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Emerald Group Publishing Limited
Article Type: Editorial From: The Journal of Adult Protection, Volume 16, Issue 4.
It's taken a while but March heralded the CPS's prosecution of two men, one of whom is a doctor, for female genital mutilation. Although this has been a criminal offence in England and Wales since the Prohibition of Female Circumcision Act 1985, subsequently replaced by the Female Genital Mutilation Act 2003, these are the first prosecutions to be undertaken.
Bleak as the coverage of the rescue mission has been for missing Malaysian flight MH370, the glimpses of passengers’ relatives have reaffirmed a truth for adult safeguarding practitioners: from the punching shock of knowing that a disaster has occurred, to the ever diminishing hope that perhaps not all passengers had died, to the anguish of not knowing what specifically happened to their relative – to their unique and private grief. The victims of such situations include not only those who have died.
Readers who have transferred their money to the Co-op Bank must be wondering how its sound founding principles ultimately gave way to mismanagement and the prospective, mega pay of the since departed Chief Executive. Check out the Resolution Foundation's review of the minimum wage (Sir George Bain) and ask why the challenging behaviour of bankers and boardrooms is being protected from the disbelieving populace.
In late March, the BBC broadcast The Great NHS Robbery which claimed that fraud may be costing the NHS £5 bn per year. Jim Gee, the former director of NHS counter-fraud, had been responsible for tackling the crime. He asserted that this figure includes the rich pickings to be made in payroll and procurement as well as patients falsely claiming exemptions and clinicians making false claims. There are around 300 fraud investigators within NHS Protect, which is responsible for tackling crime against the NHS in England. The broadcast contrasted this figure unfavourably with the Department for Work and Pensions, which employs six times as many staff to combat potential and alleged welfare benefit cheats. The programme highlighted stolen medical equipment being sold on eBay, a GP using patient records to obtain prescriptions for (their own) drug addiction and a dentist charging (£1.4 m) for work undertaken on behalf of inter alia deceased patients. The government denies Jim Gee's estimate. Viewers were reminded of Margaret Hodge's questioning of Serco directors and the CEO of Cornwall and the Isles of Scilly at the Public Accounts Select Committee. Readers may recall that Serco falsified information concerning the availability of clinicians and their responsiveness on over 200 occasions and yet this had no commissioning consequences. If Serco hadn’t withdrawn, Cornwall and the Isles of Scilly would have continued to pay them – which suggests that there is no real management of such contracts. Margaret Hodge reflected that this and other private sector providers have proved that they are accomplished at securing contracts but that their delivery won’t necessarily live up to the promise. We’re confident that there's a “nudge” which could be deployed […].
Speaking of which, our bid would be for re-visiting The Spirit Level by Richard Wilkinson and Kate Pickett. Evidence of growing inequality is damaging to all of us. The UK's upbeat job figures embrace the newly “self-employed”, i.e. those who have chosen respite from the Department for Work and Pensions’ punitive sanctions for their new label plus, of necessity, working tax credit. Similarly, we should be cautious about regarding Zero Hours Contracts as jobs. Yes, they have the merit of inflating the numbers of people with jobs but they do not allow employees working for less than 18 hours a week at the minimum wage that would allow them to build a state pension. We wonder if Thaler and Sunstein (2008) can come up with a persuasive case for business as usual?
The Mental Health Commission for Scotland reported that a woman in her 50s took her life at the end of 2011 after being given zero points in her “work capability” assessment – dismissing her mental health problems – and her weekly benefits were subsequently docked by 30 percent. The Department for Work and Pensions dismissed the investigation by the Commission. Check out the investigation and the banal response.
There have also been recent problems highlighted in Norfolk as people who are in need of work-related assessments by Atos have been informed that if they have mobility difficulties and cannot manage stairs they cannot be assessed at the office in Norwich. Although there is a lift to the second floor office, claimants have been advised that since the lift would not be available in the event of emergency, if they would not ordinarily be able to ascend/descend the stairs to the second floor (without assistance), then their assessments have to take place elsewhere: in many situations, this requires a minimum round-trip of 90 miles. Just in case we have forgotten, the Atos assessments are for individuals living with chronic ill-health and/or a disability, a reasonable number of who will have significant mobility problems […].
At the beginning of April we learned that upending welfare benefits will not necessarily produce the anticipated results. Of course there would be distress resulting from the “bedroom tax” (or the removal of the spare room subsidy) most particularly for people who have carers or equipment or even those with specially adapted properties […] but things must be hard if even the House of Commons Work and Pensions Committee accepts that the reforms […] may be causing harm to vulnerable households.
