PASAUK Autumn Newsletter 2013
Contents
Introduction
Page 2
Letter from the Chair
Page 3
Self-neglect research
Page 7
Safeguarding Guidance for the Housing Sector
Page 8
Duty to Cooperate or Power to Coerce?
Page 12
‘Risking Your Dignity?’
This year’s Annual Seminar and Annual General Meeting
Page 15
Safeguarding & Health & Wellbeing Boards
Page 16
A rose any other name?
Page 19
From other newsletters
Page 22
Future Events
Page 24
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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Introduction
This is the third PASAUK Newsletter of 2013. We apologise for the fact that the
publication of the Newsletter has again been slightly delayed. The reality of being a
small organisation based on volunteers who have other work commitments in the
area of adult safeguarding and related professions means that we are not always
able to meet our target dates. We still intend to publish four newsletters a year, with
the aim that the fourth will be available shortly before Christmas.
This edition has been compiled by Pete Morgan, the Chair of the Board of Trustees
and sees a return to the normal format after the Summer Newsletter that contained
two articles that had been previously published elsewhere. We hope you found them,
and the responses the Newsletter also contained, interesting and stimulating. It is
something we would hope to repeat in the future as part of an on-going strategy to
develop relationships with other charities and organisations working in the area of
safeguarding adults and to generate constructive discussion and debate on pertinent
issues. If you are aware of articles that you think would be of interest to PASAUK
members, please forward them to us and we will negotiate with their source to
include them in a Newsletter. Equally, if you would like to write a response for
inclusion alongside the original, please forward that too.
We are always looking for suggestions for future topics or even articles. If there are
particular issues you would like to see addressed through the Newsletter, or if you
would like to contribute an article yourself, please forward them to the PASAUK
office. Articles should be up to 1500 words in length, and any submissions may need
to be edited in terms of length.
Likewise, if you are aware of any conferences, seminars etc that would be of interest
to fellow members, please let us know. We may be able to include them in the
‘Future Events’ section.
We plan to distribute the next edition before Christmas, so any contributions should
therefore be forwarded to the PASAUK office ([email protected]) by the end of the
first week of December to give sufficient time for the editing of the Newsletter to take
place.
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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Letter from the Chair
Welcome to the third Newsletter of 2013; I hope you found the Summer edition a
worthwhile read. The inclusion of two articles from companion publications plus
responses to the arguments they contained was aimed to help generate thought and
discussion, not only for PASAUK members but for the readers of those companion
publications who kindly agreed to the use of their articles but also published our
responses to them. Safeguarding adults is a multi-agency and professional activity
that has to bring together different perspectives in a coherent response to an
individual’s circumstances that also reflects and respects the individual’s wishes and
aspirations. The more we work together, not just directly with service users, their
families and friends, but in sharing views and experiences as practitioners, the more
effective and inclusive our practice will be. Please give us your feedback so we can
continue to develop the Newsletter and ensure it remains interesting and tackles
issues, dilemmas and concerns that impact on you in your work. Ideally, of course,
you could write an article on an issue or dilemma that is of concern to you; it doesn’t
have to provide a solution, merely outline and discuss the particular issue as it
impacts on adults at risk, you and colleagues. If you did find the Summer Newsletter
interesting, I hope you showed to colleagues and encouraged them to join PASAUK.
If you didn’t, I hope you are inspired to do so by this issue!
I hope you had a good summer; after a rather wet Spring, the improvement in the
weather was a welcome relief. The downside is that it is always a little depressing
how quickly it seems to fade into the past and the mornings get darker and the
evenings draw in. The season of ‘mists and mellow fruitfulness’ is with us, but
hopefully some of the mists swirling around safeguarding adults will clear and it won’t
only be the harvest that is ripening and being productive as legislation to support it
gets closer to becoming a reality.
The Care Bill, as it is now known, is progressing through Parliament with a target
date of next late Spring/ early Summer for receiving the Royal Assent – that, I
understand, is parliamentary speak for April/May 2014. PASAUK has been a
member of the Safeguarding Adults Advisory Group that the Department of Health
established to assist civil servants advise ministers on the drafting of the Bill. The
next stage is the setting up of task and finish groups to look at areas to be covered
by the guidance – statutory and practice – that will accompany the Bill when it
becomes an Act. PASAUK will again be represented on those groups and the wish
of the Department is that members of those groups will consult widely within the
organisations they represent and beyond to inform the development of the guidance.
At the moment, it is planned to establish four groups, looking at issues for:
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 Family & Community;
 Multi-agency working;
 Practice (direct contact with service users etc) and
 Adults Boards.
Which groups we will be asked to join is not yet known. I would also hope that we will
be able to contribute in some way to the debates in the groups we are not members
of, but we will keep you informed of developments and seek your input to the
debates that will take place.
We have again included in this edition items from the Dignity News, the newsletter of
the Dignified Revolution, which we hope you will find interesting. You can join the
mailing list to receive the newsletter, details are to found later in this newsletter. I
would also remind you that there is a wealth of articles and links available on
SAaRIH, the Safeguarding Adults at Risk Information Hub. As a member of
PASAUK, you have free access to SAaRIH as a benefit of your membership – do
remember to use it. It is a very useful and up-to-date resource.
The last edition included an article written by Imogen Parry, a PASAUK member who
is a housing and safeguarding specialist, which first appeared in a Chartered
Institute of Housing publication. There is currently renewed interest in safeguarding
adults in housing services and a similar recognition of the role housing can play in
both a proactive as well as a reactive sense to abuse and neglect at a strategic and
political level. The Department of Health has commissioned the Social Care Institute
for Excellence (SCIE) to develop safeguarding guidance for the housing sector. This
project is being led by Elaine Cass who attended the workshop Imogen and I
facilitated for the Department in June. Further information on this development can
be found later in this newsletter.
