Safeguarding Adults Under the Care Act 2014

Understanding Good Practice

Adi Cooper, Emily White

• Publisher: Jessica Kingsley Publishers
• Year: 2017
• ISBN:
  9781784503581
• Topic: Ciencias sociales
• Subtopic: Trabajo social

Practice in safeguarding adults is changing, with a shift in approach to ensure it is person-centred and outcome-focused. The Care Act 2014 introduced new safeguarding duties for local authorities, and this book describes what up-to-date practice should look like, and how to provide the best quality care and support for adults who may be at risk of abuse or neglect.

Chapters cover core areas of practice according to Care Act and adult safeguarding principles, identify the fundamental skills and knowledge practitioners working in this area should be able to utilise and introduce the emerging challenging issues in the workplace. As well as being invaluable to practitioners working directly in this field, this is also ideally suited to be a text for any social work course or programme on adult safeguarding practice.

Section 1

MAKING SAFEGUARDING
PERSONAL: APPROACHES
TO PRACTICE

Chapter 1

The ‘Making Safeguarding
Personal’ Approach to Practice

Jane Lawson

Introduction and context

This chapter examines developments leading to the explicit inclusion of Making Safeguarding Personal (MSP) within the statutory guidance and what we can take from this for current practice. It emphasises that putting core principles into practice and using these as a measure of effectiveness must be at the heart of safeguarding adults. It underlines and gives practice examples of central aspects of an MSP approach to practice. These are explored in greater depth in this chapter.

MSP began as a national programme in 2009. The work continues to be supported by the Association of Directors of Adult Social Services (ADASS), the Local Government Association (LGA) and the Department of Health (DH). The programme gathered pace, and in 2014/15 all local authorities in England were engaged in progressing MSP. Resources linked to findings of councils that participated in the programme are referenced below. They offer helpful practice advice and are available on the LGA website.1

What is safeguarding adults? What is Making Safeguarding Personal?

The definition of safeguarding adults is set out in the Care and Support Statutory Guidance:

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. This must recognise that adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances… People have complex lives and being safe is only one of the things they want for themselves. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. (DH 2016, paras.14.7–14.8)

This emphasises the person’s involvement, the balancing of wellbeing with safety, and prevention. Expectations set out in the guidance in respect of MSP add value to this approach:

Making safeguarding personal means it should be person-led and outcome-focussed. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. (DH 2016, para.14.15)

The guidance makes it clear that MSP is not only for local authority professionals, but it is for everyone: ‘Making safeguarding personal…underpins all healthcare delivery in relation to safeguarding, with a focus on the person not the process’ (DH 2016, para.14.207).

Policies and procedures across organisations ‘should assist those working with adults on how to develop swift and personalised safeguarding responses and how to involve adults in this decision making’ (DH 2016, para.14.52).

Changing the culture: emerging themes in support of a personalised approach to practice in safeguarding adults

Safeguarding practice has been slow to adopt a personalised approach, despite the narrative of personalisation having been centre stage for over a decade. For example, in 2005 a Green Paper (DH 2005, p.30) acknowledged that:

The person’s own assessment of their needs might conflict with those of their professional assessor… The person’s personal assessment must be transparent… That is what happens in the rest of our lives. We work out what we want and then, in trying to achieve it, we may have to negotiate. (DH 2005, p.31)

In 2010 the Department of Health set out a vision, highlighting the need to empower people to understand and manage risks in their own lives:

Personalised care is for everyone, but some people will need more support than others to make choices about how they live their lives… Making risks clear and understood is crucial to empowering service users and carers, recognising people as ‘experts in their own lives’. (DH 2010a, pp.25–26)

Key messages for practice

These same themes are underlined by councils across England (those that engaged in MSP programmes in 2013–15) as fundamental aspects of the MSP approach to practice:

•Engaging core principles in practice about rights and risks, choice and control

•Engaging with people (having conversations) to understand what contributes to ‘wellbeing’ in their lives; seeking to support wellbeing alongside safety

•Ensuring that those who lack mental capacity (as well as those who have capacity) are empowered and included within safeguarding support

•Empowering people so that they are partners in understanding and managing risk in their own lives

•An emphasis on the need for transparency and openness in managing conflicting outcomes (both of the person and between the person and professionals or organisations)

•The role of advocacy in all of the above.

The Making Safeguarding Personal Evaluation Report for 2014/15 offers greater detail on what supports MSP and the challenges for delivery (Pike and Walsh 2015). It underlines the necessary context and support to enable the MSP approach. In particular the role of Safeguarding Adults Boards and the culture change necessary to facilitate MSP are emphasised, alongside changes in policy and procedure. Prioritising staff development, support and opportunity for reflection, high-level organisational support and engagement across sectors and organisations are all needed (Pike and Walsh 2015, pp.13–15, 59–62).

