Adult Safeguarding Research Articles

Gambling and adult safeguarding: connections and evidence

Purpose Opportunities to gamble have boomed in the UK in recent years, since the passing of the Gambling Act 2005. The implications of this for adults with care and support needs and for safeguarding services have not been greatly investigated. The purpose of this paper is to address the interface of how gambling affects adults with care and support needs in England and adult safeguarding.

Safeguarding practice in England where access to an adult at risk is obstructed by a third party: findings from a survey

Purpose Being able to speak in private to an adult about whom there is a safeguarding concern is central to English local authorities’ duty under the Care Act 2014 to make enquiries in such cases. While there has been an on-going debate about whether social workers or others should have new powers to effect these enquiries, it has been unclear how common obstructive behaviour by third parties is and how often this causes serious problems or is unresolved. The purpose of this paper is to address this knowledge gap. Design/methodology/approach A survey of local authority adult safeguarding managers was conducted in 2016 and interviews were undertaken with managers and social workers in three local authorities. Data were analysed descriptively. Findings Estimates of numbers and frequency of cases of obstruction varied widely. Most survey respondents and interview participants described situations where there had been some problems in accessing an adult at risk. Those that were serious and long-standing problems of access were few in number, but were time consuming and often distressing for the professionals involved. Research limitations/implications Further survey research on the prevalence of obstructive behaviour of third parties may not command greater response rates unless there is a specific policy proposal or a case that has “hit the headlines”. Other forms of data collection and reporting may be worth considering. Interview data likewise potentially suffer from problems of recall and definition. Practical implications At times professionals will hear of, or encounter, difficulties in accessing an adult at risk about whom there is concern. Support from supervisors and managers is needed by practitioners as such cases can be distressing. Localities may wish to collect and reflect upon such cases so that there is learning from practice about possible resolution and outcomes. Social implications There is no evidence of large numbers of cases where access is denied or very difficult. Those cases where there are problems are memorable to practitioners. Small numbers of cases, however, do not necessarily mean that the problem of gaining access is insignificant. Originality/value This study addressed a question which is topical in England and provides evidence about the frequency of the problem of gaining access to adults at risk. There has been no comparable study in England.

Safeguarding adults reviews: How can they improve practice?

Safeguarding adults reviews are an important part of the safeguarding process as they allow lessons to be learned. Julie Dalphinis describes the findings of a recent study which looked at all recent reviews in London and found ways the process could be improved Safeguarding adults reviews are a statutory requirement of the Care Act (2014). They take place when an ‘at-risk’ adult has died—or suffered permenant harm—from serious abuse and neglect, and there is concern about how the agencies involved in protecting the individual acted. The aim is to learn lessons to prevent similar circumstances happening again. This article provides an overview of a recent review of the process in London and provides recommendations for improving practice in primary care.

