Discriminatory abuse: a scoping exercise

Background

This scoping exercise developed from a combination of improvement priorities 20 and 21 from the Analysis of Safeguarding Reviews: April 2017- March 2019 identified the absence of recognition of equality characteristics within Safeguarding Adult Reviews recording but also the absence of recognition of discriminatory abuse of case management and more broadly failed to recognise unconscious bias.

• Improvement Priority 20: This research highlights the need for better recording of ethnicity in SARs. Terms of reference for all SARs must include consideration of how race, culture, ethnicity and other protected characteristics as codified by the Equality Act 2010 may have impacted on case management, including recognition of unconscious bias.
• Improvement Priority 21: Consideration should be given to the dissemination of briefings on good practice regarding all forms of abuse and neglect but especially those newly highlighted by the Care Act 2014 within adult safeguarding, such as domestic abuse, modern slavery and discriminatory abuse (hate and mate crime).

The Care and Support statutory guidance gives limited explanation on what discriminatory abuse is. Discriminatory abuse is described as, ‘harassment, slurs or similar treatment’ because of one’s protected characteristics and refers readers to a discriminatory page which refers readers onto the Equality Act 2010. The SCIE website has given some guidance, giving ‘types of discriminatory abuse’ and ‘signs and indicators’. This then leaves councils and SABs to provide further discriminatory abuse themselves, keep explanations brief or look to cross-over crime-reduction partnerships with police or community safety where discrimination is explored. Often SABs would have links on their websites to other agencies, which led this research to look beyond SAB websites and look to websites or national organisations that referred to safeguarding and discriminatory abuse.

Data

The lack of recognition of discriminatory abuse is reflected in the low numbers of safeguarding enquiries where discriminatory abuse is reported as the abuse category into the Safeguarding Adults Collection (SAC) reported annually through NHS Digital. For years 2017/18 and 2018/191 a staggering 67 per cent of all reporting councils did not report any enquiries where the abuse type was discrimination. In 2019/20 there was a small increase in the reporting of discriminatory abuse, but 61 per cent of councils still reported not one discriminatory abuse type of Section 42 enquiry.

There appears to be an under-reporting of discriminatory abuse for those with all the protected characteristics: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; or sexual orientation.

Whilst some Boards have captured information around disability discrimination on their websites, there is very little to describe how adults would be safeguarded against any other discriminatory abuse types. Discriminatory abuse in 2019/20 forms 0.56 per cent of all abuse types reported in concluded Section 42 enquiries. When making comparisons, discriminatory abuse reporting is on a par with sexual exploitation category which sees reporting levels of 0.61 per cent, only modern slavery is reported at a lower level of 0.23 per cent. Whereas, for example, organisational abuse represents 4.27 per cent of abuse type reported, neglect and acts of omission which represent 31.82 per cent and physical abuse at 20.54 per cent of all reported Section 42 enquiries.

Summary of SAB evidence

This paper summarises the findings from reviewing the websites of 58 Safeguarding Adults Boards (SABs) in England and other organisations and agencies that have created content around discriminatory abuse. For the vast majority there was little detail around the definition of discriminatory abuse. Several SABs simply listed discriminatory abuse amongst the other abuse type, with no further explanation. Others gave a list of characteristics of discrimination under the Equality Act 2010. A few did explore discriminatory abuse in more depth, which included signs and indicators and others explored this further within their policies and procedures.

There are a few notable exceptions such as Merseyside SAB which has a comprehensive website including a video, explaining different types of hate crime, a stop hate line explanation poster, a good example of where the police failed Fiona Pilkington and her daughter Frankie - closest example to discriminatory abuse under Care Act 2014 categories.

Several SABs made reference to mate hate which were closest to the discriminatory abuse. The link between safeguarding and hate crimes was not always made explicit. If they were it was usually limited to discrimination towards disability. Often there was no illustration of other types of discrimination. There is a real absence of equality strands intersecting with safeguarding adults, although there is some reference to discrimination of disability and safeguarding, particularly around hate crime and some excellent examples of resources tacking disability hate crime from organisations like Association for Real Change and Mencap. A few SABs included ‘everyday discrimination’ examples – such North East Lincolnshire SAB, Coventry SAB and Oxford SAB.

Summary of other evidence

As well as SABs referring to resources from other organisations on their websites, (see above) other agencies such as the police were sometimes put on as a link from SABs. These sometimes did have very good coverage of hate crimes and non-criminal incidents which were notable which the local SABs had a link to, a good example of this was Devon and Cornwall Police.

It is important to consider the growing significance of diversity in adult social care services as the aging population will be increasingly particularly speaking different languages, diverse life experiences and/or of different faiths, with differences in sexuality being more likely to be expressed and known.

The need to be diversity-ready and competent in recognising and naming discriminatory abuse is important.

