Safeguarding is everyone’s business. Safeguarding means looking out for and trying to protect others in our community who are: vulnerable, or may be at risk of harm. If someone is at risk, an alarm needs to be raised. Everyone can make a difference.
Abuse can happen anywhere. It may happen at home, in a care home, hospital, day centre or in a public place. Anyone can be an abuser, but it is usually someone known to the person.1
With the introduction of the Care Act 2014, Safeguarding adults is now based on a legal framework. The safeguarding provisions of the Care Act include:
The West of Berkshire Safeguarding Adults Board is made up of local organisations which work together to protect adults at risk of abuse or neglect and keeps them safe. It is made up of senior staff from local agencies such as social care, health services, police, probation, fire and rescue, drug and alcohol services.
The SAB’s role involves a range of activities, from raising awareness of safeguarding adult issues; delivering and commissioning high quality services; training and developing staff to recognise and respond appropriately to potentially harmful situations; investigating allegations of abuse or neglect; undertaking safeguarding adult reviews and developing services to support victims and perpetrators of abuse and neglect.
The Care Act 2014 defines the main different forms of abuse and neglect:
Any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance.
In 2000, the Department of Health and the Home Office jointly published the ‘No Secrets’ document. This provided the framework for councils to work with partner agencies such as the police, NHS and regulators to tackle abuse and prevent its occurrence. While they were urged to keep records there was no detailed guidance on what should be recorded and as a consequence, any data available was not comparable across councils.
Safeguarding Adult Returns (SAR) is a mandatory data collection which records information about individuals for whom safeguarding referrals were opened during the reporting period (also referred to as adults at risk) and case details (also referred to as allegations) for safeguarding referrals which concluded during the reporting period. The purpose of the collection is to provide information which can help stakeholders to understand where abuse may occur and improve services for individuals affected by abuse.
1st April 2013 – 31st March 2014 is the first year the SAR has been collected. Alerts and action types are no longer collected and demographics are recorded based on counts of individuals rather than referrals.
Local data has been sourced from the Reading Borough Council Safeguarding Adults Annual Summary 2014/15 which is based on the data used to collate the SAR for 2014/15 and the previous SAR/AVA Abuse of Vulnerable Adults. Reading have only been recording “alerts” since 2012/13, prior to this all safeguarding incidents were recorded as referrals. The breakdown of data into these two categories means we can identify the number of concerns raised around an individual against the number of referrals that require further action.
Table 1: Alerts and referrals (April 1st – March 31st)
The number of alerts has slightly increased on last year, but was almost double what was recorded in 2012/13. This increase is due to better recording and better understanding of what constitutes a safeguarding referral.
Figure 1: Number of safeguarding Concerns (Total) 2014/15
Referrals increased by 6% from 2013/14 to 2014/15. There was an upward trend from July 2014 due to increasing awareness of the Care Act duties which include an additional category of self-neglect. The total of alert only and referrals has shown a steady increase over the last 3 years with 625 in 2012/13, 654 in 2013/14 and 702 in 2014/15. These total figures can help us work out approximately the number of reports per month for each of these years.
|Number of reports per month||52||54||58|
Table 2: Number of reports per month (2012/13 – 2014/15)
The percentage of Alerts which go on to become referrals had reduced since 2012/13 and this year remains at the same level – 86% in 2012/13, 75% in 2013/14 and 75% in 2014/15.
Closed referrals – The percentage of completed referrals of all referrals is 91% for 2013/14 and 97% for 2014/15 indicating better use of documentation.
Figure 2: Number of safeguarding enquiries (referrals) received 2014/15
Further breakdown of the referrals to Reading are available for 2014/15.
The majority of referrals to safeguarding adults for 2014/15 are between 18-64.
Figure 3: Number of individuals by age referred to safeguarding 2014/15
There were more female referrals than male seen in 2014/15. This is due to the structure in population locally and reflects the picture of more referrals for females nationally.
