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Emerald Group Publishing Limited
Article Type: Editorial From: The Journal of Adult Protection, Volume 16, Issue 2.
The urgent circumstances of the ex-patients of Winterbourne (hidden from) View Hospital, disquiet about the failed warning systems at the Hospital and indignation about international private equity profiting from tax-payers were all in danger of becoming muted – irrespective of the endeavours of self-advocates and their families and organisations such as Mencap, the Challenging Behaviour Foundation, Respond, Studio 3, the National Development Team for Inclusion and the Journal of Adult Protection. Then the Department of Health published Winterbourne View: Transforming Care One Year On. Over 30 months after the broadcast of the BBC Panorama Undercover Care: The Abuse Exposed, it revealed that one ex-patient has died, ten are in supported living, 24 are in residential care homes and 13 are in-patients in other units (the destinations of three ex-patients from Wales are not known). Throughout England there are 3,250 people in such in-patient units, many of whom are destined to spend a long time in such provision. It is dismaying that some providers of these services were unable to identify valid residential postcodes of their patients, i.e. they are “orphans” – even though the cheques continued to be paid.
The national response to the scandal was a programme of timetabled actions challenging inter alia the rationale for services purporting to provide assessment and treatment for adults with learning disabilities, with autism and with mental health problems. A Joint Improvement Programme supported by NHS England, the LGA and the Department of Health (2013) published a stocktake of progress during October 2013 (Local Government Association, 2013). If this disappointed idealists, then Winterbourne View: Transforming Care One Year On has pitched us into disbelief. The majority of patients are fully funded by and have been placed by the NHS – yet local authorities are expected to pick up the tab when they leave.
Not surprisingly, a particularly bleak lesson is that in-patient services do not feel threatened by the landscape of abuse revealed at Winterbourne View Hospital or the endeavours of the joint improvement programme. It remains disappointing that physical restraint in all its manifestations continues to be permissible in assessment and treatment and other in-patient services – but there is a glimmer of hope. Check out the Royal College of Nursing's (2013) Draft Guidance on the Minimisation of and Alternatives to Restrictive Practices in Health and Adult Social Care, and Special Schools.
Money is at the heart of this scenario. At a time when billions are being gouged from the local government budget – in the knowledge that more “savings” are to be made – how can local authorities willingly assume financial responsibility for supporting people returning to their own communities when to do so could render them bankrupt? Early expectations that funding would be transferred no longer prevail. Local authorities cannot pick up the bill for the commissioning decisions of the NHS. Local authorities do not fund people in hospitals but the NHS does fund people in our communities – it is just that here's a dream opportunity for the NHS to divest themselves of their responsibilities.
Still – austerity is working! Forget xenophobia, the bedroom-tax, the increasing reliance on food banks and the ever-tightening criteria of service eligibility. The bank bonus scandal is history. Thanks to Polly Toynbee (The Guardian, 17 January 2014), we know now that there are more bankers in Britain earning in excess of £800,000 than in the entire EU and that Barclays pays more people £1 m than the entire Japanese corporate sector. Clearly, they need their 100 per cent bonuses and the rest.
Profit-driven priorities do tend to get in the way as the Competition Commission found recently. They concluded that the dominance of the largest private healthcare groups has been keeping prices artificially high. Roger Witcomb, the chairman of the private health inquiry group concluded: “Requiring operators to sell hospitals is a big step and we have focused on those areas where a sale will be effective in increasing competition – where a single operator owns a cluster of hospitals which face little rivalry”. But, oh dear, not all the private healthcare groups agree. Perhaps it is because the three largest made excess profits of £173-193 m a year between 2009 and 2011 (Rankin, 2014).
Fergus and Judith Wilson have a buy to let empire in Kent. Fergus Wilson wrote about the rationale for their eviction of tenants receiving housing benefits (Wilson, 2014). The Wilsons want housing benefit payments paid directly to them rather than to the tenants – some of whom are not able to prioritise paying their rent. Perhaps it is time to look at the mortgage interest tax relief of such empires and ask questions about the public value of such relief.
In this issue of the journal we are pleased to bring you a selection of papers about a number of different topics in the field of adult safeguarding. This includes several papers that are focused on practice-related issues, particularly in care settings, which we hope will be of interest to readers.
