The Care Act 2014 makes it clear that abuse of adults links to circumstances rather than the characteristics of the people experiencing the harm. Labelling groups of people as inherently ‘vulnerable’ is seen to be disempowering.
The definition of “vulnerable adult” originated in the 1997 Consultation Document “Who Decides?” ‘No Secrets’ was published in 2000 as government guidance for developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. It encouraged organisations to work together to protect vulnerable adults from abuse.
The definition and use of “vulnerable adult” from No Secrets (2000) will have been used in many older safeguarding vulnerable adults policy and procedures but should now be replaced with the new definition from the Care Act (2014).
Terminology: “Adults at risk of harm”
The terminology of ‘vulnerable adults’ has moved towards ‘adults at risk of harm’, usually shortened to ‘adults at risk’ in policies and procedures.
‘Adult with a care and support need’ may also be used. Refer to specific categories of people who may be at increased risk of harm, for example ‘adults with a physical or learning disability’ or ‘older people’.
Safeguarding Adults at Risk
The policy and procedures that any organisation implements should reflect this and include the current definition of adults at risk rather than that of vulnerable adults.
All organisations have a duty to ensure that the welfare of all adults is ensured. As part of this they need to understand when to implement their safeguarding adults reporting procedures. Safeguarding duties apply to an adult who:
Has needs for care and support (whether or not the local authority is meeting any of those needs) and;
Is experiencing, or is at risk of, abuse or neglect; and;
As a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of, abuse or neglect.
Regulated activities are the activities that the DBS can bar people from doing. It is a criminal offence for a barred person to seek to work, or work in, activities from which they are barred. It is also a criminal offence for employers or voluntary organisations to knowingly employ a barred person in regulated activity.
The CQC provides guidance on which activities are considered regulated.
This is their quick reference guide, showing how regulated activities and service types are likely to link to each other. It is important to review the regulated activities
regulations, decide which regulated activities your service carries out, and then apply to register for those activities. If you carry on a regulated activity without being registered for it, you may be prosecuted and liable to a fine.
The Department of Health has also published information on the scope of regulated activity in relation to adults.
If you are interested in supporting this research or hearing more about the process, please contact Dr Mike Hartill, Director of the Centre for Child Protection and Safeguarding in Sport (CPSS), at or 01695 584763.
The hidden scale of abuse of adults at risk can be assessed by tracking individual council’s levels of referrals.
Case Study – a Borough Council
For instance, 118 paid staff were accused of abusing vulnerable adults in XXX Borough Council last year, but only 14 were disciplined. Furthermore referrals to xxx Borough Council have increased by 80 per cent to 380 people over the last 12 months. Of these 380 people, 192 were elderly and 152 had a learning disability. Continue reading Hidden extent of the abuse of adults at risk→
The CRB will still be merged with the Independent Safeguarding Authority (ISA), in Darlington, to create the new Disclosure and Barring Service (DSB) in 2012.
However it has been confirmed that the DSB will operate from both the existing sites, rather than from just one – as the Home Office had suggested in February. The Home Office also expects all 700 CRB staff to keep their jobs – bar some cost-cutting changes at “executive management level”.
The rethink appears to flow from a realisation that there is little duplication in the work done by the CRB and the ISA.
Following the introduction of filtering certain convictions and cautions from DBS certificates on 29th May 2013,Employers will not be able to take certain old and minor cautions and convictions into account when making decisions about any individual. HR policies, job specifications and application forms will therefore all need to reflect the filtering changes.
It is important that employers ask the right questions, and that employees give the right (legally accurate) answer. The DBS suggests that Employers include the following paragraph below in their standard application forms:
‘The amendmentsto the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions are ‘protected’ and are not subject to disclosure to employers, and cannot be taken into account. Guidance and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring Service website.’
The debate about the care of vulnerable adults, in particular the elderly, is intensifying. A year-long inquiry by The Equality and Human Rights Commission into standards of care for the elderly at home has uncovered “appalling” evidence of pensioners being deprived of food and drink, handled roughly, humiliated and even robbed. Many incidents amounted to “abuses of human rights”, which left elderly people feeling profoundly depressed, in tears and even expressing “a desire to die”, the report said. Many care workers often spend just 15 minutes with an elderly person, ticking off pre-arranged “tasks” in an approach that displayed “chronic disregard” for their dignity.
