Researching in care homes – what was learnt from a study of handovers?

Caroline NorrieCaroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London (330 words)

What can researchers of care services learn from our recent handover study?  We asked ourselves this question and discussed this at the annual conference of the British Society of Gerontology held in Swansea last week (pictured below is the new beach side campus) at the start of July. Our paper summarised the findings of our unique exploration into handovers in care homes and then we paused to ask what could be relevant to other researchers studying care home practice and systems. Continue reading

Gambling – a risky business?

Stephanie BramleyCaroline NorrieDr Stephanie Bramley (Research Associate, left) and Caroline Norrie (Research Fellow) of the Social Care Workforce Research Unit at King’s introduce their new study. (1335 words)

In May the Unit began working on a new project exploring gambling participation by adults at risk. Here we explain some of the background to this study and set out what we intend to focus on. We would be pleased to hear from people with an interest in this subject—either existing interest or new interest following this blog.

Gambling is a popular leisure activity in Britain. The Gambling Commission says that 45% of adults participated in gambling during the last 4 weeks. Playing the National Lottery is the most popular activity, followed by online gambling, scratchcards, other lotteries, horses, sports betting, online betting and private betting. Between October 2014 and September 2015 the British gambling industry generated a gross gambling yield of £12.6 billion (the amount retained by gambling operators after the payment of winnings, but before the deduction of the costs of the operation) (Gambling Commission, 2016) and in the 2015-16 tax year the tax revenue from betting and gaming reached £2.7 billion (HMRC, 2016). Continue reading

Common causes: the origins of the Child Poverty Action Group and its relations with social work

Caroline NorrieCaroline Norrie is Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (1,049 words)

The Child Poverty Action Group (CPAG) is 50 this year. As part of the celebrations, last month the Social Care Workforce Research Unit jointly hosted a seminar with the Social Work History Network to highlight the history of CPAG and its links with the social work profession.

CPAG is the leading national pressure group working to end poverty among children, young people and families. It campaigns to influence policy; produces information about access to benefits; and provides training for professionals across the UK about welfare rights (including tax credits, and universal credit). Continue reading

Let’s Talk – Piloting an educational drama in a care home

Caroline Norrie Dr Michelle CornesCaroline Norrie (left) and Michelle Cornes are, respectively, Research Fellow and Senior Research Fellow at the Social Care Workforce Research Unit. (666 words)

A Transformative Research Fund grant has been awarded to researchers from the Social Care Workforce Research Unit (SCWRU) at King’s College London to pilot an educational drama initiative in a care home in Cumbria. Care home staff, multi-agency colleagues (such as GPs and physiotherapists) and residents will hopefully volunteer to take part in a drama called Let’s Talk, which is designed to stimulate discussion about working relationships. As well as piloting the drama, three interprofessional, reflective ‘Community of Practice’ (CoP) meetings will be held which will act as a forum to discuss care home practices and ideas for change. Continue reading

Helping quality improvement in social care – listening to Registered Social Care Managers’ voices

Caroline Norrie Dr Michelle CornesCaroline Norrie (left) and Michelle Cornes are, respectively, Research Fellow and Senior Research Fellow at the Social Care Workforce Research Unit. (735 words)

Members of the Cumbria Registered Social Care Managers Network (CRSCMN) met recently to discuss what support is needed to help social care services make quality improvements in care homes and domiciliary care agencies.

Care home and home care managers were joined by a representative from Care Sector Alliance Cumbria who has responsibility for the recruitment and retention element of workforce development in this rural county. Michelle Cornes from the Social Care Workforce Research Unit (SCWRU) is Facilitator of the CRSCMN. SCWRU researcher Caroline Norrie, who has recently been working on two projects about adult safeguarding including whole-home investigations, also attended. Continue reading

Data and Debate – reflections on the SSRG Annual Workshop

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s, was at the Social Services Research Group Annual Workshop this week. (801 words)

This year’s Social Services Research Group (SSRG) Annual Workshop, held at the London School of Economics (LSE) on 15 April was a particularly thought-provoking event. Entitled ‘Evidencing Service Improvement for Vulnerable Children and Adults’, the workshop featured an expertly chosen group of speakers whose presentations stimulated animated discussion from the floor. With the Care Act coming on stream and the increased drive for integration, participants, who were predominantly social care managers with responsibilities for data and organisational performance, enjoyed a great opportunity to discuss service re-figuration and its measurement. Continue reading

Making Safeguarding Personal (MSP) – the way forward for adult social care

by Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at King’s College London. (952 words)

Professionals working in the adult social care field gathered at Friends House in Euston, London, on 30 June 2014 to share knowledge and experiences of Making Safeguarding Personal (MSP). MSP was initiated by the Association of Directors of Adult Social Services (ADASS) and the Local Government Association (LGA) as a sector-led response to concerns that adults at risk are not being involved in investigations and decisions when councils have concerns about abuse or neglect (adult safeguarding).