Figure 4: Number of individuals referred to safeguarding by gender 2014/15
The trend with ethnic origin is mostly white (78%) – percentages are not much different to previous years. However the “not known” percentage is creeping up and will need to be monitored.
|Percentages – Ethnicity||2009/10||2010/11||2011/12||2012/13||2013/14||2014/15||2001 Census (ONS)|
Table 3: Ethnicity percentages for Reading 2014/15
We can see that Asian residents are under represented by 11% when compared to the data from 2011 Census, however the 10% of referrals whose ethnic identity is not known significantly hampers the reliability of performance information in this area.
2014/15 was the first year that primary support reason data was collected. This data tells us the main reason a person requires social care services and a better description of the impairment impacting on the individual’s quality of life. It may not be related to an underlying health condition.
The change in categorisation makes it difficult to compare to previous returns. However, we can see that most referrals remain in the physical support category (40%).
Figure 5: Number of individuals referred to safeguarding by primary support reason 2014/15
This looks at the number of repeat referrals as a percentage of all referrals received in the period. Referrals are counted regardless of the incident so it could be the same incident being re-referred or different incidents involving the same safeguarding adult.
|Percentages – Repeat Referrals||2010/11||2011/12||2012/13||2013/14||2014/15|
Table 4: Repeat referrals percentages 2014/15
The numbers of repeat referrals have been dropping since 2012/13 which demonstrates more effective resolution and risk management of issues reported.
There is evidence that the majority of those at risk of any form of abuse is by someone known to the victim. The most common type of abuse was neglect and acts of omission. This is largely in line with the national trend.
Figure 6: Source of risk 2014/15
Abuse Types comparison data -The new SAR for 2013/14 and 2014/15 return looks at closed referrals during the period for the next tables.
(Note: most of these would’ve come from cases opened in previous year’s results which may skew the comparison a little – this is due to safeguarding enquiries which run for a period of weeks to months & were not signed off at the end of the accounting period).
|Percentages – Abuse Types||2009/10||2010/11||2011/12||2012/13||2013/14||2014/15|
Table 5: Abuse types (%) 2014/15
The top 4 categories of abuse remain the same being neglect, physical, emotional/psychological and financial. The percentages were very similar for these for categories with a range of 22% – 24% for 2013/14. However, for 2014/15 the same four categories cover a much larger range of 18-29%:
Financial abuse as reported has been declining over the last 3 years – from 27% in 2012/13 to 18% this year.
Neglect as reported has increased over the same 3 year period from 21% in 2012/13 to 29% this year.
Figure 7: Types of abuse 2009/10 – 2014/15
From 2015/16, there are four new categories of types of abuse to be added to the national data collection (domestic abuse, sexual exploitation, modern slavery and self-neglect). Some of these categories may already be recorded under the headings previously recorded, so this may impact on comparable data for next year.
Reported organisational abuse has more than doubled from 2% to 5% from last year reflecting an improved identification and investigation process. This increase is also reflected in the increase of abuse reported in Care Home (Res/Nurs) and Hospitals as well as the statistics from reported Alleged Perpetrator which also shows an increase in abusers from Social Care Support.
Figure 8: Location of safeguarding referrals 2014/15
Table 6 below shows the types of abuse recorded against the location/setting of the referrals. The most common location/setting is known to take place in an individual’s own home by someone known to them.
|Percentages – Location/Setting||2009/10||2010/11||2011/12||2012/13||2013/14||2014/15|
|Care Home (Res/Nurs)||14%||16%||15%||14%||17%||21%|
|Own Home (inc supported accomm)||68%||63%||66%||70%||65%||57%|
|Service within Community (commissioned service in community setting)||3%||3%||1%||1%||2%||3%|
|Other (public places/homes of other people)||11%||12%||10%||10%||11%||10%|
Table 6: Location/setting of safeguarding referrals 2014/15
Most alleged abuse occurred in “Own Home” (57%) although this is decreasing year on year since 2012/13.
Alleged Abuse in Care Homes and Hospital locations has shown an increasing trend over the same period from 14% in 2012/13 to 21% this year in Care Homes and from 5% in 2012/13 to 9% this year for Hospitals.
This may not mean that more abuse is occurring within these institutions but may just be that recording/reporting of incidents has improved.
Figure 9: Location/setting of abuse 2009 – 2015
The majority of alleged abusers are – known individual (55%) as in previous years, although this is showing a declining trend in the last 3 years.
