Purpose The paper examines three English research papers on self-neglect, from 1957, 1966 and 1975, discussing them in the context of more recent thinking and the statutory framework in England.
Design/methodology/approach In reviewing the three research papers, developments and points of continuity in the field of self-neglect were identified and are discussed in this paper.
Findings In light of the findings of the three articles, the present paper traces some of the classificatory refinements in this field that have taken place since the papers were published, notably in respect of hoarding and severe domestic squalor. Some of the difficulties in making judgements about behaviour thought to breach societal norms are described, and the challenges practitioners face in intervening in cases, particularly where the person concerned is refusing assistance, are examined.
Originality/value By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect.
Purpose This paper presents the results of a thematic analysis of safeguarding adults reviews (SARs) where homelessness was a factor to illuminate and improve safeguarding practice and the support of adults who are homeless in England.
Design/methodology/approach SARs were identified from a variety of sources and a thematic analysis was undertaken using data extraction tables.
Findings In addition to identifying shortcomings in inter-agency co-operation, SARs highlighted a failure to recognize care needs and self-neglect among people with experience of homelessness and evidenced difficulties in engagement between professionals and people with experience of homelessness.
Research limitations/implications The authors may have failed to find some SARs in this category (there is no central registry). SARs vary in quality and in detail; some were not full reports. The approach to people's experience of homelessness was broad and covered more than the circumstances of people who were rough sleeping or living on the streets.
Originality/value This paper contributes to the current practice debates and policy initiatives in respect of homelessness and safeguarding in England. It may have wider relevance in the rest of the UK and internationally.
Purpose The purpose of this paper is to examine safeguarding adults reviews (SARs) that refer to mental health legislation in order to contribute to the review of English mental health law (2018).
Design/methodology/approach Searches of a variety of sources were conducted to compile a list of relevant SARs. These are summarised and their contexts assessed for what they reveal about the use and coherence of mental health legislation.
Findings The interaction of the statutes under consideration, in particular the Mental Health Act (MHA) 1983, the Mental Capacity Act (MCA) 2005, together with the Care Act 2014, presents challenges to practitioners and the efficacy of their application is variable.
Research limitations/implications In light of the absence of a duty to report SARs to a national register, it is possible that relevant SARs were missed in the search phase of this research, meaning that the results do not present a complete picture.
Practical implications Examining cases where use of legislative provisions in mental health has been found wanting or legislation may not be easily implemented may inform initiatives to increase understanding of the law in this area.
Originality/value This paper's originality and value lie in its focus on mental health legislation as discussed in SARs at a time when both the MHA 1983 and the MCA 2005 are the focus of attention for reform.
Purpose Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems.
Design/methodology/approach Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews' observations and recommendations. The main circumstances, recommendations and common themes were identified.
Findings The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual's circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults' lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially.
Research limitations/implications The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives
Practical implications This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals.
Originality/value The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults' health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are "visible" in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.
Purpose Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.
Design/methodology/approach Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews' observations and recommendations. The main themes were identified.
Findings The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are "visible" in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.
Research limitations/implications Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.
Practical implications This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.
Social implications The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.
Originality/value The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.
Abstract: As a whole there was remarkably little controversy in England over the Care Act 2014, once debates over funding caps had been kicked into the long grass. After all, who could oppose the idea of better information, clearer entitlements, and more support for carers? Among the non-contentious areas were specific proposals for Serious Case Reviews (SCRs) to become Safeguarding Adults Reviews (SARs). In light of the many concerns in children's services about the dominance of SCRs in policy and practice debates this lack of interest and discussion may seem surprising. In this paper we explore why such reviews concerning adults are largely seen as non-contentious and frame our analysis around four different 'prompts'; those from Parliament, from earlier SCRs, from practice analysis and from practice development. We draw on our own wider research programme on Adult SCRs and subsequently SARs. This programme of research has explored different facets of the review process and undertaken different thematic analyses by location or user group.
• Summary: The article reports findings from an audit of Serious Case Reviews into the death or harm of a vulnerable adult in England. Serious Case Reviews may be undertaken by local authorities in partnership with other agencies. There is little government guidance and practice appears variable. • Findings: Interviews were undertaken in 2007 with persons who had been appointed to Chair Serious Case Reviews and with those who commissioned such Reviews or managed the process. The findings confirm the aspiration of such Reviews to be opportunities for learning from mistakes, if any, and to thereby offer greater safeguards for vulnerable adults. In practice however, the conduct of such Reviews may be difficult if there is a lack of cooperation, a lack of resources and if there is little opportunity to share findings and recommendations outside the locality. • Application: This study supports the sharing of Serious Case Reviews to encourage learning from mistakes and missed opportunities to safeguard vulnerable adults. It also found agreement among those with experience in such Reviews that greater guidance on conduct and collaboration would be welcome.
