Information Classification: CONTROLLED Self-Neglect policy and best practice guidance The Cornwall and Isles of Scilly Safeguarding Adults Board Ann Smith November 2019
Information Classification: CONTROLLED Why? • Learning from outcomes of Safeguarding Adult Reviews (SARs) • Learning from the Thematic Review of Self- Neglect • To provide best practice guidance to all • To ensure consistent approaches across the Multi agency partnership www.cornwall.gov.uk
Information Classification: CONTROLLED SARs – Common Themes • Little evidence of risk assessments being undertaken • Self-neglect was not fully considered in the assessments • No evidence of any capacity assessments being undertaken • Case notes and recording on assessments was not always evident • No recording of case discussions or supervision on the case notes • Care package commissioned www.cornwall.gov.uk
Information Classification: CONTROLLED Thematic Review by Professor Micheal Preston-Shoot Responding to the Challenges of Working with People who Self-Neglect: A Thematic Review of Learning from Safeguarding Adult Reviews Commissioned by Cornwall and Isles of Scilly Safeguarding Adults Board www.cornwall.gov.uk
Information Classification: CONTROLLED • Review considered 5 SARs and 1 learning from experience review • Three half-day workshops were held with practitioners and managers drawn from across agencies in Cornwall and the Isles of Scilly. 75 staff members attended. • 7 Good practice case examples reviewed • Practice across 4 domains • Domain One: Direct Practice with the Individual • Domain Two – Team around the Adult • Domain Three – Organisations around the Team • Domain Four – Safeguarding Adults Board www.cornwall.gov.uk
Information Classification: CONTROLLED Thematic Review Findings – Domain 1 (direct practice with individuals) • Evidence of person-centred practice that involves discussion of risk and professional curiosity but it is not consistent. • There is evidence that the components of best practice with adults who self-neglect are known. • The availability of time to manage cases of self- neglect was a recurring theme. • Attention could also be paid to the quality of risk assessments and to the assessment of executive mental capacity. www.cornwall.gov.uk
Information Classification: CONTROLLED Thematic Review Findings – Domain 2 (team around the person) • Evidence of effective collaboration but too often it appears to be dependent upon individuals. • Evidence of positive outcomes from the use of multi-agency risk management meetings in some instances. • Not always clear to practitioners when MDT risk management meetings should be convened • There is a lack of clarity also regarding when use of the duty to enquire (section 42, Care Act 2014) should be the safeguarding pathway in self-neglect cases. • Levels of legal literacy are variable and easier access to legal, mental capacity and mental health specialists strongly indicated. • Recording systems are also perceived to act as barriers to the sharing of information www.cornwall.gov.uk
Information Classification: CONTROLLED SAB recommendation Review the self-neglect policy and ensure there is a clear escalation route where a person has been identified as self-neglecting and what action should be taken by whom. Ensure that any providers are able to trigger this process. www.cornwall.gov.uk
Information Classification: CONTROLLED Introduction What is Self-Neglect • There is no universally accepted definition of self- neglect but the Care Act Statutory Guidance (updated 2018) defines self-neglect as: • ‘A wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding ’ and states: • ‘Where someone demonstrates lack of care for themselves and or their environment and refuses assistance or services. It can be long-standing or recent’ (DH 2018: Annex J). www.cornwall.gov.uk
Information Classification: CONTROLLED The Policy This policy provides procedures and guidance for dealing with concerns in relation to self-neglect for adults with care and/or support needs. It should be read alongside the CIoS Adult Safeguarding Policy. CIoS SAB expects all agencies, both statutory and voluntary, to engage fully with this Policy and Guidance in order to achieve the best outcome for the person. https://www.cornwall.gov.uk/health-and-social- care/adult-social-care/safeguarding- adults/safeguarding-adults-board/ www.cornwall.gov.uk
Information Classification: CONTROLLED Self-Neglect and Raising a Concern The Care Act Statutory Guidance (2018) states: • “It should be noted that self -neglect may not prompt a section 42 enquiry. An assessment should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour. There may come a point when they are no longer able to do this, without external support.” www.cornwall.gov.uk
Information Classification: CONTROLLED Self-Neglect and Raising a Concern • However, where there is reasonable cause to suspect that the adult is unable to protect him or herself from self-neglect or the risk of it as a result of their care and support needs, and the risk is high or very high, a Safeguarding concern should immediately be triggered. • This will also be the case where previous attempts to work in a multi-agency way have failed to produce a reduction in risk. www.cornwall.gov.uk
Information Classification: CONTROLLED Key Messages and Making Safeguarding Personal • All agencies have a role in supporting people who self-neglect, so please ensure you and your agency are fully committed to playing your part • Be prepared for long-term involvement – self- neglect situations are rarely resolved quickly • Communicate clearly and regularly with all those involved with the person and consider how often formal meetings are required • Consider whether advocacy is needed www.cornwall.gov.uk
Information Classification: CONTROLLED Key Messages continued • Be prepared to challenge decisions if you don’t agree with them, and escalate them if necessary • Don’t dismiss self - neglect as a ‘lifestyle choice’ or take an initial rejection of support as final • Don’t close a case simply because the person refuses an assessment or won’t accept a plan • Always remember to ‘Think Family’ and consider any risks to those living with or closely related to the person who is self-neglecting www.cornwall.gov.uk
Information Classification: CONTROLLED Supporting tools and information • Key Legislation and how this relates to particular areas of concern/risk involved with Self-neglect • Adult Risk Management draft meeting agenda • Assessment of Need and Risk • Self- neglect Risk Indicator Assessment tool • 16 point ‘Quick Guide’ www.cornwall.gov.uk
Information Classification: CONTROLLED Quick Guide www.cornwall.gov.uk
Information Classification: CONTROLLED Expectations/ Managers responsibilities • To supervise and oversee workers supporting people who self-neglect • To encourage team discussions, sharing of knowledge and experience and support multi agency working • To support workers to raise Safeguarding concerns as required • To oversee ARM meetings, decision making and action planning • To support MCA and Executive Capacity assessments • To keep an up to date record/ register of all Self- neglect cases within their localities • To contribute to multi agency audits as requested. www.cornwall.gov.uk
Information Classification: CONTROLLED References and Further Reading • Braye, S., Orr, D. and Preston-Shoot, M. Self- neglect Policy and Practice: Building an Evidence Base for Adult Social Care • Braye S, Orr D and Preston-Shoot M (2011) SCIE report 46: Self-neglect and Adult Safeguarding: findings from research. London: SCIE • Braye S, Orr D and Preston-Shoot M (2015) Practice tool: Working with people who self- neglect. Dartington; Research in Practice for Adults www.cornwall.gov.uk
Information Classification: CONTROLLED References and Further Reading • DH (2016) Care and support statutory guidance. Updated 9th May 2016. Available online: https://www.gov.uk/guidance/care-and-support- statutory-guidance/annexes • Naik AD, Lai JM, Kunik ME and Dyer CB (2008) Assessing capacity in suspected cases of self- neglect. Geriatrics, 63, 2, 24-31. Full text available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28 47362/ • SCIE Self-neglect resources and services: https://www.scie.org.uk/atoz/?f_az_subject_thes aurus_terms_s=self-neglect&st=atoz www.cornwall.gov.uk
Information Classification: CONTROLLED Cornwall Council County Hall Truro TR1 3AY Tel: 0300 1234 100 www.cornwall.gov.uk www.cornwall.gov.uk
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