Editorial

Article Type: Editorial From: The Journal of Adult Protection, Volume 14, Issue 2

Welcome to the second issue of volume 14. As seen in previous issues, here is a selection of recent news items relating to safeguarding, that readers may wish to be aware of or to consider further.

Since the last issue there have been a number of publications and developments that may be of significance to those with an interest in safeguarding and protection. In late November 2011, the National Institute for Health and Clinical Excellence (NICE) (2011) issued guidance on the longer term management and treatment of self-harm. The guideline states that psychological interventions should be provided for individuals who self-harm in order to assist with behavioural difficulties. However, at roughly the same time, the Royal College of Psychiatrists (RCP) (2011) published a report detailing the results of a national audit, which established that many therapists delivering psychological therapies are not sufficiently or adequately trained to appropriately assist individuals with anxiety and/or depression. So, obtaining good quality interventions might be problematic! In addition, again in late November 2011, the charity MIND (2011) published the findings of its independent inquiry into acute and crisis mental health care, which found that in the experience of a number of service users, emergency treatment was either inaccessible, or ineffective, or both. Whilst some “excellent provision”is available for emergency and crisis care, there appear to be significant problems with both acute inpatient hospitals and with crisis provision from community mental health teams. Examples of such problem areas include staffing difficulties, individuals struggling to obtain appropriate levels of help and poor quality care. There may be safeguarding implications linked to a number of these situations, particularly perhaps concerning the quality of care and treatment received.

Finally in late November 2011 (obviously a busy month in policy terms!) the Equality and Human Rights Commission (EHRC) (2011) published the results of their inquiry concerning the provision of home care for older people. The inquiry, undertaken across England, found disturbing evidence that poor treatment of many older people receiving care at home appears to be breaching their human rights and that too many people were not able to either voice their concerns about their care or to be heard to about what kind of support they want. The final report of the Commission’s inquiry indicated that potentially hundreds of thousands of older people lack protection under the Human Rights Act and called for this legal loophole to be closed. It called into question social care commissioning practices that focus on a rigid list of tasks, rather than on what older people actually want, and that seem to give far more weight to considerations of cost (and minimizing these) than to provision of an acceptable quality of care.

Around half of the older people, friends and family members who provided evidence to the inquiry expressed genuine satisfaction with their home care. However, the inquiry also revealed many examples of older people’s human rights being breached, including physical or financial abuse, disregarding their privacy and dignity, failing to support them with eating or drinking, treating them as if they were invisible, and paying little attention to what individuals want. Some of the respondents were surprised that they had any choice at all as they thought they had little say in how their care was arranged (EHRC, 2011). Additionally, in mid-December, just before the 2011 Christmas break, the Good Governance Institute produced a briefing relating to arrangements at the level of Safeguarding Boards and the need to secure appropriate and good quality governance planning and implementation in order that Boards can operate more effectively (for further information, please see: www.good-governance.org.uk/Product%20Menus/safeguarding-adults-bap.htm).

From the beginning of January the whistle-blowing helpline introduced for NHS staff was extended for use by staff and employers within the social care sector(BBC News, 29 December 2011). The helpline underwent something of a re-vamp for this to incorporation to take place and the revised telephone number is: 08000 724 725. Individuals across the sector may wish to take note of this development, including advising colleagues about the existence of the line, as necessary (Department of Health (DH), 2011). Also in January 2012, colleagues from Age Cymru initiated a campaign, with the title, Rule out Abuse,which is lobbying for a new (Welsh) law to protect adults at risk of abuse. The campaign and associated charter are calling on the Welsh Government to commit to three basic principles, which should be fundamental to all work in adult protection. These are: to prioritise safety, to protect individuals from harm and respect individual choices and to promote individuals’ rights to dignity and respect. Visit: www.ageuk.org.uk/cymru/professional-resources/comments/we-can-rule-out-abuse-in-wales-/and www.ageuk.org.uk/cymru/get-involved/make-a-donation3/rule-out-abuse/for further details and information about the campaign and to sign the charter.

