lifespansafeguarding v4 04.03.15
TRANSCRIPT
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Lifespan Safeguarding for people with learning disabilitiesTeam managers’ workshop
Margaret Flynn Caroline BennettAmanda Harvey
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Workshop aims and objectives
• To understand lifespan perspectives in safeguarding people with learning disabilities
• To share the experience of undertaking a Serious Case Review at Winterbourne View Hospital
• To share understanding of safeguarding in the context of the SEND reforms in the wake of the Children and Families Act
• To work more effectively across the lifespan• To engage with the experience of transition • To understand the limitations of safeguarding practice• To ensure that the experiences of children, young people and adults
with learning disability are at the heart of professional practice
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Introductions• Your name and job role (adults/
children?)
• A strength of yours (something you do well) in safeguarding people with learning disabilities
• A challenge in safeguarding people with learning disabilities that you’d like to address today
Individual characteristics
MotivationPerceived utility
PersonalityLearner readiness
Training design and delivery
Needs analysisContent relevance
Discuss transferPractice & feedback
Case studiesTransfer distanceSelf management
Learning goalsFollow up
Workplace factorsSupport (Manager)
Support (Colleagues)Opportunity to use
Strategic linkFollow up/ evaluation
Feedback
(Baldwin and Ford, 1988; Burke and Hutchins, 2007; Pike 2012.)
Training transfer
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What is lifespan safeguarding?
• A lifespan approach for children, young people and adults
• Challenges • What can help?
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Adults: Key principles of the Care Act (1)• ‘The person knows best• Person’s views, wishes feelings and beliefs should
always be considered• The focus is on well-being, prevention or delaying
the development of the need for care and support and reducing needs
• Decisions should be made taking all circumstances into consideration
• Decisions with the person’s participation
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Adults: Key principles of the Care Act (2)• We need to balance the person’s wellbeing with that
of family and friends involved with the person• We need to protect people from abuse and neglect• We need to minimise the restriction of rights or
freedom of action• A strength based approach is critical to assessment
and promoting independence’
LGA/ ADASS regional MSP events, 2014/15
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‘it is unhelpful to prescribe a process that must be followed whenever a concern is raised’ s14.4
‘Making safeguarding personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety’ s 14.5
‘It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals.
s14.4
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Context – children’s • Disabled children and young people are:
– 3x more likely to experience abuse and neglect – More likely to be abused by someone in their family or
someone known to them– Less likely to be subject to a CP Plan
• Children and Families Act– Participation– Outcomes focused assessment and planning from 0-25– Personalisation and Personal budgets
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First thoughts • How do adults’ and children’s
contexts line up?• What helps a lifespan
approach? • What are the potential
challenges?• How can these challenges be
redYou can record your ideas on page 4 of the delegate workbook
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Too awful to remember – too awful to forget…
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What lodges in the memory?• “…from a financial
perspective, Winterbourne View Hospital was one of the best performers in the group”
• The arbitrary violence, degradation and great distress of patients and residents
• The insight and responsibility of having the whole picture
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Serious Case Reviews are• Points of reference• Multi-agency view• Editing,
contextualising, offering explanatory frameworks
• Holding individual and agencies to account but not to blame
• A means of learning about shortcomings
• A way of improving interagency safeguarding practice
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SCRs are also• A means of engaging
with the circumstances of abuse
• High stakes territory since reputations and businesses are potentially threatened
• Disconnected from NHS processes
• Messy and contentious
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The lessons…• If there hadn’t been an
undercover reporter…• Is a hospital a place of
healing?• The SCR did not
identify all crimes • Business opportunism
does not have to comply with LD policy – there are profit-distorted priorities
• Do hospitals solve problems?
• Should LD nursing and psychiatry be in sole charge?
• QA systems are safeguards?
• Institutional care went with the closure of the long stay hospitals?
• Are clinical decisions so difficult to challenge? (SoS 2014, NCASS conference)
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Winterbourne View Hospital has taught us to keep asking questions rather than accepting assumptions, for example:
• Contracts will be honoured
• Commissioners know what they are purchasing
• Decisions about contract renewal are based on hard data
• Services offer value for money
• Commissioned services will take the actions required by regulators
• Clinical governance keeps people safe and healthy
• Employees will be brought up short by the recognition of shared humanity
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And• Light touch regulation
works• We understand cruelty
– most of which is about callousness; or downplays the harmful effects; or the belief that it is justified
• Compliance results in a high quality/ valued service
• Employees take action because: I do unto others/ I’m a humanist/I have a duty of care/ it’s bad for business/ it could be my daughter/son/ brother/ sister
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The state of play post - Winterbourne
• LD Census (HSCIC, 2015) – still high numbers of people with LD, autism or Aspergers in long stay institutions
• Little change since last census in numbers or situation (anti-psychotic meds use, self-harm, average length of stay)
• Note 160 people under 18 were in inpatient units in the 2014 census.
• National Audit Office (2015) report: the government has not met it goals post- Winterbourne. #JusticeforLB, #JusticeforNico and the LB Bill
Discussion: What are the commonalities between adults and children’s?
2020
You can record your ideas on page 7 of the delegate workbook
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Break
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Lifecourse planning• What is lifecourse planning?• Good planning should be:– Informed by up to date multi agency
assessments–Person-centred–Co-produced–Outcome focused
• Power of prevention
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What tools can we use? (Activity)
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Transition • What are the risks?–Adolescent choices and behaviours in risk
• What helps?–Promoting resilience–Positive relationships–Engagement
• What can we do? (Activity)
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Lunch
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Mental Capacity Act 2005
The principles of the MCA (1)
– A person must be assumed to have capacity unless it is established that they lack capacity.
– A person is not to be treated as unable to make a decision unless all practicable (doable) steps to help him to do so have been taken without success.
– A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
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Mental Capacity Act 2005
The principles of the MCA (2)
– An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
– Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
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Mental capacity and lifespan safeguarding• The Mental Capacity Act applies to everyone in
England over the age of 16• What implications does this have for lifespan
safeguarding?
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Positive risk enablement• Benefits of risk enablement for
young people
• What supports risk enablement
• How can a lifespan approach be a protective factor?
• Activity 3
But… is the concept of risk a useful one?• Finlayson (2015) argues that we should stop talking
about ‘risk’ and start talking about ‘worries’• He questions whose interests are served by a risk
assessment model – the person’s or the professionals’?
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What are we worried about?How worried are we?How can we worry less?
• He recommends returning to ordinary language and ways of doing things, e.g. asking…
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Discussion
• Finlayson’s paper is reproduced in your workbook, section 8
• What implications does it have for your work?
• Could this idea work in adults? In children’s? If not, why not?
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Break
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The experience of children, young people and adults – a personal perspective
Peter
Dominic
Session: What next? Reflection and forward planning for practice development
• What have been the key points from today?
• What needs to come next? Personal action planning
• Completion of the evaluation questionnaire
• Closing round of anything remaining to be said today
• You can record your ideas on pages 24 – 25 of your delegate workbook
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Further reading/ references
• see workbook section 11
