Safeguarding 11: Neglect

neglectNeglect is a criminal offence linked to the concept of the ‘duty of care’. In fact it is impossible to convict a person of neglect unless they did indeed have a duty of care toward the person whose needs have been neglected.

To make sense of this just imagine how ridiculous it would be to prosecute some random stranger whenever a person’s care needs are neglected. The stranger is not guilty of neglect because the neglect had nothing to do with them. They were not expected to deliver the care in the first place.

Neglect then is the failure to fulfil one’s duty of care.

What then do we mean by ‘duty of care’?

In every job there are specific duties and responsibilities that need to be met. These vary depending upon the job itself but most people are clear about what their responsibilities are. However in terms of safeguarding there are a number of less obvious meanings of the word ‘neglect’.

For example the Protection of Vulnerable Groups Act 2006 and the Adult Support & Protection (Scotland) Act 2007 both reiterate the long-standing duty all health and social care workers have to report abuse. This means that if we are aware of abuse, perhaps by a colleague, and do nothing we also will be guilty of neglect. Employers who fail to deal appropriately with allegations of abuse among their workforce are also guilty of abuse and could face criminal prosecution.

This may seem hard but it is a necessary part of health and social care work for several reasons.

Bullies are attracted to work involving vulnerable adults;
Care staff are often the only people in a position to spot abuse;
Service-users are often dependent upon us for their safety.

When I make this point during training sessions people often object on the grounds that the alerter (the person reporting abuse) may themselves face problems with the rest of their colleagues if they ‘rock the boat’. This is true and I’m not about to pretend that it’s easy to be the alerter. However I would like to make the following points:

The law is what it is and it won’t change just because we might not like it;
Being unpopular for a while is not so bad as prosecution, conviction and a ban from working in social care because we didn’t report what we saw.

It’s also important to realise that there are two distinct roles in adult protection. One is ‘alerter’ and the other ‘investigator’. The alerter is not – indeed cannot be the investigator except in extreme circumstances.

This means that the alerter does not need evidence to report their concerns. Gathering evidence is the job of the investigator. If you have a suspicion, even if you have no proof, your duty is to report it, nothing more. If you wait until you have proof the abuse may go unreported for months or even years. This is not in the best interests of the service-user. In any case, most alerters are not in any position to investigate – that needs management authority or even police powers on occasion. Don’t wait for something you might never get.

You must not discuss your concerns with the alleged abuser. If you do you may increase the risk to the service-user and also interfere with what may become a police investigation. Simply report your concerns and then ‘walk away’ unless you are given a specific task to perform by your manager. This is as much a part of your duty of care as any other element of your work so failing to comply means neglect just as surely as failing to feed, clothe or care for those in our care who need it.

Some acts of parliament such as the Mental Capacity Act 2005 (itself another ‘layer’ of safeguarding for those who lack capacity) create and define their own offence of ‘wilful’ neglect. This is the offence of failing to learn about or comply with the law as it relates to our work. For example since April 1st 2007 it has been an offence to assume a person lacks the capacity to make their own decisions without first helping them to decide. This is just one of many examples where practice has had to change in recent years to avoid ‘wilful neglect’.

Another is the duty of care we all have as care workers to assess a person’s mental capacity before performing care tasks. Failure to do so could result in up to five years imprisonment depending upon the circumstances and the seriousness of the situation. That’s why all members of care staff are expected to understand how to assess mental capacity from the nurse or doctor to the support worker and care assistant.

The law changes. Practice must change too.
If you still do what you did 5 years ago you may be breaking the law.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 8: Psychological/Emotional abuse

“for there is nothing either good or
bad, but thinking makes it so”

William Shakespeare, Hamlet, Act 2, Scene 2

With this simple line Shakespeare’s Hamlet summed up the basic notion behind psychological and emotional abuse. Eleanor Roosevelt said it rather differently three and a half centuries later when she pointed out that an insult only hurts if we agree with it. What both of these different expressions of the same principle have in common is this:

If I want to change the way you feel I must first change the way you think, either about yourself or about your situation.

thumbnailCA3H80ASAnything that causes distress or confusion or that misleads the other person causes psychological and or emotional harm. If the behaviour that causes that harm cannot be justified then it is also abusive.