As I mentioned in the last newsletter, PASAUK was been invited to attend a series of
Roundtable discussions with the Labour Party Frontbench in the House of Lords to
advise re the Care Bill. There have been a total of three meetings to date, all of
which PASAUK has attended. The focus was not just on those sections of the Bill
directly relating to safeguarding adults, but there are common themes that run
across all sections of the Bill. Central to these is the issue of resourcing: not just the
impact of the Dilnott proposals on local authorities’ budgets, but the implications of
monitoring the contribution of ‘self-funders’ to the cost of their care as well as
assessing when they meet the eligibility criteria for local authority support from a
needs basis as opposed to a financial one. The workload implications for local
authorities are potentially huge with knock-on implications for their ability to
appropriately and proportionally respond to safeguarding alerts or concerns as they
will have a duty to do.
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It would also seem that a Duty to Report will not be introduced as part of the Bill;
personally, I’m not sure what doing so would achieve apart from further straining
local authority resources. There are already requirements for service providers to
report concerns through regulations and contracting arrangements; if these are
monitored and quality assured effectively a statutory requirement to report is
unnecessary except for members of the public and unregulated or noncommissioned services. While this would cover a large number of adults at risk who
do not use the former services, it would also place a huge burden on the latter in
terms of staff training etc. This could result in either over-reporting with obvious
implications for local authorities and unnecessary intrusion into people’s lives or
services shutting down or restricting access to the most vulnerable. All of these
would seem to me to be undesirable and likely to have a negative effect on the
quality of life of those for whom safeguarding is meant to enhance their quality of life.
On a slightly more positive note, the impression was given that the issue of Powers
of Entry has not gone away, whatever the government and the Department of Health
might think or want! This is perhaps not surprising given the fact that the logic the
Department used in its response to the consultation on the Powers could have been
used with equal validity to have supported their introduction. The introduction of
Powers on a similar basis to those in Scotland was supported by the majority of
practitioners, albeit with some variations on how they would be accesses and
implemented but opposed by a majority of the public respondents to the consultation.
The fact that most of the latter seemed to have a very extreme and inaccurate view
of the way social workers operate was not considered in any way to reflect upon the
validity of their views. This is not to suggest that there aren’t serious and genuine
concerns about the potential for the misuse and abuse of any Powers if they came
into existence; there are and they are held by social workers and other practitioners
and professionals, but checks and balances can be put in place to manage them.
The introduction of any Powers, however, still seems unlikely given the continued
opposition of the Department of Health based, it would seem, on the opposition of
the public. This may only change when the research into the views of service users
and families in Scotland of the introduction of the Powers there is published,
hopefully later this year.
What may have a more dramatic impact, at least in the short term, is the possibility
of a Duty of Candour being introduced into the Bill at the Report Stage. What has
concerned me for a long time has been the denial at a strategic level of the impact of
the budgetary reductions – one could say ‘cuts’ – that local authorities in particular
are facing, though the Police and Health agencies are also effected, will have on
safeguarding adults. I have heard senior managers talking of ‘the difficulties’ they will
face maintaining current levels and quality of service in the future; reality is that they
won’t have difficulties doing so, they won’t be able to. As an Independent Chair of a
Safeguarding Adults Board, part if not the most important part of my role is holding
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member agencies to account to each other for what they are doing or not doing to
safeguard adults. How that can be done without a Duty of Candour I have yet to
work out. Equally, it is vital that Boards and their members are honest with service
users, their families and carers as well as the general public as to what they can
expect in terms of services and their quality and the potential impact of any changes
in service delivery on their quality of life, including safeguarding.
By definition, as the state shrinks, as the current government policy will takes effect,
agencies will have to reprioritise their activity into those things they WILL do, those
they would LIKE to do resources permitting and those they will STOP doing. Failure
to be honest and transparent can only result in service users being placed at
increased risk of abuse and neglect and agencies and services being criticised for
not meeting public and political expectations. This in turn will further damage the
reputations of those agencies, already at a low, as well as staff morale, making
people less likely to seek assistance and support when they need it, leaving them at
increased risk of abuse and neglect again. Sounds to me like a perfect example of a
vicious circle and would provide further justification for service and resource
reduction.
Interestingly, as I write this the Royal College of General Practitioners, at its annual
conference, has declared that cuts in funding are having a dangerous effect on the
services they provide. I wonder what the response from the government will be and
what the size of the cuts is, compared to the cuts faced by local authorities. The
statement from the Royal College is headlining in television and radio news
broadcasts; will there be a similar declaration from the ADASS conference later in
the month? If there is, will it get the same news coverage? Will the Care Bill be
resourced appropriately? Do forgive me my cynicism.
It is not all doom and gloom, of course. Amid the horror stories that appear regularly
in the media about the likes of Winterbourne View, Mid-Staffordshire NHS
Foundation Trust and the recent publicity of the lack of services offered to Philip
Simelane, the young man who stabbed Christina Edkins to death on a bus in
Birmingham, it is too easy to lose sight of the good work that is done to protect and
safeguard adults in this country. While it is important to recognise and acknowledge
when things go wrong, it is also important to celebrate the work done by the vast
majority of health and social care workers in this country. It is also important to
continue to press for better infrastructure to support those staff, including legislation
such as the Care Bill and the guidance that will support it. PASAUK will continue to
play its part, in partnership with other agencies and individuals, in the latter; if you
are aware of examples of the former that we could highlight in a future edition of this
Newsletter, please let us have them, suitably anonymised, and we will publish them
as part of our commitment to disseminate good practice.
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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We continue to try to make the website more relevant and of interest to members,
actual and potential. We developed the Members Forum as a means of members
sharing issues of concern and pertinence to their practice; we felt that the demise of
local groups had left a void that the website might be able to fill. Sad to say, the
Forum doesn’t appear to have been a success. It isn’t clear what the reasons for that
might be, I guess there will be several of varying importance for different members.
One of these may be that many members are registered using work e-mail
addresses and their employers ‘block’ access to websites; not sure how we can get
round that one, but the Trustees will be reviewing the Forum and other issues when
they meet later this month. If you have any ideas or suggestions as to how we can
encourage better use of the Forum and generally improve the website and the
services we provide to members, please let us know using the usual address –
[email protected] .
