1. Prevention of abuse Jill Manthorpe Social Care Workforce Research Unit Kings College London Email: jill.manthorpe@kcl.ac.uk

2. Rings of prevention Primary intervention aims to prevent abuse occurring in the first instance Secondary intervention aims to identify and respond directly to allegations of potential abuse Tertiary intervention aims to remedy any negative and harmful consequences of the abuse, and put in place measures to prevent future occurrences

3. Primary prevention Social –Zero tolerance and targeted approaches (research based) –Public and peer education Legal –Crime & Disorder Act 1998 –Trading Standards Welfare –Advice and Information –Mental Capacity Act 2005 – Lasting Powers of Attorney

4. Emerging areas of prevention Human trafficking [Olympics 2012] [Children & Vulnerable Adults exploited as commodities]. Trafficking Toolkit National Referral Mechanism [NRM] [Adults and/or children deemed to be trafficked] Also e-abuse generally

5. The Scope for Safeguarding Adults Prevention Responses Individuals Communities Safer communities initiatives. Service planning for vulnerable groups Community responses to support individuals and groups Investigation and protection planning Empowering person centred approaches Risk assessment and enablement

6. Secondary prevention Social –Changes in Human Rights ethos Legal –New status eg MCA, new crimes, victim rights Welfare –Policies and procedures, investigations, inquiries

7. Example of prevention In Hospital X all grade 3 or 4 pressure sores that occur on the ward or are observed on admission are notified to the Police who visit the ward in uniform to investigate

8. Tertiary prevention Social –Compensation, Legal –Redress, confinement, banning, injunctions Welfare –learning the lessons, SUI, SCR, therapy, perpetrator assistance, peer support

9. Ill-treatment & wilful neglect Mental Capacity Act 2005 section 44 defines ill-treatment and wilful neglect –Criminalises neglect and abuse occurring in a relationship of trust Can include professionals and family carers The offender indulges in behaviour believing the person lacks capacity Serious departures from required standards of treatment that they were aware they were under duty to perform If reported and prosecuted, penalty for criminal offences may be fine and/or a prison sentence for up to five years

10. Balancing prevention Recent judgments under MCA –physical health and safety can sometimes be bought at too high a price in happiness and emotional welfare. The emphasis must be on sensible risk appraisal, not striving to avoid all risk, whatever the price, but instead seeking a proper balance and being willing to tolerate manageable or acceptable risks as the price appropriately paid in order to achieve some other good…What good is it to make someone safe if it merely makes them miserable? (Re MM 2007)

11. Some conclusions Little evidence on prevention but emerging Role in collecting evidence Need for common languages What are we trying to prevent? And what are desired outcomes?

12. Disclaimer This presentation presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1005). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.