Martin Stevens,
Social Care Workforce Research Unit
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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
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‘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
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ADASS, 2005 - National
Framework of standards
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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
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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)
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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
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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)
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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
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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
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Not a bolt on
Risk and recording
Finance is a fear
Don’t neglect neglect
Addressing carer issues (see Cooper et al BMJ 2009)
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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?
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What links a support plan with a safeguarding
plan?
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What links a best interests decision with a
right to risk?
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Who will stand up ‘come the inquiry’?
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Recording (being clear)
◦ on paper? on video? Informant histories
◦ use of advance decision making processes?
◦ carers’ wishes and needs
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Best interests debates
Learning from IMCAs and MHAs
Duties of care (not clear but get sign off from
managers)
IBSEN conference 3 feb 2009
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Converging of systems
Mutual understanding of values
Skills sharing between safeguarding and selfdirected support
No quick solutions or transfers (eg a Risk
Enablement Panel)
Meaningful practice guidance
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Increasing involvement of safeguarding
professionals
◦ Transforming Social Care
◦ Local approaches to risk assessment
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Local Safeguarding policies under review
◦ ...they will have IB at the forefront when they start
reviewing the adult safeguarding policy’. (ASCS)
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IBs discussed with local Safeguarding
Boards
Definitions of ‘vulnerable people’ to include
people using Direct Payments
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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)
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Protection – empowerment
Individual-collective responses
Abuse – Poor practice
Abuse is in the eye of?
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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 Stevens
martin.stevens@kcl.ac.uk
020 7848 1860
Social Care Workforce Research Unit
King's College London
Strand
London
WC2R 2LS