The distinction between ‘harm’ and ‘abuse’ is as important here as anywhere. After all you can’t please all of the people all of the time and people do sometimes become upset for their own reasons even though no-one has done anything wrong. If a person becomes upset because you’re carrying out your legitimate duties then that’s not your fault.

For example the relative who chooses to become angry or distressed because the carer refuses to do what they demand is not being abused. They have no right to demand that they obey them – your duty is to the service-user, not the carer and so you are not being abusive by doing what you think is right, whatever the carer’s opinion might be.

However sometimes our dismissal of others opinions, wants and needs really is abusive. The service-user who becomes distressed when the carer insults or ridicules them is a victim of emotional and psychological abuse. We may not be able to please all of the people all of the time but that doesn’t excuse meanness.

Deliberately misleading, isolating or demeaning another person is likely to be psychological abuse as are intimidation, over use of criticism and hostility. If these things are done from a position of authority they may well also meet the European criteria for torture precisely because of the distressing impact they have on the victim. Repeatedly focussing upon distressing situations for no good reason such as constantly surprising dementia sufferers with the news of their parents’ death for example is a form of psychological/emotional abuse too.

Earlier we made the point that abuse is a violation of an individual’s rights. Rights are not only about the things we shouldn’t have to put up with – they’re also about our entitlements. For example service-users have the right to experience a stimulating environment (so long as they can cope with it). Endless hours of daytime television is not really appropriate psychological stimulation which is one reason why so many people in residential care or long term hospital placements become clinically depressed. What would happen to your mood if all you had to occupy your mind were chat shows relating to a world you no longer felt part of? Physical and environmental circumstances have psychological and emotional impact, for better or for worse.

Over-stimulation due to noise, overly bright lights or even simply too much frenetic activity can cause psychological harm. Critical, demeaning staff or dehumanising routines create difficulties too, particularly in relation to self-esteem. Consider the psychological impact of having someone else make your basic decisions such as what you wear or eat, what time you get up, when you bathe and even when you go to the toilet. Imagine someone else feeding you.

Of course it is undeniable that many people in our care need a great deal of support and assistance with all these things and more. However – when they are able to exercise choice about when and with whom for example they are much more likely to maintain a sense of independence and control than when they are simply factored into a routine that is decided ‘in the office’.

To the busy care worker these things are functional – they’re just routine and can become no more than ‘tasks’ to be performed in the minds of the staff. To the incapacitated patient or resident they may be the last aspect of independence supporting their self-esteem. Even routine can be a form of psychological abuse. We’ll explore this concept a little more when we cover Institutional abuse shortly.

As with so many aspects of abuse it’s always worth wondering how you would feel if you were in that situation. If you’d become distressed, depressed, angry or humiliated then there’s a good chance that the same will be true for your service-users.

The fact that they may not complain is no guarantee that they are satisfied. It is usually the most depressed and/or dehumanised people who complain the least because they have simply given up. That’s one reason why health and social care inspectors monitor complaints about a service. The service that has no complaints is often the service chosen for an inspection visit simply because it is impossible to please all of the people all of the time and so if nobody is complaining the inspectors often want to know why not.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 7: Sexual abuse

It is a fundamental principle of law that people must consent to sexual encounters before they can be considered legal. Sexual contact without consent can constitute a variety of criminal offences, all of which come under the wider definition of ‘abuse’.

This idea of ‘consent’ is very clear when we consider ‘forced’ offences such as a violent rape or sex with a minor who is not yet sufficiently mature to give informed consent. Even with adults who might usually be deemed to have the capacity to consent situations can arise that might invalidate that capacity such as drug-assisted rape. Even ‘taking advantage’ of a drunken partner can constitute an offence because their ability to consent (and therefore to withhold consent) is impaired.

Other situations that can impair consent involve the relative status of those involved. This is why, even between adults, sex involving someone who is in ‘a position of trust’ can be unlawful. For example a teacher who seduces a sixteen year old pupil might face prosecution even though his or her pupil is old enough to consent. The relationship they share breaches the trust normally expected in such a situation.

