This is an essential, practical guide to best practice in adult safeguarding which supports students and practitioners to develop the skills, knowledge and ethical awareness to confidently address the challenges of adult safeguarding across a wide range of practice contexts in the UK.
The authors explore the current context of adult safeguarding in the UK, together with the legislation, rights and principles that are the basis of best practice, and with a focus on developments in practice following the implementation of the Care Act (2014).
Practitioners are supported to develop their practice by exploring new research and innovative ways of working within the field, while promoting the importance of learning from experience and building resilience in adult safeguarding work. This book includes:
• helpful case studies and examples of professional decision making from experienced adult safeguarding practitioners;
• top tips and models to enable confident application of knowledge to practice;
• tools for reflection to extend the practitioner’s development.
Best Interests Assessors (BIA) are specialist practitioners with a unique professional identity. This is the first book to consider this complex role in depth, offering practical guidance and exploring its particular challenges in the context of the Mental Capacity Act and Deprivation of Liberty Safeguards legal framework.
How can you work with people who lack capacity to make sure their voice is heard? How can you maintain quality of assessments and decision-making while managing an increasing workload? How do you keep up to date with case law and work out how to apply it to day-to-day practice?
The book answers these questions and many more, allowing you to meet the ever-changing requirements of the role, whilst maintaining professional knowledge, values and ethics in practice, now and in the future. Activities including case studies, legal summaries, decision making activities, CPD support and case law will be welcomed by BIA students, practitioners and others interested in the role.
If you were to Google ‘what is adult safeguarding in the UK?’ you would collect a wide range of definitions. Is adult safeguarding a multi-agency procedure? A way of reducing risk? A means to promote well-being? We would argue that the central purpose of adult safeguarding is to promote and support the human and civil rights of adults who are unable to claim, and are sometimes prevented from claiming, their own rights. The practice of adult safeguarding is about working alongside adults to solve problems, to challenge discrimination, to give the same right of access to protection that all citizens can claim and to enjoy the same quality of life. You might argue that this is what all services should be promoting in their work with adults. This is true. However, if these rights were always respected and promoted there would be no need for adult safeguarding. Our role as practitioners is to promote these rights in every aspect of health and social care, indeed in our society, so there will be less need for adult safeguarding approaches.
This rights approach is what has motivated us through years of practice. We have been social workers, trainers and leaders in safeguarding roles. You will have your own perspectives and, as you gain more practice experience, your own wisdom.
We hope that you enjoy dipping in and out of this handbook, you could read it chapter by chapter, but having had the comfort of handbooks or the advice of wise colleagues in moments of doubt and bewilderment during our practice we wanted to create one for you based on our learning, and hope that it is of help.
All adult safeguarding practice must be informed by a human rights perspective and consider the legal framework that supports human rights. Fundamentally, adult safeguarding practice is about promoting and protecting the human rights of adults whose care and support needs make it difficult for them to exercise their autonomy and will. There are two main strands regarding human rights in adult safeguarding practice:
Human rights as a legal framework that provides structure, definitions of rights, duties and responsibilities and a template for action.
Human rights as a perspective that informs our values and actions in practice.
To use a human rights perspective, we must understand what human rights are as set out in law, where we might see abuses of the human rights of adults with care and support needs and how our decisions must be informed by values based on the principles of human rights.
The first legal framework for addressing the abuse of vulnerable adults in England, ‘No Secrets’ (Home Office and Department of Health, 2000) described ‘abuse [as] a violation of an individual’s human and civil rights by any other person or persons’ (para. 2.5), placing human and civil rights at the centre of adult protection practice. The Care Act 2014 does not reference the Human Rights Act 1998 or UN Rights Conventions, for example the United Nations Principles for Older Persons (1991). The Equality Act 2010 is referenced only with regard to accessible information and in one chapter (16.78) with reference to discrimination in schools for disabled people. The statutory guidance chapter on adult safeguarding does include the statement ‘safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect’ (Chapter 14.7) but gives no further context for these rights.
The Care Act 2014 was implemented in 2015 accompanied by statutory guidance. It is worth looking at what the actual legislation says about each of the sections relating to adult safeguarding before looking in more depth at the accompanying statutory guidance so that we can be clear about our own, and others’, legal duties.
While all children under the age of 18 can be protected via children’s legislation, only specific groups of adults are protected under the Care Act 2014 in England, and in similar legislation in Wales and Scotland and policy in Northern Ireland. Who the duty to enquire applies to is often subject to misunderstanding and controversy. The guidance issued with the Care Act 2014 is statutory; therefore, it must be acted on by a local authority unless a legally sound reason for not doing so can be demonstrated. The Care Act statutory guidance is not detailed, and can be subject to wide interpretation, particularly regarding who the duty to enquire applies to, and what an enquiry is. We will focus on the legal definition of an enquiry in Chapter 9 but in this chapter we will look at who the duty to enquire applies to and the other sections of the Care Act which apply to adult safeguarding. The three elements are set out in part 1 of section 42. This section applies where a local authority has reasonable cause to suspect that an adult in its area (whether or not they are ordinarily resident there).
Fundamental to practice with adults at risk is the law that supports their rights to make decisions as adults. The MCA offers a framework that asks professionals and others supporting the decision making of adults, where there may be conditions that affect their abilities to make decisions, for example as a result of mental ill health or learning disability, to promote their rights to decide for themselves or to have decisions made on their behalf in accordance with their best interests. The MCA sets out principles, tests and checklists to enable practitioners to ensure that they practise in a manner that is compliant with the values and purpose of the Act.
