The safeguarding system in care homes in Northern Ireland does not protect people or prevent harm, a review said.
The voices of residents at Dunmurry Manor in Belfast were repeatedly unheard, an expert report commissioned by the Department of Health said.
It addresses the whole adult safeguarding arrangement around care homes and will spark major legislative reform, the Department of Health said.
The review warned: “The safeguarding system is not suited to communal living.
“It is too procedural, it does not solve problems, it fails to involve residents and their families and it does not prevent harm or protect people.”
Serious concerns have been raised previously surrounding the quality of care for residents with dementia at Dunmurry.
The review by social care experts CPEA said: “Adult safeguarding in Northern Ireland has diminishing persuasive power because its practice has strayed too far from the policy intentions of 2015 and from residents’ human rights.”
It added: “It seems that safeguarding practice with care home residents is founded on doing things right rather than doing the right thing.
“That is, procedures typically prevail over residents’ best interests.”
The report pointed to inconsistencies in record-keeping between different health authorities.
It said not enough credence was given to basic fact-finding by care homes.
It said: “Much safeguarding practice is premised on the conviction that people must be kept safe at all costs.
“Since the approaches developed in Northern Ireland are not supported by research, safeguarding is an inadequate and blunt response.
“There are more effective and nuanced approaches to addressing the challenges which arise from living in communal settings.
“It appears that safeguarding is the only tool within reach.”
The review was ordered by the Department of Health following the Commissioner for Older People’s 2018 Home Truths report on Dunmurry Manor.
The latest review, published on Thursday, said: “Families’ voices were repeatedly unheard and Dunmurry Manor Care Home did not improve.
“Adult safeguarding practice did not actively contribute to keeping Dunmurry Manor Care Home residents safe.”
It said the boundaries of adult safeguarding have expanded to embrace care home surveillance, monitoring and inspection without legal powers or evidence of effectiveness.
“Monitoring, as an activity, appears excessive, unplanned and lacking in purpose and outcome.
“Arguably this expanded work programme has fed a false assumption that all care homes are ‘risky’ and ‘abusive’ environments.”
The report proposes eight actions, including establishing an adult safeguarding/adult protection change programme and an adult safeguarding/protection Bill.
Health Minister Robin Swann has pledged to bring forward a new adult safeguarding Bill to help protect care home residents and other vulnerable members of society.
He said: “I am determined to lead social care into a better place in Northern Ireland, and an adult safeguarding Bill will help achieve that goal.”
The minister intended to consult on a range of legislative options before Christmas.
He added: “I have asked the chief social worker, Sean Holland, to chair a new Adult Safeguarding Transformation Board to oversee this work and to strengthen the governance around adult safeguarding to achieve a more accountable, regional approach.”