Workers in health and social care are also in a position of trust and the dynamics of the care relationship can distort consent just as the relationship between teacher and pupil can. This means that even if the service-user appears to consent there is likely to be a problem.

The Safeguarding Vulnerable Groups Act 2007 builds upon the legal definitions laid down in the ‘No Secrets’ document and emphasises the issue as does the Sexual Offences Act 2003. Sexual encounters that abuse a position of trust are likely to result in prosecution. This is also true of offences that are not physical but still come under the sexual abuse umbrella of offences as we shall see later.

Some service-users have such impaired understanding that they can’t really consent to sex at all with anyone in any circumstances whether involving someone in a position of trust or not. In these circumstances the superficial solution would be to prevent all sexual experiences and often this is precisely what happens but not always.

To simply prevent all sexual activity would be to ignore the need for a full quality of life, including the need for sexual fulfilment. This enforced celibacy might not really be in their best interests. So, even though an individual may not fully understand all the implications of sexual contact that other people might consider, if they express a genuine desire for a ‘full’ relationship this may be supported by ‘the system’ if other circumstances are ‘right’.

Such decisions should be taken in consultation with the local Adult Protection or Safeguarding team. It’s too big a decision for care providers themselves. Remember that safeguarding vulnerable adults is a concern for the whole of society and so society has put in place a system to manage it.

For workers in the ‘front line’ then, if you have any doubts about a service-user’s ability to consent you must inform the Local Authority (LA) Safeguarding team straight away.

Of course not all sexual abuse involves penetration or even physical contact at all. Inappropriate suggestion, comment or innuendo is also sexual abuse. Most people understand the idea of sexual harassment as it applies to people who are not in our care. The same principles apply for service-users but with even more emphasis than for the rest of us. Basically, the less able an individual is to protect themselves the more they are protected in law.

Comments that embarrass or demean the individual can fairly be described as psychological/emotional abuse but if they are of a sexual nature then they might also be sexual abuse. It doesn’t matter how inoffensive the carer or worker might consider their comments to be. Once we know that the service-user is at all uncomfortable with our words we need to reconsider them.

It is particularly important to take care how we may be perceived when delivering ‘intimate’ care. As well as the obvious considerations about who delivers that care, the sex of the worker for example, the conversation between carers and service-users or even between carers themselves can be humiliating for the vulnerable adult in our care. There is no excuse for knowingly humiliating, embarrassing or otherwise distressing service-users in these situations. I have heard tales of care workers discussing intimate details of their own sexual encounters whilst ‘intimately’ assisting elderly ladies who were offered no choice about whether or not they wanted to listen. Quite apart from the fact that the care staff were ignoring the people they were employed to care for (and presumably to care about) this is hardly the time or the place for such discussions.

Unfortunately it is this area of sexual abuse – the embarrassing or degrading comment – that is most misunderstood. There are many reasons why people involved in intimate care develop a sense of humour that might be misconstrued by their service-users or other interested observers. This does not make them ‘bad’ people or even inappropriate carers. They just may need to stop and think more about how they ‘come across’ to the service-user.

We can see then that sexual abuse might mean a range of different things and also that it depends upon the context of the relationship, the interpretation and the understanding of the service-user.

It’s also vital that we are able to understand and acknowledge cultural and religious differences between carers and the vulnerable adults they care for. This is more than the well-publicised concerns that particular religious groups might have, for example the inappropriateness of male carers bathing Islamic women. There is a relatively marked cultural divide between the generations and although there are exceptions it is a general principle that elderly ladies will have different values from the young adults who care for them.

If we assume that the majority of sexual abuse is unintended (and, with the exception of physical assaults, I think that’s probably true) then it’s worth taking the time to learn a bit about the values and culture of our service-users.

References and further reading

Department of Health (2000) No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, London, Department of Health.

