1. Self Neglect in Dorset, Bournemouth and Poole
Verena Cooper – DSAM Dorset CCG
Working within the Mental Capacity Act – if used correctly can look at the balance of the impact and the likelihood of negative and positive outcomes
Risk needs to be shared – no one person / agency should take full responsibility – the benefit of the MARMM is solidarity
People should be supported to make real choices
Risk may be minimised but not eliminated
Identification of risk carries a duty to do something about it
Risk may change due to circumstances, therefore triggers to risk, escalation and contingency plan essential

2. Defensible Decision making tool Information sharing
Dorset, Bournemouth & Poole guidance will be an appendix to the Adult Safeguarding Policy and Procedures
In the tool kit is
Risk assessment tool
Clutter tool
Defensible Decision making tool
Information sharing
Risk assessment tool for defensible decision making
Self neglect and hoarding assessment tools
Clutter tool for hoarding
There is a hyperlink within the guidance to
the tools

4. Safeguarding duties apply to adults who:
Has needs for care and support and
Is experiencing or at risk of abuse and neglect and
As a result of their care and support needs is unable to protect themselves from either risk of the experience of abuse or neglect
SAFEGUARDING is everyone’s business
In Self Neglect / hoarding a Multi agency response is required even if the LA safeguarding procedures are not invoked
Different from other types of safeguarding as there is not anyone causing the harm apart from the individuals themselves
It is complex
At is heart is knowing – understanding the person
being – professional qualities of respect, empathy, honesty, reliability being alongside and staying alongside the individual
doing - balance between hands on, hands off approach, seeking small opportunities for agreement and engagement – deciding when risks are so great intervention must take place
The care act places well being, prevention and safeguarding at its heart
In self neglect / hoarding a multi agency response is required even if the LA safeguarding procedures are not invoked.

5. What can I expect from the safeguarding teams ?
Three levels of response – safeguarding can be anything from support and advice to a full scale Section 42 safeguarding enquiry
Safeguarding undertake a Section 42 enquiry, coordinate and manage procedures – Review of current situation
Situation is deteriorating and risk is escalating, professionals have increasing concerns – consider discussion with safeguarding
Multi disciplinary - individual needs advice and support – Plan and hold initial MARMM
Safeguarding is everyone’s business
Emergency actions must be put in place – i.e. has a crime occurred, does the person need immediate medical attention (Physical or Mental Health)

6. Ten stages
Stage 1 and 2
Safeguarding concern apply the three part test
Initial response – including emergency services
Stage 3 and 4
Consider information sharing
Risk assessment
Stage 5
How will the concern be handled – three levels of response
Stage 6 and 7
Outcomes and expectations of the person
Actions to support person
Stage 8 and 9
Most relevant person to provide key support / access?
Resource allocation – time and dedication
Stage 10
Defensible decision making
Working within the Mental Capacity Act – if used correctly can look at the balance of the impact and the likelihood of negative and positive outcomes
Risk needs to be shared – no one person / agency should take full responsibility – the benefit of the MARMM is solidarity
People should be supported to make real choices
Risk may be minimised but not eliminated
Identification of risk carries a duty to do something about it
Risk may change due to circumstances, therefore triggers to risk, escalation and contingency plan essential
Department of Health (2010) outlines elements of defensible decision making :
All reasonable steps have been taken
Reliable assessment methods have been used
Information has been collated and thoroughly evaluated
Policies and procedures have been followed
Practitioners and managers adopt an investigatory approach and are proactive
Challenge for professionals balancing empowerment with duty of care

7. Information sharing
Information sharing should be consistent with the principles of the Caldicott Review 2013 – information to share or not to share
Information shared on a need to know basis when it is in the best interest of the adult
Decision about what information is shared and with who be taken on a case by case basis
Whether information is shared with or without the adult at risk’s consent it should be
necessary for the purpose for which it is being shared
Shared only with those who have a need for it
Be accurate and up to date
Be shared in a timely fashion
Be recorded proportionately demonstrating what a course of action was chose, - I did this because…… I chose this because …….
Shared securely

8. Key Messages Be familiar with the self neglect and hoarding tool kit
Communicating and engaging with
the individual
Consider principles of the MCA
Consider MHA
Proportionate Risk Management / Mitigation
Services available
Decision making and documentation
Explore legislation to assist process
– what are the risks, protective factors, actions to mitigate risk, triggers, escalation and contingency plan
- fire, housing, environmental health