Abuse of Vulnerable Adults in England , Final Report, Experimental Statistics

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1 Abuse of Vulnerable Adults in England , Final Report, Experimental Statistics Published: 6 March 2013

2 We are England s national source of health and social care information Author: Responsible statistician: Adult Social Care Statistics team, Health and Social Care Information Centre Pritpal Rayat, Section Head Version: V1.0 Date of publication 6 March Copyright 2013, Health and Social Care Information Centre. All rights reserved.

3 Contents Executive Summary 5 Key Findings 5 1. Introduction 7 Background 7 Coverage 8 Future Safeguarding Collections 8 2. Adult Safeguarding Alerts 9 Introduction 9 Number of Alerts 9 Alerts Which Met the Safeguarding Threshold Adult Safeguarding Referrals 12 Introduction 12 Number of Referrals 12 Number of Referrals by Region 18 Referrals Relating to Adults Already Known to CASSR 20 Number of Repeat Referrals 20 Source of Referral 22 Nature of Alleged Abuse 26 Location of Alleged Abuse 29 Relationship to Alleged Perpetrator Safeguarding Referrals Completed in Year 35 Introduction 35 Number of Completed Referrals 35 Case Conclusion 36 Outcomes for Vulnerable Adult 39 Serious Case Reviews 43 Protection Plans 44 Outcome for Perpetrator, Organisation or Service 46 Appendix A: Editorial Notes 50 Appendix B: Data Quality 52 Appendix C: How are the statistics used? Report Users and Uses 58 Copyright 2013, Health and Social Care Information Centre. All rights reserved. 3

4 Appendix D: Related Publications 59 Appendix E: Collection Proforma 61 Appendix F: Glossary of Terms 70 4 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

5 Executive Summary This summary provides the key findings from the Abuse of Vulnerable Adults (AVA) data collection for the period 1 April 2011 to 31 March The collection records safeguarding activity relating to vulnerable adults aged 18 and over in England. For the purposes of the AVA return the definition of a vulnerable adult is described as a person who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself. Abuse in this collection is defined as a violation of an individual s human and civil rights by any other person or persons. Data for the AVA collection is recorded by adult safeguarding teams based in Councils with Adult Social Services Responsibilities (referred to as CASSRs or councils within this report). At the end of the reporting year this data is submitted to the Health and Social Care Information Centre (HSCIC) through a secure data collection system. The AVA is a mandatory return and all of the 152 CASSRs in England made a submission in The key safeguarding activities discussed within the return are alerts and referrals. The safeguarding process begins with an alert, the first contact between a person concerned about the alleged abuse of a vulnerable adult and the council safeguarding team. The alert/concern is then assessed by the safeguarding team to determine the level of risk. Where a sufficient level of risk is considered present, the alert is said to meet the safeguarding threshold and a referral is instigated. A referral is a detailed investigation of the concern raised and usually involves gathering evidence about the case, assessing the reliability of the information gathered and deciding the appropriate action/s to be taken for the alleged victim and/or alleged perpetrator. Data from the AVA collection can be used to answer a number of questions about safeguarding activity. The report quantifies the activity taking place, the groups of individuals at risk of harm, the nature and location of the abuse being alleged and identifies which groups of individuals have allegedly committed abuse. Key users of the data are central and local government, researchers and the public. The information is used to monitor the impact of social care policy, benchmark safeguarding activity in relation to other councils and to understand the time and resource required to maintain activity in this field. This report utilises the final findings of the AVA collection and supersedes those presented in the provisional report published in November Key Findings One hundred and twenty one councils submitted alert data in Not all councils are able to record alerts and this is discussed further in Appendix B. A total of 136,000 safeguarding alerts were reported by the 121 councils, an increase of 44 per cent (41,000 alerts) compared to the previous reporting year. This increase is attributable in part to the 22 councils who submitted alert data for the first time in Although 101 councils submitted alert data in , two of these councils were unable to do so in the following reporting year. For the 99 councils who submitted data on alerts in both and , the number of alerts has grown by 24 per cent (23,000 alerts). This could indicate a rise in the reporting of abuse and/or a rise in abuse taking place. Feedback from councils has indicated that there have been a number of changes to team structures and recording systems during the reporting year and that additional training has been delivered. Some councils have informed us that planned awareness campaigns have increased the knowledge of safeguarding procedures within communities. These factors may have contributed to the rise in alerts during the reporting period. A total of 108,000 safeguarding referrals were reported by 152 councils in , an increase of 11 per cent (11,000 referrals) compared to the previous year. Councils reported that 86,000 referrals were Copyright 2013, Health and Social Care Information Centre. All rights reserved. 5