In one case, an elderly blind man said two council carers were talking to each other over his head, leaving him feeling like “a lump of meat”. In another, a 76-year-old woman with advanced cancer was told her care worker could not prepare her a microwave meal because of “health and safety” rules. Baroness Greengross, the commissioner responsible for the report, told The Daily Telegraph that 250,000 vulnerable pensioners in England were receiving “poor or very poor” standards of care at home…but the true figure may be far higher because many are “too frightened to complain”, she said. Continue reading Equality and Human Rights Commission join debate about elderly care→
The release of the new draft inspection framework by Ofsted has implications for schools’ safeguarding procedures.
Safeguarding was a separate judgement in the last framework and ‘the effectiveness of safeguarding procedures’ came under leadership and management. It was also given the status of being a ‘limiting judgement’, so if a school was inadequate against this, then overall effectiveness was likely to be inadequate too.
however in the new framework, limiting judgements no longer exist and safeguarding no longer has its own section. Instead under the leadership and management judgement in the new Ofsted framework, school leaders are required to demonstrate that they ensure that all pupils are safe. Inspectors will be looking for evidence that school leaders and managers at all levels manage safeguarding arrangements to ensure that there is safe recruitment, and that there are effective procedures in place to identify children in need or at risk of significant harm. To qualify as ‘outstanding’ in this aspect of leadership and management, the school’s arrangements for safeguarding pupils must ‘meet statutory requirements and give no cause for concern’. The same phrase is used for ‘good’ and ‘satisfactory’ schools. Schools will register as ‘inadequate’ if safeguarding arrangements do not meet statutory requirements and give serious cause for concern.
It is therefore clear that the emphasis on safeguarding has been reduced in the new evaluation schedule.
The changes will be overseen by the newly-appointed chief inspector of schools , Sir Michael Wilshaw who hopes to improve standards by cracking down on “ineffective” teachers. He said “very robust” performance management systems were needed. From January, he will head Ofsted and its new streamlined inspection framework, which will emphasise four key areas – pupil achievement, teaching standards, behaviour and school leadership. He has been described as traditional in his approach to improving standards at the London school of which he was head. BBC News: Academy head named Ofsted chief
A CQC report on 100 hospital inspections found that too many hospitals in England are falling short in the most basic care they are giving elderly patients. It carried out unannounced visits at 100 hospitals to assess dignity and nutrition standards, and identified concerns in 55 cases, describing the findings as “alarming”. Common areas of concern included a lack of support for those who needed help eating, poor hygiene and curtains not being closed properly.
Health Secretary Andrew Lansley said he would encourage whistle-blowers to highlight any concerns they had about the standard of hospital care for the elderly. He said: “We expect that staff across the NHS, if they see examples of poor care they blow the whistle on that, which is precisely why we have introduced changes to the staff contract.”
The inspections were ordered by Mr Lansley after several highly critical reports by campaigners, including the Patients Association.
In two cases – Sandwell General in West Bromwich and Alexandra Hospital in Worcestershire – the problems were judged to represent a major problem to patients. In the case of Sandwell, this led to the closure of the ward where there were the most problems, while a follow-up visit to the Alexandra showed measures had been put in place to rectify the issues. At another – James Paget in Great Yarmouth – moderate problems were identified, but when a return visit was made and the issues had not been resolved the hospital was issued with a warning notice, meaning if swift improvements are not made it could face sanctions including prosecution or closure of services. Continue reading the BBC story
Examples of poor care
“The patient constantly called out for help and rattled the bedrail as staff passed by… 25 minutes passed before this patient received attention.”
“We saw a staff member taking a female patient to the toilet. The patient’s clothing was above their knees and exposed their underwear.”
“Nobody was routinely offered hand-washing before or after their meals and hand gel was not within easy reach.”
