COVID-19 resources on Safeguarding adults

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Scared, angry, discriminatory, out of my control: DNAR decision-making in 2020

The British Institute of Human Rights

Findings from a study to gather information from people who have experienced Do Not Attempt Resuscitation (DNAR) decision making, both since and prior to the Coronavirus pandemic. The report shows a worrying picture around the rights of involvement in care and treatment decisions, including DNARs. The evidence depicts serious issues of discrimination related to disability and age, and the intersection between the two, as well as other factors. Coronavirus has shone a spotlight on this, and some reported an increase in worrying DNAR decisions; but none of this is new, these problems are ongoing. The report’s key findings are: 100% of people involved said there needs to be more easily accessible information about human rights; almost 60% of people involved said they had received no information about their right to life during Coronavirus; 65% of people involved said that they (or a person they care for/about) had a DNAR order put on your medical file. 21% said they didn’t know; of those who had seen a DNAR order put in place almost half (47%) were not related to end-of-life care; less than a third of people (29%) who were involved in DNAR decision-making felt fully listened to, most felt listened to a bit (46%), and 25% felt not listened to; 91% of people involved felt that discrimination was an issue in the DNAR decisions they’d experienced.

Last updated on hub: 03 March 2021

Frustrated, angry and unfair: staff experiences of DNAR decision-making in 2020

The British Institute of Human Rights

This report provides findings and recommendations from research with staff working across health, care and social work, who have shared their experiences of Do Not Attempt Resuscitation (DNAR) decisions. The findings show a worrying picture around the people’s rights to involvement in care and treatment decisions, including DNARs, and in staff confidence and ability to ensure human rights considerations are part of everyday decision-making. Of the people who attended the research workshop and completed a survey: 97% said there needs to be more easily accessible information about human rights; whilst 78% felt supported to meet the legal duty to uphold human rights in their day-to-day work, only 46% said they felt supported to uphold human rights in their day-to-day work during Covid-19; only 8% said people’s right to involvement in care and treatment decisions is explicitly discussed with them, an only 25% felt supported to involve people in DNAR decisions; over 40% of participants said it is assumed that people who have had a DNAR order placed on their file do not have mental capacity (only 26% said capacity assessments (a legal requirement) had been conducted); almost 30% of participants felt DNAR decisions during Covid-19 are worse (14% said they had not changed but were usually poor). 20% had made more challenges to DNAR decisions during Covid-19; only 16% felt fully listened to; more than 50% of participants felt that discrimination at least sometimes happening in DNAR decisions. The recommendations set out in this report focus on both the current Covid-19 context and the wider use of DNAR orders in “ordinary” times, and the need for them to be framed exactly as they are, as human rights issues.

Last updated on hub: 03 March 2021

COVID-19 and safeguarding adults: resource pack

Local Government Association

These resources were collected between March and December 2020 to support safeguarding work during the COVID-19 pandemic. Information was compiled initially through a ‘safeguarding issues grid’, in response to issues raised by Safeguarding Adults Board (SAB) Chairs, SAB Managers, Principal Social Workers and others regarding safeguarding adults during the COVID-19 pandemic. Topics covered include: care provision; clinically extremely vulnerable to Covid-19; closed environments; day centres; domestic abuse; digital communications; digital safety; home care; informal carers; institutional care; mental capacity; multi-agency working; people at higher risk from coronavirus; scamming; self-isolation and treatment of coronavirus; social distancing; social workers; testing; vaccinations; volunteers; whistleblowing; community engagement; safeguarding adults board duties; safeguarding adult reviews; and using data on safeguarding activity.

Last updated on hub: 08 February 2021

COVID-19 Adult Safeguarding Insight Project: findings and discussion

Local Government Association

Findings of a project aimed at creating a national picture about safeguarding adults’ activity during the COVID-19 pandemic. The report is based on the analysis of data submitted on a voluntary basis by local authorities; in all, 92 councils participated in the insight project – over 60 per cent of single tier and county councils in England. In general, safeguarding concerns dropped markedly during the initial weeks of the COVID-19 lockdown period, only to return to and then exceed normal levels in June 2020. The trend of Section 42 enquiries showed a similar decline during the initial weeks of the COVID-19 lockdown period and upturn in June, although the June upturn was not as great. The effects of COVID-19 and lockdown on safeguarding activity are localised and may vary across England as the pandemic impacted the country unevenly. The percentage distribution of types of abuse within Section 42 enquiries did not appear to change considerably overall, although there is some evidence that some forms of abuse, particularly domestic abuse, increased slightly overall and significantly within some councils, as well as psychological abuse and self-neglect. The percentage of Section 42 enquiries where the risk is located in the individual’s own home has increased markedly since the start of the COVID-19 lockdown period, with evidence from participants that this is a direct result of the confinement of people in their homes. During the lockdown period, while dealing with the unprecedented challenges of the pandemic, some councils developed innovations in their practices and systems. Examples provided by participating councils in the qualitative data, are described in this report.

