Health Committee

19 April 2004                                                  No. 14, Session 2002-03


Elder Abuse - Report Published

Abuse of older people is a hidden, and often ignored, problem in society. The profile of child abuse has been dramatically raised in the past few years and the Government has acted to introduce controls and measures to identify and tackle that problem; but abuse of older people remains in the background. It has been put to us that 500,000 older people in England are being abused at any one time, yet many people are unaware of the problem and few measures have been taken to address it. Abuse occurs in institutional settings, but more often in the home. It can be perpetrated by carers, relatives and strangers, and can take many forms - sexual abuse, financial abuse, abuse of medication in controlling and sedating patients, physical abuse, neglect and behaviour designed to degrade and humiliate.

Our inquiry found that much abuse of older people is not reported because many older people are unable, frightened or embarrassed to report its presence. Often carers take no action because they lack training in identifying abuse or are ignorant of the reporting procedures. The lack of reporting results in difficulties in determining the true scale of the problem and this is compounded by a lack of research. Further, varying definitions of 'elder abuse' exist within the health and social care sectors. To enable the extent of the problem to be accurately determined and for uniformity we recommend that an agreed, consistent and comprehensive definition should be applied by all government departments, statutory agencies, independent bodies, charities and organisations.

Inspection of NHS establishments caring for older people is an important instrument in the identification of abuse. Therefore, we recommend that the Department reviews the frequency and effectiveness of the inspection of NHS establishments providing care for older people and, in recognising the importance of lay personnel having an input into the inspection process, we urge that further measures are taken to increase user engagement.

We found that the over-prescription of medication is sometimes used in the care environment as a tool for managing residents, and for the carer it can be a means to ease the burden of care of the elderly, especially of those with dementia. The frequency of review of medication and the administration of drugs by unqualified staff is of particular concern to us. We therefore recommend measures are taken to ensure compliance with the National Service Framework target that all people over 75 years of age should normally have their medicines reviewed at least annually, and those taking four or more medicines should have a review every six months. We further recommend that the National Care Standards Commission and its successor body should ensure that medication systems within care homes and domiciliary care reflect good practice and that they disseminate procedures that exceed the national minimum standard.

Concerns were raised about the incidence of financial abuse of older people. We advocate that the prevention, detection and remedying of financial abuse should be included as specific areas of policy development by adult protection committees and we endorse the recommendations in the Draft Mental Incapacity Bill relating to the abuse of powers of attorney.

Evidence given to us showed that the lack of training in issues relating to elder abuse (for example, identification, prevention and reporting) is encountered in all the settings in which abuse occurs. We call for mandatory training in the recognition, reporting and treatment of elder abuse for those professionals working and caring for older people.

While welcoming the introduction of the Single Assessment Process, and the opportunities that it presents for regularly reviewing the care of older people, we believe it is vital that these targets are met in all authorities, and we recommend that the Department should monitor the compliance of authorities, and should report on the outcomes of the process. Currently there are no standards for adult protection contained within the National Service Framework. In order to ensure consistent good practice, we recommend that this omission is rectified.

The registration of workers in the care environment was of particular concern to us. We propose that the Government should attend to the issue of registering domiciliary care workers as a matter of the utmost urgency. We urge the Government to expedite the implementation of the Protection of Vulnerable Adults list fully across both health and social care settings.

Of particular concern to us was the certification of death. We call for implementation of stricter controls to ensure that certification of the death of a resident in a care home owned or managed by a GP, or a close relative, should be performed by a GP other than the owner/manager. We further recommend that the practice of the payment of retainer fees to GPs should be abolished.

Notes to Editors

The Health Committee will publish its Second Report of Session 2003-04 on Elder Abuse on Tuesday 20 April at 00.01 am. A press conference will be held at 10.30 am in Committee Room 16 on Tuesday 20 April.

Confidential advance copies of the report, which will be embargoed until 00:01 am on Tuesday 20 April, will be available for collection on Monday 19 April between 12 noon and 1 pm from the reception desk at 7 Millbank, London SW1. Please present this Press Notice; a signature will also be required.

Advance copies of the report will also be made available to the Press form the Press Gallery, House of Commons, at 12 noon on Monday 19 April. Witnesses' copies will be posted to them.

Following publication, copies of the Report will be on sale from the usual Stationery Office outlets (tel. 0845 702 3473) and the Parliamentary Bookshop (tel. 020 7219 3890). Following publication the Report may also be viewed at

The Health Committee is a Select Committee of the House of Commons. It is appointed under Standing Order No 152 to examine the expenditure, administration  and policy of the Department of Health and associated public bodies. The Committee has power to send for persons, papers and records.