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This is a repository copy of The Advantages and Disadvantages of Different Models of Organising Adult Safeguarding.
White Rose Research Online URL for this paper:http://eprints.whiterose.ac.uk/101630/
Version: Accepted Version
Article:
Norrie, Caroline, Stevens, Martin, Graham, Katherine Elizabeth orcid.org/0000-0002-0948-8538 et al. (2 more authors) (2017) The Advantages and Disadvantages of Different Models of Organising Adult Safeguarding. British Journal of Social Work. pp. 1205-1223. ISSN 1468-263X
https://doi.org/10.1093/bjsw/bcw032
[email protected]://eprints.whiterose.ac.uk/
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TheAdvantagesandDisadvantagesofDifferentModelsofOrganisingAdult
Safeguarding
Authors:
Caroline Norrie, Martin Stevens, Katherine Graham*, Jo Moriarty, Shereen Hussein and Jill
Manthorpe
Social Care Workforce Research Unit, King’s College London, *Social Policy and Social
Work, University of York.
Abstract
Professionalsexpressdivergentviewsaboutwhetheradultsatriskarebestservedby
safeguardingworkbeingincorporatedintosocialworkers’caseworkorbeingundertaken
byspecialistworkerswithinlocalareaorcentralisedteams.Thispaperdrawsonfindings
fromthefinaltwophasesofathree-phasestudywhichaimedtoidentifyatypologyof
differentmodelsoforganisingadultsafeguardingandcomparetheadvantagesand
disadvantagesofthese.Weusedmixed-methodstoinvestigatefourdifferentmodelsof
organisingadultsafeguardingwhichwetermed:A)Dispersed-Generic,B)Dispersed-
Specialist,C)Partly-Centralised-SpecialistandD)Fully-Centralised-Specialist.
Ineachmodelweanalysedstaffinterviews(n=38),staffsurveyresponses(n=206),feedback
interviews(withcarehomemanagers,solicitorsandIndependentMentalCapacity
Advocates)(n=28),AbuseofVulnerableAdults(AVA)Returns,AdultSocialCareUserSurvey
Returns(ASCS)andservicecosts.Thispaperfocusesonqualitativedatafromstaffand
feedbackinterviewsandthestaffsurvey.Ourfindingsfocusonsafeguardingasaspecialism;
safeguardingpractice(includingmulti-agencyworking,prioritisation,tensions,handover,
staffconfidenceanddeskilling);andmanagingsafeguarding.LocalAuthority(LA)
participantsdescribedandcommentedontheadvantagesanddisadvantagesoftheir
organisationalmodel.Feedbackinterviewsoffereddifferentperspectivesonsafeguarding
servicesandimplicationsofdifferentmodels.
Background
Therehasbeenconsiderablegovernmentinterestanddebateamongstaffworkinginadult
safeguardinginEnglandoverthelast15yearsabouttheconstructionofadultsafeguarding
practicesandtheremitofadultsafeguardingwork.‘Adultsafeguarding’isthetermgivento
protectingadultsatriskfromabuseorneglect.Localauthorities(LA)taketheleadinadult
safeguarding,workingtogetherwithprofessionalsinhealth,socialcareandthepolice,
amongothers.Professionalsexpressdivergentviewsaboutwhetheradultsatriskarebest
servedbysafeguardingworkbeingincorporatedintosocialworkers’caseworkorbeing
undertakenbyspecialistworkersorganisedinlocalityteamsorcentralisedteams(Parsons,
2006,Ingram,2011).
LAsinEnglandhavesoughttodevelopsystemsandprocessestorespondtoadult
safeguardingconcernsandprotectadultsatriskinaconsistentandequitablewaywithout
impingingontheirhumanrights.From2000,LAsfollowedgovernmentGuidance‘No
Secrets’(DepartmentofHealthandHomeOffice,2000)toworkwithotheragenciessuchas
thepoliceandtheNHStoensureadultsatriskaresafe.Furtherproceduralguidancewas
includedinthe‘NationalFrameworkforStandardsinSafeguarding’(AssociationofDirectors
ofSocialServices,2005),theConsultationonandtheReviewof‘NoSecrets’(Departmentof
2
Health,2009),andarevisedGovernmentstatementofpolicyonadultsafeguarding
(DepartmentofHealth,2011).ItisonlywiththerecentpassingoftheCareAct(2014)
(implementedin2015)thatadultsafeguardinghasbecomeastatutoryrequirementforLAs.
GovernmentguidelinesandlegalrequirementsforLAsremainnonethelesspermissivein
respectofstaffingconfigurationsandteamorganisationinlocaladultsafeguardingservices
undertheCareAct2014(CareAct2014a).
Ourliteraturereview,undertakenaspartofPhase1ofthisstudy(Grahametal.,2014),
identifiedalackofevidenceexploringtheoutcomesofdifferentwaysoforganisingadult
safeguarding.Fourarticles(outof83relevantarticleslocated)directlyfocusedonthis
matter,Twomeyetal.,(2010)addressedthetopicintheUnitedStates,Johnson(2012),in
Scotland,Ingram(2011)inEnglandandWales,andParsons,(2006)inEngland.Itisevident
thereforethatoptionsfordeliveringadultsafeguardingservicesanddecisionsabout
channellingstaffintothisspecialistareaareofinterestinmanynationalcontexts.
ImportantlyParsons(2006)placedEnglishLAsonatheoretical‘continuumofspecialism’
fromfullyintegratedintoeverydaysocialworkpracticetocompletelyspecialisedand
discusseddifferentapproachestomulti-agencyworkinginadultsafeguarding.