Delivering System Wide Patient Centred Co-odrinated Care TODAY

Introduction: Cumbria/North Lancashire has established a resource matching/e-referral system in our major provider organisations (currently 1800+ e-referrals/month) across all health and care, independent and 3rd sector stakeholders. In addition, we are engaging cross border e-referrals for Cumbrian patients accessing specialised services in the North East/ Newcastle Hospitals FT. This system-wide co-ordinated care provides full transparency and accountability throughout each patient’s journey and optimises care outcomes whilst ensuring optimal resource utilisation. Aims/Objectives: 1- Adult health and care electronic booking of residential and nursing care beds from independent sector; 2- Health and well-being and Integrated Care Community e-referrals to health and well-being hubs/sector services; 3- e-referrals for Assessment, Discharge and Withdrawal notices from health organisations to adult social care, in accordance with the Care Act 2014, Schedule 3; 4- e-referrals to adult safeguarding; 5- acute/hospital e-referrals to community hospitals/community based services; 6- Continuing Health Care, fast track,checklist, DST and Panel process automation 7- GP e-referrals to emergency, acute, community, and CountyCouncil services, (aligned with NHS eRS for elective); Method/Rational: 1. NHSE Safety Patient Alert–the handover of patients is a complicated and multi factorial process. Communication is identified as a particular area of risk and accounted for 33% of 10000 incidents reported to NRLS. Review of these incidents indicated that patients are sometimes discharged without adequate/timely communication of essential information to relevant staff/teams. 2.Success Regime-January 2016 Deloitte’s report Our population is super-ageing, with a higher than average growth in the proportion of older people High levels of ill-health prevalence rates; we have a high treatment burden in primary/secondary care. Geography makes service delivery harder than average–communities spread over large distances; isolation a key factor. Key services (urgent /emergency care, secondary care diagnosis /treatment and rehabilitation) are not always provided sufficiently promptly; core access standards are not consistently met – this is especially the case for people who are frail/need multi agency care Results/Conclusions: Citizens/patients–Enhanced patient safety from reduction in time spent in hospital e.g. reduced risk of medication errors, dehydration, under nutrition, hospital acquired infections; improved timeliness of transition across services Supported social prescribing referrals via GPs to commissioned health/well being services; voluntary sector services. Streamlined referral processes into Adult Safeguarding using electronic forms Health and care providers – improved shared data quality; standardised demographic and relevant clinical data; improved communication; transparency of progress of e-referrals to support proactive management of care pathways and minimise blockages. Industry-collaboration between suppliers of EPR’s to link with the e-referral system and provide standardised interfaces that enable health/care staff to optimise the use of a real time DOS-dynamic interoperability. Academic / research- totally new data sets emerge. Commissioners – ability to see a comprehensive directory of services and load balance resources. Health and Wellbeing/ASC commissioning strategies forStaff – reduction in wasted time/effort from paper and fax; ability to devote time to positive action to support patient care. Enhanced patient choice in long term care / compassionate care placements. Enhanced patient outcomes via clearer, well suited patient journey to appropriate care settings Estimated £400,000 efficiency savings annually thus far*NHS England IDCR report

10,000 Voices: service users’ experiences of adult safeguarding

PurposeThe purpose of this paper is to describe a small scale pilot study undertaken in Northern Ireland to gather service user feedback from individuals who have been subject to adult safeguarding procedures.Design/methodology/approachThe aims, methods and findings of the “Adult Safeguarding: 10,000 Voices” pilot project are presented.FindingsThe pilot project highlighted how an initiative which captures the experiences of patients, service users, carers and staff in the health and social care sector (10,000 Voices) could be successfully adapted for use in adult safeguarding, facilitating the collation of complex experiences and enabling insights to be gleaned and shared.Research limitations/implicationsThe pilot study is limited by the small number of participants. The findings are preliminary.Practical implicationsFor the first time in Northern Ireland the 10,000 Voices model was utilised in the context of a non-health related service, namely, adult safeguarding.Social implicationsThis outline of the model and methodology for obtaining service user feedback can inform user involvement in other contexts.Originality/valueThis paper provides an accessible overview of an innovative approach to engaging service users in adult safeguarding, such approaches, to date have been limited.

Pressure points: learning from Serious Case Reviews of failures of care and pressure ulcer problems in care homes

PurposeSerious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.Design/methodology/approachIdentification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.FindingsThe authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.Research limitations/implicationsReviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.Practical implicationsThis analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.Social implicationsThe value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.Originality/valueThe value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.

Moving to a Systems Approach to Safeguard Adults in Residential Care

In 2016, the Health and Social Care Institute Adult Safeguarding Collection data indicated care homes are a setting of high risk of harm to adults. This research study considers the outcomes of a sample of 11 Serious Case Reviews into the abuse of adults in the care setting. Its purpose is to help identify professional practice messages that might lead to the prevention of harm in care homes for the future. Serious Case Reviews have recognised a weakness in safeguarding practice relating to the way in which practitioners have dealt with safeguarding events. In all the reviews, the practitioner response was observed to be one that focused on the individual harmed. There was an absence of regard to the wider picture of cumulative concerns, showing a worrying pattern of provider failure leading to the death or serious injury of further residents. In response it is proposed adult social care professionals consider a systems approach to safeguarding in the care home environment. Implementing a holistic view of the home that includes a data intelligence system to signify when there are cumulative concerns that could indicate the need for actions to prevent escalation to greater harm for adults.

Safeguarding Adults in Nursing Practice Northway Ruth Jenkins Robert Safeguarding Adults in Nursing Practice 240pp £21.99 Learning Matters/Sage 9781473954847 1473954843 [Formula: see text

It is refreshing to find a book that relates nursing practice to adult safeguarding in the way this does. Mainly written for nursing students, it incorporates NMC Standards for pre-registration nursing education and essential skills clusters, which are threaded throughout the book.

