Imogen Parry
Independent Safeguarding Adults Consultant,
Researcher and Trainer for the Housing Sector
and
Co-Chair of the Housing and Safeguarding Adults
Alliance
1
SHIP Conference
29 January 2015
Learning objectives of this workshop:
• Know what you/your organisation needs to do to be ready for
implementation of the safeguarding aspects of the Care Act 2014
and related statutory guidance
• Understand the lessons for housing providers from Adult Serious
Case Reviews
• Be better equipped to address difficulties relating to partnership
working
• Be able to identify how to improve your organisation’s approach to
adult safeguarding, operationally and strategically
2
Disincentives and barriers for all social housing
providers to be involved in adult safeguarding
 Weak regulatory and legislative
responsibilities, contributing to:
 lack of a safeguarding culture
 insufficiently trained staff
 under-reporting of abuse
 limited data on vulnerabilities of tenants
 Problems and complexities of partnership
working
3
New drivers and incentives for housing providers’
engagement in adult safeguarding (1)
 Increasing public, political and media awareness of abuse
 Reputational risk for all providers of services for adults at
risk
 Increasing numbers of adults at risk living in social
housing
 Safeguarding links to other agendas that housing is (or
should be) engaged in: anti-social behaviour; crime
reduction; domestic abuse; disability hate crime; health
and well-being
4
New drivers and incentives for housing providers’
engagement in adult safeguarding (2)
 Evidence through SCRs of failures of housing
providers to prevent murder, abuse and neglect of
adults at risk, including those living in general needs
housing
 SCIE guidance on ‘Adult safeguarding for housing
staff’
 Care Act 2014 and statutory guidance
5
From ‘No Secrets’ to the Care Act
 Review of No Secrets 2008/9
 Consideration of safeguarding included in the Law
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
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Commission review of Adult Social Care Law 2010/11
Care and Support Bill published July 2012
Care Bill published May 2013
Care Act 2014 received Royal Assent May 2014
Statutory guidance consultation June – August 2014
Final statutory guidance published October 2014
Care Act and statutory guidance due for implementation
from April 2015 – see
www.local.gov.uk/care-support-reform.
6
The limitations of ‘No Secrets’ 2000
 Statutory guidance – not legislation
 Preceded the Mental Capacity Act 2005, much case law
arising from the Human Rights Act 1998, DoLS
 Referred to ‘vulnerable adults’ (not ‘adults at risk’) and
‘adult protection’ (not ‘adult safeguarding’)
 Limited list of types of abuse
 Focus on process and procedures which contributed to
‘risk aversion’ not ‘outcomes’ (MSP)
 Lack of clarity about differences between poor practice,
abuse, crime
 ‘Only’ sheltered and supported housing staff included
7
Statements of Government Policy on
Adult Safeguarding
 Issued in May 2011 and May 2013; now incorporated into the Care
Act statutory guidance 2014
 Set out adult safeguarding principles:
 Empowerment – presumption of person led decisions and informed





8
consent
Prevention – it is better to take action before harm occurs
Proportionality – proportionate and least intrusive response
appropriate to the risk presented
Protection – support and representation for those in greatest need
Partnership – local solutions through services working with their
communities. Communities have a part to play in preventing,
detecting and reporting abuse
Accountability – accountability and transparency in delivering
safeguarding
Who is a ‘vulnerable adult’ or
‘adult at risk’?
Under the Care Act 2014 safeguarding duties apply
to an adult who:
(a) has needs for care and support (whether or not
the authority is meeting any of those needs)
(b) is experiencing, or is at risk of, abuse or neglect,
and
(c) as a result of those needs is unable to protect
himself or herself against the abuse or neglect or
the risk of it.
9
9
The Care Act 2014 - safeguarding sections
42 - 45
• New duty for local authority to carry out enquiries (or
cause others to) where it suspects an adult is at risk of
abuse or neglect.
• Requirement for all areas to establish a Safeguarding
Adults Board (SAB)
• SABs to carry out safeguarding adults reviews (SARs)
• New ability for SABs to require information sharing
from other partners to support SARs or other
functions.
