National action plan to prevent the abuse of older people

I am proud that we in Wales have created a National Plan to tackle the abuse of older people – this is the first of its kind in the UK informed by and developed to address, the experiences and challenges of older women and older men. Whilst we recognise the huge steps we have taken over the years to tackle ageism, identify and prevent abuse, and address safeguarding arrangements and governance we still have a huge amount to do.

I am grateful for the input of the Older People’s Commissioner for Wales and key stakeholders into this Plan. We have listened to what you have had to say, and what matters to you. This Plan highlights that collectively:

• we need better data and evidence, and to develop a programme of research to obtain that
• we need to better train and develop our workforce to support and protect older people
• we need to ensure that older people have access to services, and the ability to access and find the information
• we need to ensure that services are joined up and provide the support and help needed at the right time without delay
• we need to develop and take forward a communication plan that raises of awareness of the issues, the Plan and what is in place to prevent and identify abuse and provide support to those who need it

We all have the right to live free from abuse of any kind. Age and individual circumstances do not diminish this basic right. It is vital that we do all we can create a Wales in which all people, older people included, are protected from abuse of all kinds. While we do not stereotype people, the aim of this Plan is to put in place measures which identify, address and prevent the types of abuse to which older people may be at increased risk.

We know that we have a long way to go and there is much to be done. This Plan is only one part of a strategy to create an age friendly Wales that supports people of all ages to live and age well, where everyone is able to look forward to growing older, where ageism does not limit potential or affect the quality of services older people receive. Ultimately, we want to be a nation that celebrates age and a nation that upholds the independence, participation, care, self-fulfilment and dignity of older people at all times.

Deputy Minister for Social Services.

Ageism and the abuse of older people is a complex societal problem that can have devastating physical, emotional and social consequences for older people. This plan sets out measures Welsh Government are taking across Government to ensure that older people are protected from all types of abuse, and to prevent them from being at risk of abuse. It builds upon much good work carried out under the Social Services and Well-being (Wales) Act 2014, the Regulation and Inspection of Social Care (Wales) Act 2016, and the Violence against Women, Domestic Abuse and Sexual Violence (Wales) Act 2015.

It recognises that the overarching themes we are seeking to address require action across Government and that taking a preventative approach to safeguarding requires an effective and proactive multi-agency response. It seeks to turn strategy into action.

It is important to remember that older people are not a homogeneous group and the experience of each individual will be different. Age friendly Wales: our strategy for an ageing society acknowledges the corrosive impact of ageism and seeks to challenge negative stereotypes of older people as a “drain on society” that could be used to validate abuse. The United Nations Principles for Older Persons have informed the development of the strategy and will guide its implementation. By rejecting ageism and age discrimination, we aim to create a more equal society that enables people of all ages to fulfil their potential no matter what their background or circumstances may be.

Although stereotyping older people is to be avoided, experience shows that some older people may:

• feel less able to access services
• be less aware than younger people of the services and options available to them
• believe that services are designed only for younger people, or people with children

Fundamental to an Age Friendly Wales is the elimination of ageism and age discrimination. As with other forms of discrimination, ageism has deep roots in our society’s cultural norms and practices, including in the language we use. We welcome the work of the Older People’s Commissioner to place a specific focus on ageism and will work to better understand its causes and impact in order to realise our aim of a more equal Wales.

Welsh Government works to identify the potential for ageist impacts and age discrimination through our policy assessment process. All Welsh Government policies are subject to a full integrated impact assessment, which gives full consideration to the impact on all members of society.

Older people may be at greater risk of some forms of abuse because of social, financial or educational circumstances - health is more likely to be a factor than it is for younger people. Older men and older women may, for example, have suffered abuse for many years from a family member and feel shame or embarrassment from years of accepting abuse without apparent complaint.

It can be more difficult for some older people to accept help. They may need more time, more reassurance and more confidence in what might happen and the services available, before they disclose abuse and accept help to move forward.

The Plan is informed by the experiences of older people in Wales throughout the pandemic. It draws from two significant reports published by the Older People’s Commissioner:

• leaving no one behind
• support services for older people experiencing abuse in Wales

It also draws on her research highlighting the barriers faced by older men in accessing services and support.

We will provide an update report within 6 months of publication of this plan to key partners, including the Ministerial Advisory Forum on Ageing and the Older People’s Commissioner’s Action Group on Abuse.

Data published by the Welsh Government indicates that older people report abuse of all kinds, and are more vulnerable to neglect than the adult population in general.

This plan has 3 overarching themes:

1. older people are supported to live independently and with dignity and are able to access relevant support from safeguarding services where they are at risk of abuse or neglect
2. older people experiencing domestic abuse or sexual violence are able to access relevant support from Violence against Women, Domestic Abuse and Sexual Violence (VAWDASV) services when required
3. older people are protected from becoming at risk of abuse or neglect

Self-neglect

Self-neglect has featured in around 40% (calendar year 2019) of adult practice reviews in Wales completed following the death of an adult with care and support needs.

Action

We will develop new practice guidance on self-neglect to support practice across relevant settings by mid 2024. This will enable practitioners to better identify and act upon signs of self-neglect and prevent the harm to self and others that may arise when it is not sensitively addressed.

This document will define self-neglect for the purposes of safeguarding practitioners, set it within the framework of the Social Services and Well-being (Wales) Act 2014 Act statutory framework and describes how it sits with the definitions of neglect used in that. It will give practitioners a clearer idea of the relationship between their obligations under 2014 Act and the issues of consent and capacity addressed in the Mental Capacity Act 2005, as amended, and the Mental Health Act 1983, when dealing with issues of self-neglect.

Adult practice reviews illustrate the complexity of practice with adults who self-neglect. The regularity with which Safeguarding Adults Boards have felt it necessary to inquire into the outcomes of cases of adults who self-neglect, and to develop procedures in response, suggests strongly that there is a need for public sector staff to have robust procedures to support them when they are working with people who self-neglect.

