A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on what Safeguarding Adults Reviews tell us about mental health social care services for adults in London. The report was co-authored with Unit Director Prof Jill Manthorpe and Research Fellow Stephen Martineau. (500 words)

Safeguarding Adult Reviews show that social care can be a matter of life or death when it comes to people experiencing mental health problems. In this new report we focus on a sample of Reviews that bear witness to the sad cases of people who may have been needing or using social care services to support them with mental health problems but who died or had been harmed and where multi-agency working was explored by the Review process. As with all such Reviews, they are designed to help learning and so improve individuals’ care and systems.

Our report ‘A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act’ was commissioned by LondonADASS (Association of Directors of Adult Social Services). We amplified the learning from Safeguarding Adult Reviews published across all London Councils between 2017 and 2020 and also consulted Coroners’ Reports to Prevent Future Deaths. Our analysis is being used by LondonADASS to inform debates about the proposed new Mental Health Act, where, curiously safeguarding appears to be overlooked. Continue reading

At the Association for Professional Declutterers and Organisers annual conference

Jen OwenJen Owen is a Research Associate at the NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London. (482 words)

Unit researcher Jen Owen virtually attended the Association for Professional Declutterers and Organisers (APDO) annual conference on 20th May 2021. APDO represents the UK decluttering and organising industry. Founded in 2004, it now has a community of over 400 professionals across the UK.

Caroline Rogers started off the day with a presentation based on her recent paper ‘Home and the extended-self: Exploring associations between clutter and wellbeing’. As a Professional Organiser herself, Caroline was motivated to study for a MSc in Applied Positive Psychology and Coaching Psychology, to see if the positive wellbeing outcomes of being on top of clutter she noticed in her clients were universal. Her presentation outlined the current significant gap in literature on clutter, and how she went about exploring the associations between home self-extension variables (subjective clutter, objective clutter, home self-expression and declutter habit) and wellbeing (measured quantitively through the PERMA model). Her findings challenge existing theories of clutter as being maladaptive, instead drawing attention to its subjective nature, and offer a refined definition of clutter as “A subjective experience of possessions (material or other) that inhibits the curation of self-identity at home”. Continue reading

Three early papers on self-neglect

At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading

Action on Elder Abuse is now Hourglass

Richard RobinsonAction on Elder Abuse recently relaunched as Hourglass. As a research team we at HSCWRU have long taken a strong interest in this area, so we are very pleased to post this piece by Richard Robinson, CEO of the charity, in its new guise, and as it nears its 30th birthday. (760 words)

On 24 March 2020, as a nationwide lockdown was announced in a bid to protect UK citizens from the coronavirus pandemic raging across the world, Action on Elder Abuse relaunched under the name Hourglass.

While the timing was extremely challenging, the rebrand was a necessary effort to mark the start of the charity’s new course as a modern, public-facing organisation building on our almost thirty years of experience. If we were to modernise and become sustainable as a charity, we had to redefine ourselves so that we could successfully champion safer ageing and break down the barriers that foster age-related vulnerability.

The Hourglass mission is simple: end the harm, abuse and exploitation of older people in the UK. Continue reading

“Not good enough, CQC”

John Burton, a social care consultant and writer, gives his personal response to the recent Safeguarding Adults Review on Mendip House. John is the author of Leading Good Care, JKP, 2015 and What’s wrong with CQC?, Centre for Welfare Reform, 2017. (973 words)

I’ve been reading the safeguarding review of Mendip House, a care home for adults with autism in Somerset. (Safeguarding Adults Review. Mendip House by Margaret Flynn, January 2018.) The home was owned and managed by The National Autistic Society (NAS), regulated by the Care Quality Commission (CQC), and the residents were placed there by local authority commissioners from all over the UK but none from Somerset itself.

Mendip House has been described as “Winterbourne View without the cameras”: a thuggish gang of staff assaulted, taunted, and stole from the residents; managers were weak and complicit. Whistleblowers told the CQC and the senior management of The NAS, but—as at Winterbourne View—they were repeatedly ignored or fobbed off. The NAS made ineffectual internal investigations but did not alert the CQC or the local safeguarding service as they should have done. The placing authorities failed to monitor the care, safety and welfare of their residents, or whether the high fees were value for money. Whistleblowers left while the perpetrators of the abuse were ticked off but remained in post. In other words, no one did their job properly or considered the residents who remained at the mercy of a horrible regime. Continue reading

Young people and gambling in changing times: implications, risks and harms?

