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

Transcription

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 [email protected] 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: 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.

27 Percentage Abuse of Vulnerable Adults in England Table 3.7: Nature of alleged abuse of vulnerable adult, England Percentages and Rounded Numbers Nature of alleged abuse Percentage Total Physical 29 39,505 Sexual 5 7,355 Emotional/psychological 16 21,665 Financial 19 24,820 Neglect 26 34,250 Discriminatory 1 1,060 Institutional 4 5,270 Source: AVA Table 4a 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 133,925 types of alleged abuse from 106,165 referrals The distribution of type of abuse across each gender is very similar, as shown by Figure Men were marginally more likely to be the alleged victim of financial abuse than women (20 per cent compared to 17 per cent respectively). Women were more likely to be the alleged victim of sexual abuse than men (7 per cent compared to 3 per cent respectively). Figure 3.13: Nature of referral by gender of vulnerable adult, Physical (39,505) 3 Sexual (7,355) Emotional / Psychological (21,665) Financial (24,820) Neglect (34,250) 1 1 Discriminatory (1,060) 4 4 Institutional (5,270) Nature of Alleged Abuse Male Female 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 133,925 types of alleged abuse from 106,165 referrals Source: AVA Table 4a Copyright 2013, Health and Social Care Information Centre. All rights reserved. 27

28 Percentage Abuse of Vulnerable Adults in England Figure 3.14 shows the relationship between different types of alleged abuse and the age of the alleged victims. For all types of alleged abuse discussed in the return, any age group can be affected. However, some types of alleged abuse affect certain age groups more than others. The majority of sexual (70 per cent) and discriminatory (66 per cent) abuse allegations are made about adults in the age group. For financial abuse, neglect and institutional abuse, the majority of referrals (between 62 and 75 per cent) involve adults aged 65 and over. For emotional/psychological and physical abuse, these allegations were equally likely to be made about younger (aged year olds) or older (aged 65 and over) individuals. Figure 3.14: Nature of referral by age group of vulnerable adult, Physical (39,505) Sexual (7,355) Emotional / Psychological (21,665) Financial (24,820) Neglect (34,250) Discriminatory (1,060) Institutional (5,270) Nature of Alleged Abuse 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 133,925 types of alleged abuse from 106,165 referrals Source: AVA Table 4a Figure 3.15 shows the relationship between different types of alleged abuse and the client type of alleged victims for year olds. Any client group can be affected by any type of alleged abuse. The chart shows a similar pattern for all abuse types. Adults with a learning disability are the most frequently affected by any abuse type. Referrals relating to financial abuse or neglect are more likely to be made for adults with a physical disability than referrals relating to other types of abuse. 28 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

29 Percentage Abuse of Vulnerable Adults in England Figure 3.15: Nature of referral by client type of vulnerable adult, Physical (18,320) Sexual (5,140) Emotional / Psychological (11,325) Financial (9,450) Type of Abuse Neglect (8,650) Discriminatory (695) Institutional (1,580) 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 55,160 types of alleged abuse from 42,145 referrals for adults aged Source: AVA Table 4a Location of Alleged Abuse This data provides information about where abuse has been alleged to have taken place. A single referral may contain allegations of abuse that have occurred in more than one location. Where this is the case, each different location should be recorded in the return. The following analysis is based on the total number of allegations at different locations within the referrals rather than the total number of referrals. Table 3.8 shows that the most frequent locations in which alleged abuse took place were the alleged victim s own home (40 per cent of all locations) or in a residential care setting (36 per cent of all locations). Copyright 2013, Health and Social Care Information Centre. All rights reserved. 29

30 Table 3.8: Location of alleged abuse of vulnerable adult, England Percentages and Rounded Numbers Location Alleged Abuse Took Place Percentage Total Own Home 40 43,285 Residential Care Setting ,940 Alleged Perpetrators Home 2 1,990 Health Setting 5 6 7,100 Supported Accommodation 5 5,525 Day Centre/Service 1 1,600 Public Place 3 3,180 Education/Training/Workplace Establishment Other 3 3,480 Not Known 4 4,095 Source: AVA Table 5a 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 109,560 locations of alleged abuse from 106,165 referrals 4. Residential Care Setting includes care home - permanent, care home with nursing - permanent, care home - temporary, care home with nursing - temporary. 5. Health Settings include mental health inpatient setting, acute hospital, community hospital and other health setting. Figure 3.16 shows how the location of the alleged abuse varies by age group. For some locations, the majority of allegations made were about younger adults (aged 18-64). These included places of education/work (95 per cent), a public place (80 per cent), a day centre/service (82 per cent), supported accommodation (72 per cent), a mental health inpatient setting (75 per cent) and in the perpetrators own home (67 per cent). For care homes and acute or community hospital settings, the majority of allegations made about abuse were about older adults aged 65 and over. This might reflect the age distribution of vulnerable people expected to be present at these locations. For referrals where the location of alleged abuse was the victim s own home, 60 per cent concerned adults aged 65 and over and 40 per cent were for adults in the age group. The data shows there is little difference between permanent and temporary care home placements. For care homes with nursing the alleged victims tend to be slightly older than those in care homes without nursing. There is currently no nationally collected social care data detailing the number of adults residing in care homes for comparison to the number of referrals. This is because national social care data on care homes only includes individuals whose residential care is funded by the council; whereas any resident can be referred to safeguarding and reported in the AVA return. 30 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

31 Location Alleged Abuse Took Place Abuse of Vulnerable Adults in England Figure 3.16: Location of alleged abuse by age group of vulnerable adult, Own Home (43,285) Care Home - Permanent (23,800) Care Home with Nursing - Permanent (11,825) Care Home - Temporary (2,295) Care Home with Nursing - Temporary (1,025) Alleged Perpetrators Home (1,990) Mental Health Inpatient Setting (2,570) Acute Hospital (2,750) Community Hospital (1,100) Other Health Setting (680) Supported Accommodation (5,525) Day Centre/Service (1,600) Public Place (3,180) Education/Training/Workplace (365) Other (3,480) Not Known (4,095) Percentage 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 109,560 locations of alleged abuse from 106,165 referrals Source: AVA Table 5a Relationship to Alleged Perpetrator Information on the relationship between the vulnerable adult and the person alleged to be causing the abuse helps us to understand what types of people might be abusing others and understand the different circumstances in which abuse might occur. A single referral may involve more than one perpetrator, therefore the following analysis is based on the total number of alleged perpetrators within the referrals rather than the total number of referrals overall. Figure 3.17 shows that the most common perpetrators of alleged abuse were social care staff, accounting for 28 per cent of all perpetrators cited. This was followed by a family member (Partner or Other Family Member categories) in 22 per cent of cases and the categories of Other Vulnerable Adult and Not Known each accounted for 13 per cent of the total. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 31

32 Percentage Abuse of Vulnerable Adults in England Figure 3.17: Relationship between alleged perpetrator and vulnerable adult, Partner (6,970) Other Family Member (17,460) 5 Health Care Worker (5,385) 0 Volunteer/ Befriender (205) Social Care Staff (31,250) 3 Other Professional (3,250) Other Vulnerable Adult (14,060) 6 Neighbour/ Friend (6,360) 2 Stranger (1,965) Not Known (14,755) 7 Other (8,165) Relationship of Alleged Perpetrator 1. Figures may not add up to 100 per cent due to rounding 2. Based on 109,820 alleged perpetrators from 106,165 referrals 3. Based on information provided by 152 councils Source: AVA Table 6b The social care staff category is broken down further in Table 3.9 below. Within the Social Care Staff category, residential care staff were most commonly reported as the alleged perpetrators. This group were cited in 60 per cent of social care staff cases. One in four (26 per cent) alleged perpetrators were cited as domiciliary care staff. Table 3.9: Breakdown of alleged social care staff perpetrator, England Relationship of alleged perpetrator - Social Care Staff (Number of referrals) Percentages and Rounded Numbers Percentage Domiciliary Care staff (7,925) 26 Residential Care staff (18,495) 60 Day Care staff (860) 3 Social Worker/Care Manager (930) 3 Self-Directed Care Staff (610) 2 Other (2,185) 7 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 31,005 alleged perpetrators reported as social care staff Source: AVA Table 6b 32 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

