SCIE Practice guide 7: Making referrals to the POVA list

Understanding POVA definitions

The Care Standards Act 2000 and Department of Health Practical Guidance contain definitions for POVA, which are summarised below. The section numbers below refer to the Care Standards Act 2000. Further guidance can also be found in No secrets: Guidance on policies and procedures to protect vulnerable adults from abuse (PDF file).

Who are 'vulnerable adults'? (Section 80[6])

A 'vulnerable adult' is someone aged 18 years and over who is:

• receiving accommodation and nursing or personal care in a care home
• receiving personal care in their own home under arrangements made by a domiciliary care agency, or
• placed with an adult placement carer by a registered adult placement service.

What is 'harm'?

'Harm' is defined as 'ill treatment or the impairment of health or (for those with conditions relating to mental health) impairment of development' (section 121).

Those making referrals to the POVA list must demonstrate the impact of the harm caused to vulnerable adults. For example, this definition of 'harm' does not include theft, yet this betrayal of trust can cause deep distress to vulnerable service users. 'Harm' also includes placing vulnerable adults at risk of harm through non-action or neglect.

No secrets (paragraph 2.5) defines abuse as 'a violation of an individual's human and civil rights by any other person or persons'. This may consist of a single act or repeated acts. Paragraph 2.7 describes different forms of abuse under the following headings:

• physical abuse
• sexual abuse
• psychological abuse
• financial or material abuse
• neglect and acts of omission
• discriminatory abuse.

Who are 'care workers'? (Section 80[2])

The POVA scheme currently covers any worker in a care position who has regular contact with a vulnerable adult in the course of his or her duties in a registered care home, domiciliary care agency or adult placement scheme. This means:

• care workers employed by registered (and registering) providers of care homes, including care workers supplied by employment agencies and businesses, as well as volunteers, all of whom have regular contact with care home residents
• care workers employed by registered (and registering) providers who run domiciliary care agencies, including workers supplied by employment agencies and businesses. These workers are employed to provide personal care in their own homes for persons who by reason of illness, infirmity or disability are unable to provide it for themselves without assistance. Agencies providing both a personal-care service (assisting with washing, feeding and dressing) and a home-help service (assisting with cleaning, ironing and shopping) must decide, in cases of misconduct, whether the POVA scheme applies to their workers, especially if the individual is cleaning for some clients and providing intimate care for others
• adult placement carers and anyone in the registered placement scheme who sees clients.

The definition of 'care worker' is very wide and includes managers, visiting practitioners such as chiropodists and hairdressers, voluntary workers and ancillary workers such as cooks or cleaners where they have regular contact with vulnerable adults. Further guidance and examples are included in Who can be referred to the POVA list.

Who is not covered?

At present, the POVA scheme does not apply to those who work with vulnerable adults in NHS or independent hospitals, clinics and other facilities, or through an independent medical agency. Other workers currently excluded are those working in supported accommodation, daycare and housing associations, and those providing services under direct payments. Vulnerable adults obtaining help from these services will continue to be protected by rigorous employment practices.

What does 'employment' mean? (Section 80[4])

'Employment' is defined as:

any employment, whether paid or unpaid and whether under a contract of service or apprenticeship, under a contract for services, or otherwise than under a contract.

The definition of employment is intentionally wide and includes both paid and unpaid work, including volunteer workers and self-employed adult placement carers. It also includes supply workers, where individuals are supplied by an employment agency or business.

Who are 'employers'?

An 'employer' is anyone who employs staff in the specified care services or who directs and supports self-employed care workers or adult placement carers. This may be a manager or owner of a single home, agency or scheme, or a manager of a home or service that is a part of larger organisation. In the latter case, the responsibility for making referrals to the POVA list lies with both the manager and the larger organisation.