Report 41: Prevention in adult safeguarding
'Each agency focused on single issues within their own sectional remits and did not make the connections deemed necessary for the protection of adult at risk' (53)
While multi-agency working is key to successful adult safeguarding work in general, it can be variable in practice.
The policy contextOpen
The aim of No secrets was to establish inter-agency collaboration as a means of safeguarding adult at risk more effectively. One of the drivers for this was the failures identified in the Serious Case Review following the murder of Steven Hoskin, a man with a learning disability:
Each agency focused on single issues within their own sectional remits and did not make the connections deemed necessary for the protection of adult at risk and proposed by No secrets.(53)
No secrets recommended that all commissioners and providers of health and social care services including primary care groups, regulators of care services and appropriate criminal justice agencies should work together in partnership 'with all agencies involved in the public, voluntary and private sectors and they should also consult service users, their carers and representative groups.'(1)
Is it happening?Open
CSCI reported a mixed picture of the effectiveness of adult safeguarding boards with 'only about half judged by service inspectors to be working effectively'. Although all boards had representation from key statutory agencies, some were not of appropriate level of seniority and others lacked continuity. Links with GPs, housing and probation were least successful. (3)
CSCI found concern among their respondents about the overall accountability for adult safeguarding, in contrast with clear lines of accountability for child protection. They further found that:
Without a means to enforce inter-agency co-operation, some safeguarding work depended on personal rather than organisational commitment.(6)
Braye et al, in an exploration of governance arrangements for safeguarding adults, found that adult safeguarding boards commonly engage in activities far wider than those implied by No secrets, extending to community prevention and awareness raising. In relating governance arrangements with safeguarding performance, they conclude with a list of characteristics of governance arrangements present in authorities receiving positive reviews in safeguarding.(54)
What helps cooperation?Open
Reid et al, reporting the findings from focus groups undertaken with 26 adult protection committees, found five key features that promoted good inter-agency working:
- a history of joint working
- development of information-sharing processes
- perceptions of goodwill and positive relationships
- mutual understanding and shared acknowledgement of the importance of adult protection.
However, they found that these features could be undermined by poor information sharing, limited understanding of roles, different organisational priority given to adult protection and poor involvement of key agencies in adult protection committee meetings. Many respondents felt that legislation would help to ensure cross-agency engagement in adult protection.(52)
Braye et al similarly conclude that specific legislation setting out the roles and functions, membership and accountabilities of safeguarding boards would help to standardise policy and procedures and ensure participation, and to hold agencies more easily accountable.(54)
Working with health partnersOpen
One of the themes from the literature is the importance (and difficulty) of securing the role of local NHS partners in the adult safeguarding agenda; see for example 2, 3. The Department of Health reported particular concerns about the poor participation of GPs and mental health trusts in safeguarding meetings.(2) CSCI found that GPs were among the least likely of local agencies to be involved in adult safeguarding boards. They also reported that the 'permissive' nature of the guidance on safeguarding, particularly regarding health and the police, has resulted in variable commitment from these partners and undue reliance on local negotiation.(3)
Braye et al found health representation on boards to be 'diverse', with all trusts in an area commonly participating as well as some examples of PCTs playing an overall representative role.(54)
The value of the inclusion of health partners is highlighted by, for example, Minshull who identifies the potential for systemic abuse and neglect in mental health care settings for older adults, while Collins and Walford (2008) highlight the profound powerlessness and fear of retribution among people with mental health problems who had been on inpatient wards.(47, 42)
Case study: Domestic violence: linking adult safeguarding and MARAC in BradfordOpen
For some years, Bradford has been developing effective links between MARAC processes and work done on safeguarding of adult at risk and wider multi-agency programmes on community safety. MARAC refers to multi-agency risk assessment conferences, for victims of domestic abuse at high risk of serious assault or homicide. Over time these links have led to better outcomes for people who may be the victims of domestic abuse.
In Bradford the MARAC coordinator sits within Bradford Metropolitan District Council's Safeguarding and Partnerships Service alongside the Council's Adult Protection Unit. This gives an immediate point of contact where connections can be made between MARAC processes and the coordinator for safeguarding adults. It also means that MARAC is connected in the minds of partner agencies with the wide safeguarding agenda and is not seen as a separate function administered by one agency, for example the police.
The MARAC coordinator convenes and facilitates MARAC meetings over two police divisions. The MARAC coordinator is supervised and supported by the Council's Safer Communities Lead Officer, who links very closely with the Bradford community safety partnership (Safer Communities). This link is valuable in that it provides a connection to the wider community initiatives operating in Bradford. A member of the Adult Protection Unit, who is also seconded by the Bradford District Care Trust, attends every MARAC meeting. This has resulted in an increase in safeguarding alerts which go on to become referrals and result in investigation.
Valerie Balding, Lead Officer, Violent Crime