Theadvantagesofincreasedspecialisationreportedintheliteraturearefacilitatinggood
workingrelationshipswithcareproviders(FysonandKitson,2012);encouragingmorein-
depthinvestigationsininstitutional/organisationallocations;andincreasingthelikelihood
ofsubstantiatingallegedabuse(Cambridgeetal.,2011).Meanwhilethedisadvantagesof
increasedspecialisationarereportedaspotentiallycreatingconflictwithoperationalsocial
3
workers(Parsons,2006);reducingcontinuityforvulnerableadults(FysonandKitson,2010);
anddeskillingofnon-specialistsocialworkers(CambridgeandParkes,2006).
ThedevelopmentofMulti-AgencySafeguardingHubs(MASHs),currentlybeingintroduced
insomepartsofEngland,isalsorelevant.WhatqualifiesasaMASHrangesfrom
straightforwardarrangementssuchastwoprofessionalsfromdifferentagenciesmeeting
regularlytosharedatabasesandsiftthroughreferralsthroughtomorecomplicatedmulti-
agencydata-sharing‘informationbubbles’,orlarge,integrated,co-located,health,social
careandotheragencyteamsofprofessionalsundertakingallLAadultsafeguardingwork
(HomeOffice,2013).MASHdevelopmentappearstobeatrendacrossadultsafeguarding
(Grahametal.,2015)althoughthisdoesnotalwaysgohandinhandwiththecreationof
specialistadultsafeguardingteams.AMASHmayprovidemanagerswithgreaterconfidence
intheirservices’consistencyandefficiency,meaningtheydonotfeeltheneedtocreate
morespecialistapproaches.
Buildingonthislimitedevidencebase,thisstudywaspartofathree-phase,mixed-method
project(seeTable1).Itsaimwastoidentifyatypologyofadultsafeguardingmodelsand
investigatepotentialadvantagesanddisadvantagesthroughuseofacasestudyapproach
(seebelowforsitedescriptions).
4
Table1:StudyMethods
Phase1 Literaturereview,interviewswith23adultsafeguardingmanagersand
developmentofatypologyofmodelsofadultsafeguarding.
Phase2
Withincase-studysitesillustratingthedifferentmodelsidentified:-
Quantitativeanalysis:
Staffsurvey;estimatedservicecosts;AbuseofVulnerableAdults(AVA)
Returns;andSocialServicesSurveydata.
(StatutorydatareturnedbyallLAstogovernmentannually).
Phase3 Qualitativeanalysis:
Interviewswithadultsafeguardingmanagers
Feedbackinterviews(withcarehomemanagers,LAsolicitorsand
IndependentMentalCapacityAdvocates(IMCAs)).
5
ThisarticledrawsonanalysisoftheinterviewswithSafeguardingManagerscollectedinthe
case-studysites(Phase1),free-textcommentsfromthestaffsurvey(Phase2),andfeedback
interviews(Phase3).
Methods
FollowinginterviewswithlocalSafeguardingManagers(Phase1,reportedinGrahametal.,
2015),phases2/3ofthestudyusedacomparative,criticalcase-studiesmethod(Flyvbjerg,
2006).WepurposefullysampledLAswhichillustratedthesixmodelsofadultsafeguarding
identifiedinthetypologyinPhase1ofourstudy(Grahametal.,2015).However,wewere
unabletorecruitasiteoperatingoneofthecentralised-specialist(seebelow)modelstoour
studybecausetherewerefewcasesofthistypeandthoseapproachedwereunwillingto
participate.Duringdatacollectionitemergedthattwoparticipatingsites(B1andB2)
operatedmoresimilar‘Dispersed-Specialist’modelsthanweoriginallyanticipated;we
thereforeretainedbothwithinthestudybutamalgamatedthemodelfortheanalysis.There
werethereforefivecase-studysitesinthestudy(withonemodelbeingrepresentedbytwo
casestudies).Astudyadvisorygroupconsistingofserviceusers,practitionersandmanagers
supportedthestudyandwereconsultedonthestudyinstruments’designanddataanalysis.
6
a)InterviewswithLAStaff
ContactdetailsofpotentialLAstaffparticipantsweregiventoresearchersbyAdult
SafeguardingManagersandfurtherintervieweeswerecontactedusingsnowballing
techniques.Interviewswereconductedinconfidentialworkplacelocationsandlasted
aroundonehour.Interviewsweresemi-structured,lastedfromaround30-60minutesand
coveredadultsafeguardingpracticeandopinionsonorganisation.Theinterviewsconducted
withAdultSafeguardingManagersineachsiteinPhase1ofthestudywereincludedinour
analysis.
b)FeedbackInterviewsaboutadultsafeguardingservices
Weconductedfeedbackinterviewswithcarehomemanagers,LAsolicitorsand
IndependentMentalCapacityAdvocates(IMCAs)abouttheiropinionsonthequalityof
adultsafeguardingservices.IMCAsareindependentadvocateswhoworkwithunbefriended
adultsatriskwholackcapacitytomakeimportantdecisionsandforwhomthereare
safeguardingconcernsorwhosecarersareimplicatedinsuchconcerns.Potential
participantswerecontactedfollowingsuggestionsbyLAmanagersoraftersearchingonline
forrelevantorganisationsandthencontactingmanagers.Semi-structuredinterviewswere
conductedbytelephoneorface-to-face,lastedfromaround30-60minutes,andfocusedon
safeguardingproceduresandsatisfactionwithsafeguardingservicesincludingLAprovided
safeguardingtrainingandsupport.
Werecordedandtranscribedallstaffinterviewsandtooknotesfromfeedbackinterviews.
