1. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog Martin Stevens, Jill Manthorpe and Kritika Samsi Shereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York

2. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog This project was funded by the National Institute for Health Research (NIHR) School for Social Care Research (SSCR) (project number - T976/EM/KCL2). The views expressed in this presentation are those of the authors, not necessarily those of the Department of Health, the NHS or the NIHR.

3. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Qualitative element  Objectives and methods  Summary of findings from staff and from service user interviews  Contrasting staff & service user views  Implications for practice

4. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Three local authorities  Semi-structured interviews with staff and service users  Consent  In person or via telephone  Lasting between 30 and 90 minutes  Audio-recorded and transcribed  Analysis  Thematic analysis  Facilitated by qualitative data management software  Quality assessed at all stages

5. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Objectives  To understand staff members perceptions and experience of  Risks and opportunities of PBs & DPs  Links between safeguarding & support planning  Participants  Senior manager/s of adult social care  Elected representative  Front-line managers & practitioners – assessment and/or safeguarding of adults

6. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Objectives  To understand budget-holders experiences of  Personal budgets  Risk assessment  Safeguarding processes  Participants  10 budget-holders & 7 proxy budget-holders  Final inclusion criteria  Over 18 years of age  AVA referral case (not just AVA alert)  Receives a PB and/or a DP  Safeguarding process commenced & resolved in the last year  Capacity to give consent and take part in an interview  Not currently in 'crisis‘

7. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Staff: n=16  6 social workers  5 team managers  3 senior managers  2 elected members  Service users: n= 12 DP/PB holders (40%)  6 people with learning difficulties  5 people who were physically disabled  1 person with mental health and physical problems

8. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Contexts  Financial constraint – higher eligibility criteria, greater unmet need, service quality  Personalisation adoption  Poverty – driver of abuse (PAs and family)  Practitioners understanding of risks of PB/DPs  Increased risk of financial abuse – inc. from proxy BHs  Affects level of monitoring  Risks associated with employing PAs  Reduce risks – choice, control  No change in level of risk – circumstance not PB/DP  Minimising risks  Varying control over DPs  DPs as a response to risky situations  Monitoring and review – financial monitoring

9. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Balancing choice and control  Autonomy versus duty of care  Balancing positive and negative risks  Safeguarding and personalisation practice  Timeliness of information – post incidents  Recommendations about pre-employment checks  Role of support planning – generic risks

10. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Awareness  Support funding  Safeguarding issue - recognition & reporting  Safeguarding process  Information  Poor information before agreeing to DP/PB – risks, employer role  Lack of information when changes implemented  Safeguarding issues and processes  Different types of abuse described  Multiple abuses – overtime and concurrently  Support staff/personal assistants - often quality related  Processes unclear, especially for people with PAs.

11. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Outcomes of safeguarding investigation  Change of support worker/agency  Advice from advocacy organisations on future safeguarding  3-month probationary period for PAs  Revised employment processes  Choice, control and independence  Around choice of funding  Around decisions about support  Around risk management

12. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Information giving  Funding arrangements  Choice of care provider/agency  Being an employer  Safeguarding processes  Continued review and support  Choice and control  Assumption of choice for service users  Feeling of little choice by service users

13. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  What are the implications of these findings for practice?  What are the implications for service users?  Are any changes needed to practice?  What changes might be needed?  How would these benefit staff and service users?

14. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog  Martin Stevens: martin.stevens@kcl.ac.uk  Fiona Aspinal: fiona.aspinal@york.ac.uk  Shereen Hussein: shereen.hussein@kcl.ac.uk  Mohamed Ismail: mohamed@analyticalresearch.co.uk  Jill Manthorpe: jill.manthorpe@kcl.ac.uk  Kritika Samsi: kritika.1.samsi@kcl.ac.uk  John Woolham: aa7970@coventry.ac.uk  Kate Baxter: kate.baxter@york.ac.uk

15. Twitter: SPRUYork Email alerts: bit.ly/emailSpru Blog: bit.ly/Sprublog Martin Stevens, Jill Manthorpe and Kritika Samsi Shereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York