The Journal of Adult Protection

Braye, Suzy; Orr, David; Preston-Shoot, Michael

2015 The Journal of Adult Protection

doi: 10.1108/JAP-05-2014-0014

Purpose– The purpose of this paper is to report the findings from research into 40 serious case reviews (SCRs) involving adults who self-neglect. Design/methodology/approach– The study comprised analysis of 40 SCRs where self-neglect featured. The reviews were found through detailed searching of Local Safeguarding Adult Board (LSAB) web sites and through contacts with Board managers and independent chairs. A four layer analysis is presented of the characteristics of each case and SCR, of the recommendations and of the emerging themes. Learning for service improvement is presented thematically, focusing on the adult and their immediate context, the team around the adult, the organisations around the team and the Local Safeguarding Board around the organisations. Findings– There is no one typical presentation of self-neglect; cases vary in terms of age, household composition, lack of self-care, lack of care of one's environment and/or refusal to engage. Recommendations foreground LSABs, adult social care and unspecified agencies, and focus on staff support, procedures and the components of best practice and effective SCRs. Reports emphasise the importance of a person-centred approach, within the context of ongoing assessment of mental capacity and risk, with agencies sharing information and working closely together, supported by management and supervision, and practising within detailed procedural guidance. Research limitations/implications– There is no national database of SCRs commissioned by LSABs and currently there is no requirement to publish the outcomes of such inquiries. It may be that there are further SCRs, or other forms of inquiry, that have been commissioned by Boards but not publicised. This limits the learning that has been available for service improvement. Practical implications– The paper identifies practice, management and organisational issues that should be considered when working with adults who self-neglect. These cases are often complex and stressful for those involved. The thematic analysis adds to the evidence-base of how best to approach engagement with adults who self-neglect and to engage the multi-agency network in assessing and managing risk and mental capacity. Originality/value– The paper offers the first formal evaluation of SCRs that focus on adults who self-neglect. The analysis of the findings and the recommendations from the investigations into the 40 cases adds to the evidence-base for effective practice with adults who self-neglect.

Manthorpe, Jill; Stevens, Martin; Samsi, Kritika; Aspinal, Fiona; Woolham, John; Hussein, Shereen ; Ismail, Mohamed; Baxter, Kate

2015 The Journal of Adult Protection

doi: 10.1108/JAP-03-2014-0011

Purpose– The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this. Design/methodology/approach– A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences. Findings– The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation. Research limitations/implications– There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments. Practical implications– Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers. Originality/value– There does not appear to have been any other previous study of Safeguarding Adult Boards’ annual reports. Documentary analysis at local level is under-developed in safeguarding studies.

Stevens, Emma L.; Cook, Katie

2015 The Journal of Adult Protection

doi: 10.1108/JAP-03-2014-0013

Purpose– The purpose of this paper was to identify safeguarding concerns for vulnerable adults, including exploring the implementation of safeguarding policy and procedures into practice. This was achieved by reviewing the content of reflective assignments written by pre-registration student nurses, identifying areas of concerns and proposing action plans. Design/methodology/approach– A qualitative approach was initially utilised to scrutinise a random 10 per cent sample of work, which was thematically analysed. From this, an audit tool was devised and then applied to evaluate a 35 per cent sample of work from the following cohort of students. Approval and consent was gained. Findings– From the initial 10 per cent sample, themes emerged around: practice issues; areas for student's development and marking or assessment issues. The standardised audit tool was devised and applied to a 35 per cent random sample of work. This determined that students identified local safeguarding policies and procedures were being followed in the majority of placement areas, although application of the Mental Capacity Act remained inconsistent. Research limitations/implications– The assessor feedback from the reflective assignments was not available to the reviewers, limiting the reviewers ability to identify if assessors had recognised and corrected any policy or practice issues that the student raised. Only assignments from the adult field of nursing were considered within the scope of this study. The authors recommend further empirical investigation into this area. Practical implications– This paper offers knowledge that can be applied in practice within both academic and health care provider services that deliver and facilitate nursing education. It has generated an audit tool that can be utilised to evaluate the knowledge of pre-registration students and has resulted in the implementation of safeguarding adults policies within an academic institution. Originality/value– Safeguarding adults concerns may be identified through studying pre-registration student assignments and promptly acting upon any concerns raised. Aspects of good practice can be acknowledged within health care provider services.