Adult safeguarding and the Care Act (2014) – the impacts on partnerships and practice

PurposeThe purpose of this paper is to look at the impacts on adult safeguarding partnerships and practice over 18 months following the implementation of the Care Act (2014) from the perspectives of an independent Chair of two Safeguarding Adults Boards (SABs) and a senior manager in adult social care in a local authority. They look at the areas of: wellbeing and safety, safeguarding activity and process, changing criteria and definitions, Making Safeguarding Personal, SABs, safeguarding adult reviews and advocacy.Design/methodology/approachThe authors draw together information from published sources, experience and networks.FindingsThe paper argues that the impact on adult safeguarding and SABs has been greater than originally envisaged in a range of areas. This appears to be as a result of adult safeguarding having been made statutory, a new framework having been put in place, and added impetus given to a cultural change in adult safeguarding practice.Originality/valueThe authors have been engaged in delivering the adult safeguarding elements of the Care Act (2014) and so provide unique insight into the experience of making the changes required to meet the new statutory requirements and achieve the objective of protecting peoples’ rights to live in safety, free from abuse or neglect.

Adult safeguarding in Wales: one step in the right direction

PurposeThe purpose of this paper is to consider the background to the recent changes to adult safeguarding in Wales as a result of the new measures introduced by the Social Services and Well-being (Wales) Act 2014 and discuss their potential impact.Design/methodology/approachThe paper relies on a range of material including reports published by the Law Commission, the National Assembly for Wales and other public bodies. It also refers to academic and practitioner material in journals and government guidance.FindingsAlthough the Social Services and Well-being (Wales) Act 2014 introduced many changes in adult safeguarding in Wales, not least the duty to make enquiries, it does not take the opportunity to include statutory powers of barring and removal. The introduction of Adult Protection and Support Orders (APSOs) is a cautious step forward – perhaps it is too cautious. More research in needed on the different approaches across the UK.Research limitations/implicationsAt the time of publication, the full effect of the new legislation has not been seen. Local authorities and others are coming to terms with the new provisions. No data on the impact of the new legislation are yet available. The paper identifies future research evaluating the working of the different approaches to safeguarding within the UK.Practical implicationsFor practitioners, the new legislation provides opportunities to rethink the approach to safeguarding. The lower threshold for referrals will mean an increase in caseloads and the need to react to both low- and high-risk cases. For authorised officers, the practical issues identified relate to the circumstances in which an APSO may be sought and what can be put in place to protect the adult at risk once the order has been used.Social implicationsFor those who experience abuse or neglect, the new legislation provides additional support when compared to the POVA process. The duty to make enquiries and the duty to report will hopefully strengthen protection and, with a lower threshold for referral, enable more preventative work to be done at an earlier stage. Whether the new APSO will make a difference remains to be seen.Originality/valueAs this is new legislation, there is very little analysis of the implications of the Social Services and Well-being (Wales) Act 2014 in relation to safeguarding. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties.

Mental Health Integration Past, Present and Future: National Survey into Mental Health Integration in England

Mental health services have undergone radical transformation in the past 30 years. A community based care model has largely replaced the acute and long term care provided in large institutions. This research seeks to examine the transformation of mental health services in England and the relevance to current policy with particular emphasis on the integration of health and social care within mental health services. Through the use of a comprehensive survey of a range of professionals, and interviews with local and national leaders across England involved in both mental health provision and social care, along with a review of published literature, this paper seeks to explore the context and factors that are affecting integration between health and social care in mental health. In 1999, the Government launched a major programme of change and modernisation in mental health services within England with the NSF for Mental Health. What has followed was an expansion of mental health services and an increasing focus on both service user experience and quality of provision. Through numerous iterations of public policy in the subsequent 15 years, there has been a coming together of health and social care provision within mental health firstly facilitated by section 31 of the 1999 Health Act and subsequently by section 75 of the National Health Service Act 2006. Combined, both Acts facilitated the transfer or secondment of social care staff to NHS bodies and the transfer of health related functions of local authorities to NHS bodies that are 'likely to lead to an improvement in the way in which those functions are exercised‟. Throughout England services have generally moved closer together through various levels of integration, ranging from co-location, shared management and information systems without formal s75 agreements to full integration with formal s75 agreements and governance. The objective was to deliver enhanced service experience to service users, improving the quality of care and reducing isolated or silo working. The experience of integration has been as varied as the numerous locations affected. Over the past decade new statutory duties of local authorities have emerged along with changing policy: Mental Capacity Act 2005 followed by the Deprivation of Liberty Safeguards, policies relating to adult safeguarding subsequently enshrined into duties within the 2014 Care Act and the drive to personalisation, prevention and recovery. All these are against a background of significant cuts to local authority budgets. Within mental health services there has been the emergence of Payment by Results (PbR), of enhanced patient safety and quality measures centred on Care Programme Approach, of an increasingly competitive environment between providers and an approximate 8% cut to NHS mental health funding (BBC News March 2015). This changing policy and economic environment has placed significant tensions on local working arrangements between the NHS and local authorities in mental health services, leading to numerous revisions of arrangements, with uncertain outcomes.

