1 Imogen Parry Independent Safeguarding Adults Consultant, Researcher and Trainer for the Housing...

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Imogen ParryIndependent 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

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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

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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 cultureinsufficiently trained staffunder-reporting of abuselimited data on vulnerabilities of tenants

Problems and complexities of partnership working

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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

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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

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From ‘No Secrets’ to the Care ActReview of No Secrets 2008/9Consideration of safeguarding included in the Law

Commission review of Adult Social Care Law 2010/11

Care and Support Bill published July 2012Care Bill published May 2013Care Act 2014 received Royal Assent May 2014Statutory guidance consultation June – August 2014Final statutory guidance published October 2014Care Act and statutory guidance due for

implementation from April 2015 – see www.local.gov.uk/care-support-reform.

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The limitations of ‘No Secrets’ 2000

Statutory guidance – not legislationPreceded the Mental Capacity Act 2005, much case

law arising from the Human Rights Act 1998, DoLSReferred to ‘vulnerable adults’ (not ‘adults at risk’)

and ‘adult protection’ (not ‘adult safeguarding’)Limited list of types of abuseFocus 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

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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

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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.

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The Care Act 2014 - safeguarding sections 42 - 45

• 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.

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The Care Act 2014 – other sections and guidance relevant to safeguarding adults

Well-being Co-operation Information sharingPrevention focus Advocates Level of needs not relevant Wide scope for what constitutes abuse or

neglect Additional types of abuse included

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Main types of abuse (italicised are new) Physical Psychological/emotional Sexual Financial Neglect Discrimination Organisational abuse Domestic abuseSexual exploitationModern slaverySelf-neglect

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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

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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’

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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

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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 processWork with service users’ networks and strengths

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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 guidanceMSP values, standards and guidesThe diagrams 1A and 1B on pages 250-252 of

the statutory guidance

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Question Para reference in the statutory guidance

Yes No In progress

Comments/ evidence

1a Do you have a senior manager with strategic responsibility for safeguarding? OR

14.187

14.109

b Do you have an operational lead for adult safeguarding?

14.187

14.109

2a 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, 14.196, 14.205

b Do they include the 6 principles?

Do they include guidance on record keeping?

Are staff vigilant about adult safeguarding?

14.13

14.87, 14.150

14.29, 14.30

c Do you have internal systems in place to ensure compliance with policies and procedures?

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3 Have you regular safeguarding training for all staff in contact with adults at risk?

14.30, 14.86

4 Can staff access regular face to face supervision from skilled managers?

Can staff access practical and legal guidance, advice and support?

14.46, 14.172

14.40

5 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?

14.117

6 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, 14.59

7 Have you sought to engage with the local multi-agency safeguarding hub (MASH) (if one exists?)

14.164

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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, 14.154, 14.34

14.167

9 Do you have arrangements in place to ensure review and learning?

10 Do you engage with all customers regarding safeguarding (eg information, awareness raising).

14.11, 14.165

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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)

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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

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Summary of findingsInternal 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)

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21 housing related SCRs BANES, 2013: ‘PQ’Bucks, 2010: Mr BBury, 2010: ‘Adult A’Cornwall, 2007, 2009:

Steven Hoskin, JKCoventry, 2012: Mrs CDorset ,2013: JT Leics, Leics and Rutland, 2008:

Fiona PilkingtonLuton, 2011: Michael

GilbertNorth Tyneside, 2011:

Cynthia Barrass/Adult A

North Yorkshire, 2012: RobertSheffield, 2004: Margaret

Panting

Southampton, 2012: Mr AStockport, 2011: Martin Hyde

Sunderland, 2012: Mrs AMSurrey, 2010, 2010: ‘CC’,

0001Tameside, 2011: David AskewTorbay, 2011: Ms YWarwickshire, 2011: Gemma

HayterWorcestershire, 2010: A1

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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).

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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.

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B. Poor support/contract monitoringAlthough 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

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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

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‘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)

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Reasons for under-reporting of abuse by housing staff include:

A narrow, uninformed focus by the housing providerDifferent definitions of vulnerabilityErroneous belief that consent by the victim is always

necessaryIncorrect assumption that evidence is needed before

making an alert or referralInadequate 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.

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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).

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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)

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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.

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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)

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‘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)

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‘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)

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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 assessmentsthe need for effective multi-agency

working that led to holistic assessments (which were focused on the victims, not their families)

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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

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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

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Cynthia Barrass – North TynesideMissed opportunities by housing provider:

Rent arrearsRefusal to grant access for gas servicingGarden maintenance issues

Housing provider was ‘reactive’, not proactiveFailure of systems to ensure follow up of the

disconnection of gas, to insist on a home visit and to alert social services

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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 guidanceSCIE 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

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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


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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’


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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

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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..............

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For further information:

Housing and Safeguarding Adults Alliance: www.housinglin.org.uk/AdultSafeguardingAndHousing

SCIE guide on ‘Adult safeguarding for housing staff’: http://www.scie.org.uk/publications/guides/guide53/

My research on Serious Case Reviews: lessons for housing providers: http://www.tandfonline.com/doi/full/10.1080/09649069.2014.895506)

Consultancy, training and research on housing and adult safeguarding: www.imogenparry.co.uk

Email: [email protected]

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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

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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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