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A policy of surveillance which interferes with the fundamental right to a private life requires credible justification and a supportive evidence base. The authority for such interference should be clearly detailed in law, overseen by a transparent process and not left to the vagaries of administrative discretion. If a state surveils those it governs and claims the interference to be in the public interest, then the evidence base on which that claim stands and the operative conception of public interest should be subject to critical examination. Unfortunately, there is an inconsistency in the regulatory burden associated with access to confidential patient information for non-health-related surveillance purposes and access for health-related surveillance or research purposes. This inconsistency represents a systemic weakness to inform or challenge an evidence-based policy of non-health-related surveillance. This inconsistency is unjustified and undermines the qualities recognised to be necessary to maintain a trustworthy confidential public health service. Taking the withdrawn Memorandum of Understanding (MoU) between NHS Digital and the Home Office as a worked example, this chapter demonstrates how the capacity of the law to constrain the arbitrary or unwarranted exercise of power through judicial review is not sufficient to level the playing field. The authors recommend ‘levelling up’ in procedural oversight, and adopting independent mechanisms equivalent to those adopted for establishing the operative conceptions of public interest in the context of health research to non-health-related surveillance purposes.

The purpose of this paper is to report on findings from an evaluative research study which looked at a timed intervention model of practice comprising of up to 24 weeks of intensive meetings with adult service users set up by one local authority in England, to prevent and delay the need for care and support. A particular focus of this paper is on adults who hoard.

The study employed a mixed-methods design, consisting of interviews with service users (n=13), social workers (n=3), social work managers (n=2) and stakeholders from external services and agencies (n=6). It included a costing analysis of staff time and an analysis of goals of service users and “satisfaction with life” self-report questionnaires (n=20), completed at pre- and post-intervention stages.

There was evidence that social workers used strengths, relationship-based and outcome-based focused approaches in their work. The techniques used by social workers to engage, achieve change and assess effectiveness with service users varied. These techniques included the use of photographs to enable the service user to map and assess their own progress over time, encouraging hoarders to declutter and reclaim their living space. The service users valued the time the social workers spent with them and the way that they were treated with sensitivity and respect.

The study focused on one local authority in England; there was no comparison group. This, and the small sample size, means that statistical generalisations cannot be made and only limited conclusions can be drawn from the quantitative data.

The paper provides insights into the work undertaken by social workers with adults who hoard. It contributes to the body of knowledge on effective social work interventions with adults who hoard.

The purpose of this paper is to explore the impact of the Health and Social Care Act, 2012 on London’s rough sleepers as seen from the perspective of one former homeless service user (currently working as a support worker in a day centre providing outreach and “drop in” facilities for people who are street homeless and other vulnerable adults including female sex workers). The discussion centres on some of the unintended impacts of changes to healthcare commissioning; the new arrangements for patient, public representation; and the enhanced role of local councils.

This paper is grounded in front line practitioner reflection/opinion and draws on practical experience and observation at Spires, as well as research and government papers published by other service providers. The aspirations of the Health and Social Care Act, 2012 are set out before its practical application are examined from the rough sleeper’s dimension.

Putting clinicians and GPs centre stage in the commissioning and purchasing of healthcare may have some benefits for individual patient choice, but it can also dilute patient public involvement in health and social care with negative effects for vulnerable and excluded groups, including rough sleepers. The terms of reference ascribed to Local Healthwatch Organisations, the official representatives of the people, are narrower than previously and limit their ability to influence official policy. The Act centralises control whilst devolving operational responsibility, especially for public health provision on which rough sleepers often rely. It is suggested that local voluntary organisations and specialist “inclusion” health groups are increasingly being expected to take over responsibility for delivering health and social care and that mainstream collaboration is much reduced rather than enhanced by this fragmentation.

This review is based on the opinion of an “expert by experience” which may not be representative.

This is one of few papers which present a front line service user/practitioner perspective on the impact of clinical commissioning on services for marginalised groups.