Domestic abuse and sexual violence

Welsh Government commissioned the Wales Violence Prevention Unit to carry out research to establish what approaches may have been successful in preventing Violence against Women, Domestic Abuse and Sexual Violence (VAWDASV), published in September 2021. One of its conclusions was:

Further research is also urgently needed for the prevention of specific forms of VAWDASV including so-called honour-based abuse, exploitation and trafficking, and how prevention programmes intersect with the needs of individuals and communities who are LGBT+, BAME, and older age groups.

The current Older People’s Commissioner has met the Deputy Minister for Social Services and the former Deputy Minister and Chief Whip (now Minister for Social Justice) to raise some of the issues faced by older people seeking to escape from domestic abuse, made all the more urgent by the pandemic. Current statutory commissioning guidance for the commissioning of VAWDASV services in Wales states:

The guidance will ensure that commissioning considers the specific needs, issues and barriers that may be experienced by people with protected characteristics under the Equality Act 2010, and who may be marginalised or excluded, including women, BME people, children and young people, older people, migrants, refugees and asylum seekers, disabled people and those who are LGBT+.

Action

We will continue to monitor VAWDASV Grants administered by the Welsh Government to regions and third sector organisations on an annual basis to ensure they are adhering to the statutory guidance for the commissioning of VAWDASV services in Wales. They will be asked to provide evidence of how they have considered and met the needs of older people.

Action

We will ensure the Violence against Women, Domestic Abuse and Sexual Violence Strategy 2022 to 2026 adopts a blueprint approach under which there is a specific workstream to address the needs of older people. Specific actions will be achieved in accordance with a programme to be established under the strategy’s programme board, to highlight the qualities and characteristics of those services found to be effectively improving the lives of older people and how good practice can be encouraged and shared.

Action

We will work with the Older People’s Commissioner to review the information and guidance on domestic abuse: safeguarding older people in Wales by mid 2024.

Action

We will build upon the home shouldn’t be a place of fear campaign to include a focus on violence against older people, women in the street and workplace as well as the home. We will continue to work with agencies specialising in supporting older people to ensure that they are addressing issues that older people are disproportionately more likely to face.

Help can be given to assist people to remain in their own home, either with or without the perpetrator continuing to live there. There are services which can strengthen the security of property to offer greater protection (known as target hardening) to a person’s property and housing related floating support can take place within their home. The Renting Homes (Wales) Act 2016 introduced a new approach to joint contracts which enables contract-holders to be added or removed from occupation contracts without the need to end the contract for all. When implemented, the new approach will help avoid the risk of homelessness and will also help victims of domestic abuse, by enabling the perpetrator to be targeted for eviction.

Financial abuse

Financial abuse can have a devastating impact on victims and their families. The Social Services and Well-being (Wales) Act 2014 included financial abuse within its definition of abuse and made clear that abuse is:

• having money or property stolen
• being defrauded
• being put under pressure in relation to money or property
• having money or property misused

It’s clear that the pandemic provided new opportunities for scammers and there is evidence that older people with needs for care and support were among the most vulnerable groups as were people living alone. In addition, the lockdown periods impacted negatively on other forms of abuse, such as intra familial financial abuse.

Scams can have a terrible effect on victims and older people can be particularly at risk of this form of abuse. Evidence from National Trading Standards shows that 85% of victims of doorstep scams are aged over 65. The impact on health and well-being can often be far greater than the financial loss. People lose confidence and can suffer from increased isolation and become more fearful. This in turn leads to a deterioration in both mental and physical health. National Trading Standards, as members of the Older Person’s Commissioners Action Group on Abuse, produced a range of material improving awareness of scams and advice on how to protect yourself, and the Welsh Government, through the Live Fear Free helpline offered advice and support for those at risk of domestic abuse of all kinds.

We delivered in May 2022 a communications campaign focussing on the issue of financial abuse, including scams, aimed at older people. We intend that this would also provide information on intra familial financial abuse, signs to look out for and places to go for assistance.

Action

We will work with partners to identify ways of recognising and avoiding financial abuse, including scams, raising awareness among older people particularly, and signposting sources of advice and assistance.

Loneliness, social isolation and older people

In recent years we have heard increasingly about the detrimental impact loneliness and social isolation can have on our physical and mental health and well-being.

Our strategy, connected communities published in February 2020, recognises that whereas anyone, of any age, can experience loneliness and social isolation, older people are particularly vulnerable. This can leave people at increased risk of abuse or neglect.

During the pandemic, many have experienced these feelings for the first time, and those who were lonely prior to the pandemic have felt even more isolated. We have taken a number of actions to try and support people to stay connected and to access the support they might need, such as:

• funding Age Cymru’s telephone befriending service ffrind mewn angen / friend in need
• making changes to our regulations to enable those who live alone to form an “extended household”
• piloting a volunteering in care homes initiative to facilitate family visits

Good progress has been made in implementing the strategy. We have worked across Government to review its 80-plus commitments to ensure they accurately reflect the changes in society that have taken place and to understand the type of support being provided for the most vulnerable and how this can be strengthened.

The establishment of an advisory group of valued external stakeholders, such as the Older People’s Commissioner’s Office and Age Cymru, has been vital in helping us to better understand the impact of the pandemic on loneliness and isolation amongst older people.

As we continue to implement the strategy we will consider key issues identified by the group such as:

• digital exclusion
• overcoming barriers to re-engaging
• types of ongoing support required
• sustaining community based support

Social prescribing will play a key role in ensuring local, preventative support is available and responsive to people’s individual needs.

We will also consider how to embed intergenerational practice, learning from participants’ feedback at our (virtual) national summit held in March 2021, helping to ensure mutual respect and understanding between generations and contributing towards an age-friendly Wales.

