Vulnerable Adults: Policy Considerations - Essay Example

 Vulnerable Adults: Policy Considerations As a prerequisite for establishing policy in the protection of vulnerable adults, a standard definition of what constitutes a vulnerable adult must first be determined. In addition, there must be a standard method of identifying abuses and a system to keep track of abusers. Several groups and organizations throughout the United Kingdom have been formed specifically to protect vulnerable adults from abuse. The Royal Pharmaceutical Society of Great Britain (Guidance) defines a “vulnerable adult” as being over 18 years of age in need of community care by reasons of mental health or other disability, age or illness, unable to care for self or protect against significant harm or exploitation (qtd. in “Who Decides—Lord Chancellors Department” (1997)). In an abusive relationship, disability or age alone does not signify vulnerability. The important factor is inability to follow a daily routine of self-care. The homeless as well as substance abusers are also considered vulnerable (Guidance). This also applies to in-home settings where a vulnerable adult needs care but is not always factored in as needing protection. In the Warrington District, the definition is more generalised—someone with a mental or physical disability who needs support from an agency, relative or friend on a day-to-day basis (Adult Protection in Warrington, Sec. 2). No age limitation is listed and access to support here is more specific. Various districts have policies in effect to protect vulnerable adults, and the overall definition of a vulnerable adult is similar in each district (Adult Protection in Warrington; Clarke; Fillary; Getting a Community Care Service; Protection). Several new policies have been put into place recently through different agencies. Even so, no standardised definition yet exists. The main result of the government’s effort to set a standard—Protection of Vulnerable Adults (POVA)—has been to create a registry of barred abusers who fit specific criteria. Once the list is in place, employers must check before hiring workers involved with children and vulnerable adults. Types of Abuse Before an individual is put on a barred list, it must be determined that the person is an abuser. It is one thing to accuse someone of abusing a vulnerable person; it is quite another to prove the abuse. There are five recognised types of abuse: Sexual – forcing a person to take part in any sexual activity without his or her consent. Physical – hitting, slapping, burning, pushing, restraining, giving too much medication, or giving wrong medication. Psychological – shouting, swearing, frightening, blaming, ignoring or humiliating a person. Financial – illegal or unauthorized use of a person’s property, money, pension book or other valuables. Neglect – when a person is deprived of food, heat, clothing or comfort, essential medication. Some sort of relationship (familial, care provider) and some expectation of trust between the suspect and the vulnerable adult is necessary. A multi-agency response is expected and a record kept of allegations within the definition of abuse. However, one area not included in the list of recognised abuses is “discrimination” although each of the different types of abuse might be brought about by discrimination. According to the Metropolitan Police Service, the Community Safety Unit will have ultimate responsibility for investigations (Vulnerable Adult Abuse, Sec. 5; Bid to Protect; Guidance). POVA Scheme The Protection of Vulnerable Adults (POVA) scheme was activated by the ministers in 2004 and created a register specifically to list abusers of vulnerable adults. Its purpose was to prevent care workers from abusing people such as the elderly and mentally ill. Care-home owners and care agencies were required to check the list when hiring carers. This scheme, being run by the Department of Education and Skills on behalf of the National Health Service did not, however, apply to staff working in the NHS or day care which created a concern that vulnerable adults in a home setting might not be protected. A “quick check” known as POVA First check, can be done within a few days in a case where patients might be at risk while waiting for a full check. If this option is chosen and the check is negative, employees can start work pending final results (Bid to protect: “Fast Track”). Abuses not acknowledged in this scheme are psychological, discriminatory and institutional, but they are listed in some district guidelines (Protection: “Types and Examples of Abuse”). A year after the scheme was put into place, a Public Health News story indicated that over 700 people had been barred from working with vulnerable adults although only 155 were permanently barred. The statistics listed in the article showed that over a third of referrals concerned male workers involved in abuse despite forming only 5-15% of workforce and a vast majority were front line workers, care assistants and support workers with 8% of these registered nurses. The top reasons were neglect and physical abuse in residential settings and financial abuse in domiciliary care, and police involvement in 40% of referrals with 7 convictions. Researchers concluded that there is a need for wider examination on quality of social care employment practice, ethnicity of staff and more guidance about roles of adult protection teams (Guidance, paras. 