Roundtable on discriminatory abuse, 14 July 2022

1. What do you understand by the terms: discrimination and discriminatory abuse?

The Roundtable discussions recognised that discrimination was much broader than discriminatory abuse. Discriminatory abuse was specific to those with care and support needs, which was understood to be defined within the Care Act 2014 and related to the protected characteristics defined in the Equality Act 2010.

There was also a recognition that there were groups of people that may experience discrimination, such as those who were experiencing homelessness or substance misuse, who may not be considered under the discriminatory abuse category.

The Roundtable acknowledged that the discriminatory abuse workstream stemmed from a combination of two improvement priorities from the National Analysis of Safeguarding Adult Reviews: April 2017 to March 2019 publication improvement priorities 20 and 21 (Michael Preston-Shoot, Suzy Braye, Oli Preston, Karen Allen and Kate Spreadbury (2020)).

The priorities identified the absence of recognition of equality characteristics within Safeguarding Adult Reviews recording but also the absence of recognition of discriminatory abuse in case management and more broadly failures to recognise unconscious bias in practice.

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 Roundtable participants identified that microaggressions and indirect discriminatory practice were more difficult for some professionals to recognise and act on. Approaches such as 'trauma-informed' practice, used by some local authorities, framing discrimination as trauma was described as problematic for others as it could be quite interpreted as paternalistic rather than in a rights-based approach. There was also an acknowledgement that there was an absence of cultural competence amongst practitioners – particularly around ethnicity and ‘race’.

The politicisation of 'race' had resulted in some resistance from staff to addressing racism in particular, and discrimination more widely, being viewed as 'political correctness' – which was considered a negative behaviour. One participant said that ethnicity of a person with safeguarding needs, for example, was not being recorded, even where ethnicity could be the basis for an abuse type.

One reflection was that safeguarding often applies to people with protected characteristics (such as age and disability), and so as a result, one could say that all safeguarding enquiries have discriminatory abuse at the heart of them. They reflected that this led to considering whether all enquiries should be viewed through the lens of equality and identification of any intersectional issues at play.

Future work may consider how trauma informed approaches interacts with human rights based/ equalities-based practice. Where trauma may be experienced by any person with care and support needs, a human rights based/equalities-based practice would look at how other factors such as 'race', age, sex, sexual orientation, religion may be an 'aggravating' reason for abuse and neglect for a person with care and support needs.

Discussion highlighted the need for better understanding of discriminatory abuse regarding recognition, recording, cultural practice and the importance of considering a systemic approach in local authorities towards discrimination abuse and ultimately discrimination. Also, it was acknowledged that SAB partners may not be armed with the knowledge they needed to identify and address discriminatory abuse.

The breakout group discussions included asking how connections were being made between different abuse categories and discriminatory abuse and how this was being manifest in assessments or reasonable adjustments. There was also recognition that there needed to be a level of courageousness in being able to challenge one’s own practice to ensure it is inclusive, flexible and imaginative to address people’s experiences of discrimination.

Groups asked how a common consensus about the definition of discriminatory abuse could be reached when discriminatory abuse is identified by either families/friends/others/professionals or adults at risk? What happens where there are barriers of lack of knowledge, identification, disclosure and communication of how discriminatory abuse can manifest and the differences between the different types of abuse.

It was felt important to have experts by experience at the centre of these discussions. One participant identified how they had worked minoritised ethnic groups to engage with ASC to help find solutions to discriminatory behaviours and how to work to solve/resolve issues that were arising.

There was a recognition that there were particular scenarios that had the unintended consequence of obscuring discriminatory abuse; these were in relation to hate crimes/mate crimes, where adults at risk of abuse and neglect were perhaps working with community safety practitioners and/or with the police and this intelligence was not being shared with ASC and would not necessarily be reported as safeguarding, brought to the attention of ASC nor recognised as discriminatory abuse.

One group reflected on the Steven Hoskins review (accepting that this was prior to the Equality and Care Acts) and how this was a clear example of 'disability hate crime' and also considered the Michael Gilbert case where physical and sexual abuse were similarly easily identifiable. However, in situations which included anti-social behaviours this was less identifiable as discriminatory abuse.

