28 June 2010 Decision Making Conference Safeguarding, choice, accountability, risk taking…. Social work decision making in context Jill Manthorpe

28 June 2010 Decision Making Conference Social Work Decisions What many people want to them to do and policy makers want to encourage Essence of professionalism? Context of protocols, pathways and evidence The future looks…?

28 June 2010 Decision Making Conference If only..

28 June 2010 Decision Making Conference Government decisions - context Commission on long-term care, to report within a year. Break down barriers between health and social care funding to incentivise preventative action. Extend the roll-out of personal budgets to give people and their carers more control and purchasing power. Use direct payments to carers and better community-based provision to improve access to respite care.

28 June 2010 Decision Making Conference safeguarding Larger evidence base for decision making Prevalence & incidence, data reporting When things go wrong eg serious case reviews Case law from Mental Capacity Act 2005, eg offences of wilful neglect/mistreatment Still legal uncertainties eg ISA under review

28 June 2010 Decision Making Conference Practice on the ground Bridging support plans & safeguarding plans Conditions of personal budgets – prevention (eg checks of PAs), recipients are ‘vulnerable adults’ Monitoring & reviewing (Recording) Looking to Scotland for evidence of intervention effects Linking up, DV, NHS, hate crime

28 June 2010 Decision Making Conference choice Major roll out of personal budgets (some blended funding) for all groups (self-directed support) Money on more direct employees (PAs) but large agency expenditure (need changes) Day centre closures Evidence positive – in the main

28 June 2010 Decision Making Conference Practice on the ground Support plan processes… Level of monitoring and review Lite touch? Duty of care? (IBSEN) More proxies (but little advance planning – Evidem) Recording choices eg paper, video…

28 June 2010 Decision Making Conference 2 gov decisions on Social Action: accountability changes Create & expand mutuals, co-operatives, charities & social enterprises, ensure greater involvement in running of public services. Public sector workers to get a right to form employee-owned co- operatives & bid to take over the services they deliver.

28 June 2010 Decision Making Conference Practice on the ground Newish relationships of accountability Commissioning requiring evidence, confidence and cost-effectiveness High use of language of productivity More fissures in working relationships leading to greater centralisation

28 June 2010 Decision Making Conference Risk High level interest in risk enablement and rights, ‘nothing ventured, nothing gained’ Not so many risk policies, more embedded Focus on assembling agreement Risk to self freed up but risk to others…. Dangerous people, perpetrators… left aside.

28 June 2010 Decision Making Conference

Practice on the ground High levels of need among state funded users: different sorts of risk; eg end of life Patient safety – managing at home Calls to manage crises; rapid decision making (advance and proxy)

28 June 2010 Decision Making Conference Decision making? Huge ethical questions (so nothing new) Evidence base from recording v system requirements Skills at risk conversations, conflict management, best interests… End thought - More decision shaping?

28 June 2010 Decision Making Conference resources Evidem.org.uk SCWRU - kcl.ac.uk NIHR National School for Social Care Research