Martin Stevens, Jill Manthorpe and Kritika Samsi Shereen Hussein: King’s College London

1. Risk, Safeguarding and Personal Budgets: Do personal budgets increase the risk of abuse?Staff and service user experiences Martin Stevens, Jill Manthorpe and KritikaSamsiShereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York

2. Acknowledgements This project was funded by the National Institute for Health Research (NIHR) School for Social Care Research (SSCR) (project number - T976/EM/KCL2). The views expressed in this presentation are those of the authors, not necessarily those of the Department of Health, the NHS or the NIHR.

3. Plan • Qualitative element • Objectives and methods • Summary of findings from staff and from service user interviews • Contrasting staff & service user views • Implications for practice

4. Methods overview • Three local authorities • Semi-structured interviews with staff and service users • Consent • In person or via telephone • Lasting between 30 and 90 minutes • Audio-recorded and transcribed • Analysis • Thematic analysis • Facilitated by qualitative data management software • Quality assessed at all stages

5. Staff interviews • Objectives • To understand staff members perceptions and experience of • Risks and opportunities of PBs & DPs • Links between safeguarding & support planning • Participants • Senior manager/s of adult social care • Elected representative • Front-line managers & practitioners – assessment and/or safeguarding of adults

6. Service user interviews • Objectives • To understand budget-holders experiences of • Personal budgets • Risk assessment • Safeguarding processes • Participants • 10 budget-holders & 7 proxy budget-holders • Final inclusion criteria • Over 18 years of age • AVA referral case (not just AVA alert) • Receives a PB and/or a DP • Safeguarding process commenced & resolved in the last year • Capacity to give consent and take part in an interview • Not currently in 'crisis‘

7. Participants • Staff: n=16 • 6 social workers • 5 team managers • 3 senior managers • 2 elected members • Service users: n= 12 DP/PB holders(40%) • 6 people with learning difficulties • 5 people who were physically disabled • 1 person with mental health and physical problems

8. Staff interview findings (1) • Contexts • Financial constraint – higher eligibility criteria, greater unmet need, service quality • Personalisation adoption • Poverty – driver of abuse (PAs and family) • Practitioners understanding of risks of PB/DPs • Increased risk of financial abuse – inc. from proxy BHs • Affects level of monitoring • Risks associated with employing PAs • Reduce risks – choice, control • No change in level of risk – circumstance not PB/DP • Minimising risks • Varying control over DPs • DPs as a response to risky situations • Monitoring and review – financial monitoring

9. Staff interview findings (2) • Balancing choice and control • Autonomy versus duty of care • Balancing positive and negative risks • Safeguarding and personalisation practice • Timeliness of information – post incidents • Recommendations about pre-employment checks • Role of support planning – generic risks

10. Service user findings (1) • Awareness • Support funding • Safeguarding issue - recognition & reporting • Safeguarding process • Information • Poor information before agreeing to DP/PB – risks, employer role • Lack of information when changes implemented • Safeguarding issues and processes • Different types of abuse described • Multiple abuses – overtime and concurrently • Support staff/personal assistants - often quality related • Processes unclear, especially for people with PAs.

11. Service user findings (2) • Outcomes of safeguarding investigation • Change of support worker/agency • Advice from advocacy organisations on future safeguarding • 3-month probationary period for PAs • Revised employment processes • Choice, control and independence • Around choice of funding • Around decisions about support • Around risk management

12. Overlaps & contrasts • Information giving • Funding arrangements • Choice of care provider/agency • Being an employer • Safeguarding processes • Continued review and support • Choice and control • Assumption of choice for service users • Feeling of little choice by service users

13. Implications for practice • What are the implications of these findings for practice? • What are the implications for service users? • Are any changes needed to practice? • What changes might be needed? • How would these benefit staff and service users?

14. Research Team • Martin Stevens: martin.stevens@kcl.ac.uk • Fiona Aspinal: fiona.aspinal@york.ac.uk • Shereen Hussein: shereen.hussein@kcl.ac.uk • Mohamed Ismail: mohamed@analyticalresearch.co.uk • Jill Manthorpe: jill.manthorpe@kcl.ac.uk • KritikaSamsi: kritika.1.samsi@kcl.ac.uk • John Woolham: aa7970@coventry.ac.uk • Kate Baxter: kate.baxter@york.ac.uk

15. Risk, Safeguarding and Personal Budgets: Do personal budgets increase the risk of abuse?Staff and service user experiences Martin Stevens, Jill Manthorpe and KritikaSamsiShereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York