Official Report: Minutes of Evidence

The Chairperson (Mr McGuigan): I welcome Ms Denise Hayward, CEO of Volunteer Now; Ms Ruth Mulholland, safeguarding manager, Volunteer Now; Mr David McClure, external affairs lead, Hourglass; and Ms Donna Johnston, ARC NI. You are all very welcome. We have received your written submission, thank you for that. I will hand over to you for some brief introductory remarks, and then we will take questions from the members.

Ms Denise Hayward (Volunteer Now): I am Denise Hayward, the chief executive of Volunteer Now. I will introduce my colleague Ruth Mulholland, who is our safeguarding manager. For those of you who do not know us, Volunteer Now is a regional organisation that supports volunteering across Northern Ireland. We have engaged with a number of the members on other issues. I will hand over to Ruth, who will kick off our remarks, and I will wrap it up.

Ms Ruth Mulholland (Volunteer Now): Thank you very much for the time this afternoon. We are delighted to be involved in the conversation. We have reviewed the Bill and addressed the main issues that require further discussion, and we will now work through those.

All organisations that deliver services or activities for adults have a safeguarding duty whilst those adults are in their care, and it is crucial that they have robust adult safeguarding policies and procedures in place. That applies to all organisations across the statutory, independent and voluntary and community sectors. Since 2009, Volunteer Now has provided safeguarding and volunteer management support and training to all sectors, to help organisations operate to the highest standards. We also deliver services to older, isolated people through our volunteer-led befriending, shopping and driving projects. We therefore understand the importance of a robust legislative framework for adult safeguarding in Northern Ireland, and we very much welcome the introduction of the Bill.

Anyone who harms an adult in their care, regardless of their role, whether it is paid or voluntary, should face appropriate sanctions for doing so. However, we have some reservations about including volunteers in the Bill, which we feel requires further consideration, and we will work through those points now.

In general, most voluntary and community organisations that run services or activities for adults have an awareness of adult safeguarding and the standards required. They have safeguarding policies and procedures in place and avail themselves of adult safeguarding training. While we must never be complacent about adult safeguarding, and regular reviews need to take place to improve practice, good practice is in place in the sector, and that can continue to develop.

If a volunteer harms an adult with whom they are working, there are already procedures and mechanisms in place to deal with that appropriately. Most organisations are aware of the need to report adult safeguarding concerns to the adult safeguarding champion within their organisation and, where relevant, to external authorities. Where the threshold has been met, criminal proceedings and prosecutions can take place and/or referral to the Disclosure and Barring Service, where referral criteria have been met. It is unusual for volunteers to be included in a legislative framework, as they are not employees. There is no formal contract drawn up between the organisation and the volunteer. The relationship between the organisation and the individual is very different from that with a paid member of staff; it is a gifting relationship, which makes it more difficult to legislate.

A volunteer role cannot be equated to that of a paid care worker. Volunteers in health and social care environments do not have the same level of responsibility as paid care workers. Those types of volunteer roles are generally light touch, or in place to complement the delivery of services and bring added value, and that should remain. It is very different from the role of a paid care worker.

Ms Hayward: There have been a lot of changes in volunteer numbers since COVID. Initially, after COVID, we saw a drop in volunteering from roughly 28% of the adult population in Northern Ireland to 17% and then back up to 21%. It has come back up to 28%, but it is clear from the data that the attitude towards and engagement with volunteering have changed. People are not giving as much time. They are more likely to do lighter-touch roles, than some of these harder roles to recruit for. They are particularly interested in less liability, less bureaucracy, and therefore the kind of role that we are talking about here is more challenging for organisations to recruit for anyway.

We already know, as well, that there are not huge numbers of volunteers working in this space. It is not the biggest sector, by any means, by number of volunteers. Sport and the faith-based sector tend to attract most volunteers. Roughly 16% of adults who are volunteering do so in that space. We did a survey, which we launched in Stormont just before Christmas, with befriending organisations, and we know from that that people are leaning more towards the short-term roles, and organisations are finding it more difficult to engage volunteers in making a regular weekly commitment, which these kinds of roles tend to require.