33 Percentage Abuse of Vulnerable Adults in England Figure 3.18 explores the relationships between the type of social care staff cited as the alleged perpetrator and the age of the alleged victim. For alleged perpetrators classed as self-directed care staff or other, the alleged victims were a mixture of younger and older adults. Of the cases where the alleged perpetrator was cited as day care staff, 62 per cent related to the alleged abuse of younger adults aged A higher proportion of older adults (aged 65 and over) were alleged to have been abused by domiciliary care (69 per cent) or residential care staff (75 per cent) than by other social care staff types. Figure 3.18: Relationship between alleged social care staff perpetrator and vulnerable adult by age group of vulnerable adult, Domiciliary Care staff (7,925) Residential Care staff (18,495) Day Care staff (860) Social Worker/Care Manager (930) Social Care Staff Self-Directed Care Staff (610) Age Age Age Age 85 and over Other (2,185) 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 31,005 alleged perpetrators reported as social care staff Source: AVA Table 6b Figure 3.19 shows the relationships between the type of social care staff cited as the alleged perpetrator and the client type of the alleged victim for adults aged The chart shows that different proportions of each client type are affected depending on the type of social care staff cited as the alleged perpetrator. Adults with a learning disability are the most commonly cited alleged victims for all social care staff alleged perpetrators. Individuals within this client type are more likely to be the alleged victim of day care staff or other alleged perpetrators than of other social care staff types. Physical disability clients are more likely to be the alleged victim of domiciliary or self-directed care staff perpetrators than of other social care staff types. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 33

34 Percentage Abuse of Vulnerable Adults in England Figure 3.19: Relationship between alleged social care staff perpetrator and vulnerable adult by client type of vulnerable adult (aged 18-64), Domiciliary Care Staff (2,485) 20 Residential Care Staff (4,615) 6 10 Day Care Staff (535) 25 Social Worker/ Care Manager (400) 41 Self-Directed Care Staff (305) 8 14 Other (1,030) Social Care Staff Physical Disability Mental Health Learning Disability Substance Misuse Other Vulnerable People Source: AVA Table 6b 1. Figures may not add up to 100 per cent due to rounding 2. Based on information provided by 152 councils 3. Based on 9,375 alleged perpetrators reported as social care staff in referrals for vulnerable adults aged Copyright 2013, Health and Social Care Information Centre. All rights reserved.

35 4. Safeguarding Referrals Completed in Year Introduction A completed referral in this return is defined as being where an investigation of allegations has been undertaken and completed with an action plan having been agreed and an outcome recorded. All referrals completed in the collection period are recorded in the return, irrespective of whether the referral began in the same collection period or a previous one. Therefore completed referrals are not a subset of referrals for a given collection period. However, the majority of referrals and completed referrals will have been opened and completed in the same year so comparisons between the two are still useful. The number of completed referrals does not include cases where a concern was raised but no further investigation was instigated, for example if the concern did not meet the council s safeguarding threshold. If a concern has instigated a full investigation and all inquiries are complete then the case should be recorded as a completed referral regardless of the conclusion or outcomes. Number of Completed Referrals There were 86,000 completed safeguarding referrals reported by 152 councils in This reflects an increase of 12 per cent (9,000 referrals) compared to the previous year. All 152 councils submitted data on completed referrals for both years. There were around 1,000 completed 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 included in the following table. Table 4.1 shows details of the 85,000 completed referrals where the key information was known. Overall, 38 per cent of completed referrals were for males and 62 per cent were for females. This is the same gender split as observed for referrals. Thirty eight per cent of the completed referrals related to vulnerable adults in the age group, followed by 27 per cent in the 85 and over age group, 22 per cent in the 75 to 84 age group and 12 per cent in the 65 to 74 age group. Table 4.1: Completed referrals by primary client type and age of vulnerable adult, England Percentages and Rounded Numbers Gender Primary Client Type and over Male Female Total Completed Referrals Percentage of Total Physical Disability , Mental Health , Learning Disability , Substance Misuse Other Vulnerable People ,475 5 Total ,920 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 Age Group 3. Completed referrals data is based on vulnerable adults whose age, gender and client type were known. The breakdown by age, gender and client group for completed referrals is similar to that seen for referrals (Table 3.1) which suggests that for any of these groups, the referral process is equally likely to be completed. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 35

36 Figure 4.1: Comparison of referrals and completed referrals by age group, Completed Referrals (84,920) Referrals (106,165) % 20% 40% 60% 80% 100% 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information provided by 152 councils. Percentage and over Source: AVA Table 1 Similarly, Figure 4.2 shows a comparison of the distribution of completed referrals by client group and referrals by client group. Again the finding is that there is almost no difference between the two distributions, thus indicating that none of the client groups are harder to reach conclusions for than the others. Figure 4.2: Comparison of referrals and completed referrals by client type, Completed Referrals (84,920) Referrals (106,165) % 20% 40% 60% 80% 100% Percentage Physical Disability Learning Disability Other Vulnerable People 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information provided by 152 councils. Mental Health Substance Misuse Source: AVA Table 1 Case Conclusion The case conclusion is the formal outcome of a completed referral and is categorised as; Substantiated, Partly Substantiated, Not Substantiated or Not Determined/Inconclusive. Definitions of these terms can be found in Appendix F. 36 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

37 The decision around substantiation should be based on the balance of probabilities ; i.e. if all allegations of abuse within a referral can be proved on the balance of probabilities then the case can be said to have been substantiated. Some councils do not feel comfortable making this decision about all cases and so not all councils were able to submit complete data on case conclusion. Counts of submitting councils for each table can be found in Annex B and further details of data quality, estimates provided by councils and issues around completion of data can be found in the data quality statement in Appendix B. Overall, 31 per cent of completed referrals were substantiated, 11 per cent were partly substantiated, 31 per cent were not substantiated and 28 per cent were not determined or inconclusive, as shown by Table 4.2 and Figure 4.3 Table 4.2: Distribution of case conclusions by age group of vulnerable adult, England Percentages and Rounded Numbers Not Determined / Inconclusive Percentage of Partly & Wholly Substantiated Age Group Substantiated Partly Substantiated Not Substantiated Total , , , and over , and over , Source: AVA Table 7a 1. Figures may not add up to 100 per cent due to rounding. 2. Data provided by 152 councils 3. Based on 83,990 reported conclusions. Some councils were unable to submit a conclusion for all of their completed referrals. Figure 4.3: Distribution of case conclusion, Not Determined / Inconclusive 28% Substantiated 31% Not Substantiated 31% Partially Substantiated 11% Source: AVA Table 7a 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils 3. Based on 83,990 reported case conclusions. Some councils were unable to submit a conclusion for all of their completed referrals. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 37

38 Percentage Abuse of Vulnerable Adults in England Figure 4.4 shows for each case conclusion category, the proportion of referrals which related to each age group. The chart shows that the distribution of age groups is similar; indicating that the age of the vulnerable adult does not have an effect on the case conclusion. Figure 4.4: Distribution of age groups (of vulnerable adult) by case conclusion, Substantiated (25,710) Partly Substantiated (8,960) Case Conclusion Not Substantiated (26,185) and over Not Determined / Inconclusive (23,140) Source: AVA Table 7a 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 83,990 reported case conclusions. Some councils were unable to submit a conclusion for all of their completed referrals. Figure 4.5 shows the distribution of primary client type by case conclusion for vulnerable adults aged 18 to 64. The learning disability client type shows a slightly different distribution compared to other client types, having a larger proportion of substantiated claims (35 per cent compared to a range of 27 to 30 per cent). There is no marked pattern of case conclusions for the remaining client types. 38 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

39 Percentage Abuse of Vulnerable Adults in England Figure 4.5: Case conclusion by primary client type aged 18-64, Physical Disability (7,360) Mental Health (7,065) Learning Disability (15,335) Substance Misuse (735) Other Vulnerable People (1,685) Client Type Substantiated Partly Substantiated Not Substantiated Not Determined / Inconclusive 1. Figures may not add up to 100 per cent due to rounding. 2. Case conclusion data was submitted by 152 councils. 3. Based on 32,175 reported case conclusions for vulnerable adults aged Source: AVA Table 7a Outcomes for Vulnerable Adult This section provides details on the outcomes of the safeguarding investigation relating to the person being, or at risk of being, harmed. They concentrate on the person at the centre of the safeguarding process, the vulnerable adult, and should reflect the actions taken from the protection plan offered to this person. More details about the specific outcomes listed in the return can be found in Appendix F. Data on the outcomes of the safeguarding investigation relating to the vulnerable adult were supplied by 152 councils. For each completed referral there can be more than one outcome. Figure 4.6 shows that in , the most common outcomes of safeguarding investigations were: No Further Action (30 per cent), Increased Monitoring (27 per cent), Other (12 per cent) and Community Care Assessments and Services (11 per cent). Table 4.3 shows that these results are consistent across each age group. There appears to be no bias towards particular outcomes in any age group. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 39

