HERTFORDSHIRE COUNTY COUNCIL

ADULT CARE & HEALTH CABINET PANEL

THURSDAY 5 JUNE 2008 AT 10.00AM

Safeguarding Vulnerable Adults

Report of the Director of Adult Care Services

[Author:Cathy Kerr, Assistant Director – Learning Disabilities and Mental Health

Tel: 01992 588820]

Executive Member:Sally Newton (Adult Care and Health)

  1. Purpose of report

1.1Local Authorities have a responsibility to ensure that there are effective multi-arrangements in place to safeguard vulnerable adults, and to intervene when concerns of possible abuse are raised. This report provides a briefing for Panel members on these arrangements in Hertfordshire.

  1. Summary

2.1In March 2000, the Department of Health (DoH) issued ‘No Secrets’, a national framework for the development of adult protection work. Adult protection is now more generally referred to as ‘safeguarding adults’.

2.2In 2001, Adult Care Services (ACS) established the multi-agency Hertfordshire Safeguarding Adults Committee, and this committee oversees our work locally to safeguard vulnerable adults from abuse. A well established multi-agency safeguarding procedure provides the framework to ensure that there is a co-ordinated and effective response when concerns about possible abuse are identified.

2.3Safeguarding investigations generally relate to concerns of abuse against an individual, and may relate to physical, sexual, financial, psychological or institutional abuse. In 2007/08 there were 383 investigations into concerns of abuse against individuals. In the last two years ACS has also conducted a number of “serious concerns about establishments” investigations, where concerns about the overall standard of care in a particular establishment are raised, for example following a high number of complaints about a home care agency, or a number of admissions to hospital from a single care home where there are similar issues, eg pressure sores/dehydration.

2.4In addition to ensuring effective arrangements to respond to allegations of abuse, ACS has other arrangements in place to protect vulnerable adults and this work is supported through other policies, eg responsible reporting, challenging behaviour, and sexuality policies. The Hertfordshire Safeguarding Adults Committee also has a role in raising awareness, and taking steps to prevent abuse. Recent initiatives include the People in Partnership anti-bullying project for people with learning disabilities, and the pilot project in West Hertfordshire with Action on Elder Abuse and home care providers to raise awareness and establish a helpline for carers and service users to report concerns.

2.5Both locally and nationally, issues around the protection of children are more widely recognised and multi-agency arrangements for safeguarding children are generally more established. However, there is now increasing recognition of abuse of vulnerable adults, and campaigns, for example by Action on Elder Abuse, have helped to raise this profile. The Commission for Social Care Inspection (CSCI) have identified safeguarding as a priority, and this now forms the basis of all inspections of local authorities with responsibility for adult social services. In Hertfordshire we expect a CSCI inspection later this year.

  1. Recommendations

3.1The Cabinet Panel is invited to:

  • Note multi-agency work led by ACS to safeguard vulnerable adults
  • Consider any areas they wish to recommend for further work
  • Consider any further briefing or information that would be helpful for elected members
  1. Background

4.1Definitions

A vulnerable adult is defined as any person aged 18 years or over:

  • who is or may be in need of community services by reason of mental or other disability, age or illness; and
  • who is, or may be, unable to take care of himself or herself against significant harm or serious exploitation.

Abuse is a violation of an individual’s human and civil rights and may consist of a single act or repeated actions. It may be physical, sexual, financial, psychological or institutional, or may relate to neglect or discrimination.

4.2National and local policy context

‘No Secrets’, published in 2000 by the DoH, set the framework for the development of adult protection work, now referred to as ‘safeguarding adults’. In 2005 the Association of Directors of Social Services (ADSS) issued national standards for safeguarding adults. The Care Standards Act (2000), and the implementation of the Protection of Vulnerable Adults (POVA) list in 2004 provide additional protection for vulnerable adults. In 2009, a new Independent Safeguarding Authority (ISA) will be established by the Home Office to provide a comprehensive vetting and barring service for people working with children and vulnerable adults.

In Hertfordshire our local policies take account of national guidance and our multi-agency procedure is well embedded. We have supported the development of national policy and aspects of our local procedures, for example in relation to concerns about establishments, is recognised as best practice.

4.3Multi agency arrangements in Hertfordshire

Our work locally is overseen by the Hertfordshire Safeguarding Adults Committee. This is led by ACS and partner representation includes the Police, NHS, probation, care providers and user/carer organisations. The committee is responsible for developing policy and procedures, for ensuring that arrangements are working effectively, and that there are active campaigns to raise awareness and prevent abuse.

4.4Safeguarding activity

(a)The Process.

Concerns about the possible abuse of a vulnerable adult may come from a number of sources: a family carer, a care worker, a friend or neighbour, a GP, or the service user themselves. Wherever the referral comes from, it is the responsibility of the local authority to ensure that this is looked into. In this context, the ACS Learning Disability (LD) and Elderly and Physical Disability (EPD) Teams, and the Herts Partnership Foundation Trust Mental Health (MH) and Mental Health Services for Older People (MHSOP) Teams are known as the “investigating teams”.

