The horrific murders of Sarah Everard, Bibba Henry and Nicole Smallman in London have heightened concerns among women, and especially younger women, about their safety outside the home. Other murders across the age groups have also been reported in the media-in part, because they make ‘news’ and increase the circulation of printed media and hits on online news sites. Although such tragic incidents are rare with men (25–34 year olds being at most risk) (Statista, 2022), it is not surprising that people of all ages express concerns, because humans are motivated to seek safety, as ‘safety needs’ come second only to physiological needs in the hierarchy of needs (see Maslow, 1943). The police-recorded crime data were significantly affected by the COVID-19 pandemic and associated restrictions, with fraud and computer misuse offences increasing substantially (Office for National Statistics (ONS), 2022). More recent data indicate that violence and sexual offences are returning and exceeding pre-pandemic levels, while robbery and theft offences have yet to return to pre-pandemic levels (ONS, 2022).
‘The experience of fraud can have a major impact upon an older person, not only due to the financial loss, but also through the sense of shame and embarrassment and consequent anxiety which may undermine the ability to live independently’.
The Annual Crime Survey measures perceptions of a crime rather than police-reported crime. However, it is considered the most reliable indicator of long-term trends in the most common crime experienced, while police recorded crime may provide a better indicator of short-term trends (ONS, 2022). Due to the pandemic, data collection was moved to telephone interviews to replace face-to-face interviews, with the latest survey ending in March 2022, suggesting that two in 10 people experienced a crime in the previous year, with the highest proportion of victims experiencing fraud (8%), followed by computer misuse (3%) and vehicle-related theft (3%).
Prior to the pandemic, Age UK's (2019) analysis of the national Crime Survey indicated that one in 12 respondents aged 65 years and over had reported being a victim of fraud in the previous 12 months with many perceiving that they had been targeted by scammers. The experience of fraud can have a major impact upon an older person, not only due to the financial loss, but also through the sense of shame and embarrassment and consequent anxiety which may undermine the ability to live independently (Age UK, 2019).
Two reports make concerning reading for those caring for older people. BritainThinks (2019) was commissioned by HM Inspectorate to analyse crime against older people and reported that age and the existence of an active social network impacted upon their experience of crime, communication preferences and need for support from the police. Remarkably, most of the 31 interviewees from multiple locations across England and Wales could not recall being asked questions that might reveal their vulnerability. While the initial police experience varied by location, some felt unsupported and overwhelmed, with a lack of ongoing communication about signposting to potential support, the investigation and case outcome, being common. This report concluded that older people may be particularly vulnerable because their support networks may have diminished due to bereavements and other factors, such as poor health with general slowing down of physical and mental abilities impacting upon resilience and capabilities to deal with challenges and upsets such as being a victim of a crime.
A second report by HM Crown Prosecution Service Inspectorate (HMCPSI, 2019) found that older victims of crime are frequently let down by both the police and wider justice system due to a limited understanding of their needs and experiences, despite older people comprising 18% of the population with eight out of 10 victims of doorstop scams being older people and 25% being domestic murder victims. Worryingly, HMCPSI found that older people were not safeguarded well due to inconsistent local partnership working exampled by an examination of 153 cases where referrals should have been made, but in 77 cases there was no evidence that the referral had occurred. Further, referral to victim support services and support to give the best evidence (support intermediaries, video-recording of evidence or hearing loops) were woefully inconsistent. In particular, district nursing services need to be alert to potential domestic abuse among their clientele with Age UK (2020) reporting over 280 000 older people aged 60-74 years experienced domestic abuse in England and Wales with unknown levels of abuse among those aged 75 years and older reflecting the vulnerability of older people to carer abuse (physical, emotional and financial) and a reluctance to report such crimes.
Health services also have a responsibility for delivering safe care in both hospitals and in the community. The Care Quality Commission (CQC) undertakes periodic inspections of services as part of the assurance process with NHS Trusts and healthcare organisations being rated according to their perceived quality of care delivery with specific attention to patient safety. However, one-off inspections may not reveal key care weaknesses as is evidenced by the number of CQC ratings being downgraded to ‘inadequate’ or ‘requires improvement’ following additional information, often from whistle-blowers. The National Guardian for the NHS (2022) reported that over 20 000 cases were raised with Freedom to Speak Up Guardians, as staff did not feel able to raise concerns with their line manager or through other organisational channels due to their unsupportive working environments, or fear of retaliation. Dr Chidgey-Clark, the National Guardian, is critical of these barriers to safe working which highlights the importance of nurturing psychological safety through organisational and team enablers of psychological safety among staff to empower staff to demonstrate integrity and speak up (O'Donovan and McAuliffe, 2020).
On a daily basis, patient harm may be avoided through the use of safety huddles to address such issues within daily community nursing practice. This will not only avoid adverse incidents, but also prevent avoidable admissions to hospital. Gray (2020) recommended the use of the Situation, Background, Assessment, Recommendation(SBAR) tool (Shahid & Thomas, 2018) to promote structured discussions within community safety huddles, with a priority board to ensure that all patients are discussed daily, despite heavy district nursing workloads, even if the safety huddles are taking place digitally.
Everyone needs to feel safe-both, district nursing clients and staff.