What is Organisational Abuse/Neglect?
Organisational abuse (sometimes referred to as institutional abuse) is neglect and poor care practice within an institution or specific care setting such as a hospital or care home or relating to care in a person’s own home. This can range from a one off incident to on-going ill-treatment; neglect might also occur as a result of the structure, policies, processes and practice in an organisation.
Spotting the Signs of Organisational Abuse/Neglect
- Run-down or poor facilities, including the standard of heating and ventilation
- Over crowded facilities
- Abusive and disrespectful attitudes towards people using services
- Lack of respect for dignity and privacy
- Not providing adequate food or drink or assistance with eating
- No flexibility or lack of choice in relation to daily routines and diet
- Not promoting independence
- Misuse of medication
- Tasks not being completed on time or correctly due to staffing pressures
- Poor moving and handling practices
- Failure to maintain moving and handling equipment
- Inappropriate use of restraints
- Lack of care plans
- Poor record-keeping and lack of procedures
- High staff turnover resulting in poor quality care
- Failure to provide care with dentures, glasses and hearing aids
- Failure to respond to abuse appropriately
- Discouraging/refusing visits or involvement of relatives, friends or carers
- Lack of personal items, clothing or possessions
- Few social, recreational and educational activities
- Not taking account of individuals’ cultural, religious or ethnic needs
What a Good Organisation Should Look Like
Leadership and Management
- The manager of the service provides effective leadership, supporting, training, coaching and directing staff to do their jobs properly
- The manager is visible, approachable and available
- There are sufficient staff to meet the needs of service users
- There are low levels of staff turnover
- There is not a high reliance on agency staff
- The service does not accept referrals for people who needs cannot be met
- The manager informs commissioners when they are unable to meet a person’s individual needs
- Policies and procedures are readily available and are followed correctly
- Problems are proactively recognised and responded to effectively
- High or low trends for Safeguarding Concerns, Complaints and Incidents are evaluated transparently and considered carefully
- External incident reporting to the Police, Care Quality Commission and the Local Authority is robust, effective and open
- Services are audited effectively and appropriately by the provider.
Staff Behaviour and Attitudes
- Staff have up to date and good knowledge of the individual needs of the people they are supporting
- Members of staff use appropriate and non-judgmental language about the people they support
- Members of staff provide personalised care, providing the adult with choice and control
- There is effective verbal and written communication between staff members
- Any negative behaviour is challenged and there is a culture of zero tolerance towards abuse
- Staff always treat people with dignity and respect
- Best Interests decisions are made appropriately in line with guidance and documented effectively
- Staff adhere to and proactively support the principles of the Mental Capacity Act.
Environment and Basics of Care
- Support is provided to ensure the person’s personal hygiene and appearance is maintained
- There are sufficient bathroom facilities provided to meet the personal care needs of the people who use the service
- Personal possessions are treated with respect, and care is taken to ensure these are not lost or misplaced
- The environment is always very clean and there are no unpleasant smells
- The environment is well maintained and there are no health & safety hazards
- There is a varied programme of activities and resources to help keep people active and occupied
- Activities are provided in multiple locations offering options and choices
- Staff are proactive in understanding and minimising the potential for conflict between service users
- People are always dressed in clothing that is appropriate to their needs and or the weather
- Staff promote independence and support the skills of the adult
- Medication is always administrated with care using appropriate and up to date guidance.
Service Design and Delivery
- People’s needs are being met in line with identified care plans
- There are high quality care plans providing an accurate record of the individual’s needs
- Care plans and risk assessments are updated and reviewed regularly to reflect any changes to personal circumstances
- Staff carry out actions that are recommended by other practitioners from outside the service
- The group of people using the service are compatible and have similar needs, helping to minimise the potential for conflict and pressure on staff/resources
- Safeguarding policies and procedures are applied consistently and correctly.
Openness
- There is regular and appropriate input from other professionals outside of the service
- Individuals have frequent contact with family, friends and other staff not directly employed by the service
- External appointments are met
- Members of staff have a wide network of colleagues outside of the service
- Appropriate referrals are made to Speech and Language Therapy, GP, Dieticians, Community Psychiatric and other Nurses
- Management and staff create a relaxed environment that encourages and values professional challenge from outside the service, as well as transparency in relation to complaints from family members
- The service facilitates appropriate, private consultations with professionals from outside the service
- Family contact is proactively encouraged and supported.
Organisational Abuse Resources
Organisational Abuse Fact Sheet – General Public
Organisational Abuse Fact Sheet – Professionals
Organisational Abuse Learning Briefing
Reporting Organisational Abuse Good Example Concern Form
Reporting Organisational Abuse Poor Example Concern Form
Creating Safer Cultures PowerPoint Presentation for Professionals
Webinar: Learning from the Whorlton Hall Safeguarding Adults Review: https://www.scie.org.uk/safeguarding/adults/reviews/whorlton-hall-webinar
Support
If you are concerned about a service you can talk to your Local Authority – Report Abuse. You call also contact the Care Quality Commission (CQC) if your concern is in relation to a registered care provider.