Social Work Practice in Safeguarding Adults - Essay Example

How might the recent consultation on No Secrets impact on social work practice in safeguarding adults? Draw on your knowledge of the personalisation agenda to inform your discussion. Introduction: During the year 2000, the UK Government published an original draft national framework, "No Secrets", so that local councils with social services responsibilities, local National Health Service (NHS) bodies, local police and law enforcement forces and other partners could develop local multi-agency codes of practice to help prevent and tackle abuse. The main aim and objective of this was to provide “guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse.” (No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, 2000). This paper could also be in terms of seeking to identify and execute pre-designed projects. Again, Department of Health, (DoH) the Home Office (HO) and the Ministry of Justice (MoJ) launched a national consultation on the review of the No Secrets guidance. This consultation paper was about how the public, especially vulnerable people should identify and manage risk, particularly as efforts are being made to move towards increasing choice and control for people with learning and other kinds of disabilities. Through this paper, a critical analysis is being directed on of how the recent consultation on No secrets impacted social work practice in relation to safeguarding adults. It needs to draw from knowledge of the personalisation agenda. At the outset, it is necessary to know how the national framework paper No Secrets defines vulnerable person. According to it, “A Vulnerable adult is any person aged 18 or over who is or may be in need of community care services by reason of: Mental or other disability, age or illness and; Who is or may be unable to take care of him / herself; or Unable to protect him / herself from significant harm or serious exploitation. “ (Abuse of vulnerable adults, 2009). Thus it becomes to understand and explain about the aspects of personalisation. In effect “This means that every person who receives support, whether provided by statutory services or funded by themselves, will be empowered to shape their own lives and the services they receive in all care settings.” (An introduction to personalisation, 2008). It also means that the degree of care and standards of providing high quality health services becomes a sine quo non in as far as health services in the UK context are concerned. It could also be in terms of the fact that vulnerable persons, people who may be higher degree of susceptible to abuses, either of psychological or physical nature, need to be afforded a better degree of care and attention that normal people. This is because these vulnerable people have a lower degree of physical and mental self defense mechanism than normal healthy people. Patients enduring the sufferings of Alzheimer’s disease: For instance, taking the case of persons suffering from advanced Alzheimer’s disease, it could hardly is possible to expect such persons to be able to take care of their needs independently, let alone be in a position to protect themselves from abuse, or injury. They are the kind of people, whom I have referred as having degree of susceptible to abuses or high risk situation, especially in care homes and institutions which, although overtly profess to protect and secure the care and lives of patients, actually cause more detriment than good to patients and inmates. The report on ‘No secrets’ testifies to this fact and this report that care at institutional centers may be compromised through mal administrational and lowered care practices seem to be corroborated by the going -ons in such institutions. In the event criminal offences take place, or are feared would take place in future, it is necessary for the law enforcement departments, including the police and law enforcement forces, to deter and prevent the likelihood of such occurrences. “Neglect and poor professional practice also need to be taken into account. This may take the form of isolated incidents of poor or unsatisfactory professional practice, at one end of the spectrum, through to pervasive ill treatment or gross misconduct at the other. Repeated instances of poor care may be an indication of more serious problems and this is sometimes referred to as institutional abuse.” ((No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, 2000, p.10). Understand and critically evaluate the factors which promote a positive sense of well being including the physical and mental health needs of adults The main aspect that impinges upon No Secret, is in terms of personalisation could also be that it should enforce pre-emptive and proactive rules that could possible deter and prevent occurrences of such acts on vulnerable people. As a matter of fact, the definition of vulnerable itself needs to be changed to address current issues, and include a broad based premise, if possible including children also. Besides, the preventive aspect is also important. The practical implementation of ‘No Secrets’ also needs to consider that vulnerable people could also be subject to harm and abuse in institutional settings like old age homes, health care centres and other settings. Thus, it is important that the degree and enforcement of interventions designed to protect and safeguard the vulnerable adults also need to be deployed regularly such that the instances of these actions are minimised. Again, it is also