sins and synergies: personalising protection

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Sins and Synergies: Personalising protection. Martin Stevens Social Care Workforce Research Unit King’s College London. Introduction. Personalisation Safeguarding Perceived risks Evidence Synergies. Personalisation. - PowerPoint PPT Presentation

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  • Sins and Synergies:Personalising protectionMartin StevensSocial Care Workforce Research UnitKings College London

  • IntroductionPersonalisationSafeguardingPerceived risksEvidenceSynergies

    open university May 2010

  • Personalisation...open university May 2010Personalisation: individuals not institutions take control of their care. Personal budgets, preferably as direct payments, are provided to all eligible people. Information about care and support is available for all local people, regardless of whether or not they fund their own care.

    DH (2011) A Vision for Adult Social Care: Capable Communities and Active Citizens p8

    open university May 2010

  • A goal for a very long time back to 1980s at leastTwin driversChallenging inflexible services to maximise autonomy Reducing role of the state and promoting market solutionsPersonalisation

  • Continued commitmentopen university May 2010This vision focuses on the Government commitments to...extend the greater rollout of personal budgets to give people and their carers more control and purchasing power; anduse direct payments to carers and better community-based provision to improve access to respite care.

    DH (2011) A Vision for Adult Social Care: Capable Communities and Active Citizens p6

    open university May 2010

  • 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 AdultsSafeguarding Marblehead Carol McClain Cosgrove

  • PersonalisationRisk

    open university May 2010

  • Personalisation and safeguardingMental Capacity Act 2005 and revised regulations are enabling people with dementia to make use of proxiesPutting People First (2007) Linked personalisation with improved safeguardingInitially 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

    open university May 2010

  • Personalisation and 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 personalisationAdult Social Care Vision (DH, 2010) argued for: sensible safeguards against the risk of abuse or neglect. Risk is no longer an excuse to limit peoples freedom (p8).

    open university May 2010

  • A context of concernTwo tier workforcechecked and unchecked (ISA and CRB)trained and untrainedVulnerability and isolation of service users and carersLack of intervention powersEasy preyPractitioners policing rolesUnder protection and over protectionMuch articulated in the Consultation on the Review of No Secrets

    open university May 2010

  • Perceived areas of riskPoorer quality servicesService users being overwhelmed by the need to manage the IBIf theres a problem they cant just ring us up and say, Sort it. Because if theyre actually employing the person, theyve got to sort that out with whoever it is thats supporting them to employ that person (Team manager people with learning disabilities team). IB used inappropriately and unproductivelyGlendinning, C., Challis, D., Fernndez, J-L., Jacobs, S., Jones, K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M. And Wilberforce, M. (2008),Evaluation of the Individual Budgets Pilot Programme: Final Report, York, The Social Policy Research Unit

    open university May 2010

  • More perceived areas of riskHiring suitable and firing unsuitable workersAre they able to deal with the problems of employing people that arent up to what they should be providing? (Care coordinator, people with learning disabilities)More open to physical and financial abuseAnd I think we may have to consider with phenomena like domestic abuse could play a part in choosing to pay a family member. (ASCS )Loss of collective voiceIBSEN Glendinning et al 2008

    open university May 2010

  • Positive risk takingWe actually need to point out to service users, Maybe the reason we dont want you to do that is because you could get hurt, and we can see it. But again, its about risk learning. You know, its positive risk taking. And were not good at that. And so thats fear for us. (Care Coordinator, Mental Health) IBSEN Glendinning et al 2008

  • EvidenceSkills for care survey of direct payments employersNo evidence of increased abusePsychological abuse the most common, with PAs and LA provided care workersLess physical abuseLess abuse for DP users compared with their own use of local authority provided servicesSome health warnings:Those using Direct Payments may have changed because of bad experiencesParticipants may have been using local authority provided services for longer than Direct Payments

    IFF Research (2008) Employment Aspects and Workforce Implications of Direct Payments,

    open university May 2010

  • Progress: Local policy developmentIncreasing involvement of safeguarding professionals Transforming Social CareLocal approaches to risk assessmentLocal Safeguarding policies under review...they will have IB at the forefront when they start reviewing the adult safeguarding policy. (ASCS)PBs discussed with local Safeguarding Boards

    open university May 2010

  • Progress: Local practice developmentsPublicity and information to people using services and general public eg use of local free newspaperFor example, on how to respond to allegations, seek advice and make a referral. (ASCS)Training for people using services and carers;We are setting up user groups to advise on the policies and we are going to other service users training on policy and categories of abuse (ASCS)

    open university May 2010

  • Progress: Local practice developmentsFollowing up complaintsCRB and ISA checks for Direct Payment usersStreamlining risk assessments and integrate all PB risk assessments

    open university May 2010

  • ExampleMrs James has dementia after the diagnosis she drew up a Lasting Power of Attorney - her daughter Sharon now makes decisions when necessary in her mothers 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.

    open university May 2010

  • Mrs JamesPositivesCare 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 mothers best interestsMonitoring may be limitedPressure on Sharon

    open university May 2010

  • Developing local policies and practiceParallel 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 subversive Glendinning et al 2008

    open university May 2010

  • Synergies? What aspects of safeguarding do we need to build into personalisation? What training, risk assessment and risk management should we use? Please tell us what you are doing locally and what more needs to be done? Q4 from No Secrets consultation

    open university May 2010

  • Synergies? What aspects of personalisation greater independence, choice and control can we build into safeguarding? How do we better reflect service users informed choices? How do we facilitate informed self-determination in risky situations and in the safeguarding process? How can we move forward on this agenda?