The vulnerable adult experiment: Situating vulnerability in adult safeguarding law and policy

This article explores the intersection of English adult protection law and policy as it impacted on the lives of people with mental disabilities. It evaluates developments that were premised on the notion of the ‘vulnerable adult’, in light of recent theoretical interrogation of vulnerability and the normative shifts in law and policy advocated by the UNCRPD. I argue that the policy and legal conceptions of vulnerability developed in England and Wales, if reworked, have the potential to transform our understanding of what it is to be vulnerable into a more radical and socially-grounded framework for adult safeguarding. This article concludes with some reflections on what further conceptual and policy work must be done in order to effect that transformation.

Safeguarding Adults in Nursing Practice (Second edition) Northway Ruth Jenkins Robert Safeguarding Adults in Nursing Practice (Second edition) 240pp £21.99 Learning Matters/Sage 9781473954847 1473954843

It is refreshing to find a book that explores nursing practice and adult safeguarding in the manner that this one does.

Renegotiating power in adult safeguarding: the role of advocacy

PurposeThe increased involvement of adults at risk in the safeguarding process has become a prominent issue within English safeguarding policy. However, there is evidence to suggest that actual levels of involvement are still low. The purpose of this paper is to present findings from a PhD study in relation to the benefits of advocacy in supporting this involvement in adult safeguarding for older people.Design/methodology/approachParticipants in the study included advocates and social workers who had experience of working with older people through the safeguarding process within two North East England local authorities. A critical realist approach through in-depth interviews was taken with all the participants.FindingsThe research findings in relation to the benefits of advocacy in supporting older people going through safeguarding processes are reported. The practical limitations and factors which help and hinder advocacy support within the process are also considered. The theoretical implications for power, empowerment, and advocacy are also explored.Research limitations/implicationsA key limitation of this research is that it did not include older people who had been through safeguarding amongst the participants.Practical implicationsKey implications for practice and policy are discussed.Originality/valueThe paper provides an overview and critique of empowerment in adult safeguarding and the role that advocates play in promoting this key principle.

On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

PurposeThe purpose of this paper is twofold: first, to update the core data set of self-neglect serious case reviews (SCRs) and safeguarding adult reviews (SARs), and accompanying thematic analysis; second, to respond to the critique in the Wood Report of SCRs commissioned by Local Safeguarding Children Boards (LSCBs) by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice.Design/methodology/approachFurther published reviews are added to the core data set from the websites of Safeguarding Adults Boards (SABs) and from contacts with SAB independent chairs and business managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of SCRs commissioned by LSCBs, with implications discussed for Safeguarding Adult Boards.FindingsThematic analysis within and recommendations from reviews have tended to focus on the micro context, namely, what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely, that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned.Research limitations/implicationsThere is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of SCRs enables conclusions to be reached about their potential to transform adult safeguarding policy and practice.Practical implicationsAnswering the question “why” is a significant challenge for SARs. Different approaches have been recommended, some rooted in systems theory. The critique of SCRs challenges those now engaged in SARs to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.Originality/valueThe paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting SARs by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned.