Supported by funding from Department of Health (DH) and the LGA, this improvement programme started in 2011/12 with the development of a toolkit. In 2012/13 five pilot councils signed up to the scheme and this year 53 councils participated. The programme has been given increased funding to continue next year across further English councils. Continue reading

Nearly there? The Care Bill and adult safeguarding

Caroline Norrie and Katie Graham provide an update on the progress of the Care Bill through Parliament with particular reference to its impact on adult safeguarding.

The Care Bill—described as “the biggest overhaul of social care rules for 65 years” (The Guardian, 9 October, 2013)—had its first reading in the House of Commons last week after completing its passage through the House of Lords. The scope of the Bill is extensive, attempting to amalgamate the dispersed and patchy adult social care legislation and including stipulations around social care assessment and funding changes. However, as researchers working on a project about adult safeguarding, we have been following the new adult safeguarding components of the Bill with much interest.

Katie attended the second reading of the Bill on 22 May. Lord Howe presented wellbeing as a central principle of the Bill whilst outlining plans for care funding arrangements (following, though not implementing, all Dilnot’s recommendations), a response to the Francis Report (not including the recommended regulation of social care and health care assistants), a strengthening of carers’ rights and a commitment to place adult safeguarding on a statutory footing.

The principles behind the Bill appeared to be welcomed by many of the speakers that day in the House, although with important caveats. Lord Howe alluded to one of the fundamental difficulties enacting the vision when saying “[a]s a nation we are living longer, which I am sure all noble Lords welcome. Managing the fiscal consequences of this will be a key challenge in the coming years”. Baroness Wheeler brought into stark reality the dire state of local authority funding, highlighting that councils “…by the end of this spending round, will have been stripped of £2.7 billion from their adult social care services, equivalent to 20% of their care budgets, as demand for services increases”.

More recently Caroline attended the House of Lords to listen to amendments tabled at the Bill’s 1st sitting of the report stage on 9 October. Discussions included an amendment which was successfully tabled by the Patron of Action on Adult Abuse, Baroness Greengross, to introduce a duty on councils to provide people with an independent advocate during assessment and support planning if they would otherwise have difficulty in understanding or communicating information, and have no one else to represent them.

Baroness Greengross also proposed amendments aimed at giving social workers powers to obtain court orders to gain access to enter private homes where they suspect a vulnerable adult is being abused but coerced into silence. These amendments were defeated with ministers arguing that existing legal powers were sufficient and social workers needed to improve their skills and knowledge in applying them to protect adults. (Power of entry is already available to social workers in Scotland.)  A survey of The College of Social Work members last year showed strong support for a qualified power of access by a social worker to interview a vulnerable adult where this was being blocked by a third party. Lobbying on this issue continues.

Other elements of the Bill with specific implications for safeguarding practice include:

Enquiries by Local Authorities

The Care Bill proposes a new legal duty for local authorities to make enquiries when they have a reasonable cause to suspect that an adult in their area has a need of care and support, is at risk of abuse and neglect and is unable to protect him or herself. The local authority must make whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in that adult’s case. The Care Bill also confirms, for the first time in law, that “abuse” includes financial abuse. That includes having money or property stolen; being defrauded; being put under pressure in relation to money or other property; and, having money or other property misused. Advocacy organisations including The College of Social Work have been active in lobbying to ensure that people with complex needs are assessed by ‘appropriately qualified staff’.

Safeguarding Adults Boards

Safeguarding Adults Boards are to become statutory and to be composed of multi-disciplinary members. Again, The College of Social Work, amongst others, has been vocal in lobbying to ensure that the local authority representative on safeguarding adult boards should be social work-qualified.

