Report 47: User involvement in adult safeguarding
The involvement of people who use services needs to be supported in a range of ways which include briefing and information on what is expected, debriefing, and accessible information and meeting formats.
This section looks how the involvement of people who use services in social care can be supported and be effective. Research shows that even groups who are seldom-heard can be involved, given enough investment of time and using methods that work for those groups, and that involvement of people who use services is beneficial in a wide range of ways – to the people themselves and to the staff who work with them, and can improve services provided.
A range of supportsOpen
Based on their study of safeguarding adults boards (SABs), Braye et al conclude that what helps involvement is:
- vision and will, support and leadership from senior staff
- open and honest communication and commitment to a rights-based approach
- creativity and imagination in finding ways of communicating
- resources of time and energy, not just money.(17)
They call for SABs to set out clear rules of engagement, with resources for participation, and to set standards for empowerment in all aspects of safeguarding.
In interviews for this report, some adult safeguarding leads pointed out the importance of the resources to help them get involved with local groups and put some of their ideas into practice, for example community awareness and publicity work and public conferences to widen awareness of safeguarding issues.
User involvement in social work trainingOpen
According to Beresford et al, people who use services first began to influence the social work profession in the 1980s, developing training materials to enable them to offer training to social workers.(43)
In 2001/02, the Department of Health reviewed social work education and training, consulting widely. People who used services shared what they wanted from social workers, emphasising personal qualities of understanding, warmth, empathy, respect and non-judgmental attitudes.(44) Based on this consultation, the Department of Health brought in a new requirement for all social workers to be educated to degree level and for user and carer involvement to be integrated into the design and delivery of the degree programme.(45)
Studies since the implementation of this policy show that involvement is now a central and invaluable part of social work training and that it helps social work students become more aware of values such as respect, partnership, equal relationships and expertise based on personal experience. (46, 47).
In Barnet Council, involvement is having an impact on recruitment of social care staff, according to Sue Smith, Safeguarding Adults Coordinator:
'People who use services have their own perspectives on what they think is important, they want a care worker to be kind, so we try to translate that language into our tendering process, so that people who are applying for a tendering process are asked how they will ensure their staff are kind, so it makes them think differently, not just checking CRB, moving and handling. Staff are now asked that question when they come for a job.'
A partnership approachOpen
A Department of Health report on practical approaches to co-production (a term for partnership or working collaboratively) examines how to create effective partnerships with people who use services, stating that the challenge is to create, 'whole systems change in the way that support is designed, planned, commissioned and delivered so that a greater proportion of decision-making processes are led by people who use services, carers and communities'. They call for organisations to take on and understand user and carer engagement and co-production and to develop co-production strategies.(48)
Allain et al argue that people who use services and carers should be able to contribute in a variety of ways, based on their individual skills and knowledge, if equal partnership and power sharing is to be a reality.(49) Hernandez et al reinforce this, finding that where culture of an organisation makes it possible to make complaints and discuss the services, through staff–user joint problem solving, people who use services are satisfied with the approach and will get involved.(50)
The Adult Safeguarding Lead in Central Bedfordshire Council, Emily White, reports on the experience of one social worker realising what partnership working looks like in safeguarding:
'One social worker was going to do the protection plan herself and put it on the system, and I asked if she would usually work with this person together to do her care plan, and she said "Yes, of course", but hadn't realised she could do the same with the protection plan, it was a bit of a lightbulb moment.'
Working in partnership with an adult at risk can take longer but is likely to work better, as Jeanie Stewart, the Safeguarding Adults Development Manager from Islington Council explains:
'A well documented timely safeguarding process doesn't necessarily mean the user feels good about it. We've had ones that have taken a lot longer where people have felt listened to and been given space and time and the feedback is more positive. When people are frail and maybe also mentally frail, rushing through a process can leave them feeling anxious. As long as you make sure they are safe, sometimes it is better to do things at their own pace so they feel listened to.'