I hope many of you are able to attend the seminar and AGM in October. The Board
will be proposing some minor changes to the constitution, but these will be circulated
to all members in advance in order to enable you to read and consider them and, if
you are unable to attend the AGM, to let us know your views by e-mail or letter. We
continue to look for new Trustees, and we plan to include a nomination form with the
agenda and papers for the AGM that will be distributed to members shortly. The
demands of a Trustee are not excessive: we meet three times a year, twice for a day
and once overnight on a Friday/Saturday when we review the previous year’s
activities and plan for the coming year. We do meet Trustees’ expenses but cannot
pay for their time, I’m afraid.
I hope you find this Newsletter of value; it again has a wider range of issues
addressed within it than has been the case with previous editions. It is too easy for a
social work perspective to predominate its content. While this may be
understandable in that I am a registered social worker, safeguarding is a multiagency activity, PASAUK aims to support all practitioners whatever their
background or profession. Please let us know your views on it, how it can be
improved etc, issues you’d like to see addressed. The next edition should be
published during the middle of December, at least before Xmas, so any contributions
to [email protected] by the first week of December, please.
Pete Morgan
Chair, Board of Trustees
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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Self Neglect Research
In the last Newsletter, we referred to research that had been commissioned by the
Department of Health on self-neglect, to be undertaken by Suzy Braye and Michael
Preston-Shoot of the Universities of Sussex and Bedfordshire respectively. The
research is supported by ADASS and a questionnaire was been sent to all Directors
of Adult Social Services in June seeking data on how each approaches self-neglect
and also asking about any local guidance and protocols about managing self-neglect
referrals and the experience of partner agencies of self-neglect cases. The closing
date for completed questionnaires is October 18th.
To date, 29 responses have been received, a response rate of 19% when a rate of
40% was hoped for. We understand that a reminder has been sent to all Directors of
Adult Social Services, as this the access route the researchers have been permitted
to use. The National Network of Independent Chairs of Safeguarding Adults Boards
has been advised of the above in the hope they will be able exert some leverage on
Directors to complete the questionnaire. Perhaps members could ask of the DASS in
their area whether or not the questionnaire has been completed and whether their
own agency has been asked to provide information to assist in its completion.
As we said in the last Newsletter, it will be interesting to see both how many
questionnaires are completed and how many Safeguarding Adults Boards are
involved in or informed of the research. It could be seen as indicative of the likely
impact of the Duty to Cooperate contained in the Care Bill on multi-agency
safeguarding activity. Again, as was suggested in the last Newsletter, it could be
argued that the questionnaire should have been sent to the Chair of the Boards. In
fairness, this may well have been impossible given the agreement under which the
research is being conducted.
Self neglect is an area of real concern for a number of agencies and a ‘grey area’
when it comes to the remit of safeguarding adults boards. The Care Bill does nothing
to clarify this and any research that can cast light on the subject and assist in finding
a way to safeguard those at risk of self neglect is to be promoted and supported. We
will ensure members are kept informed of the progress and findings of the research.
Safeguarding Guidance for the Housing Sector
As mentioned earlier in the Letter from the Chair, the Social Care Institute for
Excellence (SCIE) has been commissioned by the Department of Health to develop
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safeguarding guidance for the housing sector. This commission has come from the
team within the Department led by Claire Crawley which is leading on the
safeguarding aspects of the Care Bill. Though there will obviously be areas of
overlap with safeguarding children, it is therefore guidance specifically relating to
safeguarding adults,. The commission is being led by Elaine Cass, Practice
Development Manager at SCIE, herself a qualified social worker. I am not aware of
the timescale for the completion of the commission, but would assume it must be
linked to the date it is hoped the Care Bill will gain Royal Assent next year. It will
have to reflect the content of the Bill and also link to the statutory and practice
guidance the Department of Health will write to support and complement the Bill
when it is enacted.
Below is the text of an e-mail from Elaine at the end of August:
“Dear Colleague
The Department of Health have asked SCIE to produce safeguarding
guidance for the housing sector. To prepare for this I attended the
PASAUK Adult Safeguarding and Housing Workshop in June, to get an
understanding of the issues relating to safeguarding and housing. The
workshop was run by Pete Morgan, Chair, Board of Trustees, PASAUK and
Imogen Parry, Safeguarding Consultant and Trainer for the Housing
Sector. Their report on the workshop is now available on the PASAUK
website
http://www.pasauk.org.uk/upload/public/PASAUK%20Report%20’Adult%
20Safeguarding%20and%20Housing’%20final%20pdf.pdf
At SCIE, we have since carried out a scope of the research, information
and guidance already available that relates to this subject area. I intend
to build the guidance from existing knowledge and resources on
safeguarding, from SCIE and other sources. I hope to produce a resource
that is relevant, accessible and useful to the housing sector and their
partners.
This is where you can help me and I hope that you will. My current
thinking is set out below. Obviously there will be overlap (particularly the
red text) – we can make that accessible to all and then produce different
sections for specific audiences. I’ve listed some questions for you at the
bottom of this email.
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I think we should develop something that addresses three different
audiences to cover the following:
Frontline housing officers and contracted staff
 Identifying ‘vulnerability’ and risk (and recording it)
 Identifying abuse (types and indicators)
 Knowing what to do about concerns (when to raise a safeguarding
alert)
 Confidentiality and data protection
 Understanding the MCA
 Empowering people to protect themselves – working with people at
risk
 Preventing abuse neglect and harm
 Self-neglect
 Supporting victims and perpetrators
Housing managers
 Raising awareness (staff and residents)
 Training and support for staff
 Information sharing, joint working and communication
 key partners and protocols (including difficulties relating to two tier
councils)
 the importance of common language and understanding
 links with domestic violence, ASB, hate crime etc
Local authority staff with safeguarding responsibilities
 Working with housing (recognising the role of housing staff in
safeguarding)
 Housing representation on the SAB
 Responding to concerns from housing staff
 Information sharing
 Joint training
 Learning from mistakes
Questions for you:
1. Am I on the right track?
2. Have missed anything obvious?
3. We are developing resources that can be used on a wide range of
digital ‘platforms’ (tablet, mobile etc). Would this be something housing
and local authority staff and managers might utilise?
