Protection to Empowerment?                                                                              From Vulnerability to Safeguarding

FROM PAVAUK TO PASAUK

Back in 1997 when PAVA was conceived in a Birmingham Hotel Conference Room the language we used; the framework we adopted in how we thought about protection and abuse; vulnerability and risk, led to a focus on practitioners. Informed by Jackie Pritchard, Professor Olive Stephenson, Claudine McCready and others. It was based and informed by limited research and the consideration of dilemmas for practitioners and the almost negligent and lack of any serious governmental national or local guidelines. This was the back drop to the creation of the Practitioner Alliance Against Abuse of Vulnerable Adults (PAVA).

There were few policy drivers at the time; even fewer champions that brought together practitioners from across all adult services. Some of us had been involved in the early days of Action on Elder Abuse (AEA) and others were anxious that abuse, potentially affecting all over 18 year olds, especially those who were vulnerable by virtue of their physical or mental health or learning needs. Elder Abuse was readily acknowledged as a pivotal concern, but equally we were anxious about the then medicalisation of elder abuse research; the dominance of a health and social care parodying in understanding vulnerability, risk and abuse. ‘All our Tomorrows’ is the iconic ADSS Triangle of Care which was six years away; ‘Quality of Life for Older People’ seven and a ‘National Framework for Standards for Good Practice and Outcomes in Adult Protection Work’ eight! No Secrets’ and ‘In Safe Hands’ reviews and latterly the Scottish legislative framework, a decade in the future!

The notion of paternalistic and patronising responses to dependency, vulnerably and risk, in hindsight underpinned our thinking and hence practice. The notion of engagement; empowerment and safeguarding, whole systems; Transformational Government; criminal justice; human rights; mental capacity and inter dependence have separately and collectively both challenged and informed today’s guidance and practice. The challenge and opportunities inherent in Personalisation generally and personal budget specifically exercises safeguarding practice in 2010.

It has long been accepted that safeguarding and protection is, at the end of the day, a neighbourhood or whole community responsibility, and as the Care Quality Commission Safeguarding Protocol states “depends on the everyday vigilance of all people who play a part in the lives of children or adults in vulnerable situations”. The notion that being vulnerable is not necessarily a permanent state; that we all move in and out of vulnerable situations throughout our life course and has increasingly become recognised since the late 1900’s. In addition to communities having a responsibility in safeguarding, so do regulated services, health and social care providers, criminal justice personnel and all have a collective responsibility to protect and promote our human rights.

In the recent Reviews of ‘No Secrets’ and ‘In Safe Hands’ the general conclusion was that whilst they may have been “groundbreaking in 2000” (debatable!) nevertheless they are, ten years later, fragile, inappropriate and ineffective. They fail to adequately reflect the needs and aspirations of people with mental health problems; BME communities; self-funders; homeless people and this is further compounded by systemic challenges and contradictions. Furthermore, vulnerability, dependency and protection have all been re-defined and re-imagined. Citizenship and empowerment are better reflections of twenty first century public policy.

Both Reviews have emphasised these conceptual changes. Both Reviews re-enforcing Safeguarding, rather than just protection principles, including the pivotal and seminal Mental Capacity Act approach. The need (ney requirement!) to empower people to make their own decisions; balance choice and control, between Regulation and those choices and ‘whose best interests’ are key protected.

How far practitioners are themselves empowered or inhibited in their practice because of inadequate training, poor supervision, abusive managerial decision-making, Siloed’s access to services, organisational cultures that continue to see “command and control” of practitioners as the same thing as effective management of resources are all too frequently the back drop against which practitioners are expected to practice! The very principles of safeguarding thus undermined and compromised.

It is no accident that PAVAUK, by changing its name to PASAUK has not changed its fundamental aim, whereby through empowering practitioners, we contribute to safeguarding adults.

One final comment. Much rightly, has been said about safeguarding principles. Principles of supporting the views and wishes of victims; practice based on consent; the balance between autonomy and protection; inclusive decision-making and all safeguarding being undertaken in the context of citizenship. These principles, and many others, that now shape the policy changes and intentions of current thinking will only take root if and when society think differently about old age and ageing, mental ill health, learning difficulties and disability and the very way our public services are constructed and we are governed.

Dr Mervyn Eastman

President PAVAUK/PASAUK