Safeguarding, choice ,
accountability, risk taking….
Social work decision making
in context
Jill Manthorpe
28 June 2010 Decision Making
Conference
Social Work Decisions
• What many people
want to them to do
and policy makers
want to encourage
• Essence of
professionalism?
• Context of protocols,
pathways and
evidence
• The future looks…?
28 June 2010 Decision Making
Conference
If only..
28 June 2010 Decision Making
Conference
Government decisions - context
• Commission on long-term
care, to report within a year.
• Break down barriers
between health and social
care funding to incentivise
preventative action.
• Extend the roll-out of
personal budgets to give
people and their carers more
control and purchasing
power.
• Use direct payments to
carers and better
community-based provision
to improve access to respite
care.
28 June 2010 Decision Making
Conference
safeguarding
Larger evidence base for decision making
• Prevalence & incidence, data reporting
• When things go wrong eg serious case
reviews
• Case law from Mental Capacity Act 2005,
eg offences of wilful neglect/mistreatment
• Still legal uncertainties eg ISA under
review
28 June 2010 Decision Making
Conference
Practice on the ground
• Bridging support plans & safeguarding
plans
• Conditions of personal budgets –
prevention (eg checks of PAs), recipients
are ‘vulnerable adults’
• Monitoring & reviewing (Recording)
• Looking to Scotland for evidence of
intervention effects
• Linking up, DV, NHS, hate crime
28 June 2010 Decision Making
Conference
choice
• Major roll out of personal
budgets (some blended
funding) for all groups
(self-directed support)
• Money on more direct
employees (PAs) but
large agency expenditure
(need changes)
• Day centre closures
• Evidence positive – in the
main
28 June 2010 Decision Making
Conference
Practice on the ground
• Support plan processes…
• Level of monitoring and
review
• Lite touch?
• Duty of care? (IBSEN)
• More proxies (but little
advance planning –
Evidem)
• Recording choices eg
paper, video…
28 June 2010 Decision Making
Conference
2 gov decisions on Social Action:
accountability changes
• Create & expand
mutuals, co-operatives,
charities & social
enterprises, ensure
greater involvement in
running of public
services.
• Public sector workers to
get a right to form
employee-owned cooperatives & bid to take
over the services they
deliver.
28 June 2010 Decision Making
Conference
Practice on the ground
• Newish relationships of
accountability
• Commissioning requiring
evidence, confidence and
cost-effectiveness
• High use of language of
productivity
• More fissures in working
relationships leading to
greater centralisation
28 June 2010 Decision Making
Conference
Risk
• High level interest in risk
enablement and rights,
‘nothing ventured, nothing
gained’
• Not so many risk policies,
more embedded
• Focus on assembling
agreement
• Risk to self freed up but
risk to others….
• Dangerous people,
perpetrators… left aside.
28 June 2010 Decision Making
Conference
28 June 2010 Decision Making
Conference
Practice on the ground
• High levels of need
among state funded
users: different sorts
of risk; eg end of life
• Patient safety –
managing at home
• Calls to manage
crises; rapid decision
making (advance and
proxy)
28 June 2010 Decision Making
Conference
Decision making?
• Huge ethical questions (so nothing new)
• Evidence base from recording v system
requirements
• Skills at risk conversations, conflict
management, best interests…
• End thought - More decision shaping?
28 June 2010 Decision Making
Conference
resources
• Evidem.org.uk
• SCWRU - kcl.ac.uk
• NIHR National School for Social Care
Research
28 June 2010 Decision Making
Conference