seen that demographic changes also need to be evident in the plans and practices of No Secrets in order for it to be rendered more effective and in accordance with the situation. Necessary changes to update the consultation documents in line with current requirement needs to be effected, more so, in a more threatened and unsafe societal environment. It is also to be believed that through social transformation induced by No Secrets, it is possible that more risk could be covered and better degree of care and security to disadvantaged people could be ensured. The main aspects regarding No Secrets could also be seen in terms of the fact that, in the case of personalisation, there should not be any constraint of choice, and people should not be in dominant control such that the interests of the patients could be compromised. The direct pay package system needs to be evolved and should be open to regular review. Action Plans needs to be implemented and all patients, especially susceptible and physically or mentally defenceless people need to be treated equally in as far as the degree of care and intervention treatment is concerned. Advocacy of equal rights and the pattern of taking proper care of the patients and enhanced degree of security need to be taken for this segment of patients. Comprehension and critical evaluation of elements that promote a positive sense of well being also needs to take into considered the physical and mental health of children as much as , if not more than that of adults, since they are more susceptible to major health risks and probabilities of being sexually attacked by stronger adults. Besides this, disadvantaged children could also be physically or mentally tortured, subjected to indignations and cruelties and made to undertake sexual or other kinds of physical or intellectual indignities of the worst kind by adult, or peer groups. Thus, the position of disadvantaged children should figure prominently with regard to No Secret. This is because it is quite possible that the positive impact of regrouping and forceful implementation of No Secret may be felt strongly in case of adults and yet would fail to make headway, since this has not been applied for the protection of the rights of disadvantaged children too. Develop an understanding of the management of risk, including those associated with safeguarding responsibilities: At the outset of the section relating to management of risks, it is important to understand that there have been often requests to widen the ambit of ‘vulnerable’ people to that of ‘people at risk.’ This would not only include in its purview, the more marginalised sections of people who are affected, but would also entail other categories like physically handicapped or mentally retarded elderly people, senile people, youngsters and children. Adults, however disadvantaged would not like to be placed at par with children, in as far as legal protection and physical security is concerned. This is due to the fact that their age differences and the degree of security that needs to be imparted vary from patient to patient spread across different age groups and class segments. However, there is another school of thought that argues that in as far as implementation of No Secrets is concerned, the main aspect is that of present situation and not anything else, like age, mental and physical disabilities or any other element. What is important is the situation in which the person finds himself/herself. Whether the norms and guidelines established through No Secrets would offer them a cover of protection and security that would be denied, or lowered otherwise. Besides, it is also seen that adults are more independent minded and would like to exercise their own decisions, and need to be allowed to make their own decision unless otherwise incapacitated in which the laws relating to decision making of incapacitated person comes into vogue. Either the person makes the decision himself if he is sound enough to do so, or the law takes a decision on to itself, which the person needs to honour and abide by. “Although adults who lack capacity may not have the same ability to make informed choices, the principles of the Mental Capacity Act (MCA) must be followed. “ (Safeguarding adults: Report on the consultation on the review of ‘No Secrets’, 2009, p.21). Personalisation is an important ingredient of safeguarding: Through personalisatio, the degree of care is enhanced manifold. Although a certain degree of enforcement and discipline is enforced during personalisation, it is for preserving the ultimate best interests of patients and vulnerable people, who otherwise may destroy themselves in the morass of iniquity. The Government’s main goal is preservation, not destruction, betterment not deteroriation. There is no lowering of control of social conduct; on the other hand , these are tightened and made more disciplined for its beneficiaries to follow. Again taking the case of people suffering from Alzheimer ’s disease, personalisation could ensure that, they are at least able to lead normal lives through specialised care and safeguard strategies. It is believed that personalisation and protecting the vulnerable people need to go hand in hand, in that the major objective of the former is to make people actually feel and be more safe and secure and create conditions wherein this safety and security is sustained over time. There are several methods by which this could be ensured and it is detailed as follows: 1. Citizenship