In Islington, the borough has employed an experienced minute taker to train staff to write better and fuller notes of their meetings with people who use services, as a way of better involving users and working cooperatively with them.
Support, training and capacity buildingOpen
The involvement of people who use services needs to be supported in a range of ways which include briefing and information on what is expected, debriefing, and accessible information and meeting formats. (5, 51, 52) Involvement coordinators interviewed by Taylor et al provided a range of support including mentoring, semi-formal meetings with a social element, advocacy, and advice on benefits and payment.(52) People who use services are likely to benefit from involvement skills training.(5) People who use services say that their groups need 'capacity building and development help to enable them to become independent'.(53)
Involving people who use services can be beneficial in a range of ways, according to Simpson and House.(54, 55) They found that involvement could lead to personal empowerment and to users acquiring practical skills and employment, as well as improving services and relationships between users and staff. Simpson and House suggest that involvement is a health technology, and should be studied as rigorously as health interventions.(54)
Although 'No secrets 'does not mention people who use services being involved in training staff, this is generally considered to be good involvement practice.(18,45) Levin also points out the value of involvement training for people who use services.(5)
Powys have developed a pilot course with people with learning disabilities, with the involvement of Victim Support, Coleg Powys, the police and other organisations. The course enabled people with learning disabilities to learn what abuse is, to make a personal protection plan and think about how to keep themselves safe. People First now run these courses and Powys are supporting this approach by training trainers with learning disabilities to help others.
Some areas have involved service users in training. Safeguarding staff in the London Borough of Barnet set up a training course for people with learning disabilities to enable them to be involved in staff training, using personal experience to get across the message to trainees. In Barnet, all of those involved with the SAB user forum have gone on to do things within their organisations, such as running events at their centres, gaining skills and confidence. Some have done a play which they got funding to have filmed and made into a DVD.
Several pieces of literature discuss general issues related to involving people from diverse groups: see for example the General Social Care Council (56), Butt (57) and Hernandez et al (50). Factors found to help included time and money to enable people to have access to information and get to meetings, taking into account the complexities people's individual lives, and of issues including age, disability, gender, sexual orientation, social class, religion, faith and ethnicity, and finding a range a range of methods to engage people beyond invitations to meetings.
Some writers have focused on ways of involving particular groups of users. For example, Slater suggests a user involvement strategy for elder abuse should take into account the emotional and moral problems in asking people who use services to relive painful experiences 'in the interest of the "greater good". He suggests that professional records of intervention should be of sufficient quality to provide at least an indirect source of user voice in such cases.(58)
Age Concern East Midlands found that it was possible to involve black and minority ethnic elders by taking the time to build relationships with people and groups, choosing comfortable, accessible venues and times, offering translation and interpretation if needed, and feeding back to participants afterwards about how information has been used and what will change as a result.(59)
The work of Murphy et al shows that involving people with dementia is both possible and worthwhile.(60) The writers recommend a variety of different approaches, including individual interviews or group discussions, or creative methods such as life-story work and poetry-writing, depending on people's levels of ability, and using indirect approaches via carers or service providers in some cases, although this has its disadvantages as the person's views are filtered through a third party. The essence of success, whatever the approach used, is in building trust and taking the time needed.
Ward et al reviewed two participative projects for older gay and lesbian people in different parts of the UK.(61) The projects aimed to promote local networks for these groups to encourage and support their involvement with consultation on local services. They found the participants had been often been collectively labelled 'hard to reach', but had been silenced by policy and practice that excluded them, not by their choice. The projects showed that it was possible to adopt participative approaches, 'which allow older lesbians and gay men to define the knowledge and understanding of their lives and experiences that inform policy and service development'. The authors state that this kind of work can inform future directions in social policy that are more person-centred and inclusive.
