Related to: Ill Health and Disability, Mental Health and Illness, Domestic Abuse, Homelessness, Substance Misuse

Key Facts

  • Adult safeguarding referalls continue to increase to 684 p.a. in 13/14, crude rates suggest that this is higher than regional rates, but lower than national. B&NES has a higher number of residential care staff identified as the alleged abuser than regional and national averages
  • Safeguarding activity can be signficantly affected by external events. For example, there was an increase in activity relating to people with learning disabilities following the Winterborne View case.
  • 80% of local respondents to a users survey felt that local services made them feel safe and secure.

Definition

Safeguarding adults is the multi-agency work done do to minimise and manage risk to adults who may be vulnerable. 1

Who is a vulnerable adult? 2

A vulnerable adult is:

  • a person aged 18 or over
  • someone who is, or may be in need of community care services due to mental health issues or other disability, age or illness.
  • a person who is, or may be unable to take care of themselves or unable to protect themselves against harm, exploitation or abuse.
  • Harm, exploitation and abuse 3

Harm and exploitation is defined by the Law Commission as including but not limited to:

  • ill treatment (including sexual abuse, exploitation and forms of ill treatment which are not physical);
  • the impairment of health (physical or mental) or development (physical, intellectual, emotional, social or behavioural);
  • self-harm and neglect; or
  • unlawful conduct which adversely affects property, rights or interests (for example, financial abuse). 4

Abuse is the violation of an individual’s human or civil rights by any other person or persons. 5

Abuse may be behaviour that is intended, or caused by lack of training and ignorance.

Abuse can happen anywhere, in someone’s own home, in a public place, in a care home, in community care or in a hospital.

Abusers or ‘perpetrators’ are often already known by the adult at risk. Perpetrators can be people such as a professional worker, another service user, a relative, a friend, a group or an organisation.

What does the data say? 6

Referrals 7

In February 2014 the NHS Information Centre (NHSIC) published Abuse of Vulnerable Adults in England 2012-13: Final Report, Experimental Statistics. 8

The NHSIC report states 176,000 safeguarding alerts were reported by 132 councils nationally during 2012-13. This has increased by 20% since 2011/12. 78% of councils that submitted data to the information centre reported an increase in alerts during the period.

61% of referrals were for women and 62 % for adults aged 65 and over. 51% were for adults with a physical disability. Physical abuse and neglect were the most common types of abuse reported in referrals, accounting for 28% and 27% respectively of all allegations. Alleged abuse was more likely to occur in the vulnerable adults own home (39% of all locations) or a care home (36%).

The most commonly reported source of harm was social care workers (32% of allegations) or a family member and of the 87,000 completed referrals, 43% of cases were either substantiated or partially substantiated.

Bath and North East Somerset received 684 new alerts during 2013/14 and supported 86 service users through the safeguarding procedure who had been referred during the previous year. At the end of March 2014, 106 cases remained open and 664 had been closed. The increase in alerts received from 2012-13 to 2013-14 was 31%, again the same as last year.

Overall from 2005/06 – 2013/14 there has been a substantial increase from under 50 alerts to over 680 alerts (>1500% increase). The increase from 2005/06 – 2008/09 was 315%, from 41 referrals to 170, and from 2008/09 – 20011/12 there was a 135% increase from 41 referrals to 400. From 2011-12 to 2013-14, the increase has been 71%.

Figure 1: Number of Safeguarding Referrals 2005-14 9

In B&NES, 57% of reported alerts met the safeguarding threshold and instigated a  referral, compared to 50% nationally (for the 132 councils who provided data).

Information from the census would indicate that Bath and North East Somerset referrals are approximately 177 per 100,000 (note this is not a standardised figure and not directly comparable) suggesting that it is higher than in the South West as a whole, but that it remains low in comparison to the rest of the UK. This is an improvement on the position from previous years. The South West, alongside Yorkshire and the Humber have the lowest numbesr of referrals per 100,000 population nationally.

27 Service users in B&NES had more than one referral for safeguarding (alerts that met the threshold and are known as repeats). In comparison, B&NES appears in the middle of it's comparator group for repeat referrals and below the England average.

