Editorial

Bridget Penhale (School of Health Sciences, University of East Anglia, Norwich , United Kingdom Of Great Britain And Northern Ireland)

Margaret Flynn (Yygubor, Anglesey, United Kingdom Of Great Britain And Northern Ireland)

The Journal of Adult Protection

ISSN: 1466-8203

Article publication date: 22 February 2019

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Citation

Penhale, B. and Flynn, M. (2019), "Editorial", The Journal of Adult Protection, Vol. 21 No. 1, pp. 1-4. https://doi.org/10.1108/JAP-02-2019-050

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:

Emerald Publishing Limited

Welcome to the first issue of 2019 and belated Happy New Year! We hope that you will all have had good festive seasons and that the year has started well for all involved in the journal – especially for readers! As in most issues of the journal, we start with a number of news items concerning safeguarding related issues that have appeared in media coverage over the past few months that readers may find interesting. Before introducing the main contents of this issue, please see below for a selection of these items from across the news media.

The heartfelt theme of Bob Hudson’s article[1] “The only way is ethics: a new approach to outsourcing social care” is timely. Endorsing the participatory strategies of Dan Hind (2010). Hudson gives an emphatic thumbs down to outsourcing social care, “Weak contracting, inadequate budgets, poor supervision, insufficient regulation and overweening providers have all been identified as factors contributing to the fragility of the model”. As we know from recent events, some of the issues relating to contracting, supervision and regulation have been identified in reviews of situations in which serious safeguarding concerns have developed and been identified, if not satisfactorily dealt with.

Hudson proposes that the ethics of decision making among public services commissioners requires attention and poses such relevant questions as these:

Are you able to distinguish between the workforce practices of different providers and prioritise the ethical providers, e.g. those accredited by the Living Wage Foundation? Are the companies responsible for delivering public services subject to the UK taxation law? Do they have transparent contracts without recourse to “commercial confidentiality?” Are you favouring smaller, local services with local knowledge of the matters affecting people? What ethical considerations are being brought to bear on “promoting good lives well-lived and protecting the wider economic, social and environmental well-being” of a locality?

A small item in the Bangor and Anglesey News (28 November 2018) merits coverage in this regard. “Council to use housing stock to slash bill for vulnerable child care” describes how Anglesey Council is setting aside some of its housing stock to accommodate children and young people requiring “round the clock support […] even taking staffing and conversion costs into account […] the move is expected to save the cash strapped authority £522,896.00 over the first two years” – the amount typically spent on “private care […] in England”. Also, during November an investigation by The Guardian[2] “found evidence of councils putting the personal details of children in online adverts, including information about previous sexual abuse and gang involvement, while inviting bids from private companies for their care […] [and since] children’s care homes are in crisis […] private companies [are] taking over and charging councils more than £7,000.00 a week”. With private providers dictating prices, the Association of Directors of Children’s Services has confirmed that the cost of such placements is “one of the biggest financial pressures on local authorities” and therefore provides a clear incentive for cost-cutting wherever possible.

During November the Office for National Statistics reported on an analysis of the death certificates of care home residents[3]. This confirmed that “as many as 1,463 vulnerable residents in NHS, local authority and privately run homes in England and Wales have died over the past five years with one of the conditions [‘malnutrition, dehydration or bed sores’] mentioned on their death certificates […]. It follows a separate Guardian investigation which revealed that some of the country’s worst care homes are owed by companies that made a total profit of £113m despite poor levels of care”. The vision of ethical commissioning that Hudson espoused is compelling and yet remains to be enacted; meanwhile the number of care providers that are struggling to meet the needs of residents, or that go out of business, continues to rise. The scenario (of ethical commissioning) is familiar to the Challenging Behaviour Foundation, which has a credible record in campaigning for better outcomes for young people and adults for whom “place-hunting” is the commissioning response. The Foundation’s hard-hitting critique of the Transforming Care Programme was given some coverage late in the year on Radio 4’s “File on Four” programme: Transforming Care – is it working[4]?”

