Reflections on year one- February 9th 2017
It was with a mixture of pleasure and trepidation that I accepted Alison’s invitation to write the first blog to appear on this website: pleasure because it is a privilege to be asked and trepidation because of the expertise and knowledge of the potential audience. I know that it is accepted that blogs contain the personal views of the author, but I should be clear that my perspective on safeguarding adults is that of a social worker and, I hope, a practitioner rather than a lawyer, academic or senior manager. This, along with a view that blogs should stimulate discussion and debate rather than provide answers, may help explain what I am about to write!
When I was asked to join the Advisory Group supporting this research project, I wondered just what specific benefits my membership would bring with it, and was advised that it was the practitioner perspective of how the Care Act 2014 was developed, supported – or not – by statutory guidance and of its impact on practice as it is experienced by both practitioners and those who are to be safeguarded. The key aspect of the above is the experience of the adult at risk, but that is going to be very much determined by the experience of the practitioner. If the aim, or at least one of the aims, of the Act is the empowering of those with care and support needs, then this can only be realised if the staff caring and supporting them are equally empowered to exercise professional judgement.
I hoped that the series of seminars would enable a discussion to take place between the various stakeholders – social workers, health professionals, lawyers, academics, civil servants, senior managers – that would transcend the vested interests of their particular constituency and reflect on the limitations that those interests imposed on the process of drafting and implementing legislation. To a large degree that has, I think, been achieved, though some speakers were more successful – should that be more willing – to do so than others!
What is essential, in my view, is that if safeguarding adults is to become the reality that the Act seeks, a more major cultural change has to occur within the agencies that are tasked with implementing the Act. It is one of the strengths and the weaknesses of the Act that it places statutory duties and responsibilities on local authorities, the police and health organisations: a strength as it means that agencies can no longer avoid being as equally committed to safeguarding adults as safeguarding children, but a weakness in that it means strategic and senior managers have become more interested in safeguarding adults. In my experience, when strategic and senior managers, not to mention elected members, become interested in something, they tend to want to control it. Not surprising, you may say, as they will be held to account when/if things go wrong. Possibly, but I don’t recall many senior managers being publicly held responsible for the serious abuse and deaths of adults receiving services from their organisations – think Southern Health, for example. A more open and less risk-adverse culture is required across the range of health and social care provision, as well as an acknowledgement that much if not most abuse and neglect happens outside of services and is not committed by staff, the two things managers have control over.
The language of the Act and its supporting Guidance doesn’t help with this; there is no definition of abuse or neglect in either – unlike ‘No secrets’ -, merely a list of types of abuse and examples of how they may be manifested, followed by a statement that local authorities shouldn’t ‘limit their view of what constitutes abuse or neglect, as they can take many forms and the circumstances of the individual case should always be considered ‘. This lack of clarity is compounded by the emphasis that Making Safeguarding Personal, a key component of safeguarding adults as envisaged by the Act and the Guidance, puts on seeing adults with care and support needs as ‘experts in their own lives’ being counterbalanced by the Guidance also stating that they ‘sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances’. Perhaps Michael Gove was right after all, who needs ‘experts’?!
Talking of Making Safeguarding Personal, the Advice and Guidance issued by ADASS and the LGA in 2013 stated ‘Unless people’s lives are improved, then all the safeguarding work, systems, procedures and partnerships are purposeless. Currently Directors and Safeguarding Adults Boards are faced with a plethora of input/output data but no way of telling from it if they really are making any impact. Directors must have a means of knowing what works and how they are making a difference to people.’ Who was responsible for developing that plethora of input/output data? Could it possibly have been Directors, the LGA and the Department of Health? Nothing on outcomes? What about the experience of the adult at risk? Too hard to quantify, possibly.
The lack of clarity is perhaps only to be expected from an Act produced by a Government committed to reducing the size of the state and its involvement in the lives of the individual, but it puts additional importance on the ability and freedom of professionals to exercise professional judgement, albeit within parameters of professional good practice informed by legal literacy. Interestingly, one of the aims of the Act, as articulated by the Department of Health, was a reduction in the number of cases being managed under safeguarding procedures – the first 9 months after the Act came into effect saw a 100% rise in this number, possibly caused in part by this lack of clarity and a hesitation to exercise professional judgement and to rely on procedures.
This project to date has shone light on the processes by which the Act came into being and how it and its equivalents has been implemented across the four legislatures of the United Kingdom; in doing so, it has thrown into stark relief some of the tensions inherent in balancing the universality of the law with the uniqueness of the individual’s circumstances and organisational and political accountability with professional judgement and accountability. One of the questions raised at the first seminar and not, in my view, adequately answered, was whether legislation is driven by research as practice is meant to be. It will be interesting to see what credence is given to this project and its findings on how future legislation is constructed and how the continuing development and implementation of the Act is managed.