Safeguarding Diogenes

James Fuller is a Peer Researcher, Expert by Experience and a Support Worker at a Day Centre for people who are homeless in London. (1,200 words)

Brighton and Hove Safeguarding Adults Board recently published the key messages arising from a review. A Safeguarding Adults Review is held when an adult in the local authority areas dies as a result of abuse or neglect. In this case, the adult was sleeping rough and had been identified as ‘difficult to engage’. Chris Scanlon and John Adlam have written extensively about Diogenes, homelessness and what to do about people whose refusal to be included remains a problem for themselves and society as a whole. This review brought into sharp focus some of these same issues. Namely how can we safeguard Diogenes? According to the essayist Plutarch, the philosopher Diogenes the Cynic (412-323BC) lived in a barrel in Corinth and spent his time pouring vitriol on his fellow beings, who he roundly despised. One day, Alexander the Great invited Diogenes to a gathering, but the drum-dweller declined. Instead of having Diogenes executed, the usual outcome for disrespecting world conquerors, Alexander went down to see him.  Having greeted Diogenes, Alexander asked him if he wanted anything. Diogenes replied: “Yes, stand a little out of my sunshine” (Plutarch, Alexander, 14 Cf.).

If, as a civilised society, we have a moral duty towards all mankind without fear or favour, how far does that burden extend in face of such dogged resistance? Or, is our proper duty to respect another person’s right to live as they wish, even to the point of killing themselves, slowly perhaps through substance abuse and/or self-neglect, or by a single act of suicide? If this is their choice, is it not also their responsibility, or should we, by default, not only take on the emotional burden, but also contribute to their demise by funding such a lifestyle, either as individuals, or through state subsidy?

The purpose of safeguarding is to ensure that multi-agency professionals working with at risk adults do so in a coherent and coordinated manner, acting under a set of issue-specific policies and procedures, in order to achieve optimal outcomes. Although there is much rhetoric about the importance of working together holistically, this review brings into sharp focus how challenging this can be. To use the analogy of ten pin bowling, the bowling ball shown below is segmented by the issues and vulnerabilities presented by the person who was subject of this review…


*Serious Paranoid Personality Disorder

…and here are the lanes down which they are known to have travelled:

Drop-page-002The arrows are significant because they highlight that this is a one-way system and like the ball, the subject must be returned or find their way back to the start in order to re-enter the same lane, or be directed down another one. As a front-line practitioner and someone with lived experience of this game, what is of concern is how to provide a coherent safeguarding response across these parallel lines. There are plenty of multi-agency policies and procedures, committees, case conferences and working parties who meet and discuss, but extending these conversations into consistent, combined activity, particularly when human as well as financial resources are scarce, can be exceptionally difficult.

In the case outlined in the review, there was some coordination between services while the person resided in one county, but none of the accumulated narrative, or care plan was conveyed to their opposite numbers who attempted to engage with the person when they abruptly moved to an adjacent district. There appears to be no suitable network between local authorities through which file data could be passed, or national data-base from which the information might have been extracted – not even the Vulnerable Adult At Risk alert that had been raised in the first location. In any event, without a formal lead agency, who was to have taken on the search?

It is tempting to retort that the service user should have made known their circumstances and were it not for the mental health and learning difficulties, this might be a reasonable hypothesis. Even so, relying on self-reporting, as we must in many cases, often leaves services woefully ill-informed, or deliberately misled.  Nonetheless, we are dealing with adults and in an environment replete with data protection, privacy and human rights legislation designed to uphold an individual’s civil liberties.  There are lines we cannot cross, even when to do so would patently be in a person’s best interests.  Instead, we must rely on our experience, ‘professional curiosity’ and emotional intelligence to build trust and encourage disclosure. This can take time and requires a degree of tolerance and continuity, which, as argued here, are in short supply in the current climate of austerity. Your blogger feels no shame in noting that in this particular review, staff from the charitable sector were singled out for their ‘person centred’ and ‘more flexible’ approach.

Despite the challenges inherent in the system, it is also the case that achieving meaningful engagement when mental health or psychoses are present is difficult, not least because by the time people are sleeping rough, they are often ‘self-medicating’, rarely taking their prescribed drugs and living in fear of being ‘sectioned’.  In the case under review, it was acknowledged that this ‘was a difficult and potentially dangerous tenant to accommodate’. Specialist supported housing providers strive for maximum inclusion, but even they must routinely screen out applicants with a history of arson, or who are likely to be violent towards other residents or staff.

