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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

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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).

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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

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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

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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.

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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.

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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

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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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