and residency needs to be made more robust and strong and suitable strategies and techniques need to be enforced that could make it more probable. However, it is also to be seen that suitable ways and means need be developed that could strike a balance between autonomy of person and his /her control aspects. The trick is that there needs to be fine balancing between these two aspects control and freedom, since one at the expense of other could become problematic not only for the care givers, but could also detrimentally affect the provision of care that is being afforded, either by State through state sponsored care, or by the person himself through his own resources. “The health and well-being of local people and communities is a key issue for all councils, and is supported, promoted and delivered both directly – through the various areas of council responsibility, each of which has an impact on people’s health and wellbeing – and through local partnerships.” (LGA response to the consultation on the review of the No secrets guidance, 2009). Develop a knowledge and understanding of how services are utilised to meet complex needs within a multi-professional context The age old concept of care in institutional settings with a care giver has given way to a more individualistic oriented perspective wherein the role of the local authority representatives are to allow the person, wherever possible, to indulge in Self care management systems or Self Directed Support. (SDS). (Duffy & John, p.8). Perhaps one of the major advantages of SDS is that it affords the vulnerable person to care for himself, which, in effect raises the bar for developing and reinforcing his own self esteem and confidence in managing his own affairs. This acts not only as a great psychological boost, but perhaps also best informs the patient to delve into the deeper recesses of self care and self improvement, in as far as taking care of himself is concerned. However, there may be instances when a person may be greatly disadvantaged or vulnerable, so much so that s/he is not in a position to take independent care. Under such circumstances, the provision of the Mental Capacity Act needs to be enforced. However, there are also other aspects that need to be taken into account in understanding how care should be provided for patients who have a history of vulnerability and who may be subjected to abuse of any kind, physical, sexual or psychological. Again, the steps that need to be followed are as follows in order to institute several control mechanism to address critical implications as follows: 1. Initial Rapport: It is necessary for representatives of local authority to strike personal rapport with patients and care providers in order to be in a position to offer specialised services, more so when there is a high degree of potential risk of abuse, resulting due to various reasons, innate or otherwise. It would be necessary under such circumstances for triage to be done so as to determine the specific kind and implication of care services to be provided. “Triage” means “to sort” and it “Looks at medical needs and urgency of each individual patient Sorting based on limited data acquisition Also must consider resource availability.” (Roming n.d., p.1). 2. The next stage is evaluation of budget needs: The appraisal and estimation of assessing needs of individual and necessary budget allocations need to be done at this stage. This could, in turn, offer leads and strategies on what kind of individual budget could be made and tried to be passed from the authorities. 3. Evaluation of capacity: Perhaps the most crucial of tests, this is intended to determine whether the vulnerable person does possess necessary capacity of judgement to take individual decisions. In the event that this is not forthcoming, the laws relating to Mental Health Act would be needed to be enforced. This could be seen in terms of deciding on the following. “ For people with long-term conditions, the offer of choice is particularly pertinent, namely: enabling individual users to identify their specific needs and desired outcomes  and agree the support and care arrangements to meet these through the personalised care planning process and agreed care plans supporting and enabling individuals to self care choices around supported living for those with more complex or social care needs to maintain independence. “(Patient choice: Choice and long term condition, 2010). Expansion of Sustenance Plan : While in earlier regimes, the care manager was in charge of chalking out plans, in present scenario, the tenets of Self Directed Support (SDS) ensures that the charge of planning jobs would be entrusted with the people who are most likely to be competent in these areas. 4. Review of Plans and signing off : Since the authorities who develop the plans and those who review or implement them are entirely different, major areas of professionalism could be seen. Besides, it is also seen that wherever necessary it would now be possible to critically appraises such plan programs, and suggest modifications, etc. as deemed necessary before final approval. 