On top of that, the recruitment process, we hear, can be more bureaucratic, and there are concerns around AccessNI, and accessing those checks, particularly using the new ID system, has been challenging for some organisations. Older people tend to be more likely to be volunteer befrienders, and they struggle with some of the procedures and bureaucracy, perhaps, a bit more than other people.

I suppose that what I am saying is that there is a context to this. If you put volunteering in this space and make it feel a bit more bureaucratic, there is a risk that that could further damage the numbers of people coming forward to volunteer. However, we are clear about and understand the need to protect people, so we are not saying that volunteers cannot be included. We say that you need to look really clearly at what the definition is, if that is what you choose to do. Therefore, we need to think about the regularity of contact and the kind of roles that you are considering and not just make a blanket assumption that all volunteers in this space should be included.

Vetting, whether in a residential home or a hospital setting, as opposed to community settings, needs to be considered as part of putting this legislation together. Again, think of whether the volunteer is providing a service on behalf of a contractor that is delivering for statutory partner as well. Sometimes that is the case. Organisations and groups will need training and support to see whether volunteer roles are going to be affected by this legislation as well.

In summary, you need to think about balancing the need to encourage people to volunteer, get involved and support older people and adults at risk in their community against the bureaucracy that potentially could ensue as a result of this kind of change. However, we are happy to support you as you think about this, by answering questions and also to support it as it is rolled out. Thank you for your time today.

Mr David McClure (Hourglass): Good afternoon, members. I thank the Committee for inviting Hourglass to give oral evidence on the Health Protection Bill.
I will start by giving some context as to what Hourglass is, and what we do. Hourglass's mission is simple: to end the harm, abuse and exploitation of older people. Every year more than 2·7 million older people across the UK experience physical, sexual, emotional, psychological, economic abuse and neglect. That number has increased, year in and year out, and it is truly a damning indictment of how society views and fails to value many older people. Hourglass is the only UK-wide charity dealing with these issues. In doing so, we operate a 24/7 helpline for older victims and survivors, their families and care practitioners.

When looking into the Bill, Hourglass would like to highlight a number of areas on which we are pleased to see progress, such as the duty to make inquiries, powers of investigation and entry, independent advocacy, duty to cooperate, access to financial records and new offences.

However, there are other areas in which Hourglass feels that the Bill has fallen short. Hourglass feels that it is positive in saying that the outline principles in the Bill are respect, dignity, safety, accountability and the best interests of adults at risk. We are, however, disappointed that a narrower scope has been drawn, compared to what was outlined in our consultation response, especially concerning a lack of focus on prevention, no explicit mention of regard for older persons and no indication of the UN principles for older persons — that is, independence, participation, care, self-fulfilment and dignity — as opposed to similar existing references in Scottish and Welsh safeguarding measures. For that, we have already shared with the Committee an amendment pertaining to the principles set out in Hourglass's response to the Adult Protection Bill consultation.

With regard to adults and risk, in the definition of harm, Hourglass is disappointed that the needs for care and support, whether the authority is meeting any of those needs and life circumstances are not included in the definition of an adult at risk. We noted in our consultation response to the proposed Bill in 2021 that we think that the inclusion of life circumstances provides a greater understanding of capacity to understand the intersections of different characteristics in circumstances and how those impact on individuals, especially older adults.

The definition in the Care Act 2014 looks at where an adult has needs for care and support, whether or not the authority is meeting any of those needs. The highlighting of those needs situates adults at risk in the relationships that make up their networks. Sadly, Hourglass knows that it is within relationships, particularly relationships of trust, dependence and interdependence, where personal characteristics and individual circumstances are exposed to abuse, neglect or exploitation. Personal characteristics in individual circumstances compound power, and it is the interplay of power in interpersonal relationships that can turn into a source of harm. Hourglass is concerned that the omission of the needs for care and support risks narrowing the number of adults who qualify for protection.

With regard to harm, Hourglass is concerned that the definition of harm in the Bill leaves gaps in safeguarding through the use of a narrower classification than its Scottish, English and Welsh legislative counterparts by not specifically covering elements of coercion, exploitation or self-harm. The Adult Support and Protection (Scotland) Act 2007 specifically mentions conduct exploiting another person. The Bill also does not include self-harm under the definition of harm, in opposition to the definition of harm in the Adult Support and Protection (Scotland) Act 2007 of self-harm, neglect and conduct which exploits or causes "fear, alarm or distress". The Bill's explanatory and financial memorandum specifically notes that self-harm is excluded but does not explain why. Self-harm, exploitation and coercive control can be key elements in the abuse dynamics concerning older people, and their exclusion narrows support, accessibility and coverage from the Bill. For that, we have also recommended another amendment.