Finally, the publication of the Serious Case Review (SCR) in relation to Nigel Leat published in late January 2012 is of relevance to adult safeguarding,albeit that it concerned the children’s sector. Leat was a teacher who abused a number of his pupils over a period of more than four years at a first school in North Somerset, where he had taught for some 15 years (see the following address for further information: www.n-somerset.gov.uk/Education/News/news-20120127-seriouscasereviewpublished.htm). Although several staff apparently raised concerns about Leat’s inappropriate behaviour, his teaching practice and relationships with some pupils (including excessive favouritism and apparent-grooming behaviour), no safeguarding referral was ever raised with the local authority Children’s Services by the school. Eventually a disclosure was made in late 2010 by a pupil, whose mother then made a report to the police and an investigation ensued. The SCR report refers to a culture of the school taking a stance of dealing with problems internally and a conviction that they did not need to refer to external organisations such as social services. Despite the fact that guidance existed within the school concerning how to raise concerns about such issues, it appears that staff were not aware of the appropriate procedures to follow and when staff raised concerns internally, no external action ensued. If we substitute education for other organisations involved in adult safeguarding then it is possible to recognise the potential for similar situations to arise within our sector too. Leat was imprisoned for an indefinite period in 2011 and the LEA summarily dismissed the head-teacher; but what has been the cost to the individuals who sustained abuse over such a period and those teachers who witnessed such events taking place without action being taken?

This issue of The Journal of Adult Protection contains a number of interesting papers. The first paper is by Suzy Braye and colleagues, and reports on a piece of research commissioned by the DH to evaluate the effectiveness of arrangements relating to the governance of adult safeguarding in England. The research used a number of different methods, including interviews with key informants and workshops held with safeguarding professionals in a number of locations across England. In the absence of any previous formal evaluation of adult safeguarding arrangements, there was limited literature to draw on, but the depth of information and detail gained from the workshops and interviews compensated for this lack. The paper usefully considers a number of different dimensions, including the structure and membership of boards, arrangements for chairing and inter-agency working and comments on the ways in which these operate and might develop. There are a number of useful recommendations for future work in this area, including further work on service user involvement in governance arrangements as well as use of the benchmarking framework developed as part of the research.

The second paper in this issue is by Ian Cummins and reports the findings of a small-scale research study, which took place in Lancashire, and which concerned assessment processes used by forensic psychiatrists of individuals detained in custody. As part of this project, information about individuals’use of community-based mental health services was gained as well as other details including demographic information relating to individuals, use of anonymised custody records and adverse incident reports for the police force during the month that the study took place. During that month some 59 forensic psychiatric assessments were requested by police custody officers and of those,only six individuals had existing links with community-based services, albeit that some of those links had not been accessed in the past month. The research recommends improved access to health care provision, but specifically mental health provision within custody settings and argues that such settings may be an important point for mental health intervention, which should be further recognised by community-based services.

The following paper, written by Shelly Jackson and Thomas Hafemeister,provides an international contribution and concerns Adult Protective Services(APS) provision in the US state of Virginia. The paper reports on a piece of research, which looked at different aspects of the investigation of and response by APS workers to situations of elder abuse that had been reported to APS. The study also examined the perceptions of the older victims involved and factors relating to the refusal of services, and it also compared findings from these aspects with the type of elder abuse that was involved. Several elements of the APS investigation and responses were found to differ by the type of abuse that had been reported. Whilst the older victims were generally satisfied with the APS intervention, over 1/3 of those who took part in the study indicated that they would have preferred not to have any involvement with APS concerning their situations. In addition, older victims’ differential responses made to offers of assistance appeared to depend on the type of abuse involved and older victims of physical abuse were most likely to refuse services. Safeguarding practitioners in the UK may find some resonance with the findings from this study and consider the implications from more local perspectives.

The final paper in this issue, by Rachel Fyson and Deborah Kitson, reports on an evaluation of adult safeguarding undertaken in one English local authority. The work was commissioned as a result of concerns about high levels of investigations that appeared to result in inconclusive outcomes. All adult social care teams within the authority were requested to complete a short form covering a number of different areas of information, about the five most recent completed safeguarding alerts that they had been involved in. The study findings indicate that there are several different factors that affect whether or not cases result in a conclusive outcome. Such factors included aspects of practice,for instance the extent of inter-agency co-operation and working, as well as whether formal safeguarding meetings were held or not. Concerns about the levels and extent of service-user involvement are also noted within the paper. Safeguarding professionals may wish to consider these findings in relation to comparable situations in their own authorities.

Our publishers, Emerald, have now introduced the system of electronic submission and review using the Scholar One system; advance notice of this innovation was reported in the first issue of this year. We hope that authors and reviewers using the system from now on will find the experience straightforward and easy to use. If any readers have ideas for potential papers that they wish to discuss before starting to write then please do make contact with one of the editors to discuss further; our contact details appear on the inside cover of journal issues. We very much hope that you will find the range of issues covered in this issue both interesting and useful and look forward to the next issue of the year, which will be the half-way point in our annual publication cycle!

Bridget Penhale, Margaret Flynn