On January 27th I attended an event on safeguarding vulnerable adults, for Gloucestershire LINk members and village agents. It was a presentation given by Gloucestershire County Council’s Head of Safeguarding Adults together with two other council staff, and Gloucestershire Constabulary’s Force Lead for missing persons and safeguarding adults.
The session mostly took the form of those bulleted lists sometimes known as “death by PowerPoint”, and the presenters’ tone was mostly self-satisfied. Towards the end there was some attempt to involve the audience in discussing case studies, and right at the end there was a very short time allocated for more general questions.
The concept of safeguarding vulnerable adults goes back to the 1998 government white paper, Modernising Social Services, although this historical background was not mentioned in the presentation. Government policy then was to rely on regulation and inspection to improve standards of care for vulnerable people.
In 2000 the government issued a guidance document, No secrets, which explained that (page 6):
In recent years several serious incidents have demonstrated the need for immediate action to ensure that vulnerable adults, who are at risk of
abuse, receive protection and support.
It’s difficult to discover, now, what those serious incidents might have been, but this news story from January 1999 might have been one of them:
Elderly people were punched, hit, tied up and bullied by health workers at a London hospital, according to an 18-month inquiry… The abuse of the 13 elderly and mentally ill patients at Beech Ward in London’s St Pancras Hospital only came to light after a health care assistant informed on five colleagues…
No secrets remains the basis for adult safeguarding today, although it always was, and still is, merely guidance with no actual force in law.
Aspects of adult safeguarding are covered, however, by several Acts of Parliament, making for a very complicated legal framework. For example, there are the Domestic Violence, Crime and Victims Act 2004, the Mental Capacity Act 2005, the Health and Social Care Act 2008, and others. In the presentation the title of one of these Acts was wrong, sowing early seeds of doubt about the presenters’ ability to deal with the complexities of the field. A recent brief guide to the law in this area, compiled by the Social Care Institute for Excellence, runs to nearly 300 pages: Safeguarding adults at risk of harm: A legal guide for practitioners
Gloucestershire Safeguarding Adults Board
The Council’s Director of Adult Social Care has ultimate responsibility for adult safeguarding in Gloucestershire. A Gloucestershire Safeguarding Adults Board (GSAB) was put in place in 2009 and now has its own website within the Council site. In the presentation we were told that it also runs its own advice line, but no special advice line is obvious on its website.
Instead of giving away any information, the GSAB website starts by asking who you are, which is not encouraging. A message on the front page says:
The content of this site is currently only available if you are logged in.
That’s actually untrue, as I was able to see some content without logging in. Perhaps there is other some content that you can only see by giving the Council even more information about who you are.
One of the things that’s actually happening in Gloucestershire is that some 65 trainers are providing training on safeguarding to the 30,000 people who work in health and social care. There are various levels to the training, from basic e-learning courses, through foundation and “level 2” courses run by approved trainers, to specialist training on, for example, the Mental Capacity Act 2005.
The e-learning is available free to anyone in Gloucestershire at kwango, where shared user names and passwords give access to eleven courses that include one on Safeguarding Adults at Risk and apparently two on the Mental Capacity Act 2005. I had a quick look at a couple of the courses, but the site soon broke down with an incomprehensible (to most people) error message:
Warning: mysql_fetch_array(): supplied argument is not a valid MySQL result resource in D:\home\Default\kwango.com\htdocs\login\index.php on line 151
There are currently no courses available.
The parts I was able to look at before it broke were mostly very tedious. Short pages of text were read out in a dreary tone. Nothing seemed to be explained. No one seemed to have intelligent choices or judgements to make. It all seemed to be about doing what you’re told.
Gloucestershire’s training programme, as far as it goes, seemed well thought out. There was some recognition of its achievements, as well as of its current limitations and failings and the need to improve. I just hope the content isn’t all this dismal.
In Goucestershire’s multi-agency approach to adult safeguarding, the Police are a key element. When various agencies are in a position to investigate a case, the police investigation takes precedence because of the possibility it will result in a prosecution.
The presentation about police work was candid about the late involvement of the police in reacting to No secrets only as late as 2010, and indeed the often delayed reaction of the police to individual cases of criminal abuse. However, an encouraging sign of intelligence in the police approach, I thought, is its database of cases relating to adult safeguarding.
I was less impressed with the case studies of police work, which were both about high-profile prosecutions. Although it was interesting to hear these tales of things we had seen in the news, they were both cases that didn’t particularly require a multi-agency approach, or if they did it wasn’t made clear why, so the case studies somewhat undermined the overall message of the event.
