Do ‘thresholds’ condone harm and abuse in health and social care?

Reading and writing about the duty of candour has caused me to stop and reflect on the use of ‘thresholds’ in protecting those who use health and social care services from harm and abuse. I am beginning to wonder if I have lost sight of the real issue here.

The issue is some people are harmed by those providing their care in health and social care settings.   The latest overview of adult social care in England from the National Audit Office clearly highlights the problem  stating

Safeguarding vulnerable adults from abuse and neglect remains a major risk throughout the sector…….In 2012-2013, 36% of safeguarding referrals were about alleged abuses by social care or health workers.’

 We have thresholds in safeguarding adults and children.  The threshold is meant to determine the level of professional response, however, I’ve witnessed thresholds being used to justify a less than meaningful response.  What message are we sending to  professionals when we base safeguarding interventions on thresholds, the system will tolerate a little bit of abuse/harm?   Thresholds should be effective as a preventative mechanism, but not if they are set too high or used as an administrative convenience to ensure  referrals of allegations of harm and abuse are kept at a manageable level for the organisation. Surely  this is counter productive to changing the ‘culture’ of any failing provider of care.  In my view to really change cultures within organisations we need to take a zero tolerance approach to harm/abuse, whether its mild, moderate or severe, it has no place in health and social care.

I came across a quote in my studies which I find very pertinent in regards to how policy/legislation translates into frontline practice

‘To assume that an official plan and its implementation in practice are the same is to fly in the face of facts. Invariably to some degree, the plan as put into practice is modified, twisted and reshaped, and take on unforeseen accretions’ (Herbert Blumer)

My fear is the ‘duty of candour’ could become another threshold where’ low level’ harm/abuse /neglect is all but ignored, or even tolerated, by organisations.  As I have pondered the use of thresholds I have decided to forget them because I believe for  cultural change in health and social to become a reality  society has to feel shocked, appalled and outraged at any level of harm/abuse/neglect, then we will see real cultural change. 

Organsations such as health and social care are populated by the individuals that make up wider society, if we can get our priorities right outside of these organisations there is a greater chance of getting them right inside those organisations.

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