It is now over ten years since the Adult Support and Protection Act (ASPA) became law in 2007. As someone involved in its early stage development and roll out it is amazing to think that ten years has passed. Scottish Care was funded at the time to develop a programme of training and support, called ‘Tell Someone’ , which brought the Act alive for those working in frontline care in care homes and homecare services. It is still a resource which is much used today. Last week the Care Inspectorate, Her Majesty’s Inspectorate of Constabulary in Scotland (HMICS), and Healthcare Improvement Scotland (HIS) published a ‘Joint Inspection of Adult Support and Protection’, the first inspection looking specifically at how well the agencies responsible for keeping adults safe are working together to protect those at risk of harm. The Inspectors looked at a representative sample of six local areas: North Ayrshire, Highland, Dundee, Aberdeenshire, East Dunbartonshire and Midlothian. In each area, they looked at the experiences of individual people, the extent to which key protection processes are in place, and how well local leaders were performing. By and large the Inspectors found that there was evidence in most areas that adults at risk are safer and better supported because of the Act and the supports which underpin it. This is positive news but conversations with those who work in the world of adult protection and safeguarding would caution against over assurance that we have got everything completely right. My concerns are as follows:
- Quite rightly the Adult Support and Protection Act has been lauded as a very solid piece of legislation and it is much envied elsewhere in the United Kingdom. Part of that admiration is that it has a set of overarching and underpinning principles which are firmly rooted in the Human Rights Act. The concepts of ‘least intervention’, of ‘proportionate response’, of ensuring any action ‘benefits the individual’; all of these are squarely human rights principles in practice. However, there is a legitimate growing concern that at times the actual practice of the Act is paying only a passing lip service to the principles which lie at its heart. At best I think we need to do more to assess whether or not we are intervening and utilising the Act in all necessary circumstances and instances. For instance, are we using ASPA within health settings as much as we should?
- When the Act was being implemented a lot of good work was undertaken in the care home sector and that resulted in the development of confidence and skill amongst the care home workforce. My concern is that some of that earlier inclusivity has been lost. Are care home managers and staff as fully included in the implementation of the Act , e.g., in case conferences, in multi-disciplinary reviews, as they might be?
- I am less convinced that there has been sufficient and appropriate attention given to issues of adult protection and safeguarding for our care at home sector. There are real challenges of lone working and being able to identify and act upon concerns of harm. Associated with this is the inevitable issue of resources. As training and learning budgets are being slashed by contractual practice across the country, are we properly equipping our social care workforce in the community to properly understand issues of adult protection, to be able to recognise the signs of harm and to have confidence in knowing what to do if they come across concerns? I am not convinced in all instances that this is the case. It is time for us to do some serious capacity building within specific sectors.
- On a wider front the Act did a lot to try to change the cultural and popular understanding of adult protection. If you look at the legislation and its associated Guidance you will not find the word ‘abuse’. At the time of its development there was a considerable debate on this matter, but the idea won out that ‘harm’ needed to be used as a term to identify a wider range of behaviours than the word abuse described, including actions which were pre-meditated, conscious and deliberate, but also unintentional and unplanned behaviours, such as potentially neglect. I am not convinced that at a popular and societal level this broader understanding of what constitutes harm has gained much ground. That might be because we have failed as a country to properly invest resource in public awareness around adult protection and what constitutes harmful behaviour.
- A related issue is the extent to which despite the Act’s existence for over a decade we have seen a rise in behaviours which have been discriminatory and thus ‘harm-full’. This is especially a concern when we consider the sharp rise in discrimination and hate on the grounds of age. How, one might ask, does the reality of increased discrimination and harm on the basis of age relate to the implementation of the Act when it impacts on someone who is defined as being an ‘adult at risk’?
- At a national level I have expressed a personal concern that we now no longer have an Adult Support and Protection Forum. Up until three years ago this was a body which brought together individuals from diverse sectors with a common purpose for improving practice, disseminating knowledge and advancing the issues around adult protection. Its loss has been a matter of significant concern especially at a time when the lessons of the benefits of national multi-agency co-operation around child protection have become so obvious.
- My final observation about the Act is that, in part because of financial constraint, we have as a society in our practice focussed on only one part of the legislation, namely the ‘protection’ of individuals who might be at risk. This is a real disappointment. The originators of this legislation envisaged the importance that as adults individuals who might require protection would of necessity benefit from ‘support’ to enable them to be free from harm. We have failed to adequately focus on a permissive, enabling approach to safeguarding and perhaps unsurprisingly have concentrated on the ‘protection’ element. This is to miss the primary energy of this ground-breaking legislation. It is to fail to recognise that in our vulnerability we all need support to prevent us from being the object of another’s wish to harm. It is to fail to give equal weight to Adult Support as much as Adult Protection.
We have come a long way in ten years. Practice is on the whole sound. But it is time for us to re-discover some of original intent and energy within the Act and its Guidance and to re-invigorate a system of right’s-based support which fosters true adult protection. Dr Donald Macaskill @DrDMacaskill
