Hampshire County Council

Adult Social Care Policy Review Committee Item 6

20 January 2005

Report on the outcome of the Adult Protection Task and Finish Group

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

Robust Adult Protection arrangements impact on the delivery of the following Corporate Aims

Aim 1 - maximising life opportunities by ensuring that vulnerable people are not subject to abusive practice.

Aim 4 - building strong and safe communities: people need to feel that the arrangements do offer protection to those who are vulnerable.

Aim 5 - improving services.

Aim 6 - developing councillors and staff

The amendments to the policy and the training programme ensure that both services and staff are in a position to respond positively and effectively.

1.

Summary

1.1

Following the presentation of the Annual Adult Protection Report to PRC on 28 September 2005 a Task and Finish Group was established to review a number of issues that required further information.

This report outlines the outcome of the meeting of the Task and Finish Group and provides details of the questions that were raised along with the answers provided by Adult Services Officers.

2.

Impact Assessment

2.1

In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. During the coming year we will analyse data to see whether there is any disproportionate impact on BEM communities. Information collected on those allegedly abused includes area and ethnic origin.

This work will inform training needs for staff and services.

3

Consultation with Local Members

3.1

Consultation within the Task and Finish Group took place with Cllr Mr A.E Dowden, Cllr Mr E.Neal and Cllr Mrs C.Bailey

4

Outcomes from the Adult Protection Task and Finish Group

4.1

A meeting of the Adult Protection Task and Finish Group was convened on 10 November 2005. In attendance were Cllr Mr A.E Dowden, Cllr Mr E.Neal and Cllr Mrs C.Bailey. Officers present were Mary Robertson Assistant Director Adults, Andrew Brooker Assistant Director Older People, Dawn Burton County Manager Physical Disability and Jane Lawson Adult Protection Officer.

4.2

Members presented officers with a number of questions relating to the Adult Protection Policy and Procedures. The prevention of abuse and the monitoring of outcomes were of particular interest and many of the questions were related to these issues.

4.3

Members also wanted to be assured that Adult Services were working within the guidance set out in the ADSS document "Safeguarding Adults" published in October 2005.

4.4

Adult Services Officers were tasked with providing answers to the questions and did so in the form of a full and detailed response dated 21 November 2005. The full response is attached to this report.

Recommendation(s)

That:

1

PRC Note this report.

2

The Annual Report on Adult Protection to PRC in July 2006 includes progress on the issues raised by the Task and Finish Group

1.

Why is there a difference between the number of reported incidents and the number of planning meetings/case conferences?

The number of meetings will never be equal to the number of referrals as some cases will not reach the stage of either a planning meeting (where professionals meet to share information and to decide how the concerns will be investigated) or a case conference (where following the investigation a plan of action is looked at). This is for a variety of reasons including:

1. Some conferences may cover more than one individual

2. Initial investigation shows that no abuse has occurred, e.g. after an allegation of theft by a carer is made the article or money is found to have been mislaid.

3. The vulnerable adult chooses not to pursue actions.

4. The allegations are malicious.

2.

A number of questions were raised regarding the outcomes of investigations.

1. What was the level of actual abuse compared to the number of cases reported?

2. What happened to paid carers and relatives identified as abusers e.g., where they disciplined or prosecuted?

3. How many cases were referred to the police?

· We know from table 9 in appendix 3 that 218 cases out of the 413 reported went to case conference. In 210 the abuse was substantiated.

· Statistics relating to Hampshire County Council employees (dismissals and referral for inclusion on the POVA List) are given in response to question 3 on this paper.

· We know that at the stage of initial referral discussions took place with the Police in 230 out of a total 413 situations. Our statistics show (table 7 of the Adult protection Abstract 2004/5, see appendix 3) that at the stage of a planning meeting in 114 situations it was decided that a Police investigation would take place.

· Table 7 of appendix 3 shows that a range of agencies other than the police are involved in planning meetings and case conferences. Adult Services, The Commission for Social Care Inspection, Provider Agencies and Health are all able to take some form of action against the perpetrator.

3. What is the national context of information on outcomes?

National research indicates that there are a low number of cases where perpetrators of abuse are brought to court and prosecuted and there are a number of reasons for this. For example the victim is unable to be a credible witness or there is insufficient evidence to support the case going to court. In each example it is the responsibility of the Crown Prosecution to make the decision. VOICE UK is an organisation campaigning on and providing support to people with a learning disability who are abused). In their publication "Behind Closed Doors" it is noted that of a total sample of 284 cases of abuse only 2 cases went to court. One ended in a prosecution. Locally and nationally vulnerable witnesses are provided with support to assist with the giving of evidence and the Court process. This is given a high priority. Referrals are made to the witness support service. One of the objectives of this is to enhance the numbers of successful prosecutions.

