Practice issues in adult safeguarding at a time of cuts

Adult safeguarding consultant Patrick Worthington (pictured) examines the key practice issues facing social care professionals in keeping adults at risk safe at a time of austerity and change.

This is an important time for adult safeguarding. We await the government’s response to the Law Commission’s recommendations on strengthening safeguarding while dealing with increasingly complex cases alongside a background of aggressive spending cuts. There is less money to do the basics let alone establish revisions to safeguarding practice.

Law Commission recommendations

We may well get statutory powers for adult safeguarding boards, a duty to investigate suspected abuse and even co-operate with other agencies, on the back of the Law Commission’s recommendations. Putting adult safeguarding on a similar legal and practice footing to child protection makes sense. A code of practice would establish multi-agency responsibilities and offer a clear guide to good practice.

Yet we cannot wait for the commission’s recommendations to come to fruition, through the government’s White Paper, due next April, and subsequent legislation. How councils respond and protect vulnerable people arises understandably strong feelings. Adult safeguarding has a high public profile due to public rancour at regulatory failings and the major exposes of hospital and care homes.

Safeguarding managers need a clear mandate when taking on poor providers. Yet we have to get the balance right between addressing abuse whilst working alongside providers to minimise or prevent future episodes.

Personalisation and Safeguarding

As we seek to embed greater individual choice so there is a real need for safeguarding to meaningfully inform local personalisation practice. We are asked to keep people safe and minimise risk while enabling people to do more for themselves. Understandably directors are keen to roll out personalisation while avoiding any untoward headlines. At times we have to accommodate unwise decision-making and we have to equip our practitioners to work constructively with this. Personalisation should be more than achieving a set of targets that under pressure directors demand to be filled, but rather a model of provision that slowly revolutionises how we provide services.

Eligibility

In terms of safeguarding, eligibility was an unhelpful red herring. Why was safeguarding initially defined as being an issue only for those who were receiving services? This certainly confused practitioners – there were too many vulnerable people deemed ineligible, such as people with moderate learning disability, personality disorder or dual diagnosis. Often difficult to engage and occasionally taking up inordinate amount of police, A&E and housing time, these groups include people who are vulnerable and often at significant risk and they don’t go away.

The Adults Facing Chronic Exclusion pilots, which ran from 2007-10, provided a good example of the value of working with such individuals in a lower key, less coercive manner. This harm minimisation approach, well-articulated in working with substance misuse, should inform local safeguarding practice.

Thresholds, whilst important to managing limited public resources, clash with the clear policy expectation to work in a more preventive way. In my experience, applying limited and timely engagement with people outside case eligibility helps manage situations that would otherwise slide into crisis and potential harm. The anticipated floodgates of referrals have not materialised despite the fears of some directors. Indeed where local authorities have adopted more enlightened safeguarding definitions the only thing that has changed is the quality of cross-agency work and the engagement with the harder to reach, which have both improved.

Paperwork

It seems that we have flooded practitioners with paperwork in the vain hope that the process itself will protect against unmanaged risks. This says more about corporate anxieties about bad press rather than meaningfully supporting practice. Anecdotal comment testifies to this lack of proportion as practitioners routinely describe their work balance as being 30% client contact time to 70% admin. Yet we know that good safeguarding and risk assessment improves by engaging with the individual.

In her review of child protection, Eileen Munro makes the important point that we need to return to trusting our social workers’ professional judgement and autonomy rather than overly relying on procedure. We also need sober and enlightened corporate approaches to risk management, informed by the views of frontline practitioners. Social workers need to feel they will be supported not blamed when things go wrong. And things will go wrong; that is a natural part of extending and enabling individual choice. That is not to say we excuse poor practice; rather we try to understand the conflicting demands on our social workers before we ask them to do the day job and deliver to a dramatically changing context of practice.

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