There is very little research around discriminatory abuse and adult safeguarding for example Care Quality Commission’s two documents: Relationships and sexuality in adult social care services and Culturally Appropriate care, the first whilst mentioning safeguarding, it does give not further guidance and the later document does not mention safeguarding at all.

A pre-Care Act document produced by the Department of Health called Safeguarding Adults and the Role of Health Services: Analysis of the Impact on Equality (2011) perhaps comes closest to broaching the issue of discriminatory abuse and safeguarding. This paper acknowledges how a person’s vulnerability (acceptance of pre-Care Act language aside) that their protected characteristic opens up the likelihood of dual discrimination. The paper suggests preventative measures to reduce discrimination:

1. health services improve the prevention of neglect and abuse as they take positive action to meet the needs of people with protected characteristics and their carers;
2. where neglect and abuse occurs, services provide appropriate protective care;
3. staff uphold the rights of people to make decisions about their safety and involve them throughout the safeguarding process;
4. staff take account of the person’s lifestyles, beliefs and rights to private life when developing protection plans with them and
5. protection plans are least restrictive of the person’s rights.

Further the document suggests the need for commissioners to:

...connect equality with strategies for safeguarding adults in how they plan, procure and assure health services. Application of the safeguarding principles guides commissioners to involve patients and carers in all aspects of commissioning care, recognising the need to take additional steps to involve those who may be marginalised or have additional communication needs."

Safeguarding adults and the role of health services, page 9

In The Adult Safeguarding Handbook by Kate Spreadbury and Rachel Hubbard, they identify the absence of adult safeguarding enquiries being recognised.

Discriminatory abuse in Safeguarding Adults Reviews

There were a few Safeguarding Adults Reviews (SARs) that broached discriminatory practices – it is not always clear if discriminatory abuse was identified. Fiona Pilkington was perhaps one of the standout examples of connecting discriminatory abuse with safeguarding adults.

Discriminatory abuse which may be a feature of SARs is not often mentioned explicitly – sometimes ‘culture’ is referred to but not much more. For example, in the exploration of ‘race’ and ethnicity in SARs there is often a passing comment as is the case in the Newham Adult A SAR. West Sussex explores the issues a little further in their SAR, Adult F which mentioned an absence of ‘cultural recognition and sensitivity’:

Cultural competence is being respectful of and responsive to the beliefs, practices, cultural and linguistic needs of diverse communities. The Community Partnership Project Report (London Board, 2007) said there were five essential elements that contribute to an individual professional’s and a whole service’s ability to become more culturally competent. The professional or service must:

• value diversity
• have the capacity for cultural self-assessment
• be conscious of the ‘dynamics’ inherent when cultures interact
• institutionalise cultural knowledge
• develop adaptations to service delivery reflecting an understanding of diversity between and within cultures.

Brighton and Hove had a SAR, Adult X which involved Adult X who was found dead in a caravan. Even though presenting with a number of ‘vulnerabilities’ including at times presenting as transgender and experiencing bullying – there was no mention of ‘experience of abuse and discrimination because he [sic] identified as a transgender person’ but not mention of discriminatory abuse and the briefing did not explore this further, although the SAR does identify this as meriting further investigation. These few cases identify potential discriminatory abuse yet do not name it as such.

There appears to be a need to connect equality with safeguarding adults in how it is spoken of, understood and identified as discriminatory abuse. There appears to be an absence of applying safeguarding principles in the context of discriminatory abuse. Looking at the data it would appear that additional steps to involve those who may be marginalised or have additional communication needs within the context of safeguarding and making those connections to discriminatory abuse need to be made.

Suggested next steps

It is proposed to establish a reference group of representatives from relevant networks and agencies, which together will provide expertise across the equality strands as they intersect with adult safeguarding. Together they would be able to review the scoping out process, identifying gaps, and barriers to reporting and identifying discriminatory abuse in adults safeguarding. They would also support the development of a sector-led improvement project in this area, drawing on any available research and relevant activity. The group would identify any appropriate outputs e.g. publications arising from this work stream. Support for the project would be commissioned by the CHIP workstream, subject to available resources.

Bibliography

• Culturally Appropriate Care (CQC, 2021)
• Safeguarding Adults Collection (SAC) England 2018-19 Experimental Statistics (NHS Digital, 2019)
• A Thematic Safeguarding Adults Review (Oates B., Newham Safeguarding Adults Board, 2019)
• Relationships and sexuality in adult social care services (CQC, 2019)
• Safeguarding Adult Review in Respect of Adult F (Rogers, L., West Sussex Safeguarding Adults Board, 2018)
• Safeguarding Adults Review: X (Rogers, L., Brighton and Hove Safeguarding Adults Board, 2017)
• Safeguarding Adults and the Role of Health Services: Analysis of the Impact on Equality (Department of Health, 2011)
• The Adult Safeguarding Handbook (Spreadbury, K. and Hubbard, R., Policy Press, 2020)

This paper was written by Dr Anusree Biswas Sasidharan, Programme Adviser at Partners in Care and Health