Write an account:
Analyse the differences between the concept of safeguarding and the concept of protection in relation to vulnerable adults. Evaluate the impact of policy developments on approaches to safeguarding vulnerable adults in own service setting. Explain the legislative framework for safeguarding vulnerable adults. Evaluate how serious case reviews or inquiries have influenced quality assurance, regulation and inspection relating to the safeguarding of vulnerable adults
514/P1 1.1, 1.2, 1.3, 1.4 suggested word count 600-700 words
In order to explore this area fully an understanding of the legislative framework and government initiatives is needed:
.Human Rights Act (1998) (adopted by the UK in October 2000): This describes individuals’ rights to live free from abuse and violence or torture. It is considered a benchmark against which services can assess how they uphold individual rights.
.Care Standards Act (2000): This led to the National Minimum Standards and means of measuring care service quality.
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.’No Secrets’ (2000): This gives guidance created as a result of serious incidents leading to abuse and also the need to ensure compliance with the Human Rights Act. This was a big step forward in relation to adult protection.
.’Valuing People’ (2001): This relates specifically to those with learning disabilities with the key values of civil rights, independence, choice and inclusion. This White Paper is written from a human rights perspective and started the personalisation agenda.
.’Safeguarding Adults’ (2005): This built on ‘No Secrets’ and created a change in emphasis with the concept of protection geared towards those who lacked capacity (see also Mental Capacity Act 2005). It resulted in a move towards earlier intervention and prevention. The concept of safeguarding emerged, with individuals taking informed risks and exercising more choices rather than authorities ‘stepping in’ to take charge.
.Mental Capacity Act (MCA) (2005): This legal framework sets out five key principles to protect vulnerable adults unable to make their own decisions. Prosecutions have been made under Section 44 of this Act for ill-treatment and wilful neglect (Crown Prosecution Service 2009).
.’Safeguarding Vulnerable Groups’ (2006): This was a creation of a vetting/barring scheme.
.Fraud Act (2006): This created a new offence of ‘fraud by the abuse of position’. It includes the misuse of money by those appointed to manage it, such as by an Enduring Power of Attorney. Fraud was not well covered by Section 44 of the MCA.
.’Deprivation of Liberty Safeguards’ (2008): This details how those unable to consent to treatment due to a mental impairment should be supported in a way that does not limit their rights. This has led to a major shift in practice and a move away from professionals’ apparent arbitrary decision-making.
‘Health and Social Care Act (2008) (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009: This led to the creation of the CQC to regulate services using the Essential Standards of Quality and Safety, consisting of 28 regulations and a shift towards outcomes, i.e. what can be expected from the care providers. There are a number of outcomes specific to helping to safeguarding individuals.
.Law Commission Review of Adult Social Care (2011): This incorporates safeguarding recommendations and proposes a formal change in terminology from ‘vulnerable adult’ to ‘adult at risk”.
.Statement of Government Principles on Adult Safeguarding (2011): This lists six key principles of Empowerment, Protection, Prevention, Proportionality, Partnership and Accountability. Local multi-agency partnerships should support and encourage communities to find local solutions and further guidance is offered on how these principles could be translated into outcomes.
Perceptions of what abuse is have changed as human rights have become more entrenched in our society. Adult protection has been overshadowed by child protection, and as such has received less attention by government.
To conclude, whereas protection implies a domination of others to make decisions for an individual rather than with them, safeguarding accepts that individuals have the right to take risks so long as they have capacity and understand the implications or consequences of any choices. Simply put, the best way to safeguard adults at risk from abuse is to enable them to safeguard themselves. Policy and practice needs to change to reflect this.
The government’s policy objective is to prevent and reduce abuse from occurring while also supporting individuals to have control and make choices. The state aims to provide the vision and direction and for this to them be implemented on a local basis. Key policy developments have been as follows:
.Our Health, Our Care, Our Say (2006) and Putting People First (2007): The white paper ‘Our Health, Our Care, Our Say’ (2006) proposed ways of making adult social care more responsive to people’s needs, more cost effective and of a higher quality. This was then developed in the cross-government and social care sector agreement ‘Putting People First” 92007), which set out the direction for adult social care planned for at least the next ten years.’Putting People First – the whole story’ (2008) then identified four key areas (universal services, early interventions and prevention, choice and control, social capital) for councils and others to focus on to enable the delivery of personalised care.
.No Secrets/In Safe Hands (Wales): This guidance gave social services a key role in coordinating local policies and services to protect vulnerable individuals from abuse and led to more collaborative working – a multi-agency approach. This impacted on care services and informed policies and practices, such as the requirement for staff training in this area. Nine years later, the findings of Safeguarding Adults: Report on the Consultation on the Review of ‘No Secrets’ placed a new emphasis on prevention and on the empowerment of individuals to maintain their own safety (Department of Health, 2009). The consultation found that safeguarding can be experienced as ‘safety at the expense of other qualities of life, such as self determination and the right to family life”. The report highlighted the importance of achieving a balance between safeguarding and the independence associated with personalisation in adult social care.
.Vetting and Barring Scheme/ISA: This initially arose from the Soham murders and the subsequent Bichard Inquiry. It was set up to put in additional checks on all those working with vulnerable individuals and supplemented existing schemes. It created additional work and expense for services when employing staff. These has also been a lot of discussion and concern about how this scheme is over-bureaucratic and a deterrent, for example to doing voluntary work with vulnerable groups. The Protection of Freedoms Act 2012 received Royal Assent on 1 May 2012 to re-model this scheme and has been known as the Disclosure and Barring Service from December 2012.
.Local Safeguarding Adults Boards: These are multi-agency boards led by social services. They ensure local policies comply with national policies and best practice. They encompass social services, health, housing, police and Crown Prosecution Service (CPS), probation, emergency services and the voluntary sector. They aim to provide strategic leadership and promote key principles of prevention and protection. All areas have them. Complications can arise when working across different local authorities with their own policies and practices, for example in reporting protocols.
A key driver in how policies have developed over the years is the recognition of abuse happening, particularly within institutions, and the need for government to take action to address it.
In recent years there has been an increase in reported failings across different services, such as:
.the Francis report in 2010 which led to 18 recommendations as a result of exposing the horrific experiences of patients at Mid-Staffordshire NHS Foundation Trust.
.BBC Panorama in 2011 exposing: Winterbourne View, where the seriousness and level of abuse uncovered led to a Serious Case Review.
.The Homecare Association has expressed concerns following the Equality and Human Rights Commission (EHRC) report ‘Close to Home’ which examined the impact of the increase in personalisation on homecare for older people. The report highlights how councils are reducing the time commissioned, pushing down the prices paid to providers which is then having a negative impact on service quality. The EHRC states that ‘given the nature and pace of these changes it is important to make sure that the legislative, regulatory and quality control systems we have in place are able to keep up, and the elements in place make sure that human rights are fully protected’. They admit they doubt this is the case.
Sarah Pickup, incoming director of the Association of Directors of Adult Social Services (ADASS) said in Community Care on 20th April 2012 that home care providers should not bid for local authority contracts if they cannot provide quality care for the prices offered as the contract ‘would not have called for poor care’. However providers do not always feel they have this option when survival of the business is at stake.
Key themes emerging from inquiries and reports are:
.a lack of management skills and transparency.
.poor induction processes.
.inadequate training and supervision with poor practice remaining unchallenged.
In a time of efficiency savings and resource cuts the potential for failings in practice is more acute than ever without a proactive approach to guard against them. As a manager this is a vital part of your role.