Social Care/Support/Services Paid – has been increasing over the last 4 years from 19% in 2011/12 to 38% this year, which links in with the increase we have seen in care home abuse.
Unknown Individual – has been decreasing over the last 4 years from 22% in 2011/12 to 7% this year.
|Percentages – Source of Risk||2009/10||2010/11||2011/12||2012/13||2013/14||2014/15|
|Social Care/Support/Services Paid (contracted or commissioned)||20%||21%||19%||21%||29%||38%|
|Other – Individual Known||56%||63%||60%||61%||59%||55%|
|Other – Individual Unknown||24%||16%||22%||17%||12%||7%|
Table 7: Source of referral 2009 – 2015
Figure 10: Source of referral of abuse 2009 – 2015
Below are two graphs breaking down the relationship of the alleged perpetrator in more detail.
Figure 11: Alleged perpetrator social care support 2014/15
Figure 12: Alleged Perpetrator non-social care support 2014/15
A case conclusion is the outcome of the investigation for a concluded referral and is categorised as Substantiated, Partly Substantiated, Inconclusive (or Not Determined) or Not Substantiated. The decision around substantiation is based on the ‘balance of probabilities’. If an allegation of abuse can be proved on the balance of probabilities then it can be categorised as substantiated.
Table 8 below shows the case conclusions for concluded referrals in Reading for 2014-15.
Figure 13: % Case conclusion of completed referrals 2014/15
This is no longer being counted in the return after this year. 2016/2017 will be looking at Making Safeguarding Personal outcomes.
|Percentages – Case Conclusions||2009/10||2010/11||2011/12||2012/13||2013/14||2014/15|
|Substantiated – fully||38%||50%||42%||42%||44%||38%|
|Substantiated – partially||1%||8%||13%||24%||23%||24%|
|Investigation ceased at individuals request
(new for 13/14)
Table 8: % case conclusion 2009 – 2015
Most cases were Substantiated fully (38%) although this is a decrease on last year’s 44%.
Inconclusive has increased over the last 3 years from 4% in 2012/13 to 13% this year.
Figure 14: Case conclusions 2009 – 2015
This is a new question added to the SAR from 2013/14. Not Recorded is a new categorisation added for this year (2014/15).
Figure 15: Assessed and lacking capacity 2014/15
36% of those lacking capacity were provided with support from social services.
|Percentages – Capacity||2013/14||2014/15|
|Yes assessed and lacking capacity||1%||18%|
|No not assessed – has capacity||45%||48%|
|Not recorded (new for 14/15)||17%|
Table 9: Capacity (%) 2013/14 – 2014/15
Most recorded as “Having Capacity” – 48%, similar to last year.
Those lacking capacity has increased from 1% to 18% – we believe this to be better recording and understanding of this question from when it was introduced last year.
“Don’t knows” decreased significantly from 54% last year to 17% (although an additional 17% were not recorded at all this year).
We expect this picture will continue to improve next year as renewed training on Mental Capacity Act (MCA) takes effect. Health planned and delivered a conference for the Thames Valley area in Autumn 2015 to promote the MCA and the application to practice.
Figure 16: Assessed and lacking capacity 2013/14 and 2014/15
The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards are designed to protect people who can’t make the decisions for themselves or who lack the mental capacity to do so.
A Deprivation of Liberty (DoL) refers to a legally sanctioned restriction of an individual’s freedom such as physical restraint or constant supervision and monitoring. DoLS are a set of legal requirements which ensure that individuals are only deprived of their liberty in a proportionate way; providing protection for individuals in their Best Interests. The safeguards relate to adults aged 18 and over, lacking decision specific capacity and whose liberty is restricted in a hospital or registered care home. A DoL is a function of the Mental Capacity Act.
Each individual for whom an application is made for a DoL must have a best interest assessment which incorporates both medical (approved to assess under S.12 of the Mental Health Act) and social care (qualified Best Interests Assessor – BIA) components. In cases of unsupported individuals, where information cannot be collected from an independent source, an Independent Mental Capacity Advocate is involved. This information is considered by the BIA who then decides the duration of deprivation and conditions, which are then authorised by the Local Authority known as the Supervisory Body.