Sexual Offences Act 2003:

http://www.opsi.gov.uk/acts/acts2003/ukpga_20030042_en_1

Sexual Offences Act 2003 sentencing guidelines:

http://www.sentencing-guidelines.gov.uk/docs/0000_SexualOffencesAct1.pdf

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 5: Financial abuse

moneyAt its most basic financial abuse is very clear and straightforward. Criminal offences such as theft, fraud and extortion leave no room for doubt. They are plainly abusive. However there are other, rather more subtle examples of financial abuse, some of which are a lot more common in practice than we might like to think. As we go through the illustrations below please bear in mind the following principles:

People have the right to choose how to spend their money if they have the capacity to do so;
When people lack the capacity to make their own decisions their finances should be used in their best interests;
People should not be coerced into parting with their money;
Financial abuse is concerned with the disposal of resources as well as money.

One relatively common practice in social care involves trips out to amenities such as the cinema or other activities that involve payment. Service-users who require support to access community resources sometimes find themselves paying for their carers to accompany them out of their personal funds. If the pair stop off at a café whilst out shopping the service-user foots the total bill. If the service-user objects to this the result is simply that they don’t go to the cinema, the café or whatever any more. Everything costs the service-user twice as much as it normally would. It’s hard to think of this practice as anything other than an abusive, coercive contempt for the service-user and their financial situation.

Another ‘trick’ involves the ‘buy one get one free’ or ‘bogof’ promotions that can be found in supermarkets. There have been cases of financial abuse in which the service-user pays for their weekly shopping but the carer ‘acquires’ the free items. This is no different from buying an item at half price and taking the full cost of the item from the service-user. It’s theft, purely and simply. The service-user has bought the full price item and is therefore entitled to the free (actually they’ve really just bought two items at half price). It’s their property because they paid for it. This is not ‘a perk of the job’ – it’s financial abuse.

Several other interesting illustrations came to light during the infamous ‘North Cornwall’ inquiry in 2006. For example residents’ personal money was ‘pooled’ together and several ‘better off’ residents were subsiding others without their knowledge or consent. Residents’ personal finances were also used to pay for maintenance of the building they lived in even though they already paid rent sufficient for that purpose.

Perhaps the subtlest form of financial abuse in North Cornwall involved the way that residential buildings were managed. Staff used to control the lighting system to encourage residents to use particular areas in order to observe them more easily. The effect was that residents were unable to access various rooms they were paying rent for. If you were denied access to half the rooms in your home how would you feel about paying the full rate to live there?

Another extremely common problem involves relatives taking it upon themselves to control the finances of vulnerable people, perhaps with learning disabilities or other conditions, and then making decisions that do not really reflect the person’s best interests. For example:

Buying or giving exotic gifts for themselves or others;
Over-saving so that the individual is effectively penniless;
Preserving elderly relatives’ funds to maintain their own inheritance.

Of course the majority of carers do not abuse their relatives but some do. These people are just as liable to prosecution as anyone else. This liability remains whether or not they have formal authority under a power of attorney although the actual charges they face will probably vary.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 3: Basic definitions

LawWe need to know what we mean by ‘abuse’ and additionally what is meant by the term ‘harm’. This may sound like an obvious and perhaps even pointless diversion but it’s vital to clarify because there are so many misconceptions about the nature of abuse.

For example one prevalent myth is that if the service-user doesn’t like what we do then it’s abuse. However this clearly isn’t all there is to it. If it were every eviction from social housing would be seen as abuse, as would every occasion when staff confront service-users about antisocial or other forms of challenging behaviour.

If there is a ‘shorthand’ way of defining abuse it’s to say that it’s a violation of an individual’s human and civil rights. This is different from simply saying that if a person doesn’t like what we do we’re being abusive. In England and Wales the law recognises seven different forms of abuse.

These are:

Financial
Physical
Sexual
Emotional’/psychological
Discrimination
Institutional
Neglect

In Scotland two other forms of abuse are identified – these are:

Self
Verbal

Harm is slightly different from abuse in that there doesn’t need to be an abusive action in order to cause harm. Bad luck happens and it’s not always appropriate to blame someone for every misfortune, whatever the solicitor might tell you.

So harm might result from abuse but then again it might not.

There is no clear definition of ‘harm’. The closest I have been able to find to a workable definition comes from Scottish legislation – The Adult Support and Protection (Scotland) Act 2007 – but really it’s a rather circular description.

