Making Safeguarding Personal ‘It's putting the human touch back into safeguarding.’ (Cooper et al 2016:22) Dr Lindsey Pike Senior Research and Development Officer Research in Practice for Adults Lindsey www.rip.org.uk

https://youtu.be/R4G4fgoRR5w

What is Making Safeguarding Personal? Making Safeguarding Personal is an approach to safeguarding that: is person-led is outcome-focused enhances involvement, choice and control improves quality of life, wellbeing and safety (Care Act Guidance) Recap what MSP is Download from http://tinyurl.com/ppf3koh

Lord Justice Munby The emphasis must be on sensible risk appraisal, not striving to avoid all risk, whatever the price, but instead seeking a proper balance and being willing to tolerate manageable or acceptable risks as the price appropriately to be paid in order to achieve some other good – in particular to achieve the vital good of the elderly or vulnerable person’s happiness. What good is it making someone safer if it merely makes them miserable? Munby, Lord Justice (2010) ‘What price dignity?’, keynote address at LAG Community Care conference: Protecting liberties, London, 14 July.

Human Rights Act ‘The State’s obligations under Article 8 (Human Rights Act) are not merely substantive; they are also procedural. Those affected must be allowed to participate effectively in the decision-making process. It is simply unacceptable (and an actionable breach of Article 8) for a Local Authority to decide, without reference to P and her carers, what is to be done and then merely tell them (to ‘share’ with them) the decision.’ (Lord Justice Munby, July 2010, Keynote Address to the Community Care Conference 14th July 2010) The law as context for a more inclusive/empowering approach to safeguarding. MCA also important here and especially the five core principles of the Act. www.ripfa.org.uk

The Care Act - Wellbeing is a broad concept…. personal dignity (including treatment of the individual with respect) participation in work, education, training or recreation physical and mental health and emotional wellbeing social and economic wellbeing domestic, family and personal relationships protection from abuse and neglect suitability of the individual’s living accommodation control by the individual over their day-to-day life (including over care and support provided and the way they are provided) the individual’s contribution to society.

Ensuring the person is at the centre Put the adult and their wishes and experiences at the centre Seek to enable people to resolve, recover and realise Key questions for whoever is undertaking the safeguarding enquiry How can we work with people to enable that to happen? What does the person want to happen? So the kind of questions that we should be asking are: What does the person want to happen? How do we know their outcomes have been understood and our intervention is making a difference? How can we work with people to enable their outcomes to be reached? Does the person feel safer and protected, at the start and throughout the process? How do we know their outcomes have been understood and our intervention has made a difference? Does the person feel safer and protected, at the start and throughout the process?

What do people want from safeguarding? When disabled people and families were speaking about ‘safeguarding’, they meant protection from the state, not by the state. At its heart this lack of trust comes from an unequal power relationship (#LLBill, Broach, 2015) Personalisation Service user involvement Risk enablement approach People who use services want to feel in control of the situation when involved in safeguarding www.ripfa.org.uk

Some of the Evidence (1) In MSP, most of the time people wanted realistic outcomes but Sometimes their expectations were more than could be delivered, sometimes less than what might be possible Sometimes they wanted more than one outcome and these were difficult to reconcile Identifying outcomes starts an honest conversation about people’s lives and what is possible It also enables a discussion about the risks and benefits of different options Concerns about approach – discuss in relation to the next three slides MSP = Making Safeguarding Personal Assessment conversation to be part of defining outcomes and solutions; creative approaches; Separating outcomes that are eligible for funding from wider outcomes or wishes; Proportionality of response – simple solutions where that produces the desired outcome, and focussing detailed work on those with more complex needs that make outcomes harder to achieve; Making time to invest in creative support planning for longer term involvements –research options, supplying information, setting things up, any ongoing support Connecting with the community as a resource for individuals; Supporting carers; Low level funding to promote informal support; A reducing budget. www.ripfa.org.uk

