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 They tend to be little girls with blonde hair and they often become withdrawn and emotionally needy shortly after joining Bill’s classes.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?
It 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:
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).
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.