There were reflections on the need for a mind shift to move away from social acceptability of discriminatory abuse in plain sight.

One of the groups drew an analogy to the historic practice in care settings of ‘tea being offered with milk and sugar to all’ and that this was no longer viewed as good practice (that is, treating everyone the same does not address discrimination). Using this example, the groups discussed a process or project that could consider the identifying the links with current practice and discriminatory practices.

Another discussion centred around assessing where on the 'unconscious incompetence - conscious incompetence - conscious competence - unconscious competence ladder' one’s practice was. The discussion also extended to the importance of not getting complacent and retraining as required regarding discriminatory abuse.

Paul R. Curtiss and Phillip W. Warren mentioned the model in their 1973 book The Dynamics of Life Skills Coaching. Curtiss, Paul R.; Warren, Phillip W. (1973). The dynamics of life skills coaching. Life skills series. Prince Albert, Saskatchewan: Training Research and Development Station, Dept. of Manpower and Immigration. p. 89. The model was used at Gordon Training International by its employee Noel Burch in the 1970s; there it was called the "four stages for learning any new skill". Adams, Linda. "Learning a new skill is easier said than done". gordontraining.com. Gordon Training International.

An ASC anti-discriminatory framework – what to look out for? To identify: how does discriminatory abuse fit within anti-discriminatory frameworks?

Consider how to embed anti-discriminatory frameworks within councils’ policies and practices, specifically within ASC and how they apply to safeguarding adults. How do we grow a better understanding and identification of the needs of different equality groups in a bid to reduce discrimination and bias, and in order to improve care, support, safety and protection?

The needs of adults with protected characteristics could be incorporated into safeguarding policies and procedures. The Care and Support statutory guidance requires SABs to ‘develop strategies to deal with the impact of issues of race, ethnicity, religion, gender orientation, sexual orientation, age, disadvantage and disability on abuse and neglect (para 14.139). Evidencing this in safeguarding policy and procedures could include:

• an equality statement with a commitment to anti-discriminatory practice;
• recognition of the increased exposure of adults with protected characteristics to barriers they may face in accessing care and support;
• explaining how anti-discriminatory values will be embedded in practice to identify and reduce bias towards adults with care and support needs who have a protected characteristic; and
• recognising additional considerations may be needed to keep adults with protected characteristics safe from abuse and neglect.

2. What do you know about discriminatory abuse in your area and how do you know it?

• What don’t you know and what do you need to find out?
• What are the gaps and challenges?
• Data: identification, reporting and recording

There were discussions about how discriminatory abuse was 'hidden in plain sight', a sense that often cases of discriminatory abuse end up taking a hate crimes route rather than a safeguarding route, so it often goes unreported as discriminatory abuse. Other times discriminatory abuse may be recorded as a secondary abuse type so again the discriminatory abuse may not be reported in the Safeguarding Adult Collection (SAC) returns, locally or internally.

There were discussions about the limitations of data recording systems, for example when discriminatory abuse was not recorded as a primary concern, this had the consequence of being difficult to extract information about this form of abuse from systems. There were discussions around not understanding the broader picture of discrimination in society, that suggested that knowing the landscape of hate crimes as dealt with by the police; hate/mate crime services and reported through community safety partnerships and safeguarding children’s partnerships would be helpful.

Recording and recording systems were widely identified as challenges across all the breakout groups. There was a recognition that there was a subsequent impact on adults experiencing that abuse that arose from the lack of effective recording. However, caution was added that recording was not just a tick box activity but should be meaningful reporting. The question was asked - how can SABs be assured of the identification, practice and actions related to discriminatory abuse?

Questions were raised regarding the recording of safeguarding enquiries; where there was an unfolding situation/growing understanding of a situation, discriminatory abuse may not be initially identified and possibly identified at a later stage. This may mean that discriminatory abuse as a category was not being captured in the data. Discussions on the robustness of the data capturing regarding discriminatory abuse was questioned as there were only small handfuls of enquiries identifying discriminatory abuse every year. It was recognised that there needed to be a reinforcement of awareness raising, identification and better understanding of discrimination abuse.