Our first paper is by Leo Quigley and focuses on a policy analysis, which reviews the possible reasons for the slow rate of progress in England in the development of adult safeguarding on a national basis, and makes recommendations for some longer-term solutions to these problems. This is achieved through a comparison with public health to explore the challenges that might exist in the development of knowledge within adult safeguarding. The paper is interesting and in some respects challenging, hopefully it will stimulate much needed discussion in this area.
Our second paper in this issue is a research paper by Lisa Oakley and Kathryn Kinmond of Manchester Metropolitan University, and focuses on the neglected area of spiritual abuse. The paper reports findings from a survey of individuals’ experiences of church and spiritual abuse, within the overall context of adult safeguarding. Respondents indicated a variety of negative experiences in this area and the majority had rather limited knowledge about such abuse and the availability of support to assist with such issues. The findings suggest a need to include considerations of these types of abuse within both policy and practice in safeguarding.
The following paper is also a research-based piece by Jill Manthorpe and colleagues, which presents the Making Safeguarding Personal Programme, which was established with the assistance of the Local Government Association and other key stakeholders such as ADASS. The paper provides an introduction and summary of the programme and presents some of the early findings that have occurred. The programme consisted of developing local arrangements in adult safeguarding through test sties within four local councils within England, with an emphasis on approaches to assist adults at risk to improve their situations and with a focus on outcomes. We look forward to learning more about the results from this programme in future.
The fourth paper in this issue is another thought-provoking contribution, provided by David Marsland and Joe Hanley. The paper examines the importance and nature of relationships (especially between residents and staff) within residential care settings within the context of the twentieth anniversary of the publication of the seminal document on learning disability (Churchill et al., 1993). The paper considers what it is about such relationships, that appears to be linked with abuse and harm and makes some useful and interesting suggestions about how these might be counter-acted. This includes a need for practitioners to focus more closely on the quality of relationships within care settings. Our fifth paper of this issue, by Celia Harbottle and colleagues is also concerned with care settings and is based on the development of a model of leadership, premised on compassion. The model is based on theoretical perspectives of attachment and although originally developed in relation to the care of looked-after children, has recently been adapted within adult safeguarding to develop a preventative framework within the care of older people. This paper too is worthy of careful consideration for the messages that it provides for practice in this area.
The final paper in this issue is by Mel Walford and concerns a piece of work undertaken with staff who had been identified as alleged perpetrators of harm within adult protection cases within one local authority in Wales. The paper aims to consider the impact of such investigations from the perspectives of alleged perpetrators and to suggest possible improvements in practice. Key findings from this small-scale project were that processes could be very prolonged and individuals involved could feel very isolated, receiving limited support or information. The Interim Welsh policy for support of individuals did not appear to be followed and suggestions are made to develop more positive practice in this area of adult protection/adult safeguarding.
We hope that you will find this issue interesting and stimulating, particularly in relation to the development of policy and practice within safeguarding. If you are thinking about writing for the journal and have some ideas that you would like to discuss, please do contact one of the editors for discussion about this. We hope that you enjoy this issue.
Bridget Penhale and Margaret Flynn
1. Aptly re-named by Ray Tallis (2013) in his introduction to NHS SOS: How the NHS was Betrayed and How We Can Save It edited by Jacky Davis and Raymond Tallis and published by One World.
Churchill, J., Craft, A., Holding, A. and Horrocks, C. (1993), It Could Never Happen Here: The Prevention and Treatment of Sexual Abuse of Adults with Learning Disabilities in Residential
Settings, ARC and NAPSAC, Chesterfield and Nottingham
Department of Health (2013), Winterbourne View: Transforming Care One Year On, TSO, London
Local Government Association (2013), Winterbourne View Joint Improvement Programme: Stocktake of Progress Report, Local Government Association, London
Rankin, J. (2014), “Private groups ordered to sell off nine hospitals”, The Guardian, 17 January
Royal College of Nursing (2013), Draft Guidance on the Minimisation of and Alternatives to Restrictive Practices in Health and Adult Social Care, and Special Schools, RCN, London
Tallis, R. (2013), “Introduction”, in Davis, J. and Tallis, R. (Eds), NHS SOS: How the NHS was Betrayed and How We Can Save It, Oneworld Publications, London
Wilson, F. (2014), “Why my housing benefit tenants had to go”, The Guardian, 11 January