“Two members of staff who were assisting people with their meals at the time were having a conversation between themselves.”
“The person did not have any assistance and the food was left on their table for over half an hour before they were assisted to eat.”
During the inspections, the regulator identified a series of common problems: These included call bells being placed out of the reach of patients, staff speaking in a condescending or dismissive way and curtains not being closed properly.
In terms of nutrition, some people who were judged to need help eating were not getting it, while interruptions meant that not all meals were being finished by patients.
The regulator also said that in too many cases patients were not able to clean their hands before meals.
Response to Report
CQC chair Dame Jo Williams said: “The fact that over half of hospitals were falling short to some degree in the basic care they provided to elderly people is truly alarming and deeply disappointing. This report must result in action.”
Michelle Mitchell, charity director of Age UK, agreed. “This shows shocking complacency on the part of those hospitals towards an essential part of good healthcare and there are no excuses.”
Janet Davies, of the Royal College of Nursing, accepted there could be “no excuse”, but added the squeeze in finances was making it harder to keep standards high on wards. “Evidence shows that patient safety and quality of care is improved when you have the right numbers and the right skills in place on wards,” she added.
The National Society for the Prevention of Cruelty to Children (NSPCC) is launching a phone helpline for paedophiles tomorrow. The emergency number – aimed at talking convicted paedophiles out of striking again – will be manned around the clock by trained counsellors. It will be funded by donations to the 127-year-old charity, so that it will be a toll-free service.
Child-sex offenders released from jail or given community service will be able to phone up if they fear a relapse or need other guidance. But they must first have agreed to sign up to the scheme, which will see them given a unique PIN number to identify them. The phone counsellors will also reserve the right to call police. Continue reading NSPCC helpline for paedophiles→
Fears that barred people will still be able to work with vulnerable groups have resurfaced following a Freedom of Information request to the ISA
In July, a report by the Child Protection All Party Parliamentary Group concluded that the government must act to prevent changes to vetting and barring procedures in the Protection of Freedoms Bill that could allow unsuitable people to work with children. However under the proposed legislation currently going through parliament, people will only be eligible for disclosures if they have ‘unsupervised’ contact with children. And another proposed change means that, in future, the person must have committed the serious offence and the ISA or Secretary of State must have reason to believe they have worked in, are working in or may work in a regulated activity.
The Independent Safeguarding Authority information showed that 36 people were suspected of applying to work with children between 1 May 2010 and 10 August 2011 while barred. However the ISA’s annual report for 2010/11 also shows it had provided evidence to the police in relation to 215 people who tried to gain employment with children or vulnerable adults while barred. Campaigners fear the numbers of cases detected and pursued by police represent the tip of the iceberg because as of 31 March 2011, there were 35,654 people on the children’s barred list. This represents a 66 per cent rise on the figure for 31 March 2010 of 21,419. The true figure for offences committed could be far higher as individual police forces do not routinely inform the ISA of all cases where a person has engaged, or attempted to engage, in regulated activity.
Following a Freedom of Information request to the Crown Prosecution Service (CPS) made by Children & Young People Now, it has emerged that, since April 2006, just 19 people appeared before the courts charged with a total of 21 offences related to working with children while on the barred list. Of those 19, only 9 were recorded as being convicted of the offence, which carries a maximum five-year prison sentence. For the latest year available, April 2010 to March 2011, 6 charges proceeded to court against 4 people.
Jan Cosgrove, National Secretary of Fair Play for Children, said: “The government must consider urgently the implications of these figures. There needs to be a mandatory reporting system to the minister and the Association of Chief Police Officers, which tracks these issues, one based on centrally decided criteria that should determine when and how police forces must inform the ISA of such attempted breaches.” He added: “The misguided proposal in the Protection of Freedoms Bill needs a complete rethink. The one thing that should inform legislators on this is the compulsive, opportunist nature of such offending. These worrying figures reinforce that lesson.”
