I'm delighted to host this post on safeguarding adults and the social care white paper by Lindsey Pike. Lindsey was recently awarded a doctorate by the Plymouth University for her research on maximising the effectiveness of safeguarding training in adult social care. Lindsey now works as a research and development officer at Research in Practice for Adults in Dartington.One of the 6 principles underpinning the approach in the social care White Paper is that
“People are treated with dignity and respect, and are safe from abuse and neglect; everybody must work to make this happen”.Some thoughts relating to are outlined below.
Focus on prevention and social capital
It seems intuitive that prevention is better than cure in safeguarding, as well as in social care generally. However there is a question over whether the rhetoric matches up to the reality. As pointed out in Martin Coyle’s blog, advocacy, which is identified by numerous authors as being integral to prevention in safeguarding, is only mentioned once; furthermore advocacy services have reportedly already been cut. Emphasis is put instead on giving people the opportunity to feedback or complain about the care they are receiving. This is important, but should not overshadow the importance of advocacy.
However, talk of prevention is not supported by funding. The ADASS budget survey for 2012 highlights that 6 councils increased their eligibility criteria level in 2012/13, with 83% now operating at ‘substantial’ and 2% operating at ‘critical’. We are assured that the proposed national minimum eligibility threshold should mean there’s ‘no need’ for local authorities to tighten current thresholds. Where this threshold is set will have massive implications for the prevention agenda in safeguarding, not least because to enter into safeguarding a person must be ‘receiving or in need of community care services’. Can people be classed as ‘in need’ of services if they don’t meet eligibility criteria?
Communities are urged to ‘make the most of their skills and talents’, and address issues like loneliness and social exclusion that can contribute to poor mental and physical health, financial abuse and neglect. Again, this is positive in theory. A publication by Research in Practice for Adults and Think Local Act Personal outlines the evidence around building community capacity. But attention is needed to ensure that the most vulnerable groups - people who aren’t eligible for support but don’t fit easily into community services - don’t slip through the net. It is these people who may be susceptible to lesser-known types of abuse; self-neglect, hate crime, mate crime, and mail scams spring to mind, while financial abuse is already reportedly on the increase. Yes, of course communities need to look out for people who may be vulnerable; but not all vulnerable people are part of a community, and not all communities know what they should be looking out for. This is a big responsibility to leave to ‘someone’ in the hope that they will take it up.
Training and Quality of Care and Support
The White Paper’s aim to place “dignity and respect at the heart of a new code of conduct and minimum training standards for care workers” throws up some challenging questions. There are two possible explanations for a lack of empathy in social care staff. If they were unable to empathise when they entered the profession, then we need safeguards at recruitment which can identify and select people who can empathise and provide appropriate care and support. While some people argue that you can teach compassion and empathy, ideally we shouldn’t have to. If we can’t recruit the right people to the job, we need to consider and act on why this might be. The other possibility is that staff lose empathy as they work with over time - perhaps due to stress, under-resourcing, understaffing, and/ or as a method of self-protection. There is little detail in the White Paper about how systemic factors that contribute to these things will be addressed and resolved.
The development of new quality standards will be meaningful if a) they can be shown to link to better outcomes for people receiving care services and b) supports are provided to help services achieve such standards. The quality and extent of advocacy and involvement in care, and in safeguarding could be used as a measure.
Lastly, ‘placing dignity and respect at the heart of training’ is not enough; dignity and respect needs to also be placed at the heart of care generally. The research literature on training transfer makes it quite clear that people will simply not be able to apply new learning to their work, if what they’ve learned simply isn’t how it’s done in their workplace. Training staff is necessary, but not sufficient to change practice; to change practice, the systems and cues in the workplace should make it easy to do what has been recommended in training. So yes, by all means make dignity and respect integral to training, but resource and support dignity and respect through systems too.
Legislating for Safeguarding Adults Boards was the much anticipated outcome of the White Paper, and should aid multiagency working by bumping safeguarding up the priority list for all. While this should be welcomed, statutory Local Children’s Safeguarding Boards have a history which we should learn from and act on - as number serious case reviews show, a legislated board does not prevent the poor handling of cases of abuse.
Boards will also have to carry out safeguarding adults reviews. While learning is rightly seen as a good thing, inquiries need to be done for the right reasons. Connor Kinsella, along with other authors such as Aylett have pointed out the repeated messages that SCRs often throw up. It seems prudent to revisit history and not just learn from, but act on lessons from previous inquiries before spending money on doing more of them. I would urge anyone interested in safeguarding to read J P Martin’s 1984 book Hospitals in Trouble (review here)- the similarities of findings of inquiries into long stay hospitals in the 70s and 80s with Winterbourne View are both striking and depressing. We know what sort of environments foster abuse, and how people slip through the gaps in care. We now need to act on that knowledge.
Finally, the paper highlights the support structures around whistleblowing that have been introduced, including a whistleblowing advice line provided by Mencap, and a dedicated team at CQC. While these are useful, further attention could be paid to the underlying values of social care, and how these can be promoted; a focus on the experience of people using services, an open approach to critiquing and discussing practice, a no-blame culture, a respect for the human rights of both people who use services and staff would also help to make whistleblowing something to be openly proud of.