Thefieldworkresearchteam(n=3)readthreetranscriptsanddevelopedacoding
7
frameworkwhichincorporatedcodesidentifiedinPhase1ofthestudy.Cross-codingwas
undertakenwith10%ofdatatoensurecommonunderstandingsofthecodingframe.The
expansionofthecodingframeworkandidentificationoftheeventualoverarchingthemes
weredevelopedthroughdiscussionsinfrequentteammeetings.Table2showsnumbersof
staffandfeedbackinterviews.
c)Staffsurvey
Anonlinepractitionersurveywasconductedin2014infourofthefivesites(dataare
missingfromthepartly-centralisedspecialistmodelduetoitslaterecruitment,see
limitations).Thequestionssoughtinformationonparticipants’demographiccharacteristics,
qualifications,localsafeguardingorganisationmodelandinvolvementwithsafeguarding;
viewsabouteffectiveness;safeguardingtraining;stresslevelsandjobsatisfaction.Several
Table2:LAStaffandFeedbackinterviews(n=70)
Site/Model
LAStaffandFeedbackInterviews
LA
Staff
IMCA/
Carers Solicitors
Carehome
managers/
housingstaff
SiteA(Dispersed-Generic) 6 1 1 4
ModelB1(Dispersed-Specialist) 10 1 1
4plus1
meetingwith7
housingofficers
SiteB2(Dispersed-Specialist) 9 1/3
ModelC(Partly-Centralised-Specialist) 7 1 4
ModelD(Fully-Centralised-Specialist) 11 1 6
Totals 42 8 2 18
8
questionsallowedparticipantstoaddfree-textcommentsandtheseresponseswere
importedintoNVivoandanalysedtogetherwiththeinterviewdata.Thestatisticalanalysis
isreportedindetailinanotherpublication(Stevensetal.,2015).Overall,thesurveywas
completedby206respondents.ResponseratesvariedacrossthesitesfromSiteA30%
(n=73),SiteB141%,(n=66),B244%(n=30)toSiteD25%(n=37).Demographicanalysis
showedthatthesamplebroadlyreflectedthepopulationofsocialworkersworkinginthe
LAs.
EthicalandresearchgovernanceapprovalsweregainedfromtheSocialCareResearchEthics
Committee(SCREC)(13/IEC08/0014),theAssociationofDirectorsofSocialServices(ADASS)
(Rg13-006)andtheindividualLAs.
FourModelsofAdultSafeguarding
Wenowpresentabriefdescriptionofourfivestudysiteswhichareillustrativeofthefour
modelsinourtypology.Thiswillbefollowedbyfindings.
(SiteA)Dispersed-Generic
(SitesB1andB2)Dispersed-Specialist(twosites)
(SiteC)Partly-centralised-Specialist
(SiteD)Fully-centralised-Specialist
SiteA(Dispersed-Generic)isasmall,cityLAinsouthEngland.Adultsafeguardingis
characterisedbybeingintegratedwithingeneralwork-streams.Thereislimitedspecialist
9
involvementinresponsetosafeguardingconcerns.Concernscomeintoatelephonecontact
centre;unlessurgentoreasilyresolvable,thesearepassedtolocalitypractitioners.
Safeguardingisregardedasacorepartofsocialworkactivity.Allallocatedordutysocial
workersaretrainedsafeguardinginvestigatorswithintheirownteams/specialitiesanda
seniorpractitionerorteammanagertakesontheroleofsafeguardingmanagerandthe
chairofsafeguardingmeetings.Thestrategicsafeguardingteamisinvolvedinoverseeing
complex,highriskorinstitutionalinvestigations.ThemanagerdescribedtheLAasmoving
fromatightlyregulatedapproachtowardsamorepersonalisedfocus.
SiteB1(Dispersed-Specialist)isalarge,Midlands,partlyruralcounty,whereLAsocial
serviceshadrecentlyseparatedfromtheNHS.Itappliesaflexiblemodeltoreflectitslarge
geographicalareawhichisdividedintoover40localityteamswheresafeguardingis
deemed‘everyone’sbusiness’.Specialistpractitionersor‘leads’workwithinteamson
investigationsandco-ordinatecases.Alertsenteracontactcentreandcasesalreadyknown
totheLAaretransferredtolocalityteams.Ifthepersonisunknownorthecaseappearsto
bequicklyresolvableorurgentitisdealtwithatthecontactcentre.Safeguardingleadsat
teamleveldecideifconcernsqualifyassafeguarding.Teammanagershavediscretionto
organisesafeguardingworkhowtheyseebest,whilefollowinglocalpolicies.Where
concernsinvolvehighprofileorseriousmultipleconcernsinorganisationsthestrategic
safeguardingteammaybeinvolved.Insomelocalitiesstaffopttotakeonsafeguarding
cases,inotherscasesareallocated.LearningDisabilitiesandPhysicalDisabilitiesteams
investigateorganisationalabuseconcernsineachother’sareassoasnottodisrupt
establishedrelationships;while,inOlderPeople’steams,organisationalabuse
investigationsareundertakenbylocalitystaff.Thissitewasdiscussingtheimplementation
10
ofaMASHandhadpilotedhavingapolicepresenceinitscontactcentretoimprovespeed
andaccuracyofsiftingthroughconcerns.
SiteB2(Dispersed-Specialist),asecondexampleofthismodel,isalarge,relativelyaffluent,
suburbancountyinSouthernEngland.HereaCentralReferralUnitwasinplacepromoting
informationsharingbetweenPolice,theCareQualityCommission(CQC),Health,Probation
andChildren’sServiceswhoareco-located.LikeModelB1(Dispersed-Specialist),however,
ModelB2(Dispersed-Specialist),usessafeguardingexpertsor‘leads’withinteamstocarry
outinvestigationsandco-ordinatecasesdependingontheclientgroupandlocalityteam.
AlertscomeintotheMASHandknowncasesaretransferredtolocalityteams.Iftheperson
isunknowntoLAsocialservicesorthecaseappearstobefairlyquicklyresolvableorurgent
itcanbedealtwithbytheMASHteam.Again,similartoothersites,whereconcernsinvolve
highprofileormultipleconcernsinanorganisationitislikelythatthestrategicsafeguarding
teambecomesinvolved.Inthismodel,safeguardingleadsundertaketrainingofcolleagues,
qualityassurance,andmanagemoreseriouscases.
