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Adult Safeguarding and the NHS

User AvatarPosted by Trevor Collinson at 08/07/2013 09:49:15
Are adult safeguarding practitioners too soft on the NHS?

A thought provoking article re-published below by Mithran Samuel on 4 July, following last weeks Community Care conference:

We seem to be talking more and more about the risks of poor care, bordering on neglect or even abuse, of vulnerable adults in the NHS, following the Francis inquiry report into Mid-Staffordshire NHS Foundation Trust. 

But adult safeguarding interventions are conspicuous by their absence in mainstream discussions about how you prevent or address these failings. Much of the focus has been on tougher regulation and inspection of services, making NHS leaders publicly accountable for what goes on in their organisations and having far greater transparency about failures. There are no references to adult safeguarding services or boards in Francis’s 290 recommendations for creating a “safer, committed and compassionate and caring service” in the NHS. 

This omission – and what it says about the role of adult protection in the NHS – is wrong-headed, argues health and social care legal trainer Michael Mandlestam, who has been a longstanding thorn in the side of the NHS over neglectful care. 

Safeguarding practitioners challenged 

At yesterday’s Community Care conference on adult safeguarding, Mandelstam challenged delegates – many of whom were council adult protection practitioners – over whether they were doing enough to respond to safeguarding issues in NHS settings. Or were they spending more of their times going after “easier targets”, such as abusive family members or small care homes struggling to maintain standards of care? 

Delegates heard a similar message from Margaret Flynn, independent chair of Lancashire Safeguarding Adults Board and author of the serious case review into Winterbourne View. She said the NHS had too long been “protected” from scrutiny  through the use of internal serious untoward incident reviews to investigate safeguarding incidents. 

While we sometimes hear horror stories about council adult protection staff intervening in care homes to address frayed carpets or similarly small issues, no one disputes their role in responding to issues of possible neglect or abuse in residential care. Similarly, no one would dispute the role of adult protection staff in investigating concerns in independent hospitals caring for adults with learning disabilities, autism or mental health problems, particularly in the wake of Winterbourne View. 

So why should things be any different for the NHS, particularly given that a quarter of beds in acute hospitals are occupied by people with dementia at any given time? 

Why is the NHS different?

One answer is that the NHS does have a series of clinical governance systems designed to keep the quality and safety of care under continuous review through audits, training and management. However, argue Mandelstam and Flynn, these systems have often been used to cover up failings, up to and including neglectful care.

A second answer – a point Mandelstam made himself – is that it is difficult to identify the point where poor hospital care – which is not the business of adult safeguarding, but of management and regulators – tips over into neglect. This might be particularly true when social care professionals are scrutinising their health colleagues over medical issues. But, Mandelstam argued, this is not a reason for inaction, but for closer scrutiny. 

A third answer is that individual safeguarding referrals investigated by local authority social workers in acute hospitals will do nothing to address neglectful care. This point was made strongly at the conference by Department of Health senior policy manager for adult safeguarding Claire Crawley. 

She was very clear to point out that neglectful care in the NHS was the business of adult safeguarding boards; but that the best way to address it was to make the NHS’s clinical governance systems more effective and transparent, and to make health service bosses fully and publicly accountable for these failings. This is in line with the Francis report and the government’s response to it. 

At a time when local authority resources are shrinking, and adult safeguarding alerts and referrals are increasing year on year, this may be the best use of resources. However, are we right to place faith in the NHS becoming much more transparent and accountable in the way Crawley suggests? Flynn and Mandelstam were doubtful. 

I’m not sure about the answer but I’d really like to hear people’s views about the role of adult safeguarding in the NHS and your experiences of engaging with health services on adult protection issues.

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