My Lords, I declare an interest as the family carer of an adult man who has publicly funded care and support.
My noble friend Lord Rix and I have tabled eight amendments in this group which together aim to strengthen the safeguarding section of the Bill, Clause 41 and accompanying Schedule 2.
I know that Mencap and others welcome the focus that the Bill gives to safeguarding. At Second Reading, my noble friend said that he regretted the lack of a duty on providers or relevant partners to inform the local authority when they suspect that an adult is at risk. The Minister replied:
“The local authority duty is to make inquiries to decide what action should be taken. One such form of action is to assess the adult’s needs … where it appears, ‘that an adult may have needs for care and support’”.—[Official Report, 21/5/13; col. 830.]
However, Mencap and others remain concerned about the lack of a duty on all providers and relevant partners to advise the local authority that there is a need to assess.
We need not look too far into the past to find examples of failings. The serious case review looking at the deaths of Francesca Hardwick and her mother Fiona Pilkington found that safeguarding procedures had failed. Likewise, at Winterbourne View hospital, it took a whistleblower with a hidden camera to expose the abuse and get the authorities and police to take action. We need to get this right and, while the Bill improves on what we have, these amendments would create watertight legislation that provided the level of protection that vulnerable people need.
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On Amendment 92ZD, it is critical that local authorities take the action to protect people from all forms of abuse and the Bill must reflect this. Currently, only financial abuse is defined. The rationale might be that others types of abuse are better understood and will be set out in the guidance, but this means that the clause looks a bit lop-sided. The amendment would add in the different types of abuse as listed in the No Secrets guidance; for example, physical, sexual, psychological, neglect and so on. It also includes an “other” category to allow for the list to be expanded on in the guidance if necessary so that there are no concerns that it will be considered an exhaustive list, which could have unintended consequences.
Amendment 92ZE is necessary because it is important to have it clarified that abuse is not always deliberate; it may be perpetrated as the result of negligence or
ignorance. This point is of such importance that it warrants being in the Bill. The wording of this amendment is again taken from the No Secrets guidance.
I turn to Amendment 92ZZAH. Clause 41 is not clear about where the abuse and neglect have to happen for the local authority to make inquiries. A small addition here would make it explicit that we are talking not just about social care settings but about all settings. This is important, as there can be a tendency to view hospitals as safe places, but the tragedies of Winterbourne View and Mid-Staffordshire tell us otherwise.
I turn to Amendment 92ZF. The Bill introduces a duty on the local authority to make inquiries when it suspects that an adult is at risk of, or experiencing, abuse or neglect. However, there is no duty on other agencies to report to the local authority when they suspect that an adult is at risk of, or experiencing, abuse or neglect. This is a gap. Currently, guidance provides information to help agencies make a judgment about whether they should refer concerns to the local authority. There are also requirements on providers to notify CQC of concerns and to have suitable arrangements in place to ensure that people are safe, but this does not go far enough. There must be a duty on all relevant partners of the local authority, including providers of relevant services such as social care, health and housing, to report to the local authority when they think that an adult is at risk of abuse or neglect. The Welsh Bill includes such a duty, and we could do worse than replicating it. Indeed, in the Welsh Bill there is a whole clause devoted to:
“Duty to report adults at risk”.
It may be that inserting a new clause, such as that proposed by an amendment tabled by the noble Baroness, Lady Greengross, would be appropriate. I look forward to the Minister’s views on this matter.
The Bill quite rightly allows safeguarding boards the ability to decide how to meet its objectives. Amendment 92ZC suggests that it is crucial that regulation and guidance set standards for investigations. It would require the Secretary of State to set out in regulation and guidance the thresholds for investigation together with the process. Such a move would bring much needed clarity for agencies as to roles and responsibilities as well as faith in the safeguarding system for families.
Currently, it is not always clear what is and is not a safeguarding concern. For services supporting people with challenging behaviour, we know that there are issues about overuse of restrictive practices. There is wide variation regarding when restrictive practices are identified as safeguarding concerns. The serious case review into Winterbourne View said:
“It is shocking that the practice of restraint on a … daily basis was not identified as constituting abuse by any professional”.
Once reported, it is crucial that there is a proportionate response. The threshold for investigation currently differs greatly between local areas. A safeguarding panel in one area, with a limited understanding of restraint, may not take a concern seriously whereas another local area may take action. There is also a lack of connection between agencies. The serious case review into Winterbourne View found that there had been plenty of warnings that something was seriously
wrong: 40 safeguarding alerts, 29 incidents where the police were involved and 78 attendances at A&E. However, information did not flow between agencies: action was not taken. Essentially, they all believed that someone else was looking. Roles and responsibilities must be clear and regulation needs to place emphasis on the importance of timescales so that concerns are investigated in a timely manner.
Turning to Amendment 92ZB, it is vital that, where appropriate, an advocate is available to support vulnerable adults who are going through safeguarding inquiries. It may be a traumatic time and it is important that individuals get the support they need to speak up. They may also need help to ensure that the inquiry and follow-up actions properly address their needs.
Amendments 92ZG and 92ZH amend Schedule 2. In addition to improving processes, we must also ensure that lessons are learnt. Schedule 2 sets out the parameters for how safeguarding adults boards should operate. There is much to welcome here, but we should go a little further. First, the annual reports compiled by each board should not only include findings of reviews but what actions have been taken to implement recommendations from the reviews. It is crucial that we learn from failings and that practices change. Secondly, I would like to request that the Secretary of State be added to the list of those who must be sent a copy of the safeguarding adults board’s annual report. Collating these would provide the Government with the national picture and allow the effective monitoring of trends as well as the ability to share good practice.
In conclusion, there is, as I mentioned earlier, much to be welcomed in the Bill’s focus on safeguarding. These amendments are simply designed to complement and strengthen what is already there and I look forward to the Minister’s response. I beg to move.