Written - Protection of Vulnerable Adults

This written statement is to inform Assembly Members about the Adult Protection Project Group that the Welsh Assembly Government has established to review our vulnerable adults protection policies and measures to ensure that they remain appropriate and robust.

For the purposes of this written statement “vulnerable adult” means a person over 18 years of age who is or may be in need of health or social care services because of mental or other disability, age or illness and who is or may be unable to take care of himself or herself, or unable to protect himself or herself against significant harm or serious exploitation.
The abuse of vulnerable adults is sadly not a new phenomenon, but it is an area that the Welsh Assembly Government will not be complacent about. The understanding of adult abuse and how to tackle it is still at a relatively early stage of development. In recent years there has been a growing awareness of and better understanding of the problem, due in part to better reporting, recording and monitoring arrangements as well as published research findings. Older people and their families are also much more confident in speaking up about these matters. Many of these issues are highlighted in the Annual Report of the Care and Social Services Inspectorate in Wales, which we debated in Plenary in January.

Through growing awareness, more people can now identify cases of treatment of people in care settings as being abusive and falling under the adult protection arrangements. More people are willing to and know how to make referrals to local adult protection arrangements so that investigations can take place. In previous years these matters might not have been identified as adult abuse or have been referred to be dealt with through employers’ staff conduct arrangements or through complaints procedures.

A better understanding of adult protection issues is rightly leading to a more open and fuller debate about how these matters should be addressed.

Tackling adult abuse is not just a matter for the Welsh Assembly Government, service providers, statutory authorities, regulatory bodies, or the police to deal with. All citizens and organisations have a role to play in protecting vulnerable adults from abuse wherever and whenever it occurs.
Nevertheless, the focus for the Welsh Assembly Government has to be those areas falling within our devolved powers and responsibilities. That is why for the purposes of this statement we are defining vulnerable adults in the context of those receiving or may be in need of health and social care services.

Our main guidance on adult protection is ‘In Safe Hands’. That statutory guidance identifies local authorities as having the lead responsibility for developing and coordinating local adult protection arrangements. In fulfilling this role, local authorities need to work closely with a number of other agencies, including commissioners and providers of health and social services; providers of sheltered and supported housing; regulators of services; the police and other law enforcement agencies and voluntary and private sector agencies. Every part of Wales already has had local adult protection arrangements in place for a number of years.

We have also introduced measures to further strengthen these local adult protection arrangements. Local authorities have appointed adult protection coordinators, there has been extensive training throughout Wales, and we have established monitoring arrangements. We have also used our powers under the Care Standards Act 2000, to require certain care settings such as care homes, adult placement schemes, domiciliary care providers and private hospitals to be regulated by the Care and Social Care Inspectorate Wales or the Healthcare Inspectorate Wales. Last year we created the Care and Social Services Inspectorate Wales to give us a more integrated view of services from commissioning through to individual planning and the service itself. We have also actively supported the UK Government in developing and implementing non-devolved measures such as the establishment of the list of people who are unsuitable to work with vulnerable adults and accordingly banned from such work.

However, we will not be complacent in fulfilling our adult protection responsibilities. Our developing understanding of abuse and how to tackle it, the changing needs of people using social care services, for example the rise in the numbers of frailer older people receiving complex and often multi-agency packages of support makes now an appropriate time to take stock. We have therefore established an Adult Protection Project Board to consider and report on the effectiveness of our adult protection policies both those in place or still being developed to ensure that they are appropriate and robust.

The terms of reference of this new Adult Protection Project Group are:

• To review the effectiveness of present adult protection and other relevant policies/legislation in ameliorating the risk of abuse in the light of emerging information from recent cases in Wales and to assess and report on where improvements could be made.
• To review the effectiveness of policy in respect of the present Care Standards Act regulatory and national minimum standards frameworks as they relate to adult protection and to assess and report on where improvements could be made.
• To identify and scrutinise all existing work streams across the Health and Social Services Department that have the potential to improve or re-enforce the effectiveness of the protection of vulnerable adult arrangements including the role of GP’s and community health staff.
• To review and assess the existing evidence on the prevalence and risks of abuse of vulnerable adults and as necessary to commission further research.
• To review the existing adult protection incident reporting and other information systems, and to assess and report on where these systems could be improved.
• To assess and report on the implications of implementing any improvements to the existing protection of vulnerable adults arrangements.
• To provide progress reports on a regular basis to the Minister and the Deputy Minister for Health and Social Services

In establishing this Project Board, we have sought to ensure that its membership is appropriate to fulfill its tasks. The membership of the Project Group is:


Bob Hudson (Chair), Director of Strategic Direction and Planning, DHSS, Welsh Assembly Government
Mick Collins, Chair of Dyfed Powys Regional Adult Protection Forum
Richard Warrilow, Chair of South Wales Regional Adult Protection Forum
T Gwyn Jones, Chair of North Wales Regional Adult Protection Forum
Liz Majer, Chair of South East Wales Regional Protection Adult Protection Forum
North Wales Police representative
Association of Directors of Social Services representative
Dr Tony Jewell, Chief Medical Officer, Welsh Assembly Government
Rosemary Kennedy, Chief Nursing Officer, Welsh Assembly Government
Rob Pickford, Chief Inspector, Care and Social Services Inspectorate Wales, Welsh Assembly Government
Steve Milsom, Acting Director, Older People and Long Term Care Policy, DHSS, Welsh Assembly Government
Peter Lawler, Acting Director, Community, Primary Care and Health Service Policy, DHSS, Welsh Assembly Government
Ian Stead, Director, NHS Human Resources, DHSS, Welsh Assembly Government
Dr Peter Higson, Chief Executive, Healthcare Inspectorate Wales, Welsh Assembly Government

In undertaking its work I anticipate that the Project Group will consider a range of policies currently being developed or reviewed. These include:

• new draft Statutory Guidance on Escalating Concerns for Care Homes;
• new draft statutory Guidance to local authorities and local health boards authorities on the commissioning of services;
• our new programme on ‘Dignity and Respect in Care’ and the role it might play in protecting older people from abuse; and
• adult protection measures contained in the Care Homes Regulatory and National Minimum Standards regimes and whether they remain fit for purpose; and
• in the light of the outcomes from the work on Regulation of Care Homes, to consider whether the adult protection measures in the Domiciliary Care and Adult Placement Regulatory and National Minimum Standards regimes need any further strengthening.

I also anticipate that the Project Board will consider other issues such as:

• whether our ‘In Safe Hands’ guidance and the arrangements supporting its implementation remain appropriate and robust;
• the potential role the Commissioner for Older People could play in protecting older people from abuse. Acknowledging that the Commissioner is fully independent and will set her own agenda;
• the outcomes from the Care and Social Services Inspectorate Wales’ planned thematic inspection of local authority adult protection arrangements to be undertaken in 2008-09;
• the role of General Practitioners and other community based NHS staff (whether directly provided or contracted services) in local adult protection arrangements; and
• the role that the Social Services Improvement Agency and the National Leadership and Innovation Agency for Healthcare could have in supporting the effective delivery of local adult protection policies and procedures.
• the Wales and England/Wales adult protection primary and subordinate legislative context to see what changes could be recommended.

At its meeting on 26 February, the Adult Protection Project Group will consider the full scope of its work programme and its timetable to report back to the Minister for Health and Social Services and myself on these matters. I will report to Assembly Members on the outcome of the work of this Group, when it is completed later in the year.