6 completed within the collection period, some of which may have been counted as referrals in the previous collection period. The number of completed referrals has increased by 12 per cent (9,000 completed referrals) compared to All 152 councils submitted both referral and completed referral data for both years. The figures above include a small number of vulnerable adults where at least one of their gender, age or client group (sometimes referred to as key information) were not known at the time of reporting. Further information is not collected for these individuals and therefore they are not included in the findings below. These findings are based on the 133,000 alerts, 106,000 referrals and 85,000 completed referrals for vulnerable adults whose key information was known. In , 61 per cent of referrals were for women and 60 per cent were for vulnerable adults aged 65 or over. Almost half of the referrals (49 per cent) were for adults with a physical disability. These figures are in line with those published in The rate of referrals per 100,000 population was highest in the Midlands. There were 340 and 320 referrals per 100,000 population in the West Midlands and East Midlands respectively. Physical Abuse was the most common type of abuse reported, accounting for 29 per cent of all allegations. Vulnerable adults were more likely to be abused in their Own Home (accounting for 40 per cent of all locations cited) or a Care Home (36 per cent) than other locations. The source of harm was most likely to be Social Care Staff (28 per cent of all perpetrators) or a Family Member (a combination of the Partner and Other Family Member categories, 22 per cent). These figures are consistent with the data. Of the 84,000 completed referrals where a case conclusion was recorded, 41 per cent of cases were either Substantiated or Partly Substantiated, 31 per cent were Not Substantiated and for 28 per cent of cases an outcome could not be determined. The most common outcomes for the vulnerable adult were No Further Action (accounting for 30 per cent of all the outcomes recorded), followed by Increased Monitoring (27 per cent) and Other (12 per cent). The most common outcomes for the alleged perpetrator or organisation were No Further Action (36 per cent) and Continued Monitoring (18 per cent). Nine per cent were recorded as Not Known at the time of reporting. The outcome data includes referrals that could not be proven, this may account for the high proportion of No Further Action outcomes. 6 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

7 1. Introduction This report provides the key findings from the Abuse of Vulnerable Adults (AVA) data collection for the period 1 April 2011 to 31 March The collection records safeguarding activity relating to vulnerable adults aged 18 and over in England. The data are supplied to the Health and Social Care Information Centre (HSCIC) by safeguarding teams based in Councils with Adult Social Services Responsibilities (referred to as CASSRs or councils within this report). The report is divided into three main chapters, each discussing a different type of safeguarding activity. Chapter two discusses the alerts that have been recorded by councils. An alert is the first contact between a person concerned about the alleged abuse of a vulnerable adult and the council safeguarding team. Where a concern is considered to meet the safeguarding threshold, a full investigation is instigated and the required actions are determined and implemented. These tasks are identified as a referral in the return. Details of the referrals recorded by councils can be found in chapter three of this report. Once all necessary tasks have been carried out, the referral is then categorised as completed in the return. Completed referrals are discussed in chapter four. The data are being made available to the public as Experimental Statistics. Experimental Statistics are defined in the UK Statistics Authority Code of Practice for Official Statistics as new official statistics undergoing evaluation. They are published in order to involve stakeholders in their development and quality improvement. Background The subject of abuse of vulnerable adults has gained increasing interest over the last decade. In 2000, the Department of Health and the Home Office jointly published the No Secrets document 1. This provided the framework for councils to work with partner agencies such as the police, NHS and regulators to tackle abuse and prevent its occurrence. Local Authorities were given lead responsibility for setting up multi- agency committees and procedures. While they were urged to keep records there was no detailed guidance on what should be recorded and as a consequence, any data available was not comparable across councils. In 2004, the abuse of older people was the subject of a Health Select Committee inquiry. This led to the Department of Health funding a project delivered by Action on Elder Abuse. The scope of the project included looking at current recording systems used by local authorities and the development and piloting of new recording and reporting systems. A report 2 on this project was published in March 2006 and recommended a national collection for the abuse of adults. The Health and Social Care Information Centre (HSCIC) carried out a fact finding survey in early The results from this and the groundwork carried out by Action on Elder Abuse were used to devise a national collection on the abuse of vulnerable adults. This collection was piloted among 31 CASSRs in The results of the pilot were used to engage with stakeholders to improve the quality and reduce the burden of the collection. In 2009, all 152 CASSRs in England were invited to take part in the national AVA return on a voluntary basis, covering a six month collection period from 1st October 2009 to 31st March In total, 128 CASSRs submitted data for the voluntary return, but not all of these were able to submit every data item required. There were also a number of data quality issues with the voluntary return, particularly around the interpretation of the guidance for the collection. The and collections have been mandated by the Minister for Care Services. In , all 152 CASSRs submitted a return to the HSCIC %20DH%20Monitoring%20Project.pdf Copyright 2013, Health and Social Care Information Centre. All rights reserved. 7

