Implications of the personalisation agenda on safeguarding older people with dementia and their carers

1. Implications of the personalisation agenda on safeguarding older people with dementia and their carers Martin Stevens, Social Care Workforce Research Unit

2. Introduction • Personalisation and safeguarding - are they linked? • What aspects of safeguarding should be integrated with personalisation? • What aspects of personalisation should be integrated with safeguarding? • Dementia – rules developing

3. Safeguarding Adults • ‘all work which enables an adult "who is or may be eligible for community care services" to retain independence, wellbeing and choice and to access their human right to live a life that is free from abuse and neglect’ 5 • ADASS, 2005 - National Framework of standards

4. Personalisation and safeguarding • Putting People First (2007) – Linked personalisation with improved safeguarding • Some predictions that personalisation will enhance safeguarding (SCIE,2008; Poll, et al 2005) but many fears expressed • No Secrets review (DH, 2009) discussed need to integrate safeguarding and personalisation • Initially people with severe dementia excluded from direct payments if unable to consent (as lacking capacity to make the decision) – Health and Social Care Act 2008 • Mental Capacity Act 2005 and revised regulations are enabling people with dementia to make use of proxies

5. Personalisation, safeguarding and dementia • Access to information more difficult for people with dementia (Glendinning 2008) • ‘The rights of people with dementia are tangled inextricably with the rights of the family caregiver’ (Tyrell et all 2006: 481) • Blanket approaches to people with dementia – increases risk and reduces choice (Manthorpe, 2004)

6. Example • Mrs James has dementia – after the diagnosis she drew up a Lasting Power of Attorney - her daughter Sharon now makes decisions when necessary in her mother’s best interests. • Sharon gets Direct Payments from the local authority (Mrs James is eligible). Sharon is now able to fund a care package using a rota of 3 workers and one day at a day centre.

7. Negatives Care workers may be abusive or neglectful Sharon might not be acting in her mother’s best interests Monitoring may be limited Pressure on Sharon Mrs James Positives • Care workers are known and Sharon is employing them • Sharon had to get a CRB check (new DP regs – she is not co-resident) • Sharon was worried about her mother being at risk previously • MCA offences apply to Sharon and the care workers • Monitoring can stop/change arrangements • Mrs James may have a better quality of care/quality of life • Sharon may be less stressed

8. Personalisation ? Risk

9. Perceptions of risk Whereas, you know, if, and I suppose it’s not just me, I’ve heard it in general conversation that is people going to be more at risk perhaps if they’ve got family or friends doing their care. You know, could they be more inclined not to get the hours that they should be getting in, in personal care? (Team manager, Older people’s team – IBSEN)

10. A context of concern • Two tier workforce • checked and unchecked (ISA and CRB) • trained and untrained • Vulnerability and isolation of service users and carers • Easy prey • Lack of intervention powers (the police mainly have powers of intervention in England). • Practitioners ‘policing’ roles • Under protection and over protection • Much articulated in the Consultation on the Review of No Secrets

11. (Early) IBSEN findings • Parallel tracks – little engagement of the IB pilots with adult safeguarding • Little building on adult safeguarding experiences among social workers • This reflected some uncertainties around Direct Payments etc & duties of care • Fears that raising safeguarding issues was at best reactionary, at worst subversive • Some evidence that the need to integrate safeguarding was being recognised

12. What aspects of safeguarding do we need to build into personalisation? • Not a bolt on • Risk and recording • Finance is a fear • Don’t neglect neglect • Addressing carer issues (see Cooper et al BMJ 2009)

13. What training, risk assessment and risk management should we use? • Training (actually skills development) is not the same as information • An adult learning approach • Ensure legalities are addressed • Embed into other skills development and supervision • Multi-agency talk and action • Local context – important to know (as ever) • Evaluate – eg do monitoring processes work?

14. What aspects of personalisation can we build into safeguarding? • What links a support plan with a safeguarding plan? • What links a best interests decision with a right to risk? • Who will stand up ‘come the inquiry’?

15. How do we better reflect service users’ choices? • Recording (being clear) • on paper? on video? Informant histories • use of advance decision making processes? • carers’ wishes and needs • Best interests debates • Learning from IMCAs and MHAs • Duties of care (not clear but get sign off from managers) IBSEN conference 3 feb 2009

16. What can be done? • Converging of systems • Mutual understanding of values • Skills sharing between safeguarding and self-directed support • No quick solutions or transfers (eg a Risk Enablement Panel) • Meaningful practice guidance

17. Progress: Local policy development • Increasing involvement of safeguarding professionals • Transforming Social Care • Local approaches to risk assessment • Local Safeguarding policies under review • ...they will have IB at the forefront when they start reviewing the adult safeguarding policy’. (ASCS) • IBs discussed with local Safeguarding Boards • Definitions of ‘vulnerable people’ to include people using Direct Payments

18. Questions • So this means monitoring? (how and who? ) • Role of Care Quality Commission, GSCC and Independent Safeguarding Authority? • Bricks without straw (yes, we mean resources) • Will debates surface about rights to entry/intervention? (the Scottish experiment)

19. Dilemmas • Protection – empowerment • Individual-collective responses • Abuse – Poor practice • Abuse is in the eye of?

20. How can we move forward? • Not just a council affair • Nor even statutory sector • Way of revitalising adult safeguarding • But there will be decisions about monitoring (over and under protection) • And the safety net of social care may be tested.

21. Thank You.... Contact: Martin Stevens martin.stevens@kcl.ac.uk 020 7848 1860 Social Care Workforce Research Unit King's College London Strand London WC2R 2LS