David Mellor EPC Associate Lecturer and Independent Chair of Stockport Safeguarding Children Board and Stockport Safeguarding Adults Board

Vulnerable People in Emergencies: Findings from Research

A dynamic term Can be dependent on

type, scale and duration of the emergency

People not considered vulnerable can become vulnerable because of

the impact or duration of the emergency

People may avoid becoming vulnerable because the support they depend upon is maintained during the

emergency

Physical & or social isolation can be an

important factor Definitions may vary between agencies

Definitions may change over time

Challenging to maintain lists of lists, or combine lists, if the list has been compiled using different

vulnerability criteria

Impossible to cover everyone – because people can become

vulnerable quite suddenly

Vulnerability

• Provides generic guidance on the pre-emergency phase

• Covers the requirements of the CCA 2004 • Consists of 19 chapters covering duties such as

risk assessment, emergency planning & communicating with the public

• Runs to 591 pages • Mentions children 4 times………

CHILDREN: Emergency Preparedness

• Children identified as vulnerable on the single ground of dependence

• Children’s Social Care to draw up plans to support survivors

• Ensure volunteers have been vetted to work with children

• Use of children as a conduit for messages to adult family members (ignored by 27 of 42 LRF websites)

• No reference to safeguarding or protecting children

Emergency Preparedness

• Aims to set out good practice in response to, and recovery from, emergencies based on lessons identified in the UK and internationally

• Stresses need for multi-agency framework at local level

• Contains 14 chapters including one on Humanitarian Assistance

• Runs to 349 pages • Devotes only 4 paragraphs to children………..

Emergency Response and Recovery

• Support for children who experience trauma • Provision of accurate and timely information to children • Need to debrief children to assist in rehabilitation • Repeats point about importance of vetting of workers • Again, no reference to safeguarding or protecting

children • Only reference to safeguarding in the entire suite of

national guidance documents is in an appendix to Evacuation and Shelter

Emergency Response and Recovery

• Schools closed with no notice to prevent spread. Safeguarding implications considered?

• Prescribed antiviral drugs to healthy children • Children treated in Adult High Dependency Units • Numbers of deaths of children not recorded in

Hine Review of Pandemic Response

Swine flu Pandemic 2009

• “What If” in Essex • “Susie the Childminder” in Hampshire • Duke of Cornwall Community Safety

Award for uniformed youth

But much brilliant work is being done locally

• The EPC ran a webinar in December 2012 which highlighted national and local gaps

• Save the Children UK was drawing upon international expertise to try and develop services for children and young people in the UK

• Save the Children and the EPC joined forces and organised the “Neither Seen Nor Heard” seminar in December 2013.

A Response was required…..

1. Building networks of

organisations which are aware of vulnerable people

2. Creating lists of lists i.e. list of

organisations with lists of vulnerable

people

3. Data sharing protocols and

activation triggers

4. Determining the scale of

requirements to be planned for

ADULTS: UK Guidance “Identifying people who are vulnerable in a crisis” Cabinet Office 2008

Four step approach advocated:

“Identifying People...” was published in 2008

Relatively recent but the landscape has

changed a lot

Local Council’s increasingly contract

out a lot of services to the elderly

Personalised budgets allow potentially

vulnerable adults to buy care from independent

providers

Scandals such as Winterbourne View &

Mid Staffs Hospital are leading to big changes

Challenges to UK Guidance

...and the growing elderly population together with shrinking budgets as a result of austerity, are creating unsustainable pressures on local councils

So more and more people with complex needs will be cared for in their own homes

Perfect Storm Ahead?

WHO – Disability and Emergency Risk Management for Health 2013 • 15% of the world’s population have a disability • People with a disability are more vulnerable in an emergency

– but are not equally vulnerable • Japan Earthquake and Tsunami (2011):

• fatality rate for general population = 1.03% • fatality rate for people with disabilities = 2.06%

• Healthy people can become disabled by the event of an emergency

Messages from Research

Disaster–Driven Evacuation and Medication Loss Public Library of Science (PLOS) 2014

• Many patients lose their medication during evacuation • Many do not bring their prescriptions with them • They may have worse outcomes and many risk dying

when their medication is not available

Messages from Research

Power Outages, Extreme Events and Health. PLOS 2012 • Electricity is the most vital of all infrastructure

services because without it most other services will not function

• Most hospitals have electricity generator back up for only 8 hours

• UK dialysis patients can register their need for power in an emergency, but a poll of dialysis patients revealed that only 38% had registered

• We could learn from countries where power outages are frequent – but there is an absence of research into good coping strategies in those countries