8 Coverage This report utilises the third and final cut of AVA data taken in November This includes data submitted by all of the 152 CASSRs in England and incorporates revisions to the data since the provisional AVA report was published in November Some councils were unable to submit all data items before the deadline and therefore some totals do not provide a complete picture of activity in England. The tables in Annex B show the number of councils who have submitted each data item. This can be used to identify England totals which are incomplete and will therefore underestimate the true national figure. National level information is provided in this report; data at a regional and council level is available via the National Adult Social Care Intelligence Service (NASCIS). NASCIS provides a set of analytical and reporting options which can be accessed from: https://nascis.ic.nhs.uk/portal/tools.aspx The AVA collection only includes cases of alleged abuse where a council safeguarding team has been notified and has entered details onto their system. It does not include cases where partner agencies have dealt with the allegation and not shared the information with the council. It is likely that there are cases of abuse that have not been reported to safeguarding teams. Furthermore, the collection only covers abuse perpetrated by others; it does not include self-harm or self-neglect. A single referral can relate to different types of abuse, locations or alleged perpetrators. Likewise a single referral may have more than one outcome for the alleged victim and/or alleged perpetrator. Some percentages in this report are based on the number of items reported rather than the number of referrals they relate to. Further details can be found within the chart and table footnotes. Future Safeguarding Collections There are no planned changes to the format of the AVA collection for compared to However there will be a small change to the collection process. Further to discussions with the Adult Review Group and analysis of the differences between second and third cut submissions, the number of data cuts will be reduced from three to two for the reporting period. This means that it will be even more important to ensure that the data is as complete and accurate as possible at first submission. The Zero Based Review group has studied the data requirements for national data collections relating to adult social care. The group announced changes to these collections from onwards which included changes to the AVA return. In summer 2012 the group undertook a period of consultation to obtain feedback from a range of key stakeholders with an interest in safeguarding, including the Association of Directors of Adult Social Services (ADASS), the Department of Health (DH), the Care Quality Commission (CQC), the Local Government Association (LGA) and The Alzheimer s Society. Following consideration of the responses received, the Zero Based Review has proposed that a new Safeguarding Adults return should replace the existing Abuse of Vulnerable Adults return for Many of the same data items will continue to be collected but in a more summarised form. The data will be more focused on the outcomes of safeguarding activity and alert data will no longer be collected. The new Safeguarding Adults return will strengthen the information held nationally and locally on the incidence of abuse, supporting local authorities to reduce incidents of abuse and neglect and to respond appropriately when incidents occur. Further details can be found on the link below: 8 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

9 2. Adult Safeguarding Alerts Introduction For the purposes of the AVA collection, an alert is defined as the first contact between a person concerned about the alleged abuse of a vulnerable adult and the council safeguarding team. An alert may arise as a result of disclosure, an incident or through other signs / indicators, such as signs of dehydration or bruising for example. Alert data is useful to quantify the scale of safeguarding concerns and highlight which groups of adults may be most at risk. Not all councils record information on alerts. For some councils this reflects an inability to report alert activity on the system. Other councils have stated that the term alert is not recognised and any contact with the council concerning alleged abuse is categorised as a referral, regardless of whether it meets the safeguarding threshold. In all cases, councils who do not record data on alerts were requested to enter zeros in all cells related to alerts in Tables 1 and 2 of the return. A single case can be recorded as an alert and a referral in the return. If an alert/concern does meet the safeguarding threshold and an investigation is opened the case should be recorded as both an alert and a referral. Some councils have incorrectly considered alerts and referrals to be mutually exclusive, leading to an under-representation of alert figures. Number of Alerts There were 136,000 safeguarding alerts reported by 121 councils in the reporting year, an increase of 44 per cent (41,000 alerts) compared to the previous reporting year. This increase is attributable in part to the 22 councils who submitted alert data for the first time in Although 101 councils submitted alert data in , two of these councils were unable to do so in the following reporting year. For the 99 councils who submitted data on alerts in both and , the number of alerts has grown by 24 per cent (23,000 alerts). This could indicate a rise in the reporting of abuse and/or a rise in abuse taking place. Feedback from councils has indicated that there have been a number of changes to team structures and recording systems during the reporting year and that additional training has been delivered. Some councils have informed us that planned awareness campaigns have increased the knowledge of safeguarding procedures within communities. These factors may have contributed to the rise in alerts during the reporting period. Of the 136,000 alerts reported in , there were 3,000 vulnerable adults where at least one of their gender, age or client group was not known. Detailed information is not collected about the cases where key information is unknown and these cases are not discussed in the following table. Table 2.1 shows the demographic profile of the individuals involved in the 133,000 alerts where the key information was known. Fifty nine per cent of these alerts were about older adults over the age of 65 and 41 per cent were about younger adults aged Almost half of the alerts (48 per cent) were about vulnerable adults with a physical disability. Twenty four per cent of the alerts were about mental health clients and a further 20 per cent were about learning disability clients. These findings are similar to those for referrals data described in Chapter 3. The fact that the demographic profiles are similar indicates that thresholds for safeguarding are not biased towards any particular group. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 9