10
The Care Act 2014 – other sections and guidance
relevant to safeguarding adults
 Well-being
 Co-operation
 Information sharing
 Prevention focus
 Advocates
 Level of needs not relevant
 Wide scope for what constitutes abuse or neglect
 Additional types of abuse included
11
Main types of abuse (italicised are new)
 Physical
 Psychological/emotional
 Sexual
 Financial
 Neglect
 Discrimination
 Organisational abuse
 Domestic abuse
 Sexual exploitation
 Modern slavery
 Self-neglect
12
12
Does the Care Act go far enough to safeguard
adults?
 The Care Act is a major improvement on ‘No Secrets’
 But there:
• are resource concerns
• is no power of entry or duty to report despite much lobbying and
•
•
•
•
•
13
debate
may be insufficient ‘teeth’ for SABs to be effective
may continue to be confusion about thresholds and sometimes an
absence of systems for low level concerns
are insufficient references to the need to make links with other issues
such as domestic abuse, hate crime and ASB
are continuing contradictions about consent issues
is insufficient emphasis on need for improved practice by all
professionals, including attitudes towards partnership working and
capacity assessments
The Care Act statutory guidance for
adult safeguarding – housing implications (1)
 14 references to housing providers, housing support
providers
 Agencies should identify a senior manager to take a
lead role in organisational and inter-agency
safeguarding arrangements
 Although not a statutory member of SABs, housing
providers and housing support providers may be
invited
 Housing support workers may be asked to ‘make
enquiries’
14
The Care Act draft statutory guidance for
adult safeguarding – housing implications (2)
 All housing providers and housing support
providers should have clear operational policies
and procedures in adult safeguarding
 All housing staff must be:
• familiar with the six principles underpinning
adult safeguarding
• trained in recognising the symptoms of abuse
• vigilant and able to respond to adult
safeguarding concerns
15
What is ‘Making Safeguarding
Personal?’
 Combines ‘personalisation’ approach with
safeguarding
 Intention of MSP is to facilitate person-centred
outcome-focused responses to adult safeguarding
 Key messages from MSP development project:
 Focus on what outcome service user wants, which may
not just be about being safe – empowerment and being
in control may be as important
 Avoid putting them through a process
 Work with service users’ networks and strengths
16
Implementation of Care Act and
MSP – letter from DH, Nov 2014
 Rather than seeking to update existing policies and
procedures and ‘bend’ them to fit the aims of the Care
Act we urge local authorities to sit down with their
partners to agree how their new arrangements will
work’
 The basis for these discussions should be:
 the statutory guidance
 MSP values, standards and guides
 The diagrams 1A and 1B on pages 250-252 of the
statutory guidance
17
Adult safeguarding self assessment checklist against the Care Act
statutory guidance for housing and housing support providers (1)
Question
1a Do you have a senior manager with
strategic responsibility for safeguarding?
OR
b Do you have an operational lead for
adult safeguarding?
2a Have you a safeguarding adults policy
and internal procedures that cover ALL
staff and are regularly reviewed?
b Do they include the 6 principles?
Do they include guidance on record
keeping?
Are staff vigilant about adult
safeguarding?
c Do you have internal systems in place to
ensure compliance with policies and
18 procedures?
Para reference
in the statutory
guidance
14.187
14.109
14.187
14.109
14.29, 14.30,
14.41,14.54,
14.86, 14.196,
14.205
14.13
14.87, 14.150
14.29, 14.30
Yes
No
In
progress
Comments/ evidence
Adult safeguarding self assessment checklist against the Care Act
statutory guidance for housing and housing support providers (2)
3 Have you regular safeguarding training for all staff in
contact with adults at risk?
4 Can staff access regular face to face supervision from
skilled managers?
14.30,
14.86
14.46,
14.172
Can staff access practical and legal guidance, advice and
support?
5 Are you involved in a Safeguarding Adults Board (SAB) or
housing sub group? If you are not directly involved, are
you able to get involved via a housing representative on
any SABs? Have you worked with other local housing
providers to seek housing representation and other
engagement with the SAB?
6 Have you discussed (internally and with the adult social
care safeguarding lead) the implications of S42(2) in the
Care Act and related para in the guidance of the possibility
of being asked to ‘make ’ enquiries?
7 Have you sought to engage with the local multi-agency
safeguarding hub (MASH) (if one exists?)
14.40
19
14.117
14.84,
14.59
14.164
Adult safeguarding self assessment checklist against the Care Act
statutory guidance for housing and housing support providers (3)
8
9
Has anyone in your organisation made
effective links with Local Authority
Safeguarding Leads to ensure
cooperation and information sharing,
improve joint working, addressing
barriers?
