The Journal of Adult Protection

Penhale, Bridget

2011 The Journal of Adult Protection

doi:

Sarah Carr

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160723

Purpose – This paper aims to present a digest of the main discussion points and key findings from a recent Social Care Institute for Excellence report on risk enablement and safeguarding in the context of self‐directed support and personal budgets. Design/methodology/approach – The paper explores how the personalisation agenda and adult safeguarding can work together in policy and practice and addresses some of the frontline concerns about empowerment and duty of care. Findings – Evidence on how self‐directed support and personal budgets can be used to enable people to take positive risks while staying safe and emerging practice is examined. It suggests that person‐centred working in adult safeguarding, along with the mechanism of self‐directed support planning and outcome review, can support the individual to identify the risks they want to take and those they want to avoid in order to stay safe. It is clear that if frontline practitioners are overly occupied with protecting organisations and individuals from financial abuse, this will impact on the capacity of those practitioners exercising their duty of care at the front line. This means that practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk taking. Defensive risk management strategies or risk‐averse frontline practice may then result in individuals not being adequately supported to make choices and take control and, therefore, being put at risk. Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement in their relationship‐based, person‐centred working. Good quality, consistent and trusted relationships and good communication are particularly important for self‐directed support and personal budget schemes. Originality/value – The use of “risk enablement panels” and “personalisation and safeguarding frameworks” are two ways to address some of the issues in practice.

Carr, Sarah

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160723

Purpose - This paper aims to present a digest of the main discussion points and key findings from a recent Social Care Institute for Excellence report on risk enablement and safeguarding in the context of self-directed support and personal budgets. Design/methodology/approach - The paper explores how the personalisation agenda and adult safeguarding can work together in policy and practice and addresses some of the frontline concerns about empowerment and duty of care. Findings - Evidence on how self-directed support and personal budgets can be used to enable people to take positive risks while staying safe and emerging practice is examined. It suggests that person-centred working in adult safeguarding, along with the mechanism of self-directed support planning and outcome review, can support the individual to identify the risks they want to take and those they want to avoid in order to stay safe. It is clear that if frontline practitioners are overly occupied with protecting organisations and individuals from financial abuse, this will impact on the capacity of those practitioners exercising their duty of care at the front line. This means that practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk taking. Defensive risk management strategies or risk-averse frontline practice may then result in individuals not being adequately supported to make choices and take control and, therefore, being put at risk. Practitioners need to be supported by local authorities to incorporate safeguarding and risk enablement in their relationship-based, person-centred working. Good quality, consistent and trusted relationships and good communication are particularly important for self-directed support and personal budget schemes. Originality/value - The use of "risk enablement panels" and "personalisation and safeguarding frameworks" are two ways to address some of the issues in practice.

Thacker, Helen

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160732

Purpose - This paper aims to respond to the findings of the initial phase of the Safeguarding Adults Programme (November 2009-March 2010), which found an unexpected inverse relationship between referral rate for safeguarding adults and population size of local authority in the data captured from April 2008 to March 2009. Design/methodology/approach - An analysis of regional safeguarding referral rates relative to population with a breakdown by service groups was undertaken; statistics from the economic deprivation index (EDI) were also used. A questionnaire was designed and sent out to the authorities regarding thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness. The data analysed here cover the following year's safeguarding referrals. Findings - The questionnaire revealed broad differences in thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness campaigns across the studied authorities. These differences contribute to obscuring real differences in underlying processes. A highly significant relationship between EDI and safeguarding referral rates was found, implying real differences in abuse rates driven by underlying socio-economic factors. Differences in abuse allegations were systematic, so that authorities with a particularly high level of referrals did not have unusually high contributions from particular service user groups or from particular referral sources. Similarly the nature of abuse allegations did not differ between authorities with high or low-referral rates. Originality/value - The paper investigates the reasons for variation and explores thresholds for safeguarding referrals.

Helen Thacker

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160732

Purpose – This paper aims to respond to the findings of the initial phase of the Safeguarding Adults Programme (November 2009‐March 2010), which found an unexpected inverse relationship between referral rate for safeguarding adults and population size of local authority in the data captured from April 2008 to March 2009. Design/methodology/approach – An analysis of regional safeguarding referral rates relative to population with a breakdown by service groups was undertaken; statistics from the economic deprivation index (EDI) were also used. A questionnaire was designed and sent out to the authorities regarding thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness. The data analysed here cover the following year's safeguarding referrals. Findings – The questionnaire revealed broad differences in thresholds, eligibility, definitions, advice and information available to referrers, accuracy of recording and public awareness campaigns across the studied authorities. These differences contribute to obscuring real differences in underlying processes. A highly significant relationship between EDI and safeguarding referral rates was found, implying real differences in abuse rates driven by underlying socio‐economic factors. Differences in abuse allegations were systematic, so that authorities with a particularly high level of referrals did not have unusually high contributions from particular service user groups or from particular referral sources. Similarly the nature of abuse allegations did not differ between authorities with high or low‐referral rates. Originality/value – The paper investigates the reasons for variation and explores thresholds for safeguarding referrals.

Galpin, Diane ; Hughes, Dorena

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160741

Purpose - This paper aims to provide a framework from which practitioners can develop a partnership approach to multi-agency decision-making. Design/methodology/approach - The authors have drawn on the direct experiences of social work practitioners currently involved in safeguarding activity and qualified social workers undertaking post qualifying social work education. Those seeking safeguarding guidance from a safeguarding adult co-ordinator/manager indicate multi-agency decision-making can be professionally, intellectually and emotionally challenging. In response to these concerns, the authors have worked together to develop a simple framework designed to support practitioners in facilitating effective multi-agency decision-making. Findings - There is a need for effective practice in multi-agency decision-making to be central to delivering a system of personalised care that both empowers and protects. The Harvard Business model identifies five key stages as being crucial to decision-making; first, establishing context; second, framing the issue; followed by generating alternatives and evaluating alternatives and finally choosing the best option. The model stops here, but for most decisions a sixth step is required to identify actions and those responsible for implementing them. Originality/value - Policy and legislation alone cannot protect adults at risk and in vulnerable circumstances from abuse, there also needs to be commitment at an organisational and practitioner level to develop decision-making processes that ensure safeguarding and personalisation is interwoven as efficiently and effectively as possible.