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4. Do you have any ideas or suggestions for making the resource more
accessible?
5. Do you have any useful practice examples we could use and share? I
know a number were discussed on the day and some have been recorded
by Pete and Imogen but it would be great to have a short write up, first
hand from those in the sector (eg. Information sharing protocols, housing
forums or subgroups to the SAB, solutions to the difficulties relating to
two tier councils).
6. I’m not sure how to include housing commissioners in this – if you are
a housing commissioner or have any views on this please let me know.
I really appreciate your time in considering these questions. Please let me
have any other relevant thoughts you have and do pass this email on to
anyone you think might have an interest.
Elaine Cass”
On behalf of PASAUK, I responded as follows:
“You look to be on the right track, though the issue of accessibility will be
key;
1. Some of the following may be covered in your outline, but not
explicitly:






Health staff need to be implicitly included, particularly those
working in mental health services;
Likewise Police and Probation and the links to MARACs and MAPPAs
should be drawn;
A section for SABs would be useful rather than just Housing
Representation;
Something linking into the Care Bill – housing being a support
service, however the Bill finally defines that term;
Something drawing out the links for Housing to Community Safety
Partnerships and Health & Wellbeing Boards and their overlaps with
SABs;
Something drawing out the continuity between SCBs and SABs and
the role of Housing in facilitating this
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a) I would hope so, but not e-technically literate so can’t really
comment upon this question. Presumably links could be set up
with SAB websites to assist access and to get local sign-up?
PASAUK would also be interested in promoting any guidance
that is produced, including a link to the SCIE website;
b) See above;
5. Will think about this one but promise nothing;
6. If you manage to crack this one, I’ll be impressed!
Hope the above is helpful. If I or PASAUK can be of any assistance, please
do feel able to contact me.”
I apologise for including the reference to the workshop and report facilitated and
written by Imogen Parry and myself, but it is relevant to record the role that PASAUK
played in helping Elaine formulate her work to date and to emphasise the role we
can therefore play in the development of the guidance.
If you would be interested in being part of any input PASAUK makes to the guidance,
please let us know using the usual address: [email protected] . We will keep
members informed of the progress of the guidance and hopefully we will include it, or
a link to it, on our website once it is completed. The role of Housing in safeguarding
adults has, historically, been ignored and denied not just by Safeguarding Adults
Boards and their predecessors, but by housing agencies themselves. Hopefully, the
emphasis within the Care Bill on ‘care and support’ will change this and enable
housing agencies and staff to fulfil their potential in muti-agency safeguarding
activity,
Pete Morgan
Duty to Cooperate or Power to Coerce?
A common complaint against No Secrets, amongst a number of its other
weaknesses, was the fact that, although local authorities were charged with leading
the coordinating of multi-agency policies and policies to protect vulnerable adults
from abuse, there was no duty to cooperate laid on any other agency. It could be
argued that even local authorities could refuse to undertake that lead role if they
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could justify not doing so, though it is difficult to see what grounds they could have
for so arguing. While No Secrets provides a list of agencies that could be parties to
the multi-agency policies and procedures, it lays no duty on them to be so. This may
be a logical and legal consequence of No Secrets being issued under Section 7 of
the Local Authorities Act 1970 via a Local Authority Circular in that such a Circular
can only apply to local authorities.
This weakness is being addressed by the Care Bill. Clause 6 (1) of the Bill states
that:
‘A local authority must co-operate with each of its relevant partners, and each
relevant partner must co-operate with the authority, in the exercise of:
c) Their respective functions relating to adults with needs for care and
support,
d) Their respective functions relating to carers, and
e) Functions of theirs the exercise of which is relevant to functions
referred to in paragraph (a) or (b).’
In Clause 6 (6) relevant partners are described as including the following:
a) where the authority is a county council for an area for which there are
district councils, each district council;
c) each NHS body in the authority’s area;
d) the chief officer of police for a police area the whole or part of which is
in the authority’s area;
e) the Minister of the Crown exercising functions in relation to prisons, so
far as those functions are exercisable in relation to England;
f) a relevant provider of probation services in the authority’s area.
The above is taken from the Bill as ordered to be printed on 9th May 2013; I am
aware that there may have been some minor amendments already made to the Bill,
but not, to my knowledge, to these clauses or any of the others that will be referred
to in this article.
In the section of the Bill entitled ‘Safeguarding adults at risk of abuse or neglect’
Clause 41 of the Bill requires local authorities ‘to make (or cause to be made)
whatever enquiries it thinks necessary’ in cases where it has reasonable cause to
suspect that an adult in its area (whether or not ordinarily resident there):
a) has needs for care and support
b) is experiencing, or is at risk of, abuse or neglect and
c) as a result of those needs is unable to protect himself or herself against
the abuse or neglect or risk of it’
Fairly obviously, Clause 41 applies to functions of the local authority ‘functions
relating to adults with needs for care and support’ and the duty to cooperate referred
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in clause 5 therefore applies to its relevant partner agencies. At this point, however,
the picture starts to get a little less clear.
Clause 7 states that, when a local authority requests the co-operation of a relevant
partner or vice versa, the partner or the local authority ‘must comply with the request
unless it considers that doing so would:
a) be incompatible with its own duties, or
b) otherwise have an adverse effect on the exercise of its functions’
I am not a lawyer and I accept that the wording of legislation can be confusing to the
lay person, but the above would seem to drive a very large hole on the duty to
cooperate. The first point is an obvious one: a local authority or relevant partner
could not be expected to cooperate by doing something that was incompatible with
its own duties ass this could mean acting illegally or ‘ultra vires’. The second point
seems more moot and liable to misuse: any action will have a cost in terms of
resources and could therefore be seen as impacting on the agency’s ability to carry
out its own functions. All that is necessary if an agency decides not to comply with a
request to cooperate is to provide written reasons for that decision to whoever made
the request. What is not clear, and may be clarified in the guidance that will support
the Bill, is what redress the requesting agency will have to challenge that decision. It
is also the case that any delay in securing that cooperation must increase the risk to
the adult about there is ‘reasonable cause to suspect’ possible abuse or neglect.