10 Table 2.1: Alerts by client type, age group and gender of vulnerable adult, England Percentages and rounded numbers Age group Gender Percentage of Primary Client Type and Male Female Total Alerts Total Physical Disability , Mental Health , Learning Disability , Substance Misuse ,750 1 Other Vulnerable People ,540 6 Total , Figures may not add up to 100 per cent due to rounding 2. Based on 121 councils who submitted alerts data greater than zero. 3. Alerts data is based on vulnerable adults whose age, gender and client type were known. Source: AVA Table 1 Thirty one councils did not record alerts in the return, therefore the total alert figures stated above do not give an accurate picture of all alert activity in England. Based on the assumption that all referrals will have been a concern about abuse at some point, alert and referral data can be combined to give a better estimate of the number of safeguarding concerns. In Table 2.2 below, alert data for councils who did report on alerts has been added to the number of referrals for councils who did not report alerts. The table shows that in there could have been around 167,000 concerns of abuse raised with safeguarding teams in England. Table 2.2: Number of alerts and referrals combined, England Rounded numbers Number Total number of alerts (including unknowns) 135,990 Total number of referrals where no alerts were recorded (including unknowns) 30,680 Alerts and referrals combined 166, Based on alerts data submitted by 121 councils 2. Based on referrals data submitted by the remaining 31 councils Source: AVA Table 1 3. Alerts data includes vulnerable adults whose age, gender or client type were not known. Alerts Which Met the Safeguarding Threshold For the 121 councils who provided information on both alerts and referrals, 60 per cent of the total alerts reported met the safeguarding threshold and instigated a referral. At council level the ratio of referrals to alerts varies greatly. The distribution of these ratios is detailed below in Table 2.3 and in chart form in Figure 2.1. The table shows the lowest ratio recorded was one referral for every ten alerts (ratio of 0.13). The highest ratio was which shows that one council had 48 times more referrals than there were alerts. The wide range of the ratios might suggest that some councils have misunderstood the intended definitions of alerts and referrals. It is expected that the number of alerts should be greater than the number of referrals because not all concerns will meet the safeguarding threshold and progress to a referral. The table shows that for the majority of councils the number of alerts is greater than the number of referrals. 10 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

11 Number of Councils Abuse of Vulnerable Adults in England Table 2.3: Distribution of referrals to alerts ratio, England Number of Ratio of referrals to alerts councils 0 to less than to less than to less than to less than 1 20 Equal to 1 7 Greater than 1 6 Minimum ratio 0.13 Maximum ratio Average ratio 0.60 Source: AVA Table 1 1. The minimum and maximum figures are based on the 121 councils who had both alert and referral data available. 2. The average figure is based on 119 councils. Data for 2 councils has been excluded as their ratios were outliers. 3. Ratios are shown as a proportion in this table, i.e. a ratio of 1 to 4 is shown as Figure 2.1: Distribution of referrals to alerts ratio, to less than to less than to less than to less than 1 Equal to 1 Greater than 1 Ratio of Referrals to Alerts Source: AVA Table 1 1. The minimum and maximum figures are based on the 121 councils who had both alert and referral data available. 2. The average figure is based on 119 councils. Data for 2 councils has been excluded as their ratios were outliers. 3. The chart is based on data from 121 councils who submitted both alert and referral data greater than zero. 4. Ratios are shown as a proportion in this chart, i.e. a ratio of 1 to 4 is shown as Copyright 2013, Health and Social Care Information Centre. All rights reserved. 11