Some of the Evidence (2) Despite what one might fear, people tend not to identify unrealistic outcomes – and when they do identify more aspirational outcomes, they don’t expect services to ‘deliver’ them (Harris 2006) With the help of the person’s social networks, ambitious outcomes can be realised (e.g. a woman from an Orkney care home who was enabled to go to a Daniel O’Donnell concert) (Cook and Miller 2012) Harris, J. (2006) Incorporating the social model into outcomes focussed social care practice with disabled people. In C. Barnes and G. Mercer (Eds) (2004) Disability, Policy and Practice: Applying the Social Model: Leeds, The Disability Press Cook and Miller developed Talking Points www.ripfa.org.uk

MSP evaluation 2014/15 Survey of MSP leads: 95/ 151 respondents (63%) Survey of multiagency staff: 63 respondents (44%) 6 telephone focus groups of MSP leads (16 participants total) 5 telephone interviews with senior leaders in safeguarding RiPfA commissioned to conduct evaluation 95 local authorities in England took part Mixed methods approach

Evaluation findings 95% of respondents thought MSP was the right approach to be taking in the current context Many respondents early in MSP journey Types of work that councils had undertaken included: partnership and project work developing approaches to safeguarding (such as family group conferencing) staff development and awareness raising changing systems using feedback and evaluation

Is MSP providing good outcomes for people? People with more direct experience of MSP were more likely to think the impact on people was beneficial Methods used to understand people’s experience of safeguarding included: Case audit; questionnaire; not yet started; recording systems; interviews (51%) (42%) (33%) (22%) (21%)

What kind of outcomes are discussed? To be and feel safer (45%) To maintain key relationships (23%) to gain or maintain control over the situation’ / ‘to know that this won’t happen to anyone else’ / ‘people have not yet specified outcomes’ (21%) “the bit we found helpful …was… recording desired and negotiated outcomes” (FG1)

A service user perspective: what is to be gained from a person-centred approach? Fire fighting to long-term solutions Helped find right people to support me Helped us see the severity of the risk Supported my family Put me at ease to share my story Built my self confidence Help and results came quickly I apply the principles on an ongoing basis in my life I did it myself! This is an account of what was helpful about a person centred approach (FGC in this case) to this woman who was ageing and had suffered 40 years of abuse at the hands of her husband. In this case FGC was provided by Daybreak an organisation in Hampshire who specialise in providing FGCs. Traditional approaches had repeatedly failed to lead to long term change. After 6 months of involvement with FGC this woman had turned her life around. These were the points she made about why and how it had been successful. ‘it helped me to…. All those things already talked about – if we involve pepole it’s sustainable not protectionist/ abusive This tells u what we need to focus on in MSP / outcomes focussed approach. www.ripfa.org.uk

What do you want? Outcomes important to people using services “This framework of fifteen outcomes has been used in practice and research settings with thousands of people across a wide range of services. This experience has shown that the outcomes are sufficiently high level to be able to capture most issues of importance to most people. In some cases, experience of using the framework has led to the identification of specific additional outcomes that are relevant for inclusion by particular services.” Cook and Miller 2012 N.B. How these match up to the Care Act well-being principles. Source: Cook and Miller 2012 www.ripfa.org.uk

Why might involvement and empowerment lead to better outcomes? Better information about the problem Working more effectively with risk Solutions are more likely to fit the persons circumstances Person is motivated to create the changes needed “Recovery” from Stockholm syndrome/re- learning to make decisions and use own agency/power to create change

Key competencies for MSP work Understanding of different forms of abuse/neglect, their causes and impact Communication skills Empathy, respect, genuineness Support others to recognise their strengths and identify outcomes Collaborative goal and objective setting, action planning, risk assessment and monitoring Assessment of mental capacity in relation to safety from abuse/neglect Knowledge of local resources Legal literacy Understanding of boundaries of own role Able to work with other professionals as part of a “virtual team” around the person

Why look to enable when working with risk? Life without risk would be life without living. It is only through accepting a level of risk in our daily lives that we are able to do anything at all. (Sorensen 2015) In weighing up benefits and risks, practitioners are often quicker to highlight the risk to a person using a service than they are to highlight the benefit (Faulkner, 2012) www.ripfa.org.uk