Safeguarding case studies
Two of the Safeguarding department’s case studies were discussed with the audience, and it was at this point that some of the audience’s doubts about the adult safeguarding process began to be voiced.
In one case study, a whistleblower contacted the Care Quality Commission (CQC) about abuse she had witnessed in the care home where she worked. The CQC took no action itself, but passed the information to the county Safeguarding department.
In discussion it was pointed out that the victim’s injuries were never assessed by a doctor, according to what we had been told. There was no indication that the victim even had a GP. The presenter seemed surprised, and we were surprised that she was surprised because it was, after all, her case study.
In discussion a village agent told us about a real case of an elderly man who had lived alone with the support of his family, and who thought everyone around him was spying on him and persecuting him. For example, he refused to have his TV converted to digital because he thought that doing so would enable people to see him through his TV.
The presenter suggested that the council Safeguarding service could have been appropriate in a case like this, even though the man was only being abused in his imagination. No one suggested a doctor, either at the time or in the discussion at the event. (Paranoid delusions are often simple to treat with modern drugs, and the man would have been spared much distress.)
A further case was mentioned by the presenter herself, in passing, during the discussion. A woman had been found to have bruising on her lower body. The Safeguarding team assumed she had been sexually abused, and called in the police. However, the investigation was called off when a doctor assessed the bruising and it was found to have been caused by a fall.
I found the Safeguarding department’s apparent resistance to medical assessment very worrying.
A report by the Commission for Social Care Inspection (CSCI) in 2008, Safeguarding Adults: A study of the effectiveness of arrangements to safeguard adults from abuse was recently recovered from the CQC, who had hidden it, as a result of a Freedom of Information request. The report had found that (page 7):
Over two-thirds of councils are failing to monitor safeguarding adequately, through appropriate management overview of both individual cases and the arrangements as a whole. At a casework level, over half of the councils inspected need to improve recording and supervision, and two-thirds to improve auditing processes.
Then in 2009, in a national consultation on the No secrets guidance and how it was working, one of the questions asked was:
QU 1D — How do we know if a safeguarding board is working effectively?
Gloucestershire’s Adult Protection Management Committee responded to other parts of the consultation but not to that question (although the mental health trust, 2gether, asked whether the model could mirror child protection). The government of the day’s report on the consultation ignored the question entirely. Even so, one of its conclusions was that (page 27):
There was strong support for the introduction of an outcomes framework. Eighty-eight per cent of respondents said that this would be useful… Respondents wanted a framework that would include both indicators and performance measures; that could be applied to individual safeguarding partners; and that could be applied to Safeguarding Boards as well.
So at the event I asked how the Safeguarding department know how effective they are. The answer was evasive. A lot of work has gone into a quality assurance framework across the South West, but this only seems to measure processes with more processes. There seems, still, to be no measure of outcomes for vulnerable people.
Perhaps a measure of how far things have, or haven’t, come since No secrets in 2000 is this news story from June 2011:
Patients at Winterbourne View were transferred after the [BBC Panorama] programme showed residents being pinned down, slapped and taunted. The hospital closed last Friday.
A presenter at the event described the Panorama programme as “unfortunate”, and had to be reminded that it was not the programme but the victims who were unfortunate.
Overall, I got the impression of Safeguarding as a kind of runaway train on which all the staff know that they have to work very hard, but none of them has the faintest idea where the thing is going. They just cling on to the hope that if they can only go faster and faster, everything will be alright.
The reality is that there’s nothing to suggest this outdated tick-box approach to vulnerability does more good than harm. Its supporters want a change in the law to give their work extra importance, yet they refuse to measure how useful it really is.
I’m not the only one to think this way, either. A few days later there was public criticism of the current approach from social worker and academic Martin Webber, in an article with the title, Social workers need to define their practice:
If I was an undergraduate social work student writing an essay on what mental health social work is, I might cynically answer: “It’s what you’re told to do”…
Social workers are increasingly being pulled out of integrated mental health services by their local authority employers to concentrate on policy priorities such as safeguarding vulnerable adults…
Systematising practice…may be an uncomfortable culture shift for social work, but it may be necessary in order to demonstrate the effectiveness of our practice.
I came away from the event dismayed by what I heard about adult safeguarding in Gloucestershire, and convinced of the urgent need to move away from “Do what you’re told” and to start systematising and demonstrating effectiveness.