12 3. Adult Safeguarding Referrals Introduction The term referral within the AVA return refers to an adult safeguarding issue that meets the local safeguarding threshold and invokes a full investigation. By collecting information on referrals, the number of individuals involved in alleged safeguarding incidents can be determined and the demographic groups at risk can be identified. Some councils do not recognise the term referral or may have a different interpretation of the word at a local level. Although the AVA guidance outlines the definition that should be used for the purpose of this return (see Appendix F for this definition), it is possible that some councils have recorded referrals based on a different understanding of this term. This may be an issue particularly for councils who do not record alerts. For some of these councils, all concerns of abuse raised are classified as referrals at a local level. In this case, the AVA guidance asks councils to report only the concerns which meet the safeguarding threshold as referrals in the return. Feedback from councils indicates that this guideline has not always been followed and for these councils, the volume of referrals may be higher than their peers. Number of Referrals There were 108,000 safeguarding referrals reported by 152 councils in (data shown in Annex A, Table 1), an increase of 11 per cent (11,000 referrals) compared to the previous year. All 152 councils submitted data on referrals for both years. There were around 1,000 referrals for vulnerable adults in for whom at least one of their gender, age or client group was not known. Detailed information is not collected about the cases where key information is unknown and these cases are not discussed in the following table. Table 3.1 includes details of the 106,000 referrals where the key information was known. The table shows that 61 per cent of these referrals involved women and 39 per cent involved men. Sixty per cent of the total referrals related to adults aged 65 or over. Within this group, the frequency of referrals increases as age increases. Forty per cent of the referrals involved adults aged between 18 and 64. Referrals were most likely to involve individuals with a physical disability and this group accounted for 49 per cent of all referrals. The majority of referrals for clients with physical disabilities were for older adults (aged 65 and over), while for all other client types the largest proportion of individuals were in the younger age group (aged 18-64). 12 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

13 Percentage Abuse of Vulnerable Adults in England Table 3.1: Referrals by client type and age group of vulnerable adult, England Percentages and rounded numbers Age group Gender 85 and Total Percentage Primary Client Type over Male Female Referrals of Total Physical Disability , Mental Health , Learning Disability , Substance Misuse ,105 1 Other Vulnerable People ,635 5 Total , Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Referrals data is based on vulnerable adults whose age, gender and client type were known Source: AVA Table 1 Figure 3.1 shows the proportion of referrals by gender for each age group. The number of referrals for females was higher than males in every age group and the proportion of females increases as age increases. This is partly due to the structure of the population which mirrors this trend and partly due to the increased likelihood of alleged abuse for older females. Figure 3.1: Referrals by age group and gender of vulnerable adult, (42,145) (12,580) (23,450) 85 and over (27,990) Age Group All Ages (106,165) Male 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 106,165 referrals Female Source: AVA Table 1 Figure 3.2 explores the relationship between age and client type of individuals involved in a referral. The chart shows that some client types are more prevalent within a particular age group. For younger adults (aged 18-64), the most common client type referred to safeguarding was adults with a learning disability, which accounted for 48 per cent of all referrals for this age group. For older adults (aged 65 and over), it was individuals with a physical disability who were most commonly alleged victims. The Physical Disability category accounted for 67 per cent of all referrals for this age group. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 13

14 Percentage Abuse of Vulnerable Adults in England Figure 3.2: Referrals by client type and age group of vulnerable adult, Physical Disability (51,625) Mental Health (25,825) 3 Learning Disability (21,980) 2 0 Substance Misuse (1,105) 6 5 Other Vulnerable People (5,635) Client Type Age Age 65 and over 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 42,145 referrals for the age group and 64,020 referrals for the 65 and over age group Source: AVA Table 1 Figure 3.3 shows the referrals for males, broken down by age group and primary client type. The patterns associated with age groups and client types are similar to that for all adults described above. Male alleged victims who had a physical disability were most likely to be older (aged 65 and over). Seventy eight per cent of this client type were aged 65 or over. For all other client types the age group had the highest number of referrals. Younger adults (18-64 year olds) were especially prevalent within the Learning Disability and Substance Misuse categories, accounting for 93 per cent and 84 per cent of these client groups respectively. This may be because these client types are less common among older people or that while older people may still have a learning disability or substance misuse problem, their primary need for care falls into the physical disability or mental health client type. 14 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

15 Percentage Abuse of Vulnerable Adults in England Figure 3.3: Referrals by client type, age group and gender (male) of vulnerable adult, Physical Disability (17,690) Mental Health (9,315) 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 41,235 referrals for male vulnerable adults Learning Disability (11,595) Client Type Substance Misuse (510) and over Other Vulnerable People (2,125) Source: AVA Table 1 Figure 3.4 shows the same chart for female alleged victims. The data demonstrates similar patterns to male alleged victims. Physically disabled clients were most likely to be older (aged 65 and over) and for all other client types the age group were the most prevalent. There are some slight differences between the genders. In the physical disability category, females are more likely to be older than males. Seventy four per cent of physically disabled females were aged 75 or over compared to 61 per cent of males from this category. For mental health clients, a higher proportion of females were in the older age groups. Sixty six per cent of females with mental health needs were aged 65 and over and the equivalent figure for males was 55 per cent. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 15