Most safeguarding adults from abuse investigations begin with an initial assessment by telephone. The need for the immediate protection of the vulnerable adult is the first consideration, and if it appears that a criminal act may have been committed, the investigating team will contact the police.

A safeguarding strategy meeting will be held where there is a suspicion or concern of abuse. This should be held within ten working days or three working days in an emergency. This meeting is convened by the investigating team and is central to developing a co-ordinated investigation, ensuring that information is shared, roles agreed and stress for the vulnerable adult is minimised. Police attendance is essential if it appears that a criminal act may have occurred. Service providers who work with the vulnerable adult should attend and the Commission for Social Care Inspection (CSCI) invited if relevant. Consideration must be given to involving the alleged victim and/or family carers. The main aim of the meeting is to produce an action plan for the investigation, including protection of the vulnerable adult. The action plan details roles, responsibilities and timescales, and where necessary follow up meetings are held.

The strategy meeting will consider arrangements to interview the vulnerable adult. If the police are to be involved, consideration should be given to using Achieving Best Evidence guidance, which was introduced to ensure best practice in the interviewing of vulnerable victims.

If the alleged abuser is a family member or carer, the factors contributing to the abuse should be carefully assessed. Alleged abusers who have a conviction for a relevant violent or sexual offence may need to be referred on to the Herts Multi-Agency Public Protection Panel. In the case of the alleged abuser being a vulnerable adult, this may need referring to the separate Mental Disordered Offenders (MDO) Panel.

An investigation into the abuse of a vulnerable adult may reveal wider concerns about a service provider. When this occurs, a Serious Concerns (about service providers) meeting is held. This may result in a requirement for the service provider to take actions to improve the standard of care and support being provided. CSCI should always be involved where the concerns relate to a registered care home or domiciliary care provider.

(b)Workforce Development

A range of workforce development activity is in place to ensure that investigating teams have appropriate training, and that requirements to safeguard vulnerable adults are understood and implemented. Current activity includes an ‘e-learning’ package that has been made widely available across ACS, health, police, care providers and user/carer organisations.

(c)Data

The table below shows the number of safeguarding investigations during the year to end March 2008:

Care Group
Elderly & Physical Disability
Learning Disability
Older Peoples’ Mental Health
Working Age Mental Health / 89
172
75
47
Total / * 383

(* Note. Final figures still being verified.)

This compares with previous years as follows :-

Care Group / 06/07 / 05/06 / 04/05 / 03/04
Elderly & Physical Disability (including Older Peoples’ Mental Health)
Learning Disability
Working Age Mental Health / 236
58
31 / 35
110
24 / 32
54
7 / 20
50
4
Total / 325 / 169 / 93 / 74

The figures overall reflect increased safeguarding activity in relation to vulnerable adults. However, historical recording problems mean that activity has sometimes been under-recorded and there have been data accuracy problems. These problems were partly addressed during 2007/08 through use of a safeguarding monitoring form. From April 2008, a screen is included on the IRIS client record system, which will ensure that this is fully addressed and that all investigations are logged.

To date, there has not been a statutory requirement to collect data on safeguarding activity. However, we recognise that this data is essential to inform future developments and safeguarding activity, and the new IRIS screen should ensure comprehensive data collection.

(d)Work to prevent abuse and raise awareness

The Safeguarding Adults Committee has overseen a number of initiatives aimed at more proactive prevention and awareness raising.

These include:-

  • People in Partnership. A training pack developed by and for people with learning disabilities, and aimed at increasing confidence of service users to report incidents, and to train partner agencies, eg Police, in tackling hate crime.
  • Action on Elder Abuse Helpline. Being piloted in West Hertfordshire from April 2008. Contact cards are given to all home care service users/carers, to raise awareness and provide a number to ring to report concerns.
  • In the coming year, the committee will oversee work to look into issues of financial abuse and identify ways to address this, for example, through a public awareness campaign, and work with care providers.

4.5Inspection of Safeguarding Adults arrangements

The protection of vulnerable adults and the role of adult social services authorities in ensuring effective arrangements is now identified as a priority, both nationally and locally, and CSCI inspections of local authorities now have a focus on safeguarding.

In Hertfordshire we expect a CSCI inspection later this year, and our inspection preparation plan includes audit and checking of our safeguarding arrangements to ensure that we are able to provide evidence of effective practice.

Background Papers

1.The Hertfordshire Safeguarding Adults Committee Procedure can be found at:

2.The DoH document ‘No Secrets’. Can be found in Chapter 16 of the above document.

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080605 AC&H Cabinet Panel

Item 4 – Safeguarding Vulnerable Adults