At the end of April we learned that Prison Governors have been ordered to cut the cost of holding inmates in England's bulging prisons by £149 m. The supersized, bargain-basement G4S-run Oakwood prison near Wolverhampton costs £15.5 k per prisoner compared with £22 k for publicly run prisons. Put alongside the changes introduced to the new Incentives and Earned Privileges Scheme which inter alia bans parcels and books sent to prisoners, and will likely also include musical provision, and we offer no prizes for guessing the likely outcomes.
Thanks to researcher Hannah Lambie-Mumford and colleagues, we can report that by weakening and removing safety nets, low wages and the rising cost of food, people are compelled to turn to food banks. Although the Department of Work and Pensions are unhappy with these research findings, food bank managers endorse their face validity.
Beyond the Barriers is a report into the Employment and Support Allowance and the Work Programme by the Spartacus Network and Ekklesia. It is a compelling read because disabled people have written it, it draws from those with first-hand experience of capricious assessments and it poses considered alternatives. The report concludes that a system, which works for sick and disabled people, while also creating value for taxpayers, need not be a contradiction in terms. Incidentally, MP Margaret Hodge of the Public Accounts Committee found an error in Atos’ tender for the Personal Independence Payments contract (a £184 m disability assessment contract). They claimed to have 740 assessment sites when they had only 96. Lisa Coleman, Atos’ Vice-President explained that this was not lying – it was “not unusual” for a tender document to be different from a contract that was agreed and signed later.
Frances Andrade took her life a week after giving evidence about abuse against Michael Brewer, a former teacher at Chetham's School of Music in Manchester, and his ex-wife Kay. The school appeared oblivious to Frances Andrade's pre-school history and the ways in which Michael Brewer sexually exploited schoolgirls. Professor Hilary Brown's Serious Case Review highlights the downside of competitive “hothousing” establishments, most particularly on those without life-saving family support. As Professor Brown noted:
Competent mental health professionals should have understood the way that people traumatised in childhood shift between states in order to cope and, had they done so, it might have prevented mental health professionals from colluding with Mrs A's pattern of distancing herself from their support as soon as she felt back in charge but then rapidly falling back down into a place where suicide seemed the only way out. Their failure to do so undermined their judgment at a time when they should have been anticipating the fact that she needed more help in the lead up to the trial and also after she had given her evidence.
Michael Brewer was convicted on five counts of indecently assaulting Frances Andrade when she was 14 and 15, and his ex-wife was convicted of indecently assaulting her.
The legacy of Winterbourne View Hospital is bleaker than we perhaps imagined, since Care Minister Norman Lamb has described the work to move people with learning disabilities out of assessment and treatment provision as an “abject failure.” The Health Services Journal reported “institutional inertia” among NHS and local government commissioners, which had undermined efforts to hit the deadline. His part in driving the transition programme had been his “most depressing and frustrating” task. Lamb accused NHS England, one of multiple health and local government organisations that had previously agreed to the June target for completion of the transition programme, of failing to prioritise the transition effort. “A significant proportion” of those who remained inappropriately accommodated in hospitals were NHS England cases, he said. “There hasn’t been enough challenge within commissioners to do this”. NHS England had reported in March about the data collected on transfer dates for individuals and acknowledged that the June date would not be met; the NHS England report detailed that of 2,577 patients, 260 had already obtained transfer dates, of which only 172 were likely to take place before the 14 June deadline.
In other news, a service that has been in existence for over 100 years, albeit in different forms, is being changed quite beyond recognition. The Probation Service has been serving local communities, supporting justice and enabling offenders to resettle. It delivered some 200,000-court reports and supervised around 220,000 offenders each year on community orders and suspended prison sentences and those released from prison on licence. The Lancashire Probation Trust hosted a moving legacy event during early May 2014 and we are confident there will be other events around the country. Although the probation service as a whole received the British Quality Foundation's Gold Medal for Excellence Award during 2011, the Conservative led coalition government has determined that it should change and a large portion of its work outsourced to private and voluntary sector providers. There are two heart-sinks for the service – the changes were not discussed with the judiciary and the changes will not result in any “savings”.
Earlier in the year, a joint statement on Safeguarding Adults was published by member organisations of the core statutory bodies (health, care and justice-related organisations). The key messages in the statement related to the central areas of: outcomes for (and experiences of) individuals in need of safeguarding, governance, leadership and commitment, information sharing, understanding risk, thresholds and interfaces and awareness raising and training.
