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Martin Stevens,

Social Care Workforce Research Unit

Personalisation and safeguarding - are they linked?What aspects of safeguarding should be integrated with personalisation?What aspects of personalisation should be integrated with safeguarding?Dementia – rules developing

‘all work which enables an adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect’ 5

ADASS, 2005 - National Framework of standards

Safeguarding Marblehead Carol McClain Cosgrove

Putting People First (2007) – Linked personalisation with improved safeguardingSome predictions that personalisation will enhance safeguarding (SCIE,2008; Poll, et al 2005) but many fears expressedNo Secrets review (DH, 2009) discussed need to integrate safeguarding and personalisationInitially people with severe dementia excluded from direct payments if unable to consent (as lacking capacity to make the decision) – Health and Social Care Act 2008Mental Capacity Act 2005 and revised regulations are enabling people with dementia to make use of proxies

Access to information more difficult for people with dementia (Glendinning 2008)‘The rights of people with dementia are tangled inextricably with the rights of the family caregiver’ (Tyrell et all 2006: 481)Blanket approaches to people with dementia – increases risk and reduces choice (Manthorpe, 2004)

Mrs James has dementia – after the diagnosis she drew up a Lasting Power of Attorney - her daughter Sharon now makes decisions when necessary in her mother’s best interests.Sharon gets Direct Payments from the local authority (Mrs James is eligible). Sharon is now able to fund a care package using a rota of 3 workers and one day at a day centre.

PositivesCare workers are known and Sharon is employing themSharon had to get a CRB check (new DP regs – she is not co-resident)Sharon was worried about her mother being at risk previouslyMCA offences apply to Sharon and the care workersMonitoring can stop/change arrangementsMrs James may have a better quality of care/quality of lifeSharon may be less stressed

NegativesCare workers may be abusive or neglectfulSharon might not be acting in her mother’s best interestsMonitoring may be limitedPressure on Sharon

Personalisation

Risk

?

Whereas, you know, if, and I suppose it’s not just me, I’ve heard it in general conversation that is people going to be more at risk perhaps if they’ve got family or friends doing their care. You know, could they be more inclined not to get the hours that they should be getting in, in personal care?(Team manager, Older people’s team –

IBSEN)

Two tier workforce◦

checked and unchecked (ISA and CRB)◦

trained and untrained

Vulnerability and isolation of service users and carers Easy preyLack of intervention powers (the police mainly have powers of intervention in England).Practitioners ‘policing’ rolesUnder protection and over protectionMuch articulated in the Consultation on the Review of No Secrets

Parallel tracks – little engagement of the IB pilots with adult safeguardingLittle building on adult safeguarding experiences among social workersThis reflected some uncertainties around Direct Payments etc & duties of careFears that raising safeguarding issues was at best reactionary, at worst subversiveSome evidence that the need to integrate safeguarding was being recognised

Not a bolt onRisk and recordingFinance is a fearDon’t neglect neglectAddressing carer issues (see Cooper et al BMJ 2009)

Training (actually skills development) is not the same as informationAn adult learning approachEnsure legalities are addressedEmbed into other skills development and supervisionMulti-agency talk and actionLocal context – important to know (as ever)Evaluate – eg do monitoring processes work?

What links a support plan with a safeguarding plan?

What links a best interests decision with a right to risk?

Who will stand up ‘come the inquiry’?

Recording (being clear)◦

on paper? on video? Informant histories◦

use of advance decision making processes?◦

carers’

wishes and needs

Best interests debatesLearning from IMCAs and MHAsDuties of care (not clear but get sign off from managers)

IBSEN conference 3 feb 2009

Converging of systemsMutual understanding of valuesSkills sharing between safeguarding and self-directed supportNo quick solutions or transfers (eg a Risk Enablement Panel)Meaningful practice guidance

Increasing involvement of safeguarding professionals ◦

Transforming Social Care◦

Local approaches to risk assessment

Local Safeguarding policies under review◦

...they will have IB at the forefront when they start reviewing the adult safeguarding policy’. (ASCS)

IBs discussed with local Safeguarding BoardsDefinitions of ‘vulnerable people’ to include people using Direct Payments

So this means monitoring? (how and who? )Role of Care Quality Commission, GSCC and Independent Safeguarding Authority?Bricks without straw (yes, we mean resources)Will debates surface about rights to entry/intervention? (the Scottish experiment)

Protection – empowerment Individual-collective responsesAbuse – Poor practiceAbuse is in the eye of?

Not just a council affairNor even statutory sectorWay of revitalising adult safeguardingBut there will be decisions about monitoring (over and under protection)And the safety net of social care may be tested.

Contact: Martin Stevensmartin.stevens@kcl.ac.uk020 7848 1860

Social Care Workforce Research Unit King's College LondonStrandLondonWC2R 2LS