Messages from Research

Water Shortages and Extreme Events: A Call for Research. Journal of Water and Health 2013

• Loss of essential services worsened mental health two to three fold

• This was exacerbated amongst the elderly, people with disabilities, parents with small children and those without money or cars who could not access locations where supplies were available

Messages from Research

Distributed to emergency management practitioners across the UK

26 responses

Good geographic spread – England, Scotland and Wales. Urban areas including London and rural communities, large & small local authorities

Follow up email & telephone conversations with respondents

Further contacts generated & followed up

Subsequent webinar provides an opportunity for further sharing of experiences

EPC Survey

Local knowledge

Private sector particularly

Utilities “Extra Care” schemes

Local Authority

Social Care

Door knocking

NHS including Clinical

Commissioning Groups

Community - Parish councils,

neighbours etc. Gypsy

Traveller sites

Survey Findings – Sources of Information

Voluntary Sector appears under utilised – Age UK mentioned once

Social Housing Providers

Private and Independent sector care providers

National databases – Department of Work & Pensions

Carers support groups

Missing Sources of Information?

Webinar Question: Are these sources of information used in your area?

Assisted waste collection Blue badge holders Users of Community

Transport

Electoral Register Cancer Care team (end of life patients)

LRF directory of orgs & the types of vulnerabilities they

hold data on

Innovative Sources of Information

“Too Difficult”?

The “Holy Grail” of

emergency planning

“Extremely difficult to deliver”

“This is a weak spot – particularly if the emergency happens Out Of

Hours”

“With the diversification of the ways that care can be provided, it is

increasingly difficult to cover all the

options”

“We have often relied on

door knocking, & it looks like we will

continue to do so”

The 2 Margarets were elderly women who lived next door

to each other in Carlisle

They both drowned in the 2005 Carlisle floods

The rest of their neighbours on the road on which they

lived were evacuated

Door Knocking has Limitations…

Why were they not

evacuated?

An inquest was held & verdicts of

accidental death were reached

Encouraging priority registration on utility databases

Encouraging sign up to Flood Warning Direct

Self-help briefings and guidance

Incorporating advice on emergencies into contacts by social care providers

Business Continuity advice to residential care homes

General Community Resilience work

….but only one mention of Public Health

Survey – Enhancing Resilience

• Systems for safeguarding children and adults are very different

• Lots of overlaps e.g. “Terrible Trio” • Safe transition to adulthood is very challenging for many

young people • Unseen army of young carers – 175,000 care for a

family member, 13,000 for more than 50 hours per week.

PEOPLE

• In Japan 32% of the population will be over 65 by 2030. Strategic decision to “counterbalance” this by mobilising young people in EP and ERR. (UK figures 25% over 65 in 2030)

• Inter-generational approach evident in flood preparedness work on East Coast of England with residents sharing their experiences of the fatal tidal surge of 1953 with school children

Inter-generational approaches

• Systematic approach to identifying, assessing and reducing the risks of disaster. Aims to reduce the socio-economic vulnerabilities to disaster as well as dealing with the environmental and other hazards that trigger them.

• (Twigg (2007)

Disaster Risk Reduction

Health Protection Agency 2012 • The traditional focus of the Health sector has been on the response to

emergencies • The challenge is to broaden the focus of disaster risk management for health

from that of response and recovery to a more proactive approach which emphasises prevention, mitigation and the development of community and country capacities to provide timely and effective response and recovery

WHO – Disability and Emergency Risk Management for Health 2013

• Community Resilience measures should aim to help people with disabilities and their support networks take responsibility for their health before, during and after emergencies

DRR: Lessening Vulnerability

From…objects of charity, medical

treatment and social protection…

To…subjects with rights capable of claiming those

rights and making decisions for their lives based on free

and informed consent

DRR: Emphasis on Rights: (UN Convention)

Recommends that the needs and voices of disabled people are heard at all stages of an

emergency particularly planning and preparation

• “Ready for Emergencies” – Education Scotland • A range of educational resources on severe weather,

terrorism, utility failure etc. • Aims to inculcate leadership, responsible citizenship and

opportunity to benefit their communities • Local “Resilient Communities” teams interact with

secondary schools in the Scottish Borders • The teams are open to young people from 16 upwards

Community Development: Scotland

National organisations have consultation, research, policy & campaigning capacities which appear under-

exploited e.g. Save the Children, Age UK

Better engagement with the private, voluntary and independent sectors (priority user sign up etc.)

A stronger focus on sharing good practice rather than going it alone locally

Opportunities