Section 53 of the ASP states harm includes all harmful conduct and, in particular includes:

conduct which causes physical harm, conduct which causes psychological harm (for example by causing fear, alarm or distress), unlawful conduct which appropriates or adversely affects property, rights or interests (for example theft, fraud, embezzlement or extortion), conduct which causes self-harm.

We can see that this still doesn’t adequately define harm but then to do so would be both unrealistic and unfair. In reality the judgement about whether or not a person is actually harmed is either obvious or decided upon the individual circumstances of the particular case.

Such decisions take into account a wide range of factors including notions of accepted best practice (in respect of workers) and also ‘custom and practice’ as well as an understanding that nobody gets through life without the occasional piece of distress. Into each life a little rain must fall.

However this does not mean that workers can go around harming people without fear of censure. In fact, if you work with vulnerable groups you are duty bound to do all that is reasonable to prevent harm or potentially face a range of consequences from dismissal to imprisonment.

What then do we mean by ‘vulnerable’?

In Scotland section 3(1) of the ASP defines ‘adults at risk’ in the following way:

Section 3(1) defines “adults at risk” as adults who:

are unable to safeguard their own well-being, property, rights or other interests;
are at risk of harm;
and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.

It’s a ‘three point test’ which makes it very clear that safeguarding legislation applies to those people who are deemed to be more vulnerable than their peers.

In England & Wales the definition of a ‘vulnerable adult’ has essentially the same meaning but is expressed in a rather less methodical way:

“A vulnerable adult is a person who is, or may be, in need of community care services by reason of mental or other disability, age or illness and who is or may be unable to take care of themselves or be unable to protect themselves against significant harm or exploitation.”

(Lord Chancellor’s dept. 1997)

Throughout this series I will concentrate on the safeguarding systems and legislation concerning England, Wales and Scotland only because these are the areas I cover as a trainer. I am not attempting to outline the rules for any other part of the world – that would be beyond both my remit and my knowledge

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 2: A little history

Adult Protection has become an increasing concern over recent years. Several high profile incidents involving abuse of vulnerable people have prompted UK society to look again at the systems we have in place to safeguard those who need it most.

Throughout this series we will outline the main points of the current safeguarding system. First though we’ll review the recent history of safeguarding to get a sense not only of how it has evolved but also of what its trying to achieve. This will make it easier to understand the current legislation and to use it in practice.

As a trainer I am convinced that people make sense of things best when they know the ‘how’ and the ‘why’ as well as just the ‘what’.

We’ll begin with the Protection of Vulnerable Adults (POVA) system. This was introduced by the Care Standards Act 2000 with guidance from the government’s ‘No Secrets’ document. This outlined the definitions of abuse and of vulnerable adult. It also created the POVA list – a register of the names of people who were deemed to be unfit to work with vulnerable people because they represented too high a risk.

The POVA list was one of three basic lists:

1.The POVA list: related to vulnerable adults
2.The POCA list: related to children
3.List 99: Related to education

These three lists were operated by different organisations but all relied upon the enhanced CRB check. The CRB check (Criminal Records Bureau) check provided information on criminal convictions. The enhanced CRB check provided more than just this basic information. It also noted suspicions and unproven allegations that might be relevant.

When delivering training on adult protection and safeguarding I almost always come across objections when I make this point. This is understandable because it seems to contradict the long-standing legal principle of the presumption of innocence: the idea that we are innocent until proven guilty.

My response to this is always to put forward the following hypothetical scenario from the world of child protection:

Imagine a teacher – a good teacher – we’ll call him ‘Bill’. Bill has been in the job for many years and gets great academic results for most of the children he teaches. Bill specialises in the 7 – 11 year old age bracket.

Some of the children Bill teaches tend to do very badly though. They tend to be little girls with blonde hair and they often become withdrawn and emotionally needy shortly after joining Bill’s classes. I don’t think I need to be too specific here – the results of paedophilia are well known and the above scenario illustrates the point well enough.

Now imagine that this teacher has been working in a particular school here in Cumbria for a few years when he notices that some of the parents have taken to ignoring him. Bill also notices that when they’re waiting for their children at the school gates some of the parents tend to bunch together and seem rather conspiratorial whenever they see him. Bill’s no fool. He knows what’s about to happen. It won’t be very long before he’s formally reported to the local police.