Prosecution is just one possible outcome. Other outcomes include:

· Referral of a member of staff employed in a registered service to the POVA list (Protection of Vulnerable Adults) Anyone whose name is on the POVA list held by the secretary of state can no longer work with vulnerable adults.

· Disciplinary action by a provider service

· Investigation by the Commission for Social Care Inspection as to the fitness of the provider service to operate

· Removal of the vulnerable adult to a place of safety

· Removal of the perpetrator of the abuse from the situation

· Close monitoring of the situation and the level of risk by all agencies involved

A comprehensive list of possible outcomes is provided on page 39 of the ADSS Safeguarding Adults framework published in October 2005. This is attached at appendix 1.

A 2004 study by Action on Elder Abuse looked at the national picture on data collection and the national reporting requirements. It found that only 19% of local authorities did record outcomes as part of their adult protection annual statistics.

Hampshire is one of those authorities.

4. What steps are we taking to enhance our information on outcomes?

· In April 2005 we enhanced our statistical database in order to gain information on a broader range of possible outcomes. We will further enhance this to include all of those listed in the ADSS framework "Safeguarding Adults (see appendix 1)

· At present we collect information at the time of the initial report of a concern and then 6 weeks after this. Many outcomes will not be apparent by this stage so from April 2006 we will include a third stage of recording at a point of 6 months after an initial referral.

· We are awaiting the outcome of the Department of Health funded project being undertaken by Daniel Blake at "Action on Elder Abuse" on new national data collection and reporting requirements. This will impose on us a framework for the collection of data. We have had discussions with Daniel which indicate that our proposal to collect additional data at the 6 month point would be in line with his thinking at present.

· An audit of all cases dealt with by Adult Services from Oct to Dec 2005 will be completed by March. This will assist us to gain further knowledge about outcomes for that period.

· Police colleagues are considering ways in which more accurate and detailed information might be collated.

· Legislation is developing all the time to help us to protect vulnerable adults and information about legislation and guidance is made widely available to all agencies in order that we ensure that we are looking at the whole range of options every time a vulnerable adult is abused. New legislation includes the Sexual Offences Act and the Domestic Violence Crime and Victims Act 2004. We aim to raise awareness of this legislation which can be used in a preventive way as well as a sanction to produce safe outcomes.

5.

How many abusers were HCC employees? How many were referred to the POVA List held by the Secretary of State?

Since April 2004 10 members of staff have been dismissed or are awaiting a hearing. Since 26^th July 2004 since the POVA list became operational there have been 8 referrals.

6.

Are staff vetted to ensure they are not on the POVA list?

Yes. Under the Care Standards Act 2000 a POVA check must be done alongside the CRB check by all employers in services registered under the Care Standards Act in respect of all prospective employees.

7.

What are we doing to ensure that individuals do not continue to abuse?

There are a range of measures that we currently take in order to ensure that abuse does not continue these include:

· Disciplinary Procedures

· Referral to the POVA list

· Enforcement action by CSCI

· Referral to the police

· Sharing information with other organisations

· Carrying out a Carers Assessment and providing services that decrease the risk of abuse

8.

Why were case examples given by Officers at the September PRC which were historic and which were not part of the 413 cases of abuse for 2004/5? This could have been misleading

The officer was asked to present two cases, one to illustrate abuse in an institution and one in an individual's own home. The case relating to the person who lived in her own home was historical. This case was chosen because it was likely that the passage of time would maintain the anonymity and privacy of that individual as well as reducing the possibility of any emotional impact. The other situation presented did relate to a situation investigated this year. It was chosen because the outcome showed that the appropriate formal action had been already been taken and reporting the situation would not jeopardise the outcome and information had already been in the public domain.

9.

What is the Department doing about Prevention?

7i) The Department of Health mandatory guidance "No Secrets" outlines a number of measures which will be effective in contributing to the prevention of abuse. Prevention is covered in section 3 of the Adult Protection policy and procedures and all measures from the DOH document are being addressed locally as follows:

· Rigorous recruitment practices (including volunteers). This now includes reference to the POVA (Protection of vulnerable Adults) List. Hampshire County Council Adult Services has taken a lead in ensuring that information is available to ensure that this process is used and understood

· Internal guidelines for staff underline the significant part they can play in preventing abuse.

These include:

A requirement for working within agreed operational guidelines on maintaining best practice in relation to

· Challenging behaviour

· Personal and intimate care

· Control and restraint

· Sexuality

· Medication

· Handling service users' money

· Whistle blowing (encouraging and supporting whistleblowers in coming forward)

Training makes it clear that poor practice in these areas leads to abuse and that these guidelines are therefore crucial.

· Training. In Hampshire this is being carried out in all sectors and across all agencies and focuses on prevention as well as intervention.

· Information for users, carers and the general public. Leaflets to publicise the issue of abuse and how to seek help are widely circulated. They are aimed at service users, the public and front line care staff. The leaflets describe what constitutes abuse and that it must not be tolerated. They also tell people how to get help. We believe empowering individuals to know what abuse is and to take action is very important. This is considered for all individuals for whom it is appropriate both in terms of stopping abuse happening at all and preventing any abuse from continuing.

