How family group conferences can improve outcomes in adult care

By Linda Tapper, former adult safeguarding lead for Daybreak FGC

Over the past few years, family group conferences for adults (AFGC) have been quietly gaining momentum across the UK. In the difficult and seemingly endless financial situation we have all been trying to cope with, and in the face of ever increasing demand for services, all local authorities are trying to find ways to make best possible use of available resources.

The cost of setting up a new FGC service can appear daunting at first, but evidence is growing that overall the use of AFGC can offer real savings. That has to be good news!

Interest in AFGC has increased due to the findings and recommendations of the Making Safeguarding Personal project, and the inclusion of AFGC in the Care Act 2014 as a potentially useful tool to address safeguarding concerns, in line with the need for a less interventionist and prescriptive approach.

Tailoring services

The evidence for the success of the AFGC comes largely from the work of Daybreak FGC in Hampshire – where I worked until this summer – but many other areas in the UK are developing services specific to their own needs, and across a range of practice areas.

Places that currently either provide an AFGC service or are looking into commissioning or setting one up include Kent, Essex, Northern Ireland, Midlothian, Edinburgh, Buckinghamshire, Swansea, Camden, Coventry, Medway – and there are probably many more…

Some of these are highly specialised services. For example, Essex has long provided AFGC for mental health patients returning home from in-patient treatment, but is now considering expanding provision. In Scotland, meanwhile, Midlothian started its AFGC provision specifically for clients with dementia to help their families plan for the future.

Many others are dipping toes in the water by commissioning one-off conferences, or small pilot programmes to try the system out, before they commit to a longer-term service.

Those who become familiar with the process, and experience its impact, soon come up with new ideas. When it comes to finding new applications for FGC the only limit is our imagination.

Different methods

Given that the AFGC process will be somewhat different for adults who have capacity to make their own decisions, and those who lack the relevant capacity, there is always some debate about how it all works. So for those still unsure, here’s some points to consider:

Adults with capacity

For adults who have the capacity to make their own choices (at least about the relevant issues for the meeting), the focus will be on helping them make their own decisions, including how and when they want to be supported.

Some people are concerned that there may be pressure on the client to agree to what the family want, but with the right preparation, appropriate support and clear information on the legal situation, the client can be assured that he or she will have the final say.

Adults who lack capacity

For adults who lack the relevant capacity, the FGC can be a ‘best interest’ meeting.

Initially there was some misconception about this, with some professionals thinking that the FGC should be held first to establish the wishes of the family, then the final decision taken at a separate best interests meeting. But who wants to attend two meetings when everything necessary can be done in one?

All Mental Capacity Act (MCA) requirements for taking best interests decisions can be fulfilled by holding a FGC: the family take the lead in proposing an action plan, taking into account the wishes of the client and the views of the professionals. The decision-maker still has the legal responsibility to ensure that the plan fulfils the requirements of the MCA and that decisions are in the best interest of the client.

FGC have been shown to be very effective when there is dispute either between family members or between family and professionals, preventing the need for (and cost of) court involvement.

See how it works

Lots of people ask if they can observe a FGC, but this is not so easy – what family wants to be in a goldfish bowl while they are trying to solve sensitive family issues?

At Community Care Live London 2016 you’ll have a chance to see how it works. Alongside enthusiastic volunteers from Daybreak, I will be demonstrating a ‘live’ AFGC – not scripted, not rehearsed, not using actors, just people who understand and are passionate about the process. You may even get chance to take part if you wish… I promise it will be an informative and entertaining session.