Hourglass is pleased with the measures laid out in the Bill to develop an Adult Protection Board with provisions including the production of an annual report to outline the yearly future strategies in the strategic plan; to define how member and partner agencies will cooperate; detail findings of serious case reviews; and illustrate the effectiveness of their adult protection work on a timely basis. Those measures would help to provide accountability and transparency on objectives, strategy and change. However, Hourglass is concerned with the placement of such an Adult Protection Board under the Department of Health's direction and oversight, which may limit its independence and autonomy.

Furthermore, we support the measures outlined in the Bill to mandate that the Adult Protection Board undertake prescribed serious case reviews. That would allow for the analysis of the quality of direct practice with the individual, providing a lens on the challenges within risk assessment, engagement, best interest, decision-making and personalised care. They also enable investigation into inter-professional and inter-agency practice, organisational factors that relate to the work of practitioner professionals and the governance of adult protection boards. However, Hourglass is very disappointed that there is no provision in the Bill for a unified and detailed electronic anonymised database of all adult protection serious case reviews for Northern Ireland. Learnings and recommendations from subject access requests risk becoming siloed, with a lack of efficient sharing and learning across trusts and wider society. Certain antisocial behaviours and the Social Care Institute of Excellence have created a repository of subject access requests in England.

In Wales, the safeguarding repository stores all new single, unified reviews and allows the use of AI and machine learning to enhance its subject and analytics functions. Replicated in Northern Ireland, that would, ideally, enhance the potential for learning from individual reviews by providing a way to share learning across the system, and provide transparency and accessibility to a more widespread audience. As such, we proposed another necessary amendment to the Bill to alleviate that issue.

Overall, Hourglass is pleased with the introduction of the Bill, which is certainly a step in the right direction. However, there are gaps that need to be addressed. In short, the Bill lacks a strong focus on prevention of abuse of older people; uses narrow definitions that exclude key forms of harm; and misses opportunities for independent oversight and to share learning for serious case reviews. We thank the Committee very much for its time.

Ms Donna Johnston (ARC NI): Thank you, Chair and Committee, for having me here. I am operations director for Positive Futures, but, today, I am representing ARC NI. ARC — the Association for Real Change — has consulted with its broad membership and experts by experience to provide the written submission that you have received. I will not repeat the full submission but instead draw attention to the main issues that, ARC believes, are most important to today's discussion.

ARC has been a critical friend to Health and Social Care in the safeguarding arena for decades and has supported the voluntary sector, as a key partner, to play its part in keeping people safe. Whilst protection is a statutory responsibility, everyone is accountable and has a key part to play, hence the importance of the independent scrutiny and increased statutory accountability of the Adult Protection Board. We request that the Committee gives due consideration to having the Adult Protection Board independently chaired and attended by multiple stakeholders, including from the voluntary sector. It is vital that the expertise and experience of the voluntary sector is represented at that forum. The biggest challenge experienced by the sector is in having a shared understanding of thresholds and approaches to risk-taking. There is a need for better collaboration and clarification of the thresholds in the Bill. We suggest that the Committee takes this opportunity to ensure that the thresholds are fully clarified and understood by all stakeholders.

ARC NI stands up for the human rights of people with a learning disability. A learning disability is a lifelong condition, and people with a learning disability are cared for for longer than the typical population. Hence, decisions made by Health and Social Care need to be considered through a human-rights lens to ensure that the population outside of older people is not disproportionately affected.

ARC has concerns that the use of CCTV may be regarded as an effective safeguard against abuse when, in reality, it cannot prevent harm and may create a false sense of security. At best, CCTV documents evidence of an incident; it does not negate it. It encourages a perpetrator to identify places that are not covered by filming. CCTV does not foster trust between provider, staff and the people supported but, rather, breeds a culture of mistrust and threat. The voluntary workforce in Health and Social Care already feels undervalued, and that erosion of trust would have far-reaching consequences. Most importantly, CCTV erodes privacy, and that impact needs careful consideration. That is in addition to the huge resource required for observation of recordings should an allegation be made, and the financial impact of purchasing, installing and maintaining CCTV. CCTV cannot be forced on to an individual who has tenancy rights just because they have needs that require support in order for them to live an independent life in the community.