There are 6 criteria which must be considered in relation to all DoLS applications before authorisation can be sought5:
The Supreme Court ruling of 19th March 2014 introduced the ‘acid test’ for consideration of restrictions. In summary previously a restriction would need to be considered on its intensity and duration as to whether or not it was considered a deprivation, the issue of the subject’s objection was also key to this. Now it is based more on the level of intrusion into and/or control over a person’s life, rather than the impact of those factors.
It was this judgment which changed the eligibility for DoLS and resulted in the steep increase in referrals.
Therefore a person is deprived of their liberty if:
Significantly, the ruling has now clarified that the principles of Deprivation of Liberty (DoL) apply to people living in the community, but the Deprivation of Liberty Safeguards only relate to people in Registered Care Homes and Hospitals.
Any issues relating to people in the community who lack capacity must be referred to the Court of Protection (CoP), until and unless the Deprivation of Liberty Safeguards legislation is changed to cover people in the community.
The Law Commission is undertaking a review that may include incorporating community-based DoL into the Safeguards. The Law Commission’s Review is due to report back to central Government in the Spring of 2017.5
The chart below shows the number of DoLS applications that were authorised in 2014/15 following the change in legislation.
Figure 17: Number of DoLS standard authorisation applications 2014/15
During 2013-14 in England, 13,000 DoLS applications were completed, this was a 10% increase compared to the previous reporting year (11,900 applications). The number of applications has increased every year since the introduction of DoLS in 2009.5
In 2013-14, there were on average 31 DoLS applications completed for every 100,000 people in England. There are some variations in this rate at regional level which may suggest differences in demographics or regional interpretation of the legislation. London had the lowest (16) whilst East Midlands had the highest (52) rates of applications per 100,000 people. These rates had remained similar over the previous 3 years. The figure above, of 31 DoLS applications per 100,000 people in England refers to the total number of DoLS applications made in that period including all instances of multiple applications for the same person. There were applications made for 9,400 individuals in 2013/14. This total gives the proportion of 23 out of every 100,000 men and 22 out of every 100,000 women in England who were the subject of DoLS applications.5
In Reading there were 8 DoLS applications in 2013/14 which equals 5 for every 100,000 population (among the very lowest rates per capita in the country). This contrasts with the figure of 419 which were received in 2014/15 or 279 per 100,000. This data demonstrates the very large increase of applications received in the year 2014/15 following the Cheshire West ruling.
Figure 18: Application authorisation granted/ not granted 2013/14 – 2014/15
In Reading, of the 419 applications received in 2014/15, 212 were granted (nearly 51%).
The two graphs below highlights that 78% of the DoLS cases at start are for those aged 65 and over and 64% are for females. This is because DoL cases primarily relate to older people with dementia and women live longer than men. Figure 21 below shows that a large proportion of DoLs are for those with dementia which also explains the higher percentage of 65+ applications.
Figure 19: Age at case start 2014/15
Figure 20: DoL applications by gender 2014/15
85% of applications are white ethnicity and a very small percentage of applications are received from other ethnicities.
Figure 21: DoL applications by ethnicity 2014/15
The graph below shows 70% of DoLS are for those with dementia, 21% have a learning disability, followed by a small % with other physical and mental health needs.
Figure 22: DoL applications by disability 2014/15
In estimating the future impact of DoLS referrals, based on previous RBC data the following assumptions have been made:
Number of potential DoLS applications within Reading (March 2015)
|Number of residential and nursing home beds within boundaries (Older people)||779|
|Less 20% commissioned by OLA (therefore RBC not the Supervisory Body)||715|
|80% of the remaining beds||572|
|LD Residential beds – 88 (assume 50% may lack capacity)||44|
|Total potential DoLS applications||616|
Table 10: Potential DoL applications within Reading 2014/15
NOTE: any authorisations granted can only be for an absolute maximum of a year so, unless a large number of new homes are provided, the numbers will remain fairly constant each year for those in residential homes. Whatever the period of authorisation, a further assessment must take place before the authorisation expires.
