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Keeping the adult central to safeguarding enquiries

Key learning points:

  • If a person will have substantial difficulty being involved in their enquiry, they need an appropriate person to facilitate their involvement in the process (not just act for them)
  • If a person has no appropriate person to facilitate their involvement or advocate for them, they have a right to an advocate which can be arranged via POhWER
  • People have said that human contact helps them feel safe. What can you do to make people feel more connected to safe people as part of safeguarding adults safety planning?
  • People have said that secure homes help them feel safe. What can you do to connect people to support with home security?
  • Remind yourself about what professional curiosity is and how you can be more curious in your practice

Introduction

With any new piece of work, it helps to think about where we want to be at the end. What are we actually looking to achieve for the adult and why? Doing this gives a sense of direction, drives momentum, and helps us think what actions are needed to get to the outcome that the adult wants.

This also reflects a key principle of safeguarding adults – empowerment. This means that people are supported and encouraged to make their own decisions and give informed consent.

I am asked what I want as the outcomes from the safeguarding process and this directly informs what happens.”

The process should be person-centred and person-led - using a “Making Safeguarding Personal” approach.

This briefing explores how we make sure the adult is kept at the centre of an effective safeguarding enquiry, in a way that is meaningful to them. It is based on learning from work being done by Norfolk County Council (NCC) Adult Social Care Safeguarding Adults Team to speak to adults after they have been subject to safeguarding enquires, and also some learning from Safeguarding Adults Reviews (SARs).

Provider-led safeguarding adult enquiries

Under the Care Act (2014) the local authority must make enquiries, or cause another agency to do so, whenever abuse or neglect are suspected in relation to an adult and the local authority thinks it necessary to enable it to decide what (if any) action is needed to help and protect the adult.

Once the local authority has come to a decision that the criteria for enquiry has been met, they may ask other agencies to carry out this enquiry. The scope of that delegated enquiry, who leads it, its nature, and how long it takes, will depend on the particular circumstances.

Making Safeguarding Personal (MSP)

Safeguarding incidents can often be distressing for the adult involved, and for those around them. Whilst the adult may be fully aware of what is happening to them, due to their needs they may be unable to protect themselves from harm. That loss of control can be compounded where professionals or organisations ‘take over’ without meaningful discussion or offering choice to the person, creating additional dependency, limiting the adult’s own agency.

From the beginning to the end of a safeguarding enquiry, the adult, or their advocate, should be actively involved. This is more than just about asking what they want at the beginning (although very important), but also:

  • being updated on progress
  • supported to understand and contribute to the process
  • empowered to shape outcomes wherever possible.

Note: the person being involved in this way is different to them consenting to an enquiry – for an excellent overview of consent in terms of safeguarding, read this article in Community Care.

To understand how that adult can both feel and be safe, we need to see the situation from their unique perspective. The work with adults who have been through a safeguarding enquiry has highlighted that the most important reported factor in helping them feel safe was the human element. For example, something as simple as having a friend or family member to talk to over a cup of tea can make the difference as to whether someone feels safe.

Almost every response referenced the benefit of human contact (beyond just practical tasks) – this evidences why, when we think about safeguarding and MSP, we should be focusing on the person and understanding their individual experience, resisting the temptation to concentrate just on the process itself.

Safeguarding is an approach that supports adults at risk to live safer lives – by recognising the importance of the people around the adult we can explore how these connections may lead to a better outcome for them, potentially empowering them to regain or retain control and remain safer for longer.

For example, is there a family member who could visit more frequently? Could a neighbour call in at regular intervals? Could the person be connected to a local group or befriending service?
The survey indicated that sometimes further actions are needed which appear to sit outside the safeguarding enquiry but are actually part of the person’s safeguarding plan. This could include:

  • Referring to a Development Worker or similar to promote community connections
  • Referring for a Care Act assessment or review to identify where some needs might be unmet
  • Referring to assistive technology for equipment that could help the person stay safer and better connected to others.

Hearing adults voices

In April 2021, Essex Safeguarding Adults Board published a joint Domestic Homicide Review (DHR) / SAR for Valerie, looking at how her son, with whom she lived, deteriorated in his ability to care for her due to his own mental health needs, and ultimately killed her. Valerie had been seen by social care and health professionals, and other family members who also had some concerns for her welfare. Valerie declined progression of the safeguarding enquiry when this was discussed with her, and one of the recommendations of the SAR is that the Safeguarding Adults Board, in promoting MSP, should include “seeking innovative means of facilitating the ability of adult’s voices to be effectively heard”.

The review noted that professional curiosity was not used to try and understand the mother / son relationship, their co-dependency, the reluctance to have support, and the accumulating risks related to these and other issues as their individual needs increased over time.

