The case for a statute to protect vulnerable adults
At the moment, social services departments in Councils across Wales are being audited (that’s a nice word for inspected) to assess the state of protection of vulnerable adults (POVA) arrangements. For anyone that’s interested – and that really should be anyone with an elderly, physically or learning disabled, substance misusing or mentally ill relative or friend, which means just about everyone – the Care and Social Services Inspectorate Wales (CSSIW) will be reporting in the New Year.
Adult protection is the less well-known cousin of child protection. Child abuse raises a visceral emotion like nothing else – a mix of horror and disbelief that an adult has so misused their advantage in authority to harm someone that their instincts should be driving them to care for.
Vulnerable adult abuse doesn’t raise quite the same emotion. If you judge popular interest using tabloid interest as a proxy, you might see a headline for a day or two, but not much sustained interest afterwards. In some ways that’s understandable – the relationship between two adults is different than between an adult and child. But the issues are much the same – a vulnerable adult, by definition, is not fully independent and relies on others for support because of some incapacity, and that trust is misused to mistreat, neglect or harm them.
I’d bet most people know when and how to report animal or child abuse, but far fewer know who to report vulnerable adult abuse to. Which is surprising, as the 2007 UK Study of Abuse and Neglect of Older People by the National Centre for Social Research and King’s College London estimated that 277,000 older people had suffered neglect or abuse the previous year – add to that the mistreatment of adults with physical or learning disabilities, mental health problems, substance misuse issues, or cognative disfunction – and the problem can’t be said to be uncommon.
One of the reasons we know less of, and less about adult abuse is the difference in the basis of responsibility that public bodies have. Child protection is on a statutory footing, mainly from the 1989 Children’s Act, whereas adult protection is only set out in government guidance.
The fact that POVA is not a statutory obligation puts everyone at more risk. A voluntary system is only as strong as the commitment of those involved, so older people are not well served, and as the process is only guidance, there’s no requirement to move or suspend an accused person. If the case does take months to resolve, and eventually leads to no further action, the accused person can seek damages against their accuser, their employer and the POVA team through the Council (even, in one case, the Inspectorate), as the process followed isn’t a statutory one, but only one set out in guidance and subject to local interpretation and variation.
So the current arrangements aren’t serving older people, staff, employers or contractors well.
There is a legal requirement for Local Children Safeguarding Boards (LSCB) to report and investigate child protection issues, and an ability to compel agencies to co-operate in serious case reviews. Despite POVA also being a multi-agency responsibility, Area Adult Protection Committees (AAPC) have little formal influence beyond what goodwill and coercion can achieve. So participation in case reviews is not a requirement, and information regarding safeguarding isn’t collected in a consistent and therefore useful way.
LSCB serious case reviews are independently audited to ensure that we have a true picture of any issues involved and that appropriate action is taken, so everyone can learn any lessons and amend their practice accordingly. AAPC case reviews aren’t routinely subject to any review, and if information isn’t gathered consistently, then not only do we not have a true picture of what’s going on, but it’s also much more difficult to learn the lessons of any one case as direct comparisons aren’t possible.
The structure, role and remit of AAPCs vary, whereas those of LSCBs are set out in statute. If police or health service participation is voluntary, then it’s unlikely that adult protection appears much in their strategic plans, to have adequate funding earmarked, or to have someone in a position of authority with a specific remit. If it’s not core business then referrals become an afterthought – Action on Elder Abuse reports that only 1% of adult protection referrals come from GPs, difficult to understand when they are the health professionals in closest contact with most vulnerable adults.
In fact, the majority of referrals come from nursing homes. Not because that’s where the majority of cases of abuse occur, but because that’s where there’s the most awareness. This more general lack of awareness hides the true nature and scale of the problem – I mentioned a figure given in the UK Study of Abuse and Neglect of Older People of 277,000 older people suffering neglect or abuse in 2006. I’d be surprised if even 10 per cent of those were referred for a POVA review, because general awareness is so low. In itself, this is possibly the strongest argument for POVA to have statutory force as it would improve awareness by enforcing responsibility.
LSCBs aren’t perfect, but there is a clear line of accountability for child protection, all the parties involved know their roles and responsibilities, and lessons are learned as part of the case review process. Of course, putting vulnerable adult protection on the same legislative basis as child protection won’t solve all the problems – all health and care professionals need mandatory POVA training, and the wider public needs education on when and how to report abuse.
But, putting POVA responsibility into statute would bring accountability and consistency, and give adult protection similar authority to child protection. It would mean that POVA would have to form part of the core business for each partner agency. Add to a statutory process a system of independent audit for case reviews, mandatory training, and increased public awareness and you’ve got the next stage in the development of a protection of vulnerable adults service worthy of the name.
Councillor John Dixon is the Executive Member for Health, Social Care and Wellbeing on Cardiff County Council and the WLGA Deputy Spokesperson for Health and Social Services.
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