Evolving care for vulnerable adults
Published 5 June 2015
The subject of safeguarding both children and vulnerable adults has been moving up the NHS agenda in recent years. Scandals such as the neglect of patients at Mid Staffordshire Hospital have shown it is very much a matter for hospitals as well as the social care sector.
Adult safeguarding has perhaps been the poor relation to children’s safeguarding in terms of clear legal frameworks governing activity and investigations. However, the Care Act 2014, which came into force in April, now puts much of what many providers are already doing onto a statutory footing, says Corinne Slingo, Partner and Head of Healthcare Regulatory at DAC Beachcroft.
“There has been a statutory framework for children’s safeguarding investigations and responsibilities for many years, but adult safeguarding has been a bit ad hoc. It has evolved in terms of how it is recognised at operational level and how it is investigated. It’s been an evolution, but not necessarily a structured evolution,” she says.
One element of the Care Act, which will have an impact on the health service, is a power enabling local authorities to make a broad range of enquiries, or ensure others do so, if they believe an adult is subject to or at risk of abuse or neglect. However, a lack of resources means that local authorities will probably be unable to go on these ‘fishing trips’, but the act will lead to an increased flow of information between hospitals, clinical commissioning groups and local authorities, where concerns around safeguarding for vulnerable adults arise. This is clearly a positive move in the vast majority of cases.
From the top
Mala Karasu, Head of Safeguarding Adults at Guy’s and St Thomas’ NHS Trust, leads a large hospital safeguarding team of nine that supports staff and patients across two hospital sites and adult community services in Lambeth and Southwark. The Trust’s focus on safeguarding comes from the top, with Guy’s and St Thomas’ Chief Nurse, Dame Eileen Sills, being the executive lead for adult safeguarding across the Trust.
Karasu says that there has to be someone at every hospital whose sole focus is safeguarding. “In some hospitals safeguarding can be added on to someone’s role, but you cannot effectively set up a system of training and raising awareness if you’re involved in other things. Adult safeguarding is quite a wide remit and every organisation has to have dedicated staff to make sure patients’ rights are upheld."
But making sure all staff are aware of the issue is a challenge, says Karasu. “At the moment 90% of our staff have done level two safeguarding training, which is quite an achievement. We want to ensure that it remains at that level,” she says.
Gary Fitzgerald, Chief Executive of the charity Action on Elder Abuse, believes that safeguarding teams are a demonstration of commitment from a Trust, but he adds: “The trouble is a lot of safeguarding tends to happen after the event. What we need to focus on is how we prevent abuse from happening in the first place. What we have to get a grip on is the culture that allows it to take place and how that culture is created. Work with older people in hospital doesn’t carry the same status as work with children,” he says.
A statutory framework may help ensure adult safeguarding receives more attention.
Slingo agrees that children’s safeguarding is in some ways more advanced than adults. She says the process of serious case reviews carried out when something goes wrong in children’s services could improve learning in adult safeguarding. She advised on the inquiry carried out by Kate Lampard into the abuse of patients by Jimmy Savile. The report looked at Savile’s unfettered access and warned that Trusts, which frequently engage volunteers and increasingly celebrities, needed to make sure these people were monitored.
“The Lampard report has enormous value for those who suffered at the hands of Savile, but a lot of the learning points that came out of the report have already been addressed. Because the awareness of safeguarding has generally been raised over the past five to ten years, everyone is a lot more astute and mindful of the risks.
“I would anticipate most of what he was allowed to do, and patients he was allowed access to, would not be permitted in modern times, and we must all work to make that so,” she says.