Safeguarding Adults

Key Themes and Issues

Gillian MacIntyre, Ailsa Stewart, Pearse McCusker

• Publisher: Bloomsbury Academic
• Year: 2018
• Print ISBN:
  9781137381002
• Edition: 1
• eBook ISBN:
  9781350313613
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Safeguarding adults is a rapidly evolving area of professional practice and this timely new text book provides an authoritative guide that critically engages with the recent developments and encapsulates some of the emerging approaches to contemporary adult safeguarding practice. Written by a collection of authors with a wealth of academic and practice experience, and with a strong focus on multi-disciplinary working, the text covers key topics such as:
- Safeguarding adults who lack capacity, or whose level of capacity is unknown or unclear
- Common issues and tensions surrounding the various UK laws and policies that seek to safeguard adults with mental health problems
- Safeguarding older adults, with a unique and insightful focus on the perspective of carers
-Current limitations in practice, including the blurred nature of the boundaries between informal and legally mandated care, relating to the safeguarding of people with learning disabilities.

Illustrated throughout by engaging case studies to help readers apply what they have learnt to everyday practice, this comprehensive guide to safeguarding adults is essential reading for students across a broad range of health and social care disciplines, as well as practitioners looking for an up-to-date source of reference.

1

Introduction

Pearse McCusker, Glasgow Caledonian University; Gillian MacIntyre, University of Strathclyde; Ailsa Stewart, University of Strathclyde

Safeguarding adults is a rapidly evolving area of professional practice that has been subject to significant policy and legislative development over the last decade in the United Kingdom (UK) and Northern Ireland (NI). This book aims to critically engage with those developments and to encapsulate some of the emerging approaches to safeguarding adults in contemporary practice. Addressing multi-disciplinary working with a range of stakeholders, including social workers, health practitioners, the police, service users and carers, and wider communities, the book combines conceptual thought and key messages from research and practice experience to provide what we hope will be a valuable resource for students on qualifying and post-qualifying social work and health courses and related disciplines. It also serves as a timely resource to support the continuing professional development of health, social care and allied professionals involved in this ethically contentious area of practice.

Adult safeguarding can be considered to be a continuum incorporating within its parameters a range of interventions and safeguards to prevent adults from coming to harm (Stewart, 2016) including compulsory treatment at one end and provision of traditional welfare supports at the other. This may include those who are unable to protect themselves by virtue of mental disorder, learning disability, physical disability and/ or physical frailty. Consequently a number of legislative avenues may be drawn upon to ensure protection, often creating a complex and interactive legislative framework for practitioners to navigate.

Already, therefore, complex and contested in terms of definitions and application, adult safeguarding has been further problematised by significant legal developments both nationally and internationally, most notably ‘Cheshire West’ (The Supreme Court, 2014) and the United Nations Convention on the Rights of Persons with Disabilities (CRPD) (United Nations, 2006). The former refers to a UK Supreme Court judgement that clarifies what constitutes deprivation of liberty for adults who may lack capacity to make decisions, representing a wholesale change in thinking and requiring new legislative provision to ensure compliance – as illustrated by the introduction of Deprivation of Liberty Safeguards in England and Wales (Social Care Institute for Excellence [SCIE], 2015) and more recent proposals by the English Law Commission to reform this system and introduce Liberty Protection Safeguards (Law Commission for England and Wales, 2017) to combat the increase in illegal deprivation cases. Much wider in scope, the CRPD amounts to a paradigm shifting international legal mandate for achieving equality before the law for people with disabilities (Spandler et al., 2015). Its influence is beginning to be felt in policy and legal developments closer to home, for example, in the Adult Safeguarding: Prevention and Protection policy in Northern Ireland (Department of Health, Social Services and Public Safety [DHSSPS], 2015). CRPD enshrines equality before the law and autonomy over decision making regardless of the perceived level of disability, reorienting the focus of statutory interventions and professional practice from assessing capacity to facilitating supported decision making. Both of these legal developments reflect the highly disputed and ethically difficult nature of seeking to protect adults from harm, whilst also upholding their human rights. They provide context for the sense of urgency policy makers and legisla-tors across the four jurisdictions in the UK have shown to keep pace.

This is reflected in the introduction of numerous pieces of legislation across the UK such as the Care Act 2014 in England and the Social Care (Self-Directed Support) (Scotland) Act 2013, which arguably represent the biggest change to the way in which adult social care will be delivered since the onset of community care. These developments place the emphasis firmly on co-production, adopting an asset-based approach where the starting point is based on the strengths that an individual brings as well as the existing sources of support that they have to draw on. With a focus on preventative rather than crisis driven work, these developments arguably offer greater opportunity to provide personalised support to enable individuals to enhance their wellbeing. Yet these shifts also require a greater understanding of risk and ability to consider adult safeguarding across a range of settings within a broad and complex legislative framework, as set out in various documents such as the Making Safeguarding Personal guidance, published by the Local Government Association in 2014.