Gender and age of referrals 10

The age breakdown by gender is similar to previous years though there is a decrease this year on the number of younger (18-64 years) adults’ referrals and an increase in 65+ age; this is more consistent with the national picture with 62% of referrals being for those 65+ years. The percentage of females to males has slightly reduced but replicates the national picture which shows the number of female referrals is 61% and the number of males is 39%. Although the above reports on alerts rather than referrals the figures as expected are broadly similar. (HSCIC 2014, p16)

Table 1: B&NES safeguarding alerts by gender and age

Ethnicity of referrals 11

For 2013-14 of the people that disclosed their ethnicity (8% either refused or didn’t declare it) 3% were non White. This is a reduction from last year and further focussed work is needed to ensure all groups are reached. The HSCIC reported that 6% of all referrals were for vulnerable adults were from non White groups (p21).

Additional work was undertaken to raise awareness amongst black and ethnic minority groups during 2010-2011.

Referrals by service user groups 12

Table 2: Number of alerts by service user group 2011-2014

% are rounded to the nearest whole

Table 2 shows the break down by service user group for 2011-12, 2012-13 and 2013-14. It shows that the proportion of alerts for each service user group has remained relatively consistent with last year, with adults with a physical disability receiving the most alerts and adults with a learning disability receiving more alerts than for adults with a mental illness. The national report also indicates that adults with a physical disability receive the most referrals at 51%; however nationally adults with a mental illness receive the second highest number of referrals. (HSCIC 2014, p16)

Last year saw a 48% increase in the number of mental health alerts from the previous year; this year that increase has reduced to 16%. However percentage increase for people with a physical disability has increased by 6% on the last reporting period.

56% of the referrals for safeguarding adults were for service users known to the Council. This is below the national the average of 66%. B&NES has a higher than average number of self funders who are not known to services. This is a notable increase from the figure in 2011-12 of 47%.

Nature of abuse at referral stage 13

Table 3: Percentage of referrals by abuse types

In comparison to national figures the percentage split of abuse type is broadly similar though locally neglect and acts of omission have increased for 2013-14 in comparison to 2012-13 and institutional abuse has reduced and is lower than the national percentage. This is thought to be as a result of increased awareness, large scale investigations that have been carried out and contract monitoring and governance. 

The continued increase in neglect referrals is thought to be down to the impact of Winterbourne View, Ash House and the Mid Staffs with people being much more aware.

B&NES saw an increase on last year on the number of alerts that are alleged to have taken place in the service user’s own home 42%, this figure is more in line with previous years with the national statistic being 39% for 2012-13. The percentages of cases that are alleged to have taken place in care homes (residential and nursing both permanent and temporary placements included) is very similar 39% rather than 38% for last year. The national picture reports 36%. (HSCIC 2014, p38).

Relationship of victim with alleged perpetrator at referral 14

The relationship between the alleged perpetrator and the vulnerable adult is set out in the table below. The percentage split is different in many cases to those reported last year and to the HSCIC figures, with the exception of the other professional section, which is similar. Of note is the significant increase in other family members being the alleged perpetrator and strangers.

Table 4: Relationship between alleged perpetrator and vulnerable adult

What does the community say? 15

The Council undertook its annual Social Care Survey which it reports to the Department of Health. The survey looks at many areas however domain 4 asks people to consider how safe they feel. The figures below set out the responses:

Table 5: ASCOF indicator survey

Those respondents who have stated they do not feel safe are contacted to see if they need any additional help or review of their situation. An improving picture is being reported for 2013-14. The questions do not relate directly to someone being supported through the safeguarding procedure; however the Department of Health are looking at a measure to put in place to collect this.

Are we meeting the needs? 16

The national government has increased its focus on the safeguarding of vulnerable adults. The Department of Health and Home Office’s guidance document No Secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse published in March 2000 continues to provide the framework for multi-agency working to safeguard adults at risk.

In May 2011 the Coalition Government set out a Statement Of Government Policy On Adult Safeguarding this document builds on No Secrets, which will remain as statutory guidance until at least 2013.

This Statement Of Government Policy On Adult Safeguarding (May 2011) sets out the Government intention to make the Safeguarding Adults Boards statutory. It also sets down six principles to govern the actions of adult safeguarding boards:

  • Empowerment – taking a person-centred approach, whereby users feel involved and informed
  • Protection – delivering support to victims to allow them to take action
  • Prevention – responding quickly to suspected cases
  • Proportionality – ensuring outcomes are appropriate for the individual
  • Partnership – information is shared appropriately and the individual is involved
  • Accountability – all agencies have a clear role

The BBC has also brought the issue of adults at risk of abuse to the attention of the wider community’s through the airing of the Panorama documentary in May 2011 Undercover Care: The Abuse Exposed, which exposed physical, psychological and institutional abuse and neglect at Winterbourne View Hospital ran by Castlebeck, a large national health and social care provider.

