Report 47: User involvement in adult safeguarding
Formal systems and involvement
Joseph Carmody, Principal Manager for Adult Safeguarding in the Royal Borough of Kingston
We thought having a big [safeguarding adults] board with lots of people involved was the answer, but all it did was stop people communicating.
This section explains the formal arrangements made by local authorities for adult safeguarding, in particular, safeguarding adults boards (SABs) in England. It reports on research into the effectiveness of adult safeguarding systems, and SABs in particular, highlighting the range of ways in which people who use services have been involved in SABs and in adult safeguarding mechanisms in general. This research indicates that more work is needed to improve the empowerment and involvement aspects of adult safeguarding. The section includes examples of SABs in practice.
Are the systems working?Open
Cambridge and Parkes examined adult safeguarding decision-making processes in one local authority, and came to the view that:
Adult protection processes tend to be organisationally led and top down, risking service user exclusion and defensive practice. Indeed, there is a substantial danger that adult protection policy and practice may further undermine the capacity of service users through a disproportionate emphasis on vulnerability.(23)
Manthorpe et al reported on the findings of statutory inspections and consultations carried out to evaluate the National Service Framework for Older People.(35) One aspect of these inspections was to look at people's experiences of adult protection. The findings showed that, although older people usually say that they know where to go to report mistreatment, many are reluctant to complain and carefully weigh up the risks of doing so. Some of those who do raise concerns are not always listened to. The researchers suggest there is a need to raise awareness of elder abuse and to increase the capacity of adult protection services to respond positively to concerns raised.
Furness carried out a small-scale qualitative study to explore the views of people living and working in private care homes about how to better protect older people.(26) Nineteen managers and nineteen residents were interviewed about their understanding of abuse, perceptions of different forms and possible action to deal with offending care staff. Only five residents said they would raise serious concerns with a CSCI inspector. Most of the residents would discuss their concerns with a house manager but only 50 per cent believed they would be taken seriously. The author concludes that care homes should develop a number of ways of demonstrating greater resident and relative involvement, for example 'friends of the care home' groups, independent advocacy, surveys and regular residents' meetings in order to offer more opportunities for residents to comment on their experiences of living in homes. She recommended that the CSCI inspections should pay greater attention to seeking feedback from people who use services.
Using a case study, Bell et al showed ways in which procedures for adult protection may fail people who have been mistreated.(36) Several people living in the community complained to a keyworker about bad treatment from a specific care worker who had visited each of them. Each was encouraged to make an official complaint. The accused care worker was suspended and an investigation begun, but then nothing more was heard about what was happening, so the people who had complained became frightened and withdrew their complaints. The authors state: 'The protection procedures had not therefore enabled these vulnerable adults to express themselves. The procedures had proved too rigid and cumbersome to facilitate any form of self expression for these complainants; their views had become completely invisible.'
What do we know about SABs?Open
Braye et al conducted a systematic review of literature and a programme of research into SABs in England.(17) The authors investigated the governance arrangements for safeguarding adults, focusing on the boards routinely set up by local authorities following the 'No secrets' guidance in order to enable interagency collaboration.(18) The research had the aim of finding out about the goals, visions and purposes of boards, and about their structure, membership, actions and accountability.
Braye et al found that SABs draw their membership from statutory, voluntary sector and independent agencies in the field of community care, including groups of people who use services, carers and individuals; however, it was not routine for people who use services to be SAB members. SABs often go beyond a focus on individual situations of abuse to work with communities on awareness-raising and prevention. In the context of personalisation, SABs have sought to promote empowerment and choice, in the awareness that choice can open up new risks. It appears that the language of safeguarding is moving away from an emphasis on vulnerability towards recognising strengths and capabilities, with the role of safeguarding being to empower people to protect themselves.
What do we know about involvement on SABs?Open
Braye et al looked at the effect of these structures on involvement of stakeholders.(17) They found a tension between 'the need to create a tightly defined strategic group of senior officers' (ideal for joint decision-making between agencies), and the wish to involve a wide range of stakeholders. To maximise efficiency, boards are tending to create layers of responsibility within boards, or to have a smaller operational board and a number of sub-groups.
They found that SABs typically have up to five sub-groups, including groups promoting participation from people who use services and carers, which necessitates structures to maintain coordination and communication between levels and groups.
Braye et al also found that participation is often through forums or public consultation. They found one good practice example of a forum for people who use services which has carried out major projects to empower users in safeguarding through devising a charter, user-defined standards and outcomes, an audit tool to benchmark practice against user standards, training for user trainers and workshops on staying safe, participation in the SAB and a contract to ensure the SAB's accountability to the forum'.(17)
Other participation models found by Braye et al included:
- procedures to increase participation during individual safeguarding investigations
- advocacy and support to promote participation
- debriefing and reviews of services to find out about satisfaction of people who use services
- research and surveys on the experience of people who have been through a safeguarding procedure.(17)
User involvement on SABs work in practiceOpen
Central Bedfordshire and Bedford Borough Councils worked with an independent charity, Advocacy Alliance, to provide a representative of people who use services to the SAB. A support group of people who had been through a safeguarding process was set up and run from October 2010 to March 2011. One person became the SAB user representative, liaising between the group and the board. They intend this role to continue.
