December 1, 2022
Last Updated on December 1, 2022
One of the most important safeguarding priorities for care organisations should be to create a culture which supports and encourages people to raise concerns. Without this culture, concerns will often go unreported and people unprotected.
Ample evidence for this assertion is found in well-publicised situations where abuse and neglect have only been identified by hidden cameras and the like. The idea that this supportive culture can sometimes be lacking is also reinforced by several surveys suggesting that under-reporting is worryingly widespread:
- In a survey of 1,544 care home staff published in 2018, 14 staff (1.1%) said they had carried out or seen a resident being hit or shaken in the last three months. 219 (14%) said the same for a resident being shouted at, insulted or spoken to harshly. The survey can be downloaded here.
- In a survey of nursing and care staff in five newly opened nursing homes, published in Nursing Times in 2017, 88% of staff who returned questionnaires said they had witnessed or suspected abuse in homes where they had worked previously.
- In a 2015 survey by Healthwatch Oxfordshire across a wide range of local health and care services, 10.8% of respondents said they had seen or witnessed abuse, of whom less than half said they had reported it.
Paying attention to safeguarding processes also supports care organisations to align with several of the Care Quality Commission’s quality statements, not just those directly related to safeguarding, for example learning culture; listening to and involving people; freedom to speak up; and learning, improvement and innovation, to name but a few.
So what can providers do to make people more likely to report concerns?
One area for improvement is in actually recognising a safeguarding issue. If you read accident books and complaints files, you may well find situations that should have been reported as safeguarding concerns but weren’t. For example, it’s not always recognised that incidents between one person supported by a service and another may constitute abuse; nor is it always recognised that regularly declining homecare visits can be part of a pattern of self-neglect and therefore possibly a safeguarding issue.
This suggests there may be questions to consider around procedures, guidance, training and supervision. But perhaps a bigger issue is that raising a concern can be a very difficult thing to do.
Identifying people’s reluctance
If you ask people supported by a service, or relatives, they will almost always say that they would raise a concern if they had one. But if you have time for a more in-depth conversation, often there is a residual worry that raising a concern could lead to repercussions for themselves or for their family member.
Similarly, a more in-depth conversation with staff may reveal a worry about the possibility of victimisation, or just concern about the likelihood of a stressful and long, drawn-out process.
Perhaps the most important part of starting to overcome these worries is having a positive and efficient response when concerns are raised, and recognising that people raising concerns may need ongoing support. Often, people say, ‘I raised a concern and didn’t hear any more, I was just left worrying about it by myself.’
If there isn’t a positive response, word will get around and will discourage others from raising any concerns they might have. So once a concern has been concluded, it’s a good idea to see if you can get feedback from the person who raised it – how did they find the process, could it have been improved from their point of view?
Keeping the communication lines open
Talk openly about safeguarding in newsletters, residents’ meetings, team meetings and supervisions – try to make it a normal, day-to-day thing. Keep saying, from induction training onwards, that concerns really are welcomed. Use staff exit interviews as a chance to check how people feel as they move on. And although it may not be straightforward due to issues of confidentiality, try to find ways of publicising how learning from previous concerns has led to improvements.
Remember that if you ask people how things are, they will usually say ‘fine’, as we all tend to, even after a mediocre meal in a restaurant. It’s really important for managers to try to find the time for more in-depth conversations with the people their services support, and with relatives, advocates and staff.
Make sure that everyone knows how they can raise a concern if they have one (most people won’t plough through a long procedure to find this out). If there is nowhere to put up a notice, you could give people a card to go in their wallet and put the information on your website.
On the subject of reporting, it’s good to have more than one easy internal reporting route, for example, being able to report to your service manager, a named senior manager, or a central contact number and email address.
And I always encourage organisations to stress that it is fine for anyone to raise a concern externally if they feel more comfortable doing so. This sends the message that you are an open organisation which genuinely wants to know about any concerns people have. Paradoxically, saying that external reporting is fine might actually make people feel more comfortable about raising a concern internally.
Getting another perspective
Adding an independent external perspective to internal safeguarding processes can also be helpful. One option is to arrange an independent safeguarding audit, triangulating evidence from policies, records, and internal reports with direct feedback from the people your services support, relatives, staff and frontline managers.
Another option is to add an external perspective to ongoing arrangements for safeguarding governance and scrutiny, for example in larger organisations, an external person sitting alongside senior managers to review patterns of concerns across various services.
The suggestions in this article may not all be right for every organisation, but it’s hoped that they will give you a few ideas to think about.