40 Figure 4.6: Outcome of completed referrals for vulnerable adult, Other 12% Community Care Assessment and Services 11% No Further Action 30% Other Outcomes 20% Increased Monitoring 27% Source: AVA Table 8a 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 100,990 reported outcomes from 84,920 completed referrals. 4.The category Other Outcomes includes all outcomes which represented five per cent or less of the total (Vulnerable Adult Removed from Property or Service, Civil Action, Application to Court of Protection, Application to Change Appointeeship, Referral to Advocacy Scheme, Referral to Counselling /Training, Moved to Increase / Different Care, Management of Access to Finances, Guardianship/Use of Mental Health act, Review of Self-Directed Support (IB), Referral to MARAC and Restriction/Management of Access to Alleged Perpetrator). 40 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

41 Table 4.3: Outcome of completed referrals for vulnerable adult, by age group, England Percentages and Rounded Numbers Outcome and over Total 18 and over Increased Monitoring Vulnerable Adult removed from property or service Community Care Assessment and Services Civil Action Application to Court of Protection Application to change appointee-ship Referral to advocacy scheme Referral to Counselling /Training Moved to increase / Different Care Management of access to finances Guardianship/Use of Mental Health act Review of Self-Directed Support (IB) Restriction/management of access to alleged perpetrator Referral to MARAC Other No Further Action Total 40,255 12,110 22,315 26, , Figures may not add up to 100 per cent due to rounding. Source: AVA Table 8a 2. Based on information submitted by 152 councils. 3. Based on 100,990 vulnerable adult outcomes from 84,920 completed referrals Thirty per cent of completed referrals had an outcome of No Further Action for the victim which is almost equal to the proportion (31 per cent) of case conclusions that were Not Substantiated (Figure 4.3). It should be noted that Not Substantiated referrals may still have outcomes and action may still be taken. Therefore it is not expected that the proportion of No Further Action outcomes and Not Substantiated referrals should match exactly. There were 142 councils that supplied data on both completed referrals and outcomes for the vulnerable adult. Eleven per cent of the outcomes for the victim were recorded as community care assessment and services. In contrast, Figure 4.7 shows that 33 per cent of completed referrals were for clients who were previously unknown to those councils. This indicates that there are people previously unknown to the council going through the safeguarding process and not requiring community assessments and services in order to safeguard them from further harm. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 41

42 Percentage Abuse of Vulnerable Adults in England Figure 4.7: Comparison of unknowns with the outcome of community care assessment and services, Unknown to the CASSR at the time of alert/referral Outcome of community care assessment and services Source: AVA Tables 1 and 8a 1. Based on results from 142 councils who supplied values greater than zero for completed referrals, number known to CASSR and total outcomes for the vulnerable adult. 2. Based on 95,355 vulnerable adult outcomes from 80,595 completed referrals including unknowns. In contrast to Table 4.3, Table 4.4 shows that for adults in the age group there are differences in the distribution of the outcomes between the client types. The rate of increased monitoring is slightly higher amongst the mental health and learning disability client types at around 30 per cent compared to around 20 per cent for the three other client types. The No Further Action outcome is highest amongst the Other Vulnerable People client type (36 per cent compared to a range of 24 to 32 per cent). 42 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

43 Table 4.4: Outcome of completed referrals for vulnerable adult, by primary client type of vulnerable adult aged 18-64, England Outcome Physical disability Mental Health Percentages and Rounded Numbers Learning Disability Substance Misuse Other Vulnerable People Increased Monitoring Vulnerable Adult removed from property or service Community Care Assessment and Services Civil Action Application to Court of Protection Application to change appointee-ship Referral to advocacy scheme Referral to Counselling /Training Moved to increase / Different Care Management of access to finances Guardianship/Use of Mental Health act Review of Self-Directed Support (IB) Restriction/management of access to alleged perpetrator Referral to MARAC Other No Further Action Total 9,255 8,810 19, ,045 Source: AVA Table 8a 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 40,255 vulnerable adult outcomes from 32,595 completed referrals for year olds. Serious Case Reviews Serious case reviews are performed when there are major concerns about adult protection and/or system failures that have resulted in people not being cared for or protected adequately. They are held in order to determine what went wrong and what lessons may be learned about the way in which staff and agencies work together to safeguard people at risk of harm. The AVA return collects data on how many safeguarding referrals completed within the collection period led to a serious case review. It is expected that there would be only a small number of these during any reporting year. There were a total of 135 serious case reviews in All 152 councils reported on this data item (data shown in Annex A, Table 8b). Sixty per cent of the reviews related to older adults aged 65 or over. Of all completed referrals, 62 per cent were about individuals in the over 65 age group. Given that these proportions are similar, it would suggest that neither younger (under 65) or older (65 or over) adults are more at risk of being involved in a serious case review. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 43

44 Protection Plans The term protection plan is used to refer to the agreed actions placed on the care plan of a vulnerable adult following an investigation into an allegation of abuse. The plan should document: what steps are to be taken to assure the future safety of the vulnerable adult; what treatment or therapy the vulnerable adult can access; modifications in the way services are provided (for example moving to same gender care or placement); how best to support the individual through any action they take to seek justice or redress; and any on-going risk management strategy required where this is deemed appropriate. Further guidance can be found in the Department of Health s guidance document No Secrets 6. It is good practice for mentally capable adults to be included in the assessment of risk and the formulation of the protection plan. In some cases proactive support is required and higher levels of acceptance may be seen to be an indicator of good engagement with the individual. The communication needs, wishes and mental capacity of the alleged victim to make decisions about achieving safety from abuse or neglect should be properly assessed. Only when an individual lacks the mental capacity to make such decisions should another individual - such as a relative - be nominated to take part in the risk assessment and protection plan on their behalf. As shown by Table 4.5, in not all councils offered a protection plan for each completed referral. A protection plan may not be necessary for referrals where the allegations of abuse were unsubstantiated or the case conclusion status could not be determined. Across all age groups 61 per cent were offered a protection plan. Table 4.5: Number of protection plans offered, by age of vulnerable adult, England Percentages and Rounded Numbers Age group No. of Completed Referrals No. of Protection Plans Offered Percentage of Referrals where Plan Offered ,350 18, ,030 5, ,980 10, and over 20,715 12, All Ages 76,075 46, Source: AVA Tables 1 and 8c 1. Figures may not add up to the total due to rounding. 2. Based on data submitted by 140 councils who provided completed referral and protection plan data greater than zero. Figure 4.8 shows for each age group, the proportion of protection plans that were accepted. Of all protection plans that were offered in , 57 per cent were accepted, 22 per cent were declined and for 21 per cent of plans, the vulnerable adult was unable to consent. The chart shows that fewer protection plans were accepted as the age of the vulnerable adult increases. The proportion of individuals who were unable to consent to a plan also increased with age Copyright 2013, Health and Social Care Information Centre. All rights reserved.

45 Percentage Percentage Abuse of Vulnerable Adults in England Figure 4.8: Acceptance of protection plan, by age of vulnerable adult, (18,295) (5,370) (10,205) Age Group 85 and over (12,500) All ages (46,375) Accepted Not Accepted Could Not Consent 1. Figures may not add up to 100 per cent due to rounding. 2. Based on data submitted by 140 councils who submitted protection plan data greater than zero. 3. Based on 46,375 protection plans offered to vulnerable adults of all ages. Source: AVA Table 8c Figure 4.9 explores the relationship between the response to a protection plan and the client type of the vulnerable adult. Mental health and substance misuse clients are more likely to accept a protection plan than other client types with 73 per cent of plans accepted by each of these groups. Adults with a learning disability were more likely to be unable to consent to a plan than other client types. Figure 4.9: Acceptance of protection plans, by client type of vulnerable adult (aged 18-64), Physical Disability (3,960) Mental Health (4,275) Learning Disability (8,865) Substance Misuse (445) Other Vulnerable People (755) Client Type Accepted Not Accepted Could Not Consent Source: AVA Table 8c 1. Figures may not add up to 100 per cent due to rounding. 2. Based on data submitted by 140 councils who submitted protection plan data greater than zero. 3. Based on 18,295 protection plans offered to vulnerable adults aged Copyright 2013, Health and Social Care Information Centre. All rights reserved. 45