At the heart of health and social care services is the pursuit of safety and dignity. Legislation and organizational policies are the main way in which statutory and independent organizations’ are tasked with enabling adults with mental health services along the road to recovery. Safety is an intrinsic motivator and basic need.

There is increased political recognition that social policy including the Mental Health Act 2007, which is a cornerstone, is in need of reform. A Conservative Manifesto pledge to reform mental health legislation is based upon the need to mitigate discrimination.

The chapter will explore the interrelationship between “poor outcomes” within the black community and safety; consider the opportunities to move from organizational complacency as a result of new policy and legal frameworks; and promote the view that developing a new discourse around safety is an integral part of improving outcomes for service users, particularly those who are poorly served currently.

A literature review plus reference to case studies will form the basis of the chapter ent and modern racism?

The purpose of this paper is to consider the importance of professional curiosity and partnership work in safeguarding adults from serious harm, abuse and neglect.

The paper draws on a range of materials including: review of published materials in relation to professional curiosity, reports from adult serious case reviews (SCRs) and safeguarding adult reviews (SARs); relevant materials drawn from the SAR Library, thematic reviews of SARs and Google searches; observations from practice and experience. It also refers to the relevant academic literature.

Lessons from SCRs and SARs show that a lack of professional curiosity and poor coordination of support can lead to poor assessments and intervention measures that can fail to support those at risk of harm and abuse. There are a number of barriers to professionals practicing with curiosity. Working in partnership enhances the likelihood that professional curiosity will flourish.

There are clear implications for improving practice by increasing professional curiosity amongst professionals. The authors argue that there is a scope to improve professional curiosity by utilising and developing existing partnerships, and ultimately to help reduce the number of deaths and incidents of serious harm.

The paper considers the importance of employing professional curiosity and partnership work in safeguarding adults’ practice, so enabling practitioners to better safeguard adults at risk of abuse and neglect.

The purpose of this paper is to set out the similarities and differences between the legal frameworks for safeguarding children and adults. It presents the case for developing a Transitional Safeguarding approach to create an integrated paradigm for safeguarding young people that better meets their developmental needs and better reflects the nature of harms young people face.

This paper draws on the key principles of the Children Act 1989 and the Care Act 2014 and discusses their similarities and differences. It then introduces two approaches to safeguarding: Making Safeguarding Personal (MSP); and transitional safeguarding; that can inform safeguarding work with young people. Other legal frameworks that influence safeguarding practices, such as the Mental Capacity Act 2005 and the Human Rights Act 1998, are also discussed.

Safeguarding practice still operates within a child/adult binary; neither safeguarding system adequately meets the needs of young people. Transitional Safeguarding advocates an approach to working with young people that is relational, developmental and contextual. MSP focuses on the wishes of the person at risk from abuse or neglect and their desired outcomes. This is also central to a Transitional Safeguarding approach, which is participative, evidence informed and promotes equalities, diversity and inclusion.

Building a case for developing MSP for young people means that local partnerships could create the type of service that best meets local needs, whilst ensuring their services are participative and responsive to the specific safeguarding needs of individual young people.

This paper promotes applying the principles of MSP to safeguarding practice with young people. It argues that the differences between the children and adult legislative frameworks are not so great that they would inhibit this approach to safeguarding young people.

Much has been made of economizing. Yet, social scientists have paid little attention to the moment of economic failure, the moments that precede it, and the calculative infrastructures and related processes through which both failing and failure are made operable. This chapter examines the shift from the economizing of the market economy, which took place across much of the nineteenth century, to the economizing and marketizing of the social sphere, which is still ongoing. The authors consider a specific case of the economizing of failure, namely the repeated attempts over more than a decade to create a failure regime for National Health Service (NHS) hospitals. These attempts commenced with the Health and Social Care Act 2003, which drew explicitly on the Insolvency Act 1986. This promised a “failure regime” for NHS Foundation Trusts modeled on the corporate sector. Shortly after the financial crash, and in the middle of one of the biggest scandals to face NHS hospitals, these proposals were abandoned in favor of a regime based initially on the notion of “de-authorization.” The notion of de-authorization was then itself abandoned, in favor of the notion of “unsustainable provider,” most recently also called the Trust Special Administrators regime. The authors suggest that these repeated attempts to devise a failure regime for NHS hospitals have lessons that go beyond the domain of health care, and that they highlight important issues concerning the role that “exit” models and associated calculative infrastructures may play in the economizing and regulating of public services and the social sphere more broadly.

