IN 2000 the Department of Health (DH) and the Home Office launched the No Secrets guidance to help health and social care organisations develop and implement policies and procedures to protect vulnerable adults from abuse (see box).
Since then, there have been significant legal and policy changes relating to adult health and social care, such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and Safeguarding Vulnerable Groups Act 2006.
But applying these changes has created challenges for healthcare staff working in front line services.
Last year the government announced a consultation, dubbed Safeguarding Adults, on the review of No Secrets. About 12,000 people took part, including 3,000 members of the public, some of whom were service users, who said safeguarding should be based on empowerment and listening to at-risk individuals and those who had been abused.
The findings were published by the DH in July this year. They revealed that safeguarding vulnerable adults is being taken seriously in some parts of the NHS, with an increasing recognition of the responsibilities of protecting people from neglect and abuse. However, the consultation also found barriers existed to providing that protection.
It found that:
* The ownership of safeguarding as a concept is proving difficult among health and social care workers.
* Engagement across the NHS is patchy.
* Clear leadership is needed.
Although most trusts have signed up to local policies, the results identified a lack of knowledge of adult protection procedures at an operational level. Staff sometimes ignored neglect or did not recognise institutional abuse, making it difficult for those who did challenge poor practice.
Some nurses were failing to meet the basics of care, particularly personal hygiene, continence and pressure area care, and poor practice was sometimes accepted as a consequence of inadequate staffing levels.
The NHS was also criticised for having no integrated systems to report and share safeguarding concerns with other health and social care partner agencies. Additionally, it was thought that the hierarchical culture in the NHS made it difficult to question staff practices.
There seemed to be a widely held perception that care provided by healthcare professionals was 'safe'. This assumption made it difficult for staff at all levels...