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Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Editorial From: The Journal of Adult Protection, Volume 13, Issue 2
You can call it liberalism.You can call it empowerment.You can call it freedom.You can call it responsibility.I call it the “big society”(Prime Minister David Cameron).
All but the last of these terms are familiar to adult safeguarding. Garton-Ash (2010) has described the above as “evangelical incoherence” and his withering response merits coverage, “You can call it milk. You can call it cheese. You can call it socks. You can call it internal combustion. I call it baked beans”. Add in the biting satire of Steve Bell’s “big society” cartoons, and big society’s short heyday is over. Irrespective of its faltering re-launches it continues to be dealt some serious blows – what with Lord Wei, England’s big society Tsar discovering that a salary is helpful and Dame Elizabeth Hoodless warning that the government’s spending cuts are in danger of “destroying” volunteering. That said – Ministers and MPs are discovering the power of community activism – the reversal on the forestry sell off being significant. It was never just about trees. It was about putting public spaces into the market and citizens, rather than consumers, emphatically saying “No!” The magnitude of the spending cuts has massive implications for the quality and quantity of services. People being ejected from valued public services and steeply rising unemployment does not bode well for the capacity of managers to sustain adult safeguarding. The implications of this cannot be revealed immediately. Frankly, it is not going to be top of the list of choices for worthiness to survive and flourish. Of course, the deficit level was unsustainable – so too is the resistance of government to its own advisers not to proceed with housing benefit reforms for example. Meanwhile, McDonald’s, PepsiCo and Diageo are set to shape public health policy with the blessing of government, the private sector is circling the NHS and resistance is promised.
In this edition, Chih Hoong Sin, Annie Hedges, Chloe Cook, Nina Mguni and Natasha Comber alert readers to the fact of violence in the lives of disabled people. They present the findings of a study commissioned by the Equality and Human Rights Commission concerning violence and hostility against disabled people. They acknowledge that the absence of nationally representative data and a surfeit of anecdotes compromise their findings. However, they confirm the significant risk of targeted violence and hostility towards disabled populations and draw attention to people’s avoidance strategies and acceptance behaviour. In turn, these can lead to criminal justice agencies believing that the disability rather than the crime has to be addressed. A finger of blame is pointed at the English guidance No Secrets (Department of Health, 2000) for blurring responsibility between social care and criminal justice. The Adult Support and Protection (Scotland) Act (2007) also gets it in the neck for its leanings towards the protectionist paradigm. Unsure where this takes us in terms of hate crime and the Association for Real Change’s interest in addressing mate crime, but few would challenge the authors’ call for more structured and explicit processes to manage risk.
Ruth Ingram describes a framework which has shaped multi-agency safeguarding procedures in Leeds and Bradford. It is something of a decision support tool which she advises has muted concerns about thresholds, i.e. it creates a structure within which agencies decide they whether they should act based on consideration of their organisational responsibilities […]. Read it and then take a look at the Association of Directors of Adult Social Services (2011) Advice Note.
Elaine Cass briefly outlines the work of the Social Care Institute for Excellence regarding adult safeguarding asserting that prevention is at the heart of their work. While I acknowledge that their Social Care TV contains compelling training materials, readers may share my reservation about the statement:
The importance of placing the person at the centre of safeguarding processes will support practitioners to move away from “service led” procedure-focused responses.
This brings babies and bathwater to mind. I accept that there is considerable variation in bringing adults who are the focus of safeguarding interventions into the foreground of practice but what is wrong with a service taking a lead or with the responses of that service being shaped by negotiated, tried and tested procedure? Why support the Pan London multi-agency policy and procedure if there are unspecified perils in adhering to these?