46 Outcome for Perpetrator, Organisation or Service This section looks at the outcomes or actions resulting from the completed referral which relate to the alleged perpetrator, organisation or service. A single completed referral may result in more than one type of outcome for the alleged perpetrator. However, if the No Further Action or the Not Known outcome was recorded for a referral then councils were instructed that no other additional outcome should be recorded for that completed referral. As shown by Figure 4.10 the most common outcome of completed referrals for the alleged perpetrator is No Further Action accounting for over a third of all outcomes for the perpetrator (36 per cent). This is followed by Continued Monitoring (18 per cent) and Not Known (9 per cent). All other outcomes account for less than 10 per cent of the total number of outcomes. Table 4.6 shows that the actions taken by the council against the person causing harm do not vary substantially depending on the age of the vulnerable adult being harmed or put at risk of harm. Figure 4.10: Outcome of completed referrals for perpetrator / organisation / service, Counselling / Training / Treatment 6% Police Action 6% Management of Access to the Vulnerable Adult 5% Disciplinary Action 5% No Further Action 36% Not Known 9% Other Outcomes 16% Continued Monitoring 18% Source: AVA Table 9 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 98,670 perpetrator outcomes from 84,920 completed referrals. 4. The category Other Outcomes includes all outcomes which occurred at a rate of less than five per cent (Criminal Prosecution / Formal Caution, Community Care Assessment, Removal from Property or Service, Referred to PoVA List / ISA, Referral to Registration Body, Action By Care Quality Commission, Referral to Court Mandated Treatment, Referral to MAPPA, Action under Mental Health Act, Action by Contract Compliance, Exoneration). 46 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

47 Table 4.6: Outcome of completed referrals for perpetrator / organisation / service, by age of vulnerable adult, England Percentages and Rounded Numbers Age Group Outcome and over 18 and over Criminal Prosecution / Formal Caution Police Action Community Care Assessment Removal from property or Service Management of access to the Vulnerable Adult Referred to PoVA List /ISA** Referral to Registration Body Disciplinary Action Action By Care Quality Commission Continued Monitoring Counselling/Training/Treatment Referral to Court Mandated Treatment Referral to MAPPA Action under Mental Health Act Action by Contract Compliance Exoneration No Further Action Not Known Total 38,330 11,655 22,040 26,645 98, Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 98,670 perpetrator outcomes from 84,920 completed referrals for vulnerable adults of all ages. Source: AVA Table 9 Table 4.7 shows that the distribution of outcomes for the alleged perpetrator is similar for each of the primary client types in the age group. There are some differences which stand out for particular client types. The most notable is for the Substance Misuse client type, where alleged abuse is more likely to lead to police action for the perpetrator or be recorded as No Further Action than for other client types. The data also show that the alleged abuse of individuals with learning disabilities is more likely to result in the continued monitoring of the perpetrator than for other client types. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 47

48 Table 4.7: Outcome of completed referrals for perpetrator / organisation / service, by client type of vulnerable adult aged 18-64, England Percentages and Rounded Numbers Client Type Outcome Physical Disability Mental Health Learning Disability Substance Misuse Other Vulnerable People Criminal Prosecution / Formal Caution Police Action Community Care Assessment Removal from property or Service Management of access to the Vulnerable Adult Referred to PoVA List /ISA** Referral to Registration Body Disciplinary Action Action By Care Quality Commission Continued Monitoring Counselling/Training/Treatment Referral to Court Mandated Treatment Referral to MAPPA Action under Mental Health Act Action by Contract Compliance Exoneration No Further Action Not Known Total 8,540 8,260 18, ,950 Source: AVA Table 9 1. Figures may not add up to 100 per cent due to rounding. 2. Based on information submitted by 152 councils. 3. Based on 38,330 perpetrator outcomes from 32,595 completed referrals for vulnerable adults aged For councils that supplied data on both case conclusions and outcomes for the perpetrator Figure 4.11 shows that the percentage of not substantiated case conclusions was consistently lower than the percentage of outcomes for the perpetrator that were either No Further Action or exoneration (a range of 28 to 34 per cent compared to a range of 37 to 40 per cent). This indicates that some cases which were partly or wholly substantiated or where the conclusion could not be determined must have an outcome of No Further Action or exoneration for the perpetrator. 48 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

49 Percentage Abuse of Vulnerable Adults in England Figure 4.11: Comparison of unsubstantiated cases with perpetrator outcome of No Further Action/exoneration, and over All Ages Not Substantiated Age Group Exoneration or No Further Action Source: AVA Tables 7a and 9 1. Based on information from by 151 councils who submitted both case conclusion and perpetrator outcome data greater than zero. 2. Based on 83,990 case conclusions and 98,670 alleged perpetrator outcomes. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 49

50 Appendix A: Editorial Notes This section outlines the methodologies employed during the collection and analysis of the AVA data. Collection Process The AVA data is submitted by CASSRs to the HSCIC in an aggregated format via an online collection system. The online collection system (Omnibus) was made available to councils in May 2012 for a six week period to allow councils to submit their first cut of data relating to the period. The collection system includes a number of at-source validations to help ensure quality and integrity of the data. If any of these validations are breached the data cannot be submitted without a reason for the breach being entered on the system or the breach being removed by changing the data. After the first cut deadline the HSCIC carried out a round of internal validations in which any breach reasons were reviewed. Additional validation tests were carried out in which outliers and anomalies were identified. Validation reports were created where necessary, which included a list of blank cells, unaccepted breach reasons and results of the additional validation tests. The collection system was made available for a further 3 week period in August 2012 to allow councils to submit their second version of data. A further round of validations was undertaken in October 2012 and CASSRs had a second opportunity to address any outstanding issues before the third and final cut deadline in November The third cut data has been used to populate this report. Age-Gender Standardisation Data presented by region has been standardised to the age and gender breakdown for England to account for variation in these variables between regions. The method used is a direct-standardisation method where the observed rate for each age / gender group is calculated per 100,000 population for each area. This is then multiplied by the England population for each age / gender group. The resulting values are summed across the age / gender groups and then divided by the total England population. Example: The observed rates for Area A are shown in Table A3. Table A3 Observed data for Area A Observed data Female Male Female Male Female Male Female Male Area A 1,091 1, , These are divided by the population in each age / gender group for Area A (Table A4) and multiplied by 100,000 to give observations per 100,000 population as shown in Table A5. 50 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

51 Table A4 Population data for Area A Population Female Male Female Male Female Male Female Male All adults Area A 820, , , ,120 89,585 66,602 38,386 18,151 2,084,607 Table A5 Observed data per 100,000 population for Area A Observed data per 100,000 Ppn. Female Male Female Male Female Male Female Male All adults Area A , , , The population data for all areas (shown in Table A6) is then used to calculate the standardised rate by multiplying the observed rate per 100,000 population for Area A in each age / gender group by the overall population for that age / gender group, as shown in Table A7. Table A6 Population data for All Areas Ppn. Female Male Female Male Female Male Female Male All adults All Areas 16,280,125 16,302,232 2,344,169 2,142,784 1,659,017 1,262, , ,067 41,188,676 The overall age-gender standardised rate for all adults (18 and over) is calculated by summing the individual age / gender components of the rate in Table A6 and dividing by the total all adults population figure in A5. This is shown in the last column of A7. Table A7 Standardised Rate for Area A Standardised data per 100,000 Ppn Female Male Female Male Female Male Female Male Area A 2,164,169,006 2,034,433, ,836, ,300,350 1,688,925, ,655,811 2,400,511, ,871,026 Standardised data per 100,000 Ppn. All adults Area A Copyright 2013, Health and Social Care Information Centre. All rights reserved. 51

52 Appendix B: Data Quality This appendix outlines further detail about the data used in this report. Relevance This section describes the degree to which the statistical product meets the user needs in content and coverage. This Final Abuse of Vulnerable Adults (AVA) Report provides information on the safeguarding activity of Councils with Adult Social Services Responsibilities (CASSRs) in England. The report provides detailed analysis of data from the AVA collection for the period 1 April 2011 to 31 March The collection covers vulnerable adults aged 18 and over in England for whom Social Services have been made aware of their being at risk of abuse or actually being abused. Data is gathered regarding the nature and location of the alleged abuse, the source of the referral and the relationship of the alleged perpetrator. Once a referral is completed the return collects information on the conclusion of each case and the action(s) taken in order to reduce or remove the risk to the individual. The report breaks down this data into age, gender and client type of the vulnerable adult in order to analyse the groups at risk. The data is used by central government to monitor the impact of social care policy and by local government to assess activity in relation to their peers. The data is also available for use by researchers looking at council performance and by service users and the public to hold councils and the government to account. The AVA collection was approved by the Outcomes and Information Development Board (OIDB). This group is co-chaired by the Department of Health (DH) and the Association of Directors of Adult Social Services (ADASS) and contains representatives from the HSCIC, Care Quality Commission (CQC), Local Government Association (LGA) and CASSR social service performance managers. Some minor changes to the collection were agreed following feedback from Local Authority representatives at the Adult Review Group (ARG). Table 5b was changed to collect data on the type of service by age and client group rather than by location and all of the titles in the return were refreshed to improve clarity. Accuracy There are a number of factors affecting the accuracy of this report. A summary of the key issues is outlined below. Data Validations Validations were assessed in the Omnibus collection system used by CASSRs to submit their data. While this may have prompted councils to address their data issues, submissions were still accepted by the system with outstanding errors as long as a breach reason was supplied. A series of post submission validations were also carried out by the HSCIC to identify outliers and anomalies. Councils were notified of these issues but returns may not necessarily have been amended. Where erroneous data has not been amended there may be differences between total rows or columns in the return and the sum of their constituent parts. Where such a difference exists, the calculations within this report will utilise the sum of the parts rather than the given total. 52 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