I am not suggesting that either a local authority or a relevant partner will decide not
to cooperate lightly, but in times of financial stringency, which is a polite description
of what the next five to ten years hold for the statutory sector, agencies will focus on
what they have to do and avoid expenditure they can in order to maximise the
resources available for their core tasks. That is entirely reasonable and managers
would correctly be criticised for doing otherwise, but it does provide a potential
loophole to enable agencies to side-step their multi-agency responsibilities.
There is a further complication in clause 41; clause 5 refers to cooperation, but
clause 41 refers to a local authority causing enquiries to be made and then ‘it’,
presumably the local authority, deciding ‘whether any action should be taken in the
adult’s case …. and, if so, what and by whom’. This may be another example of my
not understanding legal terminology, but my understanding of the concept of
‘causation’ is that you do not have the option of cooperating with it. Gravity causes
me to come back to earth if I jump in the air, I don’t ‘cooperate’ with gravity.
This has been raised in the Roundtable discussions with the Labour Frontbench in
the House of Lords, who didn’t reject it, so I assume it has some legal validity as an
argument. Again, this may be a matter that will be resolved by clarification in the
guidance that will support the Bill once it has received the Royal Assent and is
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enacted. It does though potentially fundamentally shift the relationship between the
local authority and its relevant partners and even beyond. Will the ability to cause
actions to be taken extend beyond the list of relevant partners to the independent
and voluntary sectors or even to individuals?
Since No Secrets, safeguarding adults has essentially been seen as a multi-agency
activity based on partnership working, coordinated by the local authority. There have
been variations in what ‘coordination’ meant and whether the local authority had lead
responsibility for the activity rather than its coordination, but agencies have worked
together, acknowledging the different responsibilities they carry and the differing
skills and expertise of their staff groups, to optimise the impact of their activity on the
individual. This clause potentially changes that completely: local authorities can
cause agencies to act as they think fit and appropriate.
In practice, I don’t imagine that local authorities will start to tell the Police or health
colleagues what they must do, though it might be interesting to see what would
happen if they did! The danger has to be that, as the Bill is currently worded, a local
authority can be held accountable and responsible for actions that it cannot ensure
take place. This may change the working relationship between the local authority
and its relevant partners and, as questioned above, beyond the statutory sector. It
may also make the local authority more risk averse in its decision making as it seeks
to ‘cover its back’ should anything go wrong.
The use of the word ‘cause’ is therefore puzzling; given clause 5 and the duty to
cooperate, clause 41 could just have referred to ‘request to be made’. Within the
many positives of the Care Bill, the above is a comparatively minor issue that needs
clarification. Always, however, the devil is in the detail: the broad brushstroke
concepts can be easily signed up to, it is what agencies have to do specifically that
will cause the debate and disagreements. These clauses of the Bill appear to be
setting hostages to fortune that may come back to haunt us when the Bill is enacted
and the only people to suffer, ultimately, will be the very people we are working to
safeguard.
Pete Morgan
‘Risking Your Dignity?’
Hopefully you will all have booked your places at the above, this year’s annual
seminar and Annual General Meeting we are co-hosting with AgeUK. As Trustees,
we are aware of the difficulties of getting agreement to attend any staff development
opportunities and that travel to London can be expensive. Last year, we held our
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AGM in Birmingham during the workshop we co facilitated with Change AGEnts and
the West Midlands Cooperative Society. This year, we have returned to London,
partially to make it easier for our members in the South-East to attend, but also for a
brutally practical reason – AgeUK are providing the venue free of charge!
We have been asked if it would be possible to organise an event in the West
Midlands again. We will look at the possibility to do so, and would consider other
venues if there is the demand. Ultimately, we have to use the resources at our
disposal prudently and such events have to at least break even.
If you aren’t able to make the seminar or the AGM, we hope you will read the revised
constitution that will be distributed before the day and let us have any comments. It
isn’t an easy read, constitutions never are, and it is perhaps more detailed than we
really need, but it is in the form we were advised to use. Equally, if you are interested
in joining the Board of Trustees, do please complete the nomination form that will be
distributed with the AGM’s agenda and the constitution. If you are unsure of the
commitment being a Trustee would bring, do contact us for a discussion. We have in
the past co-opted interested individuals for a year so they can try it and see – indeed
so we can try them and see too! The reports to the AGM will be tabled on the day but
will be placed on the website after the meeting, as will any presentations that are
used by either the speakers or the workshop facilitators.
Safeguarding & Health & Wellbeing Boards
The Serious Case Review of the abuse at Winterbourne View and the reports into
the Mid Staffordshire NHS Foundation Trust made a number of recommendations
that lie outside the remit of safeguarding adult boards. Indeed the Francis Report into
the Mid Staffordshire NHS Foundation Trust doesn’t mention the safeguarding adult
board at all. While the local safeguarding adult procedures were invoked with regard
to Winterbourne View, the SCR identified major issues ‘up-stream’ of them in the
form of unsafe commissioning and reviewing processes as well as a host of internal
issues and poor practice within the independent hospital and its parent company.
While not wishing to appear to minimize the abuse and neglect that was suffered by
some of the most vulnerable adults in both institutions or the poor response of
agencies to the whistleblower at Winterbourne View, had effective commissioning
and quality assurance processes been in place some of the poor practice that
became embedded as institutional abuse could have been identified and dealt with
at an earlier stage.