Thank you for taking the time to listen.

The Chairperson (Mr McGuigan): Thank you. Diane is not here, but, given what she said in the previous session, I think that she would have been pleased to hear that evidence. That is the clearest view on CCTV that we have heard.

I want to go back to the points that some of you made on the impact of bureaucracy on volunteers and, maybe, the lack of clarity in the Bill and how the legislation could be understood. How should the Department change the Bill or bring in guidance that alleviates some of the concerns about the affect on the voluntary sector? How can it make clear legislation that is easily understood by the voluntary sector, whereby people know what they have to do and abide by?

Ms Hayward: It is quite unusual for volunteers to be mentioned at all in a Bill such as this. If we have seen that before, it has been in a very clearly defined setting. Do you need to specifically mention volunteers? There is already quite a lot of guidance about adult safeguarding that impacts volunteers. Volunteers do not have a contract of employment. We have worked really hard with unions over the years to make sure that volunteers are seen as additional and complementary to paid staff, not as replacing paid staff. It is about thinking through whether volunteers need to be specifically mentioned in the Bill. If they are, it is about being clear about the regularity of contact and the roles that you are talking about, and not just putting in a blanket statement about volunteers. Volunteers do not have a register — there is no Nursing and Midwifery Council for volunteers. Part of the worry is about the bureaucracy that will follow and the potential to create other tiers of bureaucracy. Honestly, if we keep doing that, nobody will volunteer for these roles. That would be a big miss, because volunteers make a real difference in the lives of vulnerable people and can do so safely. This legislation may not necessarily help us to do that.

The Chairperson (Mr McGuigan): Thank you. That is helpful. David, you talked about the need for stronger emphasis on prevention. You specifically mentioned the UN Principles for Older Persons and the creation of a central repository for serious case reviews. How will that impact? What would be the impact if it were not included?

Mr McClure: Referencing older people and the UN Principles for Older Persons helps anchor safeguarding in dignity, independence and participation, not just protection. The principles already guide approaches in Scotland and Wales. Including the term would ensure that the Bill reflects the realities of ageing, independency and ageism, and that it is not just generic adult safeguarding.

The Chairperson (Mr McGuigan): OK. Fair enough. Thank you.

Miss McAllister: Thank you very much for coming to the Committee today. A good number of the points that you have highlighted are new, which is helpful for us. It is good to have an adult safeguarding officer here, because we have not had too many at the evidence sessions, so, Ruth, I will start my questions with you and your current practices. If we, as a Committee, support the removal from the Bill of volunteers in the voluntary sector, rather than those in statutory, trust-led services —. Do you feel that your safeguarding practices are sufficient? Can you give the Committee confidence that, if it proposed that removal, that will not have the unintended consequence of people being left at risk? How are lessons learned and things altered across the community and voluntary sector?

Ms Mulholland: Adult safeguarding started to have a proper focus in probably 2005 or 2006. In 2009, the Department commissioned us to develop minimum standards of practice for organisations that work with adults. There has been a lot of updates and work on those standards. Our role is to support the sector and other sectors to implement the standards. We also carry out policy reviews and training. We know, from interacting with all those organisations, that there is already a lot of good practice in place. As I said, we can never be complacent. We are certainly not saying that every organisation is where it should be; no organisation could ever say that. There is a need for constant review and improvement. It is very much about the organisation taking ownership of that from trustee board level right down to our support. If volunteers are included in the legislation, organisations need to understand the context and scope. Obviously, that will have an impact on us because of the need to educate those organisations. Our training already addresses the legislative context, but we would have to build on that and explain what the legislation means for those organisations in practice.

Miss McAllister: The capacity issue might mean that funding would need to be transferred from the Department.

Ms Mulholland: Yes. We sit on the training and development subgroup within the adult protection structures. Part of our role is to inform the group about the Bill and what organisations need to be told. We will be keen to explore that area more when the legislation is in place. Yes, there is a capacity issue.