To widen involvement, Islington Council's safeguarding team worked with the Dignify Project at Toynbee Hall, which raises awareness among older people and professionals about elder abuse and what to do about it. Jeanie Stewart, Safeguarding Adults Development Manager says, 'Some small group work was done with older people in hard-to-reach groups, and some of our own staff were also trained on continuing that work.' They also maintain good relations with their local Independent Mental Capacity Advocacy service. Islington has also set up a 'Leaders in safeguarding' forum, to embed the ethos of user involvement in safeguarding among managers.
In Powys, the experience of adult safeguarding showed that different groups of people who use services require different forms of involvement, as Mick Collins, Adult Protection Lead for Powys County Council explains:
'We thought we could do a course similar to the one for people with learning disabilities in mental health. When our trainer arrived to do the first course, thinking a similar approach would work, this was a very different group of people. One mum brought a baby which was of far more interest to the group than he was'.
So they rapidly adjusted the approach and now have workshops for people with mental health issues, with mental health service users involved in the delivery.
A rights-based approachOpen
Lewis argues for a move from dominant cultural forms which render certain people or groups less invisible or 'misrecognised', (that is, where people are seen as lacking value and as inferior), towards valuing 'individuals, groups, identities, experiences, knowledges and expertise and (potential) contributions, humanity and personhood; upholding citizenship status and rights; and affording people dignity and respect'.(9)
Beresford and Hasler report on a national consultation event for people who use services and policymakers on the future of social care organised by Brunel University and the Commission for Social Care Inspection.(62) A priority issue was to base social care on values of independent living and human rights, with people who use services entitled to the support they need to live their lives on as equal terms as possible with the rest of the community.
Mind also argue for a rights-based approach to involvement, quoting the United Nations Convention on the Rights of Persons with Disabilities which was ratified by the UK Government in June 2009.(22) Mind have called for a revision of adult safeguarding procedures in the wake of this ratification.
Several of the case study participants described efforts to improve information that is distributed in the community and to reach out to wider parts of the community.
CSCI found positive practice in learning disability services at East Sussex County Council, where 'innovative work had been done to involve people who use services in promoting safety'.(63)
Safeguarding staff at the London Borough of Barnet have worked with people who use services to produce an accessible leaflet on what happens after abuse is reported, what social workers do, and on how they work with others on keeping people safe. That leaflet has now been adopted by many local authorities across the country.
In Islington a community conference on adult safeguarding was held for the first time in 2010. There was a good attendance of people who use services and carers. One purpose was to launch the safeguarding annual report and ask people who use services and carers their ideas on what should be done to improve safeguarding. They plan to repeat this annually.
Islington Council also has a policy officer trained in Plain English who will do a summary of issues and decisions made at the SAB to give to people who use services and carers, and the safeguarding team are planning to make available online easy-to-read versions of their 'Safeguarding me' toolkit.
In Powys a street survey was carried out a few years ago asking whether people had heard of adult abuse and protection. Mick Collins, Adult Protection Lead for Powys County Council, says:
Of course most hadn't, so we told them and gave them leaflets. We hope to repeat the survey this year around the market towns. We hope that we will find increased recognition of adult abuse, but even if we do not find this the activity will once again provide an opportunity to spread the word.
Enfield Council's Safeguarding Adults Team run an awareness week, raising public awareness of abuse and adult protection, giving talks to carers and people who use services, and have started monthly surgeries, in libraries, along with the domestic violence unit for people to ask questions about safeguarding, or come and talk. Information from this feeds back into service development.
Wokingham Borough Council (with support from Thames Valley Police) launched a Safer Places scheme. The idea came from a learning disabilities self-advocacy group who had the idea and wanted help to develop it. The scheme encourages shops around the borough to lend a helping hand to vulnerable adults, aiming to help people who might need help feel more secure when out. It has since been broadened out to other groups. On trying to develop accessible information Johan Baker, the Adult Safeguarding Prevention Advisor for Wokingham Council has this advice: 'Cut out the jargon and use terms like "feeling safe". Find out from people at risk of abuse what feeling safe means to them.'