While statutes and policies are essential for defining the parameters of adult safeguarding and establishing the degree and limits of States’ responsibilities in relation to it, they represent only a part of the activity required to realise the central aim of protecting adults from harm. Indeed there appears to be a significant gap in providing a cohesive discourse that explores the multi-disciplinary nature of this emerging field of practice. Consequently, the aim of this book is to encourage readers to engage with some of the key conceptual themes associated with safeguarding adults across the jurisdictions and their application to practice, it is consequently not a legal textbook. Readers are, therefore, invited to consider barriers to and ways of developing ethical and anti-oppressive safeguarding practice that promote the rights of individuals whilst providing appropriate support and protection from harm and are guided to references for explicit legal frameworks.

The book comprises two main sections. Part 1 provides an overview of some of the emerging themes and issues in the field of adult safeguarding. While some consideration of key legislative and policy developments across the UK and NI is necessary in order to set the context for further discussion, the aim is not to examine these in depth, as previously noted, but rather to use them as a contextual framework in order to unpack and explore central themes. This will include providing the reader with an overview of safeguarding work with adults exploring this concept in order that further consideration of issues and dilemmas can take place. Part 1 also provides critical analysis of concepts such as ‘risk’, ‘abuse’, ‘harm’ and ‘capacity’, setting this against some of the challenges involved in intervening in the lives of adults. This section ends with an in-depth exploration of the multi-disciplinary nature of adult safeguarding, drawing attention to professional roles and responsibilities.

Part 2 of the volume explores the key concepts and issues identified in Part 1 as they relate to people who use services. While it is recognised that classifying people by the services they use is not without its problems, this approach allows the reader to develop a more nuanced understanding of how some of the ethical dilemmas and tensions identified apply to particular service user groups or areas of practice. Concepts of risk and capacity, for example, will play out in different ways when working with different groups of service users, as will decisions about appropriate thresholds for intervention. Readers are thus given the opportunity to consider the different knowledge and skills required to work across various relevant areas of practice, and case examples will demonstrate the multi-disciplinary and ethically challenging nature of this work. The particular user groups discussed in Part 2 represent some of those likely to be subject to safeguarding concerns, but this is not an exhaustive list. There are highly relevant areas of safeguarding practice, including work with older people, substance misuse and intimate partner violence, which are referred to only briefly here and require further exploration. Neither should it be assumed that all adults in the groups covered in this volume are at risk of harm or likely to be subject to safeguarding. Indeed the discriminatory nature of such assumptions is one of the themes that run throughout the Chapters.

Readers are invited to take messages from each Chapter and consider how these might apply to their own professional contexts. To this end, each Chapter draws on rich case study material taken directly from the authors’ own practice or personal experience and ends with implications for practice. While each Chapter shares the aim of encouraging readers to use this material to make sense of the key issues within each Chapter, the way in which the case study material is presented within each Chapter depends very much on the authors’ own backgrounds.

One of the primary aims of this volume was to have relevance to a diverse audience, including service users and carers, students, practitioners and academics alike. Spanning the four countries of the UK, the authors bring knowledge and expertise of adult safeguarding across a range of service user groups and disciplines. While their own work and experiences may be situated within a particular country or with a particular service user group, their contributions to the volume have applicability across the jurisdictions. One consequence of seeking views from a wide range of contributors is that the book presents a multiplic-ity of opinion on the question of safeguarding and on issues relating to personal and professional experiences, and the service user groups discussed. As such, the definitions and language used in the Chapters often reflect profession-specific or personal perspectives, and the editors have welcomed this diversity rather than seeking to work from agreed terms or meanings. Thus, ideas about highly contested terms, including disability, ageing and mental health and distress may be read as reflecting the respective writers’ particular sets of knowledge and values, including the degree to which they encapsulate social or medical models of disability.

That said, we have taken several noteworthy decisions in relation to terminology. The term ‘vulnerable adults’ has been rejected on the grounds that it places the locus for potential harm with the individual rather than within the wider social context that surrounds them. In Scotland, the preferred terminology refers to ‘adults at risk of harm’ and this is gaining currency across other jurisdictions. Conversely, the term ‘adult protection’, which is used in Scotland, is less common in England, Wales and Northern Ireland, perhaps reflecting discomfort with overtones of paternalism or being considered too narrow for the consideration of such a broad legislative and practice framework. Instead, in these jurisdictions, ‘adult safeguarding’ is the given definition and consequently is the one used predominantly throughout the text; where authors have chosen to use ‘adult protection’ for specific reasons, this has been left unchanged. This discussion on terminology helps encapsulate the potential benefits of each country learning from one another in relation to aspects of adult safeguarding as practices, laws and policies develop over time. It also illustrates the consistent process of change that this hitherto neglected area of practice is now engaged in, which this volume seeks to contribute to in critically reflective and reflexive ways. A brief synopsis of each Chapter is now provided, drawing out particular and shared themes that will hopefully be of value to the reader.

