Personalisation is about letting older and disabled people take risks others take for granted. But this means councils must find new ways of keeping them safe
The government’s adult social care vision, due out shortly, is expected to be based around four Ps – partnership, prevention, personalisation and protection. The last two of these Ps have long been seen as being in tension.
Personalisation is about allowing disabled and older people to make choices – and take risks – that others take for granted. Safeguarding is about preventing these same people coming to harm.
The spectre of more disabled and older people receiving personal budgets, purchasing support not commissioned by the council, nor regulated by the Care Quality Commission, and handling money that may leave them open to abuse by carers, has obvious safeguarding implications.
However, Action on Elder Abuse chief executive Gary FitzGerald warns: “I don’t know how much time it’s going to take before people have a grasp of how personalisation and safeguarding fit together.”
Plans from the previous government to produce new guidance on safeguarding to fit the personalisation era came to nothing. At the same time, Labour pressed ahead with the roll-out of personalisation, something the coalition wants to speed up.
Labour aimed to have 30% of service users on a personal budget by April 2011, and the coalition wants to extend this to all users by 2013.
Action on Elder Abuse is advising the Department of Health on how safeguarding practice can be brought into line with this timetable. Meanwhile, councils have been developing ideas to ensure that personalisation and safeguarding are in step with each other (see panel).
Though FitzGerald has concerns about the speed of the roll-out of personal budgets, he rejects any straight contradiction between personalisation and safeguarding.
“I can see situations where constructing an individual budget, where you could control who had access to it, and how decisions were made, could empower that older person, provided the family did not have access to it,” says FitzGerald.
“Safeguarding and personalisation are two sides of the same coin,” adds Pete Morgan, chair of the Practitioners Alliance Against Abuse of Vulnerable Adults (Pava). “They are both about empowering people.”
Ruth Cartwright, British Association of Social Workers’ joint manager for England, says giving service users personal budgets can help them to break free of abusive situations. But they need to have appropriate support networks around them to enable this.
Personalisation has also seen changes to the social work role. As services users have taken on more responsibility for assessing their own needs and managing their own care, non-qualified staff have moved into care management, leaving social workers to concentrate on more complex cases and safeguarding.
FitzGerald says social workers are integral to helping service users negotiate the wider range of providers generated by personalisation, some of which will not be CQC regulated. But he worries that they could be seen as an easy target for cuts because of the reduction in their care management responsibilities. Cartwright echoes these fears.
However, few argue that safeguarding adults in a personalised world means stopping them taking risks. Indeed, both Cartwright and Morgan agree that the current approach of social work managers in councils is too risk averse. “While managers stay very much risk averse and put straitjackets on their staff and what they can do, you won’t empower social workers or service users to take risks,” says Morgan.
Cartwright adds: “You have to give service users credit; they are quite savvy and they can work things out.”
How councils are combining personalisation and safeguarding
Barking and Dagenham Council in London is in the process of developing plans to introduce a pre-payment card for those receiving personal budgets.
Council funding would be transferred onto the card and that would then be used to pay for care.
The council believes this could provide a way to empower those suffering financial abuse by setting up a payment system an abuser would not have access to. The intention would be that most suppliers of care would be paid by direct debit.
Also, in the event of abuse, it would ensure there was an audit trail that would be readily accessible by the authorities, allowing them to step in quickly.
The scheme is likely to be managed by an external financial service partner.
As increasing amounts of care are likely to be provided informally under personalisation the community’s role in safeguarding will increase.
The primary care trust and council in Barking and Dagenham have, for the past year, run a campaign, entitled I Care, to encourage greater reporting of safeguarding concerns to enable early intervention. The council has seen a doubling in referrals over that time.
The campaign focuses on alerting members of the community to common signs of abuse or neglect with slogans such as, “Jim’s milk has been there a while. Who cares?”.
Similar campaigns have also been run in Essex urging those with concerns to call the council for help and advice.
Guidance from the Association of Directors of Social Services in 2005 recommended an eight-step procedure for handling adult safeguarding cases. The stages include alerts of possible abuse, deciding whether a safeguarding enquiry is necessary, formulating a plan for assessing risk, carrying out the assessment, drawing up a plan for tackling any risks identified, reviewing the plan and recording any outcomes.
However, this can make safeguarding a separate process, outside social workers’ normal working practice in a personalised environment.
Kingston Council in London has condensed its safeguarding procedures into just four stages: alert, strategy, case conference and review. “The idea is that if you align the practice so that it’s uniform and familiar for practitioners they are more likely to be able to get on with it,” says Joe Carmody, practice manager for adult safeguarding at the council.
He adds that this fits the personalised way of working alongside the client, which is about getting to know the person and assessing their needs, planning care with them and then reviewing that care.
The council believes that this, along with other measures, will lead to a better experience of the safeguarding system for service users.
While helplines to report safeguarding concerns have been developed previously, Barking and Dagenham Council is hoping to use the same tactic in a preventive manner.
The council is investigating starting a 24-hour helpline to provide support for personal budget holders on everything from acting as an employer of personal assistants to managing finances.
The plans are still subject to funding, but the council believes they could provide the kind of fast-acting response that could avoid unsafe care situations arising.
Speaking to a client on their own can uncover latent safeguarding concerns, which they might not voice with a carer for fear of embarrassment or repercussions.
Kingston Council now includes lone appointments as part of its standard operating procedures for social workers.
This came about because safeguarding referrals were analysed by the safeguarding team. “We are not only looking for single alerts; we are looking for patterns and if we pick up a pattern we feed it back to those who are working on the frontline,” says Joe Carmody, practice manager for adult safeguarding at the council.
Carmody says he doesn’t have full data to show that the lone appointments system has worked yet, but anecdotal evidence from social workers suggests that it is delivering safeguarding results.
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This article is published in the 4 November issue of Community Care magazine under the headline Safeguarding in a Personalised Era