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This raises questions over the relationship between safeguarding adults boards
(SABs) and other partnerships and how far the remit of SABs extends. Anyone who
has heard Claire Crawley speak on the Care Bill (she is the Senior Policy Manager –
Adult Safeguarding at the Department of Health and leads the team advising
ministers on the safeguarding aspects and clauses of the Care Bill) will be aware of
the view of the government that too many things are referred into and block the
safeguarding procedures that ought to be dealt with using other processes and
procedures. In particular, Claire refers to commissioning and quality assurance
procedures along with criminal proceedings as being among those that are meant,
and that safeguarding needs to be more focused on what used to be called adult
protection rather than the provision of safe services. While I have some concerns as,
taken to their logical conclusion, Claire’s views could leave very little still within the
remit of SABs, the general principle has to be correct. Her example of a frayed
carpet in a care home being raised as an Alert may be a very extreme one, but it is
easy to use the safeguarding procedure as a means of escalating situations as a
means of accessing scarce resources.
What exactly are Health and Wellbeing Boards (HWBs)? They were established
under the Health and Social Care Act 2012 as a forum where key leaders from the
health and care system work together to improve the health and wellbeing of their
local population and reduce health inequalities, taking on their statutory functions
from April 2013. Each top tier and unitary authority has to have its own HWB with
members collaborating to understand their local community’s needs, agree priorities
and encourage commissioners to work in a more joined up way. As a result, patients
and the public should experience more joined-up services from the NHS and local
councils in the future. HWBs will also give communities a greater say in
understanding and addressing their local health and social care needs.
They will achieve this by having strategic influence over commissioning decisions
across health, public health and social care. As their membership will include
democratically elected representatives and patient representatives, HWBs will
strengthen democratic legitimacy and provide a forum for challenge, discussion, and
the involvement of local people. As they will undertake the Joint Strategic Needs
Assessment (JSNA) and develop a joint strategy for how these needs can be best
addressed, the HWBs will drive local commissioning of health care, social care and
public health and create a more effective and responsive local health and care
system. Other services that impact on health and wellbeing such as housing and
education provision will also be addressed.
The HWBs will have a minimum membership of:
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




one local elected representative
a representative of local Healthwatch organization
a representative of each local clinical commissioning group
the local authority director for adult social services
the local authority director for children’s services and
the director of public health for the local authority
They will be free to expand their membership to include a wide range of perspectives
and expertise, such as representatives from the charity or voluntary sectors.
As part of their rationale is to increase democratic accountability HWBs are under a
statutory duty to involve local people in the preparation of the JSNA and the
development of joint health and wellbeing strategies. A member of all HWBs will be a
representative of the local Healthwatch, which has a formal role of involving the
public in major decision making around health and social care and its work is
expected to feed into that of the HWBs, which are themselves accountable to local
people through having local councillors as members.
As can be seen from the above, there are areas of overlap between the remits of
HWBs and SABs and in their memberships. However, if one thinks of the remits as
being three rather than two dimensional, those areas of overlap are partial, in that
HWBs have an interest in commissioning processes and procedures for health and
social care services across the piece, while SABs are interested only in those parts
that relate to safeguarding activity, not the general provision of safe services in the
clinical sense. For example, HWBs will want to assure themselves that safe acute
hospital services are being commissioned; SABs will want to assure themselves that
acute hospital services have proportionate and effective safeguarding adult
procedures and processes in place. The boundary between the two is not a precise
one, it is a blurred one, as can be seen in the area of Serious Incidents, not all of
which will generate Safeguarding Alerts and require scrutiny by the SAB, but the
SAB will need to assure itself that processes are in place and operative to identify
those ones that should.
It follows from the above, that SABs have a role to fulfill in holding HWBs to account
for the general commissioning strategies they pursue and the quality assurance
processes they put in place to ensure they are implemented; equally, the HWBs
have a role to fulfill in holding SABs to account for the strategies they put in place to
quality assure the safeguarding adults procedures and processes of member
agencies and those services are commissioned from as well as the general strategy
for ensuring adults are safeguarded locally. The concept of ‘holding to account’ is a
difficult one, for there isn’t a hierarchy between the two boards, nor a direct lineThe views expressed in this Newsletter are those of the author, not necessarily PASAUK
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management structure either. It is more a relationship of transparency and
openness, where each can be ‘a critical friend’ of the other. In many ways, it mirrors
the relationship between members of SABs, who aren’t directly accountable to one
another – except where one is commissioning services from another, the Clinical
Commissioning Groups and the provider NHS Trusts, for example. It can also be
seen that the same relationship should exist between the HWBs and the local
Safeguarding Children Boards (SCBs) and therefore with the SAB.
A number of SABs and HWBs are developing protocols to formalise their
relationship, some including SCBs. I am working on one where I am the Independent
Chair of the SAB, and once it is finalised will seek agreement to make it available to
members on the website. I can’t imagine that will be a problem as it will be available
on the respective websites of all three boards. The logical step after that would be to
try to include the local Community Safety Partnership, but, like eating an elephant,
better to start with small but manageable chunks than biting off more than you can
chew!
Pete Morgan
A rose by any other name?
Language is a very powerful tool, and a potentially very dangerous one if misused. A
favourite put down or attempt at a knock-out punch in an argument used to be ‘But
that is just semantics’, where semantics was seen to just be a matter of the meaning
of words or terms. The implication was that one was nit-picking, getting bogged
down in trivia rather than dealing with the practicalities of the situation. As someone
whose first degree was in Philosophy, I felt pulled both ways: I found a two hour
tutorial trying to tease out the difference between ‘ought’ and ‘should’ tedious in the
extreme and was drawn to Marx’s view that ‘Until now, the philosophers have only
interpreted the world in various ways; the point, however, is to change it’ (Theses on
Feurbach 1845). At the same time, I could appreciate the need to be clear about the
meaning of the language one used if an argument or discussion was to be in any
real way productive. What has this to do with safeguarding adults, you might ask, if
you haven’t already stopped reading and gone on to other things?
It might, on first appearances, seem to have very little, but I would suggest
otherwise. The language we use and the definitions we give to the terms we use can
have major implications for the way in which we interact with those around us and
how they interact with us. Language can both give and take away power, it can
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19
enfranchise and disenfranchise, it can be inclusive or exclusive and it can encourage
or dis-encourage participation in the processes of safeguarding adults.