Tragically, this person deteriorated rapidly and exhibited such chronic self-neglect that local residents near the caravan where she was living sought to have her removed.  The mental health team were alerted to her worsening condition, but following a rapid assessment concluded (once again) that she had capacity. This decision did not reduce the serious concerns that surrounded them, but soon afterwards she was found dead.  A tube had been connected to a gas canister outside the caravan and run into her sleeping bag.

The coroner’s verdict was ‘misadventure to which self-neglect contributed’. No blame was laid at any agency’s door. That is surely right. Even so, the Safeguarding Adult Review that followed concluded that a failure to invoke prescribed safeguarding procedures robustly meant that ‘an integrated and coordinated multi-agency partnership led approach was not achieved’. There is a line tucked away in the review’s concluding remarks which struck a cord. We may not be able to solve Diogenes problems through our concerted offer of help and support, but respecting and listening to them is key:

“The determined focus on reconnecting [the person] with [their] local area, whilst understandable as it offered [them] the best chance of being housed, was done in such a way that risked [them] feeling unheard”.

James Fuller is a Peer Researcher, Expert by Experience and a Support Worker at a Day Centre for people who are homeless in London.


Brighton and Hove Safeguarding Adults Board: Safeguarding Adults Review Professionals Briefing (March 2017).

Scanlon, C and Adlam, J. (2008) Refusal, social exclusion and the cycle of rejection: A cynical analysis? Critical Social Policy 28(4) 529-449.

What can the city banks learn from social care?

The Registered Managers’ Programme from The National Skills Academy for Social Care aims to better equip Registered Social Care Managers to meet the challenges they face, to reduce their isolation by networking them at local and national level, and to enable them to recognise their leadership role. As part of the Programme, they are funding Local Networks to support Registered Managers on the ground, either where demand has been identified but no Network exists, or to strengthen and expand existing ones.

One such network has recently been established in Cumbria with support from the Social Care Workforce Research Unit at King’s College London, and it builds on earlier work around communities of practice. For more information contact

This post was written by the members of the Cumbria Registered Social Care Managers’ Network following their meeting last month.

The focus of this meeting (4 June 2014) was celebrating the work of the huge number of social care workers who do a great job every day and make a really positive difference to the lives of people who need care and support. Inevitably though, the conversation moved to discussing the recent Panorama programme (Behind Closed Doors, 30 April 2014) on abusive care, and the impact programmes like this have on staff in the sector. That led to us thinking about what registered social care managers can do to raise the profile of care that is caring and compassionate?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

For the front-line care workers in attendance at this meeting, programmes like Behind Closed Doors are far removed from their day-to-day experiences of delivering care. A good day for some starts with crumpets, toast and jam and a chance to catch up with each other (called a ‘hand over’ in the jargon). There are enormous challenges in delivering good quality carefor example how to be personalised, compassionate and ‘quick’ (in your 15 minute time slot with each resident). Work is often stressful, physically demanding (12 hour shifts) and emotionally draining. Needless to say, the situation is not helped by the current climate of austerity and chronic underfunding. However, the job brings with it enormous rewards and a great sense of personal satisfaction. At the heart of the work is your team, like a family almost, and all the emotional benefits which flow from being collegiate.

Added to this, is the sense that you are making a very real and positive difference to people’s lives. In this business it is the ‘smiles and the thank yous’  that count for most… The six figure bonuses, pay rises, company cars and expenses said to be absolutely essential to recruit and retain the ‘best’ staff in the more compassionate(less) industries are seemingly not so important in social care. Maybe the city banks have something to learn from social care managers in this respect?

Cumbria Registered Social Care Managers’ Network

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

Where programmes like Panorama can have a particularly detrimental impact is that they can work to undermine the confidence and integrity of some social care managers. The desire to ‘protect’ the public from abusive care often sees the inspectorates and commissioners of services imposing further layers of monitoring and regulation. However, unless carefully implemented as part of a wider culture of learning and improvement, this can quickly lead to a ‘them’ and ‘us’ scenario in which there is a lack of trust and authentic partnership working. While the ‘best managers’ will follow the rules and regulations, reporting ‘poor practices’ or any ‘safeguarding’ incidents as they are required to do, they can be left feeling demoralised and ‘brow beaten’ by the response. ‘Poor managers’ meanwhile will keep their heads down; they will not engage externally and will remain largely hidden from view, that is, until the television cameras go in.

How to engender trust and authentic relationships (the ‘smiles and the thank yous’) between commissioners and providers of social care services is a question we shall return to in future meetings. Celebrating the role of the social care worker and raising the profile of ‘good care’ has just been a first step.

For more information about this post please contact Michelle Cornes, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. The Unit is part of The Policy Institute @ King’s.