Adult Safeguarding Research Articles

The deprivation of liberty safeguards (DoLS) and adult safeguarding

PurposeThis paper seeks to consider the Deprivation of Liberty Safeguards (DoLS) and, in particular, the extent to which the functions of supervisory bodies can, or should be, performed as part of wider “safeguarding” responsibilities.Design/methodology/approachThe paper reports the views of practitioners, given in response to comments made by the Care Quality Commission.FindingsSome practitioners believe that DoLS and safeguarding functions should be consolidated, and some, that they should remain discrete; most, however, accept that the two functions should work closely together, and also that an understanding of the Mental Capacity Act is important for each; there is a suspicion that DoLS‐activity is greatest where the two functions are kept discrete (and, it is assumed, DoLS practitioners therefore have more to prove); there is also concern about financing, particularly within discrete DoLS services, and, furthermore, some suspicion about the whole business of “safeguarding”; the Neary case continues to cast a long shadow.Originality/valueThis is believed to be the first time practitioners' views have been sought or at least published on this question.

Criminal record changes ahead

There are two significant changes on the horizon concerning the safeguarding of young children and vulnerable adults that will result in the creation of a new service and an online checking system.

Outcomes following adult safeguarding alerts: a critical analysis of key factors

PurposeThis paper seeks to report some of the findings from an evaluation of adult safeguarding in one English local authority. The evaluation was commissioned in the context of concern regarding the number of safeguarding investigations that resulted in inconclusive outcomes.Design/methodology/approachAll adult social care teams in the local authority were asked to complete a short pro forma about the five most recent adult safeguarding alerts that they had managed to completion. Data collected included: characteristics of the alleged victim and alleged perpetrator; details of the professionals involved; whether or not a safeguarding plan meeting/case conference was held; and the outcome of any investigation. Respondents were also asked to comment on factors that they perceived to have helped or hindered the investigation.FindingsFindings suggest that a significant number of variables influence the likelihood of cases resulting in a conclusive outcome. These variables included not only the characteristics of alleged victims, but also elements of safeguarding practice – including inter‐agency co‐operation, social workers' pre‐existing knowledge of the alleged victim, and the convening of safeguarding plan meetings. A failure to actively involve alleged victims in the safeguarding process was also noted.Research limitations/implicationsThis is a relatively small sample from a single local authority.Originality/valueThis is the first study to provide qualitative evidence about the factors which influence the success or otherwise of adult safeguarding practice. The findings are likely to be of value to professionals working in adult safeguarding who are seeking to understand “what works” in managing investigations following safeguarding alerts.

The governance of adult safeguarding: findings from research

PurposeThe purpose of this article is to report the findings from research into the governance of adult safeguarding policy and practice in England, with particular focus on interagency partnership arrangements expressed through Safeguarding Adults Boards.Design/methodology/approachThe study comprised a systematic search and thematic analysis of English‐language literature on adult safeguarding governance, a survey of Safeguarding Adults Board documentation, and key informant interviews and workshops with professionals involved in adult protection.FindingsThe effectiveness of adult safeguarding governance arrangements has not been subject to prior formal evaluation and thus the literature provided little research‐led evidence of good practice. The survey and workshops, however, revealed a rich and complex pattern of arrangements spanning a number of dimensions – the goals and purpose of interagency working, the structures of boards, their membership, chairing and rules of engagement, their functions, and their accountabilities.Research limitations/implicationsThe research focus here is England, and thus does not incorporate learning from other jurisdictions. Whilst the research scrutinises the extent to which Boards practise empowerment, service users and carers are not directly involved in the fieldwork aspects of this study. In view of the absence of outcomes evidence identified, there remains a need to investigate the impacts of different forms of governance.Practical implicationsDrawing on this research and on governance frameworks in the context of related interagency fields, the article identifies standards to benchmark the approach to governance taken by Safeguarding Adult Boards.Originality/valueThe benchmarking framework will enable Safeguarding Adults Boards to audit, evaluate, and further develop a range of robust governance arrangements.

Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England

The risks of financial exploitation and abuse of people with dementia remain under-researched. Little is known of the views of those responsible for local adult safeguarding systems about prevention and redress. We explore current repertoires of responses of such persons and consider barriers and facilitators to minimizing risks of financial abuse for people with dementia. Fifteen qualitative interviews were undertaken with a purposively sampled group of Adult Safeguarding Co-ordinators in England in 2011. Framework analysis delineated themes in the transcripts; these were included in an iteratively developed coding framework. Five themes were explored: (1) incidence of financial abuse; (2) impact of dementia on safeguarding responses; (3) warning signs of financial abuse, including neglect, unpaid bills, limited money for provisions; (4) encouraging preventive measures like direct debit to pay for bills, advance care plans, appointing Lasting Power of Attorney; and (5) barriers and facilitators in safeguarding, including the practice of financial agencies, cultural barriers, other systemic failures and facilitators. Not all systems of financial proxies are viewed as optimally effective but provisions of the Mental Capacity Act 2005 were welcomed and seen as workable. Healthcare professionals may need to be more alert to the signs and risks of financial abuse in patients with dementia both at early and later stages. Engaging with safeguarding practitioners may facilitate prevention of abuse and effective response to those with substantial assets, but the monitoring of people with dementia needs to be sustained. In addition, professionals need to be alert to new risks from electronic crime. Researchers should consider including financial abuse in studies of elder abuse and neglect.

'Inherently Risky?': Personal Budgets for People with Dementia and the Risks of Financial Abuse: Findings from an Interview-Based Study with Adult Safeguarding Coordinators

The shift within publicly funded social care towards personal budgets and Direct Payments may present some risks as well as advantages to people with dementia. Fifteen Adult Safeguarding Coordinators were interviewed in 2011, building on earlier interviews. Thematic analysis was used to identify three main consistencies in response. Most participants saw personal budgets as potentially risky, but outlined ways in which these risks could be minimised and felt that the principles of risk empowerment could be used by practitioners to support people with dementia, carers and care staff and enable greater protection against financial abuse. Principles of the Mental Capacity Act were seen as offering some safeguards for when an individual lacks capacity, but not when they are vulnerable, mildly confused and less vigilant. Alongside a need for social work practitioners to be more alert to signs and risks of financial abuse, safeguarding practitioners urged regular reviews and monitoring that flag up inconsistencies in spending patterns. If not, system neglect may add to individual cases of abuse.

Prevention of abuse: a brief review of the literature

PurposeThe purpose of this paper is to review the literature on prevention in adult safeguarding and to identify the themes that emerge, with particular reference to personalisation and the views of service users.Design/methodology/approachPrimarily a brief literature review; the review began with a scope on data, literature, and best practice in relation to prevention in adult safeguarding. Using reference harvesting and expert recommendations, the project manager identified further material, achieving a final list of 52 documents.FindingsThere are many factors that may contribute to preventing abuse in the context of adult safeguarding. However, it is difficult to demonstrate that abuse has been or is being prevented with any certainty. The views of service users consulted for the review of No Secrets are that they would prefer to be empowered to make their own decisions with regard to safeguarding – and not to have all of the decisions made for them in an overly protective or risk‐averse approach to safeguarding. It is recommended that local authorities consider risk enablement for service users as a parallel process to adult safeguarding.Practical implicationsThere are some practical suggestions for how local authorities who are tasked with co‐ordinating adult safeguarding can work to prevent abuse within different communities.Originality/valuePrevention of abuse has not always been high on the adult safeguarding agenda; this article and the accompanying material now occupying the SCIE web site seek to redress this balance.

Adults at risk.

An online Safeguarding Adults at Risk information hub has been set up in Northern Ireland by the Department of Health, Social Services and Public Safety, as a resource for practitioners, managers, researchers, educators and policy makers.

A Cognitive Mask? Camouflaging Dilemmas in Street-Level Policy Implementation to Safeguard Older People from Abuse

National policy to safeguard older people from abuse in England and Wales gives social services the lead role in co-ordinating local multi-agency adult safeguarding procedures. With the exception of Lipsky's (1980) work on street-level bureaucracy, relatively little research attention has considered the day-to-day reality of social workers charged with implementing public policy. This article reports findings of multi-method research carried out in a social services department in Wales to identify the constraints and realities social workers faced when implementing policy to protect older people from abuse. Data sources were thirty-three social workers and managers and local adult safeguarding documentation and statistics. Methods included semi-structured interviews, focus groups, observed meetings, and documentary and statistical analysis of adult protection activity. The research found the dilemmas social workers grappled with were inherent in the structure of their work, as Lipsky had proposed. Dilemmas included known poor practice and quality in some care services, resource shortfalls and delays in investigating alleged elder abuse. The paper concludes by developing the metaphor of a ‘cognitive mask’ to describe how social workers manage the dissonance arising from dilemmas inherent in the context of their work to safeguard elders and it suggests how this ‘mask’ can be removed.