Lennard, Chris

2015 The Journal of Adult Protection

doi: 10.1108/JAP-05-2014-0017

Purpose– The purpose of this paper is to give a brief background to the Deprivation of Liberty Safeguards (DoLS), and studies which factors Best Interests Assessors consider when making a judgement on Deprivation of Liberty. It examines some of the reasons why professionals may be under-using DoLS, including lack of knowledge, complex processes and paperwork, and the pejorative nature of the word “deprivation”, and looks at a possible way forward. Design/methodology/approach– The paper looks at the evidence to the House of Commons and House of Lords Committees on the Mental Health Act and Mental Capacity Act, as well as previous and current research papers. It examines the nuances of difference between restriction and deprivation, and the cumulative impact of several restrictions, which may, in fact, amount to a deprivation, illustrated by case studies from the author's own practice. Findings– It makes the case that health and social care professionals should err on the side of caution, by making precautionary DoLS applications, arguing that MCA DoLS is a forerunner of good practice, and that good care planning allied to judicious application of the MCA leads to better, more robust and more defensible decision making. Originality/value– And it points the way to a possible future, citing the recommendations of the Select Committee on the MCA for a clearer link between DoLS and the principles underpinning the MCA, and for simplifying and clarifying the legislative provisions and the associated paperwork.

Trainor, Patricia

2015 The Journal of Adult Protection

doi: 10.1108/JAP-03-2014-0008

Purpose– The purpose of this paper is to look at safeguarding documentation in relation to 50 adult safeguarding files for the period April 2010 to March 2011. This was followed up with semi-structured interviews with a small number of Designated Officers whose role it is to screen referrals and coordinate investigations. Findings from the research were used to redesign regional adult safeguarding documentation to ensure Designated Officers have access to the information necessary to assist them in reaching decisions. Designated and Investigating Officer training was also updated to reflect learning from the research thereby reducing the potential for variation in practice. Design/methodology/approach– A file tool was developed which examined the recorded information in safeguarding documentation contained within 50 service user files. The review tool looked at the personal characteristics of the vulnerable adult, the nature of the alleged abuse and the decisions/outcomes reached by staff acting as safeguarding Designated Officers. A semi-structured interview schedule asked Designated Offices to comment on the training and understanding of the process as well as the factors they believed were central to the decision making process. Their responses were compared to data obtained from the file review. Findings– A key finding in the research was that while factors such as type of abuse, the vulnerable adults’ consent to cooperate with proceedings, identity of the referrer, etc. did influence decisions taken there was a lack of clarity on the part of Designated Officers in relation to their roles and responsibilities and of the process to be followed. Research limitations/implications– The research was limited to one Health & Social Care Trust area and had a small sample size (n=50). Practical implications– The findings of the research led to a revamping of existing safeguarding documentation which had failed to keep pace with developments and was no longer fit for purpose. Adult safeguarding training courses within the Trust were redesigned to bring greater focus to the role and responsibilities of designated and Investigating Officers and the stages in the safeguarding process. Adult Safeguarding leads were established within programmes of care and professional support mechanisms put in place for staff engaged in this area of work. Social implications– Better trained and supported staff alongside more efficient safeguarding systems should lead to better outcomes in the protection of vulnerable people from abuse and harm. Originality/value– The research built on existing albeit limited research into what potentially influences staff involved in critical decision-making processes within adult safeguarding.

Hewitt, David

2015 The Journal of Adult Protection

doi: 10.1108/JAP-06-2014-0021

Purpose– The purpose of this paper is to explain a decision of the Court of Appeal about the duty an Approved Mental Health Professional (AMHP) will sometimes have to consult a patient's nearest relative, and to set that decision in the context of an earlier one. Design/methodology/approach– Each decision is examined in detail and one is compared with the other. Reference is made to the Mental Health Act 1983 Code of Practice. Findings– It will be harder for an AMHP to establish that consultation is not reasonably practicable, and it will be correspondingly easier, in some cases, for a nearest relative to obtain information about a patient or achieve proximity to her. Originality/value– This is thought to be the first time the two cases have been considered together or in their true context.