Analysing the Safeguarding proposals

On 11 July 2012 the Government announced a range of measures relating to the reform of Adult Social Care and, included within the measures, there were a number of proposals on adult safeguarding. The Minister, Paul Burstow, has said that this is the first time that a draft Bill can be viewed and commented upon clause by clause alongside the explanatory text (http://careandsupportbill.dh.gov.uk/home/).

Lead agency and composition of Boards:

Much (but not all) of the new legislation is about infrastructure. Local Authorities are confirmed as the lead agency for coordinating adult safeguarding, with the roles of other agencies also recognised. Consequently, there will be a mandatory requirement for three statutory agencies to be members of a Safeguarding Board: the Local Authority, NHS (defined as a clinical commissioning group), and the police. The Boards can then decide who else they wish to invite as participants. There will be a duty on members to cooperate.

Some issues to consider:

It was expected that the three main agencies identified would be included and these requirements should, for the first time, ensure that there is guaranteed attendance and participation by them. Importantly, representatives must have the required skills and experience and must co-operate with each other.

·      There is some unhappiness that more organisations were not designated as mandatory participants (e.g. care providers, regulators, or local people and/or organisations). However, there is scope for Boards to make these decisions locally, which suggests there may be a need for local lobbying and pressure to ensure these do not become exclusively statutory and out of touch with the needs of victims and their families.

·      What appears completely missing from the Bill is any discussion or proposals around funding of the Boards or their Safeguarding activities. It is therefore hard not to conclude that the Government is simply ducking this issue. This issue however is crucial, and is driving the Association of Directors of Adult Social Services (ADASS) to concentrate on thresholds and ‘targeting’ as a means of reducing the number of people who could qualify for safeguarding support and intervention. Without a clear funding formula there is a real danger that Adult Safeguarding will have insufficient resources and will be exclusive rather than inclusive in nature.

It is noticeable that, when Welsh Ministers consulted on these matters earlier in the year, they commented, “The … arrangements we will make to strengthen the statutory duty to co-operate should help ensure that resources and capacity exist to support the work of the Boards. However, experience tells us that such things cannot be left to chance. I have therefore asked officials to advise me on proposals to change the law relating to contributions from partners. They asked the question, “What arrangements would ensure that … Boards are properly resourced?”

·      Currently, there is pressure to merge Adult Safeguarding Boards with Children’s Safeguarding Boards to make them a joint responsibility. Although there is a policy argument put forward in such cases, there is also an underlying financial one too, and there is some anxiety among Adult Safeguarding staff that this will lead to adult’s issues being overwhelmed by the children’s agenda. The obvious danger is that the two groups have very differing circumstances and options and it is difficult to see the advantages, other than the sharing of infrastructure costs. Perhaps a better model is the merging of Adult Safeguarding and Domestic Abuse services?

·      Will the establishment of Boards be sufficient to address the problems that older people and their families now face? Not by themselves. As we indicated in a previous comment on these matters, safeguarding includes more than just the local authority led teams. It includes the Care Quality Commission, the Independent Safeguarding Authority, the Office of the Public Guardian, and multiple other regulatory bodies such as the Nursing and Midwifery Council. In a wider sense, there are also the various Ombudsman’s bodies, such as the Local Government Ombudsman who can now investigate complaints by ‘self funders’ of social care. Unless an effective method is established to ensure coordination between how all these agencies think and act, we will almost certainly continue to experience people getting differing responses to the same issues, and being transferred from one agency to another.

Functions of Safeguarding Boards

Safeguarding Boards will have a high level of local discretion as to their focus and role, with a primary function being to protect adults from abuse or neglect by providing leadership, ownership and coordination of multiagency working at local level. They will be required to publish an annual strategic plan, and an annual report.

Some issues to consider:

·      This could be considered to be where political dogma comes up against safeguarding reality. It is ‘localism’ and Big Society concepts being imposed upon the protection of very vulnerable people. Can it work? Possibly, if there is genuine local ownership and accountability. Will it work? Local Authorities do not have a good track record of listening to, or responding to, the needs of their communities. In fact, a recent report suggested the UK is less democratic now than it has ever been – i.e. people are increasingly disinterested and more cynical about the whole political process.

