Report 47: User involvement in adult safeguarding
Learning from audits
Royal Borough of Kengsington and Chelsea, Safeguarding Adults Coordinator, Mary Wynne
We are asking staff to check if service users are invited to case conferences, how this was communicated to them, and about follow up. This is different from before.
'No secrets' stated that agencies should routinely gather information on the outcomes of investigations and users' views on how well this has worked for them.(18) It is clear from the case studies that auditing involvement is working well in terms of learning from experience and changing staff attitudes. This section contains in-depth case studies explain the learning in specific areas that has arisen from audit, feedback and review processes.
The literature on auditsOpen
It is important to learn from involvement, so that mistakes can be corrected and good practice built on, according to Levin and Branfield.(5, 53) People who use services, as well as staff, need to know what difference their involvement has made. (64, 48).
One example of good practice comes from a small study of the experiences of people who had been through an adult protection investigation.(65) The purpose of the research was to find out whether these people felt informed, supported and empowered by the process, and what could be learnt to inform practice or policy. The results showed that people were informed of the results of the investigation but more needed to happen to keep them fully involved and ensure they felt protected by the system.
Research also suggests some ways of involving people who use services in the design and carrying out of research, for example by checking draft surveys with a range of stakeholders, ensuring support for survey participants, and learning from other areas on what type of survey or audit and involvement has worked there (see for example 66, 67).
Case study: IslingtonOpen
In the London Borough of Islington, audit now routinely includes questions on whether user involvement featured in the safeguarding process, that is, whether people who use services had an opportunity to be involved in meetings or someone was identified to represent them if they lacked capacity themselves, for example an Independent Mental Capacity Advocate (IMCA). A feedback questionnaire for people who use services in safeguarding audits is included.
Islington revamped its audit tool to ensure they record the evidence of users, carers and advocates. According to Jeanie Stewart, Safeguarding Adults Development Manager, the change was a success:
'It is really powerful when the record says for example Mrs Smith said "I am frightened about him" or "I don't want to get my grandson in trouble but…" the record shows we have we have heard the voice of the individual and we are not just making decisions on their behalf.'
Islington Council's safeguarding team plan to include a 'you said/we did' element within its coming annual community safeguarding conference, looking at comments and feedback from the previous year, and making demonstrable links with the work they've been doing on adult safeguarding.
Case study: KensingtonOpen
At the Royal Borough of Kensington and Chelsea (RBKC), detailed auditing is now happening with people who've been through a safeguarding enquiry. The RBKC Safeguarding team have devised a set of questions to ask people who use services directly about their experience of the process to find what is really happening, rather than just tick boxes.
The RBKC, Safeguarding Adults Coordinator, Mary Wynne, says: '[through audit] We are asking staff to check if service users are invited to case conferences, how this was communicated to them, and about follow up. This is different from before.'
Case study: EnfieldOpen
In Enfield Council, the audit process of having someone scrutinise staff practice, and the work on raising understanding of the Mental Capacity Act has been seen as helpful. Results from the audit process have been fed back to the safeguarding board and practice forums and this led to a change in working. The safeguarding lead is hopeful that the results of the service user questionnaires will change policy.
The Safeguarding Adults Team have also launched a 'Safeguarding adults at risk' information pack, with the aim of getting feedback direct from users who have experienced the safeguarding process. It contains a questionnaire, to be given at the end of every episode of safeguarding intervention. It is in an easy-to-read format, and includes a simple checklist with pictures, asking questions such as 'How did you feel about the investigation? Were you offered an advocate? To what extent did you take part in making and agreeing the protection plan? To what extent were you involved? Do you know who to contact in future to prevent abuse?' and further comments. The results will go to the SAB, practice forums, care teams, service teams, managers, and organisational learning.
Case study: SuttonOpen
Sutton Council did have a user feedback survey, but Adrienne Stathakis, Sutton Council's safeguarding lead, says safeguarding staff thought it was 'very dry', and that they 'wanted a different qualitative and outcome focused way to do things'.