At present, anyone who has committed certain serious offences is automatically barred. The barred list includes all individuals who have committed sexual offences against children, as well as other specified sexual and violent offences. Discretionary bars can be made as a result of employers or other regulatory bodies referring relevant safeguarding information to the ISA, a key change introduced in the wake of the murders of Holly Wells and Jessica Chapman by Ian Huntley in Soham in 2002. The ISA made 517 such discretionary bars in 2010/11.
A ‘Deaths in custody’ corporate manslaughter crime has been created so that Police and other authorities can now be prosecuted over deaths in custody in England, Scotland and Wales.
BBC News highlights that the new legislation of The Corporate Manslaughter and Homicide Act, which has now come into effect means police forces, the MoD, UK Border Agency and private firms managing people held in custody can be prosecuted for corporate manslaughter. Corporations can already be prosecuted for corporate manslaughter or for the equivalent offence (corporate homicide) in Scotland. The extension of these offences to public bodies involved in detention means they could be prosecuted if they failed to ensure the safety of someone in their care. Examples could include deaths during an immigration removal or when someone has been restrained using an unauthorised or badly taught body hold.
The law does not cover incidents abroad, such as where someone dies in the custody of British forces. However, British nationals can be convicted of causing a death through gross negligence, even if the fatality occurred overseas. The provisions are not retrospective, meaning the law could not apply to cases such as Jimmy Mubenga, an Angolan man who died during his deportation in October 2010.
Under the Safeguarding Vulnerable Groups Act of 2006, priosoners were included as ‘vulnerable adults’. However the Protection of Freedoms Bill will remove this status when it becomes law.
The Home Office has issued a tender for a company to run the outsourced ‘disclosure and barring services’. This will replace the Criminal Records Bureau (CRB) and Independent Safeguarding Authority (ISA). The new service will merge their functions together as part of the implementation of the Protection of Freedoms Bill.
The tender notice in the Official Journal of the European Union says the contract will last for eight years and is valued at between £250m and £350m. As yet there is no firm date for the new service to come into effect. A Home Office briefing on the protection and freedoms bill says that timescales will be finalised when the bill receives royal assent, which is now expected to be in mid-2012.
Council leaders and safety campaigners have condemned government plans to relax the criminal checks designed to protect passengers from dangerous taxi drivers. Currently, prospective taxi and private car hire drivers must pass an enhanced criminal record bureau (CRB) check, which gathers information from local police records, the Police National Computer, child protection and sex offenders registers. The checks are repeated every three years to satisfy licensing authorities that these drivers do not pose a risk.
Under the Protection of Freedoms Bill, they would only be entitled to a ‘Standard’ CRB check which only includes convictions, cautions and reprimands, and would not show if they were barred from working with children or vulnerable adults. Transport for London, the capital’s licensing authority, rejected 240 drivers between 2002 and 2008 after enhanced checks uncovered incidents of rape, terrorist activities, organised crime and drug dealing. They say these incidents would have been missed by less rigorous checks. Continue reading Taxi Drivers no longer eligible for eCRB→
There will be a review of vulnerable adult protection in Northern Ireland.
Edwin Poots,The Northern Ireland Health Minister is looking into creating new policy to ensure the protection of vulnerable adults in care. His announcement of a review of the system came after the number of people alleging abuse against vulnerable adults was revealed to be 1,184 referrals to health trusts in 2009-2010, the last year for which there is accurate data. Of these 1,184 referrals almost two-thirds, 750, were considered serious enough for a protection plan to be put in place.
Responsibility for child protection falls to the department of health and the five health and social care trusts who are individually responsible for providing residential care services to children and young people within their areas.
The Welsh Government is calling for urgent action to improve education services in Pembrokeshire following two highly critical reports. One identified serious failings in procedures to protect children from abuse, the other criticised the quality of education services. Education Minister Leighton Andrews told Pembrokeshire council it has two months to come up with an action plan. He has launched a crusade against “complacency in the classroom”.