The aim of this chapter is to explore changes since the COVID-19 pandemic in welfare policies and services for people with learning disabilities and autism in England, focusing mainly on educational and health and social care sectors.

A review of official policy documents published on GOV.UK from January 2020 to May 2021 has been conducted using keywords on the topic in question, and semi-structured interviews took place in 2022 with four key informants/stakeholders working in health and social care or education sectors of people with learning disability or autism in England.

The main findings indicate a need to shift practices online due to the pandemic, for both education and health and social-care practice. It is also clear that reforms and adjustments were implemented in guidance, policies and frameworks for the support of persons with learning disabilities and autism. It has been increasingly difficult for people with disabilities to access healthcare services and medication during the pandemic, and this has had an impact on their overall health and wellbeing too. Experts suggested that smoother changes and more support are required, in terms of provision of services, research, access to healthcare, educational services, mental health, employment, as well as more public funding on such services for people with learning disabilities and autism.

The main lessons learned were focusing on the use of online resources, digitalisation of services and access to them, but also difficulty of the system to adapt fast to major changes required in order to support people with disabilities.

Opinion is divided on whether a new power of entry should be introduced for social workers in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk in England who have decision-making capacity. The purpose of this paper is to investigate the prevalence and circumstances of situations where access to an adult at risk is denied or difficult and what helps those in practice. The study consists of a literature review, a survey of adult safeguarding managers and interviews with social care staff in three case studies of local authorities. As part of the contextual literature review, during 2014 the authors located parliamentary debates on the subject and this paper reports on their analysis.

Following approaches were used in historical research, documentary analysis was carried out on transcripts of parliamentary debates available online from Hansard, supplemented by other materials that were referenced in speeches and set in the theoretical context of the representations of social problems.

The authors describe the content of debates on the risks and benefits of a new right to access for social workers and the role of parliamentary champions who determinedly pursued this policy, putting forward three unsuccessful amendments in efforts to insert such a new power into the Care Act 2014.

There are limits to a focus on parliamentary reports and the limits of Hansard reporting are small but need to be acknowledged. However, adult safeguarding research has surprisingly not undertaken substantial analyses of political rhetoric despite the public theatre of the debate and the importance of legislative initiatives and monitoring.

This paper adds to the history of adult safeguarding in England. It also offers insight into politicians’ views on what is known/unknown about the prevalence and circumstances of the problems with gaining access to adults with capacity where there are safeguarding concerns and politicians’ views on the merits or hazards of a power of access.

The inclusion of modern slavery in the Care Act 2014 as a form of abuse means that the subject of modern slavery is now included in the remit of adult safeguarding in England. The purpose of this paper is to discuss the background to the Modern Slavery Act 2015 and its provisions.

A policy analysis was undertaken in 2016 drawing on research and commentary related to the interface between modern slavery and adult safeguarding.

There is little material as yet focussing on adult safeguarding and modern slavery but the inclusion of modern slavery in this area of practice and organisations will require practitioner responses, organisational collaboration and revisions of data collection and analysis. Newspaper accounts of criminal charges under the Modern Slavery Act 2015 may be important first evidence of the interface potentially between modern slavery and adults at risk of abuse and neglect that are the focus of adult safeguarding concern.

Information about modern slavery may provide relevant background and contextual detail for adult safeguarding communities, furnishing links and resources for this new area of their work.

This paper is likely to be of interest to policymakers, researchers and practitioners in examining their new duties under the Care Act 2014 and the Modern Slavery Act 2015, and to wider public and private bodies considering their responsibilities in responses to modern slavery more broadly.