There were discussions about the links between local recording systems with NHS Digital Safeguarding Adults Collection and whether they were robust to effectively capture reporting of discriminatory abuse, and that the lower numbers were subsequently reported. The Group concluded that low reporting was more likely to be associated with a lack of understanding and recognition of discriminatory abuse at a local level.

A collation of local data from a range of sources, including community safety and safeguarding children’s partnerships was suggested to help contextualise how prevalent discriminatory abuse was in a locality, or at least enable benchmarking. This would assist in identifying whether discriminatory abuse featured in these areas as well as in safeguarding concerns and enquiries and may support safeguarding adults’ prevention strategies and locating potential gaps. Another group discussed reports such as the Lammy Report that identified over-representation of minoritised ethnic groups in the criminal justice system, and those showing disproportionate negative outcomes in mental health for these groups in comparison to their white counterparts. This led onto considering the need for exploration of the impacts for minoritised ethnic people in adult safeguarding.

Discriminatory abuse recording – reflecting on practice

Key questions:

• Are you recording discriminatory abuse?
• Do your reporting systems allow you to report more than one abuse type (more than a primary abuse type?) 
• Are you recording indirect as well as direct discriminatory abuse?

Gaps

Different gaps were identified in different local authority areas and the need for further exploration of any specific concerns that were identified. One area identified a need to focus on discrimination regarding adults with learning disabilities as their specific challenges were not understood and there had been complacency amongst communities.

The social acceptance or normalisation of abuse was a key challenge for these adults, so discriminatory practices and abuse were not identified and this not being recorded. Another locality acknowledged a lack of robust recording of religion and religious beliefs by agencies involved. One area identified a need to look at sex and gender, and issues surrounding non-binary and trans identities, the lack of recording and a need to see and explore the implications of the data that emerged.

A further locality spoke of a lack of identification of Black Asian and minoritised ethnic groups in reporting, which was significantly low which was particularly striking as there were high levels of minoritised ethnic people in that area. There was a particular issue identified regarding older people and needing to grow better understanding of ageism.

There was also an intersectional issue regarding age and gender that was reflected upon, where older women were not thought to experience domestic abuse as victims, as this abuse type was associated with younger women. One group discussion identified the importance of improving understanding of intersectionality.

One group discussed the importance of recognition of discriminatory abuse and wider discriminatory issues within workspaces. They suggested that policies and procedures were required to ensure reporting and escalation of discriminatory practices. They also emphasised the need to ensure that staff are trained in dealing with discriminatory practices, even when outside the remit of safeguarding. Another conversation discussed how groups of people are marginalised and oppressed by systems, including the safeguarding system, which maintain that discrimination – and suggested that this required further exploration and investigation.

Discriminatory abuse: identifying gaps in data and activity

When reviewing local safeguarding data, and gaps are identified regarding specific equality groups – consideration should be given to: whether there has been effective engagement with those groups; reflection on what the barriers might be for those groups; and how to explore practitioners misunderstanding of societal and cultural dynamics to improve cultural competence in practice.

Consider:

• How staff can better engage with and get to know the specific equality groups (also consider intersectionality) locally
• Whether you have the appropriate advocate/ interpreters/other communication professionals to support engagement activities
• Building relationships with community connectors and organisations who represent or reflect the group you are wanting to work with
• Think about how ASC is understood amongst communities, in a way that is most inclusive. Consider production of materials or media that is specific to the group you are trying to engage with to highlight adult safeguarding and ASC more broadly.
• Whether you have capacity and resources to respond to engagement.

Professional curiosity: a proactive approach

There were discussions on the cost-of-living crisis and the potential for increased safeguarding reporting, particularly for adults who may be targeted because of their vulnerabilities and specifically because of their protected characteristics. Participants discussed the importance of being more vigilant in recognition, reporting of risks and experience of abuse, embedding professional curiosity in all practitioners.