SiteC(Partly-Centralised-Specialist)isalargeLAinapartyruralareainNorthEngland.Here
riskpredictsifaspecialistresponseisrequired.Adultsafeguardingissplitbetweenlocality
teamsandacentralisedspecialistsafeguardinginvestigationteam.Safeguardingreferrals
areallocatedonthebasisof‘seriousness’and‘complexity’withthespecialistsafeguarding
investigationteamtakinghigherriskreferrals.Riskisdefinedbytheimpactoftheconcern
upontheindividualandlikelihoodofarepetitionusingacolourcodedsystem.Referralsfor
olderpeopleandpeoplewithlearningdisabilitiesarescreenedbyacentralisedsafeguarding
frontlinedecisionmakingteam(currentlyasub-sectionoftheinvestigationteam)situated
11
withinaMASHalsocomprisingchildren’sservicesandthepolice.Otherservicessuchas
mentalhealthteams(whoareresponsiblefortheirownsafeguardingconcerns)have
representativesintheMASH.Aninitialinformationgatheringprocessprecedesadecision
aboutwhetherthealertrequiresasafeguardingresponse.Onceadecisionhasbeenmade
toinvestigatefurther,socialworkersintheMASHdeviseastrategyandpasstoeitherthe
localityteamsorspecialistinvestigationteamtoinvestigate.
SiteD(Fully-Centralised-Specialist)isasmall,relativelydeprivedcityinNorthEngland.Here
aspecialistteamofsocialworkersundertakesalladultsafeguardingworkincluding
screeningalertsandinvestigatingconcerns.‘Conversation’wasidentifiedbytheHeadof
Safeguardingasanimportantpartoftheprocessandpotentialalertersareencouragedto
discusstheirconcernsbeforemakingthealert.Thespecialistsafeguardingteamisco-
locatedwithstaffwithdecisionmakingpowersfromthelocalNHSTrust,police,fire,mental
healthandchildren’sservices.ThisMASHisthecentreofinvestigationofsafeguarding
concerns;thedecisionmakingfunctioniscentralised;theinitialstrategyisdevelopedinthe
MASH;andreferralsfromotheragenciesaredirectedtotheMASH.
TheabovedescriptionsillustratethedifferencesbetweenhowLAsoperationalisetheiradult
safeguardingservices(onascalefromdispersedtomorecentralisedapproaches)aswellas
pointingtosomecontextualfactorsatplay.
Findings
12
Findingsarepresentedunderthreemainthemesdrawingontheinterviewandsurveydata:
Firstisthenatureofsafeguarding,includingwhetheritisaspecialistbodyofknowledgeand
howdecisionsaremadethataconcernshouldreceiveasafeguardingresponse.Thesecond
themeisSafeguardingPractice,whichcovers:Multi-agencyWorking;Prioritisation;Case
Handover;Tensions;andConfidenceandDeskilling.ThethirdthemecoversManagingthe
SafeguardingFunction,andfocusesonPerformanceManagement/Auditandfeedback.
Thenatureofsafeguardinginthedifferentmodels
Shouldsafeguardingbeaspecialistbodyofknowledge?
Staffinlessspecialisedsites,A(Dispersed-Generic)andB1/2(Dispersed-Specialist),viewed
themselvesasexpertsintheirownserviceusercategory(e.g.peoplewithlearning
disabilitiesorolderpeople)andvaluedthis,emphasisingitimprovedthe‘journey’foradults
atrisk.MeanwhileahighlyspecialistsafeguardingteamwasfeltbystaffinSiteC(Partly-
Centralised-Specialist)andSiteD(Fully-Centralised-Specialist)tobringspecialistknowledge
ofsafeguardingprocesses,lawandprocedures,includingthoserelatedtomulti-agency
working.Forexample,staffinSiteD(Fully-Centralised-Specialist)discussedtheiradvanced
practiceandcompetenceintheuseofthelegalprocessesofInherentJurisdictionandhow
theyfeltconfidenttointervenetoensuretheclosureofafailinghospitalwardandtheirrole
ininvestigatingabuseincarehomes.InSiteC(Partly-Centralised-Specialist)aparticipant
discussedgainingknowledgeaboutTradingStandards(consumer)lawandusingthisto
protectadultsatrisk.
13
However,astaffmemberinSiteD(Fully-Centralised-Specialist)consideredthattheir
enhancedsafeguardingknowledgemeanttheteammightlackexpertiseinworkingwith
particulargroups(e.g.peoplewithlearningdisabilities)whichcouldmeaninvestigations
withtheseadultsatrisktooklongertocomplete.Herethiswastosomeextentmitigatedby
havingalargemulti-professionaladultsafeguardingteamwithintheMASHincluding
professionalswithexperienceacrossserviceusergroupsandincludingnursingknowledge
whichwasadvantageouswheninvestigationswereundertakenincarehomes.Incontrast,
SiteC(Partly-Centralised-Specialist)hadasmallerspecialistteamwithlessinter-
professionalexpertisesocaseswhichdemandedspecialistserviceuserknowledgecouldbe
passedtoteamsoutsidetheMASH.Feedbackfromacarehomemanagerinthissite
howeverwasthatthesafeguardingteamwerelackinginnursingknowledge;thisillustrates
theimportanceofconstructingaspecialistteamwiththeappropriateskillsetand
professionalknowledge.
Commentsinthestaffsurveysuggestregularrefreshertrainingisapriorityforpractitioners
acrossthesitestoreflectlegaldevelopments,particularlyrelatedtocaselawregardingthe
MentalCapacityAct2005anditsDeprivationofLibertySafeguardsandthesafeguarding
implicationsoftheCareAct2014.Inallsites,withtheexceptionofSiteD(Fully-Centralised-
Specialist),respondentsidentifiedcourtworkasanareainwhichtheyfelttheyneeded
furtherskillstraining.CommentsbypractitionersininterviewsandinthesurveyinSiteA
(Dispersed-Generic),SiteB1(Dispersed-Specialist)andSiteD(Fully-Centralised-Specialist)
highlightedthechallengesofmaintainingcompetenceinsafeguardingskillsandexpertise
forthosestaffwithfewopportunitiestopracticetheirskills.