53 Blank Cells As part of its work on Data Quality Assurance, the HSCIC published its first report on the quality of nationally submitted health and social care data 7 in July For social care, this consisted of national level tables showing the number of missing data items in some of the social care collections and charts showing the number of councils with a high proportion of missing data items. This report has expanded on that work. For the AVA return, 10 of the 152 councils submitted blank cells. A total of 433 cells were left blank, accounting for 0.1 per cent of the total cells. A higher proportion of cells were populated in the return than in the previous year. For the AVA return, 22 councils submitted blank cells and a total of 2,847 cells were left blank, accounting for 0.9 per cent of the total. However, this does not necessarily equate to an improvement in data quality as some of the populated cells should have been left blank. In the guidance, councils were asked to submit zeros in the alert columns if alerts were not recorded. For all other data items, councils were asked to leave cells blank if data was not recorded. This may have led to some confusion around which rule was appropriate since some councils have informed us that they have incorrectly submitted zeros where cells should have been left blank. Caution would therefore be advised around the interpretation of council level data recorded as zero or blank in the return. This issue is especially prevalent among subset categories such as the of which: Dementia and of which: Number placed by other authority groups. Table A1 looks at the proportion of cells left blank by each council in their return. Only councils which had blank cells are included in the table. Table A1: Number of Blank Cells by Council Council Name (Council Number) Number of Blank Cells Proportion of Blank Cells Cumbria County Council (102) % Hartlepool Borough Council (111) % Kirklees Metropolitan Council (211) % Medway Council (821) % Merton Borough Council (730) % Nottingham City Council (512) % Royal Borough of Kingston upon Thames (729) % Staffordshire County Council (413) % Suffolk County Council (609) % Westminster City Council (713) % 7 Copyright 2013, Health and Social Care Information Centre. All rights reserved. 53

54 Blank cell information is also available split by AVA table. Annex B provides a detailed view of how many councils have submitted each data item within the tables. Known Missing Data Issues Analysis of the AVA return has highlighted a number of missing data issues. In , there were 120 councils who submitted alert data greater than zero for adults whose age, gender and client type were known. This represents an increase in the number of councils recording alerts. A total of 101 councils recorded alert data in , of which only 99 were able to do so again in Alert activity will be collected for but this information will not be required for the reporting period when the current AVA collection will be replaced by the new Safeguarding Adults return 8. For some councils, not recording alerts reflects an inability to report this 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. Where alerts do not meet the threshold they should not be classified as a referral in the return. Feedback from councils suggests that this guideline has not always been followed. For councils who have classified alerts which do not meet the threshold as a referral, this can have an impact on other aspects of the return. These councils may appear to have a higher number of referrals per 100,000 population than their peer group. This can also lead to inflated proportions of Unsubstantiated or Not Determined referrals and higher proportions of No Further Action outcomes. A number of councils have stated that due to challenges in the recording of data, some figures are not fully representative of all activity that has taken place. These councils are listed below, together with the subject area for which a partial data set has been supplied. Table A2: Partial Data Submitted by Councils Council Name (Council Number) Dudley Metropolitan Borough Council (408) Hampshire County Council (812) Lancashire County Council (323) Leeds City Council (212) Newcastle upon Tyne City Council (107) Rotherham Borough Council (206) Tameside Metropolitan Borough Council (311) Warrington Borough Council (322) Warwickshire County Council (404) Partial Data Completed referrals Case conclusions for completed referrals Referrals, repeat referrals, completed referrals Mental health referrals/repeat referrals/completed referrals Protection plans and dementia cases Mental health alerts/referrals/repeat referrals/completed referrals Referrals only Alerts Alerts 8 Further information on the new Safeguarding return can be found at 54 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

55 Known Data Quality Issues Councils have informed us of a number of issues relating to their interpretation of AVA definitions. Some of these issues could be due to a lack of clarity in the guidance or due to a misunderstanding of the terminology used in the guidance. The key issues are highlighted below. 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. Not all concerns will meet the safeguarding threshold and progress to a referral and for this reason we would expect the total number of alerts to be higher than the total number of referrals. For a small number of councils, total referrals are higher than total alerts which may suggest a misunderstanding of these definitions. Feedback from councils suggests that there is a lack of clarity around the table 7 definitions for the Not Determined/Inconclusive and Unsubstantiated categories. This suggests that there may be differences in the understanding of these options between councils. Several councils have reported issues with the completion of table 8 and 9. In some cases, the Other (table 8), Not Known (table 9), and No Further Action (table 8 and 9) outcomes have been used by councils as a default category. Default categories have sometimes been used when councils have not been able to record specific outcomes on their system or where none of the available categories were felt to be appropriate. Some councils have recorded the No Further Action outcome on the system as this reflected the situation at the point of recording but some action had been taken during the investigation which has not been recorded. Other councils have reported that No Further Action has been recorded as well as other actions for the same referral. Where councils have had any of the above issues with table 8 or 9, this may lead to a higher proportion of Not Known, Other, and/or No Further Action outcomes compared to their peer group. Estimates Where CASSRs were unable to submit data for either an entire table or for some of their safeguarding cases they were invited to provide estimates. Estimating data helps to reduce under-reporting and allows figures to be more representative of the true national figure. In the reporting period, 14 councils informed us that they had used estimates within their data. This is a similar level to where 13 councils stated they had used estimates. Further councils could have used calculated figures in their return without informing the HSCIC. Different estimation methodologies could have been used for this process. Table A3 below provides a summary of councils who have indicated that they have estimated some or all of the data in the tables stated. All of the below estimates were entered into Omnibus before the final submission deadline and will therefore be included at local and national level in the National Adult Social Care Intelligence Service (NASCIS). Copyright 2013, Health and Social Care Information Centre. All rights reserved. 55

56 Table A3: Estimated Data Submitted by Councils Council Name (Council Number) Tables Central Bedfordshire Council (626) Halton Borough Council (321) 1, 6a, 6b 1, 4a, 4b, 5a, 6a, 6b Hertfordshire County Council (606) 8a, 9 Hounslow London Borough Council (728) Lancashire County Council (323) Manchester City Council (306) Nottinghamshire County Council (511) Oxfordshire County Council (608) Southend-on-Sea Borough Council (621) 1, 5b, 8c 7a, 7b 1, 5b, 6a, 6b 3, 6a, 6b 1, 5b 6b, 8c Suffolk County Council (609) 1 Westminster City Council (713) 3, 5a, 6a, 6b, 8a, 9 Wigan Metropolitan Borough Council (313) Wirral Metropolitan Borough Council (319) Wokingham Council (619) 7a, 7b 6a, 6b 8c Salford City Council informed us of an issue with their alerts data just after the final deadline for changes. There is limited scope for correction of figures at this time and therefore we are only able to use the revised figures for England level totals in this report and on NASCIS. We are unable to show the revised council level figures for Salford City Council in NASCIS due to the late correction. Timeliness and Punctuality The AVA collection is undertaken annually with submitted data covering a full financial year. A provisional report was published in November last year utilising the second submission of data from councils. The final report utilises the third and final cut of AVA data submitted in November This final publication has been released in line with the pre-announced publication date and is therefore deemed to be punctual. Accessibility This final AVA report is available to download from the HSCIC publication webpages in PDF format. Annex tables aggregated to national level are available to download in Microsoft Excel format and the council level data submitted by CASSRs is also available in CSV format via the AVA publication webpage. Please see link below. The underlying council level data is available in the National Adult Social Care Intelligence Service (NASCIS) via the Online Analytical Processor (OLAP). This data is rounded to avoid disclosure risks. The data is also presented as a series of Comparator Standard Reports in PDF format. Access to data and reports on NASCIS can be found at the below address. 56 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

