1. Revised Self-Neglect Policy and Best Practice Guidance
July 2018

2. Why did we need to revise our policy and guidance?
Recent Safeguarding Adult Reviews (SARs) have shown that:
Some professionals weren’t aware of the existing policy
Some people found the policy lengthy and unclear on certain points
There was some confusion about roles and responsibilities
There was a lack of clarity about when a ‘self-neglect case’ should be managed under Safeguarding procedures
Mental capacity issues were not considered in sufficient
depth in the cases reviewed

3. What are the key changes?
It’s shorter! (24 pages plus appendices)
It’s a more user-friendly format
It aims to be clear and use plain English
It starts with a list of ‘key messages’ in bullet points
It includes a 3-page ‘Quick Guide’ summary, with a flowchart

4. What are the key messages? (1)
Safeguarding procedures should only be initiated when other attempts at engagement have been tried – unless the situation is high risk
Clarification that the agency / professional which identifies a self- neglect situation will normally be responsible for arranging an initial Multi Agency Risk Management (MARM) meeting
A ‘Lead Agency’ / ‘Lead Worker’ should be identified at the MARM meeting – will be the most appropriate agency / person involved with the self-neglecting person
All agencies are expected to prioritise MARM meetings and
reviews

5. What are the key messages? (2)
It’s essential that professionals are given time to ‘get to know’ the person and find out what motivates them
Mental capacity assessments should be thorough and include issues of ‘executive capacity’
Creative approaches are often needed
Risk assessments should focus on specific risks
The Self-Neglect process should only be closed when there has been a clear reduction in risk
The case should be re-considered under Safeguarding procedures if risks cannot be reduced to acceptable levels

6. Essential Points Self-neglect is everyone’s business!
A multi-agency approach is always needed
Dismissing self-neglect as a ‘lifestyle choice’ is not acceptable
Don’t ‘close the case’ because the person initially refuses help or refuses the Self-Neglect Plan

7. Where can I find out more?
The new Policy can be found on the B&NES Safeguarding website
Quick Guide to the Self Neglect Policy and Guidance (July 2018)
Self Neglect Policy and Guidance (July 2018)
Appendix 1 - Assessment of Need and Risk
Appendix 2 - Self Neglect Agenda Template
Appendix 3 - Self Neglect Crisis Intervention Plan
It has links to other policies / guidelines – e.g. Avon & Somerset Fire and Rescue’s clutter image rating scale
References for further reading
Each agency to facilitate staff training

8. The Revised Escalation Protocol (1) (Multi-agency Protocol for Resolving and escalating professional differences of opinion regarding safeguarding decisions )
Joint LSAB / LSCB Protocol
Professional disagreements should be resolved at the lowest possible stage
However, when an adult is thought to be at risk of immediate harm, situation must be escalated within 24 hours
The safety and wellbeing of the adult are paramount
Any disagreements must be resolved in a timely and professional manner
Professional differences and disagreements should be viewed positively - improvements can often take place through learning

9. The Revised Escalation Protocol (2)
If unresolved, the problem should be referred to the relevant manager
When a resolution is reached, Appendix A should be completed and sent securely to the LSAB Business Manager
If a resolution is not achieved, a report must be written by the Service Manager and attached to Appendix A, and sent to the Chair of the LSAB via the LSAB Business Manager
If the LSAB convenes a Resolution Panel, it will include representatives from three agencies. The Chair of the Panel will be the Director of Safeguarding and Quality Assurance or someone acting on their behalf
LSAB & LSCB Escalation Protocol (June 2018)
Escalation Report Proforma