Adrienne had been involved for many years with BILD, the British Institute of Learning Disabilities, and worked with them to adapt their model of quality review to fit all the safeguarding client groups. The model uses face-to-face interviews, but not necessarily with a social worker. Instead of asking a series of questions, the interviewers have a real conversation with people. Volunteer interviewers are sought from the local community, and can include people who use services, carers, potential users, voluntary sector providers and people from other professional groups. They receive training in how to do the reviews. The aim is to test out ten outcomes (based on the seven outcomes of 'Our health, our care, our say'). The survey is easy to use, as Adrienne explains:
We don't ask people what the safeguarding process was like, instead we ask, "After you've been through the safeguarding process has it improved your quality of life?" This information is used to develop our services and our safeguarding processes. It is possible that a safeguarding process stops the abuse but does not help the person's quality of life. For example one lady was being financially abused, we stopped that, but so many checks and balances were put in place that she lost her independence to choose how to spend her money. Often, staff put in a protection plan, the abuse stops, and that is great, but we have to look at what happens afterwards. The most isolated people are the most vulnerable to abuse. We stop the abuse but they are still vulnerable and isolated. Using this model we are getting to hear about people's experience.
Case study: East SussexOpen
In East Sussex, the County Council has learned from interviews that, when a vulnerable adult has felt unable to attend a case conference, it's not sufficient to simply tell them what happened and give them the notes. As Chris Barker explains: 'Instead, the care coordinator will go to their home to tell them about actions arising from the case conference, or that the case has been closed'.
The council's rating for 'maintaining personal dignity and respect', which covers safeguarding, was 'performing well' in the 2009 annual performance assessment, up from 'adequate' in 2008. It suggests the work is making a difference.(68)
In East Sussex the council's safeguarding co-ordinators select people who have been through a safeguarding process to be interviewed about their experience of the process. They seek to balance the need for feedback with avoidance of the risk of causing further distress:
It's important that these [interviews] are face-to-face and, where possible, one-to-one. For someone with learning disabilities, for example, there will be staged contact to build a rapport…On the first visit the co-ordinator will be introduced, they'll go back another time for a cup of tea, and build up to the interview… With an adult with mental health problems we have to make a judgement about how an interview could affect them. We shouldn't enter their life when it's not the right moment for them.Carol Redford, Safeguarding Coordinator, reported in (Reported in 68)
Twenty-six interviews were carried out between February to December 2009, four with a carer or relative if it was not possible to talk to the person who uses services. Themes emerging include a variation in feeding back the outcomes of investigations to people. Angie Turner, the council's Head of Safeguarding, says, 'Some service users didn't know the case was closed. We might tick our boxes, have our case conference and close the case, but how is that fed back? They don't feel involved in the process' (68).
Case study: KingstonOpen
In the Royal Borough of Kingston upon Thames (RBK), two audit processes are happening side by side to ensure individual involvement in safeguarding. A user feedback format for people at risk was developed with people who use services, and one in four case records are audited to ensure that the procedural requirements of the safeguarding process (including involving the adult at risk) have been completed. The results of this are fed back to team managers where involvement has or hasn't happened.
With Kingston University, RBK also developed a qualitative audit to audit all cases that involve a case conference, to get feedback from adults at risk, carers and people alleged to have caused harm. The survey began on 1 April 2011.
As Joseph Carmody, the Principal Manager for Adult Safeguarding from RBK explains, at the end of a case conference, 'We will sit down and go through with the people who have attended how they want to give their feedback, or whether they want to give feedback.' This will be collated on a rolling basis to build quantitative and qualitative data on what is being done well and not well.
Case study: PeterboroughOpen
At Peterborough City Council, an interview process based on work done in Surrey has been designed to be conducted in the month following case closure. It has been piloted from February 2011. Straightforward questions ask about the involvement of the person who uses services in their safeguarding process and safeguarding support plan, for example whether they felt involved in making the plan, do they have a copy, do they know who to contact for an update on it? The study was consulted on at three boards with user involvement – the Older People's Safeguarding Board, Learning Disability Partnership Board, and Adult Safeguarding Board.
Ali Burrow-Smith, service manager within Peterborough Community Services for Adult Social Care and Learning Disability, commented that it is usual social work practice to support and involve people who use services through the whole safeguarding process and in everything they do, and said, 'We hope the survey will find out that this is in fact what service users experience.'
Case study: BromleyOpen
Safeguarding staff at the London Borough of Bromley have created a means for obtaining feedback from people who use services and a form which is used as the basis for a supported interview with the adult at risk or their representative or advocate. All responses are reported to the Performance Audit and Quality sub-group of the Bromley Safeguarding Adults Board to enable lessons to be learned and fed back to practitioners.