Evidence suggesting the need for change and the necessary direction for change

The necessary shift in culture has been slow. ‘There are…strong messages that people feel driven (sometimes out of control) through a process… Often they want more than one outcome, which are sometimes not easy to reconcile. People generally want to feel safe but also to maintain relationships…’ (LGA 2013, p.11).

This is reflected in the experience recounted by the wife of a man who was the focus of a Serious Case Review. She reflected: ‘The word “protection” suggests altruistic idealism and protection of those with care and support needs. The reality is otherwise. The word is a euphemism for bullying power and a tendency to deny the positive elements that create happiness in a person’s life’ (Westminster Safeguarding Adults Board 2011, p.48).

There are numerous reviews (Serious Case Reviews and Safeguarding Adults Reviews) where a lack of a personalised approach is reflected in the findings of reports. These are available on council websites and include reviews into the deaths of: Steven Hoskin (Cornwall Adult Protection Committee 2007); CC (Surrey Safeguarding Adults Board 2010); Gemma Hayter (Warwickshire Safeguarding Adults Partnership 2011); Mr BB (Westminster Safeguarding Adults Board 2011); and Mrs ZZ (Camden Safeguarding Adults Board 2015). They indicate the need for application of a range of skills and knowledge in ‘making safeguarding personal’, including:

•listening skills

•attention to the issue of choice and the person’s ability to exercise choice

•adherence to the principles of the Mental Capacity Act 2005 (MCA); and the MCA 2005 Code of Practice (2007)

•positive and person-centred approaches to risk

•empowering and including people who use services and their families

•prevention strategies, particularly in respect of those isolated in their communities

•expertise in working with people with whom it is challenging to engage and with whom finding a balance between choice and safety is crucial

•effective interpretation and application of the law.

The following case study, from the perspective of a person who was in need of safeguarding support, gets to the heart of why change is needed and what that change should look like. It sets out the experience and views of Annie, who was offered support in the form of a Family Group Conference (FGC; see Chapter 3).

CASE STUDY

Annie had experienced abuse from her husband for over 40 years. As the abuse continued and Annie was getting older, it became increasingly difficult to withstand. Traditional approaches had had little impact. A FGC was offered and accepted by Annie. Six months later she had left her husband and Annie now coordinates FGCs herself. When asked what it was about the support of the FGC that led to successful outcomes, Annie said the following about the approach:2

•‘It helped me move from firefighting to long-term solutions.

•It helped find the right people to support me.

•It helped us to see the severity of the risk.

•It supported my family.

•It put me at ease to share my story.

•It built my self-confidence.

•Help and results came quickly.

•I apply the principles on an ongoing basis in my life.

•I did it myself!’

Principles into practice

MSP is supported extensively within the Care and Support Statutory Guidance (DH 2016) which sets out core principles for practice.

Putting the wellbeing principle into practice: a case study from research

The Care and Support Statutory Guidance lists aspects of life central to a person’s wellbeing and offers an essential tool for putting MSP into practice (DH 2016, para.1.5). Achieving the necessary balance between wellbeing and safety can only be realised by working alongside the person and understanding the relative importance of aspects of their life. The wellbeing principle is underlined for all organisations both in the statutory guidance and elsewhere, including in the NHS England (NHSE) Safeguarding Accountability and Assurance Framework (2015) and Compassion in Practice (NHSE 2012).

Recent research on mass marketing fraud (Olivier et al. 2015) illustrates how the wellbeing principle can be put into practice. This research shows that some people who engage in scams do so because it presses many of the wellbeing ‘buttons’ as set out in the above statutory guidance. For some the loss of money is worth it when weighed against the wellbeing gains. Intervention therefore needs to look at the whole person and their social network in considering what it would be like for the person if engagement with scams ceased and what might replace the sense of wellbeing that the engagement provided (Olivier et al. 2015, pp.368–369). The research carried out by Croydon social workers and Trading Standards officers ...

Table of contents

• Cover
• Title Page
• Contents
• Foreword
• Introduction
• Section 1: Making Safeguarding Personal: Approaches to Practice
• Section 2: Working with Risk and Using the Law
• Section 3: Current Issues for Practitioners
• Appendix
• Author Biographies
• Subject Index
• Author Index
• Join Our Mailing List
• Acknowledgements
• Dedication
• Copyright
• Of Related Interest