[PPT] - practice guidance The Cornwall and Isles of Scilly Safeguarding PowerPoint Presentation

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Self-Neglect policy and best practice guidance

The Cornwall and Isles of Scilly Safeguarding Adults Board

Ann Smith November 2019

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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

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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
n the case notes
Care package commissioned

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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

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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

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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.

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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

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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.

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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
ne’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).

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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/

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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.”

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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.

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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

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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

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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’

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Quick Guide

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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.

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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

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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

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