It is hard to see how people will easily or quickly ‘buy into’ this model, not least all those older people and their families who have had services cut or withdrawn, and all those who fought hard to keep their local authority care homes open and who failed because there were other (financial) priorities in the minds of decision makers.

·      Additionally, a purely localist approach cannot address national issues that might arise, so a less extreme strategy might have been better. We have several times said to Department of Health (DH) Civil Servants that there would be a need to ensure that national issues (e.g. Winterbourne View on Learning Disabilities or the Health Services Ombudsmans report on Older People) need to be factored into this thinking to prevent a local Board from simply ignoring such national scandals, but they have ignored these concerns.

·      Will this approach be sufficient to address the problems that older people and their families now face?  If there was confidence that the Boards would develop their strategies in a manner that reflected the needs of local communities, and the experiences of victims and families, then it is possible. Current experience makes it difficult to have that confidence, and the lowering of political expectations by constituents makes it difficult to see how there will be immediate accountability for failings. Additionally, of course, most people’s perception of safeguarding is based on how the systems, procedures and processes work ‘on the ground’ and it is there that people’s experiences count. This suggests a need for close monitoring of safeguarding interaction, and quick responses to emerging concerns by victims or their families. Fundamentally, there will need to be pressure applied to local authorities (more than that anticipated by local accountability) if a localist safeguarding approach is to be possible.

Serious Case Reviews (by another name)

They will be required to commission ‘safeguarding adults reviews’ where an adult experiencing abuse or neglect dies, or there is reasonable cause for concern about how the Board, or one of its members, or someone else involved in the case had acted.

Some issues to consider:

·      Safeguarding Adults Reviews are ‘serious case reviews’ by another name. Why call them something different? Probably to break with current systems that are perceived to be overly bureaucratic, costly and time-consuming – probably with some justification. There seems to be an inevitability that people will make an ‘industry’ out of almost everything, and safeguarding is no exception.

·      Will this approach be sufficient to address the problems that older people and their families now face?  Probably, in the sense that there needs to be a process that considers deaths and other serious issues from the perspective of learning (to avoid if possible a repeat of errors). But these are not fora for holding people to account, which is often what families want, and this is often where other systems (e.g. regulators and the courts) fail. Which is why we need to consider safeguarding in its widest sense, and not just in relation to Boards.

 

How safeguarding will work on a day to day basis.

There will be a statutory duty on Local Authorities to inquire (or cause an inquiry) into allegations of abuse, although there will be no regulations defining the nature or detail of such inquiries. This will be left to professional judgement.

Some issues to consider:

·      Here’s the crux of the issue, because it is often the reality of safeguarding intervention that causes the most problems. Too often people find themselves powerless to act or get protection or justice from the very systems established to help them. Too often the outcome of safeguarding is either meaningless in terms of dealing with the problem (e.g. increased monitoring) or fails to utilize common sense, leaving people frustrated, angry or grieving. The reality ids that we do need ‘professional judgement’ because it would be impossible to establish a set of rules that covers every circumstances, but that professional judgement needs to be guided toward sensitivity, level headedness, fairness etc etc. And currently, it is not (at least not everywhere).

·      What that of course means is that it will be insufficient to say that professional judgement is sufficient guide, unless that judgement is based on good quality training, an understanding of the complexities (and the emotional impact) of abuse, and an ethical guide to what are positive outcomes. So, this proposal by itself will be insufficient.

·      Will this approach be sufficient to address the problems that older people and their families now face?  Not unless there is a significant investment in training, monitoring, listening to victims and their families, and then working with them. And it is difficult to see the advantage of approaching issues such as these on a localist basis.

Who should be the recipient of safeguarding?

