28 June 2010 Decision Making Conference

Safeguarding, choice , accountability, risk taking….Social work decision making

in context

Jill Manthorpe

28 June 2010 Decision Making Conference

Social Work Decisions

• What many people want to them to do and policy makers want to encourage

• Essence of professionalism?

• Context of protocols, pathways and evidence

• The future looks…?

28 June 2010 Decision Making Conference

If only..

28 June 2010 Decision Making Conference

Government decisions - context• Commission on long-term

care, to report within a year. • Break down barriers

between health and social care funding to incentivise preventative action.

• Extend the roll-out of personal budgets to give people and their carers more control and purchasing power.

• Use direct payments to carers and better community-based provision to improve access to respite care.

28 June 2010 Decision Making Conference

safeguarding

Larger evidence base for decision making

• Prevalence & incidence, data reporting

• When things go wrong eg serious case reviews

• Case law from Mental Capacity Act 2005, eg offences of wilful neglect/mistreatment

• Still legal uncertainties eg ISA under review

28 June 2010 Decision Making Conference

Practice on the ground

• Bridging support plans & safeguarding plans

• Conditions of personal budgets – prevention (eg checks of PAs), recipients are ‘vulnerable adults’

• Monitoring & reviewing (Recording)• Looking to Scotland for evidence of

intervention effects• Linking up, DV, NHS, hate crime

28 June 2010 Decision Making Conference

choice

• Major roll out of personal budgets (some blended funding) for all groups (self-directed support)

• Money on more direct employees (PAs) but large agency expenditure (need changes)

• Day centre closures• Evidence positive – in the

main

28 June 2010 Decision Making Conference

Practice on the ground

• Support plan processes…• Level of monitoring and

review• Lite touch?• Duty of care? (IBSEN)• More proxies (but little

advance planning – Evidem)

• Recording choices eg paper, video…

28 June 2010 Decision Making Conference

2 gov decisions on Social Action: accountability changes

• Create & expand mutuals, co-operatives, charities & social enterprises, ensure greater involvement in running of public services.

• Public sector workers to get a right to form employee-owned co-operatives & bid to take over the services they deliver.

28 June 2010 Decision Making Conference

Practice on the ground

• Newish relationships of accountability

• Commissioning requiring evidence, confidence and cost-effectiveness

• High use of language of productivity

• More fissures in working relationships leading to greater centralisation

28 June 2010 Decision Making Conference

Risk

• High level interest in risk enablement and rights, ‘nothing ventured, nothing gained’

• Not so many risk policies, more embedded

• Focus on assembling agreement

• Risk to self freed up but risk to others….

• Dangerous people, perpetrators… left aside.

28 June 2010 Decision Making Conference

28 June 2010 Decision Making Conference

Practice on the ground

• High levels of need among state funded users: different sorts of risk; eg end of life

• Patient safety – managing at home

• Calls to manage crises; rapid decision making (advance and proxy)

28 June 2010 Decision Making Conference

Decision making?

• Huge ethical questions (so nothing new)

• Evidence base from recording v system requirements

• Skills at risk conversations, conflict management, best interests…

• End thought - More decision shaping?

28 June 2010 Decision Making Conference

resources

• Evidem.org.uk

• SCWRU - kcl.ac.uk

• NIHR National School for Social Care Research