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1 Imogen Parry Independent Safeguarding Adults Consultant, Researcher and Trainer for the Housing Sector and Co-Chair of the Housing and Safeguarding Adults.

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Presentation on theme: "1 Imogen Parry Independent Safeguarding Adults Consultant, Researcher and Trainer for the Housing Sector and Co-Chair of the Housing and Safeguarding Adults."— Presentation transcript:

1 1 Imogen Parry Independent Safeguarding Adults Consultant, Researcher and Trainer for the Housing Sector and Co-Chair of the Housing and Safeguarding Adults Alliance SHIP Conference 29 January 2015

2 2 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

3 3 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

4 4 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

5 5 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

6 6 From ‘No Secrets’ to the Care Act Review of No Secrets 2008/9 Consideration of safeguarding included in the Law 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–

7 7 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

8 8 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 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

9 9 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

10 10 The Care Act safeguarding sections 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.

11 11 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

12 12 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

13 13 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 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

14 14 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’

15 15 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

16 16 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

17 17 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 of the statutory guidance

18 18 Question Para reference in the statutory guidance YesNo In progress Comments/ evidence 1a Do you have a senior manager with strategic responsibility for safeguarding? OR b Do you have an operational lead for adult safeguarding? a Have you a safeguarding adults policy and internal procedures that cover ALL staff and are regularly reviewed? 14.29, 14.30, 14.41,14.54, 14.86, , b Do they include the 6 principles? Do they include guidance on record keeping? Are staff vigilant about adult safeguarding? , , cDo you have internal systems in place to ensure compliance with policies and procedures? Adult safeguarding self assessment checklist against the Care Act statutory guidance for housing and housing support providers (1)

19 19 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? 14.30, Can staff access regular face to face supervision from skilled managers? Can staff access practical and legal guidance, advice and support? 14.46, 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? 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? 14.84, Have you sought to engage with the local multi-agency safeguarding hub (MASH) (if one exists?)

20 20 Adult safeguarding self assessment checklist against the Care Act statutory guidance for housing and housing support providers (3) 8 Has anyone in your organisation made effective links with Local Authority Safeguarding Leads to ensure cooperation and information sharing, improve joint working, addressing barriers? Are roles and responsibilities clear and is there collaboration at all levels? 14.53, , Do you have arrangements in place to ensure review and learning? 10Do you engage with all customers regarding safeguarding (eg information, awareness raising) ,

21 21 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)

22 22 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

23 23 Summary of findings Internal lessons for housing providers: A. Poor data base of vulnerabilities (7 cases) B. Poor contract/support monitoring (4 cases) C. Narrow focus/poor understanding of safeguarding/not referring (10 cases) External lessons for housing providers: D. Exclusion of housing from information sharing/ assessment/ monitoring (11 cases) E. Thresholds too high/ failure to capture low level concerns (7 cases) F. Problems with Adult Social Care: assessments (including risk, capacity); diagnosis; choice (16 cases)

24 24 21 housing related SCRs BANES, 2013: ‘PQ’ Bucks, 2010: Mr B Bury, 2010: ‘Adult A’ Cornwall, 2007, 2009: Steven Hoskin, JK Coventry, 2012: Mrs C Dorset,2013: JT Leics, Leics and Rutland, 2008: Fiona Pilkington Luton, 2011: Michael Gilbert North Tyneside, 2011: Cynthia Barrass/Adult A North Yorkshire, 2012: Robert Sheffield, 2004: Margaret Panting Southampton, 2012: Mr A Stockport, 2011 : Martin Hyde Sunderland, 2012: Mrs AM Surrey, 2010, 2010: ‘CC’, 0001 Tameside, 2011: David Askew Torbay, 2011: Ms Y Warwickshire, 2011: Gemma Hayter Worcestershire, 2010: A1

25 25 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).

26 26 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 recorded, there were problems with the incompatibility of the data with other agencies’ systems.

27 27 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

28 28 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

29 29 ‘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)

30 30 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.

31 31 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).

32 32 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)

33 33 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.

34 34 F. Quotes from SCRs on problems with Adult Social Care: choice; assessments (including risk, capacity); diagnosis (1) ‘ 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)

35 35 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)

36 36 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)

37 37 F. Problems with ASC risk and capacity assessments; diagnosis Failures of assessment, diagnosis and multi- agency 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)

38 38 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

39 39 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

40 40 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

41 41 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

42 42 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

43 43 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 organisation and within Adult Social Care

44 44 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 objectives and Care Act checklist

45 45 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

46 46 For further information : Housing and Safeguarding Adults Alliance: SCIE guide on ‘Adult safeguarding for housing staff’: / / My research on Serious Case Reviews: lessons for housing providers: Consultancy, training and research on housing and adult safeguarding :

47 47 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

48 48 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 !

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