No Secrets (Adult Protection)

No Secrets (Adult Protection) is a UK Government publication guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse (Adult Protection).^[1]

The Department of Health website states that

"This document gives guidance to local agencies who have a responsibility to investigate and take action when a vulnerable adult is believed to be suffering abuse. It offers a structure and content for the development of local inter-agency policies, procedures and joint protocols which will draw on good practice nationally and locally."

History of no secrets

The No Secrets (England) and In Safe Hands (Wales) documents were issued as guidance in 2000, under section 7 of the Local Authority Social Services Act 1971. Section 7 guidance does not carry the same status as legislation; instead local authorities have their compliance assessed as part of a statutory inspection process. With ‘good reason’ a local authority can ignore such guidance.

Recent Adult protection failures

There have been several notable cases where severe harm and even death have occurred as a result of local agencies not acting in accordance with the "No Secrets" guidelines some of which make quite harrowing reading one particularly gruesome murder of a young man with learning difficulties (Developmental delay) ^[2].The Cornwall Adult protection committee serious case review^[3] into Mr Hoskins death referred to no secrets saying "What is striking about the responses of services to Steven’s circumstances is that each agency focused on single issues within their own sectional remits and did not make the connections deemed necessary for the protection of vulnerable adults and proposed by No Secrets (Home Office/ Department of Health 2000)2. ^[4].

Reasons for such failures

The main reason for these and other failings (Stafford District General Hospital^[5], Margaret Panting^[6], are the fact that these are the only Government documents addressing the development of multi-disciplinary structures for adult protection, and they are only guidelines. although the Association of Directors of Social Services ^[7] brought out what was essentially a best practice guide called ‘Safeguarding Adults'^[8] in 2005. Existing legislation only relates to paid social care. The majority of abuse happens in people’s own homes, often perpetrated by family, friends or neighbors. Which means only guidance exists to protect the majority of older people experiencing abuse. The majority of elder abuse occurs within the community, and specifically within people’s own homes and is often perpetrated by family members and relatives. In legislative terms however the primary thrust of Government protective policy has focused upon the much smaller number of people in receipt of social care, and this has been regulated primarily through the Care Standards Act 2000 and more latterly the Safeguarding Vulnerable Groups Act 2006. Abuse within the community, unless perpetrated by paid domiciliary workers, is addressed through the No Secrets guidance.

More reasons for failure

The guidance has been effective in facilitating the creation of some form of adult protection system in all local authority areas, it has failed to deliver on a number of important issues, e.g.there is a lack of consistency and equality across areas in terms of the construction and level of adult protection systems provided, there is variable collaboration across statutory agencies, there are significant funding and staffing deficiencies in many areas, there is no consistency in the timing and duration of investigations, and there is no power to ensure access to victims, or to ensure safe outcomes. Lack of legislative underpinning - major reason for the inconsistent application of the ‘No Secrets’ guidance. ?Organizations and individuals firstly do what is legally required of them (their statutory duty), and only as a secondary activity consider those matters that fall into the category of a ‘statutory power’ i.e. what they are authorized but not compelled to do. It is argued that there is insufficient funding, and Adult protection work minimal. Some statutory agencies may invest what is necessary to maintain a skeleton response, with other agencies perceiving the work to be optional.

Final Criticisms and a proposed way forward

Another criticism is personalisation -empowering people’s choice and control over care through the provision of direct payments or individual budgets^[9] – no effective safeguards being pre-planned or proposed -by accepting a personalisation package someone loses the automatic safeguards of the Care Standards Act 2000 and the Safeguarding Vulnerable Groups Act 2006 systems become optional. There are still many discrepancies with some agencies providing clear policies and procedures^[10] and others only functioning at a very basic level

There is an amendment to the guidelines due to be published in September 2010.

What is hoped for by many agencies, is:-

• 1.) A statue for Adult Protection Committees-
• 2.) A duty on agencies to collaborate, actively participate at a senior level in committees, and work together
• 3.) A duty on agencies to share information.
• 4.) The right to access the adult at risk, without obstruction and data to inform policy planning.
• 5.) Adequate funding for adult protection work

References

1. ^ http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationsPolicyAndGuidance/DH_4008486 Link to UK Department of Health "No secrets" Guidelines.
2. ^ http://www.dailymail.co.uk/news/article-461727/Man-learning-difficulties-tortured-forced-viaduct-death.html Steven Hoskins, Man with learning difficulties 'tortured and forced off viaduct to his death'
3. ^ http://www.towerhamlets.gov.uk/idoc.ashx?docid=1fd6e027-7ef4-4a08-bf58-e55141b79c5b&version=-1 The Cornwall Adult protection committee: The Murder of Steven Hoskin, A Serious Case Review
4. ^ Steven Hoskins
5. ^ http://www.telegraph.co.uk/health/healthnews/5030012/Staffordshire-hospital-scandal-the-hidden-story.html Staffordshire hospital scandal: the hidden story
6. ^ http://safeguardingadultsforum.co.uk/docpload/18112009321312-~-Case_review_in_respect_of_MP%20fire%20and%20rescue.DOC Margaret Panting
7. ^ http://www.adass.org.uk/ Association of Directors of Social Services (ADSS)
8. ^ http://www.adass.org.uk/index.php?option=com_content&view=article&id=522:safeguarding-adults-key-documents&catid=125:safeguarding-adults-&Itemid=406 Safeguarding Adults
9. ^ http://www.direct.gov.uk/en/DisabledPeople/financialsupport/DG_10016128 direct payments or individual budgets
10. ^ http://www.staffordshire.gov.uk/health/care/reportingabuse/ policies and procedures

External links

• dh.gov.uk: Department of Health No secrets documentation