Adult Safeguarding and the Care Act 2014 – 18 months on September 22nd 2016 ESRC Seminar, University of Bedfordshire Dr Adi Cooper O.B.E. Independent Chair Haringey and City & Hackney Safeguarding Adults Boards, Visiting Professor University of Bedfordshire Claire Bruin Service Director, Adult Social Care, Cambridgeshire County Council

Areas to cover: how it is working; strengths and weaknesses; what is still to do Wellbeing and safety: impact on safeguarding practice Activity and process: changing criteria and definitions Making Safeguarding Personal Safeguarding Adults Board; Safeguarding Adults Reviews Advocacy in safeguarding

Wellbeing and Safety – impact on practice Alert to concern – more person centred language recognising the impact of abuse and neglect on the adult Investigation to enquiry – action taken or instigated by the Local Authority in response to a concern – primary aim of the enquiry is to improve the wellbeing of the adult Section 42 enquiries with focus on outcome for the person and removing or reducing risk Delegation of responsibility for undertaking enquiries driving different relationship with providers – the provider must act to address any abuse or neglect in their services and protect the adult(s)

How it is working; strengths and weaknesses; what is still to do Strengths/Weaknesses Wellbeing is central to Care Act, features in assessments and safeguarding responses, so becoming more familiar Policies and procedures rewritten to reflect new requirements Focus on outcomes supports MSP Trust required to delegate responsibilities for section 42 enquiries Still to do Significant cultural change for staff who need ongoing training and support to embed in their work Reflective practice discussions/supervision can support professional decision making around wellbeing and safety Working with providers to undertake enquiries to build trust

Activity and process – changing definitions – impact – how it is working Care Act Stocktake - Safeguarding referrals appeared to almost double in the first six months after the Care Act 2014 came into force Awaiting national Safeguarding activity data for 2015/16 – anecdotally seems to have had variable impact New areas for many such as modern slavery and self neglect, updating in areas such as domestic abuse, required many places to introduce new policies, procedures and training (e.g. pan London Multi Agency Policy and Procedures) Changes in the definition – variable impact depending on pre-Care Act practice (threshold debates)

strengths and weaknesses; what is still to do Strengths/Weaknesses Freeing up assessment and planning process / relies on professional skills and competencies Developing understanding of new categories/needing to increase awareness of how to recognise the signs of abuse or neglect What is still to do Ensuring full understanding of new definition across relevant agencies Exploring different ways to respond to different situations – learning from other colleagues or experts e.g. Salvation Army re Modern Slavery Reinforcing the need for collaborative multi-agency approaches to provide the most appropriate response for each person

What is Making Safeguarding Personal? Making Safeguarding Personal means adult safeguarding: is person-led is outcome-focused enhances involvement, choice and control improves quality of life, wellbeing and safety and meets Care Act Guidance. ‘a shift from a process supported by conversations to a series of conversations supported by a process’ ‘ensuring an emphasis in those conversations on what would improve quality of life as well as safety’ ‘talking through with people the options they have and what they want to do about their situation’ ‘developing an understanding of the difference we make’

Making Safeguarding Personal – temperature check 2016 – Approach & Findings Aims: measure progress of implementation; inform the 2016/17 programme; offer reflective coaching and expert advice to MSP leads Method: Interview schedule with open and closed questions; comparison questions built in from previous year’s survey; LA safeguarding leads were interviewed by an expert in MSP; 76% of English local authorities surveyed. Findings: Direction of travel there has been a substantial shift in the adoption and implementation of MSP by adult social care services in 15/16; the majority of local authorities have now introduced the MSP approach; most local authorities are moving into the next phase of embedding user-focused work into their practice and culture; the MSP approach started mainly in safeguarding teams but is now rapidly spreading out into generic teams; there has been an overall increase in partners’ involvement in MSP since 2014/15

Making Safeguarding Personal – temperature check 2016 – Findings continued Person centred outcomes and practice: MSP is creating a big turnaround from 'doing to' people to 'doing with' them; services are moving away from purely substantiating abuse to safer and restorative resolutions; when actively engaged, the outcomes people wanted were very often very modest, eg. an apology; re-assurance; recognition of the risks and how to deal with them; an MSP approach appears to take up no more time than a traditional approach but seems to lead to better outcomes for service users and can save resources in the long run; a couple of respondents warned that some staff had misunderstood MSP and failed to take into account the public duty to protect people.

Making Safeguarding Personal – temperature check 2016 – findings continued Drivers for change: - the Care Act and enthusiasm of social workers were the main drivers of change but it also required commitment and support from senior management and changes to infrastructure; Councils that were outward facing and collaborative were further on with MSP than those who were fairly isolated, regardless of resources; social workers have embraced MSP and see it as a refreshing change from care management to social work core values; lack of resources was often a blockage but workers and managers found ways around it with varying degrees of success; excess pressure from additional referrals and alerts was a blockage to progress, especially the added pressure of the massive increase in DoLS.

Reflections Legislation has been helpful Care Act has been a significant lever for change in a process that was gathering momentum at the time of developing the statutory guidance; it validates and support the MSP approach What is working? Practice is shifting to become much more person centred and outcome focused across England Still to do Further embed MSP, and extend to partners Implement the recommendations from the MSP temperature check

Safeguarding Adults Boards – Care Act impact Difference in becoming ‘statutory’- lots of preparation work(some started in 14/15, others in 15/16, continuing into 16/17): reviews of membership to ensure appropriate seniority; reviews of structures, terms of reference, constitution; review of polices and procedures to be Care Act compliant and introduce new ones some shift in ‘statutory partners’ roles’ e.g. chairing sub groups, senior representation, executive membership Development of SAB strategies and public consultation with Healthwatch (NB user engagement role from MSP 2016) SAB Annual Reports 2015/16 & Links with LSCBs, HWBs, CSPs etc

Reflections Strengths /weaknesses Care Act demonstrates status and consistent accountability processes Expectations set the bar high / delivery and sustainability are challenges Still to do involve and engage local people and communities financial sustainability for SABs Holding partners to account effectively

Safeguarding Adult Review - impact ’a new industry’? Anecdotal information suggests an increase in numbers of SARs requested and initiated post Care Act More SAR sub-groups and panels established and developed Various methodologies being developed to reflect ‘proportionate’ principle Focus on newer areas of the Care Act e.g. self neglect and modern slavery emerging

Reflections Legislation helpful/unhelpful Less prescriptive than SCRs Promoted a learning focus (rather than blaming) No national repository / communication mechanisms for sharing learning more widely outside the SAB. Still to do: Develop ways to evaluate impact Sharing learning wider – regionally and nationally quality markers – what good looks like (respond to Wood Review challenges)

Advocacy: Reflections Usage Variable and often minimal - not enough awareness Advocacy services Not enough commissioned/ not enough appropriately experienced advocates / not enough resources Still to do Generate awareness of requirements to use safeguarding advocates, commission advocacy that can support safeguarding, and train enough advocates to undertake this role From MSP temperature check conversations

References & Links Care Act Stocktakes – http://www.local.gov.uk/care-support-reform/- /journal_content/56/10180/6341378/ARTICLE Cooper, A. et al (2016) Making Safeguarding Personal Temperature Check 2016, Association of Directors of Adult Social Services, London Department of Health (2016) Statutory guidance to support local authorities implement the Care Act 2014 Updated March 2016, London, HMSO LGA Making Safeguarding Personal materials - http://www.local.gov.uk/web/guest/adult-social-care/- /journal_content/56/10180/6074789/ARTICLE