Safeguarding Adult Reviews

The Care Bill proposes local authority Safeguarding Adults Boards must carry out a formal case review if an adult at risk in their area dies in circumstances where abuse or neglect are known or suspected. It must also carry out a review if it suspects that an adult has experienced serious abuse or neglect. Any review must identify the lessons to be learnt from that adult’s case, and apply those lessons to future cases. The stated aim of a review will be to ensure that lessons are learned from such cases; not to allocate blame, but to improve future practice and partnership working, to minimise the possibility of it happening again. With regard to this issue, The College of Social Work has argued for Safeguarding Adult Review teams to “include a social worker with substantial experience of safeguarding work”. Our Unit continues its work on the current system of Serious Case Reviews for adults.

Last week saw the third reading of the Bill in the Lords; a time for tweaking with no major changes suggested. However, there was considerable discussion over an amendment that was tabled, but which after discussion was removed. This focused on safeguarding of vulnerable adults in ‘approved premises’. Lord Patel of Bradford argued that vulnerable people in probation services are not adequately catered for in the Bill and called for a review on “the discharge by probation trusts of their responsibilities for safeguarding adults residing in approved premises” a year after the enactment of the Bill. Lord Patel argued that planned privatisation of probation provision could make it difficult to ensure effective safeguarding provision for those people using probation services. This abandoned amendment raised once more the question of the clarity of roles and responsibilities of all agencies working with people who may be at risk of abuse.

When summing up her contribution to the second reading of the Bill Baroness Campbell said that much depends “on how local authorities choose to implement their responsibilities and powers under this legislation. There is a great danger that this Bill could be ignored as fine words but without teeth”. We await to see what changes, if any, will be made to the Care Bill as it now proceeds through the House of Commons.

Caroline Norrie and Dr Katie Graham are both researchers at the Social Care Workforce Research Unit, King’s College London. They are working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.

Abuse of vulnerable adults – referrals for investigation up 4% this year

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit, examines figures published by the Health and Social Care Information Centre on the abuse of vulnerable adults in England in the context of the Models of Safeguarding research project being undertaken at the Unit.

English councils referred 112,000 cases of alleged abuse against vulnerable adults for investigation in 2012-13, a 4 per cent rise (from 108,000 in 2011-12) for the 151 councils which submitted data in both years. This is according to figures just released from the Health and Social Care Information Centre (HSCIC). This provisional report – Abuse of Vulnerable Adults in England 2012-13: Experimental Statisticsfinds the rate of referrals per 100,000 population was highest in the West Midlands (320), North West (300) and London (295) regions in 2012-13.

Safeguarding alerts (which are the initial point at which concerns are raised) have also increased during 2012-13.  A total of 173,000 alerts were recorded by 140 (out of 152) councils. Considering the 117 councils who recorded alerts in both years (comparing 2012-13 provisional data and 2011-12 final data), this is a sharp increase of approximately 19 per cent (rising from 134,000 to 159,000). However figure readers need to take into consideration councils’ different methods of categorising and defining alerts.  In some councils, all concerns received are recorded as referrals and cannot be split up for reporting, making this data complex to interpret.

We don’t know whether this steep rise is due to increased reporting as a result of greater public awareness about adult safeguarding, an actual rise in abuse – or a combination of the two.  From the point of view of public services however, it means more work at a time when resources are being cut.

HSCIC chair Kingsley Manning said the report, ‘plays an important role in laying bare issues affecting some of the most vulnerable in society, the role of our local authorities and also that of the public in alerting councils to cases of alleged abuse.’

A very similar picture to last year is presented with regards to the characteristics of the people alleged to have suffered abuse, alleged perpetrators, locations and forms of abuse.  In 109,000 (of 112,000) cases referred for investigation in 2012-13, the following key information was known:

About the person alleged to have suffered abuse:

  • Just over three in five (61 per cent, or 67,000)1 were aged 65 or over.
  • Half (50 per cent, or 55,000) had a physical disability.
  • Just over three in five (61 per cent, or 66,000)1 were women.

