Synthesising unsuitable people:

1. Synthesising unsuitable people: Exploring approaches to barring people from working in social care services. Social Care Workforce Research Unit

2. Introduction • Background • The POVA List • Terminology • The research • How to Synthesise unsuitability • POVA List implications for concept of vulnerability and risk

3. Background • Risk as a backdrop (McLoughlin, 2007) • Increasing policy focus on safeguarding/protecting adults, particularly since the late 1990s • No Secrets (2000) first dedicated Government policy • 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)

4. 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

5. But, we’ve got a lot of lists… • POCA (children) list • List 99 (teachers) • POVA (adult social care) list Independent Safeguarding Authority 2009

6. When to refer to POVA In deciding whether an individual should be referred to the Secretary of State for inclusion on the POVA list, providers of care and employment agencies and businesses must decide whether, in their view, the individual has been guilty of misconduct which harmed or placed at risk of harm a vulnerable adult. DH (2006) Guidance on Protection of Vulnerable Adults Scheme

7. Definitions of vulnerable adult Care Standards Act (2000) • an adult to whom accommodation and nursing or personal care are provided in a care home; • an adult to whom personal care is provided in their own home under arrangements made by a domiciliary care agency; or • an adult to whom prescribed services are provided by an independent hospital, independent clinic, independent medical agency or National Health Service body.

8. Additional definitions The Safeguarding Vulnerable Groups Act, (2006) added • He is detained in lawful custody, • Receives any form of health care • He is by virtue of an order of a court under supervision by a person exercising functions for the purposes of Part 1 of the Criminal Justice and Court Services Act 2000 (c. 43), • He receives a welfare service of a prescribed description, • Receives payments to purchase services

9. Terminology • ‘Adult’ was created as a category of care recipient only recently • Increasingly all people using social care services seen as vulnerable • Protection: seen as connected to paternalism (Slater, 2004) • ‘Vulnerable adults’ • Disabling: suggests a deficit model, • Priveliges individual focus, • Gives social care workers more power? Elder Woodward (2004)

10. POVA Research Purpose: To inform developments in the operation of the POVA List • What are the commonalities & differences in a sample of referrals to the POVA list? • What factors are associated with decisions to put staff onto the POVA list? • How are decisions made about whether to put staff on the list?

11. 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’

12. POVA process Screening Provisional listing ‘Observations’ stage, in which referred persons can put their case and further information can be sought from care providers Submission to the Secretary of State recommending confirmation (or not) A final decision by the Secretary of State/Independent Safeguarding Authority

13. Initial reactions • Screening The way the law stands is... if you can’t establish the misconduct causing harm you cannot look at suitability. • Initial reaction shapes investigation I 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.

14. Gathering evidence • Paper exercise • Variable quality • Detecting bias • Sources • Disciplinary hearings • Care plans • Managers’ and colleagues’ views • Service users’ and relatives’ views • Police investigations

15. 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

16. 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

17. Mitigation for the person Remorse Admission of guilt Previous good record The person Reaction Intentions Age of worker Ongoing stress/ mental health

18. Victimisation Immediate stress Racism discrimination Misconduct Relationships with staff Staff shortages Working conditions Mitigation of misconduct Reaction to behaviour of service user

19. Factors supporting unsuitable verdict • Types of misconduct It 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 harm I 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 misconduct If 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.

20. Dimensions of unsuitability Person (alleged perpetrator) Harm caused Unsuitable Misconduct Notunsuitable

21. Building a picture Harm although 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 Person ...claims mitigating circumstances that one of them nipped him, Misconduct …the fact that he [Rob] has shouted and thrown water at a resident when helping them to bed Not unsuitable Unsuitable

22. 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.

23. Contextual influences Synthesising unsuitable people Referral Initial reaction Case investigation Reaction and judgement Evidence gathering Synthesis Harm Person Misconduct Not unsuitable Unsuitable

24. POVA starting point • Abuse/harm at a certain level of publicity • Incident(s) of harm has taken place within a formal relationship • Worker has been reported to manager • Manager investigated and satisfied • Disciplinary proceedings taken place (usually) • Dismissal or move to a non care position

25. 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?)

26. Conclusion • Balance of individual responsibility and context • Binary outcome • Fixing judgement of risk and vulnerability • ‘Vulnerable Adult’ terminology a semantic or substantive issue? • Silo approach or a justifiable space for action?

27. 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