5. Finally Review Mechanism which seeks to ensure that the plans work according to prejudged and determined programs and any variations or changes need to be justified accordingly. It is believed that complex cases would need the specialised services of social workers, especially those which cannot be suitably solved through the help of law enforcement authorities, or police. This could be, for example is, when the incidence of abuse is within the family, and criminal action may not be feasible, or would produce limited results. Under such circumstances it is necessary that the active assistance of social service workers is taken to remedy the situation. “Real commitment and ownership of the issues by those who direct organisations is vital if their practitioners are going to be motivated and able to do the work.” (No secrets in practice, 2004). Analyse and evaluate key social policy initiatives and the impact they have on adults in the context of anti-oppressive practice. “The Government recently launched a consultation on the review of the No Secrets guidance, which aims to bring together policy on adult safeguarding and risk empowerment, to ensure that safeguarding is fully integrated into the personalisation agenda.” (Prioritising need in the context of putting people first: A whole system approach to eligibility for social care guidance on eligibility criteria for adult social care, England 2009 (consultation stage), 2009, P.32). “All commissioners or providers of services in the public, voluntary or private sectors, should disseminate information about the multi-agency policy and procedures.” (No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse, 2000, p.34). The key social initiatives could be in terms of spreading the message loud and clear through the use of social workers, and also making use of literature, including staff manuals that could provide individual staff members of the need for responsive and responsible action to counter the threats of perceived abuses to vulnerable people. It “states that all agencies should provide training for staff and volunteers about how to recognize and prevent abuse.” (No secrets in cumbria, 2003). It could also be in terms of setting forth robust, viable and strict recruitment procedures while absorbing personnel for filling vacancies in the respective department’s cadres. The credentials of prospective employees need to be checked before recruitment, especially those having direct access to such vulnerable people and who are in a better position to take advantage of individual vulnerabilies to perpetrate abuse of any kind- physical, mental, sexual or moral, including threats, coercion and duress for benefits. Moreover, it is also believed that the screening process should be rigorous that could obviate or even eliminate chances of potential abuse through care givers etc. Again the uses of volunteer social service organisations and agencies could also be taken, who could work in tandem with enforcement agencies or other institutions where abuse is feared or have been committed, for the purpose of seeking redressals and reducing the risks of perpetration of such occurrences in future. “A duty of co-operation would be useful if it was clearly defined. It could cover attendance at meetings and supply of information.” (Rodger 2009, p.5). Again providing relevant information to care givers, users and members of the general public through leaflets, or other literature or materials could also be done to heighten the awareness to such events and ways and means by which mentally or psychically deficient persons could seek protection. It is seen through empirical studies that safety is heavily compromised in institutional settings, raising pertinent questions about where safety could be administered. This could even be done at the privacy of their houses or non institutional settings. Conclusion: The enforcement and implementation of No Secret guidelines, by far, needs to be well conducted in order to achieve its real goals and objectives. Besides a certain degree of suzerainty and autonomy need to be afforded in order to get best results. While strict norms could enforce discipline it could also become autocratic which is not helpful for health care segments. For attaining this it is important that all the concerned officials, inter departmental agencies, local body authorities, enlist the cooperation of members of the public also. It is only under such circumstances that No Secret guidelines could meet with a remarkable degree of success and achieve its set targets of reducing the incidence and likelihood of abuse on weaker and vulnerable kinds of people in this country. “Government departments have worked closely together on the preparation of this guidance and we commend it to local authority social services departments, the police service, and the health service. It will also be of interest to the independent sector, as well as users and carers.” (Northfield, 2000). Reference List Abuse of vulnerable adults, 2009. [Online] Cheshire West and Chester. Available at: http://www.cheshire.gov.uk/socialcareandhealth/adults/vulnerable_adults/ [Accessed 25 January 2010]. An introduction to personalisation, 2008. [Online] Department of Health. 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Available at: http://www.emergency-management.net/4th_symposium/bio_present/RomigEmergenciesTriage.pdf [Accessed 27 January 2010]. Safeguarding adults: Report on the consultation on the review of ‘No Secrets’, 2009. [Online] Department of Health. Available at: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102981.pdf [Accessed 25 January 2010]. Northfield, J., 2000. No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. [Online] NHS Evidence – Learning Disabilities. Available at: http://www.library.nhs.uk/learningdisabilities/ViewResource.aspx?resID=29137 [Accessed 25 January 2010]. Read More