Thinking around: what are the practical challenges of bringing safeguarding & personalisation?

1. 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

2. Your questions • Ensuring safety • Legal changes • Emerging interest in self-neglect • Checking & vetting • Transition Sandwell June 2012

3. 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

4. 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

5. 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

6. 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

7. 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

8. Emerging concerns • Two tier workforce • checked and unchecked (ISA and CRB) • trained and untrained • 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

9. 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

10. 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

11. 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

12. Over and Under Protection Crystallised in Vetting and Barring Hybrid working – kin as carers Little on ‘out of area’ monitoring Sandwell June 2012

13. 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

14. Risk ‘heat map’ Contribution to quality of life High Low Low Medium Sandwell June 2012 High

15. 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

16. 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 What can be done?

17. How can we move forward? • 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. !

18. 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