Mental capacity

Deprivation of Liberty Safeguards (DoLS)

The Deputy Minister for Mental Health and Well-being issued a written statement on 5 April 2023 in response to the announcement by the UK Government to step away from the introduction of the Liberty Protection Safeguards (the LPS) and the implementation of the Mental Capacity (Amendment) Act 2019 (the 2019 Act).

The statement confirmed the UK Government decision that the necessary legislation to implement the LPS will not be brought forward within this Parliament and confirmed the Welsh Government’s deep disappointment with this decision not to proceed with implementation at this time.

In light of the UK Government decision, we will want to consider what opportunities exist to strengthen arrangements to protect and promote the human rights of those people who lack mental capacity. Actions may be possible to support the current application of DoLS, and to strengthen Wales position to transition to the LPS in the future.

The Welsh Government has identified and resourced workforce training to support practitioners to protect and support people’s rights by better enabling them to put into practice the principles of the Mental Capacity Act training and plan care which accordingly protects and promotes the persons human rights.

Dementia

Welsh Government published Dementia action plan: strengthening provision in response to COVID-19 in September 2021. This document is intended to complement the Dementia action plan for Wales and to support implementation in light of the experience of the pandemic. It is important to recognise that people with dementia may be at risk of abuse and neglect. In such circumstances it is important to ensure services are based around the individual’s needs and preferences.

Action

Of particular relevance to this action plan, the Dementia action plan identifies as one of the overall cross-cutting themes a ‘protecting rights / person centred approach’; support for care homes and support for unpaid carers. The document states that Welsh Government will:

• Provide a summary of outcomes reported through the Intermediate Care Fund (ICF) funded projects, which are being matched to areas of the Dementia Action Plan. This will include developments supporting the ‘teams around the individual’ approach, enabling families and carers to access respite care that is able to meet the needs of the carer as well as those of the person living with dementia.
• Continue to work with the care home sector to help support the rights based approach to care for people living with dementia and their families, and enabling access to the rehabilitation they require in response to COVID-19. This will include ongoing work supporting care home residents’ well-being, identified through the work of the Care Home Action Plan.

Care homes

The Care Homes Action Plan first published by the Welsh Government in July 2020 set out the Welsh Government’s support for the sector over the winter period in light of lessons identified from the first wave of COVID-19, and a final update was issued in March 2021. We have grant funded Age Cymru to continue its engagement with care home residents to gain a better understanding of their experience during the pandemic in order to inform policy development and develop good practice.

Inquests into the deaths of 8 people whose cases were considered as part of Operation Jasmine shone a light on the impact poor leadership and management has on the culture of an organisation and how this in turn impacts on the safety and well-being of people receiving a service. A negative culture in care home services creates the environment in which the neglect, abuse and breaches of people’s human rights can occur.

Following the outcome of the inquests Care Inspectorate Wales (CIW) worked jointly with Caerphilly County Borough Council, Aneurin Bevan University Health Board and Social Care Wales (SCW) to hold a reflection and learning event with stakeholders and partners in December 2021 to ensure the lessons identified from Operation Jasmine are not forgotten. A webinar has been produced and will be shared with all local authorities and health boards in Wales to further share learning. CIW and SCW will take forward a programme of work focusing on leadership and management and cultures in social care services.

CIW has changed its recording of safeguarding concerns raised. Once embedded, this will enable information to be shared. The Care Inspectorate Wales Strategic Plan for 2020 to 2025 commits to "publish ratings for care homes and domiciliary support services; and to further develop our approach to joint working and inspections to support improvement".

Aligned to the local authority inspection team’s review of services for older people, CIW’s adult and children’s services inspection team undertook a national review of care homes for people living with dementia. The review was prompted and informed by:

• Welsh Government’s Dementia Action Plan for Wales 2018 to 2022, which re-iterated that people have a right to live well in a care home
• Welsh speakers’ dementia care: Alzheimer’s Society Cymru and the Welsh Language Commissioner 2018 recommended that CIW and Healthcare Inspectorate Wales (HIW) recognise that a lack of care in the Welsh language for those who require it constitutes poor care which may have a harmful effect on people
• the report Use of antipsychotic medicine in care homes National Assembly for Wales 2018 identified significant concerns about the inappropriate use of antipsychotics in care home settings
• CIW and HIW review of healthcare support provided by Betsi Cadwaladr University Health Board for older people living in care homes in North Wales in 2018

They found:

• in general, people and their families were positive about care provided in the majority of services
• there was a need to improve access to support for people speaking Welsh as their first language
• staff training in dementia required improvement as did consideration of the environment in which people live due to the complexity of their needs
• medicines management was an area for improvement particularly in relation to antipsychotic medication. Secondment of a pharmacist to CIW during 2020 to 2021 will provide an opportunity to develop relationships with pharmacy colleagues to support improvement in services
• providers were embracing new technology to improve services
• work needs to be undertaken to improve hospital discharge for people living with dementia. The COVID-19 pandemic highlighted the importance of these last points: 
  • people were supported to keep in contact with their loved ones through the use of technology
  • our calls with providers during this time presented a clear need for improved hospital discharge processes

Action

The CIW strategic plan for 2020 to 2025 commits to 'use the findings from our inspections and reviews to improve services locally and nationally' and, in doing so, to 'continue to develop our approach to securing improvement and enforcement to ensure people are safe and receive high quality services'. CIW will also 'publish ratings for care homes and domiciliary support services'.

Domiciliary care

There are significant challenges within the social care sector, and particularly within reablement and domiciliary care services. This relates to the level and complexity of need and the sufficiency of staff to provide care.