1-16). Criminal Records Bureau (CRB) The CRB is an executive agency of the Home Office which vets applications for people who want to work with children and vulnerable people. It has recently launched an on-line Umbrella Body database that offers details of over 1700 registered organizations offering an Umbrella service for non-registered organisations which might need access to CRB checks (Criminal Records, par. 1). The search facility has been enhanced to best meet the needs of customers wishing to find a specific Umbrella Body. The Umbrella Body Guidance publication available on the site describes the importance of Umbrella Bodies to provide access to CRB checks for those organisations which for one reason or another are not able to register directly with the CRB, for instance: Lack the necessary administration source Require a small number of checks per annum Do not wish to pay CRB registration fee Cannot meet minimum requirements for registration Need assistance to comply with Code of Practice Need help with interpretation ` (CRB Related Docs, par. 2.2) SCIE Guide 2006 It is noted that the updated practice guide “relates specifically to the process involved in making referrals to the POVA list. It does not cover procedures relating to checks against the POVA list, the Criminal Records Bureau (CRB) or List 99” (Practice Guide 7, Sec. 5, par. 2). Existing legislation and related guidance are available at the Department of Health Web site. In addition to a detailed overview on the site, information is updated on a daily basis. Timeline The DH Web site relating to vulnerable adults offers a list of areas in which protection of vulnerable adults has been updated or instituted. Because of all the links and sub-links involved, a timeline has been created below to show the chronological development of the POVA scheme. As part of the timeline, various communities who have made suggestions for change are noted: Department of Health Timeline Protection of Vulnerable Adults October 2001 “No Secrets” and “In Safe Hands” originally set up for children and used to create prerequisites for protection of vulnerable adults. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/POVA/fs/en July 2004 Protection of Vulnerable Adults (POVA) scheme by SCIE and Department of Health – abusers will be placed on a register. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/POVA/fs/en 2004 Community guidelines – Bath & North East Somerset develop an on-line Inter Agency Vulnerable Adults Policy and Procedure based on POVA. http://www.bathnes.gov.uk/BathNES/socialandhousingservices/adultservices/protectingvulnerableadultsfromabuse/ProtectionforVulnerableAdults-InterAgencyProcedure.htm October 2004 SITRA bulletin – “Protecting Vulnerable Adults”- notes that scheme needs a more consistent approach and ways to develop a standard. http://www.sitra.org.uk/index.php?id=716 July 2005 Health Select Committee appointed by House of Commons to examine expenditure, administration and policy of Department of Health. http://www.parliament.uk/parliamentary_committees/health_committee.cfm July 2005 POVA Referrals – the first 100 referrals http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/POVA/fs/en July 2005 BBC Public Health News – POVA scheme, one year old – 155 permanently barred from working with vulnerable adults – Wider examination needed. http://news.bbc.co.uk/2/hi/health/3920977.stm August 2005 Royal Pharmaceutical Society of Great Britain “Guidance on Protection of Vulnerable Adults” – states there is no specific legislation which directly protects vulnerable adults. http://www.rpsgb.org.uk/pdfs/vulnadultsprotectguid.pdf November 2005, Bichard vetting and barring scheme based on inquiry report – New procedures needed for vulnerable adults. http://www.everychildmatters.gov.uk/vettingandbarring/ 2006 Community guidelines – Warrington Bureau Council develops a Web site to offer protection for vulnerable adults without initial intervention of Social Services or Police. http://www.warrington.gov.uk/social/adult_protection.asp January 2006 Community guidelines – Essex Vulnerable Adults Protection Committee (EVAPC) offers common guidelines over multiple agencies – Essex agencies, social services, police, NCSC and health agencies. http://www.essexcc.gov.uk/vip8/ecc/ECCWebsite/dis/faq.jsp?channelOid=15176&guideOid=20056&oid=20070 February 2006 Community guidelines – The London Borough of Merton lists types and examples of abuse against vulnerable people. http://www.merton.gov.uk/living/care/adultservices/vulnerable.htm March 2006, modified April 2006, updated 2 August 2006 A new vetting and barring scheme published. It is called the Safeguarding Vulnerable Groups bill for a central vetting process in an effort to resolve complaints about the POVA scheme. http://www.everychildmatters.gov.uk/vettingandbarring/ April 2006, updated September 2006 The Criminal Records Bureau launches its new on-line Umbrella Body database for use of non-registered organisations which might need access to CRB checks. http://www.crb.gov.uk/Default.aspx?page=3339 May 2006 Department of Health update with overview of POVA and implementation flow chart. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/SocialCare/POVA/fs/en June 2006 The Action for Elder Abuse is a charity covering England, Ireland, Scotland and Wales. New Web site developed to protect and prevent abuse of vulnerable older adults. http://www.elderabuse.org.uk/ September 2006 Community guidelines. Worcestershire County Council considers abuse of older people a multi-agency responsibility and discusses future strategy and planning. http://www.worcestershire.gov.uk/home/wcc-social-aop-abuseormistreatment September 2006 Community guidelines. Wakefield District offers an up-to-date Web site with information on how to handle a suspicion that a vulnerable adult is being abused. http://www.wakefield.gov.uk/HealthAndSocialCare/AdultsAndOlderPeople/AdultProtection/default.htm Safeguarding Vulnerable Groups Bill The government followed the recommendation of the Bichard Inquiry Report to plan a new vetting and barring scheme for people whose jobs bring them into contact with children and vulnerable adults. The following factors were identified as systemic failure requiring a new legislative framework: Inconsistent decisions were being made by employers on the basis of CRB disclosure information. CRB disclosure information is only valid on the day of issue There are inconsistencies between List 99, the POCA list and POVA list The current barring system is reactive to harmful behaviour rather than preventative There are inconsistencies in police disclosure of information between police authorities (Safeguarding . . . Bill, par. 5) The new scheme, called the Safeguarding Vulnerable Groups bill (2006) provides for a central vetting process built on the Criminal Records Bureau (CRB) and will go into effect in 2007. Key features include the development of a single list replacing List 99, POCA and POVA. For the first time, an on-line check will include those employed privately (nannies, music teachers, care workers) and those who have frequent access to education and health records. Where evidence suggests someone presents a risk to children or vulnerable adults, an independent statutory board will take decisions on whether to include that person on the barred list. Benefits covering a broader base and making an effort to address criticisms are as follows: New system consolidates relevant information Transfer of barring decisions from ministers to new Board Enabling parents to check barred list Secure on-line access for employers to make an instant check rather than the current paper-based process Continuous updating of barring decisions and notification process Employers will be penalised if they employ someone on the barred list to work with children or vulnerable adults or if they employ someone who has not been through the central vetting process. Penalties will be up to five years in prison and ₤5,000 fine. Employees who apply for work with children or vulnerable adults when they are barred from doing so or apply for work with children or vulnerable adults if they are not subject to monitoring will receive the same penalties. Police and local authorities will provide CRB with relevant information and offer expertise to the independent panel (Safeguarding, Secs. 1-7). New Policies for Social Workers In an effort to increase support for vulnerable adults, social workers will be more carefully screened and must meet a much higher standard of dependability as noted below: The Government is determined that vulnerable adults should be afforded the greatest protection possible from harm. In addition to raising standards of care through National Service Frameworks, regulating providers of care in a more thorough and consistent way than hitherto, and introducing national minimum standards for regulated care services, the Government has taken action to specifically address the abuse of vulnerable adults (Vulnerable Adults, par. 1). A generalised and useful Web site for the benefit of anyone in Social Care is called communitycare.co.uk. In answer to a recent survey, Gordon Carson noted that many councils have gone ahead with threats to tighten access to care for older people’s services as they fight funding shortfalls. With new schemes promising more support for vulnerable adults, the restrictions for eligibility criteria contradict the government’s efforts. For social workers trying to cope with additional demands and less support in their particular district, the new vetting and barring scheme takes on more importance for them. Social workers often have a large case load and increased responsibility for users and carers at all levels, including vulnerable adults. The British Association of Social Workers offers comments on the Safeguarding Vulnerable Groups Bill. They basically agree with the overall bill, for instance, creation of a consolidated list of barred individuals, the secure on-line access to an instant check and transferring decision making from the ministers to an Independent Barring Board (IBB), but question some other aspects of the bill: Is there a need for two lists—one for children and one for vulnerable adults? It seems probable that someone presenting a risk for one group would also present a risk for the other. In some instances, parents or other direct payment recipients might not want to carry out checks because a prospective carer is a relative or close friend. However, it may be that the person has a significant history which the parent might not be aware of or not wish to acknowledge. In this respect, a single provision is being presented in two different lights. To the local authority, it is a safeguard; to the direct payment recipient, it is an unnecessary bureaucracy. There is confusion about referring matters to the IBB. Duties to refer matters should be in the same place and are not. There is also confusion about who pays for monitoring and who is subject to monitoring. Should a referral to the IBB be made when risk of harm is probable or when it is just possible? Discrimination Against Vulnerable Adults In regard to abuse of disabled people, the question arises whether the abuse is due to an individual vulnerability or a consequence of social attitudes toward the disabled. Anti-discriminatory practices are not always acknowledged in considering abuse of vulnerable adults but this is an area that needs further discussion and study. With the infusion of refugees into the United Kingdom, discriminatory abuse becomes more a possibility, especially when the carer