57 Required elements of the report may be available in other formats upon request. Clarity and Comparability A copy of the collection proforma is included in Appendix E along with a glossary of terms in Appendix F. Improvements have been made to the guidance and the validation process to facilitate consistent use of definitions between councils. The data contained within this report is comparable to the Final AVA Report for Assessment of User Needs and Perceptions User feedback on the format and content of The Abuse of Vulnerable Adults Report is invited. Please see link below for our online feedback form. NASCIS users are invited to provide feedback on any part of the NASCIS service via the below address. Please note you may need to sign in or create an account in order to use this form. Performance, Cost and Respondent Burden In , a compliance cost survey was undertaken for the social care collections, including the AVA. The survey asked councils to supply the additional costs of supplying this data to the HSCIC, in terms of staff hours per pay band. The compliance cost survey was voluntary for councils to participate in and 88 councils provided data for AVA. The figures have been grossed up to provide a cost estimate for 128 councils (as per AVA responders) of 178,200. The survey results can be found under the link 21 April 2011 on the HSCIC Adult Review Group web page. The address for this page is given below. Confidentiality, Transparency and Security Please see links below to the relevant HSCIC policies and procedures. Statistical Governance Policy (Select from the right hand side panel of this page) Small Numbers Procedure (Select from the right hand side panel of this page) Freedom of Information Process Data Access and Information Sharing policy Copyright 2013, Health and Social Care Information Centre. All rights reserved. 57

58 Appendix C: How are the statistics used? Report Users and Uses This section contains comments based on responses from the users listed. All these users have found the information in the report useful for the purposes set out. Department of Health The Abuse of Vulnerable Adults data helps to support adult safeguarding policy development. For example, the data can be used to estimate the amount and type of safeguarding activity which currently takes place. This can help to inform assessments of how policy reforms might impact on the volume and nature of safeguarding work carried out by local social services, the police, the NHS, and other agencies. The AVA data also helps to inform: Speeches and briefings for Ministers and senior officials. Media Enquiries and other correspondence. Councils with Adult Social Services Responsibilities Different councils will use the AVA data in different ways but there will be some commonality between them. Ways in which councils may use the AVA data will include: Benchmarking against other councils. Measuring/monitoring local performance. Policy development. Service development, planning and improvement. Management information, local reporting, accountability. Informing business cases. Identifying any immediate priorities/areas for concern. Alzheimer s Society The Abuse of Vulnerable Adults data enables better prevention of abuse and better recognition of it and support for people when it does happen. For this reason, information and demographic data about who perpetrates it towards whom, where, when and how is often essential for awareness raising and support planning 58 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

59 Appendix D: Related Publications This publication draws together statistics from the Abuse of Vulnerable Adults collection. The HSCIC produces a number of other reports on Adult Social Services activity. All HSCIC publications relating to social care activity, finance, staffing and user experience surveys can be downloaded from the HSCIC website at Links to the latest version of specific reports are detailed below. Adult Social Care Activity Registered Blind and Partially Sighted People Year ending 31 March 2011, England is available at People Registered Deaf or Hard of hearing Year ending March , in England is available at Community Care Statistics: Social Services Activity, England, is available at Measures from the Adult Social Care Outcomes Framework England, , Final release Adult Social Care Finance Personal Social Services: Expenditure and Unit Costs Final Release which is available at Community Care Statistics : Grant Funded Services (GFS1) Report - England which is available at Adult Social Care Staffing Personal Social Services Staff of Social Services Departments at 30 September 2012 is available at Adult Social Care User Surveys Adult Social Care Survey - England, , Final is available at Survey of Carers in Households /10 England is available at Copyright 2013, Health and Social Care Information Centre. All rights reserved. 59

60 Adult Social Care Data for the UK Information within this report relates to activity that has taken place in England. Similar publications for Wales, Scotland and Northern Ireland can be found via the following links: For the Welsh Assembly Government For the Scottish Government For Northern Ireland - Department of Health, Social Services and Public Safety Social Care for Children Information on social care for children is available at 60 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

61 Appendix E: Collection Proforma The collection proforma on the following pages was made available to CASSRs to enable them to prepare the required data items for entry on the Omnibus system. Age group: Age group: Age group: Age group: 85 + Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 1: Number of alerts, referrals, repeat referrals and completed referrals, by age, primary client group and gender of vulnerable adult Primary client group: Physical disability, frailty and sensory impairment (Total) of which : Sensory Impairment Mental Health (Total) of which : Dementia Learning Disability Substance misuse Other Vulnerable People Total aged Physical disability, frailty and sensory impairment (Total) of which : Sensory Impairment Mental Health (Total) of which : Dementia Learning Disability Substance misuse Other Vulnerable People Total aged Physical disability, frailty and sensory impairment (Total) of which : Sensory Impairment Mental Health (Total) of which : Dementia Learning Disability Substance misuse Other Vulnerable People Total aged Physical disability, frailty and sensory impairment (Total) of which : Sensory Impairment Mental Health (Total) of which : Dementia Learning Disability Substance misuse Other Vulnerable People Total aged 85 and over Total (aged 18 and over) Excluding Unknowns Full Total (aged 18 and over) Including Unknowns* of which: Number placed by other authority from outside council area Number known to CASSR at time of alert/referral Alerts Referrals Repeat Referrals Completed Referrals Female Male Total Female Male Total Female Male Total Female Male Total * Data must be entered in this row as it used for cross table validations. If you have no unknowns then this row should be equal to the previous row. If you do have unknowns they should be added to the totals in the previous row and entered in this row. Please see the AVA guidance for the definition of unknowns. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 61

62 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 2: Number of alerts, referrals, repeat referrals and completed referrals, by ethnicity and age of vulnerable adult Ethnicity: White White British White Irish Traveller of Irish Heritage Gypsy/Roma Any other White background Mixed White and Black Caribbean White and Black African Asian or Asian British Indian White and Asian Any other Mixed background Pakistani Black or Black British Caribbean Bangladeshi Any other Asian background African Any other Black background Other Ethnic Groups Chinese Any other ethnic group Not stated Refused Information not yet obtained Total Alerts Referrals Repeat Referrals Completed Referrals Total Total Total Total 62 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

63 Social care staff Health staff Other sources of referral Overall Total Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 3: Source of referral, by age and primary client group of vulnerable adult and over 18 and over Source of Referral: Social Care Staff (CASSR & Independent) - Total of which : Domiciliary Staff Residential Care Staff Day Care Staff Social Worker/Care Manager Self -Directed Care Staff Other Health Staff - Total of which: Primary/Community Health Staff Secondary Health Staff Mental Health Staff Self Referral Family member Friend/neighbour Other service user Care Quality Commission Housing Education/Training/Workplace Establishment Police Other Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL Copyright 2013, Health and Social Care Information Centre. All rights reserved. 63

64 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 4a: Nature of alleged abuse, for referrals, by age and gender of vulnerable adult * Nature of alleged abuse: Physical Sexual Emotional/psychological Financial Neglect Discriminatory Institutional Total of which: Included multiple types of abuse** and over Total 18 and over Female Male Total Female Male Total Female Male Total * Multiple Entries are permitted in this table ** Unique count of referrals where multiple types of abuse took place Table 4b: Nature of alleged abuse, for referrals, by age and primary client group of vulnerable adult * Nature of alleged abuse: Physical Sexual Emotional/psychological Financial Neglect Discriminatory Institutional Total of which: Included multiple types of abuse** Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse and over Total 18 and over Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL * Multiple Entries are permitted in this table ** Unique count of referrals where multiple types of abuse took place 64 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

65 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 5a: Location alleged abuse took place, for referrals, by age of vulnerable adult * Location alleged abuse took place: Own Home Care Home - Permanent Care Home with Nursing - Permanent Care Home - Temporary Care Home with Nursing - Temporary Alleged Perpetrators Home Mental Health Inpatient Setting Acute Hospital Community Hospital Other Health Setting Supported Accommodation Day Centre/Service Public Place Education/Training/Workplace Establishment Other Not Known Total and over Total 18 and over * Multiple Entries are permitted in this table: (a person should be recorded under each location where abuse is alleged to have taken place) Table 5b: Type of service, for referrals, by age and primary client group of vulnerable adult* and over 18 and over Type of Service Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL Own Council Commissioned Service Commissioned by Another CASSR Self Funded service Service funded by Health No Service Total * Multiple Entries are permitted in this table: (a person may be receiving more than one type of service at the time of the referral) Copyright 2013, Health and Social Care Information Centre. All rights reserved. 65

66 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 6a: Relationship of vulnerable adult to alleged perpetrator(s), for referrals, by age and gender of the vulnerable adult * Relationship of alleged perpetrator: Partner Other family member Health Care Worker Volunteer/ Befriender Social Care Staff - Total of which: Domiciliary Care staff Residential Care staff Day Care staff Social Worker/Care Manager Self-Directed Care Staff Other Other professional Other Vulnerable Adult Neighbour/Friend Stranger Not Known Other Total of which: the alleged perpetrator lives with the vulnerable adult the alleged perpetrator is the main family carer and over Total - 18 and over Female Male Total Female Male Total Female Male Total *Multiple entries are permitted in this table Table 6b: Relationship of vulnerable adult to alleged perpetrator(s), for referrals, by age and primary client group of the alleged victim * and over 18 and over Relationship of alleged perpetrator: Partner Other family member Health Care Worker Volunteer/ Befriender Social Care Staff - Total of which: Domiciliary Care staff Residential Care staff Day Care staff Social Worker/Care Manager Self-Directed Care Staff Other Other professional Other Vulnerable Adult Neighbour/Friend Stranger Not Known Other Total of which: the alleged perpetrator lives with the vulnerable adult the alleged perpetrator is the main family carer Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL *Multiple entries are permitted in this table 66 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

