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

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

Personalisation... Sandwell June 2012 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....

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 Personalisation Sandwell June 2012

Continued commitment Sandwell June 2012 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

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

Early perceptions of risk Poorer quality services Service users being overwhelmed by managing IBs – If theres a problem they cant just ring us up and say, Sort it. Because if theyre actually employing the person, theyve got to sort that out with whoever it is thats 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

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

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

Financial abuse – Evidem MCA study Focus group with people with dementia Focus group with carers Survey data of – Alzheimers Society staff – Nursing and social services staff – People with dementia – Carers Interviews with Safeguarding Adult Coordinators Sandwell June 2012

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

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

Positive risk taking We actually need to point out to service users, Maybe the reason we dont want you to do that is because you could get hurt, and we can see it. But again, its about risk learning. You know, its positive risk taking. And were not good at that. And so thats fear for us. (Care Coordinator, Mental Health) See Nothing Ventured Nothing Gained DH 2010 IBSEN – Glendinning et al 2008 Sandwell June 2012

Risk heat map Maximise safety enhancement and risk management - protect the individual and manage the activity Carefully balance safety enhancement and activity management to protect the person Minimal safety enhancement necessary - carry out with normal levels of safety enhancement Substitute - can the same personal benefit be delivered in a different way - seek different activities? Carefully balance safety enhancement and activity management to protect the person Minimal safety enhancement necessary - carry out with normal levels of safety enhancement Find alternatives - level of risk is not related to the benefit/value to the person - find alternatives Challenge real value of the activity to the individual - seek alternatives that are more attractive and lower risk Undertake the activity or seek alternatives that may provide a better relationship with their needs Hig h Low High Medium Lo w Contribution to quality of life

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

What can be done? 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

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 & doesnt. !

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 ) 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