MSP Evaluation/ Temperature check ‘Recognising people’s right to lead a risky lifestyle’ ‘Looking at the level of risk the person will allow’ ‘It enables positive risk taking whilst safeguarding individuals from potential abuse.’ ‘Shifting the focus from risk to wellbeing’ Pike and Walsh (2015), Cooper (2016) www.ripfa.org.uk

What is risk enablement? As an approach, risk enablement identifies a link between risk and enablement. Risk enablement recognises that taking carefully considered risks can enable individuals and help improve their wellbeing. Positive risk-taking is a way of working with risk that promotes enablement. It is important to remember that the ‘positive’ in positive risk-taking refers to the outcome not the risk. Positive risk-taking is far more about the process of assessing risk and making balanced decisions – whilst risk enablement is a broader term that refers to the principle of working with risk to enable people – Co-production, strengths based work, multi-agency working and effective work with community assets could all come under the umbrella of ‘risk enablement’ at times. Re ‘positive risk’: risk always refers to the likelihood of harm, but positive risk-taking balances that with the likelihood of achieving outcomes and in doing so seeks to build on strengths rather than a traditional ‘deficit-based’ approach – hence the positive! Applicable to work with both long and short-term support needs (think of examples) www.ripfa.org.uk

Making safeguarding personal and risk Prioritising self-determination: people can choose to take risks Duty of care to protect from harm: What is too risky? How can practitioners make defensible decisions about risk How can they work around their multiagency colleagues around that www.ripfa.org.uk

Good practice in the MCA is key

Check list for future action What’s working well in Cornwall? Which areas need development? ‘permission’ to work differently meaningful engagement of people who use services development of the right skills (including legal literacy) revise policy, procedures and systems sharing good practice effective use of the Mental Capacity Act emphasis on and confidence in professional judgement support from SAB and involve partners acknowledge challenging financial climate and work on understanding longer term resource impact of MSP Ask delegates to write their responses on post its (one colour for working well, the other needing development). Collate responses for input into SAB strategy.

Thanks for listening Questions?

References and further reading Cooper A et al (2016) Making Safeguarding Personal temperature check 2016. London: ADASS Pike L (2016) Involving people in safeguarding adults: Leaders’ Briefing. Dartington: Research in Practice for Adults Pike L (2015) Safeguarding adults from abuse. In Walden D (ed) Reimagining Adult Social Care: Evidence Review. Dartington: Research in Practice for Adults Preston-Shoot M (2015) Safeguarding in light of the Care Act: Leader’s Briefing. Dartington: Research in Practice for Adults Preston-Shoot, M., & Cooper, A., (2015) eds. Special Issue on Making Safeguarding Personal, Journal of Adult Protection, Vol.17, No.3 https://www.ripfa.org.uk/resources/case-law-summaries/case- law-nov2016/

Useful Links Knowledge Hub details MSP - https://knowledgehub.local.gov.uk/group/makingsafeguardingpersonal Adult Safeguarding Community Practice - https://knowledgehub.local.gov.uk/group/adultsafeguardingcommunityofpractice Further Information LGA Care and Support reform adult safeguarding page: http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/6523063/ARTICLE DH Care Act Fact sheets - https://www.gov.uk/government/publications/care-act-2014-part-1-factsheets SCIE information on the Care Act - http://www.scie.org.uk/care-act-2014/ and SCIE on self neglect http://www.scie.org.uk/publications/reports/69-self-neglect-policy-practice-building-an-evidence-base-for-adult-social-care/files/report69.pdf MSP Materials MSP Evaluation 2014/15 http://www.local.gov.uk/web/guest/adult-social-care/-/journal_content/56/10180/6074789/ARTICLE LGA Making Safeguarding Personal materials: http://www.local.gov.uk/web/guest/adult-social-care/-/journal_content/56/10180/6074789/ARTICLE

Contact @ripfa @lindsey_pike https://www.ripfa.org.uk ask@ripfa.org.uk www.rip.org.uk www.ripfa.org.uk 29