So Bill applies for other jobs in other schools out of the area. His overall academic record is good and the head will give him a good reference (not least because she’s heard the rumours too and wants rid of the problem). Bill leaves Cumbria and takes up a post in a school in the neighbouring county of Lancashire. There’s no conviction and so no information follows him. He’s in a different education authority with a clean slate.

A couple of years later, having continued his abuses with a fresh group of Lancastrian children, Bill moves again, perhaps to Lincolnshire this time. And then a year or two later he moves once more – this time to your home town. Now Bill’s teaching your children.

That’s OK isn’t it?

New Scotland YardIt doesn’t take a genius to understand that if we can only use convictions to identify abusers we will fail more often than we succeed. But this gives us a dilemma as a nation. Whatever we do we cannot have a perfect system – mistakes will be made. The choice we have had to make as a society is what the price of our mistakes will be.

If we rely upon convictions only then the price will be countless abused children. Imagine how many youngsters a teacher will come across in the space of a career. How many vulnerable elderly residents might an abusive ’carer’ come into contact with too?

If we use wider sources of information the price of our mistakes will be some people having to get a different job. Neither outcome is ideal but then it’s not an ideal world. Which price do you consider to be the lesser of two evils? I think – and the government thinks – that the lesser price is the fact that some people will need to get a different job.

So child protection systems solved the problem, at least in part, by considering wider information and adult protection has followed suit – hence the enhanced CRB check (Now the DBS). Even then it doesn’t necessarily mean that the individual whose information shows up on the check is barred from working in the care sector but they may have some things to discuss with prospective employers at interview.

Only in the more extreme cases are people actually prevented from working with vulnerable adults and that was what the old POVA list was about. People whose names ended up on the POVA list were legally barred from working in social care.

In 2005 Kings College London produced a report analysing the first 100 referrals to the POVA list. Their findings were significant and in parts very worrying. The document can be viewed online here.

Firstly it was clear that the vast majority of referrals came from the independent sector with only around 5% of referrals generated by the NHS. This is unlikely to be because the NHS does not have any abuse issues – in fact it may demonstrate a culture of neglect and ‘turning a blind eye’ that needs to be addressed as a matter of urgency. When abuse in the NHS does come to light it is often extreme and systemic as was demonstrated in the North Cornwall scandal of 2006.

The report also noted that in many cases abusive practice had been tolerated and left to continue for long periods. This was especially true in smaller establishments. The vast majority of abuse involved front line workers.

Perhaps most worryingly several workers had actually been convicted of relevant offences and yet continued to work in health or social care. The main arguments put forward in mitigation by those accused of abuse were:

Overwork;
Lack of training (particularly relating to challenging behaviour and hostility);
Accidental harm/lack of intent to cause harm;
Mental health problems experienced by the alleged abuser (often linked to working conditions).

“In our reading of the referrals there appeared sometimes to be a merging of poor skills and abuse”

The Kings College report acknowledged the reality of many of these mitigating circumstances and asked for greater scrutiny of employers and their practices when determining the truth of such allegations:

“As a means of reducing harm to vulnerable adults, it is clearly important to ensure that people of general ill-will or those who lack capacity are prevented from working in social care. However, it is also important to balance the focus on individual abusers and episodes of abuse with a wider examination on the quality
of social care employment practice, availability of training, working conditions, impact of under-staffing and ongoing nature of stress.”

“Consequently, it is possible that previous CSCI reports on the provider unit or company may be a valuable addition to the information to be considered in making decisions about referrals. In situations in which a worker claims not to have had training, examination of such records may help provide better evidence. Furthermore, some referrals included evidence about staffing levels at the time of and immediately preceding the incident or periods of misconduct would be useful. Such evidence may help in deciding individual cases, but also identify situations which might give rise to ongoing concern about the safety of service users in those establishments.”

Although several workers were dismissed and some were reported to the police not all of them were prosecuted. This is because it can be difficult to establish guilt in a court (beyond reasonable doubt) even when there is enough evidence (balance of probabilities) to dismiss them.