Miss McAllister: I want to ask about referrals that you have to make. You are one organisation, but you have quite a wide spread. Do referrals happen often in the volunteer space because people are concerned? Are volunteers aware? Obviously, they are live to social issues and social justice — they have made the decision to volunteer, so they care. Do referrals happen often?

Ms Mulholland: There is certainly an awareness. We do not have exact information on how often referrals happen, but, thankfully, Denise and I have not had to do a lot of referrals over the years. However, referrals do happen, and the expertise is very much pulled from statutory authorities in those cases. Our information to organisations is that, where there is any doubt at all about the threshold for protection having been met, they need to liaise with statutory authorities on that. They have that duty. We have the adult safeguarding champion and appointed persons training, which explores issues of consent and capacity for organisations that are more equipped to make those decisions. However, some of the organisations that we work with are run entirely by volunteers and do not have that capacity. That is when they pull in expertise from the statutory authorities — the gateway teams — on what they should do and how they should take that forward.

Ms Hayward: Adult safeguarding is still new. Child safeguarding is much better established. For some organisations, there is still a learning curve, and they are still trying to think about where adult safeguarding is relevant for them. Sport is an example of that: adult safeguarding has started to be explored and considered in sport only recently, whereas child safeguarding is very well established in those kinds of settings. Organisations are still learning about it. Ruth is right. There is no point in us sitting here and saying that a volunteer will never hurt somebody — that is not true — but we are saying that the legislation needs to be clearly defined.

Miss McAllister: Thank you. I ask this question to David from Hourglass: do you think that the amendments are helpful for us to consider? Other organisations have also raised the issue of self-harm, so we have heard about it a number of times. I want to ask about the serious case reviews, because we have not discussed those overly at Committee. You are a UK-wide organisation, and you will probably have more experience of how those reviews are implemented. Have you found that the implementation of those reviews or their equivalent across the jurisdictions works well or could be improved? Have any failed or not worked well because the legislation is not strong enough?

Mr McClure: In our experience, the tools that have been implemented in England and Wales have led to that learning, which is what we need. Typically, 87% of abuse happens in private homes, so you are already at a hindrance there. It is about the hidden harm: that is where the repositories are beneficial. They offer a proper anonymisation safeguard and also improve transparency, consistency and prevention.

Miss McAllister: You mentioned the central repository. We have had a similar issue in Northern Ireland with the Policing Board, on which I sit. The Police Ombudsman reviews often very serious cases. The Policing Board is the accountability body and implements a lot of changes and learning, yet it does not have the necessary access or data-sharing with the Policing Board. I understand how, with that, you could learn to move forward. Who would have access to a central repository? Is the intention for the likes of trusts to implement changes in the system?

Mr McClure: I suppose that it will be down to the Adult Protection Board. If it will be carrying out the serious case reviews, it would, in essence, be down to that board. However, similar to the ombudsman, there should be separate entities. They should have full autonomy to go out and explore and not be the — what is the word? There is a risk or a perception that the challenge could become constrained, so it is about their having the independence to go out and review the cases.

Miss McAllister: That brings me to my last question. Did you say that the chair of the Adult Protection Board should be independent? I am genuinely not sure what view the Committee will take on that issue, but it is worth exploring. Do you mean having an independent chair of a board that is under the direction of the Department?

Ms Johnston: Yes. We are happy that it remains under the Department. However, we feel strongly that an independent chair is necessary. We are concerned that there is a conflict of interest, because the Department is not only the commissioner but the provider. Our strong preference would be for an independent chair.

Miss McAllister: OK. How does that work in England, Wales and Scotland?

Mr McClure: I would have to check that and come back to the Committee.

Miss McAllister: Sorry, I put you on the spot. I was just checking. Thank you very much. It is all very helpful for us.

Mrs Dillon: Thank you very much for giving us your perspectives on the Bill. David, has the Department said why it has not included the specific principles that you mentioned?

Mr McClure: As far as I am aware, no, it has not.

Mrs Dillon: Given that it is in the legislation in Scotland and Wales, maybe we need to ask that question of officials when we get the opportunity. Do we know the Department's rationale for including volunteers in the Bill? To clarify: am I correct that there is no specific mention of volunteers in the legislation in other jurisdictions?

Ms Hayward: I am not sure about that. That may be something for you to check.

