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Effective Outcomes: Making Safeguarding Personal

This chapter was added to the manual in April 2015.

Defining and measuring outcomes is an important part of Safeguarding Adults work. To ensure safeguarding is personal, effective outcomes play a crucial role in establishing a good overall quality assurance framework, at individual, agency and Safeguarding Adult Board (SAB) levels.

Outcomes need to reflect the ‘journey’ of the individual as they progress through the process of being safeguarded and it is imperative that, they are placed at the centre of this process.

Defining and measuring outcomes needs to go beyond collecting numbers. Although statistical outputs are necessary and useful when analysing data, they do not, give us information on the quality and effectiveness of the safeguarding from the point of view of the adult involved.

Information and feedback from adults themselves should form the basis for measuring how effective the safeguarding process has been and will form the basis for improving outcomes.

It is important to remain focused on outcomes rather than just the process of safeguarding. The outcomes should be to:

  • Promote well-being and prevent abuse and neglect from happening in the first place;
  • Ensure the safety and wellbeing of anyone who has been subject to Abuse and Neglect;
  • Take action against those responsible for abuse or neglect taking place;
  • Learn lessons and make changes that could prevent similar Abuse or Neglect.

The vision for adult social care and health services is one where the person has real choice and control over what happens - “no decision is made about me without me”. (People who lack capacity need someone to represent them in their best interests). Actions taken therefore need to be shaped by the best outcome for the person who has suffered abuse and neglect and fully involving that person, or their representative or advocate, in decisions.

Making Safeguarding Personal (MSP) is a sector led initiative in adult safeguarding. It aims to develop an outcomes focus to adult safeguarding work which should result in safeguarding being done with, and not to, people. MSP began in 2009 and is a programme led by the Local Government Association (LGA) Safeguarding Adults Programme and by ADASS. This work under MSP aims to shift emphasis from processes to a commitment to improving outcomes for people at risk of harm.

The key focus of MSP is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them (and their representatives or advocates if necessary) how best those outcomes might be realised and then seeing, at the end, the extent to which desired outcomes have been realised.

MSP continues to explore how to support and empower adults to resolve the circumstances that put them at risk. It aims to encourage practice that puts the person more in control and generates a more person centred set of responses and outcomes. In this way the outcomes focus is integral to practice and the recording of practice in turn generates information about outcomes. This information needs to be capable of being aggregated for Safeguarding Adults Boards (SABs).

Making Safeguarding Personal is a shift in culture and practice in response to what we now know about what makes safeguarding more or less effective from the perspective of the person being safeguarded.

As well as the six key principles that underpin all adult safeguarding work (please see Safeguarding Principles and Values), it is important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is crucial that all organisations recognise that adult safeguarding arrangements are there to protect individuals. Everyone has different circumstances, preferences, life-styles and histories, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised. The case study below (taken from The Department of Health Guidance: Care and Support Statutory Guidance) helps to demonstrate this:

Two brothers with mild learning disabilities lived in their family home, where they had remained following the death of their parents some time previously. Large amounts of rubbish had accumulated both in the garden and inside the house, with cleanliness and self-neglect also an issue. They had been targeted by fraudsters, resulting in criminal investigation and conviction of those responsible, but the brothers had refused subsequent services from adult social care and their case had been closed.

They had, however, had a good relationship with their social worker, and as concerns about their health and wellbeing continued it was decided that the social worker would maintain contact, calling in every couple of weeks to see how they were, and offer any help needed, on their terms. After almost a year, through the gradual building of trust and understanding, the brothers asked to be considered for supported housing; with the social worker’s help they improved the state of their house enough to sell it, and moved to a living environment in which practical support could be provided.

Having a person-centred approach involves the following:

  • Having conversations with people about how best to respond in safeguarding situations. This should be done in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety;
  • Seeing people as experts in their own lives and working alongside them;
  • Collecting information about the extent to which this shift has a positive impact on people’s lives;
  • Shifting from a process supported by conversations to a series of conversations supported by a process.

Adult Social Care Outcomes Framework (ASCOF)

Safeguarding Adults forms one of the domains in the Adult Social Care Outcomes Framework (ASCOF).

ASCOF Domain 4: Safeguarding people whose circumstances make them vulnerable, and protecting from avoidable harm.

4A: Proportion of people who use services who feel safe - Safety is fundamental to the wellbeing and independence of people using social care, and the wider population. Feeling safe is a vital part of users’ experience of their care and support.

4B: Proportion of people who use services who say that those services have made them feel safe and secure - The extent to which users of care services feel that their care and support has contributed to making them feel safe and secure.

The 2014/15 publication announced the development of a national measure on safeguarding outcomes - one of the first to focus on those who have been through an adult safeguarding enquiry and their views on how the enquiry was dealt with. A set of questions has been developed and cognitively tested in preparation for a pilot survey undertaken by volunteer local authorities in summer 2014. This testing has successfully created a number of questions which can be used in a face to face interview, with confidence by local authorities, to seek the views of adults, or relatives/friends/carers or IMCAs where appropriate.

Findings from this work highlighted how pleased adults were to be asked about their experiences. Using these questions would enable local authorities to better understand the experience of those going through the safeguarding process in their locality but would also facilitate the comparison to other local authorities. The questionnaires and all survey documentation can be found on the Health & Social Care Information Centre’s (HSCIC) website.