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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 [email protected] 7848 1860
Social Care Workforce Research Unit King's College LondonStrandLondonWC2R 2LS