Report 47: User involvement in adult safeguarding
Barriers to involvement
Concerns about risk can be used to block the involvement of people who use services in adult safeguarding.
This section looks at the barriers to involving people who use services, and hears from safeguarding leads from a range of local authorities about their views on these difficulties.
Risk and empowermentOpen
The relationship between attending to risk and promoting empowerment is raised frequently in the literature. In the consultation on 'No secrets', many people said that they were offered safety, 'often at the expense of other qualities of life, such as dignity, autonomy, independence, family life and self determination'.(21) Concerns about risk can be used to block the involvement of people who use services in adult safeguarding.
On this point, Johan Baker, Adult Safeguarding Prevention Advisor from Wokingham Borough Council, said:
'It is difficult to engage users in meaningful way about risk and about understanding what abuse is. It is hard for people to recognise they are vulnerable. Anyone can be vulnerable.'
Some safeguarding leads pointed to the tension between promoting involvement and a duty of care. Mary Wynne, Safeguarding Adults Coordinator at the Royal Borough of Kensington and Chelsea, said:
'Although policy and principle is for service users to be involved in everything, some decisions have to be taken regardless of the views of the Reference Group, as legal requirements or public safety may override individual wishes. We may have to carry out an investigation because people are at risk and that can cause tension around people's rights to make decisions versus the public interest. This can make people feel you are not listening, but it depends how you explain to people what you are doing. For instance, in cases of domestic violence, the police may arrest the perpetrator even against the wishes of the victim. Staff have a duty of care.'
Users' views of riskOpen
The safeguarding lead from Enfield Council, Sharon Burgess, said that people who use services should be involved as much as possible in safeguarding processes and discussing risk, except where there is a data protection issue:
'It's about them really. It's like where we used to be with involving children, people were like "You can't do that!"'
Paternalistic practice can be slow to change, but it is happening, according to Sharon Burgess. She described a growing recognition from practitioners about the importance of involving users in discussing risk:
'In some of the teams people had been doing well at contacting families, so a safeguarding intervention would happen, a protection plan would put in place, but nobody was contacting the service user. There hadn't been a mental capacity assessment to say that the service user didn't have capacity to understand or a best interest decision to say that someone should be their representative, so this was a big learning curve for some of the care teams. Often people don't want to worry older people with problems. However, the teams are very committed to service user involvement and in developing their practice.'
Risk-averse work practicesOpen
Researchers have found that social workers' attitudes to risk vary according to the groups of people who use services. (36, 37, 39) Social workers often saw people who use mental health services as posing a risk to others, but for other groups, including older people and people with disabilities, they were more likely to see risk as a part of normal life, needing to be managed, but having positive potential in terms of self-development.
Barry found evidence of a generally risk-averse culture in social work.(39) She reported that, while social workers did not place much confidence in the predictability of risk assessment tools, these tools are used widely, replacing rather than informing professional judgement.
Johan Baker, Adult Safeguarding Prevention Advisor at Wokingham Borough Council, argues that it is important that social workers see these issues as part of their core work: 'Make sure dealing with abuse and prevention is part of social workers' everyday work and task, core business, rather than about specialist teams.'
Involvement causing harm?Open
Risk of causing further harm can inhibit social workers from involving people. Pinkney et al found that social workers in adult protection often wished to engage people who use services more fully, but were concerned about the complex situations for victims of abuse, who might not agree they were at risk of harm or might not want to come forward and be identified.(40)
Islington's Safeguarding Adults Development Manager, Jeanie Stewart, found that it is not a simple matter to put a feedback questionnaire for people who use services into the audit process, as it could stir up difficult feelings:
'Some users are hard to engage as they are frail or so distressed. Is it ok to go back and open it all up again? The last audit got some user feedback, but a lot of staff were anxious about approaching service users who had been through particularly difficult situations.'
Failure to recognise and involve certain groupsOpen
According to Lewis, some groups may be unrecognised or 'misrecognised' (that is, where people are seen as lacking value and as inferior) and thus effectively excluded from individual or strategic involvement because of their particularly powerless status.(9) Lewis gives an example of how people who use mental health services can be misrecognised in involvement situations because of the assumptions related to their status as people who use services:
The compelling injustice of this misrecognition as these struggles became turned back on the individual as a sign of their 'mental illness' or 'madness' was noted by the following participant in the context of discussing a long-standing dispute over the payment of his expenses for attending meetings: 'I'm still the madman because I'm the one who's kicking up all this bloody fuss over one pound fifty.'(9)
Women who experience domestic violence may be excluded from consultations because they are seen as unreliable witnesses, according to Mullender and Hague, even though they have first-hand knowledge of their risks and what might help them to be safe.(41)
Older people may not be sufficiently heard and enabled to report abuse. According to Cooper et al it can be demonstrated that a far higher proportion of older people experience physical or psychological abuse than is reported or shown in objective studies.(42)
The research indicates a need for special attention to the issues working against involvement of people in the above groups.
The research of Braye et al into SABs found SABs were unclear about how to represent stakeholder groups, for example whether staff of organisations working for people who use services should sit on SABs on their behalf.(17)
Mary Wynne, Safeguarding Adults Coordinator from the Royal Borough of Kensington and Chelsea, confirmed this, saying:
There is a dilemma on how to get real representation. The people who come forward tend to be the ones already involved on other forums. The problem is how to reach the ones who are least able to participate. It is possible that we might place too much emphasis on some people's views and opinions that might not be representative of the wider group.
In Bromley Council, research by the Adult Safeguarding Coordinator, Ruth Warren, and her colleagues into the views of people who use services only achieved small numbers because of a very selective process for selecting suitable cases. They are looking into whether they should to move to a more universal questionnaire to be automatically sent out on closure of the safeguarding referral, in order to get 'a more representative view of the service user experience'.