Since No Secrets was published in 2000, there has been a debate as to the
appropriateness or otherwise of the term ‘vulnerable adult’. This debate based on the
perception by some, often portrayed as a young physically or sensory disabled
lobby, that the term was itself abusive, that it held within itself inherent overtones of
‘otherness’, of being somehow ‘inferior’. In this view, any abuse that was
experienced by ‘a vulnerable adult’ was in some way a reflection of that vulnerability,
that there was a causal relationship between the abuse and the individual’s
vulnerability. In a way, there was seen to be an equivalent to the medical model of
disability, where a disability was caused by a physical condition rather than by
society’s response to any individual, that vulnerability was a characteristic of the
individual rather than caused by the social context in which they found themselves.
This argument produced at least two distinct responses: the first one was to agree
wholeheartedly with it and to argue for a new term to be used; the second was to
acknowledge the validity of the argument, but to counter-argue that any change of
terminology was fated to be counter-productive and, at best, a short-term solution.
Any new term, would, in the course of time, come to be seen as pejorative in some
way or other and that it would, in any event, be impossible to find an alternative term
that would be acceptable to all those disparate groups it would have to encompass.
As time went by, another strand was added to this latter argument, namely that any
change would only confuse the situation and put more people at risk of abuse or
neglect as the term’ vulnerable adult’ was at least understood by staff, paid and
volunteers, who worked with those at risk of abuse or neglect.
Eventually, the former argument was successful and there was a general
acceptance that a new term was required in order to address both the expressed
view and wishes of those who safeguarding procedures and processes are meant to
safeguard and their political perspectives as well as those of the professionals
working with them; this was contemporaneous with the move from adult protection to
safeguarding adults. The move was based on a similar argument, that ‘protection’
was inherently discriminatory in that it suggested something that was ‘done to’
someone while safeguarding was something that was ‘done with’ them. The term
that achieved general acceptance was ‘adult at risk’, though there were concerns
that this was too broad as being at risk covers a large number of situations and it is
also a term used in other contexts, including legal ones, with a different definition.
The change of term didn’t bring with it a change of definition. The No Secrets
definition of a vulnerable adult was 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 him or herself, or unable to protect him or herself
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against significant harm or exploitation.’ Interestingly, it doesn’t mention either abuse
or neglect. It is also a very inclusive definition; it requires evidence that someone
doesn’t need community care services and is able to protect themselves etc rather
evidence that they do need them or can’t protect themselves. There were concerns
that some local authorities were misusing the definition and linking it to their eligibility
criteria, but this was a fault that lay with the authorities, not the definition. There were
also concerns that the terms ‘significant harm’ and ‘exploitation’ were not defined
and some confusion as to what constituted ‘community care services’, but the
definition itself wasn’t a major cause of dissatisfaction.
The Department of Health’s consultation on the Review of No Secrets in 2008/9
contained a question about changing the definition of ‘a vulnerable adult’ but not
about changing the term itself. The Law Commission’s consultation on Adult Social
Care Law in 2011 contained questions relating to both issues and recommended that
the term be changed to ‘adult at risk’ and that this be defined as ‘anyone with social
care needs who is or may be at risk of significant harm’ This definition brought with it
some difficulties in that it appears to omit those with health care needs and has
implicit links to eligibility criteria – how else do you judge whether or not someone
has social care needs? It still failed to define what is meant by ‘significant harm’. It
does however avoid some of the stigmatisation inherent in the term ‘vulnerable adult’
but doesn’t draw any distinction between those who can safeguard themselves and
those who can’t.
When the government introduced the Care and Support Bill – now the Care Bill – it
seems to have acknowledged the concerns about the term ‘vulnerable adult’ but
ducked the issue of identifying an alternative. Clauses 41 – 46 are written under the
rubric ‘Safeguarding adults at risk of abuse or neglect’, which gives the impression
that the new term is ‘adults at risk’ if not ‘adults at risk of abuse or neglect’. However,
clause 41defines this section of the Bill ‘applies where a local authority has
reasonable cause to suspect that an adult in its area (whether or not ordinarily
resident there):
a) has needs for care and support (whether or not the authority is meeting
any of those needs),
b) is experiencing, or is at risk of abuse or neglect. And
c) as a result of those needs is unable to protect himself or herself against
the abuse or neglect or the risk of it.’
The above retains the inclusive element of the No Secrets definition by being explicit
that the adult does not need to be receiving care and support services, just be in
need of them and doesn’t link the abuse or neglect to those needs but does
recognise the importance of whether or not the adult can protect themselves.
Elsewhere in the Bill, it continues to refer to ‘adults’ or ‘an adult in its area’ where ‘it’
is the local authority.
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This can be seen as politically astute: it keeps the definition open and inclusive, it
avoids the stigmatisation that service users and others were so against and implicitly
recognises the importance of the Mental Capacity Act 2005 and the right of adults to
make unwise decisions and remain in situations and relationships of risk. It does
however leave those of us with a role in safeguarding adults with a problem:
previously we could refer to a term that defined who we worked with, a term that had
a general acceptance of who it covered if not with itself. We are now left with a
comparative void as opposed to the discrete group that we work with.
This may not seem to be a problem, and may not be a problem in practice, but in a
time of shrinking resources and increased demand for them for a number of reasons
including demographic pressures, the loss of a distinct term will make it more difficult
to retain a distinct identity and profile with the public and particularly politicians. It
also makes it more difficult to collect and therefore analyse data to support resource
allocations, especially when other services, such as domestic abuse services, could
argue that they service the same groups and individuals. My fear isn’t that ‘a rose by
any other name would still smell as sweet’, but that we’ve lost the name and the rose
may longer be recognised.
Pete Morgan
From other newsletters
Copied with thanks from the newsletter of the Dignified Revolution, the Dignity
News.