14.53,
14.154,
14.34
Are roles and responsibilities clear
and is there collaboration at all
levels?
14.167
Do you have arrangements in place to
ensure review and learning?
10 Do you engage with all customers
regarding safeguarding (eg information,
awareness raising).
20
14.11,
14.165
Serious Case Reviews
 A review of the circumstances of the death of a
vulnerable adult if abuse or neglect was suspected
 ‘The overriding reasons for holding a review must
be to learn from past experience, improve future
practice and multi-agency working’ (ADASS and
LGA, 2013)
21
My research on adult Serious Case Reviews
 Half the 21 subjects lived in specialist housing (or
received specialist housing services), half lived in
general needs housing
 All but 2 individuals had either physical health or
mental health issues, the other 2 had learning
disabilities
 3 cases showed between 5-7 features indicating
vulnerability
 Thematic analysis identified 6 themes/lessons
22
Summary of findings
Internal lessons for housing providers:
A.
B.
C.
Poor data base of vulnerabilities (7 cases)
Poor contract/support monitoring (4 cases)
Narrow focus/poor understanding of safeguarding/not
referring (10 cases)
External lessons for housing providers:
D.
E.
Exclusion of housing from information sharing/
assessment/ monitoring (11 cases)
Thresholds too high/ failure to capture low level concerns
(7 cases)
F.
23
Problems with Adult Social Care: assessments (including
risk, capacity); diagnosis; choice (16 cases)
21 housing related SCRs
 BANES, 2013: ‘PQ’
 North Yorkshire, 2012: Robert
 Bucks, 2010: Mr B
 Sheffield, 2004: Margaret Panting
 Bury, 2010: ‘Adult A’
 Southampton, 2012: Mr A
 Cornwall, 2007, 2009:
 Stockport, 2011: Martin Hyde
Steven Hoskin, JK
 Coventry, 2012: Mrs C
 Dorset ,2013: JT
 Sunderland, 2012: Mrs AM
 Leics, Leics and Rutland, 2008:
 Torbay, 2011: Ms Y
Fiona Pilkington
 Luton, 2011: Michael
Gilbert
 North Tyneside, 2011:
24
Cynthia
Barrass/Adult A
 Surrey, 2010, 2010: ‘CC’, 0001
 Tameside, 2011: David Askew
 Warwickshire, 2011: Gemma
Hayter
 Worcestershire, 2010: A1
A. Poor data base of vulnerabilities
‘Commissioners cannot organise the
improvement of services unless
they know quite a lot about the
people using them’
(The Information Governance Review, Dame Fiona Caldicott,
2013, p.14).
25
A. Poor data base of vulnerabilities
 Failure by landlords to record the vulnerabilities of
all tenants was a contributory factor to the eventual
death or serious harm of the 7 individuals
 The reasons for these poor data bases included:
 not understanding the nature of vulnerability
 not asking the right questions
 not recording the answers
 not having an adequate IT system to record
vulnerabilities.
 In some cases, even where vulnerabilities were
26
recorded, there were problems with the
incompatibility of the data with other agencies’
systems.
B. Poor support/contract monitoring
 Although most SCR discussion on contract monitoring
focuses on failures by Adult Social Care (ASC),
housing agencies can also be culpable.
 The monitoring role of housing staff was often not
made clear in the SCRs but this role is recognised in
the Quality Assessment Framework of the Supporting
People programme
27
C. Narrow focus/ poor understanding/ not
referring
Failure by housing staff to refer abuse or
hate crime into safeguarding was a
contributory factor in the deaths or serious
harm of 12 individuals living in social
housing
28
‘All staff need to have a greater curiosity
and enquiring approach about what
they observe and to be aware when
they need to pursue further
information either directly with the
individual or through other agencies’
(SCR concerning PQ, Bath and North East Somerset, para.24)
29
Reasons for under-reporting of abuse
by housing staff include:
 A narrow, uninformed focus by the housing provider
 Different definitions of vulnerability
 Erroneous belief that consent by the victim is always
necessary
 Incorrect assumption that evidence is needed before making
an alert or referral
 Inadequate policies regarding service refusal and
insufficient understanding of the Mental Capacity Act 2005
 Poor practice in offering accommodation to victims rather
than addressing the abuse through safeguarding procedures.