Recruitment and retention barriers are multifaceted and require a range of actions and cohesive partnership working to address; we are and will remain committed to taking action alongside our partners to enhance our workforce and creating a sustainable workforce for the future. It is essential to consider all of our commitments, and the considerable funding we are investing in social care, in a systemic way, not as single actions. Social Care Wales’s wecare.wales campaign promotes the variety of roles available in social care through web-based materials and television adverts. This national recruitment campaign is having a real impact in terms of people accessing materials about social care work and people feeling more positive about working in the sector. Considerable personal challenge to staff is impacting and the opening of hospitality and retail presents attractive alternative employment options.

A Pay and Progression Framework has been developed in partnership through the Social Care Fair Work Forum and is currently out for consultation as part of the Rebalancing Care and Support Programme Consultation.

The voluntary framework aims to improve the working arrangements for those working in the social care sector by setting out a series of bands for different job roles and includes the skills, values, knowledge, understanding, and typical tasks for each one. It will also, in the future, include a career map of opportunities for progression in the sector.

SCW has also established a jobs portal for social care, to help bring people looking for a role together with employers that are seeking to fill vacancies.

Welsh local authorities and health boards have been allocated an estimated £70 million for 2022 to 2023 to implement the Real Living Wage uplift to £10.90 an hour with workers feeling the benefit by June 2023. The significant increase in the local government settlement from the £43m allocated in the previous year reflects our commitment to meeting the pressures we are seeing in social care.

The Real Living Wage delivers a significant increase in pay for many workers and increases the attractiveness of social care work. This further uplift should further help to support recruitment and retention for the social care sector.

We are also in the process of commissioning an independent evaluation to examine the impacts and success of implementation. This research will help us to learn and make improvements to the ways in which rollout has been applied and work in partnership to develop and enhance processes.

We know the difference the Real Living Wage can make to low paid workers, but we know the Real Living Wage wont resolve all of the sector’s workforce issues. It is however, a vital first step and provides an important foundation for improved working conditions for social care.

We continue to work very closely with the Social Care Fair Work Forum to hear the voices of our workforce to shape how we further improve the terms and conditions of social care workers. This includes exploring opportunities to improve sickness benefits and the development of a Pay and Progression Framework.

Action

We are funding national and targeted recruitment work and local authorities are engaged in a range of initiatives to increase capacity. Welsh Ministers introduced the Real Living Wage for social care workers from April 2022. Work to improve pay, terms and conditions more generally via the Social Care Fair Work Forum is continuing.

The Minister for Health and Social Services and Deputy Minister for Social Services announced a plan in June 2023 to support the strengthening of care services in the community to alleviate pressure on the health and care system over the coming winter and beyond. Building on the 670 extra community beds delivered in Winter 2022 to 2023, the intention is to ensure people living with frailty are supported to live at home, reducing hospital admissions and improving access to reablement services.

Action

We will continue to work with the Medication Administration in Domiciliary Care (MADC) working group, which comprises Welsh Government officials and stakeholders. The aim is to establish national practice and training with regard to domiciliary care and the safe administration of medication, reduce the number of incidents where unsafe use or storage of medicines is recorded.

Unpaid care

Thousands of unpaid carers of all ages across Wales support people with complex needs to live independently and well in their own homes and reduce pressure on the Welsh health and social care system. Many older carers live with their own health conditions and although caring for a friend or family member is a rewarding experience for many, unpaid carers can overlook their own needs.

The strategy for unpaid carers, published in March 2021, states that all unpaid carers must have the opportunity to take breaks from their caring role to enable them to maintain their own health and well-being. Practical support for unpaid carers can prevent families reaching crisis point. Financial support can also reduce stress and help unpaid carers struggling to cope with the cost of living crisis. Welsh Government recognises the importance of making sure unpaid carers are recognised and feel valued and we continue to invest in supporting carers to have a life alongside caring.

In May 2022, we invested £29 million to provide 57,000 unpaid carers in Wales who were in receipt of Carers Allowance on 31 March 2022, with a one-off payment of £500. We have also allocated £4.5 million over three years to continue our Carers Support Fund. The fund, administered by Carers Trust Wales, was established in 2020 and has helped over 16,000 unpaid carers on low incomes to buy basic essential items or access information and advice to manage their caring role. The fund has helped to identify a substantial number of carers who were previously unknown to services. Eligibility for the grants is not linked to benefit entitlement. Unpaid carers of all ages in Wales will also benefit from a £9 million fund to set up a new national short breaks scheme. The 3-year investment (2022 to 2025) will increase opportunities for unpaid carers to take a break from their caring role and aims to transform the way unpaid carers access respite and short breaks in Wales.

The evidence we reviewed when compiling the equality impact assessment supporting the strategy for unpaid carers demonstrated the detrimental effect of caring duties on some carers’ health and wellbeing, with older carers at higher risk than younger carers. Respite and flexible short break options can be a vital part of the care and support unpaid carers require to manage their caring role and can temporarily reduce caring responsibilities.

Voice

A code of practice on advocacy services was issued under the Social Services and Well-being (Wales) Act 2014.

The Code set out the requirements for local authorities to ensure that access to advocacy services and support is available to enable individuals to engage and participate when local authorities are exercising statutory duties in relation to them. It recognised the importance of a variety of forms of advocacy, statutory and non-statutory, formal and informal.