67 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 7a: Case conclusion of completed referrals, by age and primary client group of vulnerable adult Age Group / Primary Client Group: Age group 18-64: Other age groups Total Physical disability, frailty and sensory impairment (Total) Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL TOTAL 85 and over TOTAL 18 and over Substantiated Partly Substantiated Not Substantiated Not Determined / Inconclusive Table 7b: Case conclusion of completed referrals, by ethnicity of vulnerable adult Ethnicity: White Mixed Asian or Asian British Black or Black British Other Ethnic Groups Not stated Total - all ethnicities White British White Irish Traveller of Irish Heritage Gypsy/Roma Any other White background White and Black Caribbean White and Black African White and Asian Any other Mixed background Indian Pakistani Bangladeshi Any other Asian background Caribbean African Any other Black background Chinese Any other ethnic group Refused Information not yet obtained Substantiated Partly Substantiated Not Substantiated Not Determined / Inconclusive Copyright 2013, Health and Social Care Information Centre. All rights reserved. 67

68 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 8a: Outcome of completed referral for vulnerable adult, by age and primary client group of vulnerable adult * Outcome of Completed Referral: Increased Monitoring Vulnerable Adult removed from property or service Community Care Assessment and Services Civil Action Application to Court of Protection Application to change appointee-ship Referral to advocacy scheme Referral to Counselling /Training Moved to increase / Different Care Management of access to finances Guardianship/Use of Mental Health act Review of Self-Directed Support (IB) Restriction/management of access to alleged perpetrator Referral to MARAC Other No Further Action Total Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse and over 18 and over Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL * Multiple entries are permitted in this table Table 8b: Number of completed referrals leading to Serious Case Review by age and primary client group of vulnerable adult No. completed referrals leading to serious case review Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse and over 18 and over Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL Table 8c: Acceptance of Protection Plan by age group and primary client group of vulnerable adult Acceptance of Protection Plan: Yes No Could not consent Total Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse and over 18 and over Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL 68 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

69 Abuse of Vulnerable Adults Table index Period: 01/04/2011 to 31/03/2012 Table 9: Outcome of completed referral for Alleged Perpetrator/Organisation/Service, by age and primary client group of vulnerable adult * Outcome for Alleged Perpetrator / Organisation/Service: Criminal Prosecution / Formal Caution Police Action Community Care Assessment Removal from property or Service Management of access to the Vulnerable Adult Referred to PoVA List /ISA** Referral to Registration Body Disciplinary Action Action By Care Quality Commission Continued Monitoring Counselling/Training/Treatment Referral to Court Mandated Treatment Referral to MAPPA Action under Mental Health Act Action by Contract Compliance Exoneration No Further Action Not Known Total Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse and over Total 18 and over Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL * Multiple entries are permitted in this table **Independent Safeguarding Authority Copyright 2013, Health and Social Care Information Centre. All rights reserved. 69

70 Appendix F: Glossary of Terms This section gives details of the definitions provided in the AVA guidance document to help councils in the completion of the return. The definitions were taken from a mixture of sources including the Department of Health No Secrets guidance 2000, report by Action on Elder Abuse on Adult Protection Data Monitoring and existing social care collections within the HSCIC. Abuse Abuse is a violation of an individual s human and civil rights by any other person or persons. Abuse may consist of a single act or repeated acts. It may be physical, verbal or psychological, it may be an act of neglect or an omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of, the person subjected to it. Age group The age range into which alleged victims are placed. The age groups used in the AVA collection are 18 and over, 18-64, 65-74, 75-84, 85 and over and also 65 and over. Age is calculated as at the last day of the reporting period, i.e. 31st March, or if the person has died before 31st March, their age should be recorded as their age at date of death. Alert An alert is a feeling of anxiety or worry that a vulnerable adult may have been, is or might be, a victim of abuse. This would be the first contact between the source of the referral and the CASSR safeguarding team about the alleged abuse. An alert may arise as a result of a disclosure, an incident or other signs or indicators. If your local system starts at the referral stage (i.e. only referrals are recorded), insert zeros in the alerts columns of Tables 1 and 2. Alleged perpetrator The alleged perpetrator is the person who the vulnerable adult, or other person/s, has asserted, but not yet proven, to have committed the abuse. Case conclusion The case conclusion is the formal outcome of a completed referral and is categorised as either substantiated, partly substantiated, not substantiated or not determined/inconclusive (individual definitions for these given in the relevant area of this glossary). The burden of proof should be consistent with the standard applied to the Protection of Vulnerable Adults (POVA) List which is on the balance of probabilities. CASSR Council with adult social services responsibilities. Completed referral A completed referral is where the active investigation/assessment of allegations is complete and has been closed and an action plan has been agreed, or an allegation has been discounted. It is important to note that this is different to no action being taken as a result of an alert not meeting your council s safeguarding thresholds. Only if a safeguarding full investigation / assessment is carried out AND the conclusion of such an investigation is that No Further Action is necessary should this be recorded as a completed referral in Tables 1 and 2 and as No Further Action in Table 8a and / or Table 9 If a referral is completed in the collection period, it is recorded regardless of whether the initial referral was made in the same collection period. Therefore completed referrals are not a subset of all referrals for a given collection period. Episode An episode refers to an alert or referral. This should not be confused with an incidence of abuse. 70 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

71 Ethnicity The ethnic categorisation is a two tier structure, with six top level categories, each with a set of subcategories. The two ethnicity Not Known categories, Refused and Information not yet obtained should be used as follows: Refused Should only be used for those clients from whom the council has requested ethnicity information and the person has refused to state their ethnicity and a record exists of the refusal to state. This is used to record active refusal, rather than a passive failure to capture information. Information not yet obtained This category should be used in all cases where ethnicity data is not held for a person but there is no record that the persona has actively refused to state their ethnicity. Example: A person is sent a form which they return having completed all requested information except ethnicity monitoring data. The ethnicity of the person should be recorded as Information not yet obtained Traveller of Irish heritage This category includes people who identify themselves as travellers and of being Irish or of Irish heritage. People who identify themselves as meeting the criteria for this category should be categorised in traveller of Irish heritage and should not be included in Gypsy / Roma. Gypsy / Roma This category includes people who identify themselves as Gypsies and or Romanies, and or travellers, and or traditional travellers, and or Romanichals, and / or Romanichal Gypsies and or Welsh Gypsies / Kaale, and or Scottish Travellers / Gypsies, and or Roma. It includes all people of a Gypsy ethnic background or Roma ethnic background, irrespective of whether they are nomadic, semi nomadic or living in static accommodation. It should not include fairground people (showmen/women); people travelling with circuses; or Bargees unless, of course, their ethnic status is that which is mentioned above. Gender For the purpose of an aggregated return, the gender shall be defined as male or female. In line with the Gender Recognition Act, transsexual people should be recorded under their acquired sex. Known to CASSR Those clients who have been assessed or reviewed in the financial year and those who have received a service in the financial year. Lives with the vulnerable adult A person is classed as living with the vulnerable adult if the two reside in the same household. The person (or people) do not have to be in a relationship with, or related to, the vulnerable person to be classed as residing in the same household. Residents in a care home are not in the same household, unless they are a couple in a relationship. Location of alleged abuse The location of the alleged abuse is categorised as one of the following: Own Home Care home permanent Care home with nursing - permanent Care home - temporary Care home with nursing - temporary Alleged perpetrator s home Mental health inpatient setting Copyright 2013, Health and Social Care Information Centre. All rights reserved. 71