To be the subject on an inquiry someone must need care or support (whether or not met by the local authority), be experiencing or be at risk of abuse or neglect, and be unable to protect themselves because of their care or support needs. There will be no definition of a ‘vulnerable adult’ or an ‘adult at risk’, but instead adult safeguarding will focus on abuse and neglect i.e. where adults in vulnerable situations are hurt because of the actions (or inactions) of others. This will not include self-harm, as the intention of safeguarding will be to address situations caused by the actions or inactions of others (but Safeguarding Boards may locally decide to include self-harm if they wish).

Some issues to consider:

·      It males sense to do away with attempts to define a ‘vulnerable adult’ We do not have a definition of a ‘domestic violence victim’, choosing instead to define the nature of domestic violence/abuse, and this allows us to address the realities of multiple situations instead of trying to make people fit into a particular definition box.

·      Self neglect is not a straightforward issue and we need to be cautious about automatically linking it to adult abuse, and this is equally true in terms of self-harm. At what point does self-neglect become the concern of anyone other than the 'neglectee'?  Should we not make a distinction between self-neglect resulting from lack of choice (e.g. insufficient pension income, physical inability or mental health problem) and self-neglect resulting from a chosen life style?  One justifies intervention and one does not. Equally, should we not make a distinction between self-harm that occurs as a consequence of previous life experiences, self-harm arising from a mental health problem, and self-harm cause through an addiction to drugs or alcohol? However, leaving these issues to local discretion seems to be more a matter of indecision at Governmental level rather than a logical step. Do we really want variance between local authorities purely on the basis of where someone might live?

·      While we accept the need to define the circumstances of abuse, we continue to have problems with linking it to care or support needs (whether or not met by the local authority). Under what circumstances would someone experiencing or at risk of abuse or neglect, and unable to protect themselves, fall outside of the parameters of adult safeguarding? As we note below, abuse will include theft and fraud. How many people want the theft to stop, cannot stop it without outside assistance, but have no need for social or health care?

What is abuse?

Abuse is defined as including the theft of money or property, fraud, coercion or undue influence in financial matters, or the misuse of money or property.

Some issues to consider:

·      The Bill indicates that abuse includes financial matters, which is good, but does not actually define abuse wider than that. So, what is it? Will we rely on case law, possible definitions in other legislation, an ethical code, or what? Or will it be defined locally by each Safeguarding Board?

Additional powers

Government will consult on the need for new powers to gain entry into private homes.

Some issues to consider:

·      It is good that the Government plans to consult on powers of entry. We have been arguing for quite some time that there are many circumstances whereby the abuser denies access to the victim (within domestic environments), and we are reasonably confident that the consultation outcome will identify such a need. Will this help victims and their families? Most definitely yes, particularly in situations where one family member is abusing and denying access to the rest of the family, and similar circumstances.

·      We regret the fact that they have ducked the issue of additional powers of intervention. This is a very difficult subject, and there are extreme views from all sides of the debate, but ignoring the issue will not solve the problem. And arguing that the inherent jurisdiction of courts is sufficient (i.e. the right of the courts to take the responsibility upon themselves) would be a deflection. We do not believe that there should be general powers that allow social workers to routinely intervene in people’s lives. But does this mean that no action should be taken in extreme cases? The Government obviously disagrees, or else we would not see Domestic Violence Protection Orders, so it is difficult to understand the reluctance to consult on these issues.

Other issues:

There is no proposal at this point to legislate to protect adults with capacity who are the subject of neglect or abuse but who are not covered by the Mental Health Act or the Mental Capacity Act. The view is that such circumstances can be covered by the ‘inherent jurisdiction’ of the courts, although this approach will be debated during scrutiny of the Bill.

·      The Law Commission Report noted the gap in law relating to protecting adults at risk who were being ill treated or neglected but were not subject to the powers of the Mental Health Act 1983 or the Mental Capacity Act 2005. They described a situation whereby three adults were placed in a care home where they suffered abuse and neglect – one under the Mental Health Act 1983, one under the Mental Capacity Act 2005 and the other (with capacity) under the National Assistance Act 1948. A prosecution for ill treatment or wilful neglect could only be initiated in the case of the first two people. Police officers had suggested that prosecutions were being dropped in practice because doctors could not confirm, or had not documented, that a person lacked capacity. It is therefore odd that the Government have not directly addressed this issue, instead of leaving it to debate on the Bill in Parliament.

