Ding-ding … 3 things which deserve your attention

Estimated reading time 6 minutes.

The bell broke on my ‘commuter’ bike the other day when I was out for a ride. 

I am trying to do more exercise in 2025. Acknowledging what my wife has rightly been telling me for a good long time now, I need to move more during the day. Like many, I can spend most of my working hours in front of a computer screen. Yes, my day in safeguarding adults can be full on, but very sedentary. 

So, to help me move more I have set myself a challenge. For each day of 2025 I will either cycle a minimum of 5 miles (8.04km) or walk a minimum of 2 miles 3.21km). I have called it the 5/2 - 2025.

A phrase we hear more of in recent years is ‘sitting is the new smoking’, but the link between illness and sitting first emerged in the 1950s. Researchers found that double decker bus drivers were twice as likely to have a heart attack compared to their bus conductor colleagues. The drivers sat for 90 per cent of their shifts, while the conductors climbed about 600 stairs each working day! (see Why we should sit less - NHS).

In short, the longer you sit, the worse your cardiovascular outcomes will be: see Accelerometer-Measured Sedentary Behavior and Risk of Future Cardiovascular Disease - PubMed.

Back to my activity challenge, I realised how clever a bike bell is - it gives just the right pitch to carry a long way and alert others. As I cycled on, I wondered what things would we want to be alert to in adult safeguarding.  In the Norfolk system I think there are three.

1. Mental capacity

This continues to be stubborn and challenging area of practice for us, which learning from our Safeguarding Adults Reviews (SAR) keeps highlighting (see SAR ‘R’ recommendation 6 10.6) and it was also picked up in the DHR / SAR ‘Doris’ - Recommendation 8 – the signed off report is currently under review as part of the Home Office quality assurance process).

And this is not just a Norfolk problem. The second national SARs analysis of 229 SAR reports reveals that poor attention to mental capacity was noted in 58% of cases across the country!

We know what the problems are:

• missing or poorly performed capacity assessments
• an absence of best interests decision-making
• a lack of scepticism and respectful challenge of decisions

From the series of facilitated discussion workshops we ran in 2023 we can add: 

• a lack of confidence across the workforce 
• sub-optimal application of the MCA
• poor practice in terms of risk assessments, documentation and failing to keep the individual at the centre of the process.

How might we try and move on this challenge? The ambition of NSAB partner organisations is to build a ‘community of practice’ around mental capacity. A network of practitioners supporting each other with reflective discussion and problem solving would in turn help to grow greater confidence across the Integrated Care System workforce.

At the last NSAB meeting an outline business case was supported to bring in some extra capacity in a consultancy type of role, to work over roughly a 2-year period to support networks to germinate. This is NOT about putting more MCA training into the system: there is already plenty of that. This is a project aimed at improving and enhancing people’s existing skills. When the role finishes the network needs to be self-sustaining.

2. Exploitation

Exploitation is a real and growing threat in several types of abuse. During the last few years, the exploitation of children and vulnerable adults has been a feature of ‘county lines’. County lines is the name given to drug dealing where organised criminal groups (OCGs) use phone lines to move and supply drugs, usually from cities into smaller towns and rural areas. They exploit vulnerable people, including children and those with mental health or addiction issues, by recruiting them to distribute the drugs (‘drug running’). Criminals may also use a vulnerable person’s home as their base of operations (‘cuckooing’).

But exploitation is wider than criminal drug activity. For example, in SAR ‘S’ we talked about the learning on recognising and responding to ‘exploitative friendships’ (see page 18) and there is more information on the exploitation page on the NSAB website. 

Positive discussions with colleagues and agencies have stimulated the establishment a Norfolk-wide exploitation group to bring different elements of this work together. A shout out here to Karen Smith from Norwich City Council, who is chairing this new group for Norfolk. 

3. Self-neglect 

And third is self-neglect. The number of cases of significant self-neglect that practitioners have been working with across many agencies continues to remain high. These are complex, challenging and difficult cases which can impact significantly on the worker involved. 

NSAB has published a multi-agency strategy, and sitting along alongside is a toolkit, to support practitioners from a range of agencies with management of cases where an adult is deemed to be at risk due to self-neglecting and/or hoarding behaviours. 

The NSAB self-neglect & hoarding subgroup has worked on refreshing and condensing the guide. This builds on a very successful event held at Wymondham Rugby Club at the end of October 2024. People from many different organisations and agencies came together to share, listen and work through some cases, and material from the event is available on the website – Working together to support people with self-neglect & hoarding issues.

As we move further into this year we will be starting to consider and draft what goes into the board’s new strategy, which is due to go ‘live’ from April 2026. These three topics might well be important to include.

On that note, it’s time to get up and move, and be thankful for some time out of the chair!

Thank you.

PS ... updates on the progress of the 5/2 - 2025 Challenge will be given in future blogs. Wish me luck.

Walter Lloyd-Smith
Norfolk Safeguarding Adults Board Manager
3 February 2025