30
D. Exclusion from information sharing
‘The duty to share information
can be as important as the duty
to protect patient
confidentiality’
(The Information Governance Review, Dame Fiona Caldicott,
2013, principle 7, page 21).
31
Quote from SCR on the exclusion of housing
from information sharing
 ‘Support Officers were not seen as professional by
social care colleagues. A support officer made a referral
to ASC and was asked to leave the resultant meeting,
even though she was an alerter and had a lot of
understanding of the situation. Housing is outside the
loop at present.’ (Steven Hoskin/Cornwall)
32
E. ASC referral thresholds too high, failure to
capture low level concerns
 The threshold issues in the 7 cases support the
argument in favour of low thresholds that responding
to low level concerns (that include harassment and
disability hate crime) helps to prevent serious harm or
death.
33
F. Quotes from SCRs on problems with Adult Social Care:
choice; assessments (including risk, capacity); diagnosis (1)
34
• ‘There was a lack of co-ordination of responses as JK’s
situation deteriorated and incidences occurred that could
have been regarded as safeguarding alerts. Services got
confused about choice and risk, they lost the ability to
work in anything but a reactive fashion. There was no
shared multi-agency assessment about her needs and the
risks she faced.’ (JK/Cornwall)
• ‘Steven’s ‘choice’ to terminate contact with ASC was not
investigated or explored with him, or other key agencies
involved in his care, even though such choices may
compound a person’s vulnerability; may be made on the
basis of inadequate or inappropriate information; or result
from the exercise of inappropriate coercion from third
parties.’ (Steven Hoskin/Cornwall)
F. Quotes from SCRs on problems with Adult Social Care:
choice; assessments (including risk, capacity); diagnosis (2)
 ‘The presumption of capacity under the MCA 2005
does not mean that professionals are exempt from
asking challenging and searching questions in
relation to individuals who are making choices
that are problematic. The presumption of capacity
does not exempt authorities and services from
making robust assessments where a person’s
apparent decision is manifestly contrary to his
well-being.’ (Michael Gilbert/Luton AND Adult A/Stockport)
35
F. Quotes from SCRs on problems with Adult Social Care:
choice; assessments (including risk, capacity); diagnosis (3)
 ‘A key finding from this review is how an alcohol
dependent individual, with serious health issues and
in need of safeguarding was consistently viewed as
making lifestyle choices’ (Ms Y/Torbay)
 ‘The housing agency make repeated attempts to refer
Gemma to Adult Social Care but were told that she did
not have a learning disability and had capacity to make
her own choices’
(Gemma Hayter/
Warwickshire)
36
F. Problems with ASC risk and capacity
assessments; diagnosis
 Failures of assessment , diagnosis and multiagency working were contributory factors to the
death or serious harm of the individual.
 Common themes included:
 failures to assess capacity or risk; assumptions
rather than assessments
 the need for effective multi-agency working
that led to holistic assessments (which were
focused on the victims, not their families)
37
SCRs regarding deaths in sheltered and
supported housing – key issues
 Mr B/Bucks – sheltered housing staff not given care
plan, not officially able to support tenants (but rang
him daily)
 Mrs AM/Sunderland – contradiction re monitoring
role of housing support agency
 Mr A/Southampton – confusion between care, support
and health support regarding respective roles
38
SCRs regarding deaths in sheltered and
supported housing – key issues
 Mrs C/Coventry – insufficient risk
assessment of equipment
 0001/Surrey – insufficient information
sharing meant risks not appreciated
 Margaret Panting/Sheffield - warden’s
concerns not responded to
39
Cynthia Barrass – North Tyneside
 Missed opportunities by housing provider:
 Rent arrears
 Refusal to grant access for gas servicing
 Garden maintenance issues
 Housing provider was ‘reactive’, not proactive
 Failure of systems to ensure follow up of the
disconnection of gas, to insist on a home visit and to
alert social services
40
Overcoming information sharing
problems – tips for housing staff
 Know about and use all relevant multi-agency information
sharing protocols
 Set up multi-agency meetings to improve these protocols and
address problems
 Draw on law and guidance in:
 Care Act and statutory guidance
 SCIE guide ‘Adult safeguarding and housing’
 SCIE Care Act resource ‘Sharing information’ (due Feb 2015)
 Increase awareness and understanding of role of housing staff
 Ensure that decisions are being taken at the right level within
your organisation and within Adult Social Care
41
Tips to housing staff re thresholds
 If told that the alert or referral cannot be accepted (as it doesn’t meet their
referral threshold or their definitions of abuse or vulnerable adult/adult at risk),
consider:
 checking what their policy says on referral criteria and definitions. Is
their interpretation open for discussion?