Differing ‘burden of proof’ has been a long-standing problem, especially in child protection. Child protection (CP) is an area of practice that has provided many answers to problematic issues and so it was used as a basic blueprint to guide adult safeguarding procedures.

Other problems identified by this and subsequent studies involved the lack of partnership working between sectors and what appears to be an element of ‘preciousness’ in some local authorities with regard to the sharing both of information and of resources.

In response to these sorts of concerns and also serious incidents such as the Soham murders (Ian Huntley) and the case of Miss X (Scottish Borders Enquiry) new legislation was drawn up and has been implemented throughout UK.

References and further reading

Department of Health (2000) No Secrets: Guidance on developing and
implementing multi-agency policies and procedures to protect vulnerable adults
from abuse, London, Department of Health.

Department of Health (2004a) Protection of vulnerable adults scheme in England
and Wales for care homes and domiciliary care agencies: a practical guide,
London, Department of Health.

Department of Health (2004b) ‘P1.1 Rounded Referrals, Assessments and
Packages of Care, for adults’ Report of findings from the 2003-04 RAP
Collection, London, Department of Health.

Fyson, R., Kitson, D. and Corbett, A. (2004) ‘Learning disability, abuse and
inquiry’, in: Stanley, N. and Manthorpe, J. (eds) The Age of Inquiry: Learning and blaming in health and social care, London, Routledge.

Health & Social Care Information Centre (2004) Community Care Statistics 2004:
Home care services for adults, England, London, Department of Health

House of Commons Health Select Committee (2004) Report on Elder Abuse,
London, The Stationery Office.

Mathew, D., Brown, H., Kingston, P., McCreadie, C. and Askham, J. (2002) ‘The
response to No Secrets’, The Journal of Adult Protection, 4(1) pp. 4-14.

Social Care Workforce Research Unit 2007) Partnership and Regulation in Adult Protection http://www.prap.group.shef.ac.uk/PRAP_report_final_Dec07.pdf

Summer, K. (2004) ‘Social services’ progress in implementing No Secrets – an
analysis of codes of practice’, Journal of Adult Protection, 6(1) pp. 4-12.

The Nursing and Midwifery Council (2004a) Reporting lack of competence: A
guide for employers and managers, London, NMC.

The Nursing and Midwifery Council (2004b) Reporting unfitness to practise: A
guide for employers and managers, London, NMC.

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

Safeguarding 1: Introduction and contents

This blog series was originally written in 2010, partly in response to a political debate raging at the time around the rights of workers vs the rights of vulnerable adults. When I began the law was clear and, I believe, appropriate in placing meaningful restrictions upon those who wanted to gain unsupervised access to vulnerable people.

However I never completed the series. That was because in May of that year the indecisive general election here in UK resulted in a new coalition government who proceeded to change the existing and planned safeguarding arrangements in UK.

The ConDem government changed the safeguarding system

The ConDem government changed the safeguarding system


What follows then is not what was originally planned. Instead I’ll be posting the basic principles of safeguarding that have remained constant. The series then is likely to be of use to front line care workers trying to make sense of what abuse is and is not as well as their own role in protecting people.

This series will cover…

Safeguarding 2: A little history

Safeguarding 3: Basic definitions

Safeguarding 4: Horror stories

Safeguarding 5: Financial abuse

Safeguarding 6: Physical abuse

Safeguarding 7: Sexual abuse

Safeguarding 8: Psychological/Emotional abuse

Safeguarding 9: Discrimination

Safeguarding 10: Institutional abuse

Safeguarding 11: Neglect

Safeguarding 12: Record, report, communicate

About the Safeguarding series

This blog series first appeared on Stuart’s personal blog early in 2010. It has been reposted here as part of a process of ‘rationalisation’ in which work from several blogs has been removed and reposted on only two.

The Convention 1: Why this, why now?

Welcome to ‘The Convention’, a series of blog articles. In this little collection of posts I intend to cover one of my favourite examples of international cooperation, the European Convention on Human Rights (ECHR).

ECHR in sessionThis much maligned and misunderstood convention is one of Europe’s most important safeguards with far-reaching implications that protect us all. For a rights and liberties geek like me the convention is not only fascinating, it’s indispensible.