Mrs Dillon: We need to understand that, because it is important. I do not want to assume anything, so we will wait to find that out. We need to know whether volunteers are mentioned, what the rationale was for that, and how it is impacting on the volunteer cohort. I absolutely share your concerns around volunteers. Every witness who has come before us and, I think, every member has talked about balance. This is a very difficult balance to strike because of the individuals who we are talking about. We are talking about people who may not have the capacity for numerous reasons, as has been outlined by all of you. David talked about self-harm and the fact that that is not specifically mentioned. That is probably another reason why we need to keep the definition wide and not specify it. It is about how we ensure that those people are identified within that definition. There have been issues raised today that will help us with our questions and conversations with officials from the Department. Thank you very much; I really appreciate it.

Mr Donnelly: Donna, I wanted to ask about your response about CCTV. It was very strong, and I think Diane, in particular, will be happy with that. [Laughter.]

Mrs Dodds: I am so sorry. It has just been one thing after another this afternoon.

Mr Donnelly: You were certainly clear in your opposition to CCTV. Are there any circumstances in which you would agree with CCTV being used? If there were clear criteria, regulations, strong controls around data-sharing, and agreement with residents before its installation, would you see the use of CCTV as appropriate?

Ms Johnston: Probably as a very last resort. I think that, if you are even considering it as a last resort, you have already failed in your duty of care. There are so many other safeguards that could come prior to CCTV. Muckamore has placed a false sense of importance on CCTV. CCTV served a purpose in Muckamore, but it served a purpose in a set of very difficult circumstances that none of us wants to be in again. It is key to remember that those recordings were covert, so staff were not aware that they were being recorded. As an extreme last resort, potentially, yes, but I would be very concerned if that were even on the table, because there are so many other preventative and protective measures that could be used prior to it. CCTV negatively impacts on the person who is at risk and the staff who are supporting them. A lot of families advocate the use of CCTV, but I am concerned that it is because they are not getting the support that they need with whatever trauma they have experienced that they think that CCTV is the only thing that can keep their loved one safe.

Mr Donnelly: Do you recognise any strength in the argument about cameras having a deterrent effect on abusive behaviour? You mentioned that potential abusers might find somewhere where there is no CCTV coverage. However, do you recognise that people having the thought that CCTV exists is a deterrent factor?

Ms Johnston: There is a potential that people might, in some sense, behave themselves a little bit better. However, for CCTV to pick up every aspect of abuse, it would need to be of a very high quality and have high quality audio. Abuse is not necessarily in just physical actions or even what is said; it is much more complex than that. CCTV might be a slight deterrent, but that is a temporary effect. In the longer term, CCTV would make safeguarding referrals much harder. I am also concerned that staff would feel that cameras were doing their job for them and that they do not need to report something because there is a camera. Even the person who is at risk might think, "It's OK. That's on camera. I don't have to speak up". I think that it would take some of the responsibility to report, to be honest and to be vigilant off those people.

Mr Donnelly: What other measures — potentially measures that are less intrusive than CCTV — do you advocate the use of?

Ms Johnston: We advocate training as a preventative measure. Managers should be present and monitor. There should be spot checks. Having a manager sit and watch CCTV, rather than be present and active in the lives of people at risk, takes up their time. There should be proper liaison with statutory bodies, such as the Regulation and Quality Improvement Authority (RQIA). Safeguarding should be at the forefront of every discussion. There are so many proven ways in which to improve safeguarding practice. The duty of candour is another. There are so many things that we could do a lot better to improve the safety of people, long before you would want to consider CCTV.

Mr Donnelly: As an organisation, do you have a particular view on the duty of candour? Are you in support of it?

Ms Johnston: Yes, absolutely.

Mr Donnelly: Does that go for everybody?

Ms Mulholland: Yes.

Ms Hayward: A few years ago, I was part of the working group for the Department of Health following the hyponatraemia inquiry. We were very supportive of the duty of candour at that stage.

Mr Donnelly: Thank you.

The Chairperson (Mr McGuigan): Thank you very much. That was very useful and has given us a lot of food for thought. Every session adds something — I will not say that every session adds a complication, but it puts a different slant on it. It is an important piece of legislation, and it is important that we get it right. Thank you.