14
Identifyingconcernsassafeguarding
Participantsinallsitesreferredtoprocessesofstandardisationofpracticesforidentifying
concernsassafeguardingalerts,andidentifyingtherisksinasituation,forexample,national
(e.g.‘Nosecrets’),regional(e.g.thePanLondonFramework)andlocalpolicies.Whattypeof
abusewasdefinedasadultsafeguarding(suchasdomesticabuseorself-neglect)wasalso
discussedbyinterviewparticipants.InSiteD(Centralised-Specialist)amanagerdiscussed
conceptualisingtheirthreshold/riskmatrix;inSiteC(Partly-Centralised-Specialist)a
managerdescribedoperatingarisk‘trafficlight’systemwithaccompanyingtime-scales(e.g.
twohoursforred;24hoursforamber).Frontlinepractitionersmeanwhileindicatedthat
thresholdsandriskassessmentvariedovertimeinrelationtolocalandnationalpressures
orinitiatives.AsurveyrespondentfromSiteA(Dispersed-Generic)forexample,notedthat
“Sometimes[the]decisionseemstobedrivenbyresources”(SiteA,staffsurvey).Asurvey
respondentinSiteB1(Dispersed-Specialist)summedup:
[Whyarethere]guidelineswhichthenappeartorequireeachandeveryTrustandLA
inthecountrytowriteitsownsafeguardingpolicy?Whatisurgentinonearea,tobe
reportedwithin24hours,isallowedtorunfor48hoursinanother?Commonand
uniformpracticeandstandards,meansaconsistentnettocatchsafeguarding
concerns(SiteB1,staffsurvey).
Thesetwoquotesillustratestaffanxietiesinthelessspecialistsitesaboutproviding
consistentadultsafeguardingthresholdsandservices.InSiteD(Fully-Centralised-Specialist)
andSiteC(Partly-Centralised-Specialist)interviewparticipantsstatedthatadesiretocreate
consistentthresholdsandservicesforadultsatriskwasanimportantfactorintheirdecision
15
tointroducemorespecialisedmodels.
SafeguardingPracticeinthedifferentmodels
Multi-agencyworking
InterviewparticipantsinSiteD(Fully-Centralised-Specialist)describedworkingeffectively
withaspecialistpoliceteamandhospitalstaff,buildinginter-professionaltrust,andworking
closelywithcarehomestoimprovepractice.However,participantsinSiteA(Dispersed-
Generic)andSiteB1andB2(Dispersed-Specialist)emphasiseddependenceonspecific
policecontactsforinformationandconveyedfrustrationsaboutprosecutionsnotbeing
takenforward:
I’vedonethisjobforalongtimeandveryrarelyhaveweseenanythinggothrough
police,tobehonest.Nodisrespecttothemasindividuals,ofcourse,butit’svery
hard.(SiteB2,Interviewee8)
InSitesA(Dispersed-Generic)andB1(Dispersed-Specialist)staffreportedmixed
experienceswithhealthprofessionals.Allsiteshighlightedtheusefulroleofworkingwith
fireservices,particularlyinSiteD(Fully-Centralised-Specialist).ParticipantsinSiteD(Fully-
CentralisedSpecialist)expressedpositiveviewsoftheirrelationshipwiththeCareQuality
Commission(CQC)aboutsafeguardingreferralsinvolvingregulatedproviders.Inothersites
relationshipswiththeCQCseemedmoredistant,althoughpredominantlypositive.Inall
siteswefoundexamplesoflocalinitiativesbeingundertakenwithprovidersandvoluntary
groupsaimedatpreventingabuse(forexampleaninitiativetoassistadultsatriskwith
learningdisabilitieswhoaretakenintopolicecustody)inSiteB1(Dispersed-Specialist).Cuts
infundingandstaffnumbersandwerefrequentlycitedasrestrictingLAs’abilitytowork
16
preventatively.Staffinallsiteswerepositiveaboutnon-socialworkprofessionalssuchas
nursestakingtheleadinsafeguardinginvestigations.
Prioritisation
Difficultiesinprioritisingworkloadswereaconcernforintervieweesandsurvey
respondentsespeciallyinthelessspecialisedsites.Atypicalcommentwas,‘Thevolumeof
ourworkloadisalwaysveryhighanditisdifficultattimestoallocatesafeguardingwork
resource-wise’(SiteA,staffsurvey).AsurveyrespondentinB1(Dispersed-Specialist)
discussedhowinvolvementinoneorganisationalabusecasecould‘occupyalltheirtimeand
impactonotherwork’.InSiteB2(Dispersed-Specialist)whereworkmayhavebeenmore
constantduetoaMASHbeinginplace,safeguardingpractitionerstookamoreproactive
role,andsafeguardingwasviewedmorefavourably(asachanceforprofessional
development).ParticipantsinSiteC(Partly-Centralised-Specialist)expressedconcernsabout
thehighthresholdforspecialistteaminvolvementandhowthisimpacteduponthe
caseloadsofthoseinthelocalityteamsholdingresponsibilityfor‘lowrisk’safeguarding
investigationsalongside‘routine’casework.FewermentionsemergedinsiteD(Fully-
Centralised-Specialist)aboutthismatter.Manycommentsweremadeinthestaffsurveyby
practitionersfromsitesA(Dispersed-Generic),sitesB1andB2(DispersedSpecialist)(but
especiallyB1),expressingtheviewamorespecialisedservicewouldimprovetheresponse
tosafeguardingconcernsbyaffordingthemgreaterpriority.Thefollowingcommentswere
inresponsetoourquestion-Whatresourceswouldallowsafeguardingservicestoimprove?
HavingaTeamdedicatedtosafeguarding,as[itis]verydifficulttomanage
effectivelyaroundothercaseloadpressures(SiteA,staffsurvey).
