Thinking around:what are the practical challenges

of bringing safeguarding & personalisation?

Jill Manthorpe on behalf of the Evidem & personalisation & risk research team:

NIHR & SSCR funded

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Your questions

• Ensuring safety• Legal changes• Emerging interest in

self-neglect• Checking & vetting• Transition

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Personalisation...

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Personalisation: 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

Likely to be in Care and Support White Paper....

• Long-standing– back to 1980s & cross party & global

• Twin drivers– Challenging inflexible

services & professionals to maximise autonomy

– Reducing role of the state, promoting market solutions

– Err, not safeguarding

Personalisation

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Continued commitment

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Government commitments to...•extend the greater rollout of personal budgets to give people and their carers more control and purchasing power; and•use 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

Why did personalisation not relate to safeguarding?

• Not just in England but also in Scotland

• Ambivalence?• Overloaded?• Anxiety?• Uncertainty eg audit,

duty of care?

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Early perceptions of risk• Poorer quality services• Service users being overwhelmed by managing IBs

– If there’s a problem they can’t just ring us up and say, ‘Sort it’. Because if they’re actually employing the person, they’ve got to sort that out with whoever it is that’s supporting them to employ that person (Team manager people with learning disabilities team).

• IB used inappropriately and unproductively

Glendinning, C., Challis, D., Fernández, 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

Emerging concerns• Two tier workforce

– checked and unchecked (ISA and CRB)– trained and untrained

• Vulnerability & isolation of service users & carers• Lack of intervention powers• Easy prey• Practitioners unable to manage ‘policing’ roles• Practitioners asked to meet audit requirements • Under protection and over protection• Much articulated in the Consultation on the Review

of No Secrets

New arenas

• The little book of big scams, 2012

• Tag line: Just remember: If it

sounds too good to be true, it probably is.

Metropolitan Police & AEA

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Financial abuse – Evidem MCA study

• Focus group with people with dementia

• Focus group with carers• Survey data of

– Alzheimer’s Society staff– Nursing and social services

staff– People with dementia– Carers

• Interviews with Safeguarding Adult Coordinators

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Point to Safeguards but limits of Mental Capacity Act

• LPA and Deputy safeguards - OPG

• Uncertainties -mild cognitive impairment

• Recognising decline• Offences of wilful neglect &

ill-treatment• Requirements on Indirect

PB holders

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Over and Under Protection

• Crystallised in Vetting and Barring

• Hybrid working – kin as carers

• Little on ‘out of area’ monitoring

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Positive risk taking

We actually need to point out to service users, ‘Maybe the reason we don’t want you to do that is because you could get hurt, and we can see it’. But again, it’s about risk learning. You know, it’s positive risk taking. And we’re not good at that. And so that’s fear for us. (Care Coordinator, Mental Health)

See Nothing Ventured Nothing Gained DH 2010

IBSEN – Glendinning et al 2008

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Risk ‘heat map’Maximise safety

enhancement and risk management - protect the individual and manage the

activity

Carefully balance safety enhancement and activity

management to protect the person

Minimal safety enhancement necessary - carry out with

normal levels of safety enhancement

Substitute - can the same personal benefit be delivered

in a different way - seek different activities?

Carefully balance safety enhancement and activity

management to protect the person

Minimal safety enhancement necessary - carry out with

normal levels of safety enhancement

Find alternatives - level of risk is not related to the

benefit/value to the person - find alternatives

Challenge real value of the activity to the individual - seek

alternatives that are more attractive and lower risk

Undertake the activity or seek alternatives that may provide

a better relationship with their needs

High

LowHigh Medium Lo

w

Contribution to quality of life

Progress: Local practice developments

• Publicity and information to people using services and general public eg local free newspaper– For 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)

– Groups to influence locally – often forgotten eg Community Nurses

What can be done?

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

personalisation• No quick solutions or transfers (eg a Risk Enablement

Panel)• Be alert to law and legal guidance

How can we move forward?

• Not just a council affair• Nor even just statutory sectors• Way of revitalising adult safeguarding• Decisions needed about monitoring• Fundamental understandings about

uncertainty of risk• Need more evidence of what works & doesn’t.

!

Disclaimer:

This report/article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (RP-PG-0606-1005) and Personalisation & Risk study funded by NIHR SSCR. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Research teams: Martin Stevens, Kritika Samsi, John Woolham, Kate Baxter, Jill Manthorpe