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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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

By drawing on the historical research context, the paper contributes to our current understanding of the field of self-neglect.

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.

SARs were identified from a variety of sources and a thematic analysis was undertaken using data extraction tables.

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.

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.

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.

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 purpose of this paper is to explore debates about the powers social workers may need to undertake safeguarding enquiries where access to the adult is denied.

The paper takes as a starting point a scoping review of the literature undertaken as part of a study exploring social work responses to situations where they are prevented from speaking to an adult at risk by a third party.

A power of entry might be one solution to situations where social workers are prevented from accessing an adult at risk. The paper focuses on the Scottish approach to legal powers in adult safeguarding, established by the Adult Support and Protection Act (Scotland) 2007 and draws out messages for adult safeguarding in England and elsewhere. The literature review identified that debates over the Scottish approach are underpinned by differing conceptualisations of vulnerability, autonomy and privacy, and the paper relates these conceptualisations to different theoretical stances.

The paper concludes that the literature suggests that a more socially mediated rather than an essentialist understanding of the concepts of vulnerability, autonomy and privacy allows for more nuanced approaches to social work practice in respect of using powers of entry and intervention with adults at risk who have capacity to make decisions.

This paper provides a novel perspective on debates over how to overcome challenges to accessing adults at risk in adult safeguarding through an exploration of understandings of vulnerability, privacy and autonomy.

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).

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.

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.

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.

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.

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.

Whether social workers should have a power of entry in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk is a topical question in England. The purpose of this paper is to present the findings of a re-examination of relevant sections of the 2012 Government Safeguarding Power of Entry Consultation.

Re-analysis of responses to question three of the 2012 Government’s Safeguarding Power of Entry Consultation was undertaken in late 2015-early 2016. The consultation submissions were located and searched for information on views of the prevalence of the situations where access to an adult at risk (with decision-making capacity) is being hindered by a third party and the nature of examples where a new power of entry might be considered appropriate by consultation respondents.

The majority of respondents to the consultation generally reported that situations when a new power of entry would be required were not encountered regularly; however a minority of respondents stated these situations occurred more frequently. Examples of situations where third parties appeared to be hindering access were given across the different categories of adults at risk and types of abuse and current practices were described. Respondents observed that the risks of excessive or inappropriate use of any new powers needed to be considered carefully.

This re-analysis sheds light on the prevalence and circumstances of the problems encountered about access to adults at risk. The legal framework of adult safeguarding continues to be of interest to policy makers, researchers and practitioners.

This article describes research investigating the steps involved in recommending to the Secretary of State for Health whether a care worker should be included on the Protection of Vulnerable Adults (POVA) list, which records individuals barred from working and volunteering with vulnerable adults in England and Wales.The aims of the study were to investigate patterns of referrals to the list; factors associated with the collection of evidence to present to the Minister and to detail the operation of the list.The article focuses on the preliminary part of the research that covered discussion groups with purposive sample of older people, managers and staff during which a vignette approach was used to explore their perspectives.