Adult Safeguarding - what's on offer?

A little history can be a useful thing …

On Wednesday the Government announced a range of measures relating to the reform of Adult Social Care and, included within the measures, there were a number of proposals on adult safeguarding. Perhaps not surprisingly, the media focused almost exclusively on the issue of social care funding which many people felt had been sidestepped, but this effectively meant that key issues did not received the public attention they deserve. This of course is the reality of the media!

Since 2004 AEA has been seeking legislation to underpin adult safeguarding. Our approach was developed as a consequence of our submission to the Health Select Committee Inquiry into elder abuse which was happening at that time (an Inquiry that was in no small part due to an MP called Paul Burstow), and further developed as we achieved the Prevalence Study in 2007, undertook work for the DH around data monitoring and collection of adult protection, and lobbied for a review of No Secrets. What was apparent was that the No Secrets guidance had only been effective to a point, but that there was too much variance between local authorities and at local level, and that the systems had insufficient consistency to ensure adequate protection for adults in vulnerable situations. It was the 2007 Prevalence Study into elder abuse that triggered the review of No Secrets (at our instigation) and it was this review that has led us to the proposals in the White Paper and draft Bill.

It has been a long road from 2004 to date, with too much politicking at the expense of adults in very vulnerable situations. Although there has been a lot of good work undertaken during that time, it is worth remembering that the last Government treated this issue with little regard and effectively derailed the whole process. So, we really must pay tribute to the commitments outlined on Wednesday. Whatever about the wranglings about detail that will surely follow (and we will no doubt have our part in that) the Minister Paul Burstow should be congratulated by everyone for following through and delivering what he promised. He deserves every acknowledgement for this, and we readily, willingly and very happily do so. Well done, Paul!

So, what have we got to work with? Well, here’s a quick overview.

Much (but not all) of the new legislation is about infrastructure. Local Authorities are confirmed as the lead agency for coordinating adult safeguarding, with the roles of other agencies also recognised. Consequently, there will be a mandatory requirement for three statutory agencies to be members of a Safeguarding Board: the Local Authority, NHS (defined as a clinical commissioning group), and the police. The Boards can then decide who else they wish to invite as participants. There will be a duty on members to cooperate.

Safeguarding Boards will have a high level of local discretion as to their focus and role, with a primary function being to protect adults from abuse or neglect by providing leadership, ownership and coordination of multiagency working at local level. They will be required to publish an annual strategic plan, an annual report, and commission ‘safeguarding adults reviews’ where an adult experiencing abuse or neglect dies, or there is reasonable cause for concern about how the Board, or one of its members, or someone else involved in the case had acted.

There will be a statutory duty on Local Authorities to inquire (or cause an inquiry) into allegations of abuse, although there will be no regulations defining the nature or detail of such inquiries. This will be left to professional judgement. To be the subject on an inquiry someone must need care or support (whether or not met by the local authority), be experiencing or be at risk of abuse or neglect, and be unable to protect themselves because of their care or support needs.

There will be no definition of a ‘vulnerable adult’ or an ‘adult at risk’, but instead adult safeguarding will focus on abuse and neglect i.e. where adults in vulnerable situations are hurt because of the actions (or inactions) of others. This will not include self-harm, as the intention of safeguarding will be to address situations caused by the actions or inactions of others (but Safeguarding Boards may locally decide to include self-harm if they wish).

Abuse is defined as including the theft of money or property, fraud, coercion or undue influence in financial matters, or the misuse of money or property.

The current power under section 47 of the National Assistance Act 1948 (which gives a local authority power to remove a person in need of care from their home) will be repealed, and the Government will consult on the need for new powers to gain entry into private homes.

There is no proposal at this point to legislate to protect adults with capacity who are the subject of neglect or abuse but who are not covered by the Mental Health Act or the Mental Capacity Act. The view is that such circumstances can be covered by the ‘inherent jurisdiction’ of the courts, although this approach will be debated during scrutiny of the Bill.