Caroline NorrieStephanie BramleyResearchers Caroline Norrie (right) and Stephanie Bramley from the Social Care Workforce Research Unit at the Policy Institute at King’s College London attended the 5th annual Harm-Minimisation Conference on Wednesday 6 December and Thursday 7 December 2017. (1,233 words)

GambleAware, the charity funded by gambling operators to fund treatment services, education and research to help minimise gambling-related harm in Great Britain, held its annual conference at The King’s Fund, London in December. This was a jam-packed two days of speakers and this year the focus was on two issues: 1) gambling and the implications for young people, and 2) gambling and sport. In this blog post we focus on the first subject, but a summary of content relating to gambling and sport is in GambleAware’s own conference report. Continue reading

Wandsworth Adult Safeguarding Conference – Modern Slavery and Partnership Working

Caroline NorrieCaroline Norrie is Wandsworth Enter and View Representative and Researcher, Social Care Workforce Research Unit, KCL. (612 words)

Public sector practitioners from across the Borough came together on 27 November, 2017 at the annual Wandsworth Safeguarding Conference – Working in Partnership, which took place in Wandsworth Civic Centre Town Hall.

The morning was dedicated to raising awareness of Modern Slavery and Human Trafficking. Attendees were informed about the high prevalence of modern slavery—the recruitment, transportation, transfer, harbouring or receipt of persons. Trafficking was defined as: the movement of people by means such as force, fraud or deception with the aim of exploiting them.

Tatiana Gren Jardan, Director of Strategy at the Office of the Independent Anti-Slavery Commissioner, discussed the role of local authorities in fighting modern slavery—and how staff may be able to identify cases in their everyday work. Tamara Barnett, from the Human Trafficking Foundation, then outlined the duties professionals have in identifying and supporting victims. Since the passing of the Modern Slavery Act 2015 specified public authorities (including Local Authorities) have a duty to report details of suspected cases of modern slavery to the Home Office. The National Referral Mechanism (NRM) framework can then be used (if an adult victim consents) with offering 45 days ‘reflection and recovery’ time for a victim to receive appropriate support. Continue reading

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.). Continue reading

Adult Social Care – where’s the evidence?

Jo Moriarty Nov 2014bJo Moriarty and Martin Stevens are Senior Research Fellows at the Social Care Workforce Research Unit. (1,192 words)

People often talk about the absence of a social care evidence base, but ‘patchy’ is a far better description. Until we arMartin Stevense more explicit about this, it will be difficult to make progress in achieving evidence based policy and practice. We took part in two Meet the Researcher sessions at an event jointly organised by Research in Practice for Adults (RIPfA), the British Association of Social Workers (BASW) and the Association of Directors of Adult Social Services (ADASS). They were part of a day-long seminar designed to bring Directors and Assistant Directors of Adult Social Care and researchers together to discuss current and future adult social care research. Continue reading

Risk, Safeguarding and Personal Budgets: exploring relationships and identifying good practice

Martin StevensDr Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (900 words)

Published today are our findings from this timely NIHR-SSCR funded study, which aimed to provide evidence about the impact of using different forms of Personal Budgets on risks of abuse, to explore practice responses to the increased emphasis on using Personal Budgets and the experiences of Personal Budget holders who had been the subject of a safeguarding referral (suspected abuse or neglect). This collaborative research (undertaken by researchers from King’s, the University of York and Coventry University) was driven by our awareness of contradictory perceptions held by practitioners and other researchers. We had heard views that people on Direct Payments (one main form of Personal Budgets) were more at risk of abuse than other social care users, but on the other hand that the increased control offered by Direct Payments was a protective factor. In order to provide some evidence to address these contradictions, we re-analysed national and local data on safeguarding referrals and take-up of the different forms of Personal Budget. Continue reading