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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

Putting People First (2007) – Linked personalisation with improved safeguarding

Some predictions that personalisation will enhance safeguarding (SCIE,2008; Poll, et al 2005) but many fears expressed

No Secrets review (DH, 2009) discussed need to integrate safeguarding and personalisation

Initially people with severe dementia excluded from direct payments if unable to consent (as lacking capacity to make the decision) – Health and Social Care Act 2008

Mental 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.

Positives Care workers are known and

Sharon is employing them Sharon had to get a CRB

check (new DP regs – she is not co-resident)

Sharon was worried about her mother being at risk previously

MCA offences apply to Sharon and the care workers

Monitoring can stop/change arrangements

Mrs James may have a better quality of care/quality of life

Sharon may be less stressed

Negatives Care workers may be

abusive or neglectful Sharon might not be

acting in her mother’s best interests

Monitoring may be limited

Pressure 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 prey Lack of intervention powers (the police

mainly have powers of intervention in England).

Practitioners ‘policing’ roles Under protection and over protection Much articulated in the Consultation on

the Review of No Secrets

Parallel tracks – little engagement of the IB pilots with adult safeguarding

Little building on adult safeguarding experiences among social workers

This reflected some uncertainties around Direct Payments etc & duties of care

Fears that raising safeguarding issues was at best reactionary, at worst subversive

Some evidence that the need to integrate safeguarding was being recognised

Not a bolt on Risk and recording Finance is a fear Don’t neglect neglect Addressing carer issues (see Cooper et al BMJ 2009)

Training (actually skills development) is not the same as information

An adult learning approach Ensure legalities are addressed Embed into other skills development and

supervision Multi-agency talk and action Local 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 debates Learning from IMCAs and MHAs Duties of care (not clear but get sign off

from managers)

IBSEN conference 3 feb 2009

Converging of systems Mutual understanding of values Skills sharing between safeguarding and

self-directed support No 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 Boards

Definitions 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 responses Abuse – Poor practice Abuse is in the eye of?

Not just a council affair Nor even statutory sector Way of revitalising adult safeguarding But 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