For adult safeguarding practitioners, questions of the person’s mental capacity most often arise when there is concern that the person does not understand or acknowledge the risks that they are facing and may choose to remain in an environment or situation with high levels of risk to themselves. However, all health and social care practice should be informed by human rights and consideration of the person’s ability to make meaningful choices about their lives. The key point when adult safeguarding and mental capacity intersect is when considering whether the adult has the capacity to be involved in their own safeguarding, particularly when considering whether the adult understands and weighs key points regarding the risks to themselves in the situation. Baker (2017, p 128) notes three questions that often arise when exploring the adult at risk’s views of the safeguarding concern:
Can and should this individual make their own decisions in this situation or be protected from harm?
Do they understand the concerns? Do they understand the likely and foreseeable consequences?
Who would be blamed if the individual came to harm? Whose risk is it to take?
Though we would question whether the attribution of blame is a valuable driver for mental capacity decision making, these questions aid our focus on key considerations for considering the involvement of adults in decision making about safeguarding.
Commonly agreed definitions can help to provide a coherent understanding of a subject like adult safeguarding, which means that people from a range of settings and professional backgrounds can discuss the issue with the confidence that they share the same meaning. This encourages inter-agency awareness, the growth of partnership working through a common understanding and the development of effective and consistent responses to the harm described, as well as resources being more readily focused on a defined population or area.
Definitions can risk simplifying complex situations. For example, if an adult is physically assaulted, they are very likely to be psychologically damaged as well as physically hurt. In addition, if the adult has been assaulted because their assailant hates disabled people this can also be defined as discriminatory abuse, and if the responsible agencies do nothing about their plight the adult may also be experiencing discriminatory abuse and potentially organisational abuse. One label will not fit all, but the clarity of defining what harms we are talking about does help to shape our response to a concern. Understanding to whom the statutory duty to enquire applies helps us to focus resources on those who are unable to protect themselves and supports the multi-agency understanding needed for effective adult safeguarding work.
Certain groups are regularly not considered to meet the criteria for the section 42 duty, potentially because of practitioners’ beliefs about ‘lifestyle choice’ which disguises the true nature of the adult’s inability to protect themselves. Studies (Homeless Link, 2014) report that between 25 and 30 per cent of the homeless population have severe mental health problems including severe depression, schizophrenia and bipolar disorder.
Contemporary approaches in adult safeguarding, for example Making Safeguarding Personal, are predicated on the practitioner being able to make a relationship with the adult and the people and agencies around them. Guidance may refer to person-centred procedures or practice, but these are not to be confused with the person-centred approaches advocated by theorists such as Carl Rogers (1951) which are based on the notion of self-determination and the value of the relationship in itself in effecting change. While the relationship in itself between the practitioner and adult may well enable the adult to make changes in their lives, our focus is also on how building a relationship will support the adult to be involved in their own protection, by exploring their situation, identifying potential outcomes and recovering from harm.
You may need to build a relationship quickly in a crisis situation, for example during a mental health crisis or when an adult needs to leave a dangerous situation. These relationships need to be effective in the short term but may not be sustained beyond the initial crisis. Relationships can take longer to develop with people who have experienced abuse over a long period, or who are self-neglecting, or for whatever reason find it hard to trust others. These relationships can sustain the adult through the ups and downs of change. Whether short- or long-lived, helpful relationships have a number of important elements in common. These elements may be present after one meeting or may take several meetings to build up.
Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, while at the same time making sure that the adult’s wellbeing is promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs in deciding on any action. (Statutory guidance, DHSC, 2018a, 14.7)
Situations where there is a risk to an adult with care and support needs can promote anxiety in all involved. The adult will be experiencing the impact of being harmed, and also the worry of statutory agencies being involved in their life. Although the intention of the practitioner is to improve the quality of the adult’s life, the power that practitioners are perceived to have can be stressful and alarming for the people at the centre of any adult safeguarding concern. The adult’s family and friends may be anxious about risk and may well have a preference for a course of action that will completely remove risk from the life of the adult but damage their independence and well-being irrevocably. Partner agencies involved can be anxious about risk and may also have a preferred course of action. In Chapter 6 we talked about understanding partnership agency cultures and how this can help in discussing risk together. There may be expectations that risk will be completely removed from an adult’s life, but a lack of understanding of the potential cost to the adult’s well-being of doing so.
A set of decisions have to be made before making a referral to the local authority about a concern. The vast majority of referrals are made by professionals or care workers rather than the adult or their family and friends. A self-referral has the advantage of the adult consenting to and wanting help to protect themselves. In order to decide to refer themselves, the adult must know that adult safeguarding exists and how to get in touch, and have the means to do so, such as access to a telephone or the internet. The adult must be able to quickly and simply make contact with an adult safeguarding service and have trust that the social workers or contact centre workers they are talking to will listen to them and help rather than make their situation worse. Adults at risk need to know that adult safeguarding is the right service for them to speak with.
Professionals or care and support staff may be referring because the adult has disclosed harm to them, or they have witnessed abuse or a set of indicators of potential harm. The referring professional should make an assessment of risk with the adult in order to decide what steps are needed to address any immediate safety issues. The emergency services may need to be called if there is a threat of or actual violence or injury.
The adult may need support if they wish to call the police. In considering this decision with the adult it is important to appreciate the implications of not doing so for any future prosecution.