The Kirklees SAB created two 'lay membership' posts. The role of these members is to hold the board to account, challenge decision-making and comment on governance. Lay members do not have to have direct experience of safeguarding, but are expected to be able to work at board level. A recruitment process was designed to identify people who were comfortable with this. Originally it was felt that having two lay member posts was essential for mutual support, but one left and the other has felt confident enough to carry out the role alone.
Enfield's SAB has direct representation of people who use services, via a sub-group of users, carers and local residents, some of whom sit on the SAB. One person on the SAB has learning disabilities, and the local authority safeguarding team go through the papers with her beforehand to make sure she understands and is fully able to contribute.
Based on their experience in Kingston, Joseph Carmody, Principal Manager for Adult Safeguarding in the Royal Borough of Kingston, advises against making the main SAB too big. He says, 'Try to be careful who you invite to sit on it. We thought having a big board with lots of people involved was the answer, but all it did was stop people communicating.'
Sutton's SAB has revamped its structure to enable better user involvement. The main board works at senior director level, dealing with strategic issues such as reviews and monitoring. Involvement happens on sub-groups which report to the board. The Quality Assurance and Performance sub-group has representatives from all the other adult partnership boards (learning disabilities, mental health, older people and carers partnership boards), and each of these can decide if they want to send a user representative to the sub-group. As Sutton Council's safeguarding lead, Adrienne Stathakis says: 'Since it is not possible to represent everyone on the SAB, this seems a better way to bring it together.'
Kingston Council invited an external consultancy to review their safeguarding processes last year. Representatives from user organisations were on the SAB but this was not working well. Feedback showed that people who use services and lay members felt that the SAB was a place where professionals with scary titles used language in a way that didn't make sense to them, and that it was too bureaucratic. They have now set up a sub-group for people who use services and the chair of this, a person who uses services with experience working with CQC, is also a SAB member. The sub-group have veto on promotional materials, see all the board documentation and report to the board on what they would like to be done. They have a facilitator from the Learning Disabilities Parliament to support people with learning disabilities, and are working to become more inclusive of other community groups, for example the Domestic Violence Forum.
The Royal Borough of Kensington and Chelsea (RBKC) have recently set up a Service User Reference Group to link with the SAB, and are working out how the SAB should be accountable to the Reference Group. This may be through someone from the Reference Group sitting on the SAB, but they want to ensure this would not be tokenistic. Alternatively, the Reference Group could receive feedback on what the board has discussed and make comments. Mary Wynne, the RBKC Safeguarding Adults Coordinator, explains:
'We have engaged service users across the health and social care spectrum, learning disabilities, old people, mental health, local LINk, carers' representatives. We have set up the terms of reference. The members see it as their group. Our role is to provide support to the group to be part of the strategic structure. We recognise there are high expectations on reference groups without people being properly supported, so we will run sessions on what it means to be part of the group…It is important to be able to strike a balance between being clear on the function of a reference group or user forum, and also to deal with people's personal experiences, and manage this sensitively.'
Forums and groupsOpen
In Barnet, instead of direct representation on the SAB, the Council set up a Safeguarding Adults Forum of approximately 30 people who use services with staff facilitators. This has now been going for three years, with a fixed membership to enable the group to build expertise. Meeting days vary to accommodate people's availability. The forum includes older people, those with physical and sensory disabilities and learning disabilities. Some belong to groups and organisations, such as the 55+ Forum, the Older Asian Association, the Multicultural Centre, the African Caribbean Association, Mencap and People's Choice. The SAB is accountable to the forum via its sub-groups which are expected to present their work to the forum for advice. The forum is also able to raise issues via the local safeguarding lead and work on specific projects, such as awareness campaigns. Sue Smith, Safeguarding Adults Coordinator from Barnet Council, explains:
'Chairs of SAB sub-groups are being challenged on what they achieve by the service user group. The user forum challenges in a helpful and supportive way. This has been empowering for the service users and for staff. It reminds the Board why they are doing this work, and brings us back to the people at the centre of things. Service users from the user forum have been involved in recruitment and selection of care workers. Last summer an independent chair of the Safeguarding Board was appointed. The user forum decided on the questions and an independent user panel asked questions to all candidates'.
In Bromley, there are two forums: one for people with learning disabilities and another for people with physical disabilities and sensory impairment. These two forums both send a representative to the SAB.
Wokingham has an Adult Safeguarding Forum with members who use services, and a broad agenda including fire safety, home safety, personal and community safety. Professionals and public attend. However, they are finding it difficult to get the wider public to acknowledge and recognise abuse.
Central Bedfordshire and Bedford Borough Councils chose to set up a time-limited user group to provide a snapshot of how people experience safeguarding. The results will form a report and case studies to feed into service development.