72 Acute hospital Community hospital Other health setting (include hospices) Supported accommodation (including extra care housing, supporting people, sheltered housing) Day centre/service Public place Education/training/workplace establishment Other Not Known Nature of abuse The main forms of abuse are defined as follows; Physical abuse - including hitting, slapping, pushing, kicking, misuse of medication, restraint, or inappropriate sanctions; Sexual abuse - including rape and sexual assault or sexual acts to which the vulnerable adult has not consented, or could not consent or was pressured into consenting; Emotional/psychological abuse - including emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, isolation or withdrawal from services or supportive networks Financial abuse - including theft, fraud, exploitation, pressure in connection with wills, property or inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits; Neglect - including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating; Discriminatory abuse - including abuse based on a person s race, sex, disability, faith, sexual orientation, or age; other forms of harassment, slurs or similar treatment or hate crime/hate incident. Institutional abuse - neglect and poor professional practice. This may take the form of isolated incidents of poor or unsatisfactory professional practice, at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems. Any or all of these types of abuse may be perpetrated as the result of deliberate intent, negligence or ignorance. Not determined/inconclusive The case conclusion should only be recorded as not determined / inconclusive when it is not possible to record the outcome against any of the other outcome categories. This is expected to be an infrequently used category. Example: If an investigation could not reach a conclusion on the balance of probabilities, such as in the event of the death of the perpetrator, victim or a key witness before statements could be taken this case would be recorded as having outcome not determined / inconclusive. Not substantiated If none of the allegations of abuse in an investigation can be proved on the balance of probabilities, i.e. there is not enough evidence to support any of the allegations or there is evidence to disprove all the allegations (or a combination of these two), the case conclusion should be recorded as not substantiated. Outcomes for Perpetrator, Organisation or Service These are the outcomes or actions resulting from the completed referral which relate to the alleged perpetrator, organisation or service. A single completed referral may result in more than one type of outcome for the alleged perpetrator. The most common outcomes are: 72 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

73 Continued Monitoring Criminal Prosecution / Formal Caution Police Action Community Care Assessment Removal from property or Service Management of access to the Vulnerable Adult Referred to PoVA List /ISA Referral to Registration Body Disciplinary Action Action By Care Quality Commission Counselling/Training/Treatment Referral to Court Mandated Treatment Referral to MAPPA Action under Mental Health Act Action by Contract Compliance No Further Action Not Known A completed referral may be reported as having an outcome for the perpetrator of No Further Action or Not Known only if no other outcome is being recorded. Outcomes for Vulnerable Adult These are the outcomes of the safeguarding investigation relating to the person being or at risk of being harmed. They concentrate on the person at the centre of the safeguarding process, the vulnerable adult, and should reflect the actions taken from the protection plan offered to this person. They are recorded using the following categories: Increased monitoring this should include all monitoring of situations that may be potentially abusive. The monitoring should have a specific purpose i.e. to minimise risk of further abuse and/or to raise the alert if further abuse occurs. Organisations and individuals involved in such monitoring should be aware of the role they are undertaking. The monitoring should be for a specific time period and should be measured at the end of that time period to assess whether the initial purpose has been met; Vulnerable adult removed from property or service; Community care assessment and services this may include a carer s assessment; Civil action this would include but not be limited to an application for a restraining order and suing for damages; Application to court of protection including to change a continuing, enduring or lasting power of attorney; Application to change appointee-ship; Referral to advocacy scheme this should be related to an aim of challenging abuse faced by vulnerable adult and/or increasing independence, well-being and choice of the vulnerable adult; Referral to counselling/training - this should be related to an aim of empowering user to challenge abuse faced by vulnerable adult and/or increasing independence, well-being and choice of the vulnerable adult. This includes activities to increase a person s ability to protect themselves; Moved to increase / different care - this would include any move to increase the level of care i.e. a move into supported accommodation, extra care sheltered housing, residential or nursing care and respite care. It would also include a move from one care establishment to another offering the same care i.e. a move from one nursing home to another; Copyright 2013, Health and Social Care Information Centre. All rights reserved. 73

74 Management of access to finances; Guardianship/use of Mental Health Act; Review of self-directed support (individual budget/direct payment); Restriction or management of access of vulnerable adult to alleged perpetrator; Referral to MARAC; Other; No Further Action this option should only be used if no other options above have been used. Partly substantiated If some, but not all allegations of abuse can be proved on the balance of probabilities, then the referral is partly substantiated. Example: a referral includes allegations of physical abuse and neglect. The physical abuse can be proved on the balance of probabilities, but there is not enough evidence to support the allegation of neglect, then this should be recorded as partly substantiated. Placed by other authority from outside council area A referral of alleged abuse of vulnerable adult in a care home should be reported through the AVA by the authority that investigates alleged abuse. This would usually be the local authority in whose area the care home is located. Example: an alert is received about a vulnerable adult who is resident in a care home located in the geographic area of authority B. The resident was placed in the care home by authority A which pays the care home fees and reviews the vulnerable adult. Authority B subsequently opens a safeguarding investigation. Authority B would report in the AVA the referral of the vulnerable adult. In authority B s AVA return, this referral would also be recorded in the of which: Number placed by other authority from outside council area row of Table 1. This referral would not appear in the AVA return from authority A. Primary client group (based on aggregate level data collected) People should be allocated to their primary client group wherever possible. This should be a professional decision based on the client s circumstances, not solely an administrative categorisation for the purposes of allocation to a particular specialist team. In some CASSRs each client has an overarching client classification, but may receive a different classification for a specific assessment, in these circumstances use the overarching client type for the return. A client may appear in only one primary client group, so there should be no double counting. The categories of primary client group are - Physical disability: includes short-term illness, people who are frail and those with sensory impairments. The following sub-category of this primary client type is identified: - Sensory impairment Mental health needs: includes mentally ill or confused people, and those with dementia. The following sub-category of this primary client type is identified: - Dementia Learning disability. Substance misuse: includes those with drug and / or alcohol related problems. Other vulnerable people: a general heading to include those whose situation cannot be appropriately fitted in any of the preceding groups. Asylum seekers/refugees/homeless and welfare benefits clients should be included here. Include carers if they are not recorded in the categories above 74 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

75 Referral A referral is recorded when a report of alleged abuse leads to an adult protection investigation/assessment relating to the concerns reported. For a referral to be recorded, it does not necessarily have to have been preceded by an alert. Note that referrals in the AVA are defined as safeguarding referrals, not referrals for community care assessments, as in the RAP (Referrals, Assessments and Packages of Care) return. Relationship of alleged perpetrator The relationship of the alleged perpetrator to the alleged victim is categorised as one of the following: Partner Other family member Health care worker (Incl. GPs, nurses, consultants) Volunteer/befriender Social care staff Total, of which: - Domiciliary care staff - Residential care staff - Day care staff - Social worker/care manager - Self-directed care staff these staff are employed by the service user by direct payment - Other Other professional Other vulnerable adult Neighbour/friend Stranger Not Known Other (incl. milk-person, post-person, taxi driver) Repeat referral A repeat referral is a safeguarding referral for which the alleged victim has previously been the subject of a safeguarding referral during the same reporting period. Note that repeat referrals are included in the referrals column of Table 1 and are therefore a subset of all referrals. Source of referral Eleven main categories are identified, with social care staff and NHS staff having a series of sub-categories identified. Social care staff Total (LA & independent sector staff), of which: - Domiciliary staff - Residential care staff - Day care staff - Social worker/care manager - Self-directed care staff these staff are employed by the service user by direct payment - Other Health Staff Total, of which: - Primary health/community health staff (GP, Acute PCT, Community-based professions allied to medicine, etc.) - Secondary health staff (accident and emergency, hospital occupational therapist, ward, hospice, community hospital, etc.) - Mental health staff joint teams - Other sources Self-referral (including automated referrals for basic services) Family member Copyright 2013, Health and Social Care Information Centre. All rights reserved. 75

76 Friend/neighbour Other service user Care Quality Commission Housing (including supporting people) Education/training/workplace establishment Police Other (including probation, anonymous, contract staff, MAPA, MARCA) Substantiated If, for a given referral, all allegations of abuse can be proved on the balance of probabilities then the case conclusion should be recorded as substantiated. Vulnerable adult A vulnerable adult is 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, or unable to protect him or herself against significant harm or exploitation in any care setting. This includes individuals in receipt of social care services, those in receipt of other services such as health care, and those who may not be in receipt of services. There is a danger that some vulnerable adults who are at risk, but do not fit easily into the aforementioned categories, may be overlooked. Some examples might be as follows: Adults with low level mental health problems/borderline personality disorder Older people living independently within the community Adults with low level learning disabilities Adults with substance misuse problems Adults self-directing their care 76 Copyright 2013, Health and Social Care Information Centre. All rights reserved.

77 Published by the Health and Social Care Information Centre Part of the Government Statistical Service Responsible Statistician Pritpal Rayat, Section Head ISBN This publication may be requested in large print or other formats For further information: Copyright 2013 Health and Social Care Information Centre. All rights reserved. This work remains the sole and exclusive property of the Health and Social Care Information Centre and may only be reproduced where there is explicit reference to the ownership of the Health and Social Care Information Centre. This work may be re-used by NHS and government organisations without permission. Copyright 2013, Health and Social Care Information Centre. All rights reserved. 77