The Welsh Government is sending in a team to monitor Pembrokeshire Council after the Care and Social Services Inspectorate for Wales (CSSIW) and school inspections body Estyn identified 25 cases of alleged child abuse in the education services. The investigation was triggered by the case of primary school head teacher David Thorley, who was jailed in 2009 for sex assaults on children in his care. (Details of that case from BBC: Sex assault head teacher jailed). The report criticised the council for its “wholly unacceptable” handling of the child abuse allegations. Continue reading Welsh Government focus on School safeguarding→
A FORMER Cwmbran senior support worker has been jailed after admitting stealing £5,670 from vulnerable adults in her care. Karen Moore, 40, of Brendon Hill, Somerset, appeared in Newport Crown Court after pleading guilty to three theft charges relating to her time working at CPI Care’s supported accomodation on Roll’s Close, Cwmbran.
Moore was a senior support worker at the facility between 2005 and 2008, where she helped four adults with learning difficulties, controlling their financial affairs, taking money out of their accounts and paying outgoings.
It was after Moore had left the position and moved to Somerset that the deception came to light in June 2010 and she was arrested and interviewed by police in Minehead. Prosecutor Hywel Hughes said CPI Care found unexplained cash deposits made by Moore, with the overall loss greater than £5,670, but this is the amount that was provable.
In interview, Moore told officers she struggles with figures and made up sheets to make cash tally, while Mr Hughes said she made withdrawals to pay off her own debts.
Judge David Morris called it a “tragedy” that someone of Moore’s intelligence and background was in front of him for him for such offences. He said she had breached a position of trust repeatedly and gave her concurrent terms of 14 months for each offence. DC Sarah Garland of Gwent Police’s protection of vulnerable adults team said: “She had a position of trust helping people live independent lives. She abused this position, so a custodial sentence is fair.
The British Medical Association (BMA) has issued new guidance for doctors regarding the treatment of vulnerable patients, stating that healthcare professionals have a duty to flag up any suggestion of abuse. It also explains the procedures if they suspect that physical and mental abuse of vulnerable adults by NHS staff or carers is being covered up.
The Guidance was commissioned by the Department of Health, and highlights the legislation in place to protect people if they choose to speak out about possible neglect. Dr Tony Calland, chairman of the BMA’s Medical Ethics Committee, noted that the guidance is there to support doctors and understand which adults have the capacity to protect their own interests. “The way doctors deal with these possible situations demonstrates how complex caring for vulnerable adults can be. There is no ‘one size fits all’ solution,” he added.
GPs should be alert to identifying abusers, spotting systemic healthcare failures and recognising signs of neglect, ranging from physical and mental abuse to financial exploitation. Whistle-blowing may involve providing information to the media or MPs. and the individual is protected as long as it is reasonable, not made for gain and meets the following conditions:
Whistle-blowers reasonably believe they would be victimised if they raised the matter internally or with a prescribed regulator
They believe a cover-up is likely and there is no prescribed regulator
They have already raised the matter internally or with a prescribed regulator.’
A poll of 290 GPs, carried out by Pulse in July 2011, found that 41% believe one or more of their patients has been subjected to abuse.
The scandal of vulnerable adults being abused at Winterbourne House highlights safeguarding gaps following the Panorama expose. The National Autistic Society (NAS) has submitted a 10,000 strong petition to Parliament asking for urgent action to address the failings in the current system of inspection of adult care services. John Pugh, MP for Stockport and Co. Chair of the Liberal Democrat Committee on Health and Social Care, presented the petition calling upon the Government to review the inspection process for vulnerable adults living in residential care. It asks for the following points to be addressed:
All organisations must create working cultures where abuse is unacceptable and clear polices and procedures are in place to report abuse and wrongdoing.
It is vital that individuals working in adult social care have the right attitude to work with vulnerable adults and that they are trained in safeguarding and managing challenging behaviour
Robust and rigorous recruitment procedures are essential.
Specific on-the-job training should be regularly assessed and refreshed.
Staff must have relevant and specific knowledge of the disabilities they are dealing with to help support individuals appropriately.
Commenting, Carol Povey, Director of NAS Centre for Autism, said: “It is completely unacceptable that any form of abuse by support staff takes place in any care service. It is deeply distressing that these vulnerable adults have been treated so diabolically and the strength of support for urgent action is palpable. In less than two weeks the NAS received over 10,000 signatures to the petition.