The programme resulted in:

  • A criminal investigation being undertaken by Avon and Somerset Police Constabulary
  • Gloucestershire Council undertaking a Serious Case Review
  • Care Quality Commission (CQC) initiating an investigation
  • The Strategic Health Authority (SHA) requesting reviews and assurance of commissioning arrangements
  • Department of Health launching a review into the events.
  • The Association of Directors of Adult Social Services (ADASS) producing a guidance note for Local Authorities and Safeguarding Adults Boards.

The Law Commission published a report on proposed changes to adult social care in May 2011 in Law Commission No. 326 Adult Social Care. It made seven safeguarding recommendations.

Bath and North East Somerset 17

Some of the types of actions taken by adult safeguarding to support victims of abuse are:

  • referral to Multi Agency Risk Assessment Conference (MARAC)
  • increased monitoring;
  • civil action;
  • removed from property;
  • referral to court

Avon and Somerset Police are reported to have been involved in 38% of cases that had completed the data field. However there were 345 cases where the field has not been completed. It is unlikely that the Police would be involved in cases that did not progress to Strategy – taking this into account it is possible that even with the blank fields they were involved in at least 34% of cases.

Table 6: HSCIC average outcomes 2012-13 compared to B&NES 2012-13 and 2013-14

For cases where the alleged perpetrator was a professional worker, 25% were substantiated; where ‘other family members’ were identified as the alleged perpetrator, 21% were substantiated; where a neighbour / friend was the alleged abuser, 38% were substantiated. In cases where another vulnerable adult was the alleged abuser 5% were substantiated.

Some of the types of actions taken by adult safeguarding in terms of the perpetrator of abuse are:

  • criminal prosecution/formal caution
  • community care assessment;
  • removal from the property or service;
  • referral to Protection of Vulnerable Adults list/Independent Safeguarding Authority;
  • disciplinary action;
  • continued monitoring;
  • exoneration

The following outcomes have been recorded for victims: increased monitoring; no further action; referral for community care assessment and/or other social care and health services; referral to MARAC; civil action; removed from property; referral to court and so on. More than one action is sometimes undertaken for service users.

Each Local Safeguarding Adult Board partner organisation has provided information outlining the specific safeguarding adults actions they have undertaken in 2013-14. The partner organisations are:

  • Royal United Hospital
  • Avon & Somerset Probation Trust (ASPT)
  • Avon and Somerset Constabulary
  • Freeways
  • Avon Fire & Rescue Service
  • Carer’s Centre Bath & North East Somerset
  • Bath & North East Somerset People First
  • Avon and Wiltshire Mental Health Partnership Trust (AWP)
  • Sirona Care and Health
  • Royal National Hospital for Rheumatic Disease
  • Curo (formerly Somer Community Housing Trust)

This information about specific safeguarding adults actions of these organisations can be found in the Local Safeguarding Adult Board annual report.

Current referrals may only be a small proportion of the adults who are being mistreated in our communities. There is a continuing commitment in B&NES to improve reporting and awareness through an on-going programme of training and awareness days and this approach is likely to increase the number of referrals.

Bath and North East Somerset Council and the Local Safeguarding Adult Board has received commentary and updates relating to Winterbourne View at each of its meetings during this period.

The Local Safeguarding Adult Board has reasonability for:

  • Developing and monitoring the effectiveness and quality of safeguarding practice.
  • Involving service users in the development of safeguarding arrangements
  • Ensuring service user and carers are involved in all aspects of safeguarding planning.
  • Communicating to all stakeholders that safeguarding is ‘everybody’s business’
  • Providing strategic leadership.

More information about the Local Safeguarding Adult Board and its sub groups are available on the council’s website.

What can we realistically change? 18

The Local Safeguarding Adult Board have set out the strategic goals they will focus on during 2012 – 2015. The goals are:

  • Strengthen arrangements to ensure the prevention of abuse is given greater focus and includes a particular emphasis on service users and citizen awareness.
  • Ensure the voice of the service user is heard; that service users are treated with dignity and respect; that they have choice and control and are empowered during the safeguarding procedure and supported appropriately to take informed risks. Ensuring responses are personalised
  • Improve the accessibility of services and information provided regarding adult protection.
  • Improve the safeguarding system through learning, sharing and disseminating best practices.