Organisational Abuse

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. Does your organisation have a Safeguarding Adults Policy and Procedure in place and do all staff know how to report Safeguarding Concerns?
  • 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.
  • Organisations should have robust checks in place for new members of staff and agency staff, such as checking they have a clear DBS certificate, have a right to work in the UK and have seen evidence of appropriate and up to date qualifications and training

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.
  • Good, caring, positive and well-trained staff are essential if you are to create a safe environment.
  • Staff should feel valued, confident to complain, raise concerns, be honest if they have made a mistake, seek advice, and feel supported by their peers and managers

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.

Working with Adults and their Families

A good organisation is open, honest and transparent and involves adults (and families/carers where appropriate) in care plans or protection plans to ensure that the adult’s views and wishes are taken into account. Practitioners should try to have a good understanding of family circumstances and dynamics, to fully consider risks and protective factors.

Adults who may struggle to engage with services without support and who do not have an appropriate representative such as a family member acting in their best interests, should be offered an independent advocate.

Adults and families are well placed to spot the signs of organisational abuse as they can often see the whole picture in relation to the care provided by professionals, particularly if there are multiple perpetrators. If an adult or family member raises concerns, listen to them and make sure that concerns are addressed promptly and that you record what you have done to resolve the issues.

Organisations should have appropriate visiting policies in place, particularly for patients/service users who are vulnerable, distressed, have communication difficulties or may be unable to contact family themselves.

Organisational Abuse Resources

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.