is ignorant about cultural beliefs as they relate to a vulnerable adult. Under the Practice Guidance for Social Workers, in the case of “forced marriages” where a marriage without personal consent is forced upon a family member to preserve cultural beliefs or religious traditions, the family member can be considered a vulnerable adult if over 18 (“Introduction”). Disabled people over 18 are automatically ‘vulnerable adults’ (40). Organisational Considerations Abuse of vulnerable adults can be reported to various services, for instance, to a primary care organisation, NHS Trust, Health Board or Social Services Authority (Guidance). According to the General Medical Council, one specific area where vulnerable adults might be discriminated against is in the medical research field. Excluding vulnerable adults from treatment in this field could be a form of discrimination; however, if they do receive treatment, consent by vulnerable adults must be carefully considered to be sure the consent is understood by them. At the time the General Medical Council developed their scheme on research, there was no legislation in England, Wales and Northern Ireland setting out the circumstances in which research involving adults with mental incapacity might be undertaken (Research, Sec. 47). The Internet has become an important source of information regarding vulnerable adults in general and offers specific information for various districts. Vulnerable adults can be identified in several areas: care homes, care agencies, estates, hospitals, clinics and among the homeless. The government has utilised the Internet to create a Web site that offers updated information based on previous schemes and new guidances regarding vulnerable adults, and districts throughout the United Kingdom have created their own Web sites for the benefit of the public to help them report abuse of vulnerable adults. Information technology has become a necessity in the 21st century. The problem that might arise from its use is that there is too much information available, creating the need to narrow any field of research to a common field. The Timeline in this paper is an effort to do that and to offer guidance to anyone wishing to research vulnerable adults. Some of the specific types of assistance offered in various chosen districts are as follows: 1. Bath & North East Somerset – Lists relevant agencies, roles and responsibilities with inter-agency procedure standards. 2. London Borough of Merton – Offers links to different kinds of abuse against relevant people. 3. Essex – Development of effective co-operative public and voluntary services and other organisations; common guidelines over multiple agencies. 4. Warrington – Better protection without initial intervention of Social Services or Police; offers referrals and useful contacts. 5. Worcestershire – Offers management response strategy/planning and considers the problem concerning vulnerable adults a multi-agency responsibility. 6. Wakefield – Offers 24-hour phone service to Social Care Direct; financial advice; newsletter for professionals and policy regarding discrimination, one of the few districts addressing this. Conclusion It is apparent that the problems faced by vulnerable adults cannot be resolved by one agency. The on-line sites of Councils in various districts all show the need for multi-agency intervention. The National Health Service offers an up-to-date on-line system for educating the public about vulnerable adults, but there seems to be no immediate way to find information on a specific problem with a variety of policies listed. It should be noted that it is one thing to accuse someone of abuse of a vulnerable adult and far more difficult to prove the abuse. A single, uniform definition of what a vulnerable adult is needs updating. The general definition at present depends on one created in 1997. Main abuses needing further study are psychological, discriminatory and institutional. Works Cited Action on Elder Abuse. 15 June 2006. 19 September 2006. http://www.elderabuse.org.uk/ Adult Protection. Updated 19 September 2006. Wakefield District/NHS. 19 September 2006. http://www.wakefield.gov.uk/HealthAndSocialCare/AdultsAndOlderPeople/AdultProtection/default.htm Adult Protection in Warrington. Web site 2006. Warrington Bureau Council. 19 September 2006. http://www.warrington.gov.uk/social/adult_protection.asp Bid to protect vulnerable adults. 25 July 2004. BBC News. (1) 18 September 2006. http://news.bbc.co.uk/2/hi/health/3920977.stm Carson, Gordon. 22 September 2006. The tightening of eligibility criteria – special report. 24 September 2006. http://www.communitycare.co.uk/Articles/2006/09/22/55762/The+tightening+of+eligibility+criteria+-+special+report.html?key=NO%20SEARCH%20TERM%20SPECIFIED Clarke, Eddie. 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Essex Vulnerable Adults Protection Committee (EVAPC). 20 January 2006. http://www.essexcc.gov.uk/vip8/ecc/ECCWebsite/dis/faq.jsp?channelOid=15176&guideOid=20056&oid=20070 Guidance on the Protection of Vulnerable Adults. 18 August 2005. Royal Pharmaceutical Society of Great Britain 18 September 2006. http://www.rpsgb.org.uk/pdfs/vulnadultsprotectguid.pdf Over 700 People Barred From Working With Vulnerable Adults, UK. 28 July 2005. UK Department of Health. 18 September 2006. http://www.medicalnewstoday.com/medicalnews.php?newsid=28224 Practice Guidance for Social Workers. Last updated 12 July 2005. Young people and vulnerable adults facing forced marriage. 24 September 2006. http://www.adss.org.uk/publications/guidance/marriage.pdf Practice Guide 7. 2006 May. Making Referrals to the POVA list. 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