17
or
Ibelieveacentralisedsafeguardingteamwouldagoodwayforward.Thiswould
enableaconsistentapproach,andIdonotbelieveitwouldmeanthatlocal
practitionersandsafeguardingleadswouldbedivorcedfromtheprocess.
(SiteB1,staffsurvey).
CaseHandovers
Decisionsaboutorganisationalmodeltypehaveimplicationsforthefrequencyofstaff
handovers,andthereforecontinuityandconsistencyoftheserviceforadultsatrisk.
RepresentativesfromSiteA(Dispersed-Generic)stressedtheimportanceofmaintaining
relationshipswithadultsatrisk:“Wefeltthat,becauseitisquiteasmallauthority,people
knowtheircasesquitewell;sometimesit’snothelpfultohavepeoplecomingintodoa
differentpieceofwork”(SiteA,Interviewee1).Incontrast,inSiteD,Fully-Centralised-
Specialist)anintervieweenotedthatthespecialistteamsometimeswantedtokeepcases
afterthesafeguardingcasehadbeenclosedandmaintain“long-armsortofmanagement,[for
exampleiftheyhadworkedonacaseforalongtime]butwe’renotsupposedtoholdcases”
(SiteD,Interviewee3).Alternatively,acrossthesitesaseparationofworkwassometimes
consideredusefulforsocialworkerswhohadworkedlong-termwithsomeoneforwhom
thereweresafeguardingconcerns,asitenabledthemtomaintainaneffectiverelationship
withthepersonandtheirfamily,andbeseenasseparatefromthesafeguardinginvestigation.
Tensions
Oneargumentfornothavingspecialistteamswasthattheseorganisationalmodelscreate
18
tensionsbetweenstaff.InSiteD(Fully-Centralised-Specialist)staffwerehighlypositive
aboutthebenefitsofworkinginaspecialistteam,butnotedthatworkingwithinalarge
multi-professionalMASHhadbeena‘massive’learningcurveandwasonlysuitablefor
‘flexibleworkerswillingtohavetheirpracticechallenged’(SiteD,Interviewee3).Inthissite,
somenon-specialistsafeguardingstaffrespondingtothesurveycomplainedaboutalackof
feedbackfromcolleagues(apartfromcaserecordinformation)aboutcaseoutcomes.InSite
C(Partly-Centralised-Specialist)somecommentsweremadeaboutlocalityteamstaff
resentingbeinggivencasestheyfeltweretoo‘complex’.Anescalationprocesswas
thereforeinplaceinvolvingmanagersadjudicatingdisputesarisingovercaseallocation
betweenthespecialistandnon-specialistteams.Meanwhile,inthelessspecialistsites,
frictionwasmentionedindifferentareas.InsiteB1(Fully-Centralised-Specialist),
participantsmentionedthatsafeguardingleadswithinteamsknewmorethantheir
managerswhowereexpectedtomanage(andsometimesChair)caseconferences.
Interestingly,inSiteA(Dispersed-Generic)reportedtensionswerenotrelatedto
safeguardingworkatall;heretheyrelatedtothedivisionofallworkintoshort,longor
medium-term,‘thereisroomforimprovementwithre-ablement(rehabilitation)andlong-
termteamsasthereappearstoomuchofadivide’(Site7,staffsurvey).Inaddition,varying
viewswereexpressedininterviewsacrossthelessspecialistsitesastowhetherstaffshould
volunteertoundertakeadultsafeguardingworkorbeallocateditautomatically.
Nonprofessionally-qualifiedcaremanagersmadecommentsinthestaffsurveyinallthe
sites(althoughespeciallyinthelessspecialisedsites),statingthattheydidthesameworkas
qualifiedstaffandthereforefeltundervaluedandunderpaidincomparison.
19
Confidenceanddeskilling
GrowingstaffconfidencefeaturedinSiteA(Dispersed-Generic)interviews.Thiswaspossibly
attributabletoarecentwelcomere-focusfromprocess-driventoamorepersonalised
approach.IntervieweesinSitesB1/2(DispersedSpecialist)andnon-specialistsocialworkers
inSiteD(Fully-Centralised-Specialist)commentedonthedifficultyofmaintainingtheir
confidenceaboutadultsafeguardingworkiftheyencounteredthisirregularly.“Theydon’t
reallyfeelthatcompetentinit,sotheyfeelthatthey’vekindofdonethetrainingandthey’re
justtryingtheirbest”(SiteB2,Interview1)“Notallpractitionersarecomfortablewith
safeguarding…[..]…somepeopledostillseesafeguardingandgo,‘OhGod,no,don’twantto
dothat.”(SiteB1,Interview8).Asmightbeexpected,specialistteamsappearedhighly
confidentabouttheirskills.Incontrast,inSiteD(Fully-Centralised-Specialist)interview
commentssuggestedthatsomelocalityteamsocialworkerslackedconfidenceandwere
reluctanttotakeonanysafeguardingrelatedworkwhichcouldsuggestanelementof
deskillingistakingplaceoutsidethespecialistteam.Thefollowingquoteillustratesthispoint
‘they[non-specialistsocialworkers]justneedtheconfidencetodoit,andwewouldsupport
them’(SiteD,Interviewee3).
Managementofthesafeguardingfunction
PerformanceManagementandAuditing
Performancemanagementandauditingweretypicallyfunctionsofstrategicsafeguarding
teams,althoughteammanagerinvolvementwasmentionedespeciallyinSiteA(Dispersed-
Generic),B1andB2(Dispersed-Specialist).Safeguardingauditresultswereraisedin
20
supervisiontoimprovepractice;thiswasespeciallyevidentinSiteA(Dispersed-Generic)
wherestafffrequentlymentionedperformancemanagementprocesses.Forexamplein
answertothequestion,ifyoucouldchangeonethingaboutworkwhatwoulditbe?A
memberofstafffromSiteA(Dispersed-Generic)wrote,‘Bymyworknotbeingassessedby
line-managementduetoperformanceindicatorsbutbythequalityofworkIdo.’(SiteA,
staffsurvey).Itispossiblethatinthelessspecialistsitesmanagersundertakemorestringent
performancemanagementinorderto‘control’workwhichisspreadoutacrossthe
organisation.Referenceswerealsomadetooutsideagenciessupportingauditing.For
example,SiteB2(Dispersed-Specialist)mentionedtheir‘efficiencypartner’,‘becausethat's
whateverybodyneedsthesedays’contractedtoundertake‘deepdive’audits(B2,
Interviewee5).