Diane Galpin; Dorena Hughes

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160741

Purpose – This paper aims to provide a framework from which practitioners can develop a partnership approach to multi‐agency decision‐making. Design/methodology/approach – The authors have drawn on the direct experiences of social work practitioners currently involved in safeguarding activity and qualified social workers undertaking post qualifying social work education. Those seeking safeguarding guidance from a safeguarding adult co‐ordinator/manager indicate multi‐agency decision‐making can be professionally, intellectually and emotionally challenging. In response to these concerns, the authors have worked together to develop a simple framework designed to support practitioners in facilitating effective multi‐agency decision‐making. Findings – There is a need for effective practice in multi‐agency decision‐making to be central to delivering a system of personalised care that both empowers and protects. The Harvard Business model identifies five key stages as being crucial to decision‐making; first, establishing context; second, framing the issue; followed by generating alternatives and evaluating alternatives and finally choosing the best option. The model stops here, but for most decisions a sixth step is required to identify actions and those responsible for implementing them. Originality/value – Policy and legislation alone cannot protect adults at risk and in vulnerable circumstances from abuse, there also needs to be commitment at an organisational and practitioner level to develop decision‐making processes that ensure safeguarding and personalisation is interwoven as efficiently and effectively as possible.

Peter Hartley‐Jones

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160750

Purpose – This paper aims to examine the investigation process employed by the Office of the Public Guardian (OPG). This process is used whenever an allegation of abuse is received against either an attorney acting under a registered lasting or enduring power of attorney or against a deputy appointed by the court of protection to make decisions on behalf of someone who lacks the capacity to make those decisions themselves. Design/methodology/approach – Case studies are used to demonstrate both how the investigation process works in practice and how one works in partnership with other organisations to help safeguard vulnerable adults. Findings – The OPG works in partnership with a range of other relevant organisations to protect vulnerable adults from financial abuse. It details the types of activities, the OPG investigating officer may undertake to examine allegations of abuse and the targets set to help ensure any allegations are investigated promptly and effectively. Originality/value – The duties bestowed upon the public guardian under the Mental Capacity Act (MCA) 2005, together with a general growing awareness of financial abuse, have had a significant impact upon the work of the investigations team. The case studies included exemplify the kinds of outcomes in cases of abuse and also demonstrate how Attorneys are subject to the same investigative scrutiny as court appointed deputies.

Hartley-Jones, Peter

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160750

Purpose - This paper aims to examine the investigation process employed by the Office of the Public Guardian (OPG). This process is used whenever an allegation of abuse is received against either an attorney acting under a registered lasting or enduring power of attorney or against a deputy appointed by the court of protection to make decisions on behalf of someone who lacks the capacity to make those decisions themselves. Design/methodology/approach - Case studies are used to demonstrate both how the investigation process works in practice and how one works in partnership with other organisations to help safeguard vulnerable adults. Findings - The OPG works in partnership with a range of other relevant organisations to protect vulnerable adults from financial abuse. It details the types of activities, the OPG investigating officer may undertake to examine allegations of abuse and the targets set to help ensure any allegations are investigated promptly and effectively. Originality/value - The duties bestowed upon the public guardian under the Mental Capacity Act (MCA) 2005, together with a general growing awareness of financial abuse, have had a significant impact upon the work of the investigations team. The case studies included exemplify the kinds of outcomes in cases of abuse and also demonstrate how Attorneys are subject to the same investigative scrutiny as court appointed deputies.

Monica Dennis; Judith Allen

2011 The Journal of Adult Protection

doi: 10.1108/14668201111160769

Purpose – This paper seeks to describe the experiences of people visiting elderly relatives in hospital, detailing the lack of care and negligent attitudes of nursing staff with regards to providing appropriate food and drink to the elderly patients. Design/methodology/approach – This paper analyses responses from 94 concerned readers, who empathised with an article published in the Daily Mail detailing negligent, unprofessional and uncaring practice in an elderly relative's hospital care. They each wrote to A Dignified Revolution (ADR) and provided their own examples of either being a patient in hospital or witnessing their loved one's distress. This paper addresses one of the most common areas of concern: the management of hydration and nutrition. Findings – The vast majority of the criticisms in the e‐mail correspondence that was received by ADR was directed towards severe deficits in nursing practice. The experiences that were shared demonstrated not only a contravention of the nurse's code of practice (Nursing and Midwifery Council), but also an abuse of older people's human rights. They also demonstrated not only the severe harm that could be caused to vulnerable older people and the trauma caused to relatives but also carers. Many respondents were dismayed at the complete lack of nursing assessments and the inconsistencies in the documentation about their relatives' care, including food and fluid charts, which was so fundamental to their care needs. Originality/value – Older vulnerable people in National Health Service (NHS) hospitals are being deprived of the fundamental right to eat and drink, a right whereby the lack of nutrition and hydration causes not only untold suffering, but can cause death. To deprive a person of food and fluid is tantamount to abuse, and to be able to eat and drink is a basic human right. However, perhaps the challenge is greater than this with regard to older people. Perhaps, a significant cultural change in attitudes and behaviour towards older people by the NHS, if not the wider society, is required in the first instance.