The Law Commission's final recommendations for a new adult social care statute

PurposeThis paper seeks to set out the Law Commission's final recommendations for the reform of adult social care, including the community care assessment process, service provision, and the recommendations for a new legal framework for adult safeguarding in England and Wales.Design/methodology/approachThe paper discusses each of the Law Commission's recommendations for adult social care and contrasts them with the proposals put forward at the consultation phase of the review.FindingsThe paper argues that a single legal framework for adult social care, including adult safeguarding, will have substantial benefits in terms of legal clarity, consistency, and efficiency. A clear and single legal framework is important for older and disabled people, and their carers, in order to understand fully their entitlements, and for local authorities and partnership agencies (such as the NHS and the police) in order to fully understand their responsibilities.Originality/valueThe paper provides a clear summary of the Law Commission's final report – in particular the recommendations for community care assessments and service provision and adult safeguarding.

Reforming the legal framework for adult safeguarding: the Law Commission's final recommendations on adult social care

PurposeThe purpose of this paper is to set out the Law Commission's final recommendations for the reform of adult social care, with a particular emphasis on the recommendations for a new legal framework for adult safeguarding in England and Wales.Design/methodology/approachThe paper discusses each of the Law Commission's recommendations for adult safeguarding and contrasts them with the proposals put forward at the consultation phase of the review.FindingsThe paper argues that a single legal framework for adult social care, including adult safeguarding, with have substantial benefits in terms of legal clarity, consistency and efficiency.Social implicationsA clear and single legal framework is important for older and disabled people, and their carers, in order to understand fully their entitlements, and for local authorities and partnership agencies (such as the NHS and the police) in order to understand fully their responsibilities.Originality/valueThe paper provides a clear summary of the Law Commission's final report – in particular the recommendations for adult safeguarding.

Health care and adult safeguarding: an audit informing the relationship of the UK vetting and barring scheme with the NHS

Purpose – The paper seeks to report on an audit undertaken in 2010 to support implementation of the Independent Safeguarding Authority (ISA) processes by National Health Service (NHS) Trusts. The ISA was set up under the Safeguarding Vulnerable Groups Act (SVGA) 2006. Concern has been expressed that some NHS employers are not familiar with their new obligations to consider making referrals to the ISA.Design/methodology/approach – This audit was designed to provide an estimate of possible NHS referrals to the enhanced vetting and barring scheme run by the ISA in England and Wales; and to explore two NHS Trusts' potential decision‐making and referrals to the ISA following disciplinary action or adverse events. The two NHS Trusts that participated engaged in a detailed review of incidents and their relationship to harm as defined in the SVGA 2006.Findings – The simple number of how many incidents have been reported to the ISA by an NHS Trust will not equate to the same number of cases of individual patients ...

Conceptualising and responding to self‐neglect: the challenges for adult safeguarding

PurposeThe research reported here aims to scope the concept of self‐neglect as it is explored in the literature and interpreted in practice by professionals involved in adult safeguarding.Design/methodology/approachThe approach taken included a systematic search and thematic analysis of English‐language literature on self‐neglect, workshops with UK‐based adult safeguarding leads and practitioners from social services, police and health services, and scrutiny of Safeguarding Adults Boards' documentation.FindingsThe concept of self‐neglect is complex with contrasting definitions and aetiology, accompanied by debates on the principles that guide intervention. Decision‐making capacity is a key pivot upon which professional responses to self‐neglect turn. Intervention in self‐neglect requires careful exploration in the context of principles of personalisation, choice, control, and empowerment that underpin policy in adult social care and safeguarding.Research limitations/implicationsAs a conceptual scoping review, this study seeks to establish broad themes of use to practitioners working with self‐neglect. It thus does not carry out a full quality review of the literature identified and discussed, but serves as a base for this to be done in future.Practical implicationsAssessment in self‐neglect should consider the influence of a number of possible causative factors, and intervention must balance respect for autonomy on the one hand and a perceived duty to preserve health and wellbeing on the other.Originality/valueThis article summarises and critically analyses the emerging key features of evidence‐informed practice in the challenging field of self‐neglect.

Adult safeguarding boards in North West England: the power of positive linking

PurposeAdult Safeguarding Boards are the means by which local authorities in England and Wales seek to work collaboratively to protect adults at risk of abuse. The last two years have heralded the emergence of the role of Independent Chairs. This paper seeks to outline the experience of Adult Safeguarding Boards from around North West England.Design/methodology/approachA general review of the seven Independent Chairs and 15 employed chairs (typically Directors of Adult Social Services) in North West England endorsed the importance of having a virtual network to work on a shared portfolio of interests.FindingsThe review highlighted concerns regarding the independence of Independent Chairs, the challenges to partnership working created by the turnover of managers, the governance of Adult safeguarding Boards, and their performance and practice.Originality/valueThe paper confirms that diversity is the dominant characteristic of Adult Safeguarding Boards in North West England.

