Hello there,
Welcome to another edition of Practice Reflections, the free newsletter dedicated to sharing research, reviews and reflections related to safeguarding. If you are new to the newsletter, thank you. I write this newsletter from my own professional perspective and I hope that I can inspire your own reflections to aid your professional growth.
I want to demystify CPD for safeguarding practitioners. I want to show that it is possible to take an active interest in research and reflect on learning to explore how it might impact my practice. That is why I am developing the Safeguarding CPD Community.
This week, I have spent time considering how CPD is essential for the growth of my own professional identity, but also for me to consider how my practice can change over time in response to my professional reflections. There are many different reports published that include practice recommendations. Indeed, I sit on such panels and make recommendations for my own local area. This led me to think that perhaps, within this newsletter, I should reflect on such reports.
My focus this week, therefore, turns to learning from a Safeguarding Adult Review (SAR). The National Network of Safeguarding Adult Boards is an excellent resource for anyone interested in the work of Safeguarding Adult Boards, and they have a very comprehensive database of published SARs that goes back to 2015.
This is an important point to note, and I believe this requires particular attention, but while I will identify the Local Authority area which published the SAR, I am in no way going to make observations or reflect on the quality of care or interventions within that area. I do not, and will never, point fingers of blame for any area. I write this newsletter as an individual professional and offer my reflections on how my own practice as a result of the reports I read. While each SAR will identify specific lessons for practitioners within the area from where it was commissioned, we know that the Health and Social Care sector needs to reflect on lessons learnt and that these lessons are often transient across organisational boundaries.
SAR Spotlight - Victoria, 2024, Harringey
Victoria died in June 2022 and was under the care of various services within the London area. It is reported that she died as a result of sepsis with various other health complications. Victoria was described as having a mild learning disability. It is recorded that she experienced several traumas during her life, including sexual abuse from her father when she was a child. While the SAR identified that Victoria had a turbulent relationship with her mother, she was ultimately dependent on her mother to meet her needs as an adult until her mother died.
At this point, the Local Authority put a package of care in place to enable Victoria’s physical health needs to be met and to access the community. It is recorded that Victoria had a number of health complications, including being clinically obese and having Type 2 Diabetes. From a mental health perspective, Victoria was diagnosed with Emotionally Unstable Personality Disorder.
Throughout Victoria’s adulthood, professionals raised concerns that Victoria was neglecting herself with references to her inability to manage her diabetes and poor attendance at various appointments. Concerns were also raised about the care team supporting Victoria with references to a lack of training and inability to meet Victoria’s needs.
As a consequence of Victoria’s poor diabetes management, she was required to have a below-knee amputation on one of her legs. Consequently, Victoria’s mobility was poor, and due to her significant weight, it was impossible for her to leave her home as the size of her wheelchair was bigger than the door.
There are several references within the SAR to Victoria having the capacity to make unwise decisions, including decisions to return back to her home following hospital admissions. There were 5 Safeguarding concerns raised with the Local Authority, but it wasn’t clear what safety plans were in place to protect Victoria from the risks identified.
Victoria was under the care of the following services:
Adult Social Care
Local Learning Disability Partnership
Integrated Care Board
Acute Hospital Trust
Social Housing
You can read the full report here
Lessons for Practice
There are 10 different recommendations that the Independent Reviewer has identified and agreed with by the local Safeguarding Adult Board. The wording of these recommendations is localised to the Safeguarding Adult Board. However, there are transferable lessons for practice for any practitioner across the UK and the rest of the world.
I believe the relevant lessons are:
Practitioners understand the policy and relevant protocols for Self-Neglect in the area they are working.
Practitioners need to have a good understanding of practice related to Mental Capacity. In particular, how to consider executive functioning as part of Mental Capacity Assessments.
Not receiving feedback from Safeguarding Referrals made is not a reason to no longer raise such concerns with the Local Authority.
Housing officers play a critical in Safeguarding and developing positive working relationships that could improve the lived experience of vulnerable people.
Organisational boundaries and threshold criteria can impede effective information sharing and joint responses to concerns.
Reflections
When reading about Victoria, I was able to see parallels with challenges I come across and hear about from colleagues across the system where I work. The lessons identified are not unique to this particular geographical area. Issues around professional confidence with completing Mental Capacity Assessments and considering executive function are common.
It is easy to sit and criticise clinicians in hindsight. However, I do believe that the issues around mental capacity can easily become theoretical. Many people come across as having a vastly greater level of understanding of mental capacity, which can make other people feel inferior (this might just be me). When talking about mental capacity assessments, we need to have in mind the realities of practice and not just view the situation from an academic perspective. That is not to suggest that we shouldn’t provide opportunities for feedback on such assessments, but to do so in a human way is often the key ingredient to creating a culture of learning and psychological safety.
Turning to the issue of Self-Neglect. There is hardly a week go past where I do not have a consultation or discussion with someone about a person who might be self-neglecting. Working with people who self-neglect takes time. It isn’t possible to turn up one day and just make changes. I believe that practitioners need time to understand and get to know the person. But it also takes skill to have conversations about the root cause of the self-neglect. I can understand that when someone is busy with high caseloads, the system puts pressure on practitioners to increase “throughput”, but people who have experienced trauma are complex and it takes time to build the trust to enable effective plans to be developed.
This is where I think the issue around capacity is a red herring. Yes, the principle of being able to make an unwise decision is fundamental to independence and autonomy, but I don’t think that just because someone has the capacity to make an unwise decision, the conversations should stop there. This has been an important reflection for me this week. As I go forward with my practice, I will hold discussions and conversations about taking time to get to know the reasons why someone is making the choices they are making, even if the person has the capacity to make the unwise decision (and unwise to who??).
This SAR report has also reminded me that it is really important to create plans which enable accountability. And that these plans should be shared plans with the person and all the agencies involved. For example, it is no good to write in the plan something that someone else is responsible for if that person is not aware of that specific action. But this adds time because it takes a little more time to check in with the relevant people to ensure that what is being written in the plan is achievable. It goes back to using Specific, Measurable, Achievable, Relevant and Time-based (SMART) actions.
Safeguarding CPD
I hope you have found value in this week’s post. I learn a lot with each post and believe that it is making me a better professional as I am dedicating time to sit and reflect on contemporary issues within the Safeguarding sector. I hope you feel the same after your own reflections.
I am in the process of developing an online community for practitioners within the Safeguarding world called the “Practice Reflections: Safeguarding CPD Community”. It will be a place where research (both open access and paid-for research), practice reviews, policy updates and knowledge briefings will be shared. I am planning a series of webinars which will be exclusive to the community. It will also become a place to network and collaborate with other professionals who share an interest in Safeguarding CPD.
If you would like to be the first to hear about the community when it opens, please click on the button below.
Finally
I have one final ask: can you please forward this post to three colleagues who you believe would find value in these posts? This newsletter will always be free and is designed to show that it is possible to develop a habit of reflection and professional growth as a busy practitioner by offering my own reflections. I want as many people as possible to know about this newsletter and you can play a part in how big this can grow.
Until next week,
Thank you for reading. And remember, you are amazing and do amazing things and the world is a better place because of you.
Take care.
p.s Do you want to provide feedback? You can do so by clicking here or click the button below to speak with me directly