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The purpose of this paper is to explore the detection and prevention of elder financial abuse through the lens of a “professional bystander intervention model”. The authors were interested in the decision cues that raise suspicions of financial abuse, how such abuse comes to the attention of professionals who do not have a statutory responsibility for safeguarding older adults, and the barriers to intervention.

In‐depth interviews were conducted using the critical incident technique. Thematic analysis was carried out on transcribed interviews. In total, 20 banking and 20 health professionals were recruited. Participants were asked to discuss real cases which they had dealt with personally.

The cases described indicated that a variety of cues were used in coming to a decision that financial abuse was very likely taking place. Common to these cases was a discrepancy between what is normal and expected and what is abnormal or unexpected. There was a marked difference in the type of abuse noticed by banking and health professionals, drawing attention to the ways in which context influences the likelihood that financial abuse will be detected. The study revealed that even if professionals suspect abuse, there are barriers which prevent them acting.

The originality of this study lies in its use of the bystander intervention model to study the decision‐making processes of professionals who are not explicitly charged with adult safeguarding. The study was also unique because real cases were under consideration. Hence, what the professionals actually do, rather than what they might do, was under investigation.

This article will examine the changes in law brought about by the Mental Capacity Act and consider the practical implications for health and social care staff.

The purpose of this paper is to present the findings of a study considering the application of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Practitioners from a range of professions were recruited to provide their views of how to respond to a variety of scenarios. GPs, nurses, social workers, physio/occupational therapists and care assistants were recruited to participate.

This study used the Delphi method to elicit participant views and generate consensus of opinion. The Delphi method recommends a large sample for heterogeneous groups, and round one had 98 participants from six different professional groups.

Participants did not respond consistently to the scenarios, but disagreed most significantly when patient decisions conflicted with clinical advice, and when to conduct a capacity assessment. These responses suggest that clinical responses vary significantly between individuals (even within settings or professions), and that the application of Mental Capacity Act (MCA) is complicated and nuanced, requiring time for reflection to avoid paternalistic clinical interventions.

Previous studies have not used a Delphi method to consider the application of MCA/DoLS. Because of this methods focus on developing consensus, it is uniquely suited to considering this practice issue. As a result, these findings present more developed understanding of the complexity and challenges for practitioner responses to some relatively common clinical scenarios, suggesting the need for greater clarity for practitioners.

2007 marks a major step forward in the history of adult protection with the implementation of the Mental Capacity Act in England and Wales. Understandably, debates about adult protection have usually focused on the more obvious types of abuse ‐ sexual, physical, financial and emotional. The Mental Capacity Act addresses a much wider issue of abuse where a person's right to make their own decisions, and to have proper safeguards and protection if decisions need making on their behalf, is overridden or ignored. This article gives an overview of the Mental Capacity Act and its relevance to the files of adult protection.

The purpose of this paper is to introduce Advance Decisions, address low uptake and examine fundamental issues that can inform the development of policy and practice in this area.

This paper discusses findings from a research project with the charity Compassion in Dying (analysing calls to its telephone helpline) and practical experience of working with the charity Advance Decisions Assistance (helping people write Advance Decisions and training healthcare professionals).

Older people themselves identify the issues of autonomy, identity and efficacy as key challenges in writing Advance Decisions and having them respected.

This paper shows how addressing the “real world” challenges of advance decision making can inform policy and practice.

This paper seeks to present findings from a review of hospital policies and practices in one NHS Trust in England.

The focus of the review was hospital staff policy and practice in safeguarding the rights of vulnerable patients. A sample of staff was surveyed to investigate their knowledge of the Mental Capacity Act 2005 in 2010. Interviews, incorporating discussion of a vignette, were undertaken with a range of staff and findings were analysed thematically. These findings are contextualised by an analysis of Trust policies and the wider literature. The findings of this case study are used to develop recommendations for the hospital and healthcare sectors.

Analysis of survey data and interviews revealed limited confidence and knowledge about the Mental Capacity Act 2005 and uncertainties about its relevance to clinical practice. In relation to safeguarding, there was limited realisation of the potential of the Act to uphold the rights of patients lacking capacity and staff responsibilities. MCA training had not made a great impression; hospital policies were inconsistent and lacked coherence.

This case study was conducted in one Trust and may not be generalisable. Other hospitals may have different training, policy and procedure systems.

The findings of this case study may be applicable to other hospitals and to other providers of health and social care services. The relevance of the MCA could be highlighted and used on several induction and training programmes. The study identifies features of policy and practice that could be investigated in other organisations.

Few studies have investigated the operationalisation of the MCA in hospital settings. This study reveals that there are opportunities to refresh MCA and safeguarding training strategies for hospital staff but these should be accompanied by changes to culture and attention to the coherence of different procedures. Audits of MCA and safeguarding compliance can be undertaken within hospitals and a systems approach could be adopted to address any issues identified and to sustain good practice.

The purpose of this paper is to determine what written information is given to informally admitted patients in England and Wales regarding their legal rights in relation to freedom of movement and treatment.

Information leaflets were obtained by a search of all National Health Service mental health trust websites in England and health boards in Wales and via a Freedom of Information Act 2000 request. Data were analysed using content analysis.

Of the 61 organisations providing inpatient care, 27 provided written information in the form of a leaflet. Six provided public access to the information leaflets via their website prior to admission. Although the majority of leaflets were accurate the breadth and depth of the information varied considerably. Despite a common legal background there was confusion and inconsistency in the use of the terms informal and voluntary as well as inconsistency regarding freedom of movement, the right to refuse treatment and discharge against medical advice.

The research has demonstrated the value of Freedom of Information Act 2000 requests in obtaining data. Further research should explore the effectiveness of informing patients of their rights from their perspective.

Work should be undertaken to establish a consensus of good practice in this area. Information should be consistent, accurate and understandable.

This is the only research reporting on the availability and content of written information given to informal patients about their legal rights.

No Secrets: Guidance on developing and implementing multiagency policies and procedures to protect vulnerable adults from abuse was introduced as formal guidance in 2000 (Department of Health, 2000). In July 2009, the government published Safeguarding Adults: Report on the consultation on the review of the ‘No Secrete’ guidance (Department of Health, 2009), paving the way for revised guidance. In the 10 years since the introduction of No Secrets, we have seen many changes in the field of adult protection, including reconceptualisation of this area of practice in terms of ‘safeguarding’. As guidance, No Secrets operates within the context of current legislation and case law. This legal landscape has developed considerably over the last 10 years and it is apposite to review those changes; the effect of which must be integrated into any review. 2010 also marks 10 years since the implementation of the Human Rights Act 1998 (HM Government, 1998) and while its influence is clear in some developments, certain case law decisions have been disappointing.