Adult Safeguarding – an ‘also runner’ in the new NHS

The NHS is currently in the process of implementing a major programme of reform following the passage of the Health and Social Care Act 2012. This is designed to support the creation of a health service that is clinically led, patient centred, dedicated to the delivery of world-class outcomes and focussed on improving the health of the population.

It is essential that there is clarity about responsibilities in relation to safeguarding within these new arrangements – and about how the new system can help drive continued improvement in practice and outcomes.

In the final report (May 2011) of her review of child protection, Professor Eileen Munro expressed concern about the possible impact of the health reforms on effective partnership arrangements and the ability to provide effective help for children suffering, or likely to suffer, significant harm. In response, the Government committed to establishing a co-produced work programme “to ensure continued improvement and the development of effective arrangements to safeguard and promote children’s welfare as central considerations of the health reforms”.

The Government is also committed to working to prevent and reduce the risk of abuse and neglect of adults.

Thus reads the background and context of the new Interim advice from the NHS Commissioning Board on children’s and adults safeguarding – with adults as an ALSO. It goes to recognise itself as primarily geared to children when it says: Although this advice focuses on the statutory requirements to safeguard children, the same key principles will apply in relation to arrangements to safeguard adults. There are, of course, one or two fundamental differences of principle but never mind.

For those who have been wrestling with the health and social care interface in adult safeguarding for many years there is the welcome prospect of the incoming NHS CB and CCGs having statutory responsibilities. Particularly important for patients in commissioned services such as those that were at facilities such as Winterbourne View Hospital – the interim advice is unequivocal about where statutory responsibility will lie in the future.

The description of the designated professionals’ roles in adult safeguarding is interesting in that it expects expertise in the Mental Capacity Act as well as a broad understanding of policy and training across local authorities, police and the third sector. It anticipates this expertise stretching across older people, people with dementia, people with learning disabilities and people with mental health conditions. It does not see them as being hosted within the commissioning support services. Thus their host is likely to be an NHS provider. It is to be hoped that the proposed service level agreements will recognise the potential for conflicts of interest in such arrangements – conflicts that come to the fore in serious case reviews scenarios.

As the advice develops the ‘also ran’ status of adult safeguarding becomes more apparent. Funding is acknowledged only to the Safeguarding Children’s Board. The Director of Adults Social Services may be able to offer advice. Priority is given to numbers of children in need. A muddled message emerges on inspection between CQC and OFSTED. Reminders appear about designated professionals engaged with Looked after Children, around the DfE production of the revised Working Together and about the Royal College of Paediatrics and Child Health. A Safeguarding Children Transition Board is established.

Missing is recognition of the issues around continuing health care, the messages around the care programme approach from Winterbourne View and any acknowledgement of the fact that safeguarding in health and social care involves a massive diversity of provider settings. The third sector is recognised but not the private sector – yet residential nursing care is largely a private enterprise in the small business sector. Private providers are a vital aspect of support at home services – where they are well placed to initiate much needed joined up health and social care in the community. These developments will be enabled by a policy and practice climate that draws on advice that is cognisant that personalised services are safe services and vice versa. That is a climate where providers are partners in the truest sense of the word.

All in all the interim advice smacks of a cobbled together document to allow the timetables for the NHS CB and CCG infrastructure to be met. It has clearly suffered from delays in the production of the revised Working Together and uncertainty about what the eventual Care and Support Act will actually make statutory requirements and when. As a consequence it has the effect of relegating adult safeguarding to an ‘also ran’ shadow to the priority of children.

However the advice ends with the statement: We anticipate that it will be replaced by a more comprehensive document in the autumn, alongside the revised Working Together statutory guidance. It being September we also look forward to adult safeguarding soon emerging from the shadows before the winter sets in.

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