The Welsh Government has funded the HOPE (Helping Others Participate and Engage) project which aims to promote access to early intervention support at community level through a range of advocacy models for older people and carers across Wales. The HOPE project will:

• establish, facilitate and support older people’s advocacy co-production forums in each region
• identify advocacy ambassadors through the forums
• recruit, train, deploy and support peer and older volunteers
• establish a programme of Continuing Professional Development (CPD) training enabling advocates across Wales to continually develop their skills and knowledge

We will continue to work with local government partners to take forward the work achieved in the adult safeguarding and advocacy conferences, which took place in February 2019. The aim will be:

• sustainable community-based peer, group or citizen advocacy services
• more older people being involved in their communities and less socially isolated
• improved early access to statutory services preventing older people and carers from needing crisis interventions
• a strategic approach to promoting advocacy in Wales

Action

We will commission research into the provision and accessibility of advocacy services for older people in care homes, not only on entry but throughout their residency. The Regulation and Inspection of Social Care (Wales) Act 2016 requires care homes to signpost advocacy services, and Care Inspectorate Wales statutory guidance indicates 'service providers put in place arrangements to enable individuals to access relevant advocacy services or self-advocacy groups (if they wish) and support for their communication needs to enable them to make decisions about their lives'. A study of how this has worked in practice and affected the lives of residents would be a useful guide for future policy work. The disproportionate impact of COVID-19 has served to highlight existing inequalities for some sections of society, including older people, those living with dementia and those living in care homes. The rights of older people in care homes and the ease of access to appropriate advocacy services for older people have been points of particular focus during the pandemic and are an important element in the recovery plan for Health and Social Care in Wales – COVID-19: looking forward.

Older people’s rights

Human rights are universal and recognised rights for everyone as set out in the Human Rights Act 1998 (HRA). The Act came into force in the UK in 2000. Human rights are distinct from but closely aligned to the well-being agenda and represent a clear benchmark about the unacceptable nature of humiliating and degrading treatment to any of us. The HRA places an obligation on public authorities, including the Welsh Government, to treat people with fairness, equality, dignity, respect and autonomy.

Age is a protected characteristic under the Equality Act 2010 which means that people cannot be treated differently because of their age. The Public Sector Equality Duty is part of the Equality Act. It aims to ensure that public bodies, including the Welsh Government, consider how they can positively contribute to a fairer society. The duty drives sound decision-making. It encourages public bodies to understand how different groups of people with particular protected characteristics will be affected by their policies and services.

Raising awareness of rights can also empower people to take control and recognise when their rights are being compromised. Defining human rights in simple terms can empower older people to challenge and change the way services are designed and delivered in Wales, but it is equally important to raise awareness of rights amongst professionals.

As stated in Making rights work for older people: guidelines for health and social care:

The clear message from case law is that knowledge and awareness of human rights documents (such as the UN Principles for Older Persons), and regularly considering them in your practice are essential in making sure you comply with the due regard duty. You should automatically consider human rights in your processes, decisions and actions.

We are undertaking a series of actions to "make rights real for older people". We have delivered a national campaign to make older people and carers aware of their rights under the Social Services and Well-being (Wales) Act 2014. We have also worked with older people and key partners to coproduce practical guidance demonstrating how health and social care professionals can embed a rights-based approach. It shows how simple changes to the way we work can uphold an individual’s human rights and have a major impact on their well-being. The group also produced a version of this guidance for older people. It is intended that these two documents will be used together to guide conversations and inspire a common understanding of the transformative effect of a rights-based approach.

In 2021 to 2022, we provided funding to each local authority to champion work towards creating an age friendly Wales and to strengthen older people’s groups and forums. These local structures can be effective in disseminating information to older people at risk of, or experiencing, abuse.

Action

We will promote further research to identify early intervention and preventative strategies to prevent the abuse of older people. This will identify approaches which can be successful in enabling older people avoid becoming at risk of, or experiencing, neglect or abuse.

Role of LLAIS

Key to efforts to reduce the risk of abuse or neglect in any setting is to listen to the experiences of service users, and empower them to speak out where they believe themselves or others to be at risk.

The drive towards closer integration of health and social services with improved public engagement is reflected in the aims of a healthier Wales. This sets out the goal of ensuring citizens are placed at the heart of a whole-system approach to health and social care services and stresses the importance of listening to all voices through continual engagement.

To realise this ambition, the Health and Social Care (Quality and Engagement) (Wales) Act 2020 replaces Community Health Councils (who currently represent the patient voice in the health service only) with a new national body, the Citizen Voice Body. Operationally known as LLAIS, the Citizen Voice Body exercises functions across health and social care. The aims of LLAIS are to:

• strengthen the citizen voice in Wales in matters related to both health and social services, ensuring that citizens have an effective mechanism for ensuring that their views are heard
• ensure that individuals are supported with advice and assistance when making a complaint in relation to their care
• use the service user experience to drive forward improvement

This new organisation is established as a national body but be structured in such a way as to enable it to perform its functions at a national, regional and local level. The Act places duties on the new body, NHS bodies and local authorities to make arrangements to co-operate, with a view to supporting each other to promote awareness of LLAIS. They are also under a duty to make arrangements to support the new body in seeking the views of the public in respect of health services and social services.

Action

Keeping people safe - we will publish a Code of Practice about how LLAIS can access places where health or social care services take place to get people’s views, and how that engagement happens by Summer 2023. There will also be statutory guidance to which NHS bodies and local authorities must have regard when dealing with representations made to them by LLAIS.

Role of Social Care Wales

Social Care Wales will:

• continue to undertake and meet its responsibilities for workforce regulation and development, delivering core and statutory functions
• continue to deliver the extension of the social care register, particularly in reference to new groups such as adult care home workers, whilst continuing to reform and improve the regulatory framework for all
• along with CIW, Social Care Wales will continue to support positive cultures in social care services

Good information sharing is central to good safeguarding practice. Practitioners must share information in accordance with to the UK’s data protection legislation. The data protection legislation allows for the sharing of information and should not be automatically used as a reason for not doing so. One of the specific circumstances which provides for information sharing is in order to prevent abuse or serious harm to others (schedule 1 para 18 of the Data Protection Act 2018). A key theme emerging from Adult Practice Reviews is the need for better multi-agency communication and information sharing. When information is not shared in a timely and effective way decisions about how to respond may be ill informed and this can lead to poor safeguarding practice and leave people at risk of abuse or neglect.