16 Percentage Abuse of Vulnerable Adults in England Figure 3.4: Referrals by client type, age group and gender (female) of vulnerable adult, Physical Disability (33,935) Mental Health (16,510) Learning Disability (10,385) Substance Misuse (595) Other Vulnerable People (3,510) Client Type and over 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 64,930 referrals for female vulnerable adults Source: AVA Table 1 Figure 3.5 shows all referrals broken down by ethnicity. Eighty nine per cent of all referrals were for vulnerable adults belonging to the white ethnic group. The Black or Black British and Asian or Asian British represent six per cent of the total number of referrals. 16 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

17 Figure 3.5: Referrals by ethnic group of vulnerable adult, Asian or Asian British 3% Mixed 1% Black or Black British 3% Other Ethnic Groups 1% Not Stated 4% White 89% Source: AVA Table 2 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 106,165 referrals Table 3.2 shows the ethnicity breakdown for the England population 3 and for safeguarding referrals reported in the AVA return. Individuals in the White ethnic group are marginally more likely to be referred and Asian or Asian British adults are marginally less likely to be referred. This could reflect the likelihood of being an alleged victim and/or the likelihood of reporting alleged abuse. Table 3.2: Ethnicity Breakdown for England population and AVA referrals England Ethnic Group Population (Thousands) Percentage of Population Percentage of Referrals White 34, Mixed Asian or Asian British 2, Black or Black British 1, Other Ethnic Groups Figures may not add up to 100 per cent due to rounding 39,425 Source: AVA Table 2 and the Office for National Statistics 2. AVA information based on 102,040 referrals provided by 152 councils 3. There were 4,125 individuals excluded from the AVA figures since their ethnicity was not stated 4. Population data is based on mid-year estimates for 2009 which is the latest data currently available 5. Population data is based on adults aged 20 and over, AVA data is based on adults aged 18 and over 3 From Population Estimates by Ethnic Group Mid-2009 (experimental) which can be found at the following address: Copyright 2013, Health and Social Care Information Centre. All rights reserved. 17

18 Number of Referrals by Region Table 3.3 looks at the number of safeguarding referrals that have taken place within each of the Government Office Regions in England during The Observed column shows the actual number (rounded to the nearest 5) of referrals that were recorded by councils. Comparison of these figures can be misleading because population characteristics can vary between regions and this can influence the number of Observed referrals. It is useful to remove the effect of population differences so that more accurate comparisons can be made between regions. This can be achieved by age-gender standardising the Observed figures and calculating the ratio of referrals per 100,000 population. These steps have been calculated in the final column of the table. A description of the methodology used for this can be found in Appendix A. The table shows that safeguarding referrals were most prevalent in the West and East Midlands where there were 340 and 320 referrals per 100,000 population respectively. The number of referrals was lowest in the South West and South East regions where there were 150 and 200 referrals per 100,000 population respectively. The number of referrals by region is also shown in chart form in Figure 3.6. Table 3.3: Referrals by region (observed and age-gender standardised rates), England Percentages and Rounded Numbers Observed Region Percentage Total Percentage Total per 100,000 population North East 5 5, North Yorkshire West and the 15 16, Humber 9 9, East Midlands 11 11, West Midlands 14 14, South West 7 7, Eastern 11 12, London 14 14, South East 13 14, England 106,165 2,335 Source: AVA Table 1 and 2011 Mid-Year Population Estimates from the Office for National Statistics 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils Age-Gender Standardised 18 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

19 Number of Referrals per 100,000 Population Abuse of Vulnerable Adults in England Figure 3.6: Number of referrals by region (age-gender standardised), North East North West Yorkshire and the Humber East Midlands West Midlands Region South West Eastern London South East Source: AVA Table 1 and 2011 Mid-Year Population Estimates from the Office for National Statistics 1. Based on information provided by 152 councils 2. Based on a total of 2,335 referrals per 100,000 population in England Copyright 2013, Health and Social Care Information Centre. All rights reserved. 19