This was described as a proactive approach that could be adopted to exploring the direct practice working with adults experiencing discriminatory abuse. However, the professional or practitioner having these conversations needed to be appropriately skilled and knowledgeable practitioners carrying out assessments with confidence to identify possible areas of discriminatory abuse.

Participants suggested capturing and exploring local evidence of personalised practice taking place, particularly in relation to the care offer/service received, and mindful of anti-discriminatory practice and promoting equality and inclusion. There were discussions as to the impact of attitudes towards the normalising of risk, using ‘lifestyle choice’ to normalise risky behaviours and avoid identification of discriminatory abuse.

Discriminatory abuse: understanding practice:

Consider doing a peer review or case file audit with a focus on discriminatory abuse.

How are the different protected characteristics addressed in safeguarding practice?

• Is the person asked explicitly about their experience of discrimination, is a personalised approach taken?
• Is there a consistent approach/emphasis on different characteristics?
• Is there evidence of professional curiosity and cultural competency?

Participants identified that at a Safeguarding Adults Board strategic level it can be difficult to know this level of detail. There were concerns that sometimes people were reluctant in sharing protected characteristics – at the point of wanting to receive care and support needs – especially if “quizzed” about areas such as sexuality.

There were discussions surrounding when people were being asked and the context and this needs to be done sensitively. For instance, One participant who had recently worked in frontline practice said that some people do not want to answer when you ask them about protected characteristics as they are wanting to receive care and support, not be quizzed about their sexuality etc.,‘It can get awkward’.

In another local authority, there was a case where a woman had been refusing services but there was no idea until after she died that the woman she lived with was her partner. There was then speculation about whether secrecy about her sexuality had led to refusal of care but also questions as to how person-centred the approach had been. Some reflections on generational issues re: disclosing sexuality – though someone else said that heterosexual people may be offended by being asked their sexuality but many LGBTQ people will be relieved and welcome recognition.

There was a discussion (brief) about how to help people to see that the question about protected characteristics is important. There was some discussion about religion, which was overlaid often by ‘race’. Two local authorities do not ask about religion but noted a number of far-right Christian organisations in their area.

Collecting data

How are you gathering protected characteristics data, who is asking and when? How does when you ask for data impacting the level and quality of data you are getting?

A question posed was: is discriminatory abuse identified in Safeguarding Adults Reviews, and sufficiently explored? There were discussions around lack of understanding and awareness of discriminatory abuse from across the partnership and potential area of development.

Is the safeguarding adults’ system discriminatory in of itself and what can we do to change this? What are the blocks and barriers (for example, culture terminology, reporting systems, etc.)?

Blocks and barriers

The blocks and barriers identified by groups were around resourcing, capacity, stress on the system and increased demand that stopped further development in this area. There was recognition that recording systems, reporting systems and Safeguarding Adults Collection returns requirements did not motivate the explicit understanding discriminatory abuse.

The solution proposed was that of audit activity.

Systemic discriminatory practice and change

There was hesitancy in labelling the safeguarding adults’ system discriminatory in of itself and an admission that the nature of unconscious bias meant that professionals may be unaware of their own biases or unable to recognise it and this may lead to underlying prejudice or discriminatory abuse. One group remarked, “Discriminatory practices does not necessarily lead to discriminatory abuse”, however if the premise were reframed, i.e. that discriminatory abuse develops from discriminatory practices (whether intentional/unintentional); are SABs assured that partners are aware of the impact of discriminatory practice on the adult?

Further questions that SABs could consider

• What are the blocks and barriers to recognition of discriminatory abuse across the different equality strands? Is there better understanding of some equality groups than others? How is assurance sought?
• How can discriminatory practices be addressed in safeguarding adults’ strategies, policy practice and procedures?
• What level of understanding do practitioners and managers have on discriminatory abuse and discriminatory practice?
• How are SABs assured differences in languages and cultural difference (real or perceived) are broached?
• How can professional curiosity, unconscious bias and equality and diversity be addressed in discriminatory abuse?
• Are older people considered for domestic abuse services and resources such as refuge information? Are there other groups who are likewise not considered for domestic abuse services and resources?

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