Report 41: Prevention in adult safeguarding
Empowerment and choice
'If people are to protect themselves from abuse, they need to be aware of what abuse is, be informed about their rights and have the skills and resources to be able to deal with it.'
Empowerment and choice need to be at the core of safeguarding policy and practice; this means working to enable adults at risk to recognise and protect themselves from abuse. It also means taking a risk enabling approach within services and ensuring that people who use services have genuine choice both of and within services.
Empowerment and preventionOpen
Enabling people to protect themselves from abuse is at the core of the principle of empowerment as identified in the report on the consultation on No secrets.(2) If people are to protect themselves from abuse, they need to be aware of what abuse is, be informed about their rights and have the skills and resources to be able to deal with it. They need to have the information, knowledge and confidence to take action. The joint guidance from CSCI/ADASS/ACPO describes this as the person's 'capability' (36).
In the consultation report on No secrets, people reported wanting help to deal with potentially and actually abusive situations in their own way. They wanted to 'do their own safeguarding, they wanted help with information, options, alternatives, suggestions, mediation, “talking to” and so on'. They did not want decisions made for them.(2)
The importance of choiceOpen
An important feature of empowerment is to offer people genuine choice when it comes to the services and supports on offer. This issue was highlighted by the SCIE's Service User Advisory Group on Safeguarding Adults. Without choice and the ability to exercise choice, the potential for abuse can become greater and the opportunity to escape it become harder.
CSCI similarly identified the rights of people to take risks and make choices within the policy environment of personalisation, choice and control.(6) O'Dowd, reporting on the Comic Relief/Department of Health research into the prevalence of abuse of older people, suggests that better prevention procedures need to involve more choice for older people and to give them a stronger voice.(27, 26)
This points to the importance of people at risk having regular practice in making independent decisions. Although most of the work to improve decision-making skills has taken place with people with learning disabilities (as discussed in section 4), having the assertiveness and resistance to defend oneself might reasonably be considered to apply to all adult at risk and abusive situations. This approach has also been applied in the field of domestic violence.
Balancing choice and riskOpen
CSCI found that people wanted the discussion about safeguarding to focus on respecting people's rights and wellbeing, rather than to take a paternalistic or unduly protective approach towards abuse and protection. This approach was seen as complementary to personalisation, although there was some concern about the situation facing people purchasing their own care.(6) As identified in the consultation report on No secrets, people are concerned about the balance between safeguarding and personalisation, between choice and risk.(2) Systems to assist in this include ensuring people have informed choice and introducing support systems for direct payments. Nevertheless, respondents to the consultation remained concerned about financial safeguarding.
CSCI found that managers leading on safeguarding are sometimes not involved in the development of self-directed support services, potentially leading to a lack of communication and understanding across this divide. They found concern among local authority staff that people using direct payments could be at risk of abuse from the workers they employ or from family managing payments on their behalf. CSCI suggested ways to help tackle this:
- good information on safeguarding in card form
- obtaining CRB and career history checks and references for personal assistants
- recruitment support from a third party
- training and support on financial and employment issues and potential abuses for people directing their own support
- routine council checks on progress through care plan reviews
- organising forums of people directing their own support to share experience and good practice.(3)
In a SCIE study looking at risk and self-directed support, Carr found little evidence of investigation into risk enabling practice for personal budgets.(5) She suggests that risk enablement needs to be a core part of the self-directed support process, saying that it, '… can transform care, not just prevent abuse'.(55)
People without capacityOpen
The consultation report on No secrets found that respondents felt that safeguarding processes for people who lack capacity should be different in significant respects from processes undertaken with people who have capacity.(2) The principles of the Mental Capacity Act make it clear that a person is not to be treated as unable to make a decision unless all practicable steps have been taken to help them to do so, and that no one should be deemed to lack capacity on the grounds that their decisions appear to be unwise.