Thinking around:
what are the practical challenges
of bringing safeguarding &
personalisation?
Jill Manthorpe on behalf of the Evidem &
personalisation & risk research team:
NIHR & SSCR funded
Sandwell June 2012
Your questions
• Ensuring safety
• Legal changes
• Emerging interest in
self-neglect
• Checking & vetting
• Transition
Sandwell June 2012
Personalisation...
Personalisation: individuals not institutions take control of
their care. Personal budgets, preferably as direct payments,
are provided to all eligible people. Information about care
and support is available for all local people, regardless of
whether or not they fund their own care.
DH (2011) A Vision for Adult Social Care: Capable
Communities and Active Citizens p8
Likely to be in Care and Support White Paper....
Sandwell June 2012
Personalisation
• Long-standing– back to
1980s & cross party &
global
• Twin drivers
– Challenging inflexible
services & professionals
to maximise autonomy
– Reducing role of the
state, promoting market
solutions
– Err, not safeguarding
Sandwell June 2012
Continued commitment
Government commitments to...
• extend the greater rollout of personal budgets to
give people and their carers more control and
purchasing power; and
• use direct payments to carers and better
community-based provision to improve access to
respite care.
DH (2011) A Vision for Adult Social Care: Capable
Communities and Active Citizens p6
Sandwell June 2012
Why did personalisation not relate
to safeguarding?
• Not just in England but
also in Scotland
• Ambivalence?
• Overloaded?
• Anxiety?
• Uncertainty eg audit,
duty of care?
Sandwell June 2012
Early perceptions of risk
• Poorer quality services
• Service users being overwhelmed by managing IBs
– If there’s a problem they can’t just ring us up and say, ‘Sort
it’. Because if they’re actually employing the person,
they’ve got to sort that out with whoever it is that’s
supporting them to employ that person (Team manager
people with learning disabilities team).
• IB used inappropriately and unproductively
Glendinning, C., Challis, D., Fernández, J-L., Jacobs, S., Jones,
K., Knapp, M., Manthorpe, J., Moran, N., Netten, A., Stevens, M.
And Wilberforce, M. (2008),Evaluation of the Individual Budgets
Pilot Programme: Final Report, York, The Social Policy Research
Unit
Emerging concerns
• Two tier workforce
– checked and unchecked (ISA and CRB)
– trained and untrained
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Vulnerability & isolation of service users & carers
Lack of intervention powers
Easy prey
Practitioners unable to manage ‘policing’ roles
Practitioners asked to meet audit requirements
Under protection and over protection
Much articulated in the Consultation on the Review
of No Secrets
New arenas
• The little book of big
scams, 2012
• Tag line:
Just remember: If it
sounds too good to
be true, it probably
is.
Metropolitan Police & AEA
Sandwell June 2012
Financial abuse – Evidem MCA study
• Focus group with people with
dementia
• Focus group with carers
• Survey data of
– Alzheimer’s Society staff
– Nursing and social services
staff
– People with dementia
– Carers
• Interviews with Safeguarding
Adult Coordinators
Sandwell June 2012
Point to Safeguards but limits of
Mental Capacity Act
• LPA and Deputy safeguards OPG
• Uncertainties -mild
cognitive impairment
• Recognising decline
• Offences of wilful neglect &
ill-treatment
• Requirements on Indirect
PB holders
Sandwell June 2012
Over and Under Protection
• Crystallised in
Vetting and Barring
• Hybrid working – kin
as carers
• Little on ‘out of area’
monitoring
Sandwell June 2012
Positive risk taking
We actually need to point out to service users,
‘Maybe the reason we don’t want you to do that
is because you could get hurt, and we can see
it’. But again, it’s about risk learning. You
know, it’s positive risk taking. And we’re not
good at that. And so that’s fear for us.
(Care Coordinator, Mental Health)
See Nothing Ventured Nothing Gained DH 2010
IBSEN – Glendinning et al 2008
Sandwell June 2012
Contribution to
quality of life
Hig
h
Risk ‘heat map’
Maximise safety
enhancement and risk
management - protect the
individual and manage the
activity
Carefully balance safety
enhancement and activity
management to protect the
person
Minimal safety enhancement
necessary - carry out with
normal levels of safety
enhancement
Substitute - can the same
personal benefit be delivered
in a different way - seek
different activities?
Carefully balance safety
enhancement and activity
management to protect the
person
Minimal safety enhancement
necessary - carry out with
normal levels of safety
enhancement
Find alternatives - level of risk
Challenge real value of the
Undertake the activity or seek
is not related to the
activity to the individual - seek alternatives that may provide
benefit/value to the person alternatives that are more
a better relationship with
find alternatives
attractive and lower risk
their needs
Sandwell June 2012
Low
High
Medium
Lo
w
Progress:
Local practice developments
• Publicity and information to people using services
and general public eg local free newspaper
– For example, on how to respond to allegations, seek advice
and make a referral. (ASCS)
• Training for people using services and carers
– We are setting up user groups to advise on the policies and
we are going to other service users’ training on policy and
categories of abuse’ (ASCS)
– Groups to influence locally – often forgotten eg
Community Nurses
What can be done?
• Converging of systems
• Mutual understanding of values
• Skills sharing between safeguarding and
personalisation
• No quick solutions or transfers (eg a Risk Enablement
Panel)
• Be alert to law and legal guidance
How can we move forward?
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•
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Not just a council affair
Nor even just statutory sectors
Way of revitalising adult safeguarding
Decisions needed about monitoring
Fundamental understandings about
uncertainty of risk
• Need more evidence of what works & doesn’t.
!
Disclaimer:
This report/article presents independent research
commissioned by the National Institute for Health Research
(NIHR) under its Programme Grants for Applied Research
scheme (RP-PG-0606-1005) and Personalisation & Risk study
funded by NIHR SSCR. The views expressed in this publication
are those of the author(s) and not necessarily those of the
NHS, the NIHR or the Department of Health.
Research teams: Martin Stevens, Kritika Samsi, John
Woolham, Kate Baxter, Jill Manthorpe