    Q5 from No Secrets consultation

    open university May 2010

  • What aspects of safeguarding do we need to build into personalisation? Not a bolt onRisk and recordingFinance is a fearDont neglect neglectAddressing carer issues (see Cooper et al BMJ 2009)

    open university May 2010

  • What aspects of personalisation can we build into safeguarding?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?How are outcomes for people who are vulnerable built into safeguarding investigations?

    open university May 2010

  • How do we better reflect service users informed choices?

    Recording (being clear)on paper? on video? use of advance decision making processes? Best interests debatesLearning from IMCAs and MHAsDuties of care

    open university May 2010

  • Policy and practice responsesMonitoring? (how and who? And who pays?)Role of regulator? (Care Quality Commission) and Health Professions Council; ISA/CRB)Managing with less moneyMixed support for increased right of entry/ intervention - No Secrets Consultation & Law Commission

    open university May 2010

  • What can be done?Converging of systemsMutual understanding of valuesSkills sharing between safeguarding and self-directed supportNo quick solutions or transfers (eg a Risk Enablement Panel)Balancing choice with legitimate interests in service infrastructure (preserve collective voice)Identifying those more at risk from personalisation

    open university May 2010

  • How can we move forward on this agenda?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.Need more evidence!

    open university May 2010

  • Thank YouMartin StevensSocial Care Workforce Research UnitKings College LondonStrandLondonWC2R [email protected] 7848 1860

    open university May 2010

  • **Personalisation one principle among many within A vision for adult social care

    Prevention:PersonalisationPartnership:Protection: there are sensible safeguards against the risk of abuse or neglect. Risk is no longer an excuse to limit peoples freedom. Productivity: greater local accountability will drive improvements and innovation to deliver higher productivity and high quality care and support services. A focus on publishing information about agreed quality outcomes will support transparency and accountability. People: we can draw on a workforce who can provide care and support with skill, compassion and imagination, and who are given the freedom and support to do so. We need the whole workforce, including care workers, nurses, occupational therapists, physiotherapists and social workers, alongside carers and the people who use services, to lead the changes set out here. ******There are lots of concerns about elder abuse and neglect. Every day it seems there are articles about arrests of care home staff, starvation in hospitals, murders of pensioners and so on But there were a range of concerns raised in the IBSEN interviews with care managers and with adult safeguarding staff that also were about their concerns.The first relates to the workforce and the harm that can be done by people who are determined to exploit vulnerable people. they may do this b y befriending them other determined to abuse from the start. CRB checks dont pick them up perfectly but they do perhaps establish that if there are risks then these are known, to some extent. Would you and I want this for ourselves or other relatives? You decide. But many people do I think. The other concern is that people will work for people under direct payment arrangements who are not skilled. After all how difficult can it be to take someone to the park or make them a sandwich? Well, it is not. But what we do know is that it is hard, stressful and emotionally draining to do social care work. And that there are many lay or general public misunderstanding about problems such as dementia that can lead people to work in ways that are not supportive, *********Summarising what we found in out interviews in 2007 and in 2008, were these five points. Some of this relfects the issues with training that is that training was sometimes done early when systems were not set up and so details could not be given and sometimes training was about culture change more than detail and did not seem to engage with safeguarding concerns. Risk was seen as beneficial, whereas practitioners know that it can sometimes lead to harm that cannot be reversed*These are 2 of the many questions posed by the No secrets consultation. It is the first that some of the tensions that we identified have been brought together and it was influenced we know by the IBSEN study and the first interviews we conducted in 2007 with adult safeguarding staff in the sites and the practitioners we talked to **The first 4 may be obvious, you cannot add safeguarding as an afterthought. If the pubkic sector is offering risk then you need to make a record of the decision making system. We thing that the Mental Capacity Act provides some useful frameworks here and commend this to you eg its Code of Practice . Many people are worried about financial abuse, it is emerging as the most common form of abuse in community settings. But neglect is actually the thng that was most prevalent in the UK study of elder mistrement and neglect, the largest study of this in the UK 9funded by DH and Comic Relief). So how will neglect be monitored, whether it is the criminal form of wilful neglect of people lacking mental capacity, or more a sign of inadequate care? lastly an article lst week in the BMJ said that half the carers or people with dementia admitted to some abusive behaviour. Lots depend on the definition bu these are igh figures, especially as these were the people who agreed to be asked about the topic ! How can we monitor care behind closed doors that oudns very Big Brother but there may be wider social responsibilities to both carers and vulnerable people?

    **Independent mental capacity advocates are able to help in some adult protection systems and the new Mental Health Act advocates may have a role *Well they asked, this is what we think. And we do think that it is important to look and see what happens as a result of the new Scottish laws that do allow intervention*These are our views, so take them as experiences from the Ivory Tower, sorry for pun Mark (chair) or maybe think if they are applicable to your locality**