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Friday, 4 November 2011

Abuse of vulnerable adults statistics

The NHS Information Centre has just produced some annual statistics on safeguarding referrals received by Councils with Adult Social Services Responsibilities (CASSRs) in England.  The NHS IC of course have produced a report, and it's been picked up on in quite a few media outlets (Telegraph, the Mirror, Community Care, Financial Times).  Apparently another, more detailed, report will be produced next March, but I couldn't wait that long for a piece of work I'm doing at the moment so I had a play with the raw data.  In my research into the Mental Capacity Act 2005, I'm particularly interested in issues for adults with learning disabilities and adults with dementia, so I tried to unpick the NHS IC data to look at the picture of abuse for these groups.  Unfortunately 'dementia' isn't a category in it's own right for a lot of it, so I often just had to make do with looking at older people instead.  Before I go on to present what I found, there are some issues with the data that are worth raising.  Mithran Samuel at Community Care has summed them up well, so I hope he doesn't mind if I quote him:

Of 73,600 completed referrals to council adult protection teams in 2010-11, 41% were wholly (32%) or partly substantiated (9%), meaning physical, sexual, emotional, financial, discriminatory or institutional abuse, or neglect had been found on the balance of probabilities.
Thirty one per cent were unsubstantiated and 28% were inconclusive, though the NHS Information Centre, which published the figures, advised that the results should be treated with caution due to data quality issues.
The figures were based on returns from 151 of the 152 councils with adult social services responsibility in England. It is the first year that councils were required to submit figures on adult protection referrals
So, I assume the working definition of 'vulnerable adult' is taken from No Secrets.  We have to be careful extrapolating from these data to the national picture: not all of these abuse referrals were substantiated, and not all abuses get referred.  I think we should be cautious of even assuming that the referrals are a representative sample of abuse across England: it may be that some forms of abuse, and abuse of some groups, is less likely to be detected.  And it may be that some types of referrals are more likely to be baseless in reality.

So, with those caveats in mind - , how susceptible to abuse are older adults and adults with learning disabilities, what kinds of abuse, and by whom?  For reference, according to some data collated by the Learning Disability Coalition, there are estimated to be 828,000 people with a learning disability in England.  That's 1.6% of the population.  And I've used some data from the Office for National Statistics (for mid-2010) to compare figures with the population of England broken down by age:  87% of the population of England are aged 18-64; 6% are 65-74; 5% are 75-84; and 2% are 85+.  Sometimes where I've wanted to just describe 'older adults' I've collapsed the data for those aged 75+, and that's 2,463,786 people, or 7% of the population.

Safeguarding alerts received by age and primary client group

As reported in the press, overall, the most safeguarding alerts were received concerning people with physical disabilities, sensory impairments or recorded as 'frail':

However, if you break this data down further you find huge age effects.  So for adults under the age of 65, the overwhelming majority of safeguarding alerts concerned people with learning disabilities:

And among adults over the age of 65, the majority of safeguarding alerts relate to physical disabilities/frailty:

If you compare the proportion of safeguarding alerts relating to people in each age category with the equivalent percentage of the population, the results strikingly show that a greater proportion of safeguarding alerts relate to older people, people with learning disabilities and people with dementia than would be predicted if the alerts were evenly distributed throughout the population.

Susceptibility to different kinds of abuse

The cover sheet for the data says that physical abuse is the most common kind; but this really masks group differences in susceptibility for abuse.  This chart shows that referrals all forms of abuse bar sexual abuse are more likely to relate to older people than people with learning disabilities.  But it also shows that people whilst the most common form of abuse for adults with learning disabilities is physical abuse; for older adults it is neglect.

I have produced different tables showing the proportion of safeguarding alerts received for each different kind of abuse, broken down by primary client group.  They're fairly self-explanatory so I'll just reproduce them here.  Safeguarding referrals relating to physical abuse:
Safeguarding referrals relating to sexual abuse:

Safeguarding referrals relating to neglect:

Safeguarding referrals relating to emotional abuse:

Safeguarding referrals relating to financial abuse:

Safeguarding referrals relating to institutional abuse:

Safeguarding referrals relating to discriminatory abuse:

Relationship to alleged perpetrator of abuse

The media reported that abuse occurred most commonly in a person's own home (42%) and that in around a third of cases the alleged perpetrator was a social care or health care worker, and in around a quarter of cases it was a family member.  I was interested in whether this differed by group.  For people with learning disabilities and people over the age of 75, the perpetrator lives with the vulnerable adult in 19% and 17% of referral cases respectively.  It is less likely, though, that they are their family carer.  Older adults are more likely to be abused by a family carer than are adults with learning disabilities (10% and 7% respectively).

So who is likely to be the abuser in safeguarding alerts?  (I'm very sorry the graph sticks out too far and messes up the page, but it's better to be able to read it I suppose).

People with learning disabilities are most likely to suffer abuse from another vulnerable adult than older people are.  My guess would be it would be somebody they are living with in a group home of some kind.  A higher proportion of referrals for people over the age of 75 related to social care staff; more likely than people with learning disabilities.  A higher proportion also related to abuse from their partner or another family member.  

However, one of the difficulties with the statistics is we are unable to calculate from these the likelihood of suffering abuse at the hands of, for instance, a family member or member of care staff, if one is older or has a learning disability.  That's because we don't know the number of people in each group in the population as a whole that have care staff etc.  It would be great if we had this data, as then we'd be able to say things like: people with learning disabilities are more/less likely to suffer abuse at the hands of care staff than older adults. But annoyingly we can't.  I have, however, contacted the NHS IC to see if they can help me out here with a more detailed data breakdown.  What I've asked for is for them to say, for every referral that related to a person in their own home or a care home, what form of abuse they were most likely to suffer.  That would be interesting.  But again, we don't have the overall population data for each site, so we can't say how likely a person with a learning disability in a care home is to suffer, e.g., institutional abuse.  What the data really tells us is what the local authority safeguarding teams' workloads are like; not what the lives of people with learning disabilities or older adults are like.

1 comment:

  1. Hi Lucy,

    Thanks for this post, I think your analysis of the NHS IC stats is really helpful. I would like to support something you raise a couple of times in your post, with regards to the limitations of these stats - if Local Authorities are reporting on their referrals, then in my experience it is likely that there will be c152 different types of results. Safeguarding is dealt with so individually in each LA it really is hard to make concrete comparisons, as you highlight these stats tell us something about safeguarding workloads, there is no doubt that alerts are continually increasing and is hard to know whether there are more referrals because awareness is raised, or for some other reason, however it is hard to draw a coherent picture from them.

    That said I really appreciate you sharing your analysis and I think you pose some great food for thought,