Number of RBC-funded people supported in Care Homes outside Reading (March 2015)
|Number of older people (assume 80%)||61||48|
|Number of people with a Learning Disability (assume 50%)||65||33|
|Number of people with Mental Health Issues
(less likely to lack capacity so assuming low numbers would lack capacity)
|Total potential out of area DoLS applications||83|
Table 11: Potential DoL applications outside Reading 2014/15
The estimated number of applications RBC should therefore receive is 699 per annum. However, approximately 20% of current authorisations are for less than a year. It is usual for those 20% to be fairly short-term; approx. 2 months. This increases the number of re-assessments required throughout the year by around 139.
Therefore the total possible number of assessments for people in a care home is 838 per year. 838 applications per year amounts to 16 applications per week (using 52 weeks per year).
Although this number does not include applications from hospitals, this estimate is believed to reflect a much higher number than reality especially when comparing to figures now available for 2014/15 of 419. Since these figures were produced in March 2015 by the SAT Team Manager 183 people in care homes have been assessed reducing the number further. Unfortunately, we are working to a “best guess” until we can establish more facts around Reading’s circumstances.
This report will therefore split the difference between 838 (estimate) and 419 (last year’s figures) by dividing 419 in two (209) and adding to 419 as a guide. This new figure equals 628. 628 referrals a year equates to 52 assessments per week.
The aim is to prevent escalation – this is the responsibility of us all – our duty of care. Much of adult abuse is hidden and goes unreported so awareness of adult abuse still needs to be raised.
It is evident that the number of alerts and referrals are increasing. This is positive as it means that safeguarding adults is being recognised by all professionals and agencies.
The SAB Board recognise the data and trends and have set the priorities for 2015-16:
Priority 1 – Establish effective governance structures, improve accountability and ensure the safeguarding adults agenda is embedded within relevant organisations, forums and Boards.
Priority 2 – Making Safeguarding Personal.
Priority 3 – Raise awareness of safeguarding adults, the work of the Board and improve engagement with a wider range of stakeholders.
Priority 4 – Ensure effective learning from good and bad practice is shared in order to improve the safeguarding experience and ultimate outcomes for service users.
Priority 5 – Co-ordinate and ensure the effectiveness of what each agency does.3
Whilst nationally local authorities have had a duty to respond to the increased number of those eligible for DoLS assessments, very little additional funding has been made available from central government. The changes are a result of case law rather than local policy and Reading Borough Council, like every other Council has had to absorb the additional costs using existing resources.
There has been a significant increase in DoLS activity from 2013/14 to the 12 months from April 2014 – March 2015. Despite the information provided to the provider sector regarding this, there is likely to be a significant number of outstanding referrals that RBC must continue to seek through provider forums, Safeguarding Adult Partnership Board and other means of engaging providers.
Reading will be required to provide adequate resources into safeguarding adults to manage the increase in alerts and referrals to the service.
There are a number of referral increases since the change in legislation in April 2014. Reading needs to increase the number of Best Interest Assessor (BIA) qualified workers which means further training of our social workers directly employed by the Council in order to manage the increase in applications.
Reading has a statutory duty to ensure that appropriately trained professional staffs are available to undertake the range of assessments required under the Regulations.
Health and social care providers across Reading Borough Council area are committed to ensuring that those people who use their services, and who lack capacity to make relevant decisions, are provided with high quality care from a trained and competent workforce that appropriately applies the Mental Capacity Act in day to day practice.
To achieve this aim, Reading Borough Council social care and health providers will apply the Mental Capacity Act Code of Practice, as well as agency/service specific procedures and guidance, to best ensure compliance with the legislation.5
West of Berkshire Safeguarding Adults Board http://www.sabberkshirewest.co.uk/
West of Berkshire Safeguarding Adults Board Annual Report 2014-15
Safeguarding Adults Return, Annual report, England 2013-14, Experimental Statistics http://www.hscic.gov.uk/catalogue/PUB15671
DoLS/ MCA Activity Report 2014/15
Care Act 2014http://www.legislation.gov.uk/ukpga/2014/23/contents
Reading Borough Council Safeguarding Adults Annual Summary 2014/15
Reading LSCB, in conjunction with the West of Berkshire Safeguarding Adults Board, have produced a safeguarding film to raise awareness of safeguarding issues for children and adults and how to report a concern.
Follow this link to view the film: Reading Safeguarding Video – with subtitles. Different download options are available, click on the ‘Clip Info/Download’ button to select.