· Commissioning of services and contract monitoring. Adult Services take our duty to commission safe services very seriously. All service providers in Hampshire are aware that part of their contract with the local authority they are required to operate within the Adult Protection policy and procedures. They must allow us to investigate adult protection concerns alongside the police and Commission for Social Care Inspection and they must make robust and safe management decisions around disciplinary/capability issues. Contracts are monitored against these requirements and steps taken if they are not complied with.

10. The ADSS document "Safeguarding Adults" published in October 2005 refers in some detail to prevention. Is Hampshire County Council adhering to all of its recommendations, can Officers use the framework set out in the guidance and is some of it already in place?

Adult Services Officers consider that this guidance will be a very useful framework within which to build on the significant progress that has already been made in the field of adult protection. Progress to date incorporates many of the key messages contained in this document. Standards 3 to 5 include guidance on prevention in the community; in service delivery and via training.

Outlined below are a number of the standards in the guidance which Hampshire Adult Services has addressed:

Standard 3: prevention in the community In Hampshire we have started to make strategic links with Community Safety Partnerships and within the Local Area Agreement. Fareham and Gosport Borough Councils have included Adult Protection in their strategies and we intend to use this example to ensure that the next strategy specifically includes adult protection but that in the meantime it is an issue discussed within the context of domestic violence and other related issues already in the strategy.

We have also begun to liaise with appropriate individuals to ensure that Adult protection is included in the Local Area Agreement. The current proposal is that Adult Protection might be included under the section of the Local Area Agreement headed 'Tackle crime and anti-social behaviour".

Hampshire County Council have also made links with domestic violence colleagues to share training and strategies and to raise awareness of common issues and ways in which knowledge, expertise and resources might be shared. These links have also been made in the Adult Protection Policy and Procedures in terms of signposting domestic violence resources for vulnerable victims of abuse.

The Department funds some advocacy projects who provide for personal safety awareness amongst vulnerable adults.

Links have been instigated with Trading Standards, Victim Support, Witness Service.

These are the foundations in terms of ensuring that Adult Protection is included in the agendas of strategic partnerships. We will continue to build on this

Standard 4 on prevention in service delivery: this builds on the prevention agenda already outlined in "No Secrets" and developments on some of these areas have already been outlined.

In addition in Hampshire we have:

· Produced a framework to assist providers in drawing up in-house policies and this is on our website

· Section 10 of the Adult Protection policy and procedures relates to the possible root causes of abuse which arise from research and these are used in practice to identify and to prevent abuse

· Guidance on the POVA list has been provided and is on our website. It is used and we have been successful in some situations in the use of it to protect vulnerable adults.

· Staff are made aware of policy and procedures through training

Standard 5: Training as a means of prevention:

There is a clear training strategy including the steps outlined in the ADSS document. Training is provided from basic awareness through to investigations and interviewing skills. We deliver consistent training internally and externally and have an extensive programme underway in independent care provider settings and in the voluntary sector.

We are promoting training within Health and the Police. Some training has already taken place in these organisations and we continue to build on this.

11.

In relation to prevention could there be a system whereby the Banking Industry and post Office could alert HCC to suspected financial abuse?

John Ripley, receiverships manager and Jane Lawson, adult protection officer are currently working with partner agencies to clarify responsibilities, roles and communication between all of those who may have a contribution to make in preventing or intervening in situations of financial abuse. This includes liaison with the British Bankers Association, the local bank for the receiverships team and the Department of Works Pensions. This work is due to be completed in the Spring and will consider whether such a system could be developed

12.

There should be a single easily remembered number that the general public can call to refer/raise an alert to suspected abuse of a vulnerable adult?

This suggestion made by members will be pursued within the Corporate Contact Centre Team. In addition, the Office of the Deputy Prime Minister is considering the establishment of a national single non emergency number. Hampshire is one of the first 7 areas in which this system will become operational and a response to adult protection referrals could potentially be built in to this system.

13.

What is being done to ensure that agency staff are trained?

Agencies are responsible for ensuring that their staff are trained in a number of areas and are aware of the relevant Hampshire County Council policies and procedures. It is proposed to enter into detailed discussions with agencies to support them in implementing Adult Protection basic awareness training as part of their current induction training programme. This will be in line with the training that is currently available to our own staff and those in independent sector provider services.

14.

Are we including adult protection in the agenda of forums such as the Local Strategic Partnerships?

Yes. As outlined in the response to question 10 under standard 3, Protection in the Community.

15.

Are we all working to the same procedures across agencies and areas

Yes the Adult Protection Policy and Procedures has been produced and amended with the full involvement of other key agencies across Hampshire, Portsmouth and Southampton. We all work to the same set of procedures and these are reflected in all training across all sectors.