I should be clear from the outset though. I’m not a lawyer and this series of posts is in no way intended to be a particularly thorough or expert exploration of the European Convention on Human Rights. Rather it is a short introduction to The Convention and the role it plays in our society. If you want advice or information about a specific case then my advice would be to take proper legal advice from a suitably qualified professional. I’m really just a bloke with an interest in rights and a passion for blogging.

Unfortunately the convention has come under attack in recent years. Sometimes these attacks come from those who seek to remove its general protections for their own advantage. More often though they come from people who simply don’t understand the convention’s purpose and history. That’s why I’ve decided to write this series – to help me to explain just what it is that so many people oppose so vehemently.

I’ve met many otherwise reasonable people who think that human rights should be removed, mainly in relation to people they don’t like, people they see as somehow ‘different’ and therefore ‘less deserving’ of legal protection. For example the far right English Defence League (EDL) recently called for the arrest and conviction of Muslim men who had already been acquitted of a murder that might not even have taken place. This anti Muslim group seemed to be more interested in the suspects’ faith than in the fact that there was no evidence against them and no case to answer.
Human rights opposers see the ECHR and the UK’s Human Rights Act as preventing them from ‘dealing with’ those who are different. For example they think that it gives citizens from other cultures, races and religions equality under the law – and they’re absolutely right, it does.

That’s one of the things that the convention was designed to do shortly after the end of the second world war. In fact, when exploring the purpose of the ECHR and the way that it affects us today it’s almost impossible to avoid considering the atrocities of the holocaust, the pressure of the jackboot on occupied Europe, the treatment of disabled people or those from ‘non Aryan’ races and the political violence of ‘National Socialism’.

It’s no coincidence that far right groups such as the British National Party (BNP) and the English Defence League (EDL) would like to see the UK pull out of the convention. It outlaws discrimination on the grounds of race or religion and so prevents them from ever achieving their goals. Similairly the UK ‘ConDem’ coalition government has found some of its more draconian policies thwarted by the convention which upholds the right of citizenship and fair treatment. The previous labour government also fell foul of the convention when it attempted to have citizens arrested and detained for long periods without charge, trial or conviction.
In terms of health and social care much of our domestic legislation such as the Human Rights Act and the Mental Capacity Act is based upon the ECHR and recent alleged care related offences at Castlebeck’s ‘Winterbourne View’ home near Bristol can be linked back to the convention as well.

And yet so many UK citizens oppose the ECHR without realising just what they are arguing against. Principles such as the right to life, the right to privacy and the freedom to follow one’s religion are all ECHR principles. The principle of ‘no punishment without law’ and the rights to liberty and to freedom of speech come from the convention too.

Sexual equality and disability rights in the workplace, as well as in care and other settings link directly back to the convention as do workers rights, freedom from slavery and even from torture. These are just some of the safeguards that we all enjoy because of the European Convention on Human Rights.

Additionally, perhaps most upsetting for neo Nazi groups such as the BNP, the convention guarantees freedom of marriage, respect for family life and the right to a fair trial. It also makes it impossible to prosecute someone for doing something that was not illegal at the time they did it. For example making immigration illegal would not criminalise current UK citizens, whatever their ethnic origin might be. Nor would it make it possible to ‘send them home’ (whatever that might mean).

In short the European Convention can be thought of as a kind of antidote. If intolerance and fascism are the disease then the ECHR is at least part of the cure. Heavy handed governments and unfair, discriminatory street movements, however loud they shout are powerless in the face of the ECHR. No wonder the UK’s neo Nazis want us to pull out of Europe.

If this description seems a little melodramatic read on. As this series develops we’ll consider how and why the ECHR was developed in the first place. The convention was and still is a direct response to Hitler’s ‘Third Reich’ and some of the worst atrocities ever committed on European soil.

Long live The Convention

About ‘The Convention’

This series of posts first appeared on Stuart’s blog in June 2011. It is not intended to be a comprehensive or even particularly authoritative reference guide to the ECHR. Rather it is a brief introduction to a much larger and infinitely more fascinating subject. You can download the entire series in PDF format here: http://stuartsorensen.wordpress.com/amj-freebies-downloads-and-services/

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