following information:
- Of the 152 local authorities in England, 109 had submitted data for the number of concluded section 42 enquiries involving self-neglect, even though this was voluntary.
- There were 3,215 concluded s42 enquiries for self-neglect, reported by the 109 authorities. Had all local authorities submitted figures for self-neglect, the total of s42 enquiries for self-neglect could have been considerably higher.
- Self-neglect made up a substantial number of completed s42 cases. In contrast, there were only 765 completed s42 enquiries for discriminatory abuse, for which virtually all local authorities submitted figures.
- The difference between local authorities in the number of completed s42 enquiries was also stark – from zero cases reported in many areas, to 645 cases in one area.
Obscuring the reality
What can we conclude from this? Well, it is not a full set of data, and NHS Digital notes that these figures must be treated with caution. But if, as the guidance that emerged from the safeguarding adults data consultation stated, ‘most self-neglect cases would not be the subject of a section 42 enquiry’ (my italics), this indicates that there could be many more cases sat outside of the official figures for s42 enquiries.
More than 3,000 s42 enquiries for self-neglect is, of itself, a huge amount of ‘new’ work for local authorities to absorb with no extra resources. Not making this increase explicit in the main statistics, alongside existing categories of abuse, is obscuring the reality. In addition, we should be concerned that some authorities are recording hundreds of s42 self-neglect cases, and others recording none. What are the authorities doing differently? What are the implications of this for service users who self-neglect? For social work caseloads?
In addition, demographic data is not available for cases of self-neglect reported voluntarily, as it is for other safeguarding areas where reporting is mandatory. Therefore, we cannot accurately know the breakdown of this population in terms of age, gender and ethnicity as we do for people who are physically abused or neglected, for example. This makes it difficult for local authorities to plan and develop appropriate services.
What these partial figures indicate overall is a missed opportunity to get a clear and consistent picture of the size and scope of self-neglect in England, even though it is now part of safeguarding. Why is reporting self-neglect not mandatory? In terms of precious resources, it is hard to see why a local authority should go to the time and trouble of submitting this information voluntarily, when others are not doing so, and the results are not appearing in the overall figures anyway. This fudging of the figures is simply disguising a real issue, which is affecting thousands of vulnerable adults and that deserves to be properly identified and resourced.
Elaine Aspinwall-Roberts is senior lecturer at Liverpool John Moores University and a registered social worker. She is currently carrying out research into multi-disciplinary approaches to working with people who self-neglect.