Reducing the risk?

The operation of a barring and vetting scheme in care services in England and Wales

1

Social Care Workforce Research Unit

Introduction

• Background

• The POVA List

• The research

• How to Synthesise Unsuitability

• POVA List implications for concept of vulnerability and risk

Social Care in the UK

• Social care services hard to define• Largely provided by independent sector

(for and not for profit) companies and organisations

• Largely provided by unqualified workers• Public funds directed at people with high

needs and with little money• ‘Self-funders’ get advice and information• State regulates services and workers

Safeguarding

• Personalisation efforts to increase choice and control adds a new dimension to risk concerns

• Risk as a backdrop (McLoughlin, 2007)• Protection of Vulnerable Adults (POVA) List

introduced in England in Care Standards Act (2000), implemented 2004

• Independent Safeguarding Authority introduced by the Safeguarding Vulnerable groups Act (2006)

• Policy unique to UK (Though international concern about adult protection/safeguarding implications

The Protection of Vulnerable Adults (POVA) List

• It creates a list of people, held by the Secretary of State, who are considered unsuitable to work with vulnerable adults in England and Wales (DH Guidance, 2006)

• Mandatory to refer workers dismissed after having harmed or placed at risk of harm

• Mandatory to check if new employees have been barred (illegal to employ)

• Illegal to seek work with ‘Vulnerable Adults’ when barred

POVA Research

Purpose: To inform developments in the operation of the POVA List

1. What are the commonalities & differences in a sample of referrals to the POVA list?

2. What factors are associated with decisions to put staff onto the POVA list?

3. How are decisions made about whether to put staff on the list?

6

Methods

• Research question 1&2– Re-analysis of all POVA referrals July 04 –

October 06 (n=5294)– Analysis of a sample of 300 referrals

• Research questions 2&3– Developing 3 vignettes of cases– Discussion groups with older people (14) and

staff (8)– Interviews with POVA team (18)– Participants asked to make judgements, give

reasons and explore ‘suitability’ / ’unsuitability’

7

Synthesising unsuitable people

Initial reaction

Contextual influences

Referral

Case investigation

Reaction and judgement

Evidence gathering

Person Harm

Misconduct

Synthesis

UnsuitableNot unsuitable

Initial reactions

• ScreeningThe way the law stands is... if you can’t establish the misconduct causing harm you cannot look at suitability.

• Initial reaction shapes investigationI think you form a view pretty quickly as to yes or no and you know, but it is emotional and then you think altogether and that is the reasons why it would be yes or no.

Gathering evidence

• Paper exercise• Variable quality• Detecting bias• Sources

– Disciplinary hearings– Care plans– Managers’ and colleagues’ views– Service users’ and relatives’ views– Police investigations

Emotional reaction and moral judgement

• I just get the feel from the nature of the abuse and the sort of other incidents that he is somebody who doesn’t care.

• My view of it is that there are one or two traits here that I personally don’t like the sound of, and therefore I would not employ him and I wouldn’t advise anyone else to employ him but that’s a personal judgement and we are all down to personal judgements in these things

Mitigating factors

• Mitigation for the referred person– Factors about the referred person that alter

the interpretation of the misconduct, to change the overall judgement of unsuitability.

• Mitigation of the misconduct– factors that can explain the immediate

conditions surrounding the incident(s), which support a more positive interpretation of the role of the referred person

Mitigation for the person

The person

Admission of guilt Remorse

Reaction

Age of worker Intentions

Previous good record

Ongoing stress/ mental health

Mitigation of misconduct

Misconduct

Victimisation

Relationships with staff

Staff shortages

Racism discrimination

Immediate stress

Working conditions

Reaction to behaviour of service user

Factors supporting unsuitable verdict

• Types of misconductIt is very important, the worse ones like physical and sexual, I mean I just think you can’t afford to... if you have any sort of evidence there... I just don’t think you can afford to let that go.

• Types of harmI am thinking of one particular case where users didn’t want any more assistance and this lady couldn’t manage by herself but her trust had been shattered by what had happened. So there are issues beyond the financial.

• Patterns of misconductIf we have got an individual with an odd spike here and there then we need to start looking to see if there is a pattern emerging here.

Dimensions of unsuitability

Harm caused

Person (alleged perpetrator)

Misconduct

Building a picture

Person...claims mitigating circumstances that one of them nipped him,

Harmalthough he if you are an old lady being put to bed and someone throws water at you and shouts at you then I think that is emotional harm caused there and I think physical

UnsuitableNot unsuitable

Misconduct…the fact that he [Rob] has shouted and thrown water at a resident when helping them to bed

A judgement of unsuitability

you can’t treat people that way even with mitigating circumstances, I wouldn’t, even if the nip had hurt Rob, I don’t think he should be reacting like that in those circumstances.

POVA end point

• ‘Confirmed on the list’– A national and legal response to abuse/harm– Full glare of publicity– Appeals– Creates an ‘unsuitable person’

• ‘Case closed’– Returns to a less broad level of publicity– Staff record (dismissed, references?)

Conclusion

• Unsuitability created as a relatively fixed trait, solidifying judgements of risk and vulnerability

• Legal, financial and moral consequences• Unsuitable person one of a set of:

– blameable scapegoats; the dishonest, inhumane, disorderly criminal 'others’ to society's truthful, humane, orderly 'self’ (Hollway and Jefferson, 1997: 260)

• Approaches to maintain good decision making• Responding to ‘personalisation and choice’• Individualistic focus – a response to a genuine

dilemma?

20

Contact details

• Martin Stevens– e-mail martin.stevens@kcl.ac.uk; tel 020 7848 1860

• Jill Manthorpe– e-mail jill.manthorpe@kcl.ac.uk; tel 020 7848 1683

• Shereen Hussein– e-mail shereen.hussein@kcl.ac.uk; tel 020 7848 1669

• Jess Harris– e-mail jess.harris@kcl.ac.uk; tel 020 7848 1665

• Joan Rapaport– e-mail Joan.Rapaport@kcl.ac.uk; tel 020 7848 1769

• Stephen Martineau– e-mail Stephen.martineau@kcl.ac.uk; tel 0207848 1694

21