  • Look at information about professional curiosity on the Norfolk Safeguarding Adults Board (NSAB) website for ways of developing the curiosity in your practice

Advocacy

Where it seems that the adult may have substantial difficulty engaging with the safeguarding process, or difficulty making any decisions about the enquiry, a suitable advocate should be found to support them. This means difficulty:

  • understanding the relevant information
  • retaining information
  • using or weighing information, especially around options being presented
  • communicating their views, wishes and feelings.

If, in carrying out a provider-led safeguarding enquiry, it becomes clear that the adult will have such a difficulty, speak with the local authority about involving an advocate. Any advocate should wherever possible be supporting the adult themselves to be involved in the enquiry, rather than making decisions on behalf of the adult.

The most likely advocate will be an ‘appropriate person’ – the Care Act says this might be a family member, unpaid carer, or friend.

However, this cannot be someone paid to care for the person, or someone the adult doesn’t consent to, or where the adult lacks capacity to decide and it is not considered in the adults best interests for them to be in that role.

The appropriate person’s role is to facilitate the person’s involvement, not just be consulted on their behalf. Ensure that the appropriate person is sharing information, supporting the person to express their wishes, and asking for their opinions on what they want to happen.

Where there is no ‘appropriate person’ to support the adult, the local authority have a legal duty under the Care Act to arrange for an Independent Care Act Advocate (ICAA). Where the adult is assessed to lack capacity to make decisions relating to the safeguarding issue e.g. any protective measures which are restrictive, they are likely also to need an Independent Mental Capacity Advocate (IMCA). This may be the same person as the ICAA if appropriate. In Norfolk advocacy is provided through the organisation POhWER.

Making Safeguarding Personal (MSP) and appropriately seeking advocacy has been the subject of several learning outcomes in national SARs. Barnsley’s SAR for Harry is clear in its recommendation (7.8) that:

“where someone has significant difficulty engaging with the enquiry and there is no-one independent to support them to do this” access to an advocate is a right, “and is not dependent on the view of other workers that the person would benefit”.

Carers

In the SAR for Valerie, where her voice was not properly heard, her son’s needs as her carer were also not recognised. Norfolk’s DHR for Daisy included a recommendation for Adult Social Services related to the “Refusal of Assessment” section of the Carers Assessment guidance, and the need to reoffer support at intervals with service users and carers to allow for changing needs and acceptance of support. If this becomes a clear need at any time during a provider-led safeguarding enquiry you must ensure update the local authority.

Daisy had been killed by her husband, who was her carer but was himself struggling to cope. These two reviews and recommendations emphasise the need to be flexible and persistent in attempts to engage with the adult and their carer to ensure as far as possible that they are aware of all available support and enabled to make informed choices.

What makes an effective enquiry?

The survey of people who have been through a safeguarding enquiry showed that practical actions are also important to feelings of safety. Most of the respondents referenced practical things (completed actions) that had been done which helped them feel safer. You could arrange for the person to be supported to e.g. get the locks changed, arrange additional support, get access to a community alarm system or mobile phone. As with the human element noted above, the conversations we have through MSP mean we understand what sits behind the adult’s feeling of safety, they guide our responses, we achieve better outcomes.

Clear risk assessment is a core part of practice, and recording of these discussions is key for our longer term understanding and management of risk. Barnsley’s SAR for Harry recommends that risk assessments should maintain consistent boundaries across agencies, supporting clear communication which is key with joint working and multiple agencies involved.

Multi-agency approaches should be standard in safeguarding, but sometimes understanding of roles and duties can be unclear, especially with delegated or other enquiries. Whilst Police or other professionals may be investigating the concern, the local authority remain responsible overall for the safeguarding enquiries taking place, and making sure the adult is fully involved.

Torbay and Devon’s SAR for Hermione (in talking about commissioned placements) notes the need for “senior managers to act as a critical friend to carefully examine the risks and mitigation measures involved” – we should always be confident to seek the support of our managers.

Analysis & evaluation - when completing an enquiry and writing up any reports, the author should be confident that in the future someone else would be able to read it and fully understand what was done, what conclusions were reached and actions taken, and the rationale behind any outcomes.

When writing enquiries describe what you have done, apply your professional judgement of the situation and record this in a clear and comprehensive way. It’s essential to apply critical thinking and analysis to the information gathered and reviewed when completing an enquiry, to minimise the risk of repeat incidents and potentially reduce risks to others. 

Some positive feedback

The surveys around MSP carried out by the NCC Safeguarding Adults Team have, in the main, shown us that safeguarding enquiries are having positive outcomes. Most adults or their advocates gave positive feedback, talking about feeling listened to and some gave particular compliments:

  • “…excellent and very helpful”
  • “quick to reply and very thorough”
  • “…very supportive and definitely listened to what I had to say”
  • “Very helpful and supportive”
  • “…it was all very complex, but I felt included in the conversations.” and “…couldn’t see how ASSD could have done more to keep him safe”

It’s important to remember that while things sometimes go wrong and we must highlight areas for improvement, there is still an awful lot of fantastic, person-centred work going on across the partnership, so well done everyone!

Further information