What next?

Next week we’ll begin to unpick some of this, and measure it against the experiences of older people experiencing abuse or neglect. There is no doubt that these initiatives will help. But how much, and to how many?

What do other people think? Let us know.

Funding isn’t the only priority in life

The majority of the news yesterday, and the majority of comments from organisations like Age UK and others, focused on the failure of Government to address the funding of social care. This is an important issue and is crucial to the lives of many thousands of older people. But equally crucial is identifying, challenging and stopping elder abuse, and yesterday also brought a range of Government proposals around Adult Safeguarding, an issue seriously neglected by everyone other than AEA and the Community Care (online) magazine yesterday. The Local Government Association (LGA) said nothing. The Association of Directors of Adult Social Services (ADASS) said nothing. The NHS Confederation said nothing. And yet this affects in excess of 500,000 older people in the UK, a figure that would command a huge outcry if it related to children.

The fact is that, for the majority of older people affected by elder abuse, Adult Safeguarding is currently meaningless or ineffective. AEA research shows that less than 10% of victims come to the attention of Safeguarding systems, and too often the outcome of a Safeguarding intervention is ‘increased monitoring’, code for not knowing what to do. The greatest fear for many local authorities is an increased referral rate to Safeguarding because they do not have the resources to cope, and the constant plaintive cry from ADASS during the last 18 months was about money and the need to lower expectations of Safeguarding to a more ‘realistic’ level, which is more code for finding a way to exclude people from protection.

The majority of elder abuse happens in an older person’s own home, often perpetrated by family members, neighbours or ‘grooming’ friends’; by our estimate at least 64% of abuse takes place behind the family front door. This is consistent with what is known internationally about elder abuse. Despite this, to date, the overwhelming majority of legislation has focused upon abuse within care settings. Other than in the field of domestic violence, which Governments have consistently sought to keep separate from ‘adult abuse’, there is no legislation that specifically addresses the nature of abuse. There seems to be an assumption that domestic violence abusers stop when they get their metaphorical pension book! Which is why AEA have campaigned since 2004 for (a) a transference of knowledge and skills between domestic violence systems and adult safeguarding, and (b) legislation to put adult safeguarding onto a statutory footing.

There is a link between domestic abuse and adult abuse, with much of domestic elder abuse meeting the Home Office definition of ‘domestic violence’. And yet the link is not recognised. How many people would know that the clause in the Domestic Violence, Crime and Victims Act 2005 of the ‘unlawful killing of a vulnerable adult or child’ (the charge faced by the abusers of Baby Peter), came about as a consequence of AEA lobbying around the case of 76 year old Margaret Panting? Older victims do not stay in the psyche of the public or the media for long, which is perhaps why politicians can treat the needs of older people so casually.

More so than ever there needs to be an independent system that investigates allegations of abuse, and takes meaningful action to protect older people who are in vulnerable situations. And the reality is that most ‘adult abuse’ is actually ‘elder abuse’, although this is something that many local authorities do not particularly highlight. The greatest referral rate to Adult Safeguarding across the UK is of older people, and this is just the tip of a colossal iceberg. But even when there are opportunities to focus on the needs of older people in this regard some local authorities struggle to do so. Worcestershire this year for example found it impossible to understand that World Elder Abuse Awareness Day has the word ‘Elder’ in it and instead used the day to launch a generic campaign on the financial abuse of ‘vulnerable people with a physical or learning disability or a mental health condition.’ That’s a bit like launching a child protection document on the International Day of Older Persons, it negates the whole point!

Of course Safeguarding includes more than just the local authority led teams. It includes the Care Quality Commission, the Independent Safeguarding Authority, the Office of the Public Guardian, and multiple other regulatory bodies such as the Nursing and Midwifery Council. In a wider sense, there are also the various Ombudsman’s bodies, such as the Local Government Ombudsman who can now investigate complaints by ‘self funders’ of social care. And these all individually and collectively have varying levels of public satisfaction, with some viewed as close to useless and others considered impossible to access.

