Balancing safeguarding and personalisation – a practitioners’ dialogue

Safeguarding co-ordinator Gaynor McGinty feels advice provided in a recently published adult protection guide underplays the importance of the service user's ability to control their own life. Guide author Pete Morgan responds

April 11, 2013 in Adult safeguarding, Adults

I found the article by Pete Morgan, What social workers should do when care arranged by a user is unsafe, to be most interesting, writes Gaynor McGinty. However, I feel that the advice given for such a situation is insufficient and needs greater clarity.

The problem is with the actual detail of the example used, because I think it confuses issues of choice and control, issues of basic staff management, and issues of safeguarding.

In the scenario, Dorothy has capacity and has had satisfactory services from a domiciliary care agency for months. A new carer is provided and in the first week of attendance wrongly uses a hoist. It hasn’t been going on for weeks, and it is apparent that this has just happened in the week the social worker visits. Dorothy clearly knows what the problem is.

But then, suddenly, Dorothy’s control over her life, what she may or may not already be doing to contact the agency herself, or what she might want to do is not considered. In fact Dorothy is not asked what she is doing about the problem, wants to do, or anything like that. She is not empowered or supported to deal with this one-off issue herself. The social worker is instead encouraged to simply jump straight into considering safeguarding thresholds, and gathering information for a strategy meeting – not with but about – the agency. Suddenly, this is an investigation into the worker and the agency’s overall performance. I have to question why?

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There is a big middle piece missing here, and that is about how Dorothy is enabled to continue safely controlling and influencing her own life. I just wonder how disempowered, embarrassed or worried she would be feeling when this situation suddenly erupts around her.

I am not advocating that issues get diverted from safeguarding, I am suggesting that there needs to be some sensitivity and responsibility toward Dorothy and what she is trying to do with her life. And that seems to be a major missing piece in the proposed strategy. As Lord Justice Munby once stated in a major ruling, what is the point in making people safe if you also make them miserable? Dorothy has choice and control, and safeguarding should be supporting that – and then perhaps checking out with commissioning or safeguarding whether other, similar issues relate to that agency.

Gaynor McGinty is an adult safeguarding co-ordinator and a member of Action on Elder Abuse’s Practitioners’ Network

I think the concerns raised about the guidance fall into two distinct areas: the first relates to the general principle of whether such guidance is helpful or not; the second relates specifically to the example of Dorothy, writes Pete Morgan.

With regard to the first, I would accept that there is always a danger with guidance such as this, that it will either be succinct and too general or verbose and too specific. By definition, these situations are complex and difficult to describe without going into great detail and at great length. In particular, Dorothy’s situation is described very briefly and additional information that would be available in a ‘real-life’ situation had to be omitted.

That is why the document, and accompanying guides on responding to cases where care arranged by a service user breaks down or is poor, contain the rider: “This briefing should be used as a guide only and a trigger for reflection on specific situations; where relevant, practitioners should seek advice from their organisation’s safeguarding lead and legal services.”

Equally, reference is made in all three to the importance of acting in accordance with the Mental Capacity Act 2005 and supporting the service user to make their own decisions. What I endeavoured to do was to use very simple scenarios to draw out general principles of good practice that practitioners could reflect upon and apply, with support, to specific situations they encountered. My own view is that a full description would pose problems as the greater detail would move the scenario further away from the situation in practice.

With regard to the second area, while I accept that Dorothy should be enabled to exercise choice and control over her own life, the concerns apply to a worker and agency who have access to other adults who may not have the capacity to safeguard themselves. She does not, in my view, have the right to prevent a safeguarding alert being raised about the quality of the care provided to her in so much as it may impact on other people.

Given the possible number of people who could be receiving care from the agency and the worker, I believe a strategy meeting, or its equivalent under the local safeguarding procedures, should be held to decide what action needs to be taken. As the guide says, it may be that the safeguarding procedures are not implemented in this case, but the concerns addressed via alternative processes.

However, that decision should be a multi-agency one, based on shared knowledge of the agency and the worker, not made by a single agency or member of staff. The local authority has a responsibility wider than just to Dorothy, to other service users and for the use of the public purse. Having said that, safeguarding is about enhancing the quality of service users’ life and Dorothy should be fully involved in the decision-making in so far as it relates to her.

Pete Morgan is chair of trustees at the Practitioner Alliance for Safeguarding Adults UK