The Making Safeguarding Personal initiative reinforces a number of these messages. The Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS), with other partners from the independent sector have been running the programme for the past two years, specifically concerning the development of more personalised responses within adult safeguarding. Local councils (adult social care departments, including safeguarding) have been involved in the development and implementation of a number of different approaches to involving service users within safeguarding. Following an initial phase of a small number of “test-bed” sites (see journal paper by Manthorpe et al., published earlier this year), the second wave of the programme took place from autumn 2013 to spring 2014 and 53 different councils took part in a number of different ways (as the approaches taken were developed in different areas these were very much tailored to the needs of the specific area in terms of changes that each local council wished to see made) as part of a targeted implementation of more person-centred and (individual) outcomes focused safeguarding practice. A report of this second phase of the programme has recently been published. This report was written by the independent co-ordinators, who were involved in liaison with participating councils and who also held a number of co-ordination activities. Planning is also underway for the next phase of the programme to be held during 2014-2015. The report of last year's programme is available from the following link: www.local.gov.uk/safeguarding-adults – please look at the section labelled: Making Safeguarding Personal for further details and links to copies of the report. We are also planning to include further papers about the work undertaken during this second part of the programme in the journal in future.
This issue of the journal contains a number of interesting papers on different aspects of safeguarding. The first paper, by McGarry and colleagues from the University of Nottingham, reports on a project that was undertaken to explore service responses to elder abuse across a range of different service sectors. The perspectives of older service users were also included where possible to achieve this. The project took place in one region of the UK and a range of organisations from NGO and statutory sectors took part. The project used a variety of methods to gather data, including telephone interviews and a postal survey. Key findings emphasise a lack of clarity in distinguishing between domestic abuse and elder abuse, the complexity of abusive relationships and family dynamics and a lack of specific service provision for older people. The challenges that organisations must confront to recognise the need for and to make adequate provision of services is highlighted in the paper, which provides much for us to reflect on.
Following the theme of elder abuse, our second paper provides results from an international (European) population-based survey of elder abuse that took place in seven different countries. The work co-ordinated by Soares and colleagues, considered a number of different elements in relation to specific types of abuse and this paper reports on the different reported experiences of respondents about somatic (bodily) symptoms in several areas: musculo-skeletal, heart, gastro-intestinal and exhaustion related, between individuals who had reported experience of psychological abuse and those survey respondents who did not report abuse. The survey took place in seven different European cities (one in each country) and covered almost 4,500 people aged between 60 and 84 years. Respondents who reported psychological abuse scored higher on the somatic symptom areas than non-abused participants and were therefore more affected by the symptoms. Additional factors such as depression and anxiety were also relevant, and both family structure and social support appeared to act as buffers for the symptoms (helping to reduce negative effects). The paper discusses the need for improvements in the situations of older people to take into account the potential effects of co-morbid conditions (such as depression), abuse and social support.
The third paper in this issue by Le Roux and Leach relates to the field of intellectual/learning disability and the very specialised area of the provision of therapeutic services for witnesses with learning disabilities in court hearings (both before and after criminal trials). The paper specifically focuses on pre-trial therapy, together with reflections on clinical practice from both a counsellor involved in this work and a supervisor. The underlying message from the paper is that professionals involved in safeguarding cases which are likely to result in court hearings should carefully consider the emotional needs of people affected by abuse and assist individuals to seek therapeutic support (or to seek this on their behalf) when this is necessary. This is a comparatively new area of practice and the area of therapeutic emotional support is one that many readers may wish to reflect on, even in the absence of any planned or likely judicial interventions for individuals.
Our final paper is another international offering, this time from India and focusing on the issue of domestic violence. The study was based on an analysis of a national survey on Family Health and provides an attempt to establish the severity and types of domestic violence experienced by women in India. Through the analysis the researchers wanted to determine the socio-economic factors that might predict violence in the domestic setting. Wealth, financial independence and formal education appeared to influence a decrease in domestic violence, whilst younger (adult) women seemed to be more vulnerable to such abuse. In certain states policies and legislation have been developed and seem to have led to a decrease in reported violence.
We hope that this issue will provide information for further consideration and possible follow-up. If any readers wish to discuss possible articles or becoming a reviewer for submissions to the journal, please do contact one of the editors for further discussion.
Bridget Penhale and Margaret Flynn
Thaler, R.H. and Sunstein, C.R. (2008), Nudge: Improving Decisions About Health, Wealth and Happiness, Yale University Press, New Haven, CT