Last updated on hub: 26 January 2021

Mid-year 2020-21 adult social care activity

NHS Digital

Local Authorities are part of the front line of organisations dealing with the coronavirus (COVID-19) pandemic in England. This management information is not looking directly at the response to the crisis. Instead, it aims to give users some insight into the impact of the pandemic on the ongoing statutory duties of local authorities to provide assessments, support and funding for the appropriate level of social care needed by its adult population, and to safeguard its citizens from abuse or deprivations of liberty. Data was collected from local authorities on a voluntary basis, to a shorter timeline than usual and without much of the comprehensive data quality assurance usually in place for the equivalent annual data collections. Key facts include: coverage – 81% of local authorities in England provided data to this one-off, voluntary data collection; long term support – the number of clients in receipt of long term social care support at the end of March 2020 was lower than the previous year, and this decreased further in the first half of 2020-21; safeguarding activity – there appears to have been a slight increase of approximately 4% in the total number of safeguarding concerns raised to local authorities so far this year, compared to half the annual total from 2019-20, and a c.9% decrease in the enquiries that commenced in the period; DoLS applications – fewer applications for Deprivation of Liberty Safeguards (DoLS) were received by local authorities in the first half of 2020-21 (a decrease of 3.3% compared to the first half of 2019-20, following many years of increasing volumes). The number of applications completed also fell, by 16.5%, compared to the first half of 2019-20.

Last updated on hub: 22 December 2020

Safeguarding adults practice and remote working in the COVID-19 era: challenges and opportunities

Journal of Adult Protection

Purpose: This exploratory paper aims to examine the literature on the impact of COVID-19 on safeguarding adults practice. Design/methodology/approach: A literature search was carried out in recently published articles to locate literature relating to COVID-19 and safeguarding adults in the UK and internationally. This included policy guidance and law, to describe the existing knowledge base, gaps in practice and areas that may require further research. Findings: The findings suggest that measures to curb the spread of the COVID-19 pandemic gave rise to remote working and virtual safeguarding practice. The findings highlight the need for empirical research into the impact of virtual safeguarding adults assessments and effective ways to support the needs and outcomes of those who may be at risk of or experiencing abuse and neglect while shielding, socially isolating or when working in an environment where social distancing is required. Research limitations/implications: The paper is based on a review and analysis of published documents and not on other types of research. Originality/value: Little is known about effective safeguarding adults practice in the era of shielding, self-isolation, social distancing and remote working. The paper adds to the body of knowledge in the field.

Last updated on hub: 09 December 2020

Safeguarding adults and COVID-19: a sector-led improvement response

Journal of Adult Protection

Purpose: This study aims to describe the sector-led response to the COVID-19 pandemic and national lockdown in terms of safeguarding adults. Design/methodology/approach: This study uses a case study method to examine a sector-led improvement response to COVID-19 and safeguarding adults. Findings: The study describes how safeguarding issues and concerns were identified and brought together, and then responded to. It reviews this initiative in the context of crisis intervention theory and discusses the achievements of this initiative regarding COVID-19 and safeguarding adults during the period April–July 2020. Originality/value: The study describes a unique joint initiative between the Local Government Association and the Association of Directors of Adult Social Services, which worked with the Networks of Chairs of Safeguarding Adults Boards, Safeguarding Adults Boards’ managers and Principal Social Workers. This initiative developed resources and shared information and good practice to support a response in unprecedented circumstances.

Last updated on hub: 09 December 2020

From ovid to COVID: the metamorphosis of advanced decisions to refuse treatment into a safeguarding issue

Journal of Adult Protection

Purpose: This paper aims to examine advance decisions to refuse treatment (ADRTs) in the context of the COVID-19 (Coronavirus 2019) pandemic. This study considers the development of ADRTs, the lack of take up and confusion among the general public, clinicians and health and social care staff. Design/methodology/approach: The paper is a conceptual piece that reflects on ADRTs in the particular context of COVID-19. It considers professional concerns and pronouncements on ADRTs. Findings: ADRTs have a low take up currently. There is misunderstanding among public and professionals. There is a need for raising awareness, developing practice and a need to allay fears of misuse and abuse of ADRTs in clinical, health and social care settings. Practical implications: The authors make recommendations that reflexive training and awareness become the norm in health and social care, that reform of ADRTs is undertaken to prevent misunderstandings and that the person becomes central in all decision-making processes. Originality/value: This paper is original in considering ADRTs as a safeguarding issue from two perspectives: that of the person making the ADRT and being confident in respect for the decisions made; and that of clinicians and other professionals being reflexively aware of the need to accept advance decisions and not acting according to unconscious biases in times of crisis.

Last updated on hub: 09 December 2020

Coronavirus (COVID-19) and adult support and protection: a quick guide

Scottish Social Services Council

This brief guide helps new or redeployed staff quickly understand the following areas: adult support and protection – what is it and who might need protection; harm – what are the signs to look for; and what to do - what workers should do if they identify a concern.

Last updated on hub: 18 September 2020

Webinar recording: Online Q and A: COVID-19 and safeguarding in faith-based organisations

Social Care Institute for Excellence

SCIE, as part of the Safeguarding Training Fund, and in collaboration with the Department of Culture, Media and Sport and the National Lottery Community Fund, held an online Q and A webinar on the safeguarding implications of COVID-19 for those working in faith-based organisations.

Last updated on hub: 15 September 2020

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