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 Adult 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.

Our research suggests that there are specific groups of people who require particular attention when it comes to improving adult social care for people with mental health problems. There are also two major problem areas: first, professional knowledge and use of the Mental Capacity Act 2005 and second, inter-agency working and communication. These are really important now but also give some ideas for people working on training and implementation of mental health and mental capacity law and practice. We recommend other areas where local councils and other groups could be creative in taking forward professional practice. These include more attention to knowing the risks of pressure ulcers, looking at Coroners’ recommendations that are sent to mental health services, generally in the NHS, and taking the opportunity to discuss good practice as well as learning from when things did not go well. We also make suggestions for the authors and commissioners of Safeguarding Adult Reviews around collecting better information and keeping an eye on the implementation of recommendations.

Elaine Allegretti, Director of People & Resilience, London Borough of Barking and Dagenham, who is LondonADASS’ Mental Health lead provided the foreword to our report. She said: ‘This report is the first of its kind to use these two data sources together to identify recommendations to improve the wellbeing of those with mental health problems in London and to highlight that safeguarding must be part of social care support for people experiencing poor mental health. Any new mental health law must include safeguarding of the rights of people with mental health problems from neglect, abuse and exploitation’. We will be working with LondonADASS to track the response to our recommendations. This study is part of our programme of research that is responding to the priorities in South London through strong collaboration with local councils, providers, practitioners and people using social care services and carers (the NIHR Applied Research Collaboration).

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Emmer De Albuquerque Green, C, Manthorpe, J & Martineau, S (2021) 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. NIHR Applied Research Collaboration South London; NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, London.

Signs of Safety: Findings from the second evaluation by King’s College London

Dr Mary Baginsky

Dr Mary Baginsky is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce. (1,109 words)

The report on the second round of Children’s Social Care Innovation Programme funding for the 10 MTM (Munroe, Turnell and Murphy) Signs of Safety (SofS) pilots has just been published. The strengths-based approach to child protection and safety is widely used around the world, as well as in two-thirds of local authorities in England (Baginsky et al., 2020). The term ‘Signs of Safety’ refers to a model of practice that consists of:

  • principles that privilege relationships with children and their families
  • disciplines in relation to assessments, behaviours and language
  • tools for assessment and planning, as well as for use with children and families.[1]

It is not known to what extent a ‘pure model’ of SofS is in place in English local authorities. The survey that identified its use also showed the variations – and pick and mix approaches – that  were in place.

Back in 2014 when the 10 MTM pilots were recruited the idea was that they worked to the model above which was developed into a whole system design that MTM considered essential to support, monitor and build high-quality SofS practice based on a supportive organisational culture and the commitment of those in senior leadership positions. The first evaluation found that: 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

Social Austerity – Child Protection and Human Rights

Dr Mary Baginsky

Dr Mary Baginsky

Senior Research Fellow at HSCWRU, Dr Mary Baginsky, reports from a conference that took place in Komotini, Greece,1-3 November. (456 words)

I spent last week in the small Greek city of Komotini which nestles in the foothills of the Rhodope Mountains near to the borders of Turkey and Bulgaria. It has a minority Muslim population, many of whom came from Turkey originally and formed a protected population under the Treaty of Lausanne. They have mostly chosen to stay in Greece through to recent times.

The Democritus University of Thrace was established in July 1973 and is based in Komotini, Greece, with other campuses in Xanthi, Alexandroupoli and Orestiada. The Social Work Department was established in the 1990s. I was invited to contribute to a conference on Social Austerity – Child Protection and Human Rights. Most of the contributions were in Greek with intermittent simultaneous translation. In addition to finding it difficult to concentrate on the translation when animated presenters were more of a draw, the fact that the written programme was all in Greek meant that the subject of each presentation was a surprise. 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

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