So what is it that Adult Safeguarding needs to address?

First and foremost (obviously) abuse in the home by people in relationships or positions of trust. But also abuse by professionals and providers of services. We all know and accept that there are overwhelming examples of kind, sensitive and dignified care being provided by many people who are often overworked and underpaid. But the evidence of abusive care in hospitals, care homes and domiciliary care is also overwhelming. That needs solving.

Which means we need to measure the latest Government proposals in a simple and straightforward manner:

·       Do they create the conditions that prevent an older person from being abused or neglected in the first place? That is about influencing the environment as much as the actions of individuals.

·       Do they create systems that recognise if an older person is being abused or neglected and ensure immediate remedial action if abuse/neglect is identified? That is about more than just an inspection process, and must include the responsibilities of care and health providers, including corporate responsibility.

·       Do they ensure that older people have equal access to the criminal justice system if they are abused or neglected? That is about laws that are financially accessible, and protect people who are unable to take action for themselves.

·       Do they command public faith and confidence?

 

There may be other measurements, what do you think?

 

It really is time that Governments, regulators, and commissioners stopped playing politics with the lives of older people and dealt with the realities that too often face them, their families and friends. So, our next blog will measure the latest initiatives against reality and public expectations. Let’s see how well they do.

The U turn that wasn't..is it significant?

On 21 March 2012 a DH civil servant addressed a Community Care conference on safeguarding and informed the audience that the threshold of 'significant harm' would be included in the new legislation. At the end of March the Minister, Paul Burstow, was asked by a delegate at the AEA conference if he could confirm that legislation would talk of risk of harm and not significant harm and he gave a categorical 'yes'. 

Well, apparently not. 

AEA asked for clarification on this point at the Safeguarding Advisory Board on 10 May and was told that the Minister had made a mistake, that he had misread the new Draft Bill, and that the DH had issued a News Release to that effect.

Actually, no they had not. 

They gave a statement to Community Care magazine which said, "

"The minister's response to a delegate's question indicated that legislation will not refer to "significant harm'. However, the current policy position is that adults at risk of significant harm should be the subject of safeguarding work, building on the No Secrets statutory guidance. Of course how these terms are defined in the first ever adult safeguarding legislation in England will be critically important, and that is why we have been talking to people working in safeguarding to get their views on these issues." 

Of course we all know the current No Secrets definition, but the question related to future legislation and not to the current position. So, why the 'correction'? Well, the real message is contained in the second part of the DH statement. This all hinges on how terms are defined in the new legislation. We won't have 'vulnerable adult', but nor it appears will we have 'adult at risk'. And, nor are we likely to have the use of a term like 'significant harm'. 

But does that mean that the threshold will be lower, as argued by the Law Commission? Possibly, but not necessarily. The Minister may have meant that the actual word would not be used while the civil servant may have meant that the intent or effect would still equate to 'significant harm'.

This, along with so much more, is apparently of such crucial significance that the DH feel unable to disclose their thinking in advance of any publication. In fact, they feel unable to tell anybody anything of significance whatsoever. They didn't even tell AEA about this 'mistake' so that we could inform our delegates.

Engagement with stakeholders? Openness? A willingness to engage and share information, or to genuinely consult? The last two years have been better characterised as delays, uncertainty, prevarication and obfuscation. Smoke and Mirrors comes to mind.

We'd probably get more transparency from MI5.

Panorama requires action, not words

In the last few months we have had multiple reports about the failings of the Care Quality Commission, and one recent report highlighting the failings (yet again) of the Nursing and Midwifery Council. In the case of CQC it seems to just trundle from one disaster to another, while the NMC appears to have gone back to the same problems it had in 2006. None of this gives the reassurances that the public need in relation to the standards of social and health care, and it doesn't help when those in positions of power suggest that such bodies need time to sort themselves out. Time is not on the side of older people and other adults in vulnerable situations.

The recent Panorama programme portrayed, yet again, that the abuse of vulnerable people, especially older people, too often goes on behind closed doors, out of sight and out of mind. Once again the public saw cruelty and neglect that brought tears to the eyes and anger to the heart. And once again, the public demand to know that something is being done.