20 Number of Councils Abuse of Vulnerable Adults in England Referrals Relating to Adults Already Known to CASSR One hundred and fifty one councils were able to indicate whether the vulnerable adult was known to the council before the safeguarding issue was raised. Councils might already know the adult through a previous social care assessment or the provision of day care for example. A total of 107,000 referrals were reported by the 151 councils, of which 62 per cent (66,000 referrals) related to individuals who were already known. Figure 3.7 summarises the proportions of known adults for each council who submitted this data 4. The chart shows that safeguarding referrals are more likely to be made about vulnerable adults already known to the council. Eighty one per cent of councils (122 councils) said they knew the individual before the safeguarding issue was raised in 50 per cent or more of their referrals. Almost half of the councils (72 councils) said that 75 per cent or more of their referrals were about people already known to them. Figure 3.7: Number of councils by the percentage of vulnerable adults known to council %-24% 25%-49% 50%-74% 75% and over Percentage Known to Council Source: AVA Table 1 1. Based on information provided by 151 councils. One council did not provide this information Number of Repeat Referrals A repeat referral is a safeguarding referral where the vulnerable adult involved has previously been the subject of a safeguarding referral about a different incident within the same reporting period. The requirement that both referrals need to be in the same reporting period limits the usefulness of this data as it does not give a complete picture of the magnitude of repeat referrals. A total of 16,900 referrals were recorded as repeat referrals. Of these, 16,800 were for vulnerable adults where all the key information was known (data shown in Annex A Table 1). The following analysis describes only the referrals where the key information was known. Table 3.4 shows the demographic details for individuals involved in repeat referrals in councils submitted this data item but this includes eight councils who made a submission of zero. 20 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

21 The overall gender breakdown is identical to that detailed earlier for all referrals. Sixty one per cent of repeat referrals were for females and 39 per cent were reported for males. Repeat referrals are most frequently made for the age group which represented 46 per cent of the total. Each of the and 85 and over age groups formed 21 per cent of repeat referrals. Adults with a physical disability represented the largest proportion (40 per cent) of repeat referrals. The Learning Disability and Mental Health categories accounted for 30 and 25 per cent of repeat referrals respectively. Table 3.4: Repeat referrals by client type and age group of vulnerable adult, England Percentages and Rounded Numbers Age group Gender Primary Client Type and over Male Female Figure 3.8 explores the age breakdown for repeat referrals. Compared to all referrals, repeat referrals are more likely to be about adults in the age group (46 per cent of repeat referrals compared to 40 per cent of all referrals) and less likely to be about individuals in the 85 and over age group (21 per cent of repeat referrals compared to 26 per cent of all referrals). Figure 3.8: Repeat referrals by age group of vulnerable adult, Total Repeat Referrals Physical Disability , Mental Health , Learning Disability , Substance Misuse Other Vulnerable People Total , Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils Percentage of Total Source: AVA Table 1 Aged 85 and over 21% Aged % Aged % Aged % Source: AVA Table 1 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 16,770 repeat referrals Copyright 2013, Health and Social Care Information Centre. All rights reserved. 21

22 Figure 3.9 explores the client type breakdown for repeat referrals. Compared to all referrals, repeat referrals are more likely to be about adults with a learning disability (30 per cent of repeat referrals compared to 21 per cent of all referrals) and less likely to relate to individuals with a physical disability (40 per cent of repeat referrals compared to 49 per cent of all referrals). Figure 3.9: Repeat referrals by client type of vulnerable adult, Substance Misuse 1% Other Vulnerable People 4% Learning Disability 30% Physical Disability 40% Mental Health 25% Source: AVA Table 1 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 16,770 repeat referrals Source of Referral The source of referral is defined as the person who initially raised the concern with social services safeguarding about the potential abuse or risk of harm. Eleven main categories of referrer have been identified for this return, however only one source may be recorded for each referral. This information can be used to answer questions around routes into safeguarding. Table 3.5 shows that the most frequent source of referral was social care staff, who raised 44 per cent of the referrals in Over a fifth (22 per cent) of all referrals were raised by health staff. This shows that partnership working between health and social care is evident, as recommended in the No Secrets 5 guidance. The percentage of self-referrals and referrals from family members, friends or neighbours (11 per cent) is encouraging as this shows that awareness of routes into safeguarding are evident in the general community Copyright 2013, Health and Social Care Information Centre. All rights reserved.

23 Percentage Abuse of Vulnerable Adults in England Table 3.5: Source of referral - Summary, England Percentages and Rounded Numbers Source of Referral Percentage Total Social Care Staff 44 46,670 Health Staff 22 23,450 Family Member/ Friend/ Neighbour/ Self- Referral 11 11,530 Other Categorised Sources ,430 Other 13 14,085 Total 106, Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils Source: AVA Table 3 3. Other Categorised Sources includes other service users, the Care Quality Commission, housing, education/training/workplace establishment and police Figure 3.10 shows a more detailed breakdown of referral sources for all adults aged 18 and over. Family members formed the biggest percentage (7 per cent) of the Family Member/ Friend/ Neighbour/ Self- Referral group. The chart shows that few alleged victims report an issue themselves; only 2 per cent of referrals were instigated this way. From the Other Categorised Sources group above, the two most common informants of alleged abuse were the police and housing agencies who reported 5 and 3 per cent of cases respectively. Figure 3.10: Source of referral Full details, Social Care Staff Health Staff 2 Self Referral 7 Family Member 1 Friend or Neighbour 0 Other Service User Source of Referral 1 3 Care Housing Quality Commission 1 Education, Training or Workplace Establishment 5 Police Other 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 106,165 referrals Source: AVA Table 3 Copyright 2013, Health and Social Care Information Centre. All rights reserved. 23