 reconsidering the facts of your referral – have you left something out or
underestimated/downplayed the risks?
 ask if they have a mechanism for gathering information on apparently low
level cases, especially where there is an emerging pattern of referrals, eg
MASH, VARM (quote Pilkington, Hayter)
 asking for advice on how to handle the situation yourself or via other
agencies
 If the case is not accepted and investigated, refer again if circumstances and
risks change
 Ensure that decisions are being taken at the right level within your organisation
and within Adult Social Care
42
Tips to housing staff encountering problems re
assessment, diagnosis, choice
 If you are told ‘it is the person’s choice’ (eg to refuse
services/intervention/proceed with prosecution) or that ‘they have
capacity and the right to make unwise decisions’ consider:
 Was the person coerced?
 Is anyone else at risk?
 Has there been a proper and recent capacity assessment on this issue?
Could a joint visit be arranged of social worker and housing worker?
 Could there be an over-riding duty of care?
 Applying for an advocate (Section 68 Care Act)
 Has the person been accurately and recently diagnosed (eg learning
disability or mental health issues) and risk assessed? Particular attention
should be paid if:



their circumstances have deteriorated and/or
their needs have increased or are very complex and/or
there is a sudden change in behaviour ie ‘an escalating problem’
 Ensure that decisions are being taken at the right level within your
43 organisation and within Adult Social
Care
Summary of action needed by housing
providers to improve adult safeguarding
 Ensure effective housing representation on SAB, MAPPA, MARAC,
MASH, CSP, VARM etc
 Housing providers should:
 Improve recording of vulnerability on data bases and IT systems to
flag up patterns and warning signs (the ‘Cynthia Barrass test’)
 Employ internal safeguarding leads
 Ensure robust adult safeguarding policies, procedures, guidance and
supervision
 Train ALL staff, regularly, in adult safeguarding and the Mental
Capacity Act 2005
 Seek inclusion in current revisions to local multi-agency safeguarding
policies, procedures and processes in the light of the Care Act and
the Making Safeguarding Personal approach
 Instil staff confidence to challenge other agencies
 Improve customer awareness of safeguarding
 Self assess against the Housing and Safeguarding Adults Alliance
44 objectives and Care Act checklist
Final words......
 Legislation alone will not address the many difficult issues




around adult safeguarding
Multi-agency working in general and safeguarding in
particular raise complex issues, for housing and for all
agencies
Housing is often neglected in multi-agency work on
safeguarding, despite the contribution that front line staff
can make
Adult Social Care and housing staff must meet locally to
identify and address barriers and to promote best practice
Identify and acknowledge the good practice already
happening..............
45
For further information:
 Housing and Safeguarding Adults Alliance:
www.housinglin.org.uk/AdultSafeguardingAndHousing
 SCIE guide on ‘Adult safeguarding for housing staff’:
http://www.scie.org.uk/publications/guides/guide53/
 My research on Serious Case Reviews: lessons for housing
providers:
http://www.tandfonline.com/doi/full/10.1080/09649069.2014.895506)
 Consultancy, training and research on housing and adult
safeguarding: www.imogenparry.co.uk
 Email: imogen.parry@btopenworld.com
46
Our objectives:
1. Increase awareness across the social housing sector, in particular
non specialist providers of general needs housing, of the need to
engage in adult safeguarding
2. Improve practice within the sector through sharing learning between
members and promoting safeguarding adults training
3. Increase awareness of the economic and social value that
participation by the housing sector brings to safeguarding adults
across all sectors
4. Demonstrate the commitment of the social housing sector to
improving engagement in safeguarding adults to a range of partners,
particularly adult social care staff
47
Our objectives:
5. Work with statutory partners to address the barriers to
effective partnership working, including those relating to
information sharing
6. Improve the strategic engagement of all housing
providers with Safeguarding Adults Boards, addressing
the barriers
7. Increase joint working on safeguarding adults between
housing providers in any geographical area
8. Capture and disseminate positive practice, and celebrate
success!
48