We also learnt that the duty of local councils to house families who are “statutorily homeless” is being compromised by the shortfall between housing benefit levels and the cost of renting. On 8 November last year, The Times reported that pressure was being placed on the prime minister to unfreeze benefits a year early “because of the level of destitution […] Last year 79,8880 were placed in temporary accommodation, including 123,130 children – an increase of 40% over five years […] [yet] housing benefit, which is claimed by a million people, is still pegged to 2011 rent levels and has been frozen since 2016[5]”. And speaking of accommodation, the Grenfell Tower Inquiry has learned that prior to the tragedy, the council landlord did not fix electrical failures, including broken lifts and other problems. The Tenant Management Organisation’s knowledge of the building’s failings produced no remedies. There are 34 people who lost their homes in the tragedy who remain to be resettled Booth (2018).

As the UK attempts to navigate fraught political waters, The Guardian has uncovered the inequalities experienced by ethnic minorities in Britain and the tenacity of racism[6]. The micro aggressions of being turned away from restaurants and clubs and excluded from social events, for example, may be associated with “unconscious bias”. However, it is being played out in shops with 55 per cent of the 1,000 people polled reporting being mistaken for employees rather than customers; 37 per cent being stopped by the police; and 62 per cent being stopped going through airport security or customs. It is difficult to disaggregate the brutal language of the “Go Home” billboards with 12 per cent of people having racist language directed at them during November/December 2018. In related coverage, the Syrian schoolboy who was filmed being attacked in a video, which was shared on social media has thanked the public for their support[7].

Credit to the Albany Arts Centre and specifically Christopher Green[8] for undertaking to create “a durational piece of theatre about residential care, in collaboration with the Albany and Entelechy Arts, drawing on their years of shared work with older people. The Home will create an old people’s home where the audience are invited to spend two nights. They will be ‘the cared for’ during their stay. The staff will be played by professional performers and community participants who are all older artists. The piece will be based on stories told by residents and staff living and working in care homes. They’ll spend the first 24 hours replicating the kind of behaviour older people have experienced in care homes; good, bad, messy, indifferent, ill-thought-through and wonderful. After 24 hours a transformation will occur. The staff will begin to change personality, the building to shape-shift. The dystopian will become a utopian possibility – a vision of how things could be. Of course, some people still won’t be happy. And this will lead to discussions of the grown-up nature of what we are dealing with. There are harsh realities: Old age isn’t for sissies. But dreaming, risk-taking and a desire to transcend the possible is the job of art and artists. The Home intends to push every boundary during audience’s two-night stay. And there will definitely be Bingo […]”. Reviews of the outcome of this experience to follow in a subsequent issue!

Why is it that we only favour independent reports when they are on message? When Philip Alston, the United Nation’s rapporteur on extreme poverty and human rights set out his findings after a two week visit to the UK[9]. In their refutation of the findings, government ministers expressed disappointment with: “the extraordinary political nature of his language” – for example:

No single program embodies the combination of the benefits reforms and the promotion of austerity programs more than Universal Credit. Although in its initial conception it represented a potentially major improvement in the system, it is fast falling into Universal Discredit […] While some surveys suggest certain claimants do have positive experiences with Universal Credit, an increasing body of research makes clear that there are far too many instances in which Universal Credit is being implemented in ways that negatively impact many claimants’ mental health, finances, and work prospects […] a real deficiency in the data DWP provides about sanctions makes it difficult to assess the regime. DWP does not make public sanctions data disaggregated by race or ethnicity, much less certain other claimant statuses such as single parents or carers. It is also impossible to determine from the data the number of sanctions that an individual has received, so it is not clear if the duration of sanctions is due to consecutive sanctions or rather an individual sanction of longer duration […].

And although the language is forthright, whether it is perceived (or read) as political or not likely depends on which side of the political spectrum one is on! Some changes to Universal Credit have been proposed in recent weeks, in part due to successful challenges being brought by individuals or groups of claimants, but the system remains deeply flawed.

This issue of the journal contains a number of papers covering different safeguarding topics. Several of these relate to the issue of Safeguarding Reviews of different types. And a further two papers relate to mental health and/or criminal justice related issues. The first of the Reviews papers, by Robinson and colleagues from Cardiff University is a thought provoking and very useful contribution relating to a research study that conducted an analysis of a series of domestic homicide, mental health homicide and adult practice reviews. The research teams undertook an analysis of 20 reviews that had taken place in order to identify possible cross-cutting themes – each report being analysed and coded by three researchers from different disciplines (law, social work and criminology), hence the resulting analyses of the reviews were multi-disciplinary in nature. Five central themes were identified from across the different reviews, these are usefully explored within the paper. Recommendations for future practice in such reviews, including a need to adopt multi-disciplinary perspectives and approaches are suggested in order to improve practice in this area.