Considering the case details of those 109,000 referrals (noting that an individual referral can contain more than one type, location or perpetrator of alleged abuse):

About the types of alleged abuse

  • Physical abuse was recorded in 39,000 allegations (28 per cent)
  • Neglect was recorded in 37,000 allegations (27 per cent)

About the alleged perpetrators:

  • Social care workers were recorded in 35,000 allegations (31 per cent)
  • A family member was recorded in 25,000 allegations (23 per cent)

About the Location of alleged abuse

  • The vulnerable adult’s own home was recorded in 43,000 allegations (39 per cent)
  • A care home was recorded in 40,000 allegations (36 per cent)

About the Case outcomes

Considering the 86,000 completed referrals where a case conclusion was recorded:

  • 37,000 were either partly or fully substantiated (43 per cent)
  • 26,000 were not substantiated (30 per cent)
  • 23,000 were inconclusive (27 per cent)

HSCIC chair Kingsley Manning noted, ‘This report in many ways makes for uncomfortable reading, not only that thousands of cases of potential abuse against vulnerable adults are being investigated each year, but more particularly that a substantial number are proven to be of substance’.

A final, more detailed AVA Report 2012-13 will be published in March 2014 when post-submission validation checks will have been carried out on the data submitted by councils.

I am currently part of a research team investigating the advantages and disadvantages of different models of adult safeguarding. Our study has been funded by the NIHR School for Social Care Research and continues our long tradition at King’s College London of research on this subject. A key part of our present study will be analysing and comparing the AVA data for six selected councils which use different approaches to organising their adult safeguarding services. As part of this study, we have recently interviewed 24 adult safeguarding managers about how they organise adult safeguarding in their areas.  Comments about the AVA returns made during these interviews include that the AVA returns are valuable in making comparisons between local authorities, but the information is viewed as provisional, given the complexity of data collection.

Some difficulties with the AVA collection are outlined in the HSCIC report. There may be a great deal of under-reporting as the data does not include cases where partner agencies dealing with an allegation do not share the information with the council. The collection only covers abuse perpetrated by others (it does not include self -harm or self-neglect)  – and these issues also need to be addressed when considering the most effective ways to support adults at risk who may decline help or care. Also, a single referral can relate to different types of alleged abuse, locations or perpetrators and may have more than one outcome for the alleged victim and/or alleged perpetrator. It is also important to remember that these figures do not represent the number of adults at risk who have been referred. They relate to individual referrals: the same person may have multiple referrals in a year.

Councils in England submitted data voluntarily to the national Abuse of Vulnerable Adults (AVA) collection in 2009. Since 2010-11, the Minister for Care and Support mandated submission of AVA collections to the HSCIC, and for the 2012-13 period, 151 out of 152 local authorities have complied. This is a major development and one which is enriching our knowledge and helps develop services.

2012-13 is the last year for collection of the AVA return.  Information about adult safeguarding activity will be then be collected through a new Safeguarding Adults Return (SAR). The SAR is one of the outcomes of a review of adult social care data collections.  Many of the same data will be collected, but it will be more focused on outcomes of safeguarding and alert data will no longer be collected.

We look forward to studying the 2013 AVA returns in greater detail – and to making comparisons with the SARs in the future. If you are interested in receiving information about our current study or having a copy of our bibliography covering our other research and publications on adult safeguarding please get in touch.

You can contact Caroline Norrie at King’s here: caroline.norrie@kcl.ac.uk

  1. Figures have been rounded to the nearest thousand.

Avoiding more Winterbourne Views: What can we learn from history?

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at King’s College London, reports from the annual conference of the Social History of Learning Disability (SHLD) research group, which is based at The Open University (OU). The conference was held at the Milton Keynes OU campus on 8 July 2013.

The conference, Avoiding More Winterbourne Views: What can we learn from history?, highlighted the life histories and experiences of people with learning disabilities – whether living in institutions or in the community. Margaret Flynn, author of the Serious Case Review into Winterbourne View was keynote speaker and opened the conference with a presentation about the history of Winterbourne View and lessons learned. Margaret drew attention to the need for commissioning organisations to improve their performance – making better choices of providers and carrying out closer monitoring of contracts. Margaret questioned, for example, why commissioners are involved in building new long stay institutions and paying to keep service users with learning disabilities in them. Margaret also commented on how the individuals managing the private equity firm which ran Winterbourne View (which they regarded as one of their most profitable homes) managed to escape both media investigation and criminal prosecution. Margaret called for the introduction of a new law to make corporate negligence a crime, which could be used to prosecute unscrupulous private care home owners. Margaret also underlined the continuing need for better and customised inspections.