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

ABSTRACTSelf-neglect, in which an individual does not attend to their hygiene, health or home surroundings, is one of the most challenging aspects of adult social care practice. In England, its inclusion within the remit of adult safeguarding, as a result of changes in adult social care law introduced under the Care Act 2014, has thrown into relief the ethical dilemmas arising from tensions between respect for autonomy on the one hand and the exercise of a protective duty of care on the other hand. This paper draws on serious case reviews and safeguarding adult reviews in self-neglect cases, along with findings from adult safeguarding research, to propose that an appropriate balance between these two moral imperatives is not always achieved in self-neglect practice. It considers why autonomy appears to be privileged over other considerations, illustrating the complex interplay between law and ethics that gives autonomy pre-eminence. It then considers how a more nuanced, situated and relational approach to autonomy can enable practitioners to move away from dichotomous interpretations of the moral imperatives present in self-neglect work, and can support more nuanced understandings of the ethics of professional decision-making. Finally, it considers the personal and organisational implications of this enhanced ethical literacy.

A response to “A preventable death? A family’s perspective on an adult safeguarding review regarding an adult with traumatic brain injury”

PurposeTo reflect on the particular case from a professional’s perspective to provide, in conjunction with the original article, a more holistic overview of some of its implications for safeguarding practice and, by definition, for the provision of health and social care support services to individuals with a traumatic brain injury and their families. The paper aims to discuss these issues.Design/methodology/approachA response to an already published article.FindingsThat a lack of “professional curiosity” on the part of practitioners across a range of professions and agencies led to a failure to initiate safeguarding processes and procedures appropriately, resulting in avoidable damage to the subject of the article, the author’s partner and their families.Practical implicationsThere is a need for a greater awareness and understanding of the implications of traumatic brain injuries across health and social care services: that hospital discharge planning and community support services need to be more flexible in identifying and meeting the needs of patients with traumatic brain injury, that there is no substitute for “professional curiosity” in ensuring that assessments are holistic, and that services are appropriate and multi-agency working is effective.Originality/valueThis is a response to an existing publication.

Piloting the older adult financial exploitation measure in adult safeguarding services

Financial abuse is arguably the most complex form of elder abuse as it may occur remote to the older person and it is impacted by issues such as cultural values, perpetrator intent and family expectations. Financial abuse may not be recognised by either the older person or the perpetrator, thus, its prevention, early identification and amelioration are important. The (Irish) National Centre for the Protection of Older People undertook a study to determine the appropriateness of the Older Adult Financial Exploitation Measure for use by the national safeguarding older person services. Findings from a small pilot study involving 16 safeguarding staff’s use of the Older Adult Financial Exploitation Measure with 52 community dwelling older people referred to their service demonstrate a higher suspicion of financial abuse as well as identifying multiple instances of possible financial exploitation in a single individual. Thus, the Older Adult Financial Exploitation Measure is considered appropriate to assist safeguarding personnel’s assessment of older people related to a suspicion of financial abuse.

Implementation and outcomes of a new safeguarding pathway for vulnerable adults presenting to sexual health services.

Adult safeguarding is the process of protecting vulnerable adults from harm or exploitation. In 2014, our sexual health clinic implemented a new adult safeguarding pathway, including an adult safeguarding proforma, an electronic database and a monthly adult safeguarding meeting. We conducted a retrospective case note review of patients entered onto the safeguarding database and found that greater numbers of adults were identified as vulnerable following the introduction of this pathway. Many required referral for onward support, highlighting the importance of robust safeguarding procedures in a sexual health setting.

Choosing to Live with Harm? A Presentation of two Case Studies to Explore the Perspective of those who Experienced Adult Safeguarding Interventions

ABSTRACTAdult safeguarding often creates a tension for welfare practitioners between promoting an adult’s autonomy and their duty to try to protect them from harm. Literature highlights the dangers of adopting simplistic notions of autonomy and capacity in assessing whether someone may be choosing to live with harm. Yet very little has been published about how adults at risk and family members experience the tension between autonomy and protection: what choices do they think they have and why might they choose one above another? The article starts to address this gap by utilising an ethic of care to explore the experiences of an adult at risk; and then a family member where older people were being harmed within family relationships. These accounts were drawn from a Scottish qualitative adult safeguarding study. They highlight how choice, autonomy and capacity are interconnected concepts; and that they can be compromised by a range of personal, relational and environmental factors. In addition they demonstrate how practitioners can support or limit the choices open to adults at risk and their family members. The ensuing discussion summarises the implications for practice and considers how voices of experience might be better captured in the future.