Feedbackonsafeguardingservices
Somedifferencesemergedinfeedbackfromsocialcareprovidersacrosssites.Mostcare
homemanagersinSiteD(Fully-Centralised-Specialist)(n=6)werehighlypositiveaboutthis
model:theyviewedtheMASHteamasextremelyhelpfulandefficientandpraisedthesocial
workersasknowledgeableandprofessional,althoughoneparticipant(SiteD,Feedback
Interviewee6)commentedtheywereoverly-powerful.InSiteB1(Dispersed-Specialist),
carehomemanagers(n=4)andtheIMCAinterviewedcommentedonthesupportive
approachandknowledgeofsocialworkersandthesafeguardingpractitioners.InSiteC
(Partly-Centralised-Specialist)carehomemanagers(n=4)reportedvariedpractice,lackof
inputfromprofessionalsotherthansocialworkers,andlackofaccesstoLAtrainingorany
groupsupport.Thecarehomemanagers(n=4)andIMCAinterviewedinSiteA(Dispersed-
Generic)commentedonsocialworkers’highcaseloads,variableoutcomes,andinconsistent
21
knowledgeoftheMentalCapacityAct(MCA)andsafeguarding,aswellasfailuretokeep
theminformedabouttheprogressofcases.
Discussion
Limitations
Weoriginallyplannedtointerviewadultsatrisktogaintheirperspectivesonadult
safeguardingservicesintheirLA,howeverwewereunabletorecruitfromthisgroup.LA
staffwerenotforthcominginsuggestingadultsatrisk,duetotheirpotentialgreat
vulnerabilityandwantingtoavoidfurtherdistress.Gainingaccessviaotherorganisations
provedimpossible.Feedbackwasthereforegiveninsteadbyamixofprofessional
participants(carehomemanagers,IMCAsandsolicitors).Thesiteschosenmaynotbefully
representativeorillustrativeofotherLAsusingthismodel;moreoverweonlyheardpractice
accountsanddidnotscrutinisecaserecords.ThelackofsurveydatafromsiteC(Partly-
Centralised-Specialist)illustratesthewell-knownriskofusingcomparativecase-study
methodsasfailuretosecuredatafromonesitecanweakenthestudyasawhole.Thislack
inthestaffsurveydatamaymeanourcomparisonsareslightlylesstrustworthythan
otherwisewouldhavebeenthecase(seeNorrieetal.).
Thefollowingsectiondiscussesfurtherthethemesidentifiedinourfindings.
Thisresearchhashighlightedthecomplexitiesofunpickingtheadvantagesand
disadvantagesofadultsafeguardingindifferentcontextsandunderlinedtheimportanceof
scrutinisingarangeofotherfactorsthatmayalsocontributetovaryingoutcomes.These
22
include,forexample,characteristicsofalocalareasuchasgeographicalsizeandnumberof
carehomes,aswellasLAfactorssuchasworkplacecultureorthepositionofsafeguarding
withintheLAmanagementstructure(i.e.withinCommissioningorbyaDirectorresponsible
forcaremanagement).
Natureofsafeguarding
Identifyingtheadvantagesanddisadvantagesofspecialisminadultsafeguardingisrelated
tolongacademicdebatewithinthesociologyoftheprofessions(Stevenson,1981).
SociologistssuchasHarvey(2005)mightviewthedevelopmentofsafeguardingwithin
socialwork,andinparallelinhealthandpoliceservices(WhiteandLawry,2009),aspartof
Neo-Liberalprocesseswhichdevalueandfragmentpublicsectorworkers’professional
knowledge.Forexample,LymberryandPostle(2010)commentthatsafeguardingis
becomingseenasthesoleareaofworkforwhichsocialworkinputisessential.Such
processesrefashionprofessionalknowledgeintoincreasinglystandardised,auditedand
managedspecialisms,whicharemoreeasilyout-sourcedtonon-statutoryprivateproviders.
Someprofessionalsresentedtheirworkbeinghighlymanaged,butthevalueofcreating
consistentthresholdsandserviceswasnotquestionedbyparticipantswhodidnotseemto
feelthiswaslinkedtoanylimitingtotheirprofessionalautonomy.
DanielandBowes(2011)madethepoint,inrelationtospecialisminsocialworkgenerally,
thatthedebatecanbeviewedasmuchaboutagencystructuresasitisaboutideasof
developingspecialistknowledgeandadvancedpractice.Thispointhassomeresonancein
relationtoourfindings,whichdemonstratedtheimportanceofcontextualandpractical
23
matters.Forexample,theexistingdegreeofintegrationbetweenhealthandsocialcareor
Children’sservicesmakesitmoreorlessfeasibleformanagerstochooseaparticularmodel
ofsafeguardingordegreeofspecialisation.
Supportersofsafeguardingasaspecialistareaarguethisworkhasbecomesocomplexthat
theknowledgeandskillsrequireddemandspecialiststaff.Wefoundtheknowledgeofthe
lawandspecialproceduresrelatingtosafeguardingweremoredevelopedamongsocial
workersworkinginspecialistteamswhichisaprimejustificationgivenfordevelopingthis
specialism,asarguedbyStevenson(1981)inherseminalearlyworkonspecialisms.In
contrast,thosewhofavouredkeepingadultsafeguardingaspartofgenericteamsstated
thatsafeguardingisanintrinsicpartofmainstreamsocialworkknowledgeandenables
socialworkerstopracticeinaholisticandperson-centredway.