Critical decisions and questions regarding serious case reviews – ideas from North West England

PurposeSerious case reviews (SCRs) are one means of learning the lessons arising from adverse, salient incidents and tragedies. Adult Safeguarding Boards in England are expected to have an SCR policy and procedure, to commission SCRs, to abstract and act on the learning, and to monitor the resulting action plans.Design/methodology/approachSince SCRs reflect a wide range of processes, the authors undertook a general review, drawing on their experiences of conducting and contributing to SCRs. They chose to pose sets of question‐prompts regarding the commissioning process, the management of the process, the appointment of a chair and author, the terms of reference, information‐sharing, confidentiality, involving relatives and making findings public. The compliance of the process with human rights legislation is also considered.FindingsWhilst the authors acknowledge the responsibility of organisations to promote continuous and cumulative professional learning, they do not promote SCRs as the sole means of learning about the ways in which professionals and agencies work together to safeguard adults at risk of abuse.Originality/valueThe paper challenges the perception that SCR can be streamlined, structured, codified, and constrained.

Enabling risk and ensuring safety: self‐directed support and personal budgets

PurposeThis paper aims to present a digest of the main discussion points and key findings from a recent Social Care Institute for Excellence report on risk enablement and safeguarding in the context of self‐directed support and personal budgets.Design/methodology/approachThe paper explores how the personalisation agenda and adult safeguarding can work together in policy and practice and addresses some of the frontline concerns about empowerment and duty of care.FindingsEvidence on how self‐directed support and personal budgets can be used to enable people to take positive risks while staying safe and emerging practice is examined. It suggests that person‐centred working in adult safeguarding, along with the mechanism of self‐directed support planning and outcome review, can support the individual to identify the risks they want to take and those they want to avoid in order to stay safe. It is clear that if frontline practitioners are overly occupied with protecting organisations and individuals from financial abuse, this will impact on the capacity of those practitioners exercising their duty of care at the front line. This means that practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk taking. Defensive risk management strategies or risk‐averse frontline practice may then result in individuals not being adequately supported to make choices and take control and, therefore, being put at risk. Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement in their relationship‐based, person‐centred working. Good quality, consistent and trusted relationships and good communication are particularly important for self‐directed support and personal budget schemes.Originality/valueThe use of “risk enablement panels” and “personalisation and safeguarding frameworks” are two ways to address some of the issues in practice.

Adult safeguarding: early messages from peer reviews

PurposeThis report aims to summarise the principal conclusions from the pilot reviews and key learning points to assist the improvement of safeguarding policy and practice.Design/methodology/approachA pilot programme of peer reviews of adult safeguarding arrangements was carried out in four English local authorities by Local Government Improvement and Development in 2009‐2010. The pilot programme sought to customise, test and adapt this established peer review methodology to adult safeguarding.FindingsKey messages from the peer reviews of the adult safeguarding arrangements include: outcomes and experience of people who use services; leadership, strategy and commissioning; service delivery, effective practice and performance and resource management; and working together.Originality/valueCouncils may need to revisit how they develop their safeguarding arrangements in the light of major policy, financial and demographic shifts over the next few years.

Safeguarding: ‘Working together to prevent sexual abuse’

Helen Ross reports on a safeguarding conference hosted jointly between Essex Safeguarding Adults Board and the Essex Safeguarding Children’s Board. The conference was attended by many delegates from children, young people and adult services within the county.

Introducing the Mental Capacity Advocate (IMCA) Service and the Reform of Adult Safeguarding Procedures

Introducing the Mental Capacity Advocate (IMCA) Service and the Reform of Adult Safeguarding Procedures

Reflections on the serious case review of a female adult (JK)

This paper originates from accessing the Cornwall Council website (Cornwall Council, 2010) in order to download the report of the serious case review into the murder of Steven Hoskin for teaching purposes on a Post‐Qualifying Social Work programme. However, there were another two serious case review reports posted, which were also relevant to the course. This reflective piece follows from a reading of the executive summary of one of them ‐ the Serious Case Review report into the death of JK (a 76‐year‐old female) in 2008 in Cornwall (Cornwall & Isles of Scilly Safeguarding Adults Board, 2009). While adult safeguarding is everybody's business, because of the original reason for accessing the report, the paper approaches the issues primarily from a social work perspective.