In Chapter 2, Ailsa Stewart and Gillian MacIntyre introduce the reader to some of the key concepts of relevance in any discussion of adult safeguarding across the UK. These include ‘power’, ‘choice’, ‘vulnerability’, ‘harm’, ‘abuse’ and risk. They argue that the reader should appreciate the contested and potentially discriminatory nature of these concepts. They draw on a range of academic literature in order to provide the reader with the conceptual underpinnings for the remainder of the book. They argue that those adults who are most likely to be subject to safeguarding measures are also most likely to experience power imbalances and structural inequalities and are less likely to be deemed to have capacity to make their own choices and decisions. They warn against making judgements about people’s capacity based on a simple label or diagnosis and highlight the need to take the individual’s broader social context into account when making decisions with regard to safeguarding. They discuss the concept of risk and highlight the shift towards an increasingly risk-averse society where the focus is on making defensible decisions. They draw on research that suggests a risk enablement approach is required to overcome potentially paternalistic approaches to safeguarding. The Chapter ends with a number of key questions or dilemmas for the reader to consider during the remainder of the book.

A core tension within adult safeguarding, that of upholding individual rights to autonomy while also protecting citizens from harm, forms the central debate of Chapter 3, written by Kathryn Mackay. It poses key questions about and explores the scope of State responsibilities for the care and protection of citizens and how these are influenced by society, the media and, increasingly, by the marketisation of health and social care. It helpfully delineates the distinctive features and benefits of safeguarding legislation across the UK and NI before providing analysis of the varied responses citizens might expect to receive depending on where they live. It thus contextualises adult safeguarding within wider political ideology, critiquing the myopic responses of governments to failures in protecting people from harm and questioning what safeguarding can actually encompass in increasingly individualised societies.

In Chapter 4, Ailsa Stewart and Gillian MacIntyre explore the complex and challenging area of safeguarding where the capacity of the adult is unclear or unknown. Concepts such as capacity and bounded rationality are drawn upon to consider the demanding and ethically complex decisions that practitioners are required to make. This discussion is situated with a UK safeguarding context and draws on relevant legislative and policy frameworks to identify a spectrum of possible thresholds for intervention. The promotion of the human and citizenship rights of adults is central to the exploration of how practitioners make determinations about those thresholds for intervention within safeguarding practice. The potential for conflict between the aims of the legislation and the promotion of these rights is therefore a key area for discussion. Case studies are used to draw out learning for practitioners and to illustrate some of the challenges in practice. The Chapter concludes by underscoring the importance of a safeguarding framework that is flexible and interactive in nature to ensure that ethically appropriate practice is promoted.

Chapter 5, written by Kaye McGregor, Eileen Niblo and Michael Preston-Shoot, sets the scene for many of the volume’s discussions by addressing one of the key themes within adult safeguarding, that of multi-disciplinary working. It compares the policy and legal frameworks that relate to how agencies work together to safeguard adults from harm across the UK, highlighting gaps that have been found to impede effective practice. The discussion identifies training, operational practice and strategic leadership as central to developing more effective multi-disciplinary working. It then uses a case study to explore these and other related factors that convey the ‘messy realities’ and uncertainties that are encountered in much of adult safeguarding practice. The case study illustrates that despite these difficulties, effective multi-disciplinary working, including shared ownership of decision making and imaginative thinking that goes beyond conventional resource delivery, can help facilitate better outcomes for adults at risk of harm.

Chapter 6, written by Jim Campbell, Gavin Davidson and Graham Morgan, considers issues around safeguarding those with mental distress. The Chapter begins by setting out the legislative context across the four countries of the UK, identifying points of similarity and difference in relation to compulsory measures, including the use of community treatment orders alongside the range of patient safeguards including mental health tribunals, access to independent advocacy, advance statements or directives and the role of the ‘named person’ (outlined in the Mental Health (Care and Treatment) (Scotland) Act 2003). The Chapter also considers the complex issue of impaired capacity as a result of mental distress and considers the extent to which individuals are supported to make decisions in line with the CRPD. The various legislative frameworks that support or impede the supported decision-making process are considered, and a proposal for a unified mental health and capacity framework in line with developments in Northern Ireland is discussed. The Chapter also explores the views of people with experience of mental distress around detention, capacity and safeguarding highlighting an acknowledgement of the need for compulsory measures in certain circumstances.

Chapter 7, written by Claire Pearson and Martin Kettle, considers some of the particular issues around safeguarding older adults. Beginning with a review of research evidence, it highlights the complexity of relationships that may often be felt as both abusive and caring, which presents particular ethical challenges for professionals in striking a balance between protection from harm and the potential erosion of key personal and social supports. Acknowledging a dearth of research relating to older people abuse, it then reports on findings from a focus group carried outwith carers, providing rich and honest insights into the lived experiences of caring set against the legal framework. A particular finding problem-atises the breadth of definitions and cultural appreciations of ‘harm’, making it very difficult to differentiate between behaviours that might be considered ‘understandable reactions’ to the stresses that invariably arise in the caring role and those that overstep a legally delineated boundary. The Chapter concludes with a number of recommendations that may inform safeguarding interventions, including the role of motivation as a potential means of classifying harm, by differentiating between malice of forethought and actions that have no ill-intent.

Chapter 8, w...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright
• Contents
• 1 Introduction
• Part 1 Safeguarding Adults: Theoretical Perspectives
• Part 2 Safeguarding Adults: Practice Perspectives
• Glossary
• Index