Summary This paper reports on a systematic thematic synthesis of literature focusing on encouraging and discouraging factors for social workers to train and practise as Approved Mental Health Professionals in England. These professionals have legal authority to authorise the detention for assessment/treatment of people with a 'mental disorder' under the Mental Health Act 1983 and other statutory responsibilities. The review included 23 papers, which reported on 14 research studies and is presented using the job demands and resources model. Findings The review identified a lack of quantitative studies and specific gaps in evidence about social workers' motivations or reasons why they do not want to become Approved Mental Health Professionals. It identified job resources and demands relating to the intrinsic nature of Approved Mental Health Professional work and extrinsic factors such as fit with social work values and the shortage of inpatient beds. Some job resources and demands overlapped and interacted. Applications The review suggests that a national survey of Approved Mental Health Professionals might be timely, to examine the relative importance of the job resources and demands; to assess their impact on levels of stress and burnout and on Approved Mental Health Professionals' motivations to continue or cease working in the role. The findings of the review support the need for increasing the number of inpatient mental health beds and community resources and establishing requirements for the availability of doctors (who may make the medical recommendation to detain) and local agreements about the role of the police and ambulance services in Mental Health Act assessments.
In: Stevens , M , Manthorpe , J , Martineau , S & Norrie , C 2020 , ' Practice perspectives and theoretical debates about social workers' legal powers to protect adults ' , Journal of Social Work , vol. 20 , no. 1 , pp. 3-22 . https://doi.org/10.1177/1468017318794275
Summary : This paper explores arguments for and against increasing social workers' legal powers in adult protection (safeguarding) in England, where there is no direct power of entry. It draws on a research study conducted in 2016–17 involving an international literature review, interviews with social workers (n = 22), managers (n = 15), older and disabled people (n = 6) and carers (n = 5) and a survey of adult safeguarding managers (n = 27). The paper contextualises findings by exploring concepts of vulnerability and autonomy. Findings : Most participants were in favour of increased powers for social workers undertaking safeguarding enquiries. A power of entry was seen to strengthen the legal basis of safeguarding and provide legitimacy for social workers to act. However, many participants expressed reservations, arguing that cases could generally be resolved with good social work, there would be a risk of negative impact on adults at risk and their families, the power of entry conflicted with social work practice and values and it could negatively affect social work relationships. Such arguments indicate a nuanced view of autonomy and vulnerability, which allow for doubt about the autonomy of people with capacity in certain circumstances. Applications : The paper suggests the need for investment in the processes of implementation of risk management if increased legal powers are introduced. There could be a value in encouraging social workers to make explicit their assumptions about the definitions of vulnerability and its impact on autonomy and to explore the subjective experience of vulnerability in their judgements about intervening in these kinds of situations.
Summary This paper explores arguments for and against increasing social workers' legal powers in adult protection (safeguarding) in England, where there is no direct power of entry. It draws on a research study conducted in 2016–17 involving an international literature review, interviews with social workers (n = 22), managers (n = 15), older and disabled people (n = 6) and carers (n = 5) and a survey of adult safeguarding managers (n = 27). The paper contextualises findings by exploring concepts of vulnerability and autonomy. Findings Most participants were in favour of increased powers for social workers undertaking safeguarding enquiries. A power of entry was seen to strengthen the legal basis of safeguarding and provide legitimacy for social workers to act. However, many participants expressed reservations, arguing that cases could generally be resolved with good social work, there would be a risk of negative impact on adults at risk and their families, the power of entry conflicted with social work practice and values and it could negatively affect social work relationships. Such arguments indicate a nuanced view of autonomy and vulnerability, which allow for doubt about the autonomy of people with capacity in certain circumstances. Applications The paper suggests the need for investment in the processes of implementation of risk management if increased legal powers are introduced. There could be a value in encouraging social workers to make explicit their assumptions about the definitions of vulnerability and its impact on autonomy and to explore the subjective experience of vulnerability in their judgements about intervening in these kinds of situations.
Purpose Being able to speak in private to an adult about whom there is a safeguarding concern is central to English local authorities' duty under the Care Act 2014 to make enquiries in such cases. While there has been an on-going debate about whether social workers or others should have new powers to effect these enquiries, it has been unclear how common obstructive behaviour by third parties is and how often this causes serious problems or is unresolved. The purpose of this paper is to address this knowledge gap.
Design/methodology/approach A survey of local authority adult safeguarding managers was conducted in 2016 and interviews were undertaken with managers and social workers in three local authorities. Data were analysed descriptively.
Findings Estimates of numbers and frequency of cases of obstruction varied widely. Most survey respondents and interview participants described situations where there had been some problems in accessing an adult at risk. Those that were serious and long-standing problems of access were few in number, but were time consuming and often distressing for the professionals involved.
Research limitations/implications Further survey research on the prevalence of obstructive behaviour of third parties may not command greater response rates unless there is a specific policy proposal or a case that has "hit the headlines". Other forms of data collection and reporting may be worth considering. Interview data likewise potentially suffer from problems of recall and definition.
Practical implications At times professionals will hear of, or encounter, difficulties in accessing an adult at risk about whom there is concern. Support from supervisors and managers is needed by practitioners as such cases can be distressing. Localities may wish to collect and reflect upon such cases so that there is learning from practice about possible resolution and outcomes.
Social implications There is no evidence of large numbers of cases where access is denied or very difficult. Those cases where there are problems are memorable to practitioners. Small numbers of cases, however, do not necessarily mean that the problem of gaining access is insignificant.
Originality/value This study addressed a question which is topical in England and provides evidence about the frequency of the problem of gaining access to adults at risk. There has been no comparable study in England.