But it cannot be enough to say that lessons must be learned from such programmes because they are the same lessons, repeated over and over again, and they are not being learned. And all the while, older people suffer and in some cases die. This needs action, not words or intentions or plans for the future. In that context, our criticism of bodies like the 'Commission on improving dignity in care' does not relate to their conclusions, but to the fact that the conclusions are old hat. We all know why abuse is happening, the only issue is what is to be done about it.

To some extent, to focus on the Panorama programme is misleading because most elder abuse (67%) happens in people's own homes, and not in care homes. And this means that we need two strands of action, one that relates to abuse by health and care workers and one that relates to abuse within our communities. One is covered by bodies like CQC, and one by the No Secrets/In Safe Hands guidance (which has been proved insufficient).

Why do care and health staff abuse? The fact is that there is no single reason. In some cases it is because they are nasty people who shouldn't be in those roles. In some cases it is because they lack the necessary training. In some cases they are conditioned by peer group activities. In some cases it is short staffing or resources and a matter of cutting corners. Certainly we know that poor staffing levels and working conditions, a lack of training, supervision and support, no policies or procedures on abuse, and poor internal communications can all contribute to abuse happening. But we also know that many people work in awful environments without ever neglecting or abusing, so there will always be personal integrity and commitment.

It is true to say that regulatory bodies, such as the CQC and NMC, are not responsible for abuse happening; that will always be the responsibility of the individual worker and their employer. But regulatory bodies contribute to abuse when their actions or inactions allow standards and expectations to degrade, when they see neglect or abuse and inject no urgency into remedial action or no seriousness into what has occurred. They then become equally culpable.

It is also true to say that bodies which commission care, (such as local authorities), and bodies which provide care, have a primary responsibility for actions of abuse and neglect. For too long local authorities have focused on squeezing every last penny from social care provision, while pretending that such a strategy has had no impact on quality of care. That is rubbish, and the infuriating thing is that it is the worst kept secret, because LGA members and others are well aware of what they are doing and its impact. And so are those care providers who take contracts they cannot realistically deliver, who cut training and supervision or 'bus' in workers to keep establishments afloat, or 'ration' incontinence pads. Etc Etc Etc.

And, at the top of it all, we have successive Governments who have played the system, ducked the issues, gone down varied and differing political 'flavours of the moment', and who have failed to display strong, robust leadership in grabbing it all and giving it a good shake.

What a mess. And no-one comes out of it smelling sweetly.

There is no easy answer that will change things overnight. We do need a multi-pronged strategy that includes adult safeguarding legislation, training, criminal justice action, and public awareness programmes. We've been saying it for years now, but we need to learn from what has worked in domestic abuse and extend it into other aspects of adult abuse.

Meanwhile, in response to Panorama, we want the Government to make an immediate statement on actions that will be urgently implemented to:

·        Instil public confidence in regulatory bodies by ensuring that inspections are focused, and that action in response to abuse is swift and proportionate to what the public expects i.e. that urgent action is taken by the regulator to stop abuse when it is witnessed or reported - and then hold people accountable;

·        Ensure that local authorities establish a funding structure for care provision that is appropriate to the quality of care expected;

·        Ensure that courts are robust in sentencing care workers and others who abuse to jail terms appropriate to their actions;

·        Hold care providers corporately accountable for abusive or neglectful actions of staff.

And in the medium term, the Government really need to reconsider:

·       The introduction of a register of social care workers;

·       The establishment of specific minimum levels of training, staffing and supervision of care provision;

It is a pity, to say the least, that Ministers have been so quiet following this Panorama programme in comparison with Winterbourne View, and that yet again CQC has shown its inability to understand the public mood. They do themselves no good in terms of building credibility.

We do need an urgency in terms of bringing forward adult safeguarding legislation, including powers of entry and intervention where necessary. In that context, it is worth again restating that the majority of elder abuse, 67%, happens in our communities behind the closed family front door. 

As a society, we have yet to deal effectively with that.