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The purpose of this paper is to explore the perceived low number of Scottish criminal convictions in cases of ill-treatment or wilful neglect of adults where the victims experienced mental disorder, and/or incapacity. Human rights and anti-discrimination legislation are drawn upon to consider whether victims are gaining equality of access to justice through the charging and conviction of those who commit these offences.

The paper uses the concept of parity of participation to first set out the wider legal framework in which access of justice takes place and to try to determine how it may be working in practice. Second the paper explores Scottish guidance, research and case law in relation ill-treatment or wilful neglect to evaluate the seeming lack of progress towards criminal convictions.

Whilst the legal framework, at least on paper, appears to promote equality of access to justice, little is known about how it is working in practice; in particular whether cultural barriers to participation are being addressed. Evaluation of Scottish statistical data on cases of ill-treatment and wilful neglect revealed a small number of cases progressing to court though there were challenges in constructing a pathway from charges to convictions. There also appeared to be no Scottish legal opinions published in connection with these cases. In addition lack of research means that little is known about why cases progress, and how victims might be being supported through the process.

It is suggested that these gaps in information, in comparison to England and Wales, might be hindering practice. In particular the apparent lack of operational definitions for ill-treatment and wilful neglect in Scotland may reduce the use of this type of criminal offence. As such criminal offences embedded within civil mental health and mental capacity legislation may currently be hidden in plain sight. The human rights consequences of the issues raised in this paper are argued as significant. Research is needed to fill these gaps and inform future guidance and training.

Improved Scottish guidance and publicity of this issue is required. Local inter-agency discussions and training could develop a better understanding of how these offences have been defined and how disabled people might be supported through the legal processes. The Scottish publication of statistical information for charging and convictions might usefully record these offences separately to give them a greater public profile in the future.

This paper highlights the dearth of publicly available information on the number and nature of Scottish prosecutions for ill-treatment or wilful neglect. It suggest ways in how this might be addressed.

The purpose of this paper is to consider the criminal offence of wilful neglect in the context of hospital health care in England.

Summarise the evidence of neglectful care in hospitals and analyse the ingredients and application of the offence of wilful neglect.

Neglect is ongoing and systemic in the hospitals and the offence of wilful neglect seems to be ineffective as either a punitive or deterrent measure.

There is a mismatch between the extent of systemic, reckless neglect in the hospitals and the application of the criminal offence of wilful neglect. The answer, if any, might be: widening of the offence to anybody who is wilfully neglected (not just those mentally disordered or mentally incapacitated people), a new offence of corporate neglect, the holding of reckless leaders to account, and a reinvigorated Care Quality Commission and Health and Safety Executive.

The author is unaware that such a review of this area of law, applied to health care, has been undertaken.

The paper seeks to contend that first, the current law treating Neglect of Duty and Breach of Trust as a single offence is incorrect; and second, that the offences can be an important tool in battling public corruption.

The paper traces the historical development of the offences throughout the Commonwealth.

The single‐offence approach lacks historical antecedents and has not been uniformly adopted.

The paper could engender debate, and correction, of the single offence approach as well as encourage greater use of the offences in prosecuting egregious conduct that would not otherwise be criminal.

Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems.

Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews’ observations and recommendations. The main circumstances, recommendations and common themes were identified.

The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual’s circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults’ lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially.

The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives

This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals.

The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults’ health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.

The purpose of this paper is to examine and explicate the concept of poor care by exploring what it is and what contributes to its occurrence in practice with a particular focus on the care of older people.

The results of systematically searched published literature were analysed using an inductive, descriptive, thematic approach as part of Rodgers’ evolutionary concept analysis method.

The concept of poor care is understood in the context of the antecedents of vulnerability, use of healthcare services and interaction with healthcare personnel. Its defining characteristics involve individual’s personal traits, interpersonal dynamics, an endangered self, misconceptions or organisational constraints.

Further research is needed to explore the recognition of poor care and reporting thresholds. In addition, the role of the “zone of tolerance” of expectations in the delivery and receipt of interpersonal care and attention for older people needs to be better understood.

Understanding the continuum and mapping the structures of poor care in contemporary UK healthcare practice can help sensitise practitioners to the widespread range and potential for instances of poor care. This concept analysis uniquely demonstrates consequences not only for the patient but also for healthcare staff and other individuals.

The Mental Capacity Act 2005 was implemented in England and Wales in 2007. This article reports the findings of interviews with 15 adult safeguarding co‐ordinators in the London area about the operation of the Act and its impact upon adult safeguarding work, particularly in relation to people with dementia. The interviews covered participants' own training and understanding of the Act, their confidence in practice and capacity to be local sources of expertise about the Act and their perceptions of whether its existence is known among the public. The article concludes that adult safeguarding co‐ordinators are mostly well informed but would welcome specific updating, especially around the new offences introduced by the Act.

The purpose of this paper is to report the findings of the Confidential Inquiry into premature deaths of people with intellectual disabilities (CIPOLD) in relation to the Mental Capacity Act (England and Wales) (MCA) 2005.

CIPOLD reviewed the deaths of all known people with intellectual disabilities (ID) aged four years and over who had lived in the study area and died between 2010 and 2012.

The deaths of 234 people with ID aged 16 years and over were reviewed. There were two key issues regarding how the MCA was related to premature deaths of people with ID. The first was of the lack of adherence to aspects of the Act, particularly regarding assessments of capacity and best interests decision-making processes. The second was a lack of understanding of specific aspects of the Act itself, particularly the definition of “serious medical treatment” and in relation to Do Not Attempt Cardiopulmonary Resuscitation guidelines.

CIPOLD did not set out to specifically evaluate adherence to the MCA. It may be that there were other aspects relating to the MCA that were of note, but were not directly related to the deaths of individuals.

Addressing the findings of the Confidential Inquiry in relation to the understanding of, and adherence to, the MCA requires action at national, local and individual levels. Safeguarding is everyone's responsibility, and in challenging decision-making processes that are not aligned with the MCA, the authors are just as effectively protecting people with ID as are when the authors report wilful neglect or abuse.

CIPOLD undertook a retrospective, detailed investigation into the sequence of events leading to the deaths of people with ID. To the authors’ knowledge, this is the first time that such research has associated a lack of adherence to the MCA to premature deaths within a safeguarding framework.

Monday 1 October sees the implementation of the majority of the Mental Capacity Act 2005 (the Act). Parts of the Act came into operation in April 2007, namely the creation of a new criminal offence of wilful neglect or ill treatment, the provision of Independent Mental Capacity Advocates (IMCAs) in England, and the Code of Practice governing the Act.The months leading up to October have been an exceptionally busy time for the Public Guardianship Office (PGO). The new legislation creates a new Office of the Public Guardian (OPG), which will replace the existing PGO. But there is more to this change than a simple re‐arrangement of words, as shown in this article.

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

Inspectors visiting districts in connection with the Foreign Meat and Unsound Food Regulations have made detailed inquiries in certain instances in regard to local methods of administration of the Sale of Food and Drugs Acts. Special visits for this purpose have also been made to other districts where inquiry appeared to be specially called for. In the course of these inquiries it was found that in some instances the public analyst had made a report to his local authority on some special investigation which had been undertaken in the district respecting a particular article of food, but that copies of such report had not always reached the Board. During an inquiry in the county of Cheshire Dr. Coutts ascertained that the county analyst had made valuable reports in regard to butter and Cheshire cheese of which the Board were unaware. Reports of this nature are of much interest to this sub‐department, and it would be of advantage if local authorities would send to the Board copies of all special reports made by the public analyst.