The second paper in this group is also a research paper written by Manthorpe and Martineau from King’s College, London. The focus of this particular study was to consider Safeguarding Adults Reviews in England and Wales that particularly relate to mental health legislation, so that relevant findings might be considered within the review of English mental health legislation that was undertaken during 2018. A list of relevant SARs was developed and those found are usefully summarised in the paper and were analysed contextually for what the report indicated about either consideration or use of mental health legislation. One of the key findings from the study was that the interaction(s) between different statutes, such as the Mental Health Act 1983, the Mental Capacity Act 2005 and the Care Act 2014, proved problematic for some professionals and this means that application of the law(s) may be variable within professional practice. Further work in this area, perhaps specifically to inform practice, rather than to contribute to an official review of legislation is likely to be useful in future and this paper is a good starting point for this process.

The third paper in this issue that is linked to reviews is a Viewpoint paper by Pete Morgan, who is a former Adult Protection Committee/Safeguarding Board manager and now an independent consultant who has experience a chair of a Safeguarding Board and also of undertaking Serious Case Reviews and Safeguarding Adults Reviews. Morgan writes about his experience of the latter, as a Reviewer, to make some observations about issues that may arise during the review process, some of which affect and may potentially hinder the review. For all those who are interested in the work of Safeguarding Adults Boards and of the topic of reviews, this paper will provide useful food for thought.

The following paper is by Eades from the Institute of Culture and Society, Western Sydney, Australia. The focus of his study was to explore the possibilities for re-engagement through interpersonal relationships for individuals who are incarcerated, in particular in relation to relationships with those who visit the person in this restricted environment. The potential for such individuals to assist with transition processes for the person following release into the community is emphasised, as is a discussion of likely protective factors that can act as further support for the person.

Our fifth paper of the issue is a policy Viewpoint paper by Cummins and Foley, which offers a perspective on the prosecution of sexual assault and rape cases and issues relating to mental health service users, which is an area of concern to those working in mental health and criminal justice agencies. The paper considers recent developments in this area, including the guidance developed by the Care Quality Commission on sexual safety in mental health settings (specifically inpatient wards) but notes with dismay apparent advice provided by the Crown Prosecution Service to prosecutors that they should not pursue “weaker” cases which might reduce the likelihood of a successful prosecution. This is a useful paper for consideration of these important linked issues.

The final full paper in this issue is by Ernst from Wayne State University in the USA and considers the issue of elder neglect by caregivers. This was a qualitative study that analysed a number of case records using a framework centred on risk and vulnerability. The cases selected were those in which neglect by caregivers had been substantiated by Adult Protective Services personnel. In relation to findings, the neglect that individuals experienced predominantly related to with-holding or refusal of medical care. The neglected older adults had multiple health conditions and caregivers also had substantial health, or mental health conditions and/or work-related responsibilities that made caregiving problematic. Lack of insight about the older adult’s needs and/or conditions was also apparent within the cases and refusal to either access or accept services – by both the older people and caregivers – was a major theme in the findings. Although the sample of cases accessed was relatively small, in-depth information about the nature of neglect by caregivers was obtained and will add to our understanding of such situations and assist in the development of responses.

The final item in this issue is a Book Review, written by Independent Safeguarding Consultant, Pete Morgan, which considers an edited volume relating to safeguarding practice under the Care Act, written by Adi Cooper and Emily White, which also contains ideas and suggestions about improving practice, something which all of us in safeguarding strive to achieve.

We hope that this issue of the journal will provide items and ideas for readers to reflect on about the apparently increasingly broad field that is adult safeguarding. As we have said previously, we are always interested in hearing from potential contributors and to discuss ideas for possible papers relating to research, policy and/or practice in this wide topic area. If you have suggestions or ideas, and wish to discuss these further, do make contact with one of us and we will be pleased to provide advice and offer support on this. Our contact details appear on the inside cover of the journal and are also available on the journal website.