Vulnerable People in Emergencies: Findings from Research David Mellor EPC Associate Lecturer and Independent Chair of Stockport Safeguarding Children Board and Stockport Safeguarding Adults Board
Vulnerability People not considered Can be dependent on vulnerable can become type, scale and duration A dynamic term vulnerable because of of the emergency the impact or duration of the emergency People may avoid becoming vulnerable Physical & or social because the support Definitions may vary isolation can be an they depend upon is between agencies important factor maintained during the emergency Challenging to maintain Impossible to cover lists of lists, or combine everyone – because Definitions may change lists, if the list has been people can become over time compiled using different vulnerable quite vulnerability criteria suddenly
CHILDREN: Emergency Preparedness • 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………
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 Response and Recovery • 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
Swine flu Pandemic 2009 • 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
But much brilliant work is being done locally “ What If” in Essex • • “Susie the Childminder” in Hampshire • Duke of Cornwall Community Safety Award for uniformed youth
A Response was required….. • 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.
ADULTS : UK Guidance “Identifying people who are vulnerable in a crisis” Cabinet Office 2008 Four step approach advocated: 1. Building 2. Creating lists of 4. Determining the networks of lists i.e. list of 3. Data sharing scale of organisations organisations with protocols and requirements to be which are aware of lists of vulnerable activation triggers planned for vulnerable people people
Challenges to UK Guidance Local Council’s Relatively recent but “Identifying People...” increasingly contract the landscape has out a lot of services to was published in 2008 changed a lot the elderly Personalised budgets Scandals such as allow potentially Winterbourne View & vulnerable adults to buy Mid Staffs Hospital are care from independent leading to big changes providers
Perfect Storm Ahead? ...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
Messages from Research 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
EPC Survey 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
Survey Findings – Sources of Information Local knowledge NHS including Local Clinical Authority Commissioning Social Care Private sector Groups particularly Utilities “Extra Care” schemes Community - Door Parish councils, knocking neighbours Gypsy etc. Traveller sites
Missing 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 Webinar Question: Are these sources of information used in your area?
Innovative Sources of Information Assisted waste Users of Community Blue badge holders collection Transport LRF directory of orgs & the Cancer Care team Electoral Register types of vulnerabilities they (end of life patients) hold data on
“Too Difficult”? “This is a weak “With the spot – particularly diversification of the if the emergency ways that care can happens Out Of be provided, it is Hours” increasingly difficult to cover all the options” “Extremely difficult to deliver” “We have often relied on door knocking, & it looks like we will The “Holy continue to Grail” of do so” emergency planning
Door Knocking has Limitations… The 2 Margarets were elderly women who lived next door Why were to each other in Carlisle they not evacuated? They both drowned in the 2005 Carlisle floods An inquest was held & verdicts of accidental death were reached The rest of their neighbours on the road on which they lived were evacuated
Survey – Enhancing Resilience 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
PEOPLE • 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.
Inter-generational approaches • 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
Disaster Risk Reduction • 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)
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