24 Table 3.6 explores the relationship between the source of referral and the client type of the alleged victim for year olds. The table shows that for most client types the majority of referrals are reported by social care staff, except for adults with mental health needs. For adults with mental health needs, the main source of referral was health staff (43 per cent of referrals). Adults in the Substance Misuse or Other category were more likely than other client types to be referred by the police (in 20 per cent and 16 per cent of cases respectively) or housing agencies (in 10 per cent and 5 per cent of cases respectively). Referrals from other sources were similarly distributed across the client types. Table 3.6: Source of referral by client type of vulnerable adult, aged 18-64, England Source of Referral Physical Disability Mental Health Learning Disability Percentages and Rounded Numbers Other Substance Vulnerable Total Misuse People Age Social Care Staff ,815 Health Staff ,920 Self Referral ,510 Family Member ,680 Friend/neighbour Other Service User Care Quality Commission Housing ,475 Education/Training/Workplace Establishment Police ,890 Other ,465 Source: AVA Table 3 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 42,145 referrals for vulnerable adults aged Figure 3.11 shows a more detailed view of social care staff referrers and looks at patterns of behaviour in relation to the different age groups. In both age groups, the highest number of referrals came from residential care staff (33 per cent for the age group and 47 per cent for the 65 and over age group). Social workers or care managers reported 23 per cent of referrals for the age group and 22 per cent of referrals for those aged 65 and over. Referrals for older adults (aged 65 and over) were more likely to come from residential care staff than referrals for younger adults (aged 18-64). Referrals for younger adults were more likely to come from other sources than referrals for older adults. 24 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

25 Percentage Abuse of Vulnerable Adults in England Figure 3.11: Distribution of social care staff referrers by age group, Domiciliary Staff (6,875) Residential Care Staff (19,260) 2 Day Care Staff (2,115) Social Worker/Care Manager (10,365) 1 0 Self -Directed Care Staff (330) Other (7,575) Social Care Staff (CASSR & Independent) and over 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 46,520 referrals made by social care staff about adults aged 18 and over Source: AVA Table 3 Figure 3.12 shows a more detailed view of social care staff referrers and looks at patterns of behaviour in relation to the different client types. The information is this chart is only available for alleged victims in the age group. The chart shows that the proportion of referrals made for each client type differs depending on the type of staff. This pattern is likely to mirror the level of contact each staff type has with different vulnerable adults. The majority of referrals made by social care staff related to learning disability clients. The proportion of referrals for this client type was higher for day care staff than for other staff types, accounting for 85 per cent of all referrals. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 25

26 Percentage Abuse of Vulnerable Adults in England Figure 3.12: Distribution of social care staff referrers by client type (aged 18-64), Domiciliary Staff (2,505) Residential Care Staff (5,880) 4 9 Day Care Staff (1,485) 23 Social Worker/Care Manager (4,115) 27 Self-Directed Care Staff (220) Other (3,580) Social Care Staff (CASSR & Independent) Physical Disability Mental Health Learning Disability Substance Misuse Other Vulnerable People 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 17,785 referrals made by social care staff about adults aged Source: AVA Table 3 Nature of Alleged Abuse There are seven types of abuse for which information has been collected in this return. These are physical, sexual, emotional/psychological, financial, neglect, discriminatory and institutional. This information can be used to understand what types of alleged abuse are being reported and what groups of adults are at risk. A single referral can involve more than one type of abuse and each different type should be recorded in the return. Tables 4a and 4b on the AVA proforma allow for multiple entries to accommodate this. Table 3.7 summarises the number of allegations made about each type of abuse. The most common type of alleged abuse is physical, which accounts for 29 per cent of the total types of abuse reported. This is followed by neglect, accounting for 26 per cent of the abuse reported. Nineteen per cent of the instances reported were about financial abuse, 16 per cent were related to emotional or psychological abuse and sexual abuse accounted for 5 per cent. Institutional and discriminatory abuse accounted for 4 per cent and 1 per cent respectively of all types of abuse reported. 26 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

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