Safeguarding Adults

1
Safeguarding Adults

• A study of the effectiveness of arrangements to
  safeguard adults from abuse.
• Sue Toole and Louise Lawton

2
Aims of the study

• To inform the review of No secrets
• To look at arrangements for safeguarding not
  prevalence
• To look across councils and regulated services

3
Evidence

• Councils
• Self-assessment data (all 150 councils)
• Service inspections (23 councils)
• In-depth case tracking and workshops (5 councils)
• Regulated services
• Performance against National Minimum Standards
  (all 22,000 services)
• Thematic probe (250 services)
• In-depth thematic inspections (94 services)

4
Overall picture

• Uneven progress in developing effective
  safeguarding arrangements by councils and care
  services leading to
• Variability in quality of support to people who
  experience abuse unacceptable in human rights
  context
• More needs to be done to ensure people directing
  their own support benefit from appropriate and
  individually tailored safeguards

5
Overall picture

• Variability in prevention of abuse and long term
  support after abuse
• Best councils active leadership and strong
  partnerships but big distance between best and
  worst
• Councils performing well on safeguarding had more
  care services performing well in their area
• Care services with higher quality rating
  generally were better at safeguarding people

6
Looking in more detail at

• Peoples experiences of safeguarding arrangements
• Quality of support and care practice
• Checking and improving arrangements
• Local strategic work

7
Peoples experiences of safeguarding arrangements

• Councils are getting information out to older and
  disabled people but this does not always reach
  all groups
• If abuse is reported, the response is quick but
  some people feel they lose control in the process
• Advocacy is valued, but in short supply

8
Peoples experiences of safeguarding arrangements

• Councils are providing some options to help
  prevent abuse for people directing their own
  support, but no council had a systematic approach
  
• In care services, many people did not remember
  being given information about what to do if they
  have concerns about abuse
• 4 out of 5 people using care services felt able
  to speak to manager/staff if they felt unsafe
• 3 out of 5 were confident of action if they
  reported a concern

9
Quality of support and care practice - councils

• Unacceptable variability in gathering
  information, risk assessment, protection plans,
  case recording
• Distinguishing safeguarding allegations from
  other concerns - the best councils used broad
  definitions and a number of options of approach,
  depending on circumstances
• Information sharing protocols generally good
  difficulties in practice with GPs, hospitals,
  mental health services and care providers

10
Quality of support and care practice - councils

• Support to people after abuse variable a menu
  of options for support is needed
• People abused in residential settings need more
  individual support
• Patchy use of legal powers - many council staff
  need better understanding of legal remedies
• More staff are trained in safeguarding but the
  independent sector need more access to training
  on local arrangements

11
Quality of support and care practice care
services

• CSCI are more likely to receive safeguarding
  alerts about poor services
• of regulated services meeting the National
  Minimum Standard (NMS) on protection from abuse
  has risen across all service types since CSCI
  started regulation
• Private sector services are least likely to meet
  the protection standard
• Thematic inspection suggests performance on
  outcomes may be worse than NMS figures suggest
• Most common shortfalls staff training and
  implementation in practice, policy/procedure and
  recruitment practice

12
Quality of support and care practice care
services

• Managers of care services in better performing
  councils knew more about local safeguarding
  procedures
• Providers policies need to dovetail with local
  procedures
• CRB checks are universally used, other
  recruitment checks less consistently evident
• 40 managers did not understand the POVA list
• Higher rated services had tended to have more
  staff trained in safeguarding

13
Checking and improving arrangements - councils

• 2/3 of councils are failing to monitor adequately
  at a casework level
• At a strategic level, levels of activity are
  monitored but most councils need to improve
  measures of experience and outcomes
• Commissioning safe services is variable but 3
  star councils have a higher of services in the
  area meeting the NMS protection standard

14
Checking and improving arrangements care
services

• Only 38 of managers said they had used
  experience from a safeguarding incident to
  improve practice
• Only 16 said that they enabled people using the
  service to feedback on how services could make
  people feel safer
• High rated services were performing better in
  learning from incidents and using feedback
  surveys

15
Checking and improving arrangements the
regulator

• CSCI have a protocol with ADASS and ACPO to
  ensure regulatory practices reduce the risk of
  abuse
• and a policy to differentiate complaints and
  abuse allegations
• Inspection work in care services now targets
  services needing closer monitoring
• Safeguarding is a key threshold in performance
  assessments of councils
• A strengthened focus on safeguarding is needed in
  new regulatory frameworks

16
Local strategic work - councils

• Variation in priority of safeguarding shown by
  differences in resources, representation on
  Safeguarding Boards, profile in commissioning
  strategies and numbers of alerts
• Only ½ Adult Safeguarding Boards are working well
  
• Most struggle to engage people using services and
  other members of the public
• Most are developing strategic work but
  safeguarding is not a theme across all relevant
  strategies
• At different stages in including safeguarding in
  commissioning strategies

17
Conclusion - Improving the current situation

• Mixed views about changes to the law
• Most support for duty to co-operate and share
  information across agencies
• Most support for change in council areas where
  difficulties are experienced with joint working
• Regardless of changes to the law, more work to
  design safeguarding into services is
  essential.

18
Conclusion - Key elements of prevention/ early
intervention

• People supported to exercise the right to be free
  of abuse including access to advocacy
• Vetted and competent workforce
• Good universal services to reduce risk of abuse
• Needs assessments and risk assessments to inform
  peoples choices
• Sound confidentiality and information sharing
• A range of options for support to keep safe that
  can be tailored to individuals needs
• Services promote safeguarding and independence
• Public awareness of the abuse of adults