Cornwall Partners in Care News

Cornwall and Isles of Scilly Safeguarding Adults Board Learning from SARs: Responding to the Challenges of Working with People who Self-Neglect

I am an independent adults safeguarding consultant commissioned by Cornwall and Isles of Scilly Safeguarding Adults Board (SAB) to evaluate the outcomes of five Safeguarding Adult Reviews (SARs) involving cases of self-neglect completed between 2013 and 2019, and to conduct a proportional review of a sixth case. In view of this pattern of review activity, the SAB has commissioned this project to assess the degree to which lessons have been learned and implemented.

By way of background I have experience of writing both Serious Case Reviews and Safeguarding Adult Reviews. I have also commissioned the same in my past and present roles as Independent Chair of one Safeguarding Children Board and three Safeguarding Adults Boards. I have also completed funded research projects on self-neglect and have published analyses of SARs on self-neglect in the Journal of Adult Protection.

Findings from SARs and research can be summarised across four domains. In the domain of direct practice with individuals, the quality of mental capacity and risk assessments, the use of history, assessment of family relationships, exploration of the person’s life journey, the use of professional curiosity and inquiry into a person’s wishes and choices all feature strongly. Across the domains of agency and interagency practice, the use of policies and procedures, the quality of supervision and manager oversight, the use of multi-agency risk management meetings, legal literacy and safeguarding literacy, and organisational cultures and working practices all feature routinely. In the SAB domain, implementation of, and follow through on action plans, the quality of different elements of the reviewing process and the use of training feature. From this evidence-base it is possible to articulate what good practice and good policy for practice looks like. It is then possible to explore facilitators locally that enable implementation of good practice and what barriers make it difficult to replicate good practice.

There will be several stages to this project. Firstly I will complete a thematic review of the five aforementioned SARs and additionally review any available evidence of the outcomes of the action plans that sought to implement SAR findings and recommendations. Next, the thematic review findings will be compared with the aforementioned model for good practice and good policy for practice. The combined evidence will be tested in meetings with SAB members and with operational managers and practitioners in Cornwall drawn from across the agencies, with opportunities to explore what facilitators and what barriers are present locally in terms of achieving best practice and implementing learning from completed SARs. It is envisaged that these stages will be completed by the beginning of April 2019.

The next two project stages will involve partner agencies using a tool that captures the above findings to complete case file audits, whilst a proportional review of the aforementioned sixth case is completed by drawing on a combined chronology and reflections from practitioners and managers involved in the case. The outcomes of these two stages will be integrated into the learning that is emerging about facilitators enabling and barriers confronting best practice, and shared in meetings with SAB members and with operational managers and practitioners. Emergent findings from the project to date will also be presented at a SAB conference in May/June 2019.

It is anticipated that the project will generate proposals for policy development, realignment of agency and interagency arrangements for working with self-neglect cases, and practice change. These proposals will be piloted and the outcomes reviewed. Thereafter SAB members will discuss how to take the learning on policy development, realignment of organisational and interagency arrangements, and practice change forward. That could include annual self-assessments and case file audits.

The project represents a form of action learning where the process and outcomes are co-produced by SAB partners, operational managers, practitioners and the project investigator/reviewer. The purpose of the project and of the proportional new review within it is to learn lessons and to implement change where indicated. It is not about the allocation of blame.

I hope to hear and learn from those directly involved in working with adults who self-neglect. I look forward to working with you.