Withregardstodefiningabuse,weheardpleasforaconsistentframeworktomake
judgementsaboutwhenaconcernrequiresasafeguardingresponse.ThisechoesEllis’
(2011)findingsthatsomesocialworkteamswelcomedtheincreasedaccountabilityand
reductioninuncertaintysuchframeworksprovide(andwhichmaybeprovidedbythemore
specialistmodels).UsingLipsky’s(1980)notionofstreetlevelbureaucracy,Ash(2013)
arguedthatpractitionersmaydevelopa‘cognitivemask’,whichcaninfluencethe
interpretationofeventsanddefinitionsofabuse.Thisdevelopsasaresultofrepeated
dissonancebetweenvaluesandtherealitiesofservicecontextsandlackofresources.Ellis
highlightedtheimportanceofthebalancebetween‘managerialandprofessionalinfluence
inshapingdiscretion’(Ellis,2011:230).
24
Safeguardingpractice
Staffandfeedbackinterviewswerecharacterisedbywidevariabilityinthereported
relationshipsbetweenLAstaffandthepolice,fireservicesandtheNHSacrossthesites.In
themoregenericmodels,muchappearedtodependonthequalityofindividual
relationshipsatpractitionerandmanageriallevels.However,thedevelopmentofstructures
suchas(MASHs,Multi-AgencyRiskAssessmentConferences(MARACS)andstatutory
SafeguardingAdultsBoards(SABs)supportedthestrengtheningofsuchrelationshipsinthe
lessspecialistmodels.
Difficultiesinprioritisinganddeskillingweretwodirectimplicationsofspecialisation.Inthe
lessspecialistsites,socialworkpractitionersreportedthatadultsafeguardingworkoften
hadtotakeprecedenceoverexistingcaseloads,makingworkloadmanagementdifficult.In
contrast,alackofconfidenceandknowledgeaboutsafeguardingwasidentifiedby
operationalsocialworkstaffworkinginmorespecialistsites.Jointworkingandtraining,and
regularinteractionbetweenspecialistsandotherteams(possiblyonsecondmenttoreduce
theriskofburnout)canbehelpfultoovercomethesepotentialconsequences.Thissuggests
theimportanceofgoodrelationshipswithotherteamsinestimatesoftheeffectivenessof
adultsafeguarding.Thecontinuingdevelopmentofspecialistteamsandpractitionersmay
promptmorepost-qualifyingtraininginsafeguarding,andindeedmanysafeguarding-
specificareasoftrainingneedwereidentifiedbysurveyparticipants.
Increasedhandoversofworkandresponsibilitywereanotherconsequenceofincreased
specialisationinsafeguarding(althoughtheywerealsoafeatureofthelessspecialised
models).Handoversareapointatwhichinformationcanbemisconstruedand,inhealth
25
care(wheremorespecificfocushasbeenplacedonthisinpracticedevelopmentand
research),havebeencharacterisedas‘variable,unstructuredanderrorprone’(Manserand
Foster,2011:183),andalsodecreasingcontinuityforserviceusers.Howeverwefoundsome
agreementovertheseparationofroles,giventheconflictthatoftenaccompanies
safeguardingconcerns.Byseparatingsafeguardinginterventions,on-goingrelationships
betweenoperational(non-safeguarding)teamswithadultsatriskofabuseandcareor
healthprovidersmightbepreserved.Inmoregenericmodels,staffgaveexamplesofhow
workwashandedovertocolleaguesinordertoachievethisaim,whileinthespecialistsite,
thiswasthenorm.
Itisinterestingtonotethedifferentkindsoftensionsthatappearedtoresultfromdifferent
organisationalarrangements.Inthemorespecialisedsites,tensionswerearoundworking
withotherLAteams.Inthelessspecialistsites,tensionsarosefromthefrustrationsof
workingwithotherorganisationsandthedivisionofnon-safeguardingwork,indicatingthat
nomatterhowcaseloadsaresplit,unforeseenstrainsmayarise.
PerformanceManagement
AsMunro(2004:4)noted,assessingtheperformanceofindividualsinanyareaofsocial
workisdifficult.Managersmaybeincreasinglykeenonauditingtoprovideevidenceabout
practiceshouldtherebecomplaints,litigationor‘badpress’.Ourresearchsuggeststhat
performancemanagementinlessspecialistmodelsismoredifficult,duetotheincreased
numbersofsocialworkersinvolved.Thisislikelytomeanthatstandardsofpracticevary
more–andthiswassupportedbyourfeedbackinterviews.
26
Finally,interviewswithcarehomemanagers,IMCAsandsolicitorsindicatedthattheywere
lesscontentwithsafeguardingservicesintheDispersed-Generic(siteA)andCentralised-
Partially-Specialised(siteC)locationsthanothersites.Thesefeedbackfindingsshouldbe
viewedasexploratoryduetothesmallnumbersinvolvedandthisisundoubtedlyafruitful
areaforfutureresearch.
Conclusion
Thiscomparisonofdifferentmodelsofadultsafeguardinghighlightssomeimplicationsof
thevariousorganisationalarrangementsadopted.Itpointstoabalanceofimproved
prioritisation,consistencyandknowledgeassociatedwithspecialistarrangements,against
potentialdifficultiesofreducedcontinuityofcareandde-skillingofnon-specialistteams.
Increasedmulti-agencyworkingandthenewrolesplayedbyMASHs,limitthedegreeto
whichsafeguardingcanbeapurelymainstreamactivity.Feedbackinterviewsoffered
divergentviewsofsafeguardingservicesinthedifferentmodelswhichmeritfurther
exploration.Thisresearchcontributestothelong-standingdebateonthepossibleneedfor
specialisminsocialwork(Stevenson,1981).
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