“No going back:  forgotten voices from Prudhoe Hospital”

“No going back: forgotten voices from Prudhoe Hospital”

From Newcastle, Tim Keilty and Kellie Woodley of self advocacy organisation Skills for People, gave a presentation about the production of a book based on residents’ memories of living at Prudhoe Hospital. They discussed the history of the institution (built in 1913 and only closed in 2005) which by the 1960s, housed 1,400 residents. Despite the harsh regime, former resident Kellie Woodley described lighter moments and the satisfaction of resistance, for example lying in wait for a disliked member of staff to enter the room, knowing she had balanced a bucket of water above a door or placing a contraband needle on the chair of another staff member.

Oxfordshire Family Support Network, a small charity run by carers for carers described their Changing Scenes Project, which offers peer to peer support for older families. Nationally, 60% of adults with a learning disability live with family carers. And approximately one-third of adults living in the family home live with carers aged 70 or over (source: Mencap Housing Time Bomb Report, 2002). This presentation consisted of conversations with four older family carers who related their experiences of battling on alone in the past without help, abusive incidents, and in more recent times standing up for their rights to get the services they wanted. One mother celebrated personalisation as a huge breakthrough in providing appropriate care for her family member.

Keeping the discussion in the present day, service user, Angela Still, from Central England, People First, presented the difficulties of community living such as isolation and her experiences of financial abuse by a neighbour. She outlined how, with the help of People First, she had been assigned a case manager, had managed to have her abuser prosecuted, and moved to a new house where she was now happy, safe and secure.

Sue Dumbleton and Jan Walmsley from the OU discussed how another Winterbourne View could be avoided. Sue, drawing on her experiences of being the parent of a young adult who has a learning disability, reflected on ‘what works’ in supporting people with a learning disability to enjoy a safe and productive life of their choosing and the role of personalisation in this.

This conference also included international perspectives with presentations from Norway and Ireland. We learned about the development of services for people with learning disabilities in Norway through the life history of Ruth, who was kept in an institution for 20 years. When Ruth finally moved to living in the community, the same staff from the institution were employed as her carers and she still had to battle to be treated as an individual and not be degraded. It was only when Ruth was given the power to choose her home care provider that she was finally free to live as she wished – “I am no longer angry because now I can decide for myself.” This presentation was given by Bjørn-Eirik Johnsen, Leif Lysvik and Terje Thomsen from Harstad University College.

Rob Hopkins and Joe McGrath

Rob Hopkins and Joe McGrath

From Ireland, Kelly Johnson, Rob Hopkins and Joe McGrath (Clare Inclusive Research Group) gave a talk about the difference between ‘belonging’ and ‘inclusion’ in a small village in County Clare with reference to the life history experiences of Joe McGrath.

Rachel Fyson from the University of Nottingham took the long view and highlighted how abuse is a constant and does not just happen in hospitals and large institutions. She argued more needs to be done to understand and prevent abuse wherever it takes place.

Mabel Cooper (1944-2013)

Mabel Cooper (1944-2013)

This annual conference was dedicated to Mabel Cooper, MA (1944-2013), a long standing member of the SHLD group, who passed away this year. The audience watched a video, shown on BBC2 in 1999, in which Mabel described her life in an institution – and the lasting impact this had on her. Mable left the institution in 1977 and during the 1980s, was Chairperson of Croydon and then London People First and worked with people with learning disabilities supporting others to speak up for themselves. Mabel’s gift for storytelling and her reflective ability meant her life story became famous around the world after it appeared, to great acclaim, in SHLD’s book Forgotten Lives (1997). Mabel’s personal testimony was also put to practical use in her work in schools. Drawing on personal experience, she was able to educate children about the lives of people with learning disabilities. Mabel’s friends Gloria Ferris, Jane Abraham and Dorothy Atkinson spoke movingly, remembering their friendship, including how they first met. “In making sure her story was told, and recorded, Mabel has left an enduring legacy”.

From my own personal viewpoint, working at SCWRU on a project about adult safeguarding, I found this conference particularly useful as it contextualised the history of care for people with learning disabilities, while at the same time raising current issues and debates. Best of all though – and what made this conference highly memorable – was it being characterised by inclusivity and forefronting the voices of people with learning disabilities throughout.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She is working on: Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults – currently in its fieldwork stage.