Action

We will produce a non-statutory guide to remind practitioners working across agencies of their responsibilities to share information to safeguard adults at risk and to support them in understanding the conditions under which information may be shared. This advice will be for all front-line practitioners and managers working with adults at risk, carers and families who have to make decisions about sharing personal information on a case-by-case basis, where there are safeguarding concerns. We will aim to publish this guidance by the third quarter of 2024.

We are working to achieve a smarter, better connected society and economy by making sure everybody in Wales has access to digital technologies, and knows how to use them. The Digital Strategy for Wales objective of inclusivity should pay due heed to the needs of older people and offers an enhanced ability to access safeguarding support.

Digital inclusion is a key social justice and equalities issue and is about ensuring people benefit from the rapid pace of technological change taking place in society.

We know there is a large proportion of people across Wales who are not digitally confident. They may:

• not personally use the internet
• lack the basic digital skills to access vital services and information
• lack access to a device and/or connectivity

The National Survey for Wales 2019 to 2020 shows that older people still account for the largest demographic of those digitally excluded, which stands at:

• 19% for those aged 50 and over
• 19% those aged 65 to 74
• 48% for those aged 75 years and over

We are committed to support everyone to gain the motivation, confidence and skills in order to make informed decisions and choose how they participate in, and make the most of, our increasingly digital world. As stated in the Digital Strategy for Wales (March 2021), for people who cannot, or decide not to, participate digitally, we will continue to apply the principles of user centred design so that there are alternative ways to access public services in Wales. This includes alternative access routes which will be as good as those offered online.

It is essential that the health and social care workforce also recognise the needs of people who are digitally excluded and that those citizens are equally supported and enabled to access services and support from the health and social care system.

By ensuring Welsh citizens are digitally confident, particularly our older population, we can contribute to the triple aims of our health and social care system in Wales, which are to improve the health and well-being of the population, to continuously improve the quality of care we provide and to ensure we get the maximum value from the resources we have available.

Through our digital communities Wales: digital confidence, health and well-being procured programme we work with organisations from all sectors that can help reach digitally excluded people. The programme is designed to provide training and support to front line staff, volunteers and organisations to engage with and develop the digital skills of citizens and front line staff. The programme commenced in July 2019 and is due to run until 30 June 2022, with an option to extend by a further 3 years.

There is a growing need for individuals, be it a young person or an adult, to not only understand their rights online, but also to navigate digital technology safely and with confidence. We recognise "stay safe, legal and confident online" now forms part of the five basic digital skills widely adopted across the UK. Training provided by Digital Communities Wales (DCW) includes tips on how to stay safe and secure online, including protecting privacy, which is passed onto citizens by front line staff and volunteers.

Digital companions campaign: DCW have been developing a communications campaign to raise awareness of digital inclusion and improve the basic digital skills of older people. They highlight the simple steps that individuals can take to support a digitally excluded person to get online, becoming their digital companion.

DCW procured and appointed an agency to develop a media plan, with resources, which includes targeted advertising on digital television channels ITV Hub, Made in Cardiff and North Wales TV, as well as on Facebook. This will include case studies of those with lived experience of digital exclusion and the impact the use of technology has since had on them. The main call to action is for individuals to simply help someone they know to use technology effectively. The resources to support people will be available on the DCW website for those who wish to access them.

In 2018 both an academic report by Dr Amanda Robinson and a practitioner report by Liane James on Domestic Homicide Reviews (DHRs), Adult Practice Reviews (APRs), Child Practice Reviews (CPRs) and Mental Health Homicide Reviews (MHHRs) in Wales were conducted. They both highlighted how the review process is chaotic and complex, with some incidents generating multiple reviews. According to the category of the review, they may be carried out by either devolved or non-devolved agencies.

This way of working may require the bereaved families to participate in multiple inquiries into their loved one’s life and death, potentially leading to the re-traumatisation and re-victimisation of the families. The academic and practitioner reports advised that this needed to change both to reduce the negative impacts on the families to make better use of resources and to enable a swifter mechanism to conduct reviews and implement the learning identified on a pan-Wales basis. The reports also found that as the reviews were not conducted in a co-ordinated manner, there was no central database for storing all of them and therefore this made application of learning into practice very difficult.

Based on the findings, the reports advised that several changes needed to be made. This included the creation of a Single Unified Safeguarding Review (SUSR) which is a cross agency framework that encompasses all elements which would usually require multiple reviews. This review will still keep the impacted family at the heart of the review process but will ensure that they are safeguarded against further harm. It was also suggested that these reviews and past DHRs, CPRs, APRs and MHHRs are stored in one central repository. As a result, the Welsh Safeguarding Repository (WSR) has been created to store all reviews in one location. This allows practitioners easier access to the reviews and enables learning to be extracted from them. The WSR is a unique system which produces thematic explorations from both a social science and a computer science perspective. This key information can then be disseminated across Wales to help protect potential victims and prevent similar future incidents.

We will provide a SUSR process which is used by both devolved and non-devolved agencies to ensure recommendations are actioned and learning embedded. This will stop the need for multiple reviews to be carried out, therefore alleviating some of the pressure on agencies and the families of the deceased. The SUSR will commence in early 2024.

We have established the Welsh Safeguarding Repository (WSR) which will store all safeguarding reviews in one central database. This will enable data to be drawn from the reviews to be used by practitioners going forward, and to produce thematic analysis of the reviews, as well as disseminating learning across Wales to ensure that lessons are identified from past incidents to help prevent similar cases in the future.

The National Independent Safeguarding Board annual report 2019 to 2020 recommended:

The Welsh Government should ensure that the Technical Guidance of the Social Care Performance Framework includes information about the abuse of older people by collecting data broken down by age group.