Richard Humphries outlines the principal findings and common areas for development from a pilot programme of peer reviews of adult safeguarding arrangements in the four localities. The safeguarding boards of each authority agreed to be part of the process and regarded external challenge as a means of improving. The findings concern the outcomes and experiences of users; leadership, strategy and commissioning; service delivery and effective practice; and working together. Richard Humphries touches on a topic of enduring concern to safeguarding personnel – personalisation. He notes that this offers a big opportunity to councils to ensure that the increasing numbers of people arranging their own care who might otherwise slip off the safeguarding radar are offered information and advice. The policy challenges he identifies include: the dangers of reverting to protection and rescue; engaging with clinicians distracted by reorganisation; and acknowledging that a culture of safeguarding that has been driven largely by a public sector mindset may become increasingly anachronistic as more pluralistic models of delivery evolve (the demise of the public sector mindset is surely a topic for future articles!) and the Law Commission’s review of adult social care legislation plus the Dilnot Commission’s work on the funding of care and support.
The hospital care of older people in England and Wales is the rightful preface to Simon Williams’ paper which revisits a Journal of Adult Protection theme of learning from inquiries. In February, the Parliamentary and Health Service Ombudsman published Care and Compassion? Report of the Health Service Ombudsman on ten investigations into NHS care of older people. This summarises ten investigations of complaints about NHS Trusts across England and two GP practices. As Ann Abraham noted in her Foreword, the report outlines:
[…] a picture of NHS provision that is failing to respond to the needs of older people with care and compassion and to provide even the most basic standards of care.
In March, the Older People’s Commissioner for Wales published “Dignified care? The experiences of older people in hospital in Wales”. The Inquiry began in June 2010 and the publication confirms the low expectations of older patients, poor and even shameful nursing practices alongside many valued practices. The recommendations are worth reading and both texts are compelling training resources for safeguarding practitioners and managers.
Simon Williams reminds readers of the NHS’s track-record in safeguarding and concludes that specific legislation will be necessary if joint working in safeguarding is to be achieved. He welcomes the Interim Policy in Wales which extends the responsibility of health safeguarding to include, for example, alleged abuse by a health professional if they are employed in the provision of primary care.
I am struck that Simon Williams makes no reference to learning partnerships. It seems to me that the best of safeguarding learning combines the expertise of adults who have been harmed/who have been at risk of harm and their partners or relatives, with that of professionals. Also crucial are the platforms that enable individuals and groups to learn together, reflect on trans-disciplinary decision making and action in meetings, supervision and in case study discussion, for example, and even the thinking about the ethics shaping such learning platforms. The best of inquiries skillfully critique the events which led to the disaster or trauma and they are loyal to the known facts. In the localities in which the cause of the inquiry occurred they are valuable catalysts challenging the rethinking of assumptions. I do not buy the claim that all inquiries are repetitive – it seems an unduly limiting appraisal.
In the light of Simon Williams’ article, essential book club reading for this month are the five documents published in March by the Department of Health:
Safeguarding Adults: Role of managers and Boards.
Role of Health Practitioners.
Role of Commissioners.
Self assessment and assurance frameworks.
Equality impact assessment.
Along with the Care Quality Commission’s overview of The operation of the Deprivation of Liberty Safeguards in England 2009/10. All are on the respective web sites.
Finally, in February, the Law Commission began a review of the regulatory regime that governs the work and conduct of healthcare and social care professionals. Given that the law is fragmented, difficult to access and inefficient, the Commission aims to modernise and simplify what exists to create a single over-arching structure within which the regulators can work.
Association of Directors of Adult Social Services (2011), Safeguarding Adults: Advice Note, Association of Directors of Adult Social Services, London
Department of Health (2000), No Secrets: Guidance on Developing and Implementing Multi-agency Policies and Procedures to Protect Vulnerable Adults from Abuse, Department of Health, London
Garton-Ash, T. (2010), “To judge Britain’s experiment, hold your breath and ignore the slogans”, The Guardian, 28 October
Older People’s Commissioner for Wales (2011), “Dignified care? The experience of older people in hospital in Wales”, available at: www.olderpeoplewales.com/uploads/media/HR_English_FA.pdf
Parliamentary and Health Service Ombudsman (2011), Care and compassion? Report of the Health Service Ombudsman on 10 Investigations into NHS Care of Older People, Parliamentary and Health Service Ombudsman, London, available at: www.ombudsman.org.uk/care-and-compassion