This newsletter is always a valuable source of information. If you would like to
guarantee a regular monthly copy of the mailing send your details to
[email protected]
A new approach to protecting vulnerable adults
The Guardian reports on an innovative tool which aims to improve information
sharing between agencies is being piloted by a council in Wales
Divided in Dying
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
22
This Compassion in Dying report highlights the need for better advance care
planning at the end of life and the urgent need to put in place workable guidance to
replace the Liverpool Care Pathway as soon as possible.
Elderly people with dementia put at risk
Elderly people with dementia are being left at risk of abuse due to the profoundly
depressing and complacent attitude by hospitals and care homes to safeguards
designed to protect patients, a damning report by MPs has warned.
Untrained staff left to take blood and insert drips
The NHS cannot guarantee the safety of millions of hospital patients as nursing
assistants are carrying out the work of doctors with no training, a government report
has warned.
Patients suffer from a 'toxic cocktail' in NHS
Patients who suffer harm or poor care in hospitals are failed by the health service
which means complaints go unheard and lessons unlearned, the NHS Ombudsman
has warned.
Care left undone during nursing shifts: workload and perceived quality of care
This BMJ report aims to examine the nature and prevalence of care left undone by
nurses in English National Health Service hospitals and to assess whether the
number of missed care episodes is associated with nurse staffing levels and nurse
ratings of the quality of nursing care and patient safety environment
Unexpected rise in deaths among older people
Public health officials are closely monitoring death rates as mortality among older
people has been unexpectedly increasing since the beginning of 2012. Source: HSJ
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
23
Future Events
Social Care and Adult Protection Training
Social Care Conferences organise training courses for those working in social care
involved in adult protection and safeguarding. These events focus on improving
quality and provision of care for vulnerable adults and integrating services to ensure
continuity of care during hospital admission, stay and discharge.
We are pleased to offer PASAUK members and contact a 20% discount*
Quote ref: SCUK20pasauk when booking
Forthcoming events:
Masterclass: Deprivation of Liberty Safeguards
Tuesday 8th October, London
Held jointly with InPractice this one-day in-depth masterclass offers the chance to
explore the rationale behind the measures for safeguarding deprivation of liberty and
examine the practical implications for healthcare professionals. There will be a
detailed analysis of what constitutes Deprivation of Liberty rather than restriction of
liberty. Delegates will have the opportunity to discuss previous case studies, and
raise issues and concerns specific to their own practice.
Further information available at: http://www.healthcareconferencesuk.co.uk/dolsdeprivation-of-liberty-safeguards-training or contact [email protected].
Information Governance: Patient Information Sharing, Management &
Confidentiality in the New Landscape
Wednesday 16 October 2013, London
Follow this conference on Twitter #Caldicott2
Chaired by Christopher Fincken, Chair, The UK Council of Caldicott Guardians, this
one day conference with will examine the practicalities of how to manage and share
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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patient and service user identifiable data and how to meet the standards of the
information governance in the new landscape laid down by the new Caldicott review.
For further information and to book your place visit
http://www.healthcareconferencesuk.co.uk/information-governance-training-nhscaldicott2 or email [email protected]
Masterclass: The Legal Use of Control and Restraint
CHOICE OF DATES: 22 October, 9 December or 30 January 2014, London
The appropriate, legal use of control and restraint is necessary in many clinical
settings. However, inappropriate use, and the lack of detailed documentation of
decisions, can make healthcare professionals vulnerable to accusations of
mistreatment. Through intensive, interactive learning, this training course will
support you in the appropriate legal use of control and restraint and give you the
opportunity to address concerns and issues you may have with a practicing
healthcare lawyer and colleagues in a similar position to you.
Further information available at:
http://www.healthcareconferencesuk.co.uk/control-restraint-masterclass-jan or
contact [email protected].
A Practical Guide to Safeguarding Vulnerable Adults in Mental Health Services
Wednesday 6 November 2013, London
With an opening address by Claire Crawley Social Care, Local Government and
Partnerships Directorate Department of Health, this conference provides a practical
guide to improving the safeguarding of vulnerable adults in mental health services.
Further information available at
http://www.healthcareconferencesuk.co.uk/safeguarding-vulnerable-adults-mentalhealth-training or email [email protected]
Masterclass: The Mental Capacity Act and Advance Decisions
Monday 11 November 2013, London
Facilitated by Kate Hill, Solicitor and Senior Trainer, InPractice/Radcliffes Le
Brasseur Solicitors. This course will explore the rationale behind the Mental Capacity
Act 2005, the major changes since the act was introduced and how the MCA
interacts with the Mental Health Act.
Further information available at http://www.healthcareconferencesuk.co.uk/mcamental-capacity-act-training or email [email protected]
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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Control and Restraint Conference
Wednesday 27 November 2013, London
This conference focuses on managing control and restraint in a way that is not
excessive and that is respectful of service users. There is a focus on reducing
control and restraint to a minimum level. The National Quality Standard for Service
User Experience (Standard 14) states that “ people in hospital for mental health care
who need to be controlled and restrained, or have treatment without their agreement
(such as medication to calm them quickly) receive them only from trained staff. They
are only used as last resort, using minimum force and making sure that person is
safe” however the recent report from MIND quoted above shows that there is huge
variation in both the levels and the practice of restraint across the NHS.
Further information available at
http://www.healthcareconferencesuk.co.uk/control-restraint-conference-training or
contact [email protected]
Safeguarding Vulnerable Older Adults in Health Services
Wednesday 15 January 2014, London
This conference takes a practical approach to safeguarding vulnerable older adults
in health services updating delegates on national policy, legal issues and case
studies of excellence in practice. The conference will have a focus session which will
discuss working together across acute, community and social care to safeguard
vulnerable older adults, implementing the new government proposals to improve
care for vulnerable older people including a named clinicians for care outside
hospital and developing effective joint working and communications channels.
Further information available at
http://www.healthcareconferencesuk.co.uk/safeguarding-vulnerable-older-adults or
contact [email protected]
(*Cannot be used in conjunction with any other offer. Full T&Cs available upon
request.)
The views expressed in this Newsletter are those of the author, not necessarily PASAUK
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