Abuse - Article 4 - Institutional Abuse

Institutional abuse is the maltreatment of a person (often children or older adults) from a system of power.  This can range from acts similar to home-based child abuse, such as neglect, physical and sexual abuse, and hunger, to the effects of assistance programs working below acceptable service standards, or relying on harsh or unfair ways to modify behavior.

The vast majority of Care Staff do not intend to abuse vulnerable people when they come into the profession, but inadequate care, neglect and abuse do occur in care settings, often when there is:

Organisational or management inadequacy, lack of communication, role conflict, inter-professional or interagency differences or poor staff relationships. Pressure on the service, exacerbated by poor staffing levels, frustrations about work or working conditions, low staff morale and burnout.

Lack of training, support or supervision, and working in isolation. To cope in difficult circumstances, care can become focused on tasks rather than people. Once the individual is no longer the focus of the care, the next step is depersonalisation. How often have you heard staff say something like ‘I have done beds four to six’? Once care deteriorates into ‘doing tasks for commodities’, potentially abusive behaviour, such as has been identified in many professional conduct cases, becomes more likely.

We all experience “off days”, encounter situations that challenge us.  We might be feeling, tired, unwell or coping with personal issues. Caring for people who are vulnerable can be challenging and violence towards staff is not uncommon. ‘Personality clashes’ sometimes occur when, no matter how much ‘unconditional positive regard’ a Healthcare Assistant tries to bring to a care situation, the patient and Healthcare Assistant find each other frustrating. 

We must be vigilant to such circumstances, in ourselves and colleagues. Sometimes it will be necessary for a member of staff to withdraw from a situation, for staff to be re-allocated, or for individuals to be offered personal development, mentoring and supervision. If staff are alleged to be responsible for abuse or poor practice they should be made aware of their rights under employment law and internal disciplinary procedures.

Prevention

All staff and volunteers should receive training on the policies, procedures and professional practices that are in place locally, commensurate with their responsibilities in the adult protection process.

Conduct cases have highlighted the importance of ensuring adequate staff induction and training, coupled with adequate managerial and clinical supervision. Policies and guidance on the following should be available and staff should adhere to these:

 

·         Anti-racist and anti-discriminatory practice.

·         Patient choice, preference and consent.

·         Health and safety.

·         Risk assessment.

·         The use of equipment.

·         The use of restraint

·         Procedures for reporting incidents, accidents or falls.

·         Procedures for dealing with money and the patient’s legal transactions, such as wills.

Misuse or maladministration of medicines and inadequate record-keeping commonly feature in cases of professional misconduct, therefore particular care should be taken to ensure that standards for medicines management and record-keeping are readily available in all care areas and are rigorously implemented in practice. Other care standards, including those for infection control and consent to resuscitation, should be implemented in all areas. 

In addition, Essence of Care: Clinical Benchmarking (NHSMA 2003) sets out a process to support improvement of fundamental care and raise standards of patient experience.  Measures to ensure best standards of evidence-based care and the monitoring and auditing of these must also be applied. There is an additional need for external monitoring such as inspections, independent advocacy schemes and Staff evaluations.

Employers have responsibilities, not only to service-users. but also employees, to ensure that their disciplinary procedures are compatible with the responsibility to protect vulnerable adults.