The Performance and Improvement Framework for Social Services became law in 2020. The work on further age disaggregation of the safeguarding return is a requirement of the new collections. The adult safeguarding return which has been carried over from the previous framework is now collected by much narrower age bands which allows for a more precise analysis of abuse and neglect by age.

Unfortunately, the COVID-19 pandemic delayed work but it has now resumed and includes work on developing the new adults receiving care and support census. A commitment has been made to produce this data.

The Adult Census Development Group will be the primary means of developing the new census. Welsh Government and local authorities in Wales participate in this group in addition to representatives selected from academia, providers and partner agencies. The purpose of the group is to ensure that the collections are valid and purposeful, reflect current practice and are fit for purpose.

This will enable better evidence of the prevalence and nature of abuse of older people in Wales.

In April 2021, with Welsh Government support, Social Care Wales convened a Safeguarding Standards Development Group that aims to create:

• a set of safeguarding standards that underpin training, learning and development activity related to children and adults in Wales
• a multi-agency set of standards for all levels of safeguarding, linked to competencies and knowledge required
• a way to map specialist topics or “other” safeguarding training outside of the core modules across to the set of standards
• an ability for these to be used across agencies, regions and differing needs within the public facing sectors

This will encourage appropriate sharing of information and emphasise the importance of making safeguarding reports.

Action

We will develop a National Training Framework with a 'train the trainer' programme (building on approved Regional Training Framework and NHS Training Framework) and to coordinate a national conversation to improve and enhance multi-agency Safeguarding Training. The standards will be approved by the chairs of Regional Safeguarding Boards and are subject to consultation.

Community Pharmacy Wales represents in excess of 700 pharmacy owners in Wales on NHS matters. Its main objective is to secure the best possible NHS service opportunities, remuneration and terms. It is the body responsible for liaising with the Department of Health and for negotiating the contractual terms for the provision of the NHS community pharmacy services.

We will support community pharmacies with material and training to identify signs of abuse and report it to social services where appropriate.

The latest figures on Stats Wales indicate that sexual and domestic abuse against people aged 65 or over is a significant proportion of the overall total. Of the cases recorded by local authorities in 2019, 284 of the 1,051 adult safeguarding cases recorded as under the sexual abuse category were of adults over 65. For domestic abuse, the figures are 1,321 out of 2,829.

We will, along with partners from the Older People’s Commissioner’s Stopping Abuse Action Group, and in conjunction with the Older People’s Needs workstream of the VAWDASV Strategy, work to raise awareness of the types of abuse suffered by older people in Wales. This will include challenging some of the stereotypical assumptions around the nature of abuse to which older women and men are vulnerable.

Action

Utilise communications channels and work with stakeholders to raise awareness of the needs of older people facing abuse and the factors which are found to obstruct those seeking assistance during 2024. This work to be built upon with the development of an awareness raising strategy.

We will provide regular reports to the Older People’s Commissioner’s Stopping Abuse Action Group and through the reporting mechanisms of the VAWDASV Blueprint Strategy. We will also formally update the Ministerial Advisory Forum on Ageing.

There are actions to be delivered under the national action plan on preventing the abuse of older people:

• objective 1: older people are supported to live independently and with dignity and are able to access relevant support from safeguarding services where they are at risk of abuse or neglect
• objective 2: older people experiencing domestic abuse or sexual violence are able to access relevant support from Violence against Women, Domestic Abuse and Sexual Violence (VAWDASV) services when required
• objective 3: older people are protected from becoming at risk of abuse or neglect

Overarching objectives

Action

Develop a programme of research to ensure we have the right data and evidence to deliver and support the objectives of this Plan.

• Owner: Welsh Government.
• Target date: mid 2024.

Action

Develop and launch a communication and awareness campaign to support and deliver this Plan.

• Owner: Welsh Government.
• Target date: early 2024.

Objective 1: older people are supported to live independently and with dignity and are able to access relevant support from safeguarding services where they are at risk of abuse or neglect

Action

We will develop new practice guidance on self-neglect to support practice across relevant settings. This will enable practitioners to better identify and act upon signs of self-neglect and prevent the harm to self and others that may arise when it is not sensitively addressed.

• Owner: Welsh Government.
• Target date: mid 2024.

Action

Care Inspectorate Wales and Social Care Wales will take forward a programme of work focusing on leadership and management and cultures in social care services with specific reference to the rights, dignity, voice and awareness/prevention of abuse to older people.

• Owner: CIW and SCW.
• Target date: ongoing.

Action

The Care Inspectorate Wales Strategic Plan for 2020 to 2025 commits to:

Publish ratings for care homes and domiciliary support services; and to further develop our approach to joint working and inspections to support improvement.

This will enable service users to become better informed and better able to live independently and with dignity, reducing the risks of abuse and neglect.

• Owner: CIW.
• Target date: second quarter of 2024.

Action

Voice, awareness, information and support. We will continue to work with local government partners to take forward the work achieved in the Adult Safeguarding and Advocacy conferences which took place in February 2019. 

The aim will be sustainable community-based peer, group or citizen advocacy services, more older people being involved in their communities and less socially isolated, improved early access to statutory services preventing older people and carers from needing crisis interventions, and a strategic approach to promoting advocacy in Wales.

• Owner: Welsh Government and ADSSC.
• Target date: mid 2024.

Action

We will commission research into the provision and accessibility of advocacy services for older people in care homes, not only on entry but throughout their residency, and examine its recommendations.

• Owner: Welsh Government.
• Target date: late 2023.

Action

We will embed intergenerational practice and tackle ageism; learning from participants’ feedback at our (virtual) national summit held in March 2021. This will help to ensure mutual respect, awareness and understanding between generations, and contribute towards an age-friendly Wales. This links with age friendly Wales: our strategy for an ageing society.

• Owner: Welsh Government.
• Target date: ongoing.

Action

Access to services, support and information. Digital companions campaign: Digital Communities Wales (DCW) have been developing a communications campaign to raise awareness of digital inclusion and improve the basic digital skills of older people by highlighting the simple steps that individuals can take to support a digitally excluded person to get online, becoming their digital companion. This will include case studies of those with lived experience of digital exclusion and the impact the use of technology has since had on them.

• Owner: Digital Communities Wales.
• Target date: late 2023.

Action

Building awareness and better joined up working. To develop a National Training Framework with a 'train the trainer' programme (building on approved Regional Training Framework and NHS Training Framework) and to coordinate a national conversation to improve and enhance multi-agency safeguarding training around preventing and identifying abuse.

• Owner: Social Care Wales.
• Target date: early 2024.

Objective 2: older people experiencing domestic abuse or sexual violence are able to access relevant support from Violence against Women, Domestic Abuse and Sexual Violence (VAWDASV) services when required

Action

We will work with the Older People’s Commissioner (OPC) to review and update the information and guidance on domestic abuse: safeguarding older people in Wales.

• Owner: Welsh Government and OPC.
• Target date: mid 2024.

Action

Meeting needs. We will continue to monitor VAWDASV Grants administered by the Welsh Government to regions and third sector organisations on an annual basis to ensure they are adhering to the Statutory Guidance for the Commissioning of VAWDASV Services in Wales. They will be asked to provide evidence of how they have considered and met the needs of older people.

• Owner: Welsh Government.
• Target date: ongoing.

Action

We will build upon the home shouldn’t be a place of fear campaign to include a focus on violence against older people.

• Owner: Welsh Government.
• Target date: mid 2024.

Action

We will continue to work with the VAWDASV Strategy Older People’s Needs workstream to ensure the needs of older people are properly addressed and services improved. This links with the violence against women, domestic abuse and sexual violence strategy 2022 to 2026.

• Owner: Welsh Government and partners.
• Target date: ongoing.

Objective 3: older people are protected from becoming at risk of abuse or neglect

Action

Providing support. Use the summary of outcomes reported through the Intermediate Care Fund (ICF) funded projects, to match against areas of the Dementia Action Plan. This will include supporting the "team around the individual" approach, enabling families and carers to access respite care that is able to meet the needs of the carer as well as those of the person living with dementia.

• Owner: Welsh Government.
• Target date: ongoing.

Action

Continue to work with the care home sector to help support the rights-based approach to care for people living with dementia and their families, and enabling access to the rehabilitation they require. This will include ongoing work supporting care home residents’ well-being, identified through the work of the Care Home Action Plan.

• Owner: Welsh Government and care home providers.
• Target date: ongoing.

Action

We will work to support our social care workforce around pay, conditions and training via the Social Care Fair Work Forum to ensure we have the right workforce, with the rights skills in the right place at the right time.

• Owner: Welsh Government.
• Target date: ongoing.

Action

Ensuring safe administration of medicine. We will continue to work with the Medication Administration in Domiciliary Care (MADC) working group, which comprises Welsh Government officials and stakeholders. The aim is to establish national practice and training with regard to domiciliary care and the safe administration of medication, reduce the number of incidents where unsafe use or storage of medicines is recorded.

• Owner: Welsh Government and stakeholders.
• Target date: ongoing.

Action

Regulation and inspection. We will publish a code of practice about requests from the CVB to enter health and social care premises to seek the views of individuals with the intention that it will come into force in summer 2023. There will also be statutory guidance to which NHS bodies and local authorities must have regard when dealing with representations made to them by the CVB.

• Owner: Welsh Government.
• Target date: mid 2023.

Action

We will produce a non-statutory guide to remind practitioners working across agencies of their responsibilities to share information to safeguard adults at risk and to support them in understanding the conditions under which information may be shared.

• Owner: Welsh Government.
• Target date: third quarter 2024.

Action

We will work with partners to produce guidance on ways of identifying and avoiding financial abuse, among older people particularly, and sources of advice and assistance.

• Owner: Welsh Government and partners.
• Target date: mid 2024.

Action

As we continue to implement the loneliness and isolation strategy we will consider key issues identified by the group such as: digital exclusion, overcoming barriers to re-engaging, types of ongoing support required and sustaining community-based support. Social prescribing will play a key role in ensuring local, preventative support is available and responsive to people’s individual needs.

• Owner: Welsh Government.
• Target date: ongoing.

Action

We will provide a Single Unified Safeguarding Review (SUSR) process which is used by both devolved and non-devolved agencies to ensure recommendations are actioned and learning embedded.

• Owner: Welsh Government and Safeguarding Boards.
• Target date: early 2024.

Action

We will use the Welsh Safeguarding Repository (WSR) to store all safeguarding reviews in one central database and through machine learning identify trends and themes.

• Owner: Welsh Government.
• Target date: mid 2024.

Action

Awareness and support. We will support community pharmacies with material and training to identify signs of abuse and report it to social services where appropriate.

• Owner: Welsh Government and Community Pharmacies Wales.
• Target date: late 2024.

Action

Developing the new adults receiving care and support census. The Adult Census Development Group will be the primary means of developing the new census. Welsh Government and local authorities in Wales participate in this group in addition to representatives selected from academia, providers and partner agencies. This will better enable us to emerging trends and risks.

• Owner: Welsh Government and Adult Census Development Group.
• Target date: mid 2024.

Action

Social Care Wales will continue to deliver the extension of the social care register, particularly in reference to new groups such as adult care home workers, whilst continuing to reform and improve the regulatory framework for all.

• Owner: Social Care Wales.
• Target date: ongoing.

Action

